Dead Sea balneotherapy

1. Introduction

Version followed: Dead Sea climatotherapy and balneotherapy as Israeli dermatology and rheumatology researchers describe it (Katz et al. 2012 systematic review; Harari 2024 review of 40 years of psoriasis studies; programmes at the Deutsches Medizinisches Zentrum and the Dead Sea Solarium Clinic), with the Jordanian curative-water account of Salameh as the Jordanian source, and the Cochrane review of indoor salt-water baths plus artificial UVB (Peinemann et al. 2020) for the indoor imitation. For the wider climate cure (Dead Sea and alpine), see guide 199 Climatotherapy.

What it is. Dead Sea treatment is not a psychotherapy. It is a medical spa and climate cure delivered at resorts and clinics on the Israeli and Jordanian shores of the Dead Sea, the lowest land surface on earth. Its components, as sources describe them, are: bathing or floating in the hypersaline sea, graded exposure to sunlight under a physician-designed protocol (climatotherapy), Dead Sea mud packs, and, away from the Dead Sea, indoor baths in Dead Sea or synthetic salt solutions followed by artificial UVB light (balneophototherapy). [source: Katz et al. 2012; Harari 2024; Adler-Cohen et al. 2012; Peinemann et al. 2020]

Core idea of how change happens (as its proponents state it). Israeli researchers attribute the effect in psoriasis mainly to the region's solar ultraviolet radiation combined with sea-water bathing; Harari names sun and sea exposure as the main factors and reports that longer stays and medical supervision improve outcomes. Jordanian and Israeli sources also claim the low altitude brings higher air pressure, more oxygen and filtered UV; these are the proponents' explanations, not established mechanisms. [source: Katz et al. 2012; Harari 2024; Salameh, Curative Water in Jordan]

Evidence status, in brief.

Psoriasis: a 2012 systematic review by Israeli authors (Katz, Shoenfeld, Sukenik and colleagues) concluded there is "bona fide evidence" that Dead Sea treatments help psoriasis. Harari's 2024 review found 26 clinical studies (1982 to 2021) reporting fast, high clearance rates, but states that how long improvement lasts and the possible long-term side effects are not yet precisely known. Most studies come from the treating centres themselves. [source: Katz et al. 2012; Harari 2024]
Indoor imitation: the Cochrane review (8 trials, 2,105 participants) found that salt-water baths plus artificial UVB may improve chronic plaque psoriasis more than UVB alone (PASI 75), with low-certainty evidence because of no blinding and a high likelihood of publication bias; only two studies, from one sponsor, supplied the main outcome. [source: Peinemann et al. 2020, via Cochrane NZ PEARLS 656]
Atopic dermatitis: uncontrolled or non-randomised Israeli studies report improvement in adults (49 patients, SCORAD and Skindex-29) and in Czech children compared with topical steroids, with about a third of the Dead Sea group lost by 18-month follow-up. This is weak evidence. [source: Adler-Cohen et al. 2012; Marsakova et al. 2020]
Rheumatology: the Katz review, written by Israeli authors, states that Dead Sea mud and balneotherapy benefit rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and knee osteoarthritis [source: Katz et al. 2012]. Independent appraisals of balneotherapy in general (not Dead Sea treatment specifically) are more cautious: the 2015 Cochrane review of balneotherapy for rheumatoid arthritis (9 trials, 579 participants) found the evidence insufficient to show it works better than no treatment, found no significant difference between mudpacks and placebo for pain, and rated the evidence very low certainty [source: Verhagen et al. 2015, Cochrane]; a 2021 overview of reviews in osteoarthritis reported short-term reductions in pain and stiffness with balneotherapy and mud therapy, but rated the quality of the reviews low to critically low [source: D'Angelo et al. 2021]. Present the Katz claims as the review's claims, not as established benefit.
Jordanian sources list rheumatism, skin disease, psoriasis, circulation, respiratory, nervous and gynaecological conditions among traditional indications; Salameh's evidence base is historical use, experience and water chemistry, with no clinical trials reported. [source: Salameh]

None of this makes Dead Sea treatment a cure for psoriasis, eczema or any arthritis. At most it is a possible adjunct that a client's dermatologist or rheumatologist may support, never a replacement for their care.

