Emotional Processing and Its Association to Somatic Symptom Change in Emotional Awareness and Expression Therapy for Somatic Symptom Disorder: A Preliminary Mediation Investigation.

Daniel Maroti,Howard Schubiner,Robert Johansson,Henrik Hallberg,Brjánn Ljótsson,Mark A Lumley,Per-Åke Olsson

doi:10.3389/fpsyg.2021.712518

Abstract

Objective: The aim of this study was to investigate emotional processing as a potential mediator in therapist-guided, internet-based Emotional Awareness and Expression Therapy (I-EAET) for somatic symptom disorder, using data from a previously published pilot study.Methods: Participants (N = 52) engaged in a 9-week I-EAET treatment. Before treatment and each week during treatment (i.e., 10 weekly measurements), emotional processing was assessed with the Emotional Processing Scale-25 (EPS-25), which contains five subscales, and somatic symptoms were assessed with the Patient Health Questionnaire-15 (PHQ-15).Results: Mediation analyses using linear mixed models showed that two EPS-25 subscales—Signs of Unprocessed Emotions and Impoverished Emotional Experience—were uniquely associated with somatic symptom reduction. The proportion of the mediated effect was 0.49, indicating that about half of the total association of the PHQ-15 with symptoms was accounted for by the two EPS-25 subscales.Conclusion: This preliminary mediation analysis suggests that improved emotional processing is associated with change in somatic symptoms in I-EAET. However, randomized controlled and comparison trials are needed to establish that I-EAET creates the change in emotional processing and that such changes are specific to I-EAET.

Highlights

Emotional Awareness and Expression Therapy (EAET) is a newly developed therapy for patients with chronic somatic symptoms stemming from central sensitization or amplification (Lumley and Schubiner, 2019)
EAET has been found to be superior to treatment as usual, education controls, or even CBT in randomized controlled trials in patients with fibromyalgia (Lumley et al, 2017), irritable bowel syndrome (IBS) (Thakur et al, 2017), pelvic pain (Carty et al, 2019), medically unexplained symptoms (Ziadni et al, 2018), and musculoskeletal pain (Yarns et al, 2020)
We examined whether an increased capacity for emotional processing is related to reduced somatic symptoms during and following internet-administrated version of EAET (I-EAET)

Summary

Introduction

Emotional Awareness and Expression Therapy (EAET) is a newly developed therapy for patients with chronic somatic symptoms stemming from central sensitization or amplification (Lumley and Schubiner, 2019). EAET, which integrates short-term psychodynamic therapy, emotion-focused therapy, and exposure therapy, proposes that addressing the consequences of trauma or stressful life events by increasing emotional awareness and engaging in emotional processing reduces patients’ symptoms. I-EAET includes four components: (a) pain neuroscience psychoeducation to help patients reattribute symptoms to central nervous system processes; (b) the identification of possible connections between stressful life events and somatic symptoms; (c) anxiety regulation via daily self-compassion meditations; and (d) emotional exposure and processing using expressive writing and being more expressive and assertive in relationships. The emotional exposure component, which targets the processing of suppressed or avoided emotions, is thought to be the key component leading to somatic symptom reduction

Methods

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Discussion

Conclusion