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Randomized Controlled Trial
. 2023 Jun 1;159(6):628-636.
doi: 10.1001/jamadermatol.2023.0975.

Efficacy of Integrated Online Mindfulness and Self-compassion Training for Adults With Atopic Dermatitis: A Randomized Clinical Trial

Sanae Kishimoto  1 , Norio Watanabe  2 , Yosuke Yamamoto  3   4 , Takumi Imai  5 , Rei Aida  5 , Christopher Germer  6   7 , Risa Tamagawa-Mineoka  8 , Ryosuke Shimizu  9 , Steven Hickman  10   11 , Yujiro Nakayama  12 , Takafumi Etoh  13 , Ethan Sahker  1   14 , Martha B Carnie  15 , Toshi A Furukawa  1
Affiliations
Randomized Controlled Trial

Efficacy of Integrated Online Mindfulness and Self-compassion Training for Adults With Atopic Dermatitis: A Randomized Clinical Trial

Sanae Kishimoto et al. JAMA Dermatol. .

Abstract

Importance: Quality of life (QOL) of patients with atopic dermatitis (AD) is reported to be the lowest among skin diseases. To our knowledge, mindfulness and self-compassion training has not been evaluated for adults with AD.

Objective: To evaluate the efficacy of mindfulness and self-compassion training in improving the QOL for adults with AD.

Design, setting, and participants: This randomized clinical trial conducted from March 2019 through October 2022 included adults with AD whose Dermatology Life Quality Index (DLQI) score, a skin disease-specific QOL measure, was greater than 6 (corresponding to moderate or greater impairment). Participants were recruited from multiple outpatient institutes in Japan and through the study's social media outlets and website.

Interventions: Participants were randomized 1:1 to receive eight 90-minute weekly group sessions of online mindfulness and self-compassion training or to a waiting list. Both groups were allowed to receive any dermatologic treatment except dupilumab.

Main outcomes and measures: The primary outcome was the change in the DLQI score from baseline to week 13. Secondary outcomes included eczema severity, itch- and scratching-related visual analog scales, self-compassion and all of its subscales, mindfulness, psychological symptoms, and participants' adherence to dermatologist-advised treatments.

Results: The study randomized 107 adults to the intervention group (n = 56) or the waiting list (n = 51). The overall participant mean (SD) age was 36.3 (10.5) years, 85 (79.4%) were women, and the mean (SD) AD duration was 26.6 (11.7) years. Among participants from the intervention group, 55 (98.2%) attended 6 or more of the 8 sessions, and 105 of all participants (98.1%) completed the assessment at 13 weeks. The intervention group demonstrated greater improvement in the DLQI score at 13 weeks (between-group difference estimate, -6.34; 95% CI, -8.27 to -4.41; P < .001). The standardized effect size (Cohen d) at 13 weeks was -1.06 (95% CI, -1.39 to -0.74). All secondary outcomes showed greater improvements in the intervention group than in the waiting list group.

Conclusions and relevance: In this randomized clinical trial of adults with AD, integrated online mindfulness and self-compassion training in addition to usual care resulted in greater improvement in skin disease-specific QOL and other patient-reported outcomes, including eczema severity. These findings suggest that mindfulness and self-compassion training is an effective treatment option for adults with AD.

Trial registration: https://umin.ac.jp/ctr Identifier: UMIN000036277.

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Conflict of interest statement

Conflict of Interest Disclosures: Ms Kishimoto reported receiving grants from The Mental Health Okamoto Memorial Foundation, the KDDI Foundation, and the Pfizer Health Research Foundation and receiving a Grants-in-Aid for Scientific Research from the Japan Society for the Promotion of Science during the conduct of the study. Dr Yamamoto reported receiving personal fees from ONO Pharmaceutical Co, Ltd; Sun Pharma; Asahi Kasei Pharma; and Nippon Shinyaku outside the submitted work. Dr Imai reported receiving personal fees from JCR Pharmaceuticals Co, Ltd and Kyowa Kirin outside the submitted work. Dr Tamagawa-Mineoka reported receiving honoraria and grants from Maruho outside the submitted work. Dr Etoh reported receiving a lecture fee from Maruho and receiving personal fees from Maruho, Kyowa Kirin, AbbVie, LEO Pharma, and Eli Lilly & Company outside the submitted work. Dr Furukawa reported receiving personal fees from Boehringer Ingelheim, DT Axis, Kyoto University Original, Shionogi, and Sony and receiving a grant from Shionogi outside the submitted work and having patents pending for an information processing method and processing apparatus and a computer program and for an information processing system and processing method and a patent for intellectual properties for Kokoro-App licensed to Mitsubishi Tanabe. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. CONSORT Diagram
Figure 2.
Figure 2.. Changes in Dermatology Life Quality Index (DLQI) From Baseline Over Time by Treatment Group
Error bars represent 95% CIs.
See this image and copyright information in PMC

References

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