Who delivers it. Treatment programmes on the Israeli shore are run by medical centres with physicians who set and monitor sun-exposure protocols (for example the Deutsches Medizinisches Zentrum, where the atopic dermatitis studies were run, and the Dead Sea Solarium Clinic, a recruitment site in the skin-damage study). [source: Adler-Cohen et al. 2012; Marsakova et al. 2020; David et al. 2005] How Israeli or Jordanian spa and climatotherapy physicians are licensed or credentialed as a specialty is [uncertain]; a client can ask the centre who supervises treatment and what medical qualifications they hold. Salameh notes most Jordanian spa sites are not internationally competitive in medical services and standards. [source: Salameh] Indoor balneophototherapy is a dermatology-led phototherapy service. [source: Peinemann et al. 2020]

The psychotherapist's role. You do not deliver Dead Sea treatment. Your role is: to address psoriasis- and eczema-related distress, stigma and isolation in their own right; to help a client think through a Dead Sea stay alongside their dermatologist or rheumatologist; to prepare them for its psychological demands (exposing skin in public, travel, hope and disappointment); to keep safety in view; and to help integrate the experience and any relapse afterwards. [synthesis, grounded in WHO 2016 on stigma and depression in psoriasis]

2. Framework

The stay itself follows the treating centre's medical protocol; the guide does not reproduce exposure schedules. As sources describe it: a physician assessment on arrival, an individualised (in the cited studies, computer-designed) protocol of gradually increasing sun exposure combined with sea bathing, repeated medical review, and outcome scoring (PASI for psoriasis; SCORAD and Skindex-29 for atopic dermatitis). The atopic dermatitis studies used multi-week stays (four weeks in the paediatric study). [source: Adler-Cohen et al. 2012; Marsakova et al. 2020; Harari 2024]

For the psychotherapist, a parallel four-phase frame [synthesis]:

Exploration and decision (one or two sessions, within ongoing therapy). Goal: understand what the client hopes for, what their physician advises, what the evidence says, and the cost and practical burden. Move on when the client has a decision they own and, if going, their treating physician knows.
Preparation (one to three sessions before travel). Goal: safety knowledge, a plan for body-exposure anxiety and stigma, realistic expectations, a relapse plan. Move on when the client can name the main risks and their coping plan.
During the stay (optional brief remote contact if your practice allows it). Goal: support for distress, homesickness or disappointment; prompt referral back to the centre's physician for any physical problem.
Integration and follow-up (two to four sessions after return, then as needed). Goal: process the experience (including a possible first experience in years of comfortable exposed skin), consolidate gains in self-image and social confidence that do not depend on skin clearance, plan for flare-ups. Close the phase when the client has a plan for living with relapse.

3. Guiding principles

It is medicine, not psychotherapy, and someone else is the doctor. Any decision about a Dead Sea stay or indoor salt-bath phototherapy runs through the client's dermatologist or rheumatologist. [synthesis]
Never instead of standard care. Do not support stopping systemic or biologic treatments for a trip; Harari himself frames the stay as having a role alongside biologics, not replacing them. [source: Harari 2024; synthesis]
Attribute every claim. "Israeli researchers report…", "Jordanian sources state…"; make clear the main studies come from the treatment centres. [source: Katz et al. 2012; Harari 2024; Salameh]
Name the evidence honestly. Short-term psoriasis improvement is reported; durability and long-term harms are not established; the Cochrane certainty for the indoor version is low. [source: Harari 2024; Peinemann et al. 2020]
Sun is the active ingredient and also the main long-term risk. Actinic (sun) damage rises with Dead Sea exposure time, even though the one large controlled study found no increase in skin cancer. Exposure is set and supervised by the centre's physician, never improvised. [source: David et al. 2005; Katz et al. 2012]
Hypersaline water is hazardous if swallowed or inhaled. Ingestion or aspiration can cause dangerous electrolyte disturbances, lung injury and heart-rhythm problems. [source: Katz et al. 2012; Odes/Almog IMAJ series; Kdmanai et al. 2026]
The distress matters regardless of the skin. Psoriasis brings stigma, exclusion, loneliness and higher rates of depression; therapy targets these directly, not only via clearance. [source: WHO 2016]
Hope is a clinical variable. Expect both strong hope and disappointment or relapse; prepare for both. [synthesis]
Pass on physical problems. Sunburn, eye injury, swallowing water, chest symptoms or palpitations go to a physician, not into a therapy agenda. [synthesis]

