# “It’s just crucial to deal with emotions as well as the pain” A qualitative acceptability study of an online emotion regulation skills-focused intervention for people with chronic pain

## TL;DR

This study explores how acceptable an online therapy for chronic pain is, focusing on improving emotion regulation skills and showing positive outcomes for participants.

## Contribution

The study introduces a new online emotion regulation skills-focused intervention for chronic pain and evaluates its acceptability through qualitative analysis.

## Key findings

- Participants found the integration of emotion regulation skills in chronic pain treatment effective and acceptable.
- The online group-based delivery and hybrid approach were well-received by participants.
- Clinical assessment is needed to ensure readiness for emotionally focused approaches and personalization of digital components.

## Abstract

Psychological interventions for people with chronic pain increasingly target emotion dysregulation as a contributing factor in psychological comorbidity and pain intensity. The acceptability of these interventions remains uncertain. This qualitative study examined the acceptability of internet-delivered dialectical behavioural therapy for chronic pain (iDBT-Pain), an emotion regulation skills-focused (ERSF) intervention aimed at enhancing emotion dysregulation. iDBT-Pain integrates DBT skills training, and pain science education, in a hybrid guided and self-directed online format.

We conducted 18 semi-structured interviews with participants enrolled in a Randomised Controlled trial which showed iDBT-Pain significantly improves emotion dysregulation, depression symptoms and pain intensity. Interviews were recorded, transcribed, and deductively analysed according to a theoretical framework of acceptability.

Participants perspectives supported the integration of emotion regulation skills within holistic chronic pain treatment, identifying their efficacy to enhance emotion regulation capabilities and reduce pain intensity. There was also acceptance of the online group-based delivery, and hybrid therapist-guided/self-directed approach.

Findings highlight the need for clinical assessment to gauge client readiness for an emotionally focused approach, assess sensitivity to others’ emotions in a group setting, and ensure personalisation of digital components to enhance engagement. These findings have implications for developing iDBT-Pain and for ERSF interventions, particularly those delivered online and to groups. The findings also underscore the role of emotion regulation as a key mechanism in chronic pain, supporting research that advocates for its deeper exploration as a central psychological target in chronic pain mental health treatment.