JULY 19, 2024
Cognitive behavioral therapy (CBT) is considered the gold standard of psychological interventions to address chronic physical pain. However, a recent study suggests that emotional awareness and expression therapy (EAET) provides superior relief.
“Many cases of chronic musculoskeletal pain, such as back pain, neck pain, tension headaches or fibromyalgia, may be significantly reduced or even eliminated by facing, processing and resolving emotional pain—in the form of anger, resentment,
Cognitive behavioral therapy (CBT) is considered the gold standard of psychological interventions to address chronic physical pain. However, a recent study suggests that emotional awareness and expression therapy (EAET) provides superior relief.
“Many cases of chronic musculoskeletal pain, such as back pain, neck pain, tension headaches or fibromyalgia, may be significantly reduced or even eliminated by facing, processing and resolving emotional pain—in the form of anger, resentment, guilt, grief and other painful emotions—arising from trauma, relationship conflicts and life stress,” study author Brandon C. Yarns, MD, MS, a staff psychiatrist in the geriatric mental health section at VA Greater Los Angeles Healthcare System, explained to Pain Medicine News.
A group of 126 racially and ethnically diverse veterans, 60 to 95 years of age with at least three months of musculoskeletal pain, were randomized to treatment with EAET (n=66) or CBT (n=60) (JAMA Netw Open 2024;7[6]:e2415842). Among trial participants, 111 (88%) completed post-treatment and 104 (82%) completed the six-month follow-up.
Researchers found EAET was superior to CBT for the primary outcome of post-treatment reduction in pain severity (estimate, −1.59; 95% CI, −2.35 to −0.83; P<0.001) and follow-up (estimate, −1.01; 95% CI, −1.78 to −0.24; P=0.01).
A greater percentage of participants in the EAET group compared with the CBT group had clinically significant (≥30%) pain score reductions after treatment (63% vs. 17%, respectively; P<0.001). Furthermore, EAET was superior to CBT in providing 50% reductions in patients’ pain scores (35% vs. 7%, respectively; P=0.002).
The study was limited by the fact that it was conducted at only one site with older veterans who were predominantly men, Yarns noted. He discussed that all therapy was conducted in person, but to improve the ability to reach more patients, EAET should be tested in a virtual/remote format. His team is conducting a larger study at two Veterans Affairs sites that will include more women and provide EAET, CBT or mindfulness training using video telehealth groups.
—Myles Starr
Yarns reported receiving grants from the Department of Veterans Affairs during the conduct of the study.
