Other treatments, like imaging, biofeedback, and hypnosis, not only relax patients but teach them to control physiological factors such as body temperature and skin moisture. "Our bodies are more plugged into the pictures we have in our heads than into reality," says Grossbart. "If you hear the screen door slam and imagine it's the wind, for example, you're calm. If you imagine someone breaking in, you're going to produce adrenaline. Since many skin conditions are sensitive to changes in temperature and moisture, you can learn to pick an image—swimming in an Olympic-size pool of cool yogurt, say—that moves the skin in the right direction." For the imagination to do its best work, patients must enter a state of focused concentration and repeat the exercise daily (a brief daydream or two won't induce serious physiological change).
None of these doctors suggests rejecting traditional skin treatments altogether. "If you have acne that's aggravated by stress, you will see improvement from stress-reduction techniques," says Colbert. "But you also have bacteria under your skin, which will be hard to get rid of without a topical antibiotic." Amy Wechsler, MD, one of only a handful of doctors in the country who is board certified in both dermatology and psychiatry, also recommends a combination of approaches. "You can't just think your way to clear skin," she says. "But when you're using a treatment that should be working and it's not, it sets off some bells: What else is going on here? In those cases, you can use these psychological techniques as adjunctive treatments."
As the mind-skin connection gains credence, beauty companies have seized on the new marketing opportunity, launching serums and balms that they say cater specifically to the effects of stress on the skin. Without any independent clinical trials to back up these product claims, dermatologists are skeptical about how effective they might be. But doctors do advocate paying extra attention to your skin during tumultuous times. "If you already use acne products, increase the frequency of application when you're entering a stressful period," says Fried. And because skin's immunity is impaired when you're under stress, making you more susceptible to sun damage, he says, it's even more important to apply (and reapply) sunscreen. A bonus: Taking special care with your daily beauty regimen may help soothe your spirits as well as your skin. Fried conducted a study in which 32 women used an alpha hydroxy acid lotion on their faces for 12 weeks. Their skin felt smoother in the end, but the participants also reported feeling happier in general. "As soon as these women saw an improvement in their skin, it fostered a wider-reaching sense of optimism," says Fried. "Their feelings of stress or depression also decreased because they felt more in control—over their skin, their bodies, their world."