Summary: For a long time, CBT has remained the gold standard among various psychotherapy options for chronic pain management. But a new study shows that a newer talk therapy, Emotional Awareness and Expression Therapy (EAET), works much better for chronic pain. Chronic pain is complex, and emotional problems play a big role in how it starts. So talk therapy can help a great deal.
Chronic pain is very different from acute pain. It is a disease in itself. It may outlast the problem that first set it off. Often, the cause of chronic pain stays unknown. We now know that chronic pain comes from both injuries and body damage and from mental factors.
So talk therapy has a special place in managing chronic pain. For a long time, cognitive behavioral therapy (CBT) has been the gold standard in managing chronic pain. Cognitive Behavioral Therapy (CBT) is a type of talk therapy. It helps people see the thoughts and feelings that shape what they do. In the end, it changes how a person acts, which drives lifestyle changes and eases pain.
Is EAET more effective than CBT for chronic pain?
This new study tested whether Emotional Awareness and Expression Therapy (EAET) beats Cognitive Behavioral Therapy (CBT) at lowering chronic pain in a mixed group of older veterans.
EAET goes after the emotional and mental factors that feed chronic pain. It looked good in smaller trials. But it had not been tested much in an older, mixed group of people.
EAET helps patients spot and work through hard emotions. These often come from past trauma or bad experiences. The goal is to reduce or end pain. In EAET, patients feel and voice these emotions in a safe therapy setting. That can change brain pathways and lower how much pain they feel. EAET is especially good for people living with emotional health issues, anxiety, PTSD, and so on.
In this randomized clinical trial, 126 veterans aged 60-95 with chronic muscle and joint pain got either EAET or CBT. Both treatments had one individual session and then eight group sessions. The team measured pain, anxiety, depression, PTSD symptoms, life satisfaction, and other outcomes. They checked at the start, right after treatment (week 10), and six months after treatment.
The results showed that EAET led to a significantly greater drop in pain than CBT. That held right after treatment and at the six-month check. In all, 63% of EAET patients reported significant pain relief (above 30% pain relief), compared to 17% in the CBT group.
EAET patients also saw bigger gains in anxiety, depression, life satisfaction, PTSD symptoms, and overall satisfaction after treatment.
The benefits were strongest in patients who started with more depression, anxiety, or PTSD.
This study matters because it is the first large trial to test EAET in an older group of mixed race and background. These patients also had complex medical and mental health conditions.
The findings suggest that EAET beats CBT at reducing pain and improving mental health in this group. The study supports adding EAET to everyday clinical care for chronic pain. That could ease the burden this condition puts on society.
Of course, more studies are still needed. It is quite likely that EAET works better in a certain group of patients, especially those with anxiety, PTSD, and other emotional issues. But keep in mind that chronic pain comes in many forms. So in the end, the pain specialist can best decide which kind of talk therapy will work for each patient.
Frequently asked questions
What is EAET therapy?
Emotional Awareness and Expression Therapy (EAET) is a psychotherapy for chronic pain that goes after the emotions underneath it. Patients learn to spot and work through hard emotions. These are often left over from past trauma or bad experiences. Then patients feel and voice them in a safe therapy setting. That work can change brain pathways and lower how much pain you feel. That is how an emotional therapy reduces physical pain.
How is EAET different from CBT?
Cognitive behavioral therapy (CBT) helps you see the thoughts and feelings that drive what you do. Then it changes that behavior and your lifestyle to ease pain. EAET works one layer deeper, on buried emotions and trauma the pain may be carrying. In a trial of 126 older veterans, 63% of the EAET group reported significant pain relief, meaning more than 30%. Only 17% of the CBT group did.
How many sessions does EAET take?
In this trial, EAET was one individual session and then eight group sessions. That is the same format as the CBT it was tested against. Patients were checked before treatment, right after it at week 10, and again six months later. EAET gave more pain relief at both points. So its edge over CBT lasted at least six months after the sessions ended.
Who benefits most from EAET for chronic pain?
The benefits were strongest in people who started with more depression, anxiety or PTSD symptoms. EAET is a particularly good fit when emotional health problems ride along with the pain. Still, chronic pain comes in many forms. So the pain specialist decides which kind of talk therapy fits each patient, rather than handing everyone the same one.
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
Dr. Gurpreet Singh Padda, MD, MBA, MHP
