Should You See a Therapist for Psoriasis?

If psoriasis is affecting your emotional well-being, seeing a therapist may help. Psychotherapy won’t cure psoriasis, but it can provide you with support, coping techniques, and a healthier way of navigating the emotional toll of living with this chronic condition.

The Emotional Side of Psoriasis

“As a chronic, immune-mediated condition with a relapsing-remitting course, psoriasis exerts continuous pressure on a person’s mental well-being,” says Mohammad Jafferany, MD, a professor of psychodermatology, psychiatry, and behavioral sciences at Central Michigan University College of Medicine in Saginaw and the president of the Association for Psychoneurocutaneous Medicine of North America.

Unpredictability can also take a toll. Psoriasis flare-ups may happen without warning, leaving people feeling anxious or powerless. “Patients often describe a sense of loss of control over their own bodies, resulting in high anxiety, and they are always in fear of relapses,” Jafferany says.

There is a biological element, too, according to Francisco Tausk, MD, a professor of dermatology at the University of Rochester in New York, where he began a multispecialty clinic in dermatology and psychiatry treating people with complicated disease, such as psoriasis and psoriatic arthritis.

And when either skin health or mental health worsen, it affects the other. “There is a bidirectional connection between them, since the stigmatization, the disfigurement, and the itch tend to exacerbate depression and anxiety, and on the other hand, depression and anxiety make the skin worse,” he says.

How Psychotherapy Can Help

Therapy can provide meaningful support for people who feel emotionally affected by psoriasis, addressing the interplay between physical symptoms and emotional state in people with psoriasis, Jafferany says.

One of the biggest benefits of psychotherapy is having a safe space to talk openly without judgment. “Many patients with psoriasis feel misunderstood or minimize their distress. Psychotherapy validates their lived experience, including embarrassment, frustration, and grief, and helps patients process those emotions constructively rather than suppressing them,” he says.

“For example, a patient might think, Everyone is staring at me, or I can’t go out like this. Cognitive behavioral therapy (CBT) works to test and reframe these assumptions, reducing avoidance behaviors and social anxiety. Over time, this can significantly improve confidence and quality of life,” Jafferany says.

Therapy provides coping strategies to manage stress, anxieties tied to unpredictability, and even day-to-day functioning like improving sleep hygiene and distracting from itchiness, Jafferany says.

It can be part of a holistic approach to your health that involves lifestyle modifications. “We don’t only refer patients for psychotherapy but also to lifestyle interventions,” Tausk says.

This could look like encouraging people to do exercise, practice mindfulness meditation, or adopt an anti-inflammatory diet to help with their overall health. “Most of our patients with psoriasis are overweight and have significant insomnia, and many have generalized pain syndrome. So we need to address all these aspects,” he says.

"But I’m Not Depressed"

You don’t need to be having a mental health crisis to make therapy worthwhile or necessary. You can benefit from therapy simply because living with psoriasis is emotionally difficult, Jafferany says. “Patients with psoriasis don’t need to meet criteria for a formal mental health diagnosis or be in acute crisis to benefit from psychotherapy.”

Sometimes distress shows up in subtle ways that are easy to dismiss. You may not think of yourself as anxious or depressed, but you may notice changes in your mood, habits, or daily functioning.

• A persistent shift in mood or feeling low, irritable, or emotionally flat more than usual
• Feelings of fear, loss, stagnation, or sadness
• Heightened anxiety, particularly around flare-ups, appearance, or how others might perceive you
• Avoiding social activities, intimacy, gyms, or swimming pools
• Passing up on work opportunities because of your chronic disease
• Stopping hobbies or activities you once enjoyed
• Feeling hopeless about flare-ups or treatments

Sleep disruption is another common issue. Tausk notes that many people with psoriasis struggle with insomnia and fatigue. “We refer many of our patients for sleep studies, since this problem disrupts so many other things,” he says.

How to Find a Therapist

A good first step is asking your dermatologist or primary care provider for a referral. Some dermatology clinics, larger hospitals, and academic centers have integrated care models, which means psychological support is already embedded into dermatology care, Jafferany says.

But you don’t need a formal referral to get started, Jafferany says. “Patients can also search independently for licensed therapists who list experience in chronic illness, mind-skin connection, or behavioral medicine,” he says.

“Which kind of therapy is better for a patient is very personal. Most patients end up finding therapists who are more eclectic and trained in the different therapies,” Tausk says.

How to Know if It’s Helping

Therapy usually does not create instant transformation. Progress is often gradual and may look different from person to person.

Over time therapy may help people with psoriasis feel more emotionally resilient and less overwhelmed by stress or flare-ups.

• Improved mood, with reduced anxiety and fewer periods of low mood
• Stronger coping skills in the face of stress
• Increased self-acceptance
• Doing better at work or school
• More awareness of thoughts and feelings
• Less social avoidance
• Expressing emotions better
• Thinking more positively

Behavioral changes are a big signal of progress. “Patients may reengage with parts of life that psoriasis had narrowed, such as social activities, exercise, relationships, and work opportunities,” Jafferany says. “Psoriasis may still be present but becomes less central to identity and less dominant in day-to-day thinking.”

Tausk says that therapy helps people better manage stress, which benefits physical symptoms, too. “Learning to deal with stress is critical,” he says. “Everything is exacerbated by chronic stress.”

The Takeaway

• Psoriasis can affect your mental health as much as your physical health, with common symptoms like anxiety, depression, stress, sleep problems, and social withdrawal for some people living with the chronic condition.
• Therapy can help people with psoriasis build coping skills, challenge negative thought patterns, manage stress, and improve self-acceptance and quality of life.
• You don’t need to be in crisis or have a formal mental health diagnosis to benefit from therapy if psoriasis is affecting your mood, relationships, sleep, or daily functioning.