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CLINICAL REPORT 225 Tailored Therapist-guided Internet-based Cognitive-behavioural Treatment for Psoriasis and Rheumatoid Arthritis: Two Case Reports Saskia SPILLEKOM-VAN KOULIL 1 , Maaike FERWERDA 1–3 , Sylvia VAN BEUGEN 1–3 , Henriët VAN MIDDENDORP 1–3 , Peter C. M. VAN DE KERKHOF 4 , Piet L. C. M. VAN RIEL 5 and Andrea W. M. EVERS 1–3,6 Departments of 1 Medical Psychology and 4 Dermatology, 5 Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, 2 Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, 3 Leiden Institute for Brain and Cognition, and 6 Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands Chronic somatic conditions, such as psoriasis, arthritis psoriatica and rheumatoid arthritis, have a large im- pact on patients’ lives. Tailored therapist-guided inter- net-based cognitive-behavioural therapy (ICBT) has been shown to be effective in improving physical and psychological well-being in these patients. Two cases are presented here, in order to provide an in-depth il- lustration of the course and content of this novel treat- ment and to investigate the therapeutic alliance in an online treatment. After face-to-face intakes, both pa- tients received therapist-guided ICBT tailored to their specific problems and treatment goals. The treatment resulted in improved physical and psychological well- being and these clinically significant improvements were maintained at 6-month follow-up. In addition, the therapeutic relationship was evaluated positively by both patients and increased further during treat- ment, indicating an adequate therapeutic working alli- ance in this online treatment. These case reports show that tailored ICBT may contribute to improved care for patients with chronic somatic conditions. Key words: internet-based intervention; e-health; psoriasis; rheumatoid arthritis; cognitive-behavioural therapy; persona- lized medicine; tailored treatment. Accepted Sep 27, 2017; Epub ahead of print Sep 27, 2017 Acta Derm Venereol 2018; 98: 225–233. Corr: Andrea W. M. Evers, Institute of Psychology, Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University PO Box 9555, NL-2300 RB Leiden, The Netherlands. E-mail: [email protected] C hronic somatic conditions, including chronic skin and pain conditions, such as psoriasis (PS), arthritis psoriatica (PsA) and rheumatoid arthritis (RA), have a large impact on patients and society at large as a con- sequence of their significant physical and psychosocial impact. Patients with these conditions are confronted with several physical complaints, including pain, fatigue, and itch, as well as psychological complaints, such as anxiety and depression, and experience limitations in their daily life functioning (1–4). PS, PsA and RA are all auto-immune conditions that share specific characte- ristics with regard to skin problems and pain symptoms. PsA and RA cause inflammatory arthritis in the joints, leading to pain, stiffness, chronic fatigue, limitations in daily life functioning, and a diminished health-related quality of life (HRQoL) (5, 6). Fatigue has been identified as a key symptom in patients with PsA and RA and was added to the core outcome set for future studies, high- lighting its importance (7–9). Both PS and PsA lead to skin lesions characterized by red plaques covered with scales. Although there might be some differences with regard to the specific pathophysiological mechanisms, the experienced symptoms and burden of illness is found to be comparable in these patient groups (5, 10–12). With regard to psychological functioning, approximately 30–40% of the patients with chronic skin and pain condi- tions have elevated distress levels and can be considered at risk for long-term psychological adjustment problems (13–16). Therefore, a multidisciplinary approach to the treatment of these patients is vital. Psychological treat­ ments, such as cognitive behavioural therapy (CBT), have been shown to be effective as an adjunct to regular medical treatments to improve physical and psycholo- gical wellbeing for patients with chronic skin and pain conditions (17–19). In addition, several studies underline the relevance of individually-tailored CBT interventions that take patient-specific risk and resilience factors into account to further improve treatment adherence and effectiveness and decrease attrition rates (20–22). How­ ever, as the lack of specialized therapists and the time and travel burden for patients limit the implementation of tailored CBT, offering these interventions online might present important advantages (23). Research shows favourable effects of internet-based CBT (ICBT) for chronic somatic conditions (24–26). For example, one randomized, controlled trial (RCT) showed that unguided ICBT can improve quality of life and levels of anxiety in patients with PS, but was limited by high drop-out rates (27). Guided ICBT has been associated with lower drop- out rates and generally higher effectiveness than ICBT without therapist support (28–32). Therapist-guided ICBT has been shown to be effective for improving psychological outcomes (e.g. anxiety, depression and distress), disease-specific physical outcomes (e.g. pain, fatigue, disability) and disease-related impact outcomes (e.g. quality of life) (24, 26). These results are similar to those for traditional face-to-face approaches. This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2018 Acta Dermato-Venereologica. doi: 10.2340/00015555-2803 Acta Derm Venereol 2018; 98: 225–233