A novel, web-based, psychological intervention for people with psoriasis: the electronic Targeted Intervention for Psoriasis (eTIPs) study

Background Psychological morbidity and reduced quality of life are common and linked with nonadherence to medication in psoriasis. Access to psychological therapy is often poor with long waiting times. Cognitive behavioural therapy (CBT) is a well-accepted therapy for psychological disorders and is particularly effective when tailored to address condition-specific concerns. Objectives To determine whether an electronic CBT intervention for Psoriasis (eTIPs) would reduce distress, improve quality of life and clinical severity in patients with psoriasis. Methods This was a wait-list, randomized trial of immediate intervention vs. usual care. Self-assessed psoriasis severity (Self-Administered Psoriasis Area and Severity Index), distress (Hospital Anxiety and Depression Scale) and quality of life (Dermatology Life Quality Index) were measured before and after intervention. Analysis was based on complete cases and all cases using multiple imputation to substitute missing values. Results Anxiety scores between groups were significantly reduced (P<005) for complete cases only; the mean (SD) scores were: intervention 76 (36) at baseline and 61 (35) at follow-up vs. control 83 (35) at baseline and after intervention 81 (44) (P=0004). Depression scores did not change; the experimental group scores at baseline were 50 (42) and after intervention 40 (37) vs. control group at baseline 52 (34) and after intervention 49 (38). Psoriasis severity scores did not change: baseline scores for the experimental group were 75 (60) and after intervention 65 (85) vs. the control group before 83 (63) and after 76 (61) (not significant). Quality-of-life scores improved in both analyses (P<005); the intervention group scores before were 66 (42) and after intervention 50 (51) vs. control before 74 (44) and after intervention 77 (45) (P=0042). Conclusions This first online CBT intervention for people with skin disease showed improvement in anxiety and quality of life in patients with psoriasis. The results are limited by the large amount of missing data and, at this stage, online delivery cannot substitute for established methods of delivery for CBT.