Virtual Cognitive Behavior Therapy Could Help with Symptoms of Atopic Dermatitis

Erik Hedman-Lagerlöf, PhD

A new study suggests that internet-delivered cognitive behavior therapy can be promising for symptom reduction in patients with moderate-to-severe atopic dermatitis (AD).

The study investigators noted that behavioral factors can play a role in the worsening of symptoms and quality of life related to AD. For example, itching can cause scratching, thus increasing inflammation. Additionally, patient experiences with the dermatologic condition can lead to negative psychological outcomes, social avoidance, and stress, further exacerbating the disease.

“Against this background, cognitive behavior therapy (CBT) based on exposure—systematic and sustained contact with stimuli related to AD symptoms and associated distress—seems to be a logical treatment option,” the investigators wrote. Nonetheless, there has been little research in this domain assessing the clinical effects of such a therapeutic approach.

The team, led by Erik Hedman-Lagerlöf, PhD, Karolinska Institutet in Sweden, enrolled 102 adults with AD in a randomized clinical trial to evaluate the potential of internet-delivered, exposure-based CBT added to standard of care

Following initial clinical assessments of the patients, the investigators randomized the population 1:1 to either the CBT intervention or to a control group—which included solely standard of care—for 12 weeks. Afterwards, patients in the control group were then initiated on CBT intervention.

The CBT program was provided through 10 modules that covered topics from understanding the disease, mindfulness training, sleep issues, avoidance behaviors, to name a few. Additionally, therapists contacted participants through messaging, offering assistance and feedback.

Overall, the main outcome sought by Hedman-Lagerlöf and his team was the between-group difference in mean reduction of AD symptoms, measured by the Patient-Oriented Measure (POEM).

Patients in the intervention group spent a mean of 10.8 hours reading the text material offered by the modules and 23.6 hours conducting treatment exercises over the course of the 12-week period.

“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 = 0.32; 95% CI, 0.14-0.49; P < .001), with a moderate to large, controlled effect size after treatment (d = 0.75; 95% CI, 0.32-1.16),” the investigators reported.

Even more, the effect size within the intervention group was considered large between baseline and 12-month follow-up. This indicated, then, that treatment was associated with long-term stable improvement.

According to logistic regression analysis, the 2 treatment groups exhibited a large difference in odds of being a treatment responder (odds ratio [OR], 3.11; 95% CI, 1.32-7.33; P = .009). This was defined an improvement of at least 4 points on POEM.

Secondary analyses also revealed that internet-delivered CBT led to significantly larger reductions in perceived stress, sleep problems, and depression., which were maintained at 12 weeks of follow-up.

Overall, treatment satisfaction was considered high for the intervention population.

“An important advantage of internet-delivered treatment is its potential to improve access to treatment,” Erik Hedman-Lagerlöf and colleagues wrote.

“Although at the start of this study most participants were expected to be treatment naive (ie, without previous experience of psychological treatment for AD), it is striking that none of the included participants had received such treatment,” they noted. “This lack of treatment probably means that most patients with AD are typically not offered psychological treatment in primary or dermatologic care.”

The study, “Internet-Delivered Cognitive Behavior Therapy for Atopic Dermatitis: A Randomized Clinical Trial,” was published online in JAMA Dermatology.