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The effects of psoriasis often run more than skin deep. This condition can have psychological repercussions that impact almost every aspect of an affected person’s life. Here, psychologist Allan Chino, Ph.D., discusses how he helps people with psoriasis conquer their negative feelings and turn a more positive face to the world.
Q: What are some of the common issues that your patients with psoriasis are concerned about?
A: By the time people come to see me they’re typically depressed or anxious or both. They’re just not thriving. They aren’t able to share their more joyful, optimistic selves with the world. In addition, many people with psoriasis have issues with self-worth. As social beings, we’re affected by the way other people treat us, and the world treats us differently depending on how we look. But even though we can’t always control how we’re treated, it is possible to have some influence over it. When because of your psoriasis you perceive yourself as being treated badly (and that perception may very well be accurate), you have two choices: one is to retreat; the other is to change internally and discover your ability to influence not only yourself but also the world around you with the way you think and your own attitude.
Q: How would you help a person improve her feelings of self-worth?
A: I would start by helping her to examine where those feelings of self-worth come from. It varies for all of us. We derive some self-worth from our jobs, our productivity, our appearance and from the feedback people give us about what kind of person we are. It’s important to know whether your self-worth comes from internal or external sources—the goal is to learn how to shift the origins of self-worth from external to internal. If you have psoriasis and you’re sensitive or self-conscious about your physical appearance as a main source of self-worth, you can do exercises to develop more positive ways of viewing yourself. Here’s one to try: Picture a pair of identical twins. Both have psoriasis, both are having a particularly bad flare, and both have to walk through a shopping mall. Twin A is extremely self-conscious about the psoriasis and other people’s reaction to it. First imagine being Twin A, walking through the mall, noticing the glances that you’re getting from other people and the worried looks from the sales staff, who might be wondering if you have a disease they can catch. Now imagine being Twin B, who has the exact same physical presentation but who strolls through the mall exuding self-confidence, completely unconcerned about what other people are thinking. As Twin B, even if you notice other people looking at you, you think, “That’s just them noticing something different. It has nothing to do with who I really am or what my values are.” This exercise illustrates a possibility: You can feel self-confident and good about yourself even with psoriasis, and even begin to transfer that skill to other areas in your life, such as your workplace.
Yet another strategy is to change the way you view your disease, to stop seeing it as a source of intimidation or embarrassment, but rather as an opportunity. Role-play is an effective way to do this. I might ask someone who usually covers up her skin when she’s aware that someone else is noticing it to pretend to be the person noticing the psoriasis, and I’ll be the person with psoriasis. Instead of covering up, I might say something like, “Oh, I saw you noticing my skin. I have psoriasis. It’s an autoimmune disease that causes my skin to become red and inflamed. It’s not contagious.” You learn another option: Instead of being embarrassed, you can use your psoriasis as an opportunity to educate someone else. When you do this you also reinforce your own growing self-confidence.
Q: How do you help people overcome depression or anxiety?
A: If somebody feels really stuck, if they’re so depressed and down that they don’t have the energy to attempt the work we might do in therapy, I may suggest that they speak with their physician about trying antidepressive or antianxiety medication. Drugs can’t take the place of therapy, but they can correct underlying chemical imbalances and get a patient to a point where she can be successful in therapy. Once she’s there and ready to change how she thinks about her disease and about herself, we’ll work on specific issues. Eventually you may feel good without medications for depression or anxiety.