Exposure-based cognitive behavior therapy for atopic dermatitis: an open trial

Photo by James Heilman [CC BY-SA 3.0 or GFDL], from Wikimedia Commons
Atopic dermatitis (AD) is the most common inflammatory dermatological disorder and is marked by itch and inflamed skin. For many patients, AD leads to substantial suffering, reduced quality of life, and an increased risk for depression and anxiety. Psychological treatments have been studied to a limited extent, despite that the nature of AD suggests that behaviors may play a key role in maintenance of the disorder. One such important AD behavior is scratching, which creates a rupture of the skin barrier that reduces the protective functioning of the skin and increase the inflammation. Itch is of course the prototypical antecedent of scratching, but other sensations, such as anxiety or low mood have also been reported as triggers for scratching. A person with AD also tends to avoid situations or events that have become associated with itch or skin symptoms, e.g., stressful social situations, The purpose of this avoidance is often to prevent worsening of symptoms, but it can also be done to prevent negative social evaluation due to present skin symptoms. Typical examples of the latter is to avoid public places where you have to take off your clothes such as bath houses, or refraining from engaging in intimate relationships. Against this background, we viewed exposure to conditioned triggers of AD symptoms and reduction of avoidance behavior as logical targets for psychological treatment. We developed a 10-week cognitive behavioral treatment where the main component was exposure to situations and events associated with AD in combination with response prevention, i.e., reduction of itch behavior. In order to enhance the willingness to and effects of exposure, the treatment also included mindfulness training. In this first open pilot trial, we found that the treatment was feasible and acceptable, and participants made large baseline to post-treatment improvements on self-reported measures of AD symptoms. We view these findings to be encouraging as they suggest that treatment with exposure-based cognitive behavior therapy might be potentially efficacious for AD and worthy of further investigation in randomized controlled trials. If this treatment would show positive effects also in further studies, then much would be gained for the large group of patients suffering from this debilitating disorder.

Read the full paper: Hedman-Lagerlöf, E., Bergman, A., Lindefors, N., & Bradley, M. (in press). Exposure-based cognitive behavior therapy for atopic dermatitis: an open trial. Cognitive Behaviour Therapy. doi:10.1080/16506073.2018.1504320

Erik Hedman
Anna Bergman
Nils Lindefors
Maria Bradley






Photo by: Pelle Sten

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