title: A novel, web-based, psychological intervention for people with psoriasis: the electronic Targeted Intervention for Psoriasis (eTIPs) study.
abstract: 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.
  
  
  OBJECTIVE
  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 < 0·05) for complete cases only; the mean (SD) scores were: intervention 7·6 (3·6) at baseline and 6·1 (3·5) at follow-up vs. control 8·3 (3·5) at baseline and after intervention 8·1 (4·4) (P = 0·004). Depression scores did not change; the experimental group scores at baseline were 5·0 (4·2) and after intervention 4·0 (3·7) vs. control group at baseline 5·2 (3·4) and after intervention 4·9 (3·8). Psoriasis severity scores did not change: baseline scores for the experimental group were 7·5 (6·0) and after intervention 6·5 (8·5) vs. the control group before 8·3 (6·3) and after 7·6 (6·1) (not significant). Quality-of-life scores improved in both analyses (P < 0·05); the intervention group scores before were 6·6 (4·2) and after intervention 5·0 (5·1) vs. control before 7·4 (4·4) and after intervention 7·7 (4·5) (P = 0·042).
  
  
  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.
authors.affiliation: University of Manchester and Manchester Academic Health Science Centre, Manchester, M13 7PT, UK. Christine.bundy@manchester.ac.uk
authors.forename: C
authors.initials: C
authors.lastname: Bundy
authors.forename: B
authors.initials: B
authors.lastname: Pinder
authors.forename: S
authors.initials: S
authors.lastname: Bucci
authors.forename: D
authors.initials: D
authors.lastname: Reeves
authors.forename: C E M
authors.initials: CE
authors.lastname: Griffiths
authors.forename: N
authors.initials: N
authors.lastname: Tarrier
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D013315:Stress, Psychological / Q000517:prevention & control; D017216:Telemedicine / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult