The Mind, Psoriasis And Stress – Why We Look Beyond The Skin

Starting With What Medicine Knows

Psoriasis is generally understood as an immune mediated inflammatory condition with genetic influence and a range of potential triggers. Psoriasis and stress are often linked in patient stories, however stress is not usually described as the root cause. Instead, it is recognised as one of several factors that can make flares more likely or more intense. Infections, injuries, hormones, medication and physical irritation can all play a part.

There is also the stress of the condition itself. Managing visible plaques, itching, sleep loss and other people’s reactions can create a daily load. That load is not just emotional, it can keep the body’s threat system switched on. The result is a loop, symptoms increase stress, stress increases symptoms, and suddenly you are managing your skin and your nervous system at the same time.

At The Surrey Institute Of Clinical Hypnotherapy we start from this medical picture and respect it. We do not present mind and body work as a replacement for dermatology or as a reason to stop prescribed care. We simply acknowledge something many people already feel in their own body, when the whole system is under pressure, flares are more likely, and when the system settles, life tends to become more manageable.

If you want to see how psoriasis and stress sit within the wider map of conditions we treat, you can visit our main Problems We Help With page, or explore the Physical Symptoms And Pain section where psoriasis sits alongside other long term health issues.

The Early Clinic Study We Ran

When I first began working with psoriasis and stress in a more focused way, I ran a small practice based study because I wanted something more solid than a handful of success stories. Before we started, I spoke in detail with a psychiatrist and a psychologist. Both felt there was no meaningful mind and body connection to plaque psoriasis and therefore psychological work would have no effect on symptoms.

That kind of scepticism is understandable and, up to a point, healthy. The difficulty is when scepticism hardens into certainty, especially when patients have already been told their options are limited. Over the years I have worked with clinicians who had psoriasis themselves and did not think their mind could influence the condition, yet they were still willing to try something different because they were tired of feeling stuck.

How We Measured Change With PASI

Each participant in the study committed to a programme of up to twelve weeks. Their GP completed a PASI score at the beginning and again three months after the start. PASI, Psoriasis Area And Severity Index, measures severity and coverage, including redness, thickness, scaling and surface area. It gave us a starting line and a practical way to track change afterwards.

Sessions were offered free of charge and nobody was paid to take part. If a GP charged a fee for completing the PASI form, we covered only that cost. To reduce some obvious confounders, we also included a condition that participants had not used drug treatments for their psoriasis in the previous year, apart from moisturising creams. It was not a perfect research design, however it did keep the focus on what this kind of mind and body work might contribute.

What We Recorded At The End

The headline outcomes from that small study are easy to state, even if they are not the whole story. Around twenty eight per cent achieved roughly a ninety five per cent reduction in psoriasis severity. A further twenty nine per cent obtained over fifty per cent reduction. Forty three per cent saw little or no reduction. Every participant reported a noticeably different attitude to their psoriasis by the end.

Those numbers are strong and they are not a promise. They are what we observed in a clinic setting, using PASI as a reference, with a group of people who committed to the work. They also raise the more interesting question, what was changing in the people who improved, and what working with psoriasis and stress was actually doing to the system.

What Those Numbers Can And Cannot Tell Us

This was not a large randomised controlled trial. Without a control group, we cannot fully rule out natural fluctuation, seasonal change, regression to the mean, expectancy effects or scoring variability between clinicians. So it would be irresponsible to claim this proves a particular method works for everyone.

What it does suggest is more modest and more realistic. Some people saw large improvements, many saw moderate improvements, and almost everyone gained psychological relief. Even if you put symptom changes to one side for a moment, that relief matters. Psoriasis and stress feed one another, and the emotional load of a long term condition can be heavy. Reducing that load is often a turning point and it is one of the reasons people seek this kind of support in the first place.

What Later Research Adds To The Picture

Since those early observations there has been published work exploring hypnosis and other psychological interventions in psoriasis. The research is mixed and it is still easy for people to overclaim. There is enough signal, though, to justify curiosity and to keep looking closely at the relationship between psoriasis and stress.

