Psoriasis is a chronic, relapsing and usually lifelong condition. Patients with psoriasis often lose hope that their condition can be managed. This may lead to poor treatment compliance. It is a well established fact that in addition to physical discomfort and disability, psoriasis can produce anxiety, depression and other psychological problems, which in turn can aggravate the disease.
A number of studies have shown that psychological stress is often caused by psoriasis and can be a factor in flare-ups of psoriasis. Pruritis in psoriasis contributes to stress and the stress in turn can lead to more pruritis. This vicious cycle can contribute to psychological problems including depression, anxiety, aggressive behaviors, obsessional behavior, and alcoholism. The other psychological problems can include poor self-esteem, sexual dysfunction, and suicidal ideation. The mechanisms by which psychological stress can make pruritis worse are not clearly understood.
Psychological counseling may be helpful in some patients with psychosocial problems. A family counseling session may also help the family members to understand the nature of the disease better and realize the role that family members can play in reducing psychosocial stress.
Traditional psoriasis treatment regimens may be augmented with stress-reduction strategies. Biofeedback training, psychotherapy and hypnosis are examples of adjuncts to traditional medical treatment.
Hypnosis may improve or resolve numerous dermatoses, including psoriasis. In addition, hypnosis can facilitate aversive therapy and enhance desensitization and other cognitive-behavioural methods.
Cognitive behaviour therapy combines two kinds of psychotherapy, cognitive therapy and behaviour therapy. CBT has been very thoroughly researched. Numerous studies have shown CBT to be as effective as drugs in treating both depression and anxiety.