Comparing the Effectiveness of Behavioral Activation and Metacognitive Therapies on Body Image Concern, Anxiety, and Depression in Patients with Psoriasis

Psoriasis has a wide range of mental health effects due to its clinical features and physical presentations. Psoriasis is associated with depression, anxiety, suicidal ideation, and negative body image. Body image includes a person's feelings about the characteristics and structure of the body. A negative body image is formed when a person experiences a negative evaluation or is ridiculed by others. High anxiety scores are always seen in patients with psoriasis. Depression is the most common mental disorder worldwide and is one of the major causes of disability. Psoriasis and depression reinforce each other. Many researchers have suggested a broader role for psychiatric and psychotherapeutic interventions to reduce the symptoms and severity of skin diseases. Therefore, this study aimed to evaluate the effectiveness of behavioral activation therapy and metacognitive therapy on body image concern, anxiety, and depression in psoriasis patients.

This research was quasi–experimental with a pretest–posttest design and a control group. The study's statistical population include all psoriasis patient referring to dermatology clinics in Razavi and Emam Reza (PBUH) hospitals in Mashhad City, Iran, in 2019. Of whom, 45 patients who obtained a higher score than the cut–off point in Body Image Concern Inventory (BICI) (Littleton et al., 2005), Hamilton Anxiety Rating Scale (HAM–A) (Hamilton, 1959), and Beck Depression Inventory–II (BDI–II) (Beck et al., 1996) were selected with available sampling method and randomly assigned to two experimental groups (15 in behavioral activation therapy, 15 in metacognitive therapy) and one control group. The inclusion criteria were as follows: providing informed consent to receive psychological treatment, having psoriasis, being between 15 and 45 years old, and obtaining a score higher than the cut–off point in the mentioned measurement scales. The exclusion criteria were the patient's lack of consent to receive psychological treatment, absence of more than two sessions, and not answering the questionnaires completely. The experimental groups underwent behavioral activation and metacognitive therapy in 8 sessions during 2 months, while the control group received no intervention. The participants completed Body Image Concern Inventory (BICI) (Littleton et al., 2005), Hamilton Anxiety Rating Scale (HAM–A) (Hamilton, 1959), and Beck Depression Inventory–II (BDI–II) (Beck et al., 1996). Descriptive statistics (frequency, percentage, mean and standard deviation) and inferential statistics (univariate analysis of covariance and Bonferroni post hoc test) were used to analyze the research data. Data were analyzed in SPSS software version 26 at a significance level of less than 0.05.

After controlling the effect of the pretest, findings showed significant differences between the experimental groups and control group in body image concern (p<0.001), anxiety (p<0.001), and depression (p<0.001). There were no significant differences between the behavioral activation and metacognitive therapy groups in depression (p=0.821) and anxiety (p=0.192). Still, there was a significant difference between behavioral activation and metacognitive therapy in body image concern (p=0.047). Behavioral activation was more effective in body image concern.

According to the result, behavioral activation therapy and metacognitive therapy have a significant effect on reducing body image concern, anxiety, and depression in psoriasis patients. The use of these therapies by therapists seems essential. Also, the effectiveness of behavioral activation therapy in reducing body image concerns is more than metacognitive therapy.