A single treatment with emotional awareness and expression therapy (EAET) was associated with a significantly greater reduction in chronic pain severity than cognitive behavioral therapy (CBT), the current psychotherapeutic gold standard, a new study suggests .
Two-thirds of patients who received EAET reported a pain reduction of at least 30%, compared to 17% of those who received CBT. The randomized clinical trial also showed that people with depression and anxiety responded more favorably to EAET, a new finding.
The study is one of the few to directly compare EAET to CBT.
“Most people with chronic pain don’t consider psychotherapy at all,” said researcher Brandon C. Yarns, MD, psychiatrist at the VA Greater Los Angeles Healthcare System and clinical professor of health sciences in the Department of Psychiatry. and biobehavioral sciences. , UCLA Health, said Medscape Medical News.
Although patients were allowed to continue taking their medications for pain and other comorbidities during the study, those who received EAET “showed greater improvements in pain, depression and anxiety,” Yarns said. “This suggests that the effect was due to EAET.”
The results were published online on June 13 in Open JAMA Network.
‘Gold standard’
EAET was first used in the early 2010s. In therapy, patients are asked to recall a difficult or traumatic memory, feel what the associated emotions feel like in the body, express these feelings with words and releasing them or letting them go. They are taught that the brain’s perception of pain is heavily influenced by flight from grief, fear, rage or guilt, Yarns said.
This contrasts with CBT – considered the current gold standard for chronic pain – which teaches patients to improve their ability to tolerate pain through guided imagery, muscle relaxation and other exercises and to adapt their thinking to change their perception of pain.
Although previous studies suggest that EAET is effective in reducing pain related to fibromyalgia and chronic musculoskeletal, pelvic, and head pain, most included primarily younger, female patients.
The research is the “first large-scale evaluation of EAET, to our knowledge, in an older, medically or psychiatrically complex, racially and ethnically diverse sample, comprising primarily men,” the investigators wrote.
The trial included 126 veterans (92% male; 55% Black or African American) aged 60 to 95 years who had suffered from musculoskeletal pain for at least 3 months. More than two-thirds of patients had a psychiatric diagnosis, and about a third suffered from post-traumatic stress disorder (PTSD). Almost all had back pain and many had pain in multiple areas.
All services were provided in person at the U.S. Department of Veterans Affairs Greater Los Angeles Health System in Los Angeles. Half received CBT, while the other half received EAET.
Each patient had one 90-minute individual session and eight additional 90-minute group sessions.
Patients were asked to rate their pain on a scale of 0 to 10 in the Brief Pain Inventory (BPI) before starting treatment, at the end of the nine sessions (at week 10) and 6 months after the end. sessions. The baseline BPI score for both groups averaged around 6.
After treatment, people in the EAET vs. CBT group had an average reduction of two points versus a reduction of 0.60, respectively, on the BPI scale. A clinically significant reduction in pain—defined as a ≥30% reduction—was reported in 63% of EAET patients compared to 17% of TBI patients (odds ratio (OR): 21.54; P. < 0.001).
At 6 months, the average reduction was 1.2 for the EAET group compared to 0.25 for the CBT group, and 40% of the EAET group reported a clinically significant reduction in pain.
Just over a third (35%) of veterans receiving EAET reported at least a 50% reduction in pain at 10 weeks, compared to 7% of those receiving CBT. At 6 months, 16% of the EAET group reported a reduction in pain by half.
EAET was also superior to CBT in reducing symptoms of anxiety, depression and PTSD after 10 weeks.
More work needed
In an accompanying editorial, Matthias Karst, MD, PhD, a clinician at the Hannover Medical School Pain Clinic, Hannover, Germany, noted that the effects of EAET “are significantly greater than those of CBT in almost all dimensions, even after 6 months. “
EAET “grants a special place to the integration of the body into emotional experience,” he writes.
The study demonstrated that “the evocation and expression of emotions are superior to simple cognitive discussion of these emotions in the treatment of patients with chronic pain.”
Commenting on the results of Medscape Medical NewsTraci J. Speed, MD, PhD, assistant professor of psychiatry and behavioral sciences and attending psychiatrist in the Johns Hopkins Pain Program at Johns Hopkins University in Baltimore, called the study “groundbreaking” because it has shown effectiveness in people with high rates of PTSD, anxiety, and depression.
“It is a little surprising how impressive the study results are in terms of maintaining effects at the end of treatment and maintaining some effects on pain sensitivity even after 6 months of follow-up,” said Speed, who was not part of the study.
However, she continued, “I don’t think this changes the current standard of practice yet. CBT is backed by decades of research and evidence demonstrating its effectiveness in treating chronic pain and I think that this will continue to be the standard of care.”
Although EAET is in its infancy, chronic pain experts are interested in learning more about the therapy, Speed added.
“This pairs well with current techniques and expands current gold standard therapeutic approaches,” she said. “We are beginning to really appreciate the role that emotions play in pain sensitivity.”
Both Karst and Speed noted that additional studies are needed to determine the durability of the treatment effects.
The sons agreed. “We need more research on the appropriate dose and perhaps how to personalize it for the patient,” he said.
The study was funded by a career development grant awarded to Yarns from the VA’s Clinical Sciences Research and Development Department. Yarns said it received grant funding from the U.S. Department of Veterans Affairs during the study. Disclosures from other authors appear in the original article. Speed reported no conflicts.
Alicia Ault is a freelance journalist based in St. Petersburg, Florida, whose work has appeared in publications including JAMA and Smithsonian.com. You can find her on X: @aliciaault.