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 critical analyzes the evidence base. Recent findings: Four initial trials (between 2006 and 2011) demonstrated 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.

Short-Term Psychodynamic Psychotherapy for Functional Somatic Disorders: A Meta-Analysis of Randomized Controlled Trials

“…All but 2 of the RCTs delivered treatment following a specific STPP model, and all but 1 had a manual or guide for treatment delivery. Four RCTs (23.5%) used psychodynamic-interpersonal therapy [28], 3 (17.6%) used ISTDP [9, 29], 2 used EAET [11], and 1 each used STDP [6], supportive expressive therapy [14], time-limited dynamic psychotherapy [13], the affect consciousness model [30], a combination of Malan’s STDP plus ISTDP, and a combination of EAET plus ISTDP. Two studies had general short-term psychodynamic approaches without a specific, cited model (online suppl.…”

“…For these reasons, STPP is considered a type of therapy that is distinct and can be studied as a collection even while technical treatment details vary among STPP subtypes [8]. Some forms of STPP, such as intensive short-term dynamic psychotherapy (ISTDP) [9, 10] and emotional awareness and expression therapy (EAET) [11], emphasize helping the patient to somatically experience and process unconscious feelings to correct emotion dysregulation underlying somatic symptoms in FSD [12] while other methods such as time-limited dynamic psychotherapy [13], Luborsky’s supportive expressive therapy [14], and Malan’s short-term dynamic psychotherapy [6] emphasize building insight into unconscious processes more so than emotional experiencing.…”

Emotions matter: The role of emotional approach coping in chronic pain

“…Broadly speaking, because emotion unawareness and suppression are prevalent in chronic pain, this study highlights the potential value of assessing patients' emotional processes and providing psychological interventions to enhance their emotional awareness and expression. For example interventions such as Emotional Awareness and Expression Therapy or Training (Lumley & Schubiner, 2019a; Lumley et al., 2017; Thakur et al., 2017; Ziadni, Carty, et al, 2018) and mindfulness‐based interventions for pain (Hilton et al., 2016), appear to accomplish this goal, with subsequent improvement in pain‐related outcomes. Such emotion‐focused interventions may optimally be part of a broader, integrative treatment that also addresses dysfunctional cognitions and behaviours (Lumley & Schubiner, 2019b).…”

Uncovering and Resolving Social Conflicts Contributing to Chronic Pain: Emotional Awareness and Expression Therapy

“…Low attrition rates observed by the researchers (Lumley & Schubiner, 2019) suggest that most patients have been open to this emotion-focused approach to addressing sources of life stress and treating chronic pain. But, it should be noted that all published trials of EAET to date have been with exclusively well-educated and self-selected female samples (motivated and open to the idea of practicing emotional awareness and expression).…”

“…While the format of EAET delivered in research trials was designed to be distinct from comparison treatment arms (cognitive-behavioral and acceptance-based treatments), Lumley and Schubiner (2019) suggest that EAET may be equally, if not more, effective if integrated with other evidence-based pain management strategies such as pacing, desensitization, relaxation, and mindfulness. Since EAET is delivered in a manner similar to other psychological therapies (individually or in groups, in primary care or outpatient clinic settings), it is conceivable that EAET techniques can be easily integrated with other psychological approaches to the treatment of chronic pain conditions EAET has been studied in several formats, including an online version.…”