Overview

Living with psoriasis can be difficult. As well as the physical effects of the condition, there are emotional effects that can be caused by:

• not being able to predict when flare-ups will happen
• physical discomfort
• being stared at
• people assuming psoriasis is contagious

Acceptance and commitment therapy (ACT) helps you cope with thoughts and emotions about the things you cannot change, so that you can focus on living by your values. It supports you to achieve your goals even if you’re feeling tired, depressed or anxious.

Here are some ACT exercises you can do to help you cope with the emotional impact of psoriasis.

Living by your values

It’s important to have a clear idea of what you value in your life. Some people value their career over everything else. Others put family first.

There are many different things we value in our lives, including:

• work
• education
• leisure
• health
• spiritual fulfilment
• relationships

What’s important to you?

Bull’s eye exercise

Use this bull’s eye exercise to help you think about your values.

This exercise uses a picture of a target. The circle in the centre of a target is sometimes called a bull’s eye.

The target is divided into 4 sections:

• work and education
• leisure
• personal growth and health
• relationships

The centre of the target (or bull’s eye) represents you living fully by your values. The outer ring represents being far away from your values. In each section, think about how close you are to the bull’s eye.

It’s normal to feel sad or stressed sometimes, especially when you’re worried about psoriasis. But these thoughts can distract us from what we really value in our lives.

Remember what your values are and try to focus on that instead.

Understanding how you cope

It’s helpful to understand what you already do to manage your emotions.

Write down a list of ways you normally cope with your feelings. For example:

• I try to push negative thoughts out of my mind
• I avoid difficult situations by not going out or by covering my skin
• I try to make my thoughts more logical
• I distract myself with TV, reading, games and music
• I use alcohol or drugs to escape my worries
• I talk to friends or family about how I’m feeling

Make your own list of things you do to cope. Then look at the list you made.

Some of your coping strategies might help you feel better for a short while, but they might make you feel worse over time.

For example:

Emma values her friendships and loves to go out. But she worries what people will say about her psoriasis. She started to avoid going out so that she does not have to face these feelings. She sees her friends less and rarely leaves the house.

 

She is less stressed about people seeing her skin, but she is not living the life she wants to live. She’s less happy because of it.

Letting your thoughts come and go

Trying not to think a certain thought often makes that thought stronger. It’s also tiring. You might be able ignore these thoughts for a short while, but it takes a lot of effort.

Instead of ignoring your thoughts, try to see them as things that come and go.

Remember that your thoughts are just thoughts. They are words in your head, created by your mind. We do not always need to take our thoughts seriously.

Here’s an exercise that helps you practice letting your thoughts come and go.

Breathing exercise

Find a place where you can be still. Sit comfortably in an upright position with your back supported against a chair, cushion or wall. You can close your eyes if you want to.

Focus on your breathing. Notice your breath entering and leaving your body.

When thoughts distract you, simply notice the thought, then gently return your attention to your breathing.

Try to keep focusing on your breathing for 1 minute.

You might notice that thoughts keep coming into your mind and they distract you from your breathing. This is normal.

Let the thoughts enter and leave your mind, then focus on your breath again.

Some thoughts might be false and some might be true.

Recognising your thoughts

Sometimes, your mind gets used to repeating negative thoughts. They can prevent you from doing things that are important to you.

For example:

Emma often thinks, “Someone will see my skin and say something mean if I go out tonight”.

 

If she listens to that thought, it might stop her from doing what she really wants and having the social life that she values.

Recognising these thoughts instead of avoiding them can help you stay on track with your life goals. This can help you find a sense of peace with psoriasis.

This does not mean you’ve failed. It means that you can stop struggling.

It’s not easy to accept difficult thoughts. Here are some exercises that can help you practice.

Name the thought

When you have a negative thought or feeling, give it a name. For example, “Here’s the thought about me failing” or “This is anxiety”.

Be aware of the thought, but do not struggle to push it away. Try to continue to do things that you value while being aware of the thought.

Rephrase the thought

You might have a negative thought like, “No one will want to talk to me”.

Add “I’m having the thought that…” in front of the thought to make a new sentence. For example, “I’m having the thought that no one will want to talk to me”.

Focus on that and see if it changes your relationship with the thought.

Then try adding “I’m noticing…” to the beginning of that sentence. For example, “I’m noticing I’m having the thought that no one will want to talk to me”.

How does that change your experience of the thought?

Make fun of the thought

Try repeating the thought several times in silly voices. Use the voice of a funny cartoon character or sing it in your head to a silly tune.

Examine the thought

Try to visualise the thought as an object.

Mindfulness

Our minds are often thinking about the past or the future. Mindfulness is about paying attention to the present. It’s about noticing and accepting the world around us, including our thoughts and feelings.

Being more aware of the present moment helps us to see our thoughts differently.

Here’s an exercise to practice mindfulness.

Body scan exercise

Sit or lie down in a comfortable place.

Close your eyes and focus on your breathing. Take slow, deep breaths.

Gently bring your attention to your body, starting with your feet. Notice how they feel. Be aware of what’s touching them. Feel the air moving around them.

Imagine breathing into your feet. When you breathe out, imagine tension flowing out of them.

Slowly move your attention up your body in this order:

• legs
• bottom
• back
• tummy
• chest
• hands
• arms
• head
• face

Spend a few minutes focusing on each part of your body, then release it and move on.

Setting SMART goals

Think about what you want to change about how you live your life.

When you set goals, try to make them SMART. SMART stands for:

• specific
• measurable
• achievable
• realistic
• time-based

Set goals that fit with your values and what you think is important in life. Write them down so you can keep track of them.

Write down:

• what your goals are
• the date you set each goal
• the date you achieved each goal