https://www.midyorks.nhs.uk/burns-psychology
This presentation will introduce the H scratch cycle that can occur in patients with a burn injury we will Begin by discussing what an itch is and how the itch scratch cycle develops some techniques and how to manage itching in yourself or a child you care for advice from an occupational
Therapist and a clinical psychologist and how to use psychological approaches such as mindfulness relaxation and habit reversal training to manage scratching itching is an unpleasant skin sensation which provokes the desire to scratch most patients who have a burn injury will experience some itching particularly during scar maturing scratching and itch can cause healed
Burns skin graphs and Dona sites to break down because skin can be fragile in these areas itching can also interfere with daily activities and sleeping the it SCP scratch cycle begins with an itching sensation which provokes the desire to scratch scratching relieves the itch and replaces it with a mild pain which is
Preferred over feeling itchy our body seems to be rewarded for scratching and itch as it causes pleasure however scratching also damages our skin which can lead to infection which can cause further damage when we scratch an itch we are rewarded in the short term by relieving the irritating
Sensation but this causes more damage Dage to the skin making it itchier causing a harmful itch scratch cycle hi this is leam from occupational therapy occupational therapy can help with any advice or treatments you need for your healed wounds itching is very common when you have a wound or a scar
But it is important to try not to scratch it because you can slow down healing or even cause a new wound when you your wound is healed there are some things that you can do to help itch we would always recommend that you moisturize and massage with a non-perfumed moisturizer three times a
Day and wash the area first with a non- perfume soap you can also get moisturizers that contain anti- itch ingredients so check the label you can try keeping as cool as possible by wearing loose clothing if you are very itchy you could put cool wet cloths over
Your skin to try and avoid further itching we would recommend to wash your clothing in a non-biological powder or liquid if itching continues to be a problem you can ask a pharmacist or a doctor about using antihistamine medication which can help control the itch if you would like any further
Advice please contact a member of the team or discuss it at your Clinic appointment there are lots of things you you can do to help a child manage an itch there are some practical things such as keeping moisturizing creams in the fridge as the corners can help with the itch using non-scented detergent
Soaps and moisturizers using cotton bedding and a few others there are also some psychological techniques you can help your child to practice such as mindfulness relaxation and hric reversal training which we will cover further on in the presentation as a clinical psychologist working into adult Burns I see a lot of patients with
Troublesome itch and one of the key things that maintains the itch scratch cycle that you’ve already read about now is expectation and that’s both the expectation of the itch itself and patients understanding of that but also expectations of any techniques or strategies to manage the itch scratch cycle so starting with patients
Expectations of their it this is often something that confuses patients confuses them that they experience itch when they’ve been to that point used to dealing with pain and that the itch can go on uh for quite a lot of time often um in episodes where might come and then
Go this might be affected by uh weather by stress therefore it can be quite a frustrating thing to be dealing with and carries a lot of uncertainty as to what its path’s going to be and how long it’s going to stick around so patients can often get frustrated if there’s a confusion
Attached to an itch there may well be some difficulty in coming to terms with it and wanting it to go understanding that it is part of uh Scar’s recovery can be a key Discovery for patients this may all be something they’ve been told before or something
They come on to learn about but knowing that it’s part of recovery changes the meaning behind the itch uh less of something to be got rid of or something that’s an enemy but actually something that’s a reflection of progress an ally um a reflection that that patients are
Moving on uh from the acute phase of their burn injury when it comes on to any of the strategies that are outlined here such as mindfulness relaxation techniques and habit reversal training the expectation I think again is important it’s important that the expectation is not that these approaches
Will cure will fix or in fact break a cycle completely but more that they used in the right way can can lessen the impact of an itch that’s not to say that what you’ve been doing to this point has been wrong and certainly we don’t want to create a sense of self-criticism for
Patients in fact when we’re scratching all that we’re doing really is trying to break the itch scratch cycle the Trap we fall into is that whilst it does interrupt that hch scratch cycle it only does so momentarily until the itch returns and we have to employ the same
Attempt time after time and that gets us into an unhelpful cycle that ultimately feeds the itch but the reason we carry on doing this is it gives us a sense of control in other words we can do something here but that control is in the short
Term and doesn’t help us in the long term to the point where the itch starts to control us so what habit reversal training is trying to get you to do is to Del delay that gratification of a scratch because the gratification as we know is only shortlived and it’s needed time after
Time after time so this is trying to create a sense of control in a more indirect form it’s active in the sense that it’s uh it’s encouraging you to be aware of the impulse to to scratch the itch but it’s getting you to increase your tolerance of the itch and what we
Know with habit reversal training is the more that you can build your tolerance of your it the less the impact is on your life both during the Working Day and when you’re hoping to sleep another thing to remember is that itches do improve over time we can’t say at what rate and we
Can’t say for you versus other people but they do improve but rather than just playing a waiting game which can be a torturous and uncertain process the strategies outlined here can give you a more genuine and sustainable sense of control living with your itch as your recovery
Continues if you’re able to put these techniques into practice they can improve your experience but it may all be that you need some extra support with this and this is available through the burns psychology Service uh that you can be referred to to from any member of the burns team in this
Exercise we’ll look at becoming mindful of physical discomfort one of the things that we often do when we feel even very mild physical discomfort is we either try and get rid of it immediately or we try to distract ourselves from it in this exercise we’ll explore the possibility
