Emotional Awareness and Expression Therapy for Older Adults with Chronic Pain: Theory, Evidence, and Video Case Example

Abstract

Chronic pain affects millions of older adults and causes substantial disability. Yet treatment is challenging, since older patients are susceptible to serious risks from pain medications or invasive procedures. Psychotherapy is a promising treatment option because it is generally well-tolerated. However, standard psychotherapies, such as Cognitive Behavioral Therapy (CBT) or Acceptance and Commitment Therapy (ACT), produce only small effect size benefits. Emotional Awareness and Expression Therapy (EAET) is an innovative psychological approach with a unique conceptual model focused on emotional conflict and trauma—major drivers of chronic pain not directly addressed by CBT or ACT. In early trials, 1-, 3-, and 8-session group and individual formats of EAET were tested in controlled and uncontrolled trials, showing medium-to-large effect size benefits for chronic pain, but participants in these trials included mostly younger women. Beginning in 2017, Dr. Brandon Yarns has worked to adapt EAET for older veterans, streamlining to focus on key mechanisms and developing an integrated 9-session EAET format that includes 1 individual session followed by 8 weekly 90-minute sessions in groups of 6-8. Two preliminary trials showed large-to-very-large benefits, including one small randomized clinical trial that showed a significant, large effect size advantage over CBT on reduction in pain severity and a medium effect size advantage on pain's interference with mood and activities. Dr. Yarns is currently completing a 5-year VA-funded replication of the EAET vs. CBT comparison for older veterans with chronic pain, and results are anticipated before the AAGP annual meeting in March 2023. In addition, Dr. Yarns has been active in the teaching and training of new EAET therapists. In this session, 1 former and 1 current trainee of Dr. Yarns will join him to introduce learners to EAET. First, Dr. Anna Zhu will present the unique theoretical framework for EAET. Second, Dr. Yarns will present the research data on EAET, including results of his new 5-year clinical trial. Third, Dr. David Carlson, current UCLA geriatric psychiatry fellow, will present a video case example of EAET to help learners understand the key interventions and differences between EAET and standard psychological approaches. Twenty minutes will be reserved for questions and comments. Overall, learners are expected to gain a full understanding of the potential of EAET to transform the lives of many older adults with chronic pain.