A brief self-guided online cognitive behavioral therapy program proved noninferior to clinician-guided treatment for atopic dermatitis, according to a new randomized clinical trial.
In the trial, published in JAMA Dermatology and conducted at Karolinska Institutet in Stockholm, researchers recruited 168 adults with atopic dermatitis (AD) who were randomly assigned to either self-guided (n = 86) or clinician-guided (n = 82) online cognitive behavioral therapy (CBT) programs over 12 weeks.
The results showed the clinician-guided group improved by 4.20 points on the Patient-Oriented Eczema Measure (POEM), whereas the self-guided group improved by 4.60 points. The estimated mean difference of 0.36 points fell within the predefined noninferiority margin of 3 points.
Significantly, the self-guided intervention required substantially less clinician time—just 15.8 minutes per patient for assessments compared with 50 minutes total clinician time in the guided group. Both groups showed similar improvements in quality of life, sleep, depression symptoms, itching sensation, and stress levels.
"Given the limited clinical resources required to deliver self-guided CBT, this treatment might be a promising means to disseminate evidence-based psychological treatment for patients with AD," suggested lead study author Dorian Kern, PhD, of the Karolinska Institutet.
The self-guided program was notably more concise, containing approximately 17,000 words vs 111,000 words in the clinician-guided version. It achieved comparable completion rates, with 81% of self-guided participants completing five or more modules compared with 67% in the clinician-guided group.
Study limitations included high data loss (about 30%) for secondary measurements and a predominantly female sample (84.5%). No serious adverse events were reported in either group.
The findings indicated that streamlined self-guided digital interventions could help expand access to psychological treatment for AD while reducing demands on clinical resources. Future research will examine the effectiveness of these interventions in primary care and dermatological specialist settings.
The study was supported by the Swedish Ministry of Health and Social Affairs and registered at ClinicalTrials.gov (NCT05517850). Conflict of interest disclosures can be found in the study.