Episode 5: What can be done for fibromyalgia - Emotional Awareness and Expression therapy

Hello and Welcome everyone to episode #5!

Today I am going to talk about another part of pain reprocessing therapy - Emotional Awareness and Expression therapy

Let me first briefly summarize the main teaching points of prior 4 episodes 

1. Fibromyalgia pain – neuroplastic pain - misfiring neurons in the brain pain centers and pain pathways. They are misinterpreting safe or neutral signals from the body. THE PAIN IS REAL. The good news is that the pain pathways CAN BE REWIRED and the pain reversed. Other names for neuroplastic pain are central SENSITIZATION or AUGMENTATION pain.
2. Reasons for pain: unprocessed emotions, prior traumatic experiences in life, exacerbated by current trauma or injuries.
3. Winning at fibromyalgia process – my unique method implemented in treatment of my patients with fibromyalgia that borrows from several fields. The principal parts of the process are: Confirm the diagnosis of fibromyalgia (best handled by a Rheumatologist), 2. Education about the neuroplastic pain and Being open to the diagnosis/the concept of neuroplastic pain, and
4. Willingness to Try the methods PRT (pain reprocessing therapy). Of those we talked about A) the practice of fierce self-compassion which combines mindfulness, identifying our emotions and giving ourselves love and compassion like we would do for other people. B) somatic tracking which consists of approaching your pain with curiosity and basically “scanning” your body for all the sensations you feel in the moment and instead of being annoyed or upset, you send safety messages to your brain such as “I am ok, brain, I am healthy and strong, it will be ok”. The purpose of that is to soothe the brain and reassure it like you would reassure a scared small child.

Today I will talk about a psychological therapy referred to as emotional awareness and expression therapy (EAET). It is SOMEWHAT new approach but HAS been studied with SUCCESS in patients with fibromyalgia. Some case studies even suggest it can lead to RESOLUTION or REMISSION of the pain in some people! This is why I am so excited about this technique and have started using it in my practice in selected patients in whom I deemed it safe to proceed.

We already touched upon how the stress and emotions from the stress, can trigger, worsen or maintain our pain. Focus of EAET is the trauma, stress and relationship problems found in many people with chronic pain. Even more precisely, it focuses on thoughts and feelings.

So how does it work? It is done in individual or group sessions, anywhere from 8-12 sessions.

After educating my patients about the role of stress and emotions in their pain, we talk about the traumas or conflicts in their lives that appear to drive their pain. Some patients have told me upon initial discussion that they did not have any repressed emotions or no past trauma. As we start talking more, it turns out they have been through so much emotional pain and charged experiences, but they just did not associate them with their physical pain. We talk about it and I ask them to express emotionsthey have been avoiding or blocking related to the trauma or stressors, especially anger, but also guilt, sadness, love and self-compassion.

Because EAET is rather new, there are few providers who have been trained specifically to deliver it. Many psychologists and other mental health providers have training in trauma-focused therapies and "exposure-based" therapies that help patients overcome their fears.

I am part of the pain reprocessing therapy course led by Dr. Schubiner who is one of the leading minds in the field of chronic pain and utilization of pain reprocessing therapy. He shares with us many successful stories and demonstrations of this techniques in his practice, the success and often immediate improvement is astounding.

A Therapist has patients revisit important conflicts or traumatic experiences that involve other people and helps patients "express the unexpressed" feelings to those people. This can be done with writing exercises but also involves "talking to" an empty chair where the imagined other person sits.

Patients are encouraged to activate and express their emotions fully, using their words, voice tone, and bodily expression (arms, face). Patients are helped to express the full range of avoided emotionsThey usually go through a range of emotions with guilt following anger, then sadness. Then they are guided by a therapist to love and self-compassion. This is all done with just imagining the other person.

Finally, patients are encouraged to plan and role play how they would like to be in real life with people who have been a source of stress or conflict. Such communication depends on the type of relationship and may involve healthy assertiveness and setting boundaries, and often includes being open, vulnerable, and expressing intimacy. Throughout therapy, patients are encouraged to work on emotional awareness, writing exercises, emotional expression, and healthy communication as homework. Successful EAET is typically associated with substantial reductions or even elimination of pain as well as improvements in functioning, mood, and relationships.

EAET and related approaches are associated with greater risk than CBT and other psychological treatments for chronic pain. EAET encourages patients to disclose and emotionally express experiences and feelings that may have been avoided for many years and that often are quite upsetting. It is not uncommon, therefore, for patients to become temporarily more upset (e.g., anxious, depressed, angry) as they start to deal with memories and feelings that have long been avoided. Pain and other physical symptoms sometimes increase temporarily. Because patients are encouraged to communicate and interact differently in their relationships, these relationships might change in ways that are unexpected. Practitioners of EAET believe, however, that such emotional and relationship changes are important to make, and even though they may be difficult in the short run, such changes can be healthy and lead to pain reductions in the longer-term.

EAET may not be appropriate for certain patients, especially those who have difficulties regulating their emotions, who have trouble thinking when they are emotional, or who tend to hurt themselves or others when memories or feelings are activated or intense. This would be all assessed during early sessions and decisions would be made how to best proceed.

That’s it for today’s session.

Please share or leave a review if you found it helpful. I would really appreciate it.

In the next episode, we will start tying all of these individual parts I have spoken about so far, together. A Winning at fibromyalgia approach is slowly emerging 

Until next time 