Effects of Assertiveness and Effective Communication Training on the Fear of Negative Evaluation in Patients With Chronic Skin Diseases

Deformity due to skin lesions in skin diseases is among the major factors that generate mental health problems and sensitivities in these patients. In addition, the psychological reactions of these patients are different based on the size, region, and type of the lesions. Skin diseases cause the fear of negative evaluation in these patients and reduce their assertiveness in social situations. It seems that the patients with Psoriasis, Vitiligo, and Alopecia diseases experience decreased assertiveness in their social interactions due to changes in dermal appearance. Such conditions lead them to inadequate communication and the lack of effective assertiveness. Therefore, the present study aimed to determine the effects of assertiveness and effective communication training on the fear of negative evaluation in patients with chronic skin diseases.

This was a quasi–experimental study with a pretest–posttest–follow–up, and a control group design. The statistical population of the present study included patients with chronic skin diseases, such as Psoriasis, Vitiligo, and Alopecia areata who referred to two dermatology clinics and Rasoul Akram Hospital in Tehran City, Iran, in 2019. Of them, 38 eligible volunteers were enrolled in the present study and were randomly divided into the assertiveness and effective communication training and control groups. The inclusion criteria of the research were as follows: having at least a high school diploma, not having severe psychiatric disorders, like schizophrenia (according to their psychiatric history), and not using any illegal drugs or prescribed medications that affect consciousness (as per their medical history). The exclusion criteria of the research included providing incomplete self–report tests, absence from more than two intervention sessions, simultaneous attending in other psychological training, and suffering from a recent trauma or debilitative stress (according their psychological history). The research instrument was the Brief Fear of Negative Evaluation Scale (Leary, 1983), i.e., completed in three stages of pretest, posttest, and follow–up. The intervention was conducted in eight 180–minute sessions. Assertiveness and effective communication training (Dalley, 2013) sessions were conducted in the experimental group. The obtained data were analyzed by repeated–measures Analysis of Variance (ANOVA) in SPSS at a significance level of 0.05.

In the present study, the training provided to the experimental group reduced the fear of negative evaluation (p=0.024), compared to the control group. Assertiveness and effective communication training presented a reducing effect over time for the fear of negative evaluation (p=0.006). Moreover, the reciprocal effect of time*intervention was the cause for decreasing the fear of negative evaluation in the experimental group, compared to the controls (p=0.002). The result of Bonferroni post hoc test indicated a significant difference between the mean scores of the fear of negative evaluation in the pretest and post test (p=0.001), the pretest and follow–up (p=0.001), and stability of the achieved effectiveness in the follow–up stage.

Based on the current research findings, assertiveness and effective communication training is significantly effective on decreasing the fear of negative evaluation in patients with chronic skin diseases, namely Psoriasis, Vitiligo, and Alopecia.