Trial Report Online Dialectical Behavioral Therapy for Emotion Dysregulation in People With Chronic Pain A Randomized Clinical Trial, 2025, Norman-Nott

Dolphin

Dolphin

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https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2833582

Original Investigation
Psychiatry
May 6, 2025
Online Dialectical Behavioral Therapy for Emotion Dysregulation in People With Chronic Pain: A Randomized Clinical Trial
Nell Norman-Nott, BPsychSc1,2; Nancy E. Briggs, PhD3; Negin Hesam-Shariati, PhD1,2; Chelsey R. Wilks, PhD4; Jessica Schroeder, PhD5; Ashish D. Diwan, MD, PhD6,7,8; Jina Suh, PhD5,9; Jill M. Newby, PhD10; Toby Newton-John, PhD11; Yann Quidé, PhD1,2; James H. McAuley, PhD2,12; Sylvia M. Gustin, PhD1,2
Article Information
JAMA Netw Open. 2025;8(5):e256908. doi:10.1001/jamanetworkopen.2025.6908


Key Points

Question What is the effect of the online dialectical behavioral therapy for chronic pain (iDBT-Pain) intervention on emotion dysregulation in people with chronic pain?

Findings In this randomized clinical trial with 89 participants, those receiving iDBT-Pain demonstrated significant improvement in emotion dysregulation over 9 weeks after randomization compared with those who continued treatment as usual.

Meaning The findings support the superiority of iDBT-pain over usual treatment to improve emotion dysregulation in adults with chronic pain.

ACTRN12622000113752


Abstract
Importance Current therapeutic approaches are inaccessible to many people with chronic pain and frequently fail to address emotion dysregulation as a key factor in psychological comorbidity and pain intensity. An effective and accessible emotion regulation–focused intervention is needed.

Objectives To compare the efficacy of online dialectical behavioral therapy for chronic pain plus treatment as usual (iDBT-Pain) with only treatment as usual on emotion dysregulation in people with chronic pain.

Design, Setting, and Participants This 2-arm randomized clinical trial was conducted from March 2023 to September 2024 in Australia. Participants were adults with chronic pain (lasting ≥3 months) and weekly pain intensity of 3 or higher out of 10 (10 indicating worst pain), without psychotic or personality disorders, and without dementia. Eligible participants were randomly assigned (1:1 ratio) to receive either iDBT-Pain for 9 weeks or treatment as usual only. Intention-to-treat data analyses were performed between August and September 2024.

Interventions The iDBT-Pain group received 8 group-based 90-minute therapist-guided online sessions as well as an app and a handbook for self-learning. Content focused on DBT skills training, including pain science education. Participants in the treatment-as-usual group continued usual care, which consisted of treatment options that can be accessed in the community.

Main Outcomes and Measures The primary outcome was emotion dysregulation at 9 weeks after randomization. The Difficulties in Emotion Regulation Scale (score range: 18-90, with higher scores indicating higher emotion dysregulation) was used in assessment.

Results Among 89 participants (mean [SD] age, 51.5 [14.2] years; 74 females [83%]), 44 (49%) were randomly assigned to the treatment-as-usual group and 45 (51%) were randomly assigned to the iDBT-Pain group. Overall, 79 participants (89%) completed the 9-week assessment. Between-group difference in emotion dysregulation over time favored iDBT-Pain over treatment as usual at 9 weeks (−4.88; 95% CI, −9.20 to −0.55; P = .03; Cohen d = −0.46 [95% CI, −0.87 to −0.08]).

Conclusions and Relevance In this randomized clinical trial, the iDBT-Pain intervention, delivered through a self-learning and therapist-guided hybrid approach, resulted in sustained improvements in emotion dysregulation in people with chronic pain.

Trial Registration Anzctr.org.au Identifier: ACTRN12622000113752
 
Hm. Maybe I need one anti-dialectical-behaviour therapy to stop me being so argumentative. But then I don't have any emotional dysregulation as far as I know. I do have a lot of chronic pain, which on average keeps me awake for 1-2 hours on going to bed at night. But I think its because my body is physically knackered.
 
News release:

Melissa Lyne
UNSW and NeuRA researchers have created an effective therapy for chronic pain that reduces pain intensity by focusing on emotional regulation.

A new study led by UNSW Sydney and Neuroscience Research Australia (NeuRA) shows that targeting emotional processing is key to treating and managing chronic pain.

