问题 21. 心理治疗：何时 以及如何治疗？

Question21.     Psychotherapy: when and how?

问题   21. 心理治疗：何时 以及如何治疗？

•Key points

•要点

•Vitiligo is a distressing disease because of its perceived stigma, cosmetic disfiguration and tendency to chronic relapse.

•白癜风是一种令人极其痛苦的疾病，因其 令人感觉耻辱、损毁容貌，并且有慢性复 发的趋势。

In certain cases treatment of psychological rebound may both improve the  self-esteem and clinical outcome: this must be started in the “liaison consultation” room where the subject will be simultaneously in contact with the dermatologist and the psychotherapist.

•在某些情况下，精神心理的振作可同时增 强患者自尊心并促进临床症状恢复：这种 治疗必须在患者可以同时接触皮肤科医生 和心理治疗师的“联络咨询”室进行。

•   Cognitive    behavior    therapy    may    be appropriate in certain cases.

•某些情况下可进行认知行为治疗。

•Answer

•解答

Vitiligo is often considered to be emotionally triggered, both by the affected subjects and doctors.

人们常认为白癜风是被患者和医生的情绪 所引发。

An incubation period of 2-3 weeks between the stress event and the clinical manifestation of vitiligo patches is reported by over 70% of patients.

超过 70%的患者称在应激事件和出现白癜风 临床表现之间有 2-3 周的潜伏期。

Even the localization of white patches has been anecdotally but significantly reported as related to specific affective relationships.

甚至白斑的位置与特定情感关系有关，这也 被当做趣闻但又确切报道过。

Thus, according to some reports,  men  who had been betrayed developed vitiligo on the genital areas and women who did not accept their pregnancy, developed vitiligo on their abdomens.

因而，根据一些报道，遭受背叛的男人在生 殖器部位会出现白癜风，而不能接受自己怀 孕的女人白癜风发生在腹部。

The case of a woman who developed vitiligo on hands in a few hours after cleaning the sheets where her son’s girlfriend had had a miscarriage, is also illuminating.

一个案例中，一位妇女在清洗了她儿子女朋 友有过流产的床单数小时后，在手部发生白 癜风，这也具有一定启示性。

These are obviously anecdotal reports in medical literature, which are of very limited “per se” value, but are clearly disclosing possible general psycho-somatic paths, which could direct researchers toward the causes and to the cure of vitiligo, in as yet un explored psycho - neuro - immuno endocrine territories.

在医学文献中有些明显的轶事报告，具有有 限的“灰色”价值，但是清楚地揭示了可能 的普遍的心理-躯体途径，将可能在未被探 索的心理-神经-免疫内分泌领域，指导研究 者探索白癜风的起因，从而治愈白癜风。

Nobody can ignore the burden of the somato-psychic rebound effect of vitiligo into the psyche of the affected subject.

无人能够忽视躯体-心理的反弹效应对白癜 风患者造成的心理负担。

Vitiligo subjects may adopt (more or less consciously) different behaviors to cope with vitiligo.

白癜风患者会采取（或多或少有意识地）不 同的行为应对白癜风。

Some will adopt the “mastery active” psychological mechanism consisting of reading, studying and researching actively the causes of the disease.

有些人会采取“主动掌握”的心理，包括阅 读、学习并主动研究病因。

Others will behave as “natural acceptors” showing good self-esteem and not trying to hide their skin lesions.

一些人表现为“自然接受”，表现出良好的 自尊心，并不去试图掩盖皮损。