Social stigma around psoriasis plaques can potentially lead to anxiety in social situations, and pain and inflammation can lead to depressive thoughts. Therapy can help you manage the possible mental health effects of psoriasis.

“Psoriasis is a chronic disease that results from an overactive immune system that speeds up cell growth and increases inflammation in the skin,” explained Kate V. Viola, a board certified dermatologist at Dermatology Partners who also holds a master’s degree in health science research and founded the skin care company Lady Polpo.

“In a healthy skin cycle, skin cells go through a process of growth, maturation, and shedding. This process is accelerated in psoriasis, which results in the accumulation of excess skin cells on the surface of the skin that results in red thick plaques with scale.”

These plaques can cause much more than just uncomfortable physical symptoms. There is a greater likelihood that you’ll develop depression, anxiety, and other mental health conditions if you live with psoriasis

Psoriasis affects an estimated 125 million people worldwide. And the authors of a 2022 research review concluded that people with psoriasis are more likely to experience certain mental health conditions than people without psoriasis.

Biological and environmental factors associated with psoriasis can lower your quality of life and negatively affect your mental health. For example, social stigma around psoriasis plaques can contribute to anxiety in social situations such as work and school. Psoriasis can also cause pain and inflammation in your joints and skin, which can potentially lead to depressive thoughts.

Not only can psoriasis affect mental health, but the reverse is also true. Heightened levels of stress and anxiety may play a role in flare-ups. This is why it’s vital to get treatment from a therapist and a dermatologist.

According to a 2022 research review, psoriasis has links to many mental health conditions. The authors concluded that people with psoriasis have a 1.5 times greater likelihood of experiencing depressive symptoms than people without psoriasis. Anxiety symptoms, schizophrenia, and suicidal thoughts are also more prevalent among those with psoriasis.

Other research suggests that psoriasis may have links to increased alcohol consumption, post-traumatic stress disorder, and bipolar disorder.

There are various reasons for these comorbidities. Still, each condition affects the other. For example, a psoriasis flare-up can cause social anxiety, and increased anxiety and stress can worsen the inflammatory psoriasis rash. Similarly, the pain that psoriasis can cause may worsen depression or suicidal ideation.

But there are biological factors too. One 2018 study reported that psychiatric reactions to stressors in the form of stress-related disorders, such as anxiety, can increase the likelihood of developing an autoimmune disorder.

This is because your body’s stress system can affect your immune system, leading to increases in chemicals called pro-inflammatory markers, which play a role in autoimmune conditions such as psoriasis.

Anxiety, depression, anger, and stress from trauma can have physical impacts on your body. Trauma from the emotions caused by psoriasis flares can also increase your risk of developing certain autoimmune diseases, sometimes to as much as seven times the risk that occurs in people without trauma.

But because of the way psoriasis and mental health conditions affect each other, it’s possible that they could also benefit each other.

“Therapy can play a crucial role in supporting individuals with psoriasis, not only by addressing the emotional and psychological aspects of living with a chronic skin condition but also by helping to manage the impact it may have on mental health,” said Viola.

Therapeutic approaches that have shown promise include:

  • cognitive behavioral therapy (CBT)
  • meditation
  • relaxation therapy
  • biofeedback
  • supportive counseling

CBT is a type of talk therapy (psychotherapy) that focuses on helping you change your thinking and behavior by making you more aware of your internal self-talk and emotions. It’s one of the most commonly sought-after types of psychotherapy.

The authors of a 2019 research review noted that CBT reduced the area and severity of psoriasis symptoms in people with moderate to severe cases. The techniques used in CBT may help people better manage stress and anxiety, decreasing inflammatory markers that can worsen psoriasis flares.

“When psoriasis flares up, it can contribute to a vicious cycle of increased anxiety, depression, isolation, and declining mental health. Anxiety or depression may occur during a flare-up when the skin is inflamed and painful,” said Brianna Paruolo, a licensed mindfulness therapist at Gold Therapy NYC.

Mindfulness-based therapies, such as meditation and relaxation therapy, may help you manage negative emotions and decrease stress, anxiety, and depression.

Supportive counseling, which often includes role-playing, boosting problem-solving skills, and behavioral reversal, can provide tools to better cope with psychological, environmental, and physical stressors. For example, a counselor may help you develop strategies for boosting your self-confidence in social anxiety situations.

Psoriasis can affect fashion choices, social interactions, and self-confidence, as you may feel self-conscious about plaques. A combination of therapy and a support group can help improve body image and self-esteem.

“The stigma around visible symptoms plays a part there. It’s tempting to avoid social situations when you’re afraid of judgment or comments from strangers. The only problem with isolation is that it makes things worse,” noted Paruolo.

“CBT helps individuals identify and change negative thought patterns, reducing anxiety and depression associated with psoriasis,” explained Viola.

Supportive therapies that include role-playing can provide tools and techniques that can come in handy during social situations. Mindfulness can promote self-acceptance, helping you notice internal negative judgments before consciously letting them go.

Therapy can provide many useful tools for stress management and self-care, as well as coping strategies you can use in daily life. Therapeutic tools often help you increase your self-awareness and discover the connection between your body and your mind, fostering a holistic approach to well-being.

Through this approach, you may realize that certain choices you make throughout your day can affect both your mental and your physical health, including:

  • getting the recommended amount of physical activity
  • maintaining a healthy diet
  • getting enough sleep
  • journaling
  • practicing mindfulness and meditation
  • integrating a gratitude practice

“Accepting your psoriasis does not mean approving of it, but radical acceptance creates a path forward to pursue effective treatment and symptom management,” said Paruolo.

Some psoriasis triggers, such as a scrape or an illness, may be out of your control. But you may be able to avoid some potential causes if you can identify them. Common triggers for psoriasis include:

  • stress
  • excessive alcohol consumption
  • smoking
  • hormonal changes
  • certain medications
  • certain foods

Taking steps to avoid some triggers, such as smoking, and to manage your psychological reactions to other triggers, such as stress, may help reduce the frequency and severity of your psoriasis flare-ups.

It may be helpful to look for a therapist who specializes in chronic health conditions. The National Psoriasis Foundation offers support groups, community, and patient resources that can help you find the right mental health professional.

Whether mild or severe, psoriasis can have negative effects on your physical and mental health. The stress, anxiety, and depression caused by plaques and pain can worsen psoriasis flares, leading to a further decrease in mental health and quality of life.

Therapy has the potential to break the cycle, helping you manage mental and physical reactions to living with psoriasis through a holistic approach.