The study is based on a randomised controlled trial led by Professor Sylvia Gustin and Dr Nell Norman-Nott, both from UNSW and NeuRA. Along with a team at NeuRA’s Centre for Pain IMPACT, they published their results, opens in a new window today in JAMA Network Open.

The trial showed that enhancing the brain’s capacity for emotional processing through therapeutic intervention is an effective approach to managing chronic pain.

“By changing how we manage emotions, it is possible to change the experience of pain itself,” Prof. Gustin says. “This is not just a temporary relief but a potential long-term improvement in quality of life for those affected by chronic pain.”

Prof. Gustin and Dr Norman-Nott developed Pain and Emotion Therapy — a novel and emerging eHealth intervention. The therapy aims to retrain the brain to more easily process emotions by improving an individual's ability to deescalate negative emotions and enhance positive ones.

Continues at:
https://www.unsw.edu.au/newsroom/ne...in-therapy-retrains-brain-to-process-emotions
 
Open label, subjective outcomes, A+B vs A, and essentially teaching them how to answer the questions.

The protocol says they recruited patients that had previously contacted the principal investigator for potential participation in studies, so a huge selection bias. (Edit: this was the primary source of participants. Some were recruited elsewhere)

They ditched the planned objective outcomes like healthcare utilisation and medications.

No meaningful differences in perceived pain.
 
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But, have you considered instead having the participants hit their faces very hard with a shovel 40 times per day?

Sounds a lot more likely to do something.
 
Dolphin said:
News release:

Melissa Lyne
UNSW and NeuRA researchers have created an effective therapy for chronic pain that reduces pain intensity by focusing on emotional regulation.

A new study led by UNSW Sydney and Neuroscience Research Australia (NeuRA) shows that targeting emotional processing is key to treating and managing chronic pain.

The study is based on a randomised controlled trial led by Professor Sylvia Gustin and Dr Nell Norman-Nott, both from UNSW and NeuRA. Along with a team at NeuRA’s Centre for Pain IMPACT, they published their results, opens in a new window today in JAMA Network Open.

The trial showed that enhancing the brain’s capacity for emotional processing through therapeutic intervention is an effective approach to managing chronic pain.

“By changing how we manage emotions, it is possible to change the experience of pain itself,” Prof. Gustin says. “This is not just a temporary relief but a potential long-term improvement in quality of life for those affected by chronic pain.”

Prof. Gustin and Dr Norman-Nott developed Pain and Emotion Therapy — a novel and emerging eHealth intervention. The therapy aims to retrain the brain to more easily process emotions by improving an individual's ability to deescalate negative emotions and enhance positive ones.

Continues at:
https://www.unsw.edu.au/newsroom/ne...in-therapy-retrains-brain-to-process-emotions
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Here goes the new normal where out of a small pilot study of actual zero scientific validity they just go straight to the press release where they make absurd boasts that would make the average con artist skip a few beats and ponder whether this is 1) straight up too unethical and 2) WHO FALLS FOR THIS CRAP?!

And by "who falls for this crap?" I absolutely don't mean the patients. Not even a little bit. This is 100% a supply-side failure.
 
Having had (my last?) Pfizer covid vaccine on April 30 followed in 3-4 days by some virus with low fever and very fiendish body aches that augmented my FM nerve transmission of pain at least 400%, plus lovely gastroentestinal symptoms a la noro (yuck), I can only say to the above research article and its authors:

How dare you.





eta correct dates
 
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Participants recruited had a pain intensity of 3/10 or higher.
A three isn't huge. At a three, I could lower my pain level with distraction or a hot bath, no problem.

I wonder if the participants who consented to this trial were those seeking help at a teritiary care site (a major referral hospital or university practice) or on its list of past patients.

They could believe that someone in authority has the power to help them; that someone knows better than they do; that these someones have the answers. Some persistance of placebo effect as well.
 
Utsikt said:
No meaningful differences in perceived pain.
Click to expand...
This therapy makes as much sense as a dentist treating a person with a tooth abscess by teaching them to smile more.

rvallee said:
Here goes the new normal where out of a small pilot study of actual zero scientific validity they just go straight to the press release where they make absurd boasts that would make the average con artist skip a few beats and ponder whether this is 1) straight up too unethical and 2) WHO FALLS FOR THIS CRAP?!
Click to expand...
yep
 
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