The Effects of a Life Stress Emotional Awareness and Expression Interview for Women with Chronic Urogenital Pain: A Randomized Controlled Trial

Carty, Jennifer N.; Ziadni, Maisa S.; Holmes, Hannah; Tomakowsky, Janice; Peters, Kenneth M.; Schubiner, Howard; Lumley, Mark A.

doi:10.1093/pm/pny182

Cited by 34 publications

(33 citation statements)

References 36 publications

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“…The two trials that compared EAET (or AAET) to relaxation training, however, found equivalence of treatments-showing neither superiority nor specificity, although the smaller sample sizes limited statistical power to detect differences between EAET and another treatment [45,42]. Moreover, for most of the trials, the beneficial effects of EAET were found only in comparison to no additional treatment (i.e., waitlist control) [44,43,39] or in uncontrolled cohort trials [40,41]. Although demonstrating efficacy compared to no additional treatment is the most common evidence supporting psychological interventions for chronic pain, trials that compare EAET to better controls and comparison treatments are needed.…”

Section: Critical Analysis Of Eaetmentioning

confidence: 98%

“…The other trial of the life stress EAET interview was conducted in a specialty women's urology clinic among 62 women (M age = 46.0 years) who had various chronic pelvic pain conditions (e.g., interstitial cystitis, pelvic floor dysfunction, or dyspareunia) [44]. The treatment and control conditions differed at baseline on depression, which was adjusted in analyses.…”

Section: Recent Trials Of Eaetmentioning

confidence: 99%

“…Generalizability of the studies is limited in several ways. Trial samples were either exclusively female [44,39,41] or largely female [43,46,45,40,42]. Although this imbalance partially reflects the gender distribution of the conditions studied, how EAET works for men remains largely uninvestigated.…”

Section: Critical Analysis Of Eaetmentioning

confidence: 99%

“…Because EAET targets the activation of negative emotions, EAET may leave patients more aware of and experiencing their emotional distress, perhaps instead of experiencing their distress as pain. Note, however, that two of the three EAET trials with the longest follow-ups-6 months-showed reductions in psychological symptoms [46,40] whereas trials with shorter follow-ups usually did not [44,42,45]. This suggests that improvements in depression or anxiety may simply take longer to occur than reductions in pain, and longer-term follow-ups should routinely be included.…”

Section: Critical Analysis Of Eaetmentioning

confidence: 99%

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

Lumley

Schubiner

2019

Curr Rheumatol Rep

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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.

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Section: Critical Analysis Of Eaetmentioning

confidence: 98%

Section: Recent Trials Of Eaetmentioning

confidence: 99%

Section: Critical Analysis Of Eaetmentioning

confidence: 99%

Section: Critical Analysis Of Eaetmentioning

confidence: 99%

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

Lumley

Schubiner

2019

Curr Rheumatol Rep

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“…EAET in its current form has been evaluated and found to be superior to treatment as usual, education controls, or even CBT in five randomized controlled trials in patients with fibromyalgia ( 17 ), irritable bowel syndrome ( 29 ), pelvic pain ( 30 ), medically unexplained symptoms ( 31 ), and musculoskeletal pain ( 18 ). Although trials of EAET have included both individual and group formats, they have all been face-to-face, and no study has been conducted through the internet.…”

Section: Introductionmentioning

confidence: 99%

Internet-Administered Emotional Awareness and Expression Therapy for Somatic Symptom Disorder With Centralized Symptoms: A Preliminary Efficacy Trial

Maroti

Widlund

et al. 2021

Front. Psychiatry

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Background: There is growing evidence that trauma, psychosocial conflict, and difficulties with emotional processing contribute to centralized somatic symptoms. Emotional Awareness and Expression Therapy (EAET) was developed to address these factors and reduce symptoms, and EAET has shown efficacy in face-to-face formats. No trial of an internet-delivered EAET (I-EAET) exists, however, so we developed such an intervention and conducted an uncontrolled feasibility and potential efficacy trial of I-EAET for patients with Somatic Symptom Disorder (SSD) with centralized symptoms (SSD-CS).Method: After screening potential participants, a sample of 52 patients (50 women, two men; age M = 49.6, SD = 11.9) diagnosed with SSD-CS initiated treatment. I-EAET consisted of nine weekly modules focused on psychoeducation, emotional awareness and exposure, and anxiety regulation with self-compassion. Therapists communicated with each patient by email for about 20 min per week during treatment, answering questions and giving feedback on homework assignments. Patients completed measures of somatic symptoms, depression, anxiety, trauma-related symptoms, and functional disability before treatment and again at post-treatment and 4-month follow-up.Results: A large reduction in somatic symptoms (PHQ-15) occurred pre-to post-treatment (d = 1.13; 95% CI: 0.84–1.47) which was fully maintained at 4-month follow-up (d = 1.19; 95% CI: 0.88–1.56). Twenty-three percent of the patients at post-treatment and 27% at follow-up achieved a 50% or greater reduction in somatic symptoms, and about 70% achieved a minimally important clinical difference. In addition, at post-treatment, there were small to medium reductions (d's from 0.33 to 0.72) in anxiety (GAD-7), depression (PHQ-9), trauma-related symptoms (PCL-5), and functional disability (Sheehan Disability Scale). For all of these secondary outcomes, improvements were slightly to substantially larger at follow-up than at post-treatment (d's from 0.46 to 0.80).Conclusion: I-EAET appears to be a feasible treatment for adults with SSD and centralized symptoms, resulting in substantial and durable improvement not only in somatic symptoms but in other psychiatric symptoms and functioning. Controlled trials are needed determine the effects of I-EAET specifically and how this approach compares to face-to-face EAET and to other internet-delivered treatments, such as cognitive-behavioral interventions. Research should also identify treatment responders and mechanisms of change in EAET.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04122846.

