[Skip to Navigation]
Original Investigation
May 10, 2023

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

Author Affiliations
  • 1Department of Health Promotion and Human Behavior, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
  • 2Department of Psychiatry, Soseikai General Hospital, Kyoto, Japan
  • 3Department of Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
  • 4Department of Healthcare Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
  • 5Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
  • 6Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
  • 7Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge, Massachusetts
  • 8Department of Dermatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
  • 9Shimizu Dermatology Clinic, Kobe, Hyogo, Japan
  • 10Center for Mindfulness, University of California San Diego
  • 11Global Compassion Coalition, San Rafael, California
  • 12Faculty of Medical Sciences, Shonan University of Medical Sciences, Yokohama, Kanagawa, Japan
  • 13Atago Dermatology Clinic, Tokyo, Japan
  • 14Population Health & Policy Research Unit, Medical Education Center, Kyoto University, Kyoto, Japan
  • 15Center for Patients and Families, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Dermatol. 2023;159(6):628-636. doi:10.1001/jamadermatol.2023.0975
Key Points

Question  Is online group mindfulness and self-compassion training efficacious in improving the quality of life (QOL) of adults with atopic dermatitis (AD)?

Findings  In this randomized clinical trial of 107 adults with AD, mindfulness and self-compassion training in addition to usual care showed significantly greater improvements in patient-reported skin disease–specific QOL compared with a waiting list control at 13-week assessment. There were few dropouts, and the effect size was large.

Meaning  These results suggest that online group mindfulness and self-compassion training improves QOL in synergy with dermatological treatments.


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

Add or change institution