A newly published study in JAMA Network Open on June 13, led by UCLA Health and the U.S. Veterans Affairs Office, discovered that chronic pain among older adults could be significantly lessened through a recently created psychotherapy. This therapy addresses past trauma and stress-related emotions that can worsen pain symptoms.Therapy, also known as emotional awareness and expression therapy, or EAET, was compared to traditional cognitive behavioral therapy, or CBT, for the treatment of chronic pain and mental health symptoms in older veterans. The study showed that 63% of veterans who received EAET reported a significant 30% reduction in pain after treatment, compared to only 17% of those who underwent CBT. Furthermore, 41% of EAET participants still had reduced pain six months after treatment, while only 14% of CBT patients experienced sustained pain reduction.A study found that patients with chronic pain reported significant improvements in addressing anxiety, depression, PTSD, and overall life satisfaction. The lead author of the study, Brandon Yarns, highlighted that many people with chronic pain do not consider psychotherapy as a treatment option, often opting for medications, injections, or surgery instead. However, the study emphasized that psychotherapy is an effective evidence-based treatment for chronic pain, with the type of therapy being an important factor. Specifically, cognitive behavioral therapy was mentioned as a beneficial type of psychotherapy for chronic pain.CBT has long been considered the top choice for treating chronic pain in veterans, according to Yarns. However, studies have shown that CBT only provides modest relief for pain. The treatment package for chronic pain includes various exercises similar to those used for depression or anxiety, such as guided imagery, muscle relaxation, cognitive restructuring, and activity pacing. The ultimate objective is to help patients improve their pain tolerance, Yarns added.
“The aim of CBT is not necessarily to cure pain, but to teach patients how to cope and live well despite chronic pain,” Yarns explained.
In comparison,EAET focuses on one primary intervention: helping individuals to experience, express, and release emotions. Developed in the 2010s, this therapy is geared towards demonstrating to patients how the brain’s perception of pain is heavily impacted by stress-related emotions. Patients are instructed to concentrate on a stressful interaction, ranging from minor incidents like being cut off by a driver to more severe traumas such as sexual assault. The goal is for patients to fully experience these emotions both mentally and physically. Following this, patients are encouraged to address these emotions, articulate their reactions, and ultimately, release them.”Treatment with EFT helps individuals confront challenging emotions with honesty and self-compassion, allowing them to release feelings of anger, pain, and guilt,” stated Yarns. The study included 126 veterans, mainly male, aged 60 to 95, with at least three months of musculoskeletal pain. Over two-thirds of the participants had a psychiatric diagnosis, and approximately one-third had post-traumatic stress disorder.The research was the first large-scale clinical trial of EAET in older adults, particularly older men and veterans. Previous studies had mainly involved younger, female participants, according to Yarns.
Half of the participants received in-person cognitive behavioral therapy, while the other half received in-person emotional awareness and expression therapy. This was done over nine sessions, including one personal session and eight small group sessions.
Prior to beginning treatment, patients rated their pain levels using a 0 to 10 scale in the Brief Pain Inventory. They also rated their pain levels at the end of the nine sessions and again six months after the treatment.The study concluded with 63% of EAET participants reporting a 30% or more reduction in pain after treatment, compared to only 17% of CBT patients. Yarns is currently researching the potential for positive outcomes using virtual group sessions, comparing EAET, CBT, and mindfulness therapy. Additionally, he plans to conduct neuroimaging studies to further understand the brain changes in EAET and CBT therapy participants.