4. Intervention inventory

Part A describes the treatment components as their providers and researchers publish them, so you can talk knowledgeably with clients and colleagues; you do not deliver them. Part B gives the psychotherapist's own interventions. All example language is illustrative.

A1. Dead Sea sea bathing and floating (balneotherapy)

Purpose and when used (as sources state): bathing in the hypersaline Dead Sea, combined with sun exposure, is one of the two main factors Israeli researchers credit for psoriasis improvement. [source: Katz et al. 2012; Harari 2024]
How it is delivered: as part of the centre's medical protocol, with sea bathing paired with subsequent sun exposure in the cited atopic dermatitis study. Bathing frequency and length are set by the treating physician and are not given here. [source: Adler-Cohen et al. 2012]
Example language (illustrative): "The centre's doctor decides how bathing fits your plan. What I can help with is how you feel about being in the water and on the beach."
Watch for: swallowing or inhaling water (medical emergency risk; see 5), water in the eyes, stinging of broken or cracked skin [uncertain: no medical source cited], fatigue or heat in older or unwell clients. Near-drowning patients in an Israeli series had a median age of 68. [source: Odes/Almog IMAJ series]

A2. Climatotherapy: physician-graded sun exposure

Purpose and when used: the sun's ultraviolet radiation at the Dead Sea is considered the main active factor for psoriasis; Israeli centres use individualised, gradually increasing exposure protocols. [source: Katz et al. 2012; Adler-Cohen et al. 2012; Marsakova et al. 2020]
How it is delivered: the centre's physician sets and reviews the protocol (computer-designed in the cited studies); outcomes are scored with PASI or SCORAD. No exposure times are given here; they are a medical decision. [source: Adler-Cohen et al. 2012]
Example language (illustrative): "Sun is the part that works and also the part with long-term costs, so it's worth asking your dermatologist and the centre's doctor how they will protect your skin."
Watch for: sunburn; signs of sun damage. A multicentre Israeli study of 460 psoriasis patients and 738 controls found more actinic damage (elastosis, solar lentigines, poikiloderma, wrinkling) that increased with Dead Sea exposure time, with no increase in melanoma or non-melanoma skin cancer in that population. Katz et al. likewise report increased actinic damage without evidence of more skin neoplasia. Clients with a past skin cancer, fair skin, photosensitising medicines or immunosuppression need their dermatologist's view before going [synthesis: risk groups not specified in the cited sources]. [source: David et al. 2005; Katz et al. 2012]

A3. Dead Sea mud applications

Purpose and when used: applied mainly in rheumatological conditions; the Katz review reports benefit in rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and knee osteoarthritis, and laboratory analysis found no mineral concentrations of health concern for intended use. [source: Katz et al. 2012]
How it is delivered: by spa staff within a programme; technique details are not described in the sources cited here [uncertain].
Example language (illustrative): "Mud treatment might ease how your joints feel for a while; your rheumatologist's plan stays the backbone."
Watch for: heat-related symptoms if mud is heated, skin irritation [uncertain]; any suggestion to stop disease-modifying medicines.

A4. Indoor salt-water baths followed by artificial UVB (balneophototherapy)

Purpose and when used: imitates Dead Sea bathing and sunshine in a dermatology phototherapy unit for chronic plaque psoriasis. [source: Peinemann et al. 2020]
How it is delivered: a dermatology service gives a salt bath then UVB; the Cochrane review found it may beat UVB alone on PASI 75 (RR 1.71, low certainty) with possibly no difference in withdrawals for adverse events (low certainty, few studies reporting). [source: Peinemann et al. 2020 via PEARLS 656]
Example language (illustrative): "If travel isn't possible, your dermatologist can tell you whether a salt-bath phototherapy service exists near you."
Watch for: the burden of repeated clinic visits, body exposure in a clinical setting, and disappointment if response is partial.

A5. Treatment of atopic dermatitis at the Dead Sea

Purpose and when used: Israeli centres offer climatotherapy for moderate-to-severe atopic dermatitis in adults and children. [source: Adler-Cohen et al. 2012; Marsakova et al. 2020]
How it is delivered: sea bath followed by gradually increased sun exposure under a medical protocol; for children, organised group stays (Czech children treated at the Deutsches Medizinisches Zentrum). [source: Marsakova et al. 2020]
Example language (illustrative), to a parent: "The studies are small and mostly from the centre itself. Your child's dermatologist is the person to weigh it against the treatment that's working now."
Watch for: in children, safeguarding on group trips, the child's own assent, separation from family, and sun protection decided by physicians [synthesis].

Part B: the psychotherapist's interventions. These are [synthesis] built on the sources above and on WHO's account of the psychosocial burden of psoriasis; no Dead Sea source publishes a psychotherapy protocol.

B1. Assessing psoriasis- or eczema-related distress and stigma

Purpose and when to use: at intake or whenever a skin or joint condition comes up; WHO reports people with psoriasis are "frequently stigmatized and excluded from normal social environments", report loneliness, isolation and feeling unattractive, and have higher rates of depression. [source: WHO 2016]
Steps: (1) Ask how the condition affects daily life, relationships, intimacy, work and leisure (swimming, changing rooms, beaches). (2) Ask about experiences of being stared at, avoided or commented on. (3) Screen for depression, anxiety and suicidal thoughts with your usual instruments and risk assessment. (4) Note avoidance and concealment behaviours (long sleeves in heat, avoiding pools). (5) Ask which care team they have and what treatments they are on.
Example language (illustrative): "Many people with psoriasis tell me the hardest part isn't the itch, it's how others react. What has that been like for you?"
Watch for: shame that makes disclosure slow; hopelessness tied to each flare; suicidal ideation (assess per standard practice). Working: client names the social impact and links it to mood.

B2. Exploring interest in a Dead Sea stay (shared decision support)

Purpose and when to use: when a client raises the Dead Sea, has been offered it, or has read promotional claims.
Steps: (1) Elicit hopes and what "success" would mean. (2) Offer a balanced summary: short-term psoriasis improvement reported mainly by the centres; durability and long-term side effects not established; indoor salt-bath phototherapy has low-certainty Cochrane evidence; eczema and arthritis claims rest on weaker data. (3) Ask what their dermatologist or rheumatologist thinks; if not yet asked, plan how to ask. (4) Weigh cost, travel, time off, and being away from support. (5) Clarify that the stay must not replace their current treatment.
Example language (illustrative): "From what's published, people often clear a lot during a stay, but nobody yet knows how long it lasts. How would you feel if it came back after a few months?"
Watch for: all-or-nothing hope ("this will fix me"); pressure from family or marketing; plans to stop medication. Working: client's decision is informed and involves their physician.

