What is Emotional Awareness and Expression Therapy?

Emotional Awareness and Expression Therapy (EAET) was developed to help people with chronic pain and has been effective in assisting people to reduce their pain. It focuses on the emotional causes of chronic pain and can be combined with other therapies beneficial for chronic pain.

What is Emotional Awareness and Expression Therapy?

Emotional Awareness and Expression Therapy (EAET) is a form of psychological therapy that targets the trauma, stress, and relationship issues that are found in many people with chronic pain, especially nociplastic pain. Nociplastic pain is predominantly influenced by the brain’s thoughts, feelings, and interpretation. Stress throughout your life and how you handle emotions from that stress can trigger, worsen, or maintain your pain. EAET focuses on helping you resolve your earlier life stresses.

Mark Lumley and Howard Schubiner developed EAET for psychological trauma or conflict in patients with primary chronic pain. It has pulled from other therapies that help clients face their traumas and conflicts, gain awareness of their feelings, experience their emotions, and express their emotions adaptively. These therapies include Prolonged Exposure Therapy, Intensive Short-term Dynamic Psychotherapy (ISTDP), Emotion-focused Therapy, Written Emotional Disclosure, and Rescripting Therapy. These therapies, along with others like EMDR designed for trauma, are helpful for people who have experienced trauma and chronic pain.

Components of Emotional Awareness and Expression Therapy

Psychoeducation is an integral part of EAET because it is crucial to understand that it is your brain that generates and amplifies your primary pain. You can reduce or increase your pain by affecting the neural pathways that regulate the pain. Your pain is real, you are not weak, and your pain is not your fault. Unfortunately, your brain has been wired to produce pain based on your experiences and events. These can include injuries, medical procedures, abuse, neglect, trauma, and other victimization. Stressful experiences can also elicit or amplify pain. This can be difficult when you are feeling helpless, hopeless, and worried about your condition.

In EAET, your therapist will challenge you to recognize and express avoided emotions. In the safety of therapy, you’ll be encouraged to recall a person, situation, and experience and express the feelings associated with that person using words, tone of voice, facial expressions, and gestures. If appropriate, you may also be encouraged to use strategies outside of therapy. Suppose you are nervous about your ability to regulate your emotions during EAET. In that case, you can work with your therapist to learn emotion regulation skills before starting EAET.

How Does Emotional Awareness and Expression Therapy Work?

EAET can be conducted in individual or group sessions. It has shown positive results with eight group sessions and different amounts of individual sessions. You may need more than eight sessions. It has demonstrated effectiveness in Internet, video, and in-person therapy forms.

EAET views nociplastic pain as reversible if you make influential changes to your emotions and relationships.

Process in Emotional Awareness and Expression Therapy

EAET has four components. First, the role of stress and emotions in your pain is taught. Second, you are encouraged to disclose and talk (or write) about the trauma you have experienced and psychological conflicts in your life that appear to drive your pain. Third, you are encouraged to express the emotions you have been avoiding or blocking related to trauma or stressors. Finally, you learn to communicate more effectively by balancing assertiveness and healthy boundaries with openness and closeness. At this point, there is usually a substantial reduction in pain and an improvement in mood and functioning.

What Does the Research Say?

What Conditions Does It Help?

EAET has been effective at reducing the symptoms of nociplastic pain conditions, such as fibromyalgia, irritable bowel syndrome, chronic pelvic pain, headaches, and non-specific musculoskeletal pain, as well as conditions with medically unexplained symptoms. In a study on fibromyalgia, EAET has also been able to improve accompanying symptoms such as insomnia (sleep issues), anxiety, depression, and cognitive difficulties.

How Does It Compare to Cognitive Behaviour Therapy (CBT)?

A study comparing EAET and Cognitive Behaviour Therapy (CBT) found that EAET was associated with significantly reducing chronic pain severity significantly than CBT. Two-thirds of the patients who received EAET reported at least a 30% reduction in pain compared with 17% of those who received CBT. The study also showed that individuals with depression and anxiety responded more favourably to EAET. EAET has been effective with both males and females from ethnically diverse backgrounds and complex psychiatric backgrounds. At ten weeks, 35% in the EAET treatment group reported at least a 50% reduction in pain compared with 7% for the CBT treatment group. Six months post-treatment, 16% in the EAET treatment group reported at least a 50% reduction in pain.

Emotional Awareness and Expression Therapy Applications in Therapy

EAET is also well-positioned to work well with other therapies that can be useful for people with chronic pain. CBT and Pain Reprocessing Therapy (PRT) complement it well.

Conclusion

EAET has had much success helping people with chronic pain reduce their pain by adding to their understanding of the pain system and expressing the emotions that are triggering, amplifying, or maintaining their pain. It has worked for multiple chronic pain conditions, and further research continues to show how effective it is.