Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
JAMA Dermatol. 2021 Jul 1;157(7):796-804. doi: 10.1001/jamadermatol.2021.1450.
Atopic dermatitis is a common and debilitating skin condition characterized by intense itching and chronic inflammation. Research on behavioral treatments with high accessibility is needed.
To investigate the efficacy of a highly scalable internet-delivered cognitive behavior therapy (CBT) for adults with atopic dermatitis.
DESIGN, SETTING, AND PARTICIPANTS: This 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.
Participants were randomized in a 1:1 ratio to 12 weeks of therapist-guided internet-delivered CBT (n = 51) or a control condition (n = 51) that gave instructions about standard care.
The 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.
A 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 = 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). 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.
Internet-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.
ClinicalTrials.gov Identifier: NCT03051958.
特应性皮炎是一种常见且使人虚弱的皮肤疾病，其特征为剧烈瘙痒和慢性炎症。需要研究具有高可及性的行为治疗方法。
研究一种高度可扩展的互联网提供的认知行为疗法（CBT）对特应性皮炎成人的疗效。
设计、地点和参与者：这是一项来自瑞典斯德哥尔摩一所医学大学的随机临床试验，纳入了 102 名来自瑞典各地的特应性皮炎成人患者，他们接受了 12 周的互联网提供的 CBT（2017 年 3 月 29 日至 2018 年 2 月 16 日）。第一个参与者于 2016 年 11 月 27 日提供了筛查数据，最后一次 1 年随访评估于 2019 年 6 月 28 日进行。
参与者按照 1:1 的比例随机分配至 12 周的治疗师指导的互联网提供的 CBT（n=51）或对照组（n=51），对照组仅接受关于标准护理的指导。
主要结局是在 12 周治疗期间，通过患者导向的湿疹衡量标准衡量的特应性皮炎症状的平均减少，以及意向治疗的组间差异。
共招募了 102 名参与者（平均[标准差]年龄，37[11]岁；83[81%]女性）并进行了随机分组。主要分析表明，与对照组相比，接受互联网提供的 CBT 的参与者每周的特应性皮炎症状有显著更大的减轻（B=0.32；95%置信区间，0.14-0.49；P<0.001），治疗后具有中等至较大的、受控制的效果大小（d=0.75；95%置信区间，0.32-1.16）。次要分析表明，互联网提供的 CBT 还可显著降低瘙痒强度、感知压力、睡眠问题和抑郁。在 12 个月的随访中仍可维持疗效。治疗满意度高，治疗师平均（标准差）每位接受治疗的患者花费 39.7（34.7）分钟提供互联网提供的 CBT。
尽管需要最少的治疗师资源，但互联网提供的 CBT 似乎对减轻特应性皮炎症状有效。因此，互联网提供的 CBT 有可能增加对这种常见皮肤疾病有效辅助行为治疗的可及性。
ClinicalTrials.gov 标识符：NCT03051958。
