Emotional Processing and Its Association to Somatic Symptom Change in Emotional Awareness and Expression Therapy for Somatic Symptom Disorder: A Preliminary Mediation Investigation

Abstract

Objective: The aim of this study was to investigate emotional processing as a potential mediator in therapist-guided, internet-based Emotional Awareness and Expression Therapy (I-EAET) for somatic symptom disorder, using data from a previously published pilot study.Methods: Participants (N = 52) engaged in a 9-week I-EAET treatment. Before treatment and each week during treatment (i.e., 10 weekly measurements), emotional processing was assessed with the Emotional Processing Scale-25 (EPS-25), which contains five subscales, and somatic symptoms were assessed with the Patient Health Questionnaire-15 (PHQ-15).Results: Mediation analyses using linear mixed models showed that two EPS-25 subscales—Signs of Unprocessed Emotions and Impoverished Emotional Experience—were uniquely associated with somatic symptom reduction. The proportion of the mediated effect was 0.49, indicating that about half of the total association of the PHQ-15 with symptoms was accounted for by the two EPS-25 subscales.Conclusion: This preliminary mediation analysis suggests that improved emotional processing is associated with change in somatic symptoms in I-EAET. However, randomized controlled and comparison trials are needed to establish that I-EAET creates the change in emotional processing and that such changes are specific to I-EAET.

Is Cognitive Change Necessary to Alleviate Symptoms in Patients With Functional Somatic Syndrome?

“…Another potential mechanism is that of emotional processing. In a study of Emotional Awareness and Expression Therapy for FSS patients, a mediation analysis distinguished two emotional processes that were associated with reductions of somatic symptoms ( 23 ). One was “impoverished emotional experience,” which is similar to the concept of alexithymia.…”

Understanding the gaps in headache and migraine treatment with psychological and behavioral interventions: A narrative review

“…EAET has been studied for several chronic pain conditions, including fibromyalgia, musculoskeletal pain conditions (e.g., back pain, neck pain), and pelvic pain, and has demonstrated medium to large effect sizes in reducing pain severity and other related symptoms, such as pain interference with mood and activities, depression, and anxiety 77,79–85 . In a randomized clinical trial for patients with diverse musculoskeletal pain conditions, some of whom had tension headaches, EAET demonstrated a large effect size and significant advantage in reducing pain intensity and anxiety compared to CBT 84 .…”

“…EAET has been studied for several chronic pain conditions, including fibromyalgia, musculoskeletal pain conditions (e.g., back pain, neck pain), and pelvic pain, and has demonstrated medium to large effect sizes in reducing pain severity and other related symptoms, such as pain interference with mood and activities, depression, and anxiety. 77,[79][80][81][82][83][84][85] In a randomized clinical trial for patients with diverse musculoskeletal pain conditions, some of whom had tension headaches, EAET demonstrated a large effect size and significant advantage in reducing pain intensity and anxiety compared to CBT. 84 EAET has also been successfully tested in a group video telehealth format, in a small uncontrolled trial in which 25% of patients had tension headaches; 85 however, EAET has not been subjected to an adequately powered clinical trial specifically focused on the headache or migraine population.…”