The effect of Barlow’s unified protocol on emotional symptoms,pain catastrophizing,and fear of movement in patients with rheumatoid arthritis: Emotion regulation as a mechanism of change

Abstract

This randomized clinical trial evaluated the Unified Protocol (UP) for reducing emotional symptoms in rheumatoid arthritis (RA) patients, with emotion regulation as a potential mediator. Fifty-two RA patients were randomly assigned to UP or a standard-treatment group, receiving eight UP sessions versus usual medical care. Pre- and post-intervention assessments included the DASS-21, DERS, Pain Catastrophizing Scale (PCS), and Tampa Scale for Kinesiophobia (TSK). Results showed that the UP significantly improved emotional regulation and reduced anxiety, depression, and stress compared with the control. Mediation analyses revealed that improvements in emotion regulation partially mediated the relationship between treatment and changes in psychological symptoms. Sobel tests corroborated the mediating role of emotion regulation. The findings support the UP as a transdiagnostic intervention for emotional disorders in RA, highlighting emotion regulation as a key mechanism of therapeutic change and contributing to evidence for the UP’s efficacy in co-occurring emotional and psychological difficulties.