H O ^
Fig 4.24 Initial Homework Tasks
n C/3
B as a C/5 w > c/3 n M
Explain treatment to someone else
Work out behavioural prescription
providing clear written instructions on what to use and when to use it; the instructions are recorded separately in the case file for future reference. At Level 3, registration of any further scratching is continued over the next four weeks at least, to note progress. It is necessary to explain carefully that registration is only required for scratching and not for the new alternative and desirable behaviours. The behavioural prescription is worked out by the patient after the second visit. It is useful to suggest also that the patient should now describe the programme in detail to another person away from the clinic (Fig 4.24). If they find explaining what is involved difficult, they should note down what has become unclear, and bring back their notes to the next visit for discussion.
4.4 Three Further Dimensions in Management Stress
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Asking about stress sometimes feels like risking the opening of Pandora's box. The topic is often avoided as it may pose problems for the interviewer who feels therapeutically impotent. In reality a sympathetic appraisal of this topic for each patient need not pose problems, and can often be very useful. During initial assessment there can be review of factors that either improve or provoke eczema. Not all patients report stress as relevant. Of those that do, some report that it is during stress, for example examinations, that the effect is most noticeable others interestingly assert it is in the period after stress has passed that their eczema seems to relapse. Either way, discussing how to manage stress is relevant. Stress and eczema are clearly linked in a reciprocal relationship, and this phenomenon is common to the relationship between morbid emotional states and all three of the common dermatoses eczema, psoriasis and acne. A first principle should be to manage the skin condition appropriately and effectively, taking into account the particular needs of the individual patient. This in itself relieves stress, and improves morale: the patient who is managing their skin well will be better able to manage their life, and the inevitable stressful events that all lives involve.