Psychological stress plays a vital role in skin disease. The worsening and reoccurrence of signs and symptoms of a wide array of skin diseases have been linked by various studies to stress. Together, stress and skin disease synergistically inhibit occupational, social, and emotional functioning resulting in diminished quality of life (Dixon, Witcraft, & Perry, 2019). Heightened levels of stress may contribute to an assortment of immediate and future adverse outcomes. These outcomes include triggering a skin outbreak, impairing function, behavioral avoidance, intense negative emotions such as shame and embarrassment, and emotional distress such as depression and anxiety (Dixon et al., 2019).

The purpose of this paper is to discuss the relationship of stress, anxiety, and depression to the specific chronic skin diseases of acne vulgaris, psoriasis, vitiligo, rosacea, and atopic dermatitis. It will also discuss how a psychotherapeutic intervention called mindfulness-based stress reduction (MBSR) may decrease anxiety and depression in individuals affected by chronic skin diseases. This paper will also highlight the impact of MBSR on treatment adherence to dermatological prescription medications. A pilot program conducted in a dermatology clinic evaluates the effectiveness of an online mindfulness-based stress reduction intervention to decrease patient anxiety and depression.

Results indicate clinical significance in that participants noted reduced anxiety and depression symptoms and scores, enjoyed MBSR and would continue MBSR. The potential benefits of this pilot program may include decreased patient anxiety and depression, increased patient satisfaction, increased treatment adherence, improved patient satisfaction of intervention, and improved patient outcomes.

Polypharmacy among psychiatric patients is a concerning trend. From 2007-2010, 58.2% of women and 41.8% of men reported taking five or more prescription drugs within the last 30 days (CDC, 2014). Negative outcomes include prescription drug abuse, side effects, interactions, treatment failure, patient dissatisfaction, and lack of treatment control. The associated practice challenges have led to the following PICOT question. In persons with mental health issues receiving care at an outpatient mental health clinic, does engaging in mindfulness practice versus no mindfulness practice change polypharmacy use over a 3-month period?

The project purpose was to evaluate the effectiveness of Insight Timer mobile mindfulness app at helping patients self-manage distressing symptoms and reduce polypharmacy. Over three weeks, mental health clinic nurse practitioners (NPs) voluntarily recruited patients (n=12) over age 18 using as needed prescriptions (PRNs), and agreed to use Insight Timer mobile mindfulness app for adjunct symptom management. Consenting participants downloaded the mobile app, and completed a brief questionnaire measuring PRN use at the start of app use, and PRN use at their next visit. A Wilcoxon signed-rank test indicated a 10-week mindfulness app trial did not significantly lower total PRN doses compared with pre-app dosing (Z = -.534, p = .593). Paired t-tests revealed no significant change in pre (M = 65.17, SD = 28.64) versus post (M = 67.75, SD = 20.22) OQ45 life functionality results (t(11) = -.420, p = .683) (d = .121) as a result of app use.

Clinically relevant results illustrated 83.33% of participants taking greater than nine PRN doses over the study period used the app six times or more in place of medication. High PRN users employed the app frequently in place of medication regardless of total PRN doses taken. Practice implications and sustainability recommendations include incorporating mobile app use in treatment plans for high PRN users and educating NP’s on the tangible benefits of mindfulness apps in reducing polypharmacy and easing symptom distress on an ongoing basis.
Keywords: mindfulness, mhealth, mobile apps, mobile smart phone, online, RCT, behavior change, polypharmacy.