Psoriasis and ACT
Learning to Live Well with a Chronic Condition
At times, it can feel like psoriasis controls my life. The flaking, itching, and discomfort can seem relentless. But over the years, I have learned to use several psychological strategies to help me cope and reduce my suffering.
Following on from my article about the distinction between pain and suffering, I wanted to share how Acceptance and Commitment Therapy (ACT) has helped me live with psoriasis. Learning to cope with psoriasis does not mean I have given up. I would love to find a cure and not have it at all. But right now, learning to cope with psoriasis means managing the amount of suffering it brings my way.
The Two Arrows: Pain vs Suffering
I have previously written about Buddha’s story of the Two Arrows, which explains how the first arrow brings the unavoidable pain, the physical symptoms of psoriasis. The second arrow is the suffering we add on top, the worry, the frustration, the feelings of hopelessness.
I cannot stop the first arrow, but ACT has helped me stop the second one hitting its target.
These are some of the techniques I use:
Defusing Unhelpful Thoughts
One of the biggest challenges of psoriasis is the way it affects how we think about ourselves. My mind tells me:
• I look awful.
• This is never going to get better.
• People must be disgusted by my skin.
In the past, I would have believed these thoughts completely. I would have felt distressed and low, which might have led me to give up on my treatments or turn down social engagements out of fear of judgment.
Now, I remind myself that thoughts are just thoughts, not facts. Just because my mind says something does not make it true.
A simple ACT technique that helps me is ‘thought defusion’. Instead of getting caught up in negative self-talk, I step back and notice it for what it is. I might say:
"Ah, there’s my mind telling that same old story again, that my skin is disgusting."
Sometimes, if a thought feels particularly overwhelming, I imagine it in a silly voice, perhaps in the style of a cartoon character. It sounds ridiculous, but it helps me unhook from it.
Unhooking from My Thinking
Instead of letting psoriasis-related thoughts consume me, I choose to focus on the things that truly matter. Spending time with my children, enjoying a walk with my dog or writing.
When my mind starts spiralling, instead of getting caught up in my thoughts, I turn my attention to the things that bring my life joy and meaning.
Considering My Values
I have spent time working out what gives my life value, what really matters to me and what sort of person I want to be. These are the things that give my life direction and I once I know my values, I know what I need to do to live according to my values.
Everyone has different values, and it can be incredibly useful to work out what yours might be. You could ask yourself:
"What would I like to overhear other people saying about me? That I am compassionate, reliable, patient?"
Everyday Mindfulness
Practising mindfulness does not mean sitting cross-legged with my eyes closed for hours. It is much simpler than that. I build mindfulness into my day in small ways:
• Walking my dog mindfully, noticing the feel of the ground beneath my feet, the scents in the air, the sounds of birdsong.
• Drinking a cup of tea mindfully, really focusing on the warmth, the taste, the way the steam curls up from the cup.
These little moments keep me grounded in the present rather than lost in worries about my skin. If you would like to try it, here is a video (I made at the start of the COVID pandemic!) to guide you through a mindful tea-drinking exercise.
Final Thoughts
Psoriasis is tough, but we do not have to make it tougher on ourselves. ACT has taught me that acceptance is not the same as giving up. It is about freeing yourself from unnecessary suffering.
If this resonates with you, try this today. The next time you notice a negative thought about your psoriasis, do not fight it or get caught up in it. Instead, take a step back and say, "Ah, there is that thought again." See if that small shift makes a difference.
There is also growing evidence that managing mental health can positively impact psoriasis symptoms, so this work is worth doing for both mind and body.
For more on ACT, I highly recommend watching Russ Harris’s videos. His explanations are clear, practical and incredibly useful.
Let me know if you try any of these techniques. I would love to hear how they work for you!