Relaxation techniques and mindfulness for chronic pruritus: what is important to know?

"Relaxation techniques and mindfulness for chronic pruritus: What is important to know?" by Dr. Christina Schut, psychologist. 

In order to better understand why relaxation techniques and mindfulness can help with chronic pruritus, it is important to get a rough overview of the scientific basis. The biopsychosocial model is particularly relevant here. This model describes the complex interaction between biological, psychological and social factors in connection with pruritus. It makes it clear that the sensation of itching is not determined in isolation by physiological processes, but is in a constant feedback loop with cognitive, behavioral and social influences. Thus, internal factors such as anxiety and external factors such as stress can intensify or alleviate itching via mediating mechanisms (e.g. thoughts, behavioral patterns, social interactions).

Mindfulness as a relevant internal factor

Mindfulness refers to non-judgmental and present-oriented attention (Kabat-Zinn, 1994). It comprises the conscious perception of one's own physical sensations, thoughts and emotions without reflexively evaluating or suppressing them. With regard to pruritus, a low level of mindfulness can lead to automated reaction patterns that are associated with less subjective control over itching. In particular, low mindfulness is associated with so-called itch catastrophizing - a cognitive distortion that can intensify the sensation of itching.

Mindfulness training can replace these dysfunctional reaction patterns with an accepting, non-reactive attitude. This can help to change the perception of itching and enable a more conscious control of one's own reaction to the symptom.

Mindfulness as a therapeutic intervention

Mindfulness-based methods are among the contextual cognitive behavioral therapies. Their primary aim is not to eliminate the pruritus, but to modify the response to it. Typical intervention programs consist of weekly sessions lasting approximately 2.5 hours and include elements such as

• Mindful awareness of breath, movement and body sensations
• Psychoeducation on the connection between stress, itching and psychological processes

Studies show that mindfulness has positive effects on both skin-related parameters (e.g. skin condition) and psychological factors (e.g. anxiety, depression, social insecurity). In addition, recent studies have found that even shorter intervention programs lasting two weeks can have short-term effects, but a lasting improvement has not yet been proven. 

External factors: stress as an intensifier of itching

Stress plays a significant role in the intensification of pruritus. The activation of the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system leads to an increased release of mediators, which can intensify the itching sensation. In line with this, studies have shown that people with chronic itching experience stressful life events more frequently and also react more sensitively to everyday stressors.

Stress management through relaxation techniques

Various relaxation techniques are available to reduce stress, which can also have a positive effect on the itching sensation:

• Progressive muscle relaxation (PMR): This method is based on the interplay of tension and relaxation of the muscles. Just two weeks of training can have a positive effect on itching and sleep quality.
• Autogenic training: By focusing on bodily sensations such as warmth or heaviness, deep relaxation can be achieved. In the case of pruritus, a modified form is often used that emphasizes cooling sensations ("My skin is pleasantly cool").

Scientific evidence

Meta-analyses show that the choice of therapeutic strategy should be based on the individual symptom factors:

• If the scratching behavior predominates, behavioral therapy is recommended
• If the focus is on stress, relaxation techniques are effective
• Cognitive restructuring can help with dysfunctional thoughts 
• However, combined approaches that integrate cognitive, behavioral and mindfulness-based elements are usually necessary

Conclusion and future developments

Every patient should be given the opportunity to try mindfulness and relaxation techniques. Mindfulness, progressive muscle relaxation and autogenic training offer promising approaches to support people with chronic itching. Ultimately, the method that suits the individual is crucial - creativity and openness on the part of those affected are essential.

There are still many aspects that can be researched for the future. For example, digital offerings such as online interventions could play an important role in the future, even though there is currently no specific app for pruritus. There should also be more intensive research into how modern technologies, such as virtual reality, can be used to support mindfulness training.