A cognitive behavior therapy (CBT) program delivered by a therapist via the internet was effective for reducing atopic dermatitis (AD) symptoms, according to study findings published in JAMA Dermatology. The findings suggest an online-based CBT could ultimately increase patient access to effective behavioral treatment for AD.

The Swedish study enrolled 102 adults (mean age, 37 years) with AD symptoms at least moderate in severity. All patients were on a stable sleep medication or antidepressant for 1 month or longer before study entry.

Participants were randomly assigned to either a therapist-guided internet-based CBT program (n=51) or a control program offering standard-of-care instructions for AD symptom relief (n=51). Both treatment periods continued for 12 weeks.


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In the internet-delivered CBT program, patients and therapists worked to establish ways to prevent skin scratching or other AD-exacerbating behaviors common in stressful or anxiety-prone environments. For example, strategies could be developed to help the patient refrain from scratching while at a party, the researchers elaborated. Treatment was delivered through 10 online modules, and CBT-trained therapists provided feedback on weekly homework assignments via asynchronous text messages.

Patients who received the internet-delivered CBT had a greater average weekly reduction in AD symptoms as assessed by the Patient-Oriented Eczema Measure (B=0.32; 95% CI, 0.14-0.49; P <.001). There was a moderate to large controlled effect size following therapy (d=0.75; 95% CI, 0.32-1.16).

Receipt of internet-delivered CBT was also associated with significantly greater improvements in 5-D Itch Scale scores (B=1.20; 95% CI, 0.28-2.11; z = 2.55; P =.01) and scores on the VAS itch scale (B=0.10; 95% CI, 0.03-0.17; z = 2.97; P =.003). Internet-based CBT was also associated with greater reduction in stress (B=5.09; 95% CI, 1.96-8.21; z = 3.19; P =.001), sleep problems (B=3.38; 95% CI, 1.28-5.48; z = 3.15; P =.002), and depressive symptoms (B=2.42; 95% CI, 0.63-4.22; z = 2.65; P =.008) compared with control.

The investigators noted that this study lacked a practitioner-administered measure of AD symptoms, which may limit the applicability of the findings across clinical practices.

Despite these limitations, the researchers suggest an internet-delivered CBT program can product significant “improvements in AD symptoms while requiring minimal therapist resources,” thereby drastically increasing “access to effective psychological treatment for this large patient group.”

Reference

Hedman-Lagerlöf E, Fust J, Axelsson E, et al. Internet-delivered cognitive behavior therapy for atopic dermatitis: A randomized clinical trial. JAMA Dermatol. Published online May 19, 2021. 2021;e211450. doi:10.1001/jamadermatol.2021.1450