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Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans

Yarns,

Jackson,

Alas

et al. 2024

JAMA Netw Open

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ImportanceChronic pain is common and disabling in older adults, and psychological interventions are indicated. However, the gold standard approach, cognitive-behavioral therapy (CBT), produces only modest benefits, and more powerful options are needed.ObjectivesTo evaluate whether emotional awareness and expression therapy (EAET) is superior to CBT for treatment of chronic pain among predominantly male older veterans and whether higher baseline depression, anxiety, or posttraumatic stress disorder (PTSD) symptoms—key targets of EAET—moderate treatment response.Design, Setting, and ParticipantsThis 2-arm randomized clinical trial was conducted from May 16, 2019, to September 14, 2023, in the US Department of Veterans Affairs Greater Los Angeles Healthcare System. The trial included a racially and ethnically diverse group of veterans aged 60 to 95 years with at least 3 months of musculoskeletal pain.InterventionsEmotional awareness and expression therapy or CBT, conducted concurrently, each presented as one 90-minute individual session followed by eight 90-minute group sessions.Main Outcomes and MeasuresThe primary outcome was Brief Pain Inventory pain severity (range, 0 to 10) from baseline to posttreatment (week 10, primary end point) and 6-month follow-up. Secondary outcomes included Patient Reported Outcomes Institute Measurement System Anxiety, Depression, Fatigue, General Life Satisfaction (NIH Toolbox), Pain Interference, and Sleep Disturbance Short Forms, Patient Global Impression of Change (PGIC), and Satisfaction with Therapy and Therapist Scale-Revised. A subset of participants completed the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). All analyses were for the intention-to-treat population and included all randomized participants.ResultsAmong 126 randomized participants (66 in the EAET group and 60 in the CBT group; mean [SD] age, 71.9 [5.9] years; 116 [92%] male), 111 (88%) completed posttreatment, and 104 (82%) completed the 6-month follow-up. The EAET was superior to CBT for the primary outcome of reduction in pain severity at posttreatment (estimate, −1.59 [95% CI, −2.35 to −0.83]; P &lt; .001) and follow-up (estimate, −1.01 [95% CI, −1.78 to −0.24]; P = .01). A greater percentage of participants in EAET vs CBT had clinically significant (at least 30%) pain reduction (63% vs 17%; odds ratio, 21.54 [95% CI, 4.66-99.56]; P &lt; .001) at posttreatment. In addition, EAET was superior to CBT on 50% pain reduction (35% vs 7%; odds ratio, 11.77 [95% CI, 2.38-58.25]; P = .002), anxiety (estimate, −2.49 [95% CI, −4.30 to −0.68]; P = .006), depression (estimate, −3.06 [95% CI, −5.88 to −0.25]; P = .03), general life satisfaction (estimate, 1.23 [95% CI, 0.36-2.10]; P = .005), PTSD symptoms (estimate, −4.39 [95% CI, −8.44 to −0.34]; P = .03), PGIC score (estimate, 1.46 [95% CI, 0.77-2.15]; P &lt; .001), and global treatment satisfaction (estimate, 0.28 [95% CI, 0.12-0.45]; P &lt; .001) at posttreatment. Higher baseline depression (estimate, −1.55 [95% CI, −0.37 to 2.73]; P &lt; .001), anxiety (estimate, −1.53 [95% CI, −2.19 to −0.88]; P &lt; .001), and PTSD symptoms (estimate, −1.69 [95% CI, −2.96 to −0.42]; P = .009) moderated greater reduction in pain severity after EAET but not CBT.Conclusions and RelevanceThe results of this randomized clinical trial suggest that EAET may be a preferred intervention for medically and psychiatrically complex patients with pain. The societal burden of chronic pain could be improved by further incorporating the principles of EAET into mainstream clinical pain medicine.Trial RegistrationClinicalTrials.gov Identifier: NCT03918642

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The Effects of a Life Stress Emotional Awareness and Expression Interview for Women with Chronic Urogenital Pain: A Randomized Controlled Trial

Cited by 34 publications

References 36 publications

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

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

Internet-Administered Emotional Awareness and Expression Therapy for Somatic Symptom Disorder With Centralized Symptoms: A Preliminary Efficacy Trial

Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans

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