JAMA dermatology | 2021
Internet-Delivered Cognitive Behavior Therapy for Atopic Dermatitis: A Randomized Clinical Trial.
Abstract
Importance\nAtopic dermatitis is a common and debilitating skin condition characterized by intense itching and chronic inflammation. Research on behavioral treatments with high accessibility is needed.\n\n\nObjective\nTo investigate the efficacy of a highly scalable internet-delivered cognitive behavior therapy (CBT) for adults with atopic dermatitis.\n\n\nDesign, Setting, and Participants\nThis randomized clinical trial from a medical university in Stockholm, Sweden, included 102 adults with atopic dermatitis, recruited from across Sweden, who received 12 weeks of internet-delivered CBT (March 29, 2017, to February 16, 2018). The first participant provided screening data on November 27, 2016, and the last 1-year follow-up assessment was conducted on June 28, 2019.\n\n\nInterventions\nParticipants were randomized in a 1:1 ratio to 12 weeks of therapist-guided internet-delivered CBT (n\u2009=\u200951) or a control condition (n\u2009=\u200951) that gave instructions about standard care.\n\n\nMain Outcomes and Measures\nThe primary outcome was the between-group difference in mean reduction of atopic dermatitis symptoms as measured by the Patient-Oriented Eczema Measure and modeled intention to treat during the 12-week treatment period.\n\n\nResults\nA total of 102 participants (mean [SD] age, 37 [11] years; 83 [81%] female) were recruited and randomized. The primary analysis indicated that participants receiving internet-delivered CBT, relative to the controls, had a significantly larger mean weekly reduction in symptoms of atopic dermatitis as measured with the Patient-Oriented Eczema Measure (B\u2009=\u20090.32; 95% CI, 0.14-0.49; P\u2009<\u2009.001), with a moderate to large, controlled effect size after treatment (d\u2009=\u20090.75; 95% CI, 0.32-1.16). Secondary analyses indicated that internet-delivered CBT also produced significantly larger reductions in itch intensity, perceived stress, sleep problems, and depression. Gains were sustained at 12 months of follow-up. Treatment satisfaction was high, and therapists spent a mean (SD) of 39.7 (34.7) minutes per treated patient providing internet-delivered CBT.\n\n\nConclusions and Relevance\nInternet-delivered CBT appears to be efficacious for reducing symptoms of atopic dermatitis, despite requiring minimal therapist resources. Thus, internet-delivered CBT has the potential to increase access to effective adjunct behavioral treatment for patients with this common skin condition.\n\n\nTrial Registration\nClinicalTrials.gov Identifier: NCT03051958.