Racism as a Source of Pain

Schubiner, Howard; Jackson, Benita; Molina, Kristine M.; Sturgeon, John A.; Sealy-Jefferson, Shawnita; Lumley, Mark A.; Jolly, Jallicia; Trost, Zina

doi:10.1007/s11606-022-08015-0

Cited by 8 publications

(4 citation statements)

References 71 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The EAET followed a manual for the individual session that was developed and piloted for this population and the group manual developed by Lumley and Schubiner, which was previously adapted for the population . The EAET participants were presented with the EAET conceptual model that failure to adaptively process and resolve emotional symptoms—resulting from adverse childhood experiences, trauma, or victimization—can change brain pathways involved in the processing of both pain and emotion, leading to or exacerbating pain symptoms . The goals of EAET are to learn that the brain’s perception of pain is strongly influenced by evading trauma- or stress-related emotions (eg, emotional pain or grief, fear, rage, and guilt) and to face and resolve such emotions to reduce or eliminate chronic pain .…”

Section: Methodsmentioning

confidence: 99%

“… 41 The EAET participants were presented with the EAET conceptual model that failure to adaptively process and resolve emotional symptoms—resulting from adverse childhood experiences, trauma, or victimization—can change brain pathways involved in the processing of both pain and emotion, leading to or exacerbating pain symptoms. 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 The goals of EAET are to learn that the brain’s perception of pain is strongly influenced by evading trauma- or stress-related emotions (eg, emotional pain or grief, fear, rage, and guilt) and to face and resolve such emotions to reduce or eliminate chronic pain. 26 , 45 The individual session presented the therapy model and invited participants to engage in a trial of emotional processing, consisting of experiencing trauma- or stress-related emotions in the body, expressing them in words, and releasing or letting them go in adaptive ways (eg, imaginarily buried or cast out to sea).…”

Section: Methodsmentioning

confidence: 99%

“…11,12 In addition, veterans have high rates of severe pain 13 and overlap between pain and psychiatric conditions, such as depression, anxiety, and posttraumatic stress disorder (PTSD), [14][15][16][17] which may further limit the effectiveness of CBT. 18 Adverse childhood experiences, [19][20][21] military combat, 22 racism or discrimination, 23,24 and psychiatric conditions 16,25 are associated with the presence and severity of chronic pain, but are not directly addressed by CBT. Emotional awareness and expression therapy (EAET) 26 was developed to target these critical drivers of chronic pain.…”

Section: Introductionmentioning

confidence: 99%

“…Adverse childhood experiences, 19 , 20 , 21 military combat, 22 racism or discrimination, 23 , 24 and psychiatric conditions 16 , 25 are associated with the presence and severity of chronic pain, but are not directly addressed by CBT. Emotional awareness and expression therapy (EAET) 26 was developed to target these critical drivers of chronic pain.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans

Yarns,

Jackson,

Alas

et al. 2024

JAMA Netw Open

Self Cite

View full text Add to dashboard Cite

ImportanceChronic pain is common and disabling in older adults, and psychological interventions are indicated. However, the gold standard approach, cognitive-behavioral therapy (CBT), produces only modest benefits, and more powerful options are needed.ObjectivesTo evaluate whether emotional awareness and expression therapy (EAET) is superior to CBT for treatment of chronic pain among predominantly male older veterans and whether higher baseline depression, anxiety, or posttraumatic stress disorder (PTSD) symptoms—key targets of EAET—moderate treatment response.Design, Setting, and ParticipantsThis 2-arm randomized clinical trial was conducted from May 16, 2019, to September 14, 2023, in the US Department of Veterans Affairs Greater Los Angeles Healthcare System. The trial included a racially and ethnically diverse group of veterans aged 60 to 95 years with at least 3 months of musculoskeletal pain.InterventionsEmotional awareness and expression therapy or CBT, conducted concurrently, each presented as one 90-minute individual session followed by eight 90-minute group sessions.Main Outcomes and MeasuresThe primary outcome was Brief Pain Inventory pain severity (range, 0 to 10) from baseline to posttreatment (week 10, primary end point) and 6-month follow-up. Secondary outcomes included Patient Reported Outcomes Institute Measurement System Anxiety, Depression, Fatigue, General Life Satisfaction (NIH Toolbox), Pain Interference, and Sleep Disturbance Short Forms, Patient Global Impression of Change (PGIC), and Satisfaction with Therapy and Therapist Scale-Revised. A subset of participants completed the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). All analyses were for the intention-to-treat population and included all randomized participants.ResultsAmong 126 randomized participants (66 in the EAET group and 60 in the CBT group; mean [SD] age, 71.9 [5.9] years; 116 [92%] male), 111 (88%) completed posttreatment, and 104 (82%) completed the 6-month follow-up. The EAET was superior to CBT for the primary outcome of reduction in pain severity at posttreatment (estimate, −1.59 [95% CI, −2.35 to −0.83]; P &lt; .001) and follow-up (estimate, −1.01 [95% CI, −1.78 to −0.24]; P = .01). A greater percentage of participants in EAET vs CBT had clinically significant (at least 30%) pain reduction (63% vs 17%; odds ratio, 21.54 [95% CI, 4.66-99.56]; P &lt; .001) at posttreatment. In addition, EAET was superior to CBT on 50% pain reduction (35% vs 7%; odds ratio, 11.77 [95% CI, 2.38-58.25]; P = .002), anxiety (estimate, −2.49 [95% CI, −4.30 to −0.68]; P = .006), depression (estimate, −3.06 [95% CI, −5.88 to −0.25]; P = .03), general life satisfaction (estimate, 1.23 [95% CI, 0.36-2.10]; P = .005), PTSD symptoms (estimate, −4.39 [95% CI, −8.44 to −0.34]; P = .03), PGIC score (estimate, 1.46 [95% CI, 0.77-2.15]; P &lt; .001), and global treatment satisfaction (estimate, 0.28 [95% CI, 0.12-0.45]; P &lt; .001) at posttreatment. Higher baseline depression (estimate, −1.55 [95% CI, −0.37 to 2.73]; P &lt; .001), anxiety (estimate, −1.53 [95% CI, −2.19 to −0.88]; P &lt; .001), and PTSD symptoms (estimate, −1.69 [95% CI, −2.96 to −0.42]; P = .009) moderated greater reduction in pain severity after EAET but not CBT.Conclusions and RelevanceThe results of this randomized clinical trial suggest that EAET may be a preferred intervention for medically and psychiatrically complex patients with pain. The societal burden of chronic pain could be improved by further incorporating the principles of EAET into mainstream clinical pain medicine.Trial RegistrationClinicalTrials.gov Identifier: NCT03918642

show abstract

Section: Methodsmentioning

confidence: 99%