Emotional Awareness and Expression Therapy for Chronic Pain: Rationale, Principles and Techniques, Evidence, and Critical Review

Abstract

Purpose of Review

Patients with chronic pain, especially primary or centralized pain, have elevated rates of psychosocial trauma and intrapersonal or intrapsychic conflict. To address these risk factors and potentially reduce pain, the authors developed emotional awareness and expression therapy (EAET). This article presents the rationale for EAET, describes its principles and techniques, reviews its development and early testing as well as recent clinical trials, and critically analyzes the evidence base.

Recent Findings

Four initial trials (between 2006 and 2011) demonstrated the efficacy of earlier versions of EAET. Four recent randomized, controlled trials of different EAET durations (1 to 8 sessions) and formats (individual or group) in patients with fibromyalgia, irritable bowel syndrome, pelvic pain, or medically unexplained symptoms support the earlier findings. EAET reliably reduces pain and interference, although improvements in anxiety and depression are less reliably achieved and may be delayed. The largest and best conducted trial found superiority of EAET over cognitive-behavioral therapy for fibromyalgia. Patient retention in EAET is high, and adverse events are rare.

Summary

EAET merits inclusion as a treatment option for primary pain conditions, and it may be the preferred treatment for some patients. Research is needed on EAET with other pain conditions and samples, using better controls and comparison conditions, and on additional ways to motivate and help patients engage in successful emotional processing.

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Acknowledgments

We are grateful for the numerous colleagues and students who have contributed to the development and testing of EAET.

Funding

Preparation of this manuscript was supported by the National Institutes of Arthritis, Musculoskeletal, and Skin Diseases under award numbers AR057808 and AR074020.

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Correspondence to Mark A. Lumley.

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Conflict of Interest

Dr. Schubiner reports grants from National Institute of Arthritis, Musculoskeletal, and Skin Diseases, supporting some of the studies reported in this article other from self-publishing company, outside the submitted work.

Dr. Lumley reports grants from National Institute of Arthritis, Musculoskeletal, and Skin Diseases supporting some of the studies reported in this article.

Mark Lumley has no conflicts of interest. Howard Schubiner is the author of a manual mentioned in this article, but otherwise has no conflicts of interest.

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All reported studies/experiments with human subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki Declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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This article is part of the Topical Collection on Chronic Pain

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Lumley, M.A., Schubiner, H. Emotional Awareness and Expression Therapy for Chronic Pain: Rationale, Principles and Techniques, Evidence, and Critical Review. Curr Rheumatol Rep 21, 30 (2019). https://doi.org/10.1007/s11926-019-0829-6

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Keywords

  • Chronic pain
  • Primary pain
  • Emotional awareness and expression
  • Emotional processing
  • Randomized trial