One of the better known studies is the Tausk and Whitmore pilot trial, which reported that highly hypnotisable participants showed greater improvement in lesions than moderately hypnotisable participants. The authors were cautious and called for further research, however it is an interesting clue, particularly because it suggests that responsiveness to hypnosis may matter. Clinically, that fits what we often see, mind and body approaches to psoriasis and stress seem to work best when the person can engage with imagery, attention and expectation in a felt, embodied way.

There is also wider evidence that psychological interventions improve mental health outcomes and functioning in people with psoriasis. That does not automatically mean clear skin, however it does support the idea that treating distress is part of treating the condition, not an optional extra. It also helps explain why working with psoriasis and stress can be valuable even when the skin does not change as dramatically as someone hopes. For some people this sits alongside wider patterns of worry or panic, which we explore more on our Anxiety And Panic page.

How Working With Psoriasis And Stress Helps In Practice

People sometimes imagine hypnosis as either mind control or wishful thinking. In practice it is neither. When we work with psoriasis and stress, the focus is usually on reducing the internal threat response, changing how the system reacts to triggers, and loosening the emotional grip the condition has on daily life.

First, we work on stress physiology. If your nervous system is stuck in fight or flight, sleep suffers, inflammation related behaviours worsen, and small stressors feel bigger than they should. Helping the system settle gives your body a better chance to repair and cope.

Second, we look at the internal relationship with the skin. Many people describe their skin with disgust or hatred, sometimes quietly, sometimes with real force. That response is understandable, however it also keeps the body in threat mode. Changing that relationship is not about pretending everything is fine, it is about reducing internal threat so the system has more room to regulate.

Third, we explore the patterns that keep pressure high, such as perfectionism, people pleasing, suppressed anger, chronic self criticism and the learned belief that you have to cope alone. These are protective strategies, not flaws, however they can become expensive over time. When those patterns ease, people often report that flares feel less inevitable and life feels less controlled by psoriasis.

The Pattern We Saw Most Often, Anger

In the study, and in clinical work since, anger has been the most common thread. Sometimes it is anger about the condition itself, the unfairness, the visibility and the constant management. Sometimes it is older anger that was never safe to express and has been carried for years.

Anger is also frequently turned inward, with people saying that they hate their skin and meaning it. When that is happening the system rarely settles. In those cases, work on psoriasis and stress often includes emotional release, forgiveness work and a rebuilding of the relationship with the body, not because it sounds nice, but because it reduces internal threat and makes calm possible.

Calm is not a cure. However calm changes sleep, resilience and how you respond to early flare signals. It also makes it easier to follow medical routines consistently, which is one of the unglamorous ways outcomes improve. This is one of the ways that focused work on psoriasis and stress tends to earn its keep.

When Research Numbers And Daily Life Do Not Match

Even when research shows statistically significant improvement, that does not automatically mean the change is big enough to matter in real life. A small shift in severity can be real, but not life changing. Clinically meaningful change often includes sleeping better, going out without scanning for judgement, wearing what you want and not feeling at war with your own body.

This is why I still value the observation from the early study, every participant reported a different attitude to their psoriasis. That is not a consolation prize. For many people it is the beginning of longer term change, and it is one of the reasons that working with psoriasis and stress can be worth doing even when the skin response is slower or more subtle.

Where To Go Next If You Want Help

If you are living with psoriasis and stress and you recognise yourself in some of what you have read, you do not have to face it alone. This article has focused on ideas, research and patterns, rather than giving a full description of treatment.

For a practical overview of how we work with plaque psoriasis in sessions, and what to expect if you decide to work with us, you can read our main service page on hypnotherapy for psoriasis. From there you can also explore the wider Physical Symptoms And Pain hub and the overall Problems We Help With page to see how this mind and body approach connects with other conditions we treat.

If you decide to get in touch, we will always work alongside your dermatology team, not instead of them, and we will be honest about what feels realistic in your situation, based on both the medical picture and the patterns your system has learned over time.