Acceptance, Commitment Therapy Program Effective in Children with Atopic Dermatitis

New findings suggest the Family Acceptance and Commitment Therapy-based Eczema Management Program (FACT-EMP) is an effective and potentially feasible approach to improving children's atopic dermatitis symptoms and parents' self-efficacy in managing the condition over 3 months.1

This program was highlighted in new research authored by a team led by Yuen Yu Chong, PhD, from the Nethersole School of Nursing at The Chinese University of Hong Kong. Chong and her team sought to conduct a pilot randomized controlled trial for the purposes of assessing the FACT-EMP’s effectiveness among children as well as caregivers.

“Eczema-related psychological challenges, such as shame, poor self-perception in children and self-criticism in parents, may benefit from an ACT approach emphasising self-compassion to reduce rumination and improve self-care,” Chong and colleagues wrote.1,2

Analyzing the Atopic Dermatitis Management Program versus Traditional Care

The investigators recruited trial participants at 3 pediatric outpatient clinics located in a Hong Kong hospital, screening caregivers and children being treated for atopic dermatitis for eligibility through the use of consecutive sampling.

Requirements for inclusion were that the children were between the ages of 6 - 12 years and that they would have a confirmed diagnosis of eczema, referred to here as atopic dermatitis interchangeably. Parents were required to be living with the children, serve as the primary caregiver, be under 65 years old, consistently take part in follow-up meetings, speak Cantonese and have access to a telephone.

The investigative team randomly assigned, through the use of a computer-generated program, parent-child pairs in a 1:1 ratio to the FACT-EMP intervention group or to a waitlist control group. The team tasked a clerical staff member who was not involved in their research to prepare numbered, sealed envelopes with allocation assignments included.

These envelopes were only procured following the assessments that were completed at baseline. Given the psychotherapeutic intervention’s nature, there was no blinding of the trial participants or of the interventionists. Nevertheless, the team kept data analysts, outcome assessors, nurses, and clinicians at the sites involved unaware of the group assignments.

The study clinics’ standard atopic dermatitis care, with medication refills as required, pediatric follow-ups on an every-3-to-12-months basis, and a 30-minute educational session on management of eczema. The educational session was carried out by an Advanced Practice Nurse, with topics such as disease triggers, skin care requirements, and proper use of medication covered in these meetings.

Those featured in the intervention cohort were sent to 4 weekly sessions involving ACT alongside education for eczema management, while those featured in the control cohort were only provided with routine care. The FACT-EMP’s feasibility and acceptability were evaluated by the investigators through rates of recruitment, retention, and completion, in addition to focus group interactions covering caregiver feedback.

In terms of their primary clinical outcomes, the research team looked at any shifts in the children’s disease severity, determined through the use of the Severity Scoring of Atopic Dermatitis (SCORAD). They also assessed improvements in parents’ ratings of self-efficacy. For the secondary outcomes assessed by the team, they looked at quality of life, parental reports of distress, psychological flexibility, and self-compassion for both parents and offspring.

There were 944 parent-child dyads screened in the period between July 2021 - June 2023, with 181 meeting the analysis’s criteria for inclusion and 78 being ultimately randomized and then assessed by the investigative team. It was determined that parents’ mean ages had been 41.3 years and that mothers made up 89.7% of parents.

Among the children involved in this analysis, there was a mean age of 8.3 years and boys made up 67.9% of the sample. The investigators concluded that rates of retention, recruitment, and completion had been 87.2%, 43.1%, and 76.9%, respectively.

Additionally, they observed no statistically significant differences in participants’ SCORAD scores between the 2 groups immediately following the trial’s intervention. Nevertheless, the team did report at the 3-month follow-up interaction that members of the FACT-EMP arm of the study demonstrated a far greater SCORAD score reductions as opposed to those in the control arm (adjusted mean difference [aMD] = −7.73; 95% CI, −13.92 to −1.54).

Additionally, the analysis demonstrated substantial improvements in parental self-efficacy scores among those in the FACT-EMP group versus the control group. The investigative team highlighted an aMD of 18.69 (95% CI, 13.80 to 33.58) immediately after the study intervention and 28.90 (95% CI, 13.93 to 43.84) by the subjects’ 3-month follow-up interactions.

“Family Acceptance and Commitment Therapy-based Eczema Management Program (FACT-EMP) demonstrated its potential feasibility, acceptability and efficacy for improving eczema symptoms and psychological well-being in parent–child dyads over 3 months,” they wrote. “Future research should include a multicentre RCT with long-term follow-up and an economic analysis to evaluate clinical efficacy, cost-effectiveness and scalability in broader clinical settings.”1

References

1. Chong, Y.Y., Chien, W.T., Mou, H.Y., Leung, S.P., Wong, O.Y. and Lam, S.Y. (2025), Acceptance and Commitment Therapy Eczema Management Program for Children With Eczema: A Pilot Randomised Controlled Trial. Clin Exp Allergy. https://doi.org/10.1111/cea.70003.
2. P. V. Chernyshov, “Stigmatization and Self-Perception in Children With Atopic Dermatitis,” Clinical, Cosmetic and Investigational Dermatology 9 (2016): 159–166.