Objective To explore the effect of rational emotive therapy combined with mindfulness decompression on postoperative physical and mental state and self-efficacy of patients with axillary osmidrosis. Methods A total of 70 patients with axillary osmidrosis admitted to our hospital from January 2022 to December 2023 were selected as the research objects. They were divided into control group and study group by random number table method, with 35 patients in each group. The control group was given routine postoperative nursing, and the study group was given rational emotive therapy combined with mindfulness decompression intervention after operation. The mental state, self-efficacy, self-perceived burden and quality of life of the two groups were compared. Results After intervention, the scores of SAS and SDS in the study group were lower than those in the control group (P <0.05). After intervention, the scores of physical function, pain management, symptom response and total score of the study group were higher than those of the control group (P <0.05). After intervention, the scores of emotion, economy and body in the study group were lower than those in the control group (P <0.05). After intervention, the scores of DLQI in the study group were lower than those in the control group (P <0.05). Conclusion Rational emotive therapy combined with mindfulness decompression for patients with axillary osmidrosis after operation is helpful to improve the mental state of patients, improve their self-efficacy, relieve psychological burden, and promote the quality of life of patients.