How Psychotherapy for Trauma May Help Chronic Pain

Research on veterans provides an interesting ray of hope.

Reviewed by Abigail Fagan

Key points

• Researchers investigated the effects of emotional awareness and expression therapy (EAET) on chronic pain.
• Over 60 percent of participants reported a clinically significant reduction in their experience of pain.
• Psychological interventions are crucial in supporting those suffering from physical pain.

Chronic pain is a condition with immense emotional impacts and one that can be brutal for its sufferers—affecting quality of life, mood, relationships, and work. Its psychological effects are well-documented. In a recent study by UCLA Health and the US Veterans Affairs Office and published in JAMA Network Open, however, the reverse direction is explored. This study took a look at the impact of emotions and stress on chronic pain, revealing fascinating possibilities for the role of psychological treatment in reducing the suffering of it.

One hundred and twenty-six predominantly male American veterans aged 60-95 participated, with all of them having reported at least three months of pain in their musculoskeletal system, and about one-third of them having post-traumatic stress disorder. The researchers investigated the effects of a relatively new therapy known as emotional awareness and expression therapy (EAET), and compared it to traditional cognitive-behavioral therapy (CBT), with half of the participants being assigned to each condition. Individual and group sessions were combined over nine weeks for each set of participants.

EAET has been gaining ground over the past 10 years and has a particular eye toward targeting the experience of pain. As its name implies, it is more emotion-based than CBT, focusing not only on cognitions and behavior, but on the subjective distress of negative emotional experiences as well. EAET teaches participants about the stress response and its effects on the mind and body, and encourages them to experience those emotions in a nonthreatening way that helps them understand them further, rather than trying to avoid them. Participants are encouraged to talk about, recall, and experience their feelings fully, rather than focusing on resetting their cognitions or doing relaxation exercises to immediately lower their anxiety.

Of the veterans who underwent EAET, 63 percent reported a clinically significant reduction in their experience of pain, and this result was sustained six months after treatment. Strikingly, the EAET condition outperformed CBT, the latter showing a clinically significant pain-reduction effect in only 17 percent of veterans. This may come as something of a surprise, as CBT has typically been thought of as the optimal psychotherapeutic treatment for veterans with chronic pain and has been widely embraced for it—but its effects have always seemed relatively modest.

What's more, veterans in the EAET condition also reported additional benefits, as would be hoped, in terms of their PTSD, anxiety, depression, and life satisfaction.

As this and other studies make clear, psychological interventions are crucial in supporting those suffering from physical pain, and newly developed psychotherapies may be even more effective than CBT. While this study focused on older men, previous research on EAET has appeared to show benefits in younger females who suffer from chronic pain as well—offering hope for a potential wide-reaching tool in the arsenal of those who fight this brutal condition on a daily basis. The mind-body connection is clearly bidirectional, and it is heartening to see multidisciplinary teams bringing all resources to the table—cognitive, emotional, behavioral, and physical—as there are fewer and fewer reasons to draw lines among them.