B3. Liaison with the client's dermatologist or rheumatologist

Purpose and when to use: with consent, whenever a stay or indoor balneophototherapy is being considered, or after an adverse effect.
Steps: (1) Get written consent to contact the physician. (2) Share only what is relevant (e.g. depression, anxiety about body exposure, relevant medicines or alcohol use). (3) Ask the physician to address medical suitability, sun protection and medication continuity. (4) Record the agreed plan.
Example language (illustrative): "Would it help if I wrote to your dermatologist so they know how much this matters to you, and you can ask them the medical questions directly?"
Watch for: the client using therapy to get a "yes" the physician has not given. Working: one coordinated plan.

B4. Safety psychoeducation before travel

Purpose and when to use: once a client has decided to go.
Steps: (1) Explain, without numbers or schedules, that sun exposure must follow the centre's medical protocol because sun damage grows with exposure time. (2) Explain that Dead Sea water must not be swallowed or inhaled: Israeli hospital series describe severe calcium, magnesium and phosphorus disturbances, chemical pneumonitis needing ventilation, and deaths, and Katz et al. report heart-rhythm disturbances after substantial ingestion. (3) Encourage the client to tell the centre's physician about heart, kidney or lung disease, pregnancy, alcohol use and all medicines, and to avoid alcohol before bathing [synthesis: general water-safety practice; the centres' own contraindication lists are uncertain]. (4) Discuss keeping water away from eyes and mouth and knowing where to get help on the beach [uncertain: no medical source cited for eye guidance]. (5) Check the client can repeat the key points.
Example language (illustrative): "The water is so salty that a mouthful breathed in can be a medical emergency, so it's worth knowing what to do if you swallow or inhale some."
Watch for: health anxiety triggered by the information; minimisation ("I'm a strong swimmer"). Working: client can state the main risks calmly. [source: Katz et al. 2012; Odes/Almog IMAJ series; Kdmanai et al. 2026; David et al. 2005]

B5. Preparing for body exposure, public bathing and stigma

Purpose and when to use: for clients who conceal their skin or fear others' reactions, before a stay or any pool or beach visit.
Steps: (1) Map feared situations (undressing, walking on the beach, others staring, comments). (2) Identify safety behaviours and their cost. (3) Build coping statements and responses to questions. (4) Rehearse in session (role-play an onlooker's question). (5) If appropriate, use graded, client-chosen real-world steps at home (e.g. short sleeves in a café) with your usual exposure-based method, consent and pacing. (6) Note that a Dead Sea centre may be the first setting where many others share the condition; explore how that might feel.
Example language (illustrative): "If someone asked, 'Is that contagious?', what would you like to be able to say?"
Watch for: overwhelming shame, dissociation, panic; clients with trauma involving their body or being looked at need slower pacing. Working: reduced anticipatory anxiety, a ready script.

B6. Expectation and relapse planning

Purpose and when to use: before travel and again at return; Harari states the duration of improvement is not precisely determined. [source: Harari 2024]
Steps: (1) Ask the client to describe best, likely and worst outcomes. (2) Separate goals that depend on skin clearance from goals that do not (confidence, social activity, self-compassion). (3) Write a flare-up plan: early signs, who to contact medically, coping strategies, self-talk.
Example language (illustrative): "Let's plan for the skin coming back, so that if it does, it's a setback you saw coming rather than a collapse."
Watch for: catastrophic thinking about relapse; making mood wholly contingent on the skin. Working: client holds a balanced expectation.

B7. Integration after the stay

Purpose and when to use: in the first sessions after return.
Steps: (1) Invite a narrative of the stay: body, social and emotional experiences. (2) Explore new experiences of comfort in their skin or among others with the condition, and what they want to keep. (3) Translate gains into everyday steps that do not depend on clearance. (4) Review any physical problems (sunburn, swallowing water, chest or heart symptoms) and pass them to a physician. (5) Revisit the relapse plan.
Example language (illustrative): "What did you notice about yourself when your skin felt less like something to hide?"
Watch for: post-trip low mood, grief at returning to routine, early relapse. Working: client keeps social gains even if skin changes.

