Mindfulness meditation and the clinically modified Buddhist psychological model in psoriasis

The literature on psoriasis highlights that having this chronic incurable condition can result in patients experiencing a heavy psychosocial burden, which can result in higher levels of anxiety, depression, and poorer wellbeing for patients. Despite the high rates of distress, and potential associations between psoriasis and distress, patients with psoriasis have historically been somewhat invisible in empirical psychological research and practice. The literature outlined in chapters 1 and 2 of this thesis identifies a clear need in the health, psychology and psoriasis literatures for research that explores and better understands how patients might be supported in coping with the burden of this condition; in addition, research needs to examine if and how potential treatment options, such as mindfulness interventions, achieve their effectiveness in improving the anxiety, depression and wellbeing levels of psoriasis patients. In order to fill these research gaps, this thesis had a number of aims: (1) to provide a greater understanding of the individual differences in the wellbeing, anxiety and depression of psoriasis patients, and the relationships between the clinically-modified Buddhist psychological model?s (CBPM) domain, mediating and outcome variables, (2) to investigate the effectiveness of MBCT on psoriasis symptoms, anxiety, depression and wellbeing, (3) examine if MBCT was effective in improving the six domains (mindfulness, attention regulation, acceptance, self-compassion, non-attachment and aversion) and two mediating variables (worry and rumination) of the CBPM theory, (4) to explore the experience of psoriasis patients who have completed an MBCT intervention, and (5) investigate if changes in the CBPM domain and mediating variables after engaging in an MBCT intervention may have a role to play in predicting the anxiety, depression and wellbeing levels of psoriasis patients. A series of mixed methods studies were employed in this PhD. The results from this PhD indicate that MBCT is an effective intervention in improving each of the CBPM domain, mediating and outcome variables, in varying degrees, in the immediate and short term. The triangulated empirical evidence from this PhD is also broadly supportive of the hypothesis set out in the CBPM theory that changes in the CBPM domains may predict changes in psoriasis patients? anxiety and wellbeing directly, and anxiety when mediated through changes in worry and rumination. This PhD?s results also have some potentially useful practice and theoretical implications. The RCT study from this PhD highlights the effectiveness of, and the suitability of delivery of MBCT to psoriasis patients who would like to improve their anxiety, depression and wellbeing levels. The PhD?s triangulated results also provide evidence for the potentially usefulness of refined CBPMs for anxiety and wellbeing, as theoretical roadmaps which may be supportive to clinicians, in order to help them to support psoriasis patients with anxiety and/or wellbeing issues