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Study Finds Emotional Awareness and Expression Therapy Superior to CBT for Chronic Pain in Older Veterans

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A recent clinical trial conducted by the US Department of Veterans Affairs has revealed that emotional awareness and expression therapy (EAET) is more effective than cognitive behavioural therapy (CBT) in managing chronic pain among older veterans. The study, published in JAMA Network Open, offers promising insights into pain management for this demographic, highlighting the potential of EAET in addressing both the physical and emotional aspects of chronic pain.

Chronic pain is a prevalent and debilitating condition among older adults, significantly impacting their quality of life. Traditional psychological interventions, like CBT, have shown only modest benefits in alleviating chronic pain. This study aimed to evaluate whether EAET, a therapy that focuses on emotional processing and expression, could provide superior relief compared to CBT.

The randomised clinical trial was conducted between May 2019 and September 2023 at the VA Greater Los Angeles Healthcare System. It involved 126 veterans aged 60–95 years, all suffering from musculoskeletal pain for at least three months. The participants were racially and ethnically diverse, with the majority being male. They were randomly assigned to either the EAET or CBT group.

Both therapies included one 90-minute individual session followed by eight 90-minute group sessions. The primary outcome measured was the change in pain severity using the Brief Pain Inventory (BPI), from baseline to post-treatment (week 10) and at a six-month follow-up. Secondary outcomes included measures of anxiety, depression, fatigue, life satisfaction, pain interference, sleep disturbance, global impression of change, and satisfaction with therapy.

The results demonstrated that EAET significantly outperformed CBT in reducing pain severity. Participants in the EAET group showed a greater reduction in pain scores both at the end of the treatment period and at the six-month follow-up. Specifically, the EAET group exhibited an average decrease in pain severity of 1.59 points at post-treatment and 1.01 points at the six-month follow-up, compared to the CBT group.

A higher percentage of EAET participants achieved clinically significant pain reductions. At post-treatment, 63% of those in the EAET group experienced at least a 30% reduction in pain, compared to only 17% in the CBT group. The odds ratio for achieving this level of pain reduction was 21.54, indicating a substantial benefit of EAET over CBT​​.

EAET also showed superior results in secondary outcomes related to psychological well-being. Participants in the EAET group reported greater reductions in anxiety, depression, and PTSD symptoms. They also experienced improvements in general life satisfaction and overall treatment satisfaction. These benefits were particularly pronounced in participants with higher baseline levels of depression, anxiety, or PTSD, suggesting that EAET is especially effective for individuals with comorbid psychological conditions​​.

The findings from this study underscore the importance of addressing the emotional and psychological dimensions of chronic pain. EAET’s focus on emotional awareness and expression appears to be a key factor in its effectiveness. By helping patients process and express difficult emotions, EAET not only alleviates pain but also improves overall mental health and quality of life.

While the study presents compelling evidence for the efficacy of EAET, further research is needed to confirm these findings in broader and more diverse populations. The study’s focus on in-person therapy sessions raises questions about the potential for delivering EAET via telehealth, especially given the increasing reliance on digital health services.

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