A new form of psychotherapy appears to work even better at treating chronic pain in older adults than gold-standard cognitive behavioral therapy (CBT), a new study finds.
U.S. veterans who received emotional awareness and expression therapy (EAET) experienced a longer and more significant reduction in chronic pain than those who underwent CBT, researchers reported June 13 in the journal JAMA Network Open.
About 63% of veterans who underwent EAET reported at least a 30% reduction in pain, which is considered clinically significant, results show. By comparison, only 17% of veterans who got CBT achieved that sort of pain relief.
Further, pain reduction was sustained among 41% of EAET participants six months after treatment, compared to 14% of CBT patients.
EAET patients also reported greater benefits for addressing anxiety, depression, PTSD and life satisfaction, researchers added.
"Most people with chronic pain don't consider psychotherapy at all. They're thinking along the lines of medications, injections, sometimes surgery or bodily treatments like physical therapy,"said lead researcher Brandon Yarns, an assistant professor at UCLA Health's Department of Psychiatry and Biobehavioral Sciences.
"Psychotherapy is an evidence-based treatment for chronic pain,"Yarns added in a UCLA news release. "What this study adds is that the type of psychotherapy matters."
CBT focuses on helping patients improve their ability to tolerate pain, using exercises designed to recognize pain triggers and respond to them in helpful ways, researchers said.
Developed in the 2010s, EAET takes a different tack by focusing on emotions, researchers said.
EAET holds that the brain's perception of pain is strongly influenced by stress-related emotions.
Patients are asked to focus on a stressful interaction. It can something as mundane as being cut off by a driver or as severe as sexual assault or traumatic injury, researchers said.
The purpose is to have patients experience these emotions in both body and mind, Yarns said, and then work to confront these emotions, express their reactions and ultimately let go.
"If there is a hurt or stressor people have a series of normal, natural emotional reactions. There might be anger, guilt and sadness. Because these feelings are painful, people often avoid them, but EAET helps people face difficult feelings with honesty and self-compassion,"Yarns said. "In therapy, they can release anger, pain and guilt that they've been carrying and are left with self-compassion in the end."
For the study, researchers recruited 126 veterans ages 60 to 90 who all were experiencing chronic pain. More than two-thirds had a psychiatric diagnosis, with about one-third suffering post-traumatic stress disorder (PTSD).
Half of the vets received CBT, while the other half underwent EAET. By the end of the sessions and six months later, veterans who got EAET had less pain, results show.
All of the sessions were held in person. Yarns said he'll next study whether virtual sessions can produce the same positive results. Brain imaging studies also will be performed to understand the brain changes in patients who receive EAET and CBT.
More information
The Society for Health Psychology has more about emotional awareness and expression therapy.
SOURCE: UCLA, news release, June 13, 2024
