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Fig 3.3 Characteristics of The Combined Approach Pharmacological treatment enhanced by behavioural change

Treatment package adapted to individual requirements Variety of cost-effective adaptations possible

Fig 3.4 Working with the Very Young Habitual scratching starts early in life Scratching develops an emotional significance Success depends on parental involvement

Early intervention prevents chronicity

satisfactory outcome occur, although biological factors may be relevant, the psychosocial issues reviewed in Chapter 4 can be of even more importance. Behavioural treatments are therefore always more potent when assessment is able to take account of personality factors and relevant social influences. Insensitively delivered, 'off the peg' treatments are never as successful as those that can be tailored to the individual's needs. For the great majority of patients this attention to detail need not become time-consuming. The 'minimal effective dose' is of relevance in behaviour modification, as it is in physical medicine. All the work that has led to the development of this manual has been done with individuals on a one-to-one basis. Other workers including Ehlers and her colleagues in Germany (1995) have successfully incorporated a habit reversal technique into a group approach. This clearly is of interest as a cost-effective adaptation. Behavioural treatments also lend themselves to self-help approaches, and it may be in the future that a self-help manual based on The Combined Approach will enable more patients to benefit from its effectiveness (Fig 3.3). In recent years behavioural treatment programmes have been designed for use on personal computers. That some patients have asserted a preference for computers over seeing a health professional may be interpreted in various ways, but as a method of providing treatment for as many people as possible, the use of computer programmes may prove important in the future management of atopic skin disease.

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3.5 Habit Reversal and the Very Young It is evident that some of the difficulties that adults have in their psychological adjustment to long-standing atopic skin disease may originate in childhood experiences: the earliest symptoms of atopic eczema often pre-date language acquisition. Scratching behaviour can clearly become a potent method of non-verbal communication between child and concerned parents. Many adults will admit that the emotional significance of their scratching goes back to a childhood need for support from significant others (Fig 3.4). Habit reversal offers parents an approach to atopic eczema in their child that is not only effective as part of

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Profile for Christopher Bridgett

Atopic Skin Disease - A Manual For Practitioners  

An account of a new behavioural approach to the treatment of atopic eczema, written for practitioners, but also for patients

Atopic Skin Disease - A Manual For Practitioners  

An account of a new behavioural approach to the treatment of atopic eczema, written for practitioners, but also for patients