A SELF-GUIDED online cognitive behavioural therapy (CBT) programme was found to be noninferior to clinician-guided CBT in reducing symptom severity for adults with atopic dermatitis (AD).
This study aimed to assess whether a brief, self-guided online CBT intervention could achieve similar clinical outcomes to a more resource-intensive clinician-guided CBT approach. Conducted at Karolinska Institutet, Stockholm, Sweden, 168 adults with AD were enrolled and randomly assigned to either a self-guided CBT programme (86 participants) or a clinician-guided CBT programme (82 participants). Both interventions lasted 12 weeks. The primary outcome was the change in scores on the Patient-Oriented Eczema Measure (POEM) from baseline to post-intervention, with a predefined noninferiority margin of 3 points.
Post-intervention, the clinician-guided group improved by 4.20 points (95% CI, 1.94–6.05), while the self-guided group improved by 4.60 points (95% CI, 2.57–6.64). The estimated mean difference between groups was 0.36 points (one-sided 97.5% CI, -∞ to 1.75), comfortably within the noninferiority margin. Clinicians spent significantly less time on the self-guided programme, averaging 15.8 minutes on assessments compared to 36 minutes on treatment guidance and 14 minutes on assessments in the clinician-guided group. No serious adverse events were reported, and 90% of participants completed the main outcome assessment.
These findings suggest that a self-guided CBT programme could effectively reduce symptom severity in patients with AD while minimising the burden on clinical resources. This approach may hold significant potential for expanding access to psychological treatments for AD, particularly in resource-constrained settings. Future research could explore the programme’s implementation in diverse populations and its long-term efficacy. For clinicians, adopting self-guided CBT could enhance treatment capacity without compromising effectiveness, representing a shift towards more scalable care delivery models.
Katrina Thornber, EMJ
Reference
Kern D et al. Self-guided vs clinician-guided online cognitive behavioral therapy for atopic dermatitis: a randomized clinical trial. JAMA Dermatol. 2024;DOI:10.1001/jamadermatol.2024.5044.