B8. Recognising and passing on adverse effects

Purpose and when to use: any time during or after a stay or a course of indoor salt-bath phototherapy.
Steps: (1) Ask directly about burns, new or changing skin lesions, eye injury, swallowing or inhaling water, breathlessness, palpitations, faintness or confusion. (2) Urgent symptoms after swallowing or inhaling Dead Sea water go to emergency care immediately. (3) Other symptoms go to the treating physician or GP. (4) Document and follow up.
Example language (illustrative): "That sounds like something a doctor needs to see today, not something to wait on until our next session."
Watch for: clients minimising symptoms to protect a cherished treatment. Working: timely medical contact. [source: Katz et al. 2012; Odes/Almog IMAJ series; Kdmanai et al. 2026]

5. Handling problems

The sources do not address psychotherapy problems; everything below is [synthesis] unless a source is tagged.

Client wants to stop medication for the trip or replace their care with Dead Sea treatment. Name your concern plainly, return the decision to their dermatologist or rheumatologist, and offer liaison (B3). Point out that even the leading Israeli review places the stay alongside biologics, not instead of them. [source: Harari 2024]
Over-idealised hope or marketing-driven beliefs (e.g. claims of curing psoriasis, or Jordanian claims about oxygen and air pressure presented as fact). Use B2: attribute claims, separate reported short-term improvement from cure, and explore what the hope protects against. [source: Salameh; Harari 2024]
Disappointment or relapse after return. Normalise (durability is unknown), use the relapse plan (B6), and work on grief and on goals independent of skin clearance. Screen for depression and suicidal thoughts per standard practice. [source: Harari 2024; WHO 2016]
Overwhelm or shame about body exposure. Slow down, return to non-exposed steps, use grounding; a client may decide not to bathe publicly, which is legitimate. With trauma histories involving the body or being watched, consider trauma-focused work first.
Health anxiety after safety psychoeducation. Keep the information factual and proportionate; refer medical questions to the centre's physician; treat persistent health anxiety in its own right.
Non-adherence to sun protection or the medical protocol (wanting "more sun to clear faster"). Explore motivation; link back to the documented dose-related sun damage and to the physician's role. [source: David et al. 2005]
Alcohol use. Discuss alcohol and bathing risk; a Japanese case of near-drowning in mineral spring water in an intoxicated man led to cardiac arrest and severe hypercalcaemia, showing how mineral-rich water aspiration plus intoxication can be dangerous. [source: Matsumoto et al. 2013]
Older clients and those with heart, lung or kidney disease. Near-drowning patients in an Israeli series of 69 (Soroka University Medical Center) had a median age of 68; most had abnormal calcium, magnesium and phosphorus, 29 developed bilateral pneumonitis and 11 needed mechanical ventilation [source: Odes/Almog IMAJ series, PubMed abstract; Kdmanai et al. 2026]. A review from the Dead Sea and Arava Science Center states that hypertension is not a contraindication to Dead Sea climatotherapy and describes studies that included people with coronary artery disease, heart failure, asthma, COPD and cystic fibrosis, while calling for more research [source: Moses 2012]; treat this as the proponents' view. Encourage full medical review before travel; the Dead Sea centres' own cardiac and kidney contraindication lists are [uncertain].
Rupture: client feels you are dismissing a treatment that helped them. Acknowledge the real improvement they experienced; clarify you are not against it but want it to be safe and to sit alongside their care.
Stuck: client's mood depends entirely on the skin. Use values-based work and self-compassion on body image; explore identity beyond the condition; consider peer support from psoriasis patient organisations.
Children on group stays. Involve parents, gain the child's assent, check the organiser's safeguarding arrangements, and keep the child's dermatologist central. [source: Marsakova et al. 2020 for the group-stay format]
Practical burden (cost, time off, travel to a region subject to travel advisories). Help weigh it; indoor salt-bath phototherapy may be an option the dermatologist can discuss. [source: Peinemann et al. 2020]

Sources

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