Summary: Chronic pain is complex, with a significant role of emotional disorders in pain development. Hence, psychotherapy can be of great help in the condition. For a long, CBT has remained the golden standard among various psychotherapy options for chronic pain management. However, a new study shows that a new kind of psychotherapy, Emotional Awareness and Expression Therapy (EAET), is much more effective for chronic pains.
Chronic pain is very different from acute pain. It is a disease in itself. It is a pain that may outlast the condition that initially initiated the pain. Often, the cause of chronic pain remains unidentified. It is now a well-known fact that chronic pain results from both injuries or physical pathologies and psychological factors.
Hence, it also means that psychotherapy has a special place in managing chronic pain. For long, cognitive behavioral therapy (CBT) has remained the gold standard in managing chronic pain. Cognitive Behavioral Therapy (CBT) is a type of psychotherapeutic treatment that helps individuals understand the thoughts and feelings that influence behaviors. Ultimately, it alters how a person behaves, promoting lifestyle changes and relieving pain.
However, now researchers have come up with a new kind of psychotherapy with a greater focus on emotional responses. This psychotherapy is even better than CBT for managing chronic pain.
This new study examined whether Emotional Awareness and Expression Therapy (EAET) is more effective than Cognitive Behavioral Therapy (CBT) in reducing chronic pain severity among a diverse group of older veterans.
EAET helps address underlying emotional and psychological factors contributing to chronic pain and has shown promise in smaller trials but has not been extensively tested in an older, diverse population.
EAET focuses on helping patients recognize and process difficult emotions, often stemming from past traumas or adverse experiences, to reduce or eliminate pain symptoms. EAET involves experiencing and expressing these emotions in a safe therapeutic setting, which can lead to changes in brain pathways and a decrease in pain perception. EAET is especially good for those living with emotional health issues, anxiety, PTSD, and so on.
In this randomized clinical trial, 126 veterans aged 60-95 with chronic musculoskeletal pain were assigned to either EAET or CBT. Both treatments consisted of one individual session followed by eight group sessions. Participants were assessed for pain severity, anxiety, depression, PTSD symptoms, life satisfaction, and other outcomes at baseline, post-treatment (week 10), and six months after treatment.
The results showed that EAET led to a significantly greater reduction in pain severity compared to CBT, both immediately after treatment and at the six-month follow-up. Thus, 63% of EAET participants reported significant pain relief (above 30% pain relief) compared to 17% in the CBT group.
EAET participants also experienced more substantial improvements in anxiety, depression, life satisfaction, PTSD symptoms, and global satisfaction post-treatment.
The benefits were particularly pronounced in participants with higher baseline symptoms of depression, anxiety, or PTSD.
This study is significant as it is the first large-scale trial to test EAET in an older, racially, and ethnically diverse population with complex medical and psychiatric conditions.
The findings suggest that EAET is more effective than CBT in reducing pain and improving psychological outcomes in this group. The study supports the integration of EAET into mainstream clinical practice for managing chronic pain, potentially easing the societal burden of this condition.
Of course, there is still a need for more studies. It is quite likely that EAET is more effective in a specific subgroup of patients, especially those experiencing anxiety, PTSD, and other emotional issues. However, it must be kept in mind that chronic pain is a diverse disorder. Hence, ultimately, the pain specialist can best decide what kind of psychotherapy will work for that particular patient.
Source:
Yarns, B. C., Jackson, N. J., Alas, A., Melrose, R. J., Lumley, M. A., & Sultzer, D. L. (2024). Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans: A Randomized Clinical Trial. JAMA Network Open, 7(6), e2415842. https://doi.org/10.1001/jamanetworkopen.2024.15842
