Itch is generally considered as unpleasant and troubling and is often accompanied by impairments in functioning of daily life. Also, the correlated scratching behavior can result in many negative consequences for the patients emotional well‐being such as depressed mood. This can in turn result in increased scratching behavior and worsening of the skin condition, i.e. itch‐scratch cycle. In several studies, stress, anxiety and depression are linked to chronic itch in patients with skin diseases. Psychological factors, as defined in bio-psychosocial models, can add to the worsening or improvement of chronic itch.

Psychological factors, for example, attentional focus, affect and expectancies are build upon earlier learning history, which includes past experiences of itch and scratching that can incite the future experiences, i.e., a worsening of itch. Based on theoretical grounds, research studies had progressively focused on the extent of attention, affect and expectancies playing a role in itch in healthy participants and in patients. Results have shown that these cognitive‐affective factors might play an important role in the exacerbation and maintenance of itch.

In stress, certain neuropeptides are released that can cause neurogenic inflammation and further deteriorate the skin symptoms. Also, it is well-known that mechanical stimulation of the skin during scratching results in release of proinflammatory cytokines which consecutively worsen itch.

Attention, affect, and expectancy are usually interlinked in multidimensional psychological treatments for itch and scratching, for example, mindfulness meditation, stress management, relaxation training, distraction or habit‐reversal strategies for focusing on alternative habits when the urge to scratch arises.

In general, multimodal interventions are offered because the factors interact with each other. For example, there is some data that more multifaceted and engaging attentional distraction tasks can effectively decrease patients’ itch and scratching, while a simple distraction task might be ineffective. Further research is essential in these strategies for optimizing patients’ attentional focus, negative affect and expectancies.

Source: Evers AWM, Peerdeman KJ, van Laarhoven AIM. What is new in the psychology of chronic itch?. Exp Dermatol. 2019;28(12):1442-1447. doi:10.1111/exd.13992