Doctors should consider treating fibromyalgia patients with therapies that target emotional awareness and expression relating to psychosocial adversity and conflict, urges a team of Michigan researchers.
Their study, “Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial,” appeared in the journal Pain.
Fibromyalgia develops due to alterations in the central nervous system, which result from an interplay of biological and psychosocial factors. Existing drugs to treat fibromyalgia are ineffective for many patients. For this reason, psychological interventions such as cognitive-behavioral therapy (CBT) were developed to teach patients self-management skills.
CBT is seen as the gold-standard, non-pharmacological treatment in this field and is recommended in treatment guidelines. However, the benefits of this therapy are modest.
Fibromyalgia patients often fail to process and resolve lifetime psychosocial adversity, traumas, interpersonal difficulties and emotional conflicts, which tend to be more common among such patients. One hypothesis for this is that fibromyalgia — a condition based on the central nervous system — might be improved and reversed in patients engaged in a “corrective emotional experience.”
Researchers at Detroit’s Wayne State University and the University of Michigan integrated techniques from trauma and emotion-focused therapies to create an approach called Emotional Awareness Expression Therapy (EAET). Its goal: to let patients attribute their pain and other symptoms to emotionally activated CNS mechanisms, and to be able to experience and express their emotions linked to adversity, trauma or conflict.
Researchers conducted a clinical trial to evaluate the use of EAET along with fibromyalgia education, which involves teaching patients about the disease. EAET was also compared to CBT. The team determined changes in multiple patient-reported outcomes, and evaluated the feasibility, acceptability and safety of conducting EAET in patients with fibromyalgia.
In total, 230 patients with fibromyalgia were randomized to receive eight 90-minute sessions of either EAET, CBT or FM education. Outcomes were evaluated at baseline, post-treatment or a six-month follow-up.
When undergoing EAET, patients had to disclose issues that were stressing them. They were encouraged and helped to identify and express emotions by engaging in role-playing and empty-chair techniques. At the same time, patients used their bodies and voices to express avoided or missed feelings.
Outside the session, patients were encouraged to communicate with people in their lives, and their weekly homeworking included expressive writing, observing emotions and communication patterns, and engaging in emotionally activating daily activities.
Results showed that EAET did not differ from fibromyalgia education in terms of pain severity, which was the primary outcome. However, patients in the EAET group did significantly better than the ones in the fibromyalgia education group regarding overall symptoms, widespread pain, physical functioning, cognitive dysfunction, anxiety, depression, positive affect and life satisfaction.
Furthermore, 34.8 percent of EAET patients said they were much or very much improved, while only 15.4 percent of fibromyalgia education patients said that.
Regarding CBT, EAET did not differ significantly from CBT on the primary or most secondary outcomes. However, EAET patients had lower widespread pain than did CBT patients. In fact, 22.5 percent of those in the EAET group reported a 50 percent pain reduction compared to only 8.3 percent in the CBT group.
“An intervention targeting emotional awareness and expression related to psychosocial adversity and conflict was well received, more effective than a basic educational intervention, and had some advantages over CBT on pain,” the team said, urging doctors to consider EAET as an additional treatment option.
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