Positive Psychology (PERMA) Themes in Interviews of Children with Atopic Dermatitis: A Qualitative Study (Preprint)

BACKGROUND Atopic dermatitis (AD) is a pruritic chronic condition associated with significant sleep disturbance, inattention, and sometimes behavioral problems. Enhancing resiliency in children with AD may promote coping strategies to improve quality of life. One strategy for strengthening resiliency is via positive psychology. OBJECTIVE Our objective was to identify positive psychology concepts mentioned by children with AD and their parent to inform strategies to strengthen resiliency in children with AD. METHODS Twenty patient-parent dyads were interviewed to provide feedback on a novel brief Cognitive Behavioral Therapy (CBT) intervention for itch rumination. Patients were 8-17 years-old and diagnosed with AD. Trained coders analyzed transcripts using a coding dictionary developed based on Seligman’s PERMA (Positive emotion, Engagement, Relationships, Meaning, Achievement) model of positive psychology. The frequency of unprompted mentions of PERMA themes and relevant quotations were captured. Transcripts were also separately coded for resiliency, the ultimate goal of PERMA. RESULTS Positive psychology concepts were mentioned by 100% of children and 95% of parents. Engagement and relationships, both negative and positive aspects, were the most common unprompted PERMA themes mentioned by children (70%) and parents (65%). Emotion elicited the most negative comments from children (95%) and parents (85%). When analyzed for resiliency, 8 participants were identified with at least one resiliency code. On average, participants with a resiliency code versus none mentioned PERMA concepts 9.1±4.7 times versus 5.9±4.6 (p = 0.14). When participants were stratified by disease severity, positive psychology concepts were mentioned more by mild patients vs moderate patients vs severe patients, 13±3.0 vs 6.2±4.9 vs 6.13±4.0, respectively (p = 0.034). CONCLUSIONS Among PERMA themes, engagement and relationships are the two most commonly mentioned categories for children with AD. Strategies targeting PERMA such as affirmations and positive reframing may improve psychosocial wellbeing and resiliency in pediatric AD. Future directions will look at incorporating “positive medicine” in AD treatment to not only relieve symptoms but also strengthen positive aspects of life.