Summary: A recent randomized trial from the University of New South Wales (UNSW) and Neuroscience Research Australia (NeuRA) demonstrates that improving emotional processing can meaningfully reduce chronic pain and enhance quality of life. The researchers developed an online intervention called Pain and Emotion Therapy—an emotion regulation–focused, therapist-guided program—which produced significant and lasting reductions in pain intensity, better emotional regulation, and improved daily functioning.
Participants who completed the intervention reported lower pain scores, improved mood and sleep, and greater ability to manage emotions up to six months after treatment. The trial highlights emotion dysregulation as an important, previously under-addressed contributor to chronic pain and points to scalable, accessible digital treatments as promising additions to conventional care.
Key Facts:
- Emotion-focused intervention reduced pain: The therapy produced about a 10-point drop in pain intensity on a 100-point scale for participants at follow-up.
- Durable improvements: Benefits in pain, mood, and sleep were sustained up to six months post-treatment.
- Online and scalable delivery: Delivered as eight therapist-guided group sessions with an app and handbook, the program reached participants across Australia, including remote regions.
Study overview and main finding
Led by Professor Sylvia Gustin and Dr Nell Norman-Nott from UNSW and NeuRA, the trial tested an online dialectical behavior therapy (DBT)-based program adapted for chronic pain, called iDBT-Pain or Pain and Emotion Therapy. Published in JAMA Network Open, the study found that training people in emotion regulation produced measurable reductions in emotion dysregulation and pain intensity, alongside improvements in related outcomes such as depression, anxiety, and sleep.
The trial tested whether enhancing the brain’s capacity to process emotion could change how pain is experienced. “By changing how we manage emotions, it is possible to change the experience of pain itself,” Prof. Gustin explains. The trial’s results suggest not only short-term relief but meaningful, lasting gains in participants’ day-to-day functioning and wellbeing.
How the therapy worked
Pain and Emotion Therapy is an eHealth intervention combining therapist-led group sessions with self-guided learning via an app and a handbook. Delivered over eight 90-minute online group sessions, the program focused on DBT skills adapted to pain science: identifying and naming emotions, learning strategies to de-escalate negative affect, and cultivating positive emotions and goal-setting. The control group continued their usual care.
Participants who completed the program reported improved emotional regulation and a clinically meaningful drop in reported pain intensity—roughly a 10-point reduction on a 0–100 scale—measured during follow-up. These improvements were accompanied by reductions in depression and anxiety symptoms and improvements in sleep quality.
Why emotion regulation matters in chronic pain
Chronic pain—pain persisting for three months or more—affects about 30% of people worldwide and carries a substantial economic and social burden. Mental health challenges are common in this population: up to 80% of people with chronic pain experience depression or anxiety, and suicide risk is elevated compared with the general population.
The researchers note that persistent pain alters the brain’s emotional circuitry, making it harder for people to regulate negative emotions. This emotion dysregulation can amplify pain and perpetuate a cycle where negative mood intensifies physical symptoms, which in turn worsen emotional distress. The trial specifically targeted this cycle by teaching emotion regulation skills.
Study participants described how emotions and pain interact in everyday life. One participant reported that chronic back pain increased worry and frustration, which then made pain worse; another described being able to lower severe pain levels after learning calming and regulation strategies in the program.
Complementing existing treatments
The research team positions the therapy as a complement to existing medical treatments rather than a replacement. Dr Norman-Nott notes that medications, including opioids, can have side effects and reduced effectiveness over time. Psychological approaches carry fewer side effects but often do not focus specifically on emotion processing. By targeting emotion regulation directly, Pain and Emotion Therapy fills an important gap in chronic pain care.
Accessibility and next steps
A major advantage of the online format is accessibility: the hybrid approach reduced barriers related to mobility, travel, and regional service shortages, allowing participants across every Australian state—including remote and regional areas—to take part from home. The program’s combination of live group sessions and a tailored app and workbook enabled flexible, ongoing practice of emotion regulation skills.
Following these positive results, the research team plans a larger clinical trial supported by the Medical Research Future Fund, scheduled to begin in 2026, and are inviting interested participants to register. “These findings improve our understanding of chronic pain by demonstrating the importance of treating the body and emotions together,” Prof. Gustin says.
About this emotional processing and pain research news
Author: Melissa Lyne
Source: University of New South Wales
Contact: Melissa Lyne – University of New South Wales
Image: The image is credited to Neuroscience News
Original Research: Open access. “Online Dialectical Behavioral Therapy for Emotion Dysregulation in People With Chronic Pain” by Sylvia Gustin et al., JAMA Network Open.
Abstract
Online Dialectical Behavioral Therapy for Emotion Dysregulation in People With Chronic Pain
Importance
Many current therapeutic approaches for chronic pain are hard to access and do not adequately address emotion dysregulation, a key contributor to psychological comorbidity and pain intensity. There is a need for an effective, accessible intervention focused on emotion regulation.
Objectives
To compare the efficacy of online dialectical behavior therapy for chronic pain plus treatment as usual (iDBT-Pain) with treatment as usual alone on emotion dysregulation in people with chronic pain.
Design, Setting, and Participants
This two-arm randomized clinical trial ran from March 2023 to September 2024 in Australia. Adults with chronic pain (≥3 months) and weekly pain intensity ≥3 of 10 were included. Participants with psychotic or personality disorders or dementia were excluded. Eligible participants were randomized 1:1 to receive iDBT-Pain for nine weeks or treatment as usual. Intention-to-treat analyses were completed in August–September 2024.
Interventions
The iDBT-Pain group received eight group-based 90-minute therapist-guided online sessions plus an app and handbook focused on DBT skills and pain science education. The treatment-as-usual group continued community-accessible care options.
Main Outcomes and Measures
The primary outcome was emotion dysregulation at nine weeks, measured with the Difficulties in Emotion Regulation Scale (range 18–90; higher scores indicate greater dysregulation).
Results
Among 89 participants (mean [SD] age, 51.5 [14.2] years; 74 females [83%]), 45 were assigned to iDBT-Pain and 44 to treatment as usual. Eighty-nine percent completed the nine-week assessment. The between-group difference in emotion dysregulation favored iDBT-Pain at nine weeks (−4.88; 95% CI, −9.20 to −0.55; P = .03; Cohen d = −0.46).
Conclusions and Relevance
The iDBT-Pain intervention, delivered through a hybrid self-learning and therapist-guided approach, produced sustained improvements in emotion dysregulation among people with chronic pain, supporting emotion regulation training as a viable, accessible component of comprehensive pain care.
Trial Registration
Anzctr.org.au Identifier: ACTRN12622000113752