Feasibility Assessment of an 8-week Attention-based Training Programme in the Management of Chronic Spontaneous Urticaria 

Abstract Background: Chronic spontaneous urticaria is a common disorder that is poorly understood and frequently misdiagnosed. Psychological difficulties are a significant factor in dermatological diseases and may also aggravate symptom burden. Mind-body interventions are used as a complementary approach to alleviate symptoms in chronic diseases and may represent a valuable non-pharmacological approach in CSU.Methods: We sought to develop and evaluate the feasibility of an 8-week Attention-based Training (ABT) programme, coupled to biofeedback technology for CSU. Through convergent interviews, we gathered information from individuals with urticaria about possible links between stress, mood and skin symptoms. Using these data, we recruited 12 participants to engage in an amended ABT programme for patients with CSU, comprising eight ninety minute sessions held weekly. Participants completed psychometric measures and measures of urticaria symptomatology prior to and after the intervention. Adherence to ABT practice was measured using individual Inner Balance devices which tracked heart rate variability. We completed qualitative interviews after the intervention to obtain feedback on participant experience of the programme. Results: Participants with CSU described how their psychological wellbeing can be linked to skin symptoms, poor sleep and difficulty concentrating. An amended ABT programme was found to be an acceptable component of care in the management of CSU. Retention of participants in the programme was challenging with 33% participants dropping out of the programme. For those who did complete the programme, adherence to ABT practice was impressive with 25% of participants exceeding weekly practice at week 8. A statistically significant fall in severity of urticaria symptomatology was observed upon completion of the intervention (x = 12.3 SD 3.3, p < 0.03). The most commonly cited barrier to implementation of the programme was the time commitment required.Conclusions: An ABT programme can be integrated into clinical care for CSU patients and is valued by individuals who take part. Further formal evaluation of ABT for CSU including the analysis of biochemical parameters is required to determine its role in the management of this distressing condition.