Of doing neither of those things but simply to notice and become aware of mild physical discomfort and just allow to be many people find that with practice becoming aware and noticing and attending to physical discomfort strangely enough although it doesn’t get rid of the physical discomfort it lightens it pain unattended doesn’t go
Away but paradoxically pain that is attended to in a particular way way through mindfulness lightens and proves itself to be bearable in this exercise I’d invite you initially to start to notice your breath and your breathing bring your awareness to your breath and your breathing noticing it not changing it just allowing your
Breath to occur it’s the thing that your body is doing every moment this is just bringing it into awareness in this particular moment now I’d like to invite you to just gently move your attention your awareness to your physical self and notice right now whatever posture you’re in whether you’re sitting lying down
Just to notice any physical sensations of mild discomfort notice where you’re sitting or lying if there is any part of you that has an urge to change position don’t follow that urge just notice it notice the thoughts notice what it feels like in your body where that feeling of mild disc
Comfort that you’re wishing to alleviate by moving your body shifting white wiggling stretching allow yourself to Simply sit within the sensation let your awareness drift around from one focus of sens ation in one part of your body where there might be some mild discomfort after you spent a few seconds
There gently allow your awareness to drift until it finds somewhere else where there is more discomfort you might like to focus on a feeling of itchiness some part of you that as you start to become aware of it you have thoughts of scratching of relieving the
Itch allow yourself to sit with the itch sit with the discomfort sit within it in the body that you’re inhabiting notice your urge to do something about it notice the thoughts that come with the urge notice them with c curiosity with attention with awareness without judgment after you notice one part of
Your body where there might be a slight Edge AAR awareness to drift and notice if there’s anywhere else that the surface of your skin feels a little bit itchy you don’t need to scratch it you can simply notice it and be aware for a few seconds in silence just let your
Awareness continue to move from place to place location to location in your body wherever you find any feelings of tightness or tension it itchiness mild discomfort and just notice it note it pay attention and move on to the next field of awareness I invite you now to bring your
Awareness back again to your breath to your breathing noticing your inward breath and your outward breath as they occur just in the moment that they occur as you notice each breath You’re simply noticing each present moment right now wherever you are progressive muscle relaxation is an exercise that reduces Stress and Anxiety
In your body by having you slowly tense and then relax each muscle this exercise can provide an immediate feeling of relaxation but it’s best to practice frequently with experience you will become more aware of when you are experiencing tension and you will have the skills to help you
Relax during this exercise each muscle should be tense but not to the point of strength if you have any injuries or pain you can skip the affected area pay special attention to the feeling of releasing tension in each muscle and the resulting feeling of relaxation let’s begin
Sit back or lie down in a comfortable position shut your eyes if you’re comfortable doing so begin by taking a deep breath and noticing the feeling of air filling your lungs hold your breath for a few second release the breath slowly and let the tension leave your Body take in another deep breath and hold it again slowly release the Air even slower now take another breath fill your lungs and hold the air slowly release the breath and imagine the feeling of tension leaving your body continue breathing slowly throughout this EX exercise try to focus on the feeling of air filling and leaving your lungs it will be normal for
Your mind to wonder when it does do your best to bring it back to the moment now move your attention to your feet begin to tense your feet by curling your toes in the arch of your foot hold on to the tension and notice what it feels Like release the tension in your foot notice the new feeling of Relaxation next begin to focus on your lower leg tense the muscles in your calves hold them tightly and pay attention to the feeling of Tension release the tension from your lower legs again notice the feeling of relaxation remember to continue taking deep breaths next tense the muscle of your upper leg and pelvis you can do this by tightly squeezing your thighs together make sure you feel tenseness without going to the point of
String and release feel the tension leave your Muscles begin to tense your stomach and chest you can do this by sucking your stomach in squeeze harder and hold the tension release the tension allow your body to go limp let yourself notice the feeling of Relaxation continue taking deep breaths breathe in slowly noticing the air fill your lungs and to hold it release the air slowly feel it leaving your lungs next tense the muscles in your back by bringing your shoulders together behind you hold them tightly tense them as hard as you can without straining and keep
Holding release the tension from your back feel the tension slowly leaving your body and the new feeling of relaxation taking its place notice how different your body feels when you allow it to relax tense your arms all the way from your hands to your shoulders make a fist and
Squeeze all the way up your arm hold It release the tension from your arms and shoulders notice the feeling of relaxation in your fingers hands arms and shoulders notice how your arms feel limp and at ease move up up to your neck and your head tense your face and your neck by distorting the muscles around your eyes and
Mouth release the tension again notice the new feeling of Relaxation finally tense your entire body your feet legs stomach chest arms head and neck tend harder without straining hold on to the Tension now release allow your whole body to go limp pay attention to the feeling of relaxation and how different it is from the feeling of tension continue taking deep Breaths begin to wake your body up by slowly moving your muscles adjust your arms and legs stretch your muscles and open your eyes when you’re ready you’ve completed the progressive muscle relaxation exercise repeat this exercise daily to experience the ongoing benefits of Relaxation habit reversal training can be used to break the it scratch cycle by replacing scratching with another Behavior habit reversal has three main stages awareness a competing response and motivation first we need to establish awareness of when an itch occurs once awareness has been established you need a replacement Behavior such as clenching
Your fists or gently patting the area that is itching instead of scratching practice this for 30 seconds if this removes the urge to itch continue with your normal routine if not repeat the behavior until the urge to itch recedes the final stage of habit reversal is remaining motivated to continue the practice
Thank you for watching this presentation on the itch scratch cycle you can find out more by heading to our B psychology website