Video telehealth emotional awareness and expression therapy for older U.S. military veterans with chronic pain: A pilot study

Yarns, Brandon C.; Molaie, Ali M; Lumley, Mark A.; Zhu, Tongtong A.; Jazi, Ali Najafian; Ganz, David A.

doi:10.1080/07317115.2022.2159909

Cited by 4 publications

(14 citation statements)

References 37 publications

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“…134 Clinical trials of EAET in older adults with multimorbidity show complete or nearly complete resolution of chronic pain (i.e., greater than 70% pain reduction) in a substantial minority of patients. 135,136 Psychological distress Multimorbidity is associated with 'psychological distress' 137,138 -a term referring to the range of human psychological responses to the environment, including disease states. 138,139 In one study, an association between psychological distress and multimorbidity was found to remain even after controlling for potential confounding factors such journals.sagepub.com/home/tpp TherapeuTic advances in psychopharmacology as age, sex, perceived social support, and economic status.…”

Section: 'Negative' Psychological Factorsmentioning

confidence: 99%

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Managing medical and psychiatric multimorbidity in older patients

Carlson,

Yarns

2023

Therapeutic Advances in Psychopharmacology

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Aging increases susceptibility both to psychiatric and medical disorders through a variety of processes ranging from biochemical to pharmacologic to societal. Interactions between aging-related brain changes, emotional and psychological symptoms, and social factors contribute to multimorbidity – the presence of two or more chronic conditions in an individual – which requires a more patient-centered, holistic approach than used in traditional single-disease treatment guidelines. Optimal treatment of older adults with psychiatric and medical multimorbidity necessitates an appreciation and understanding of the links between biological, psychological, and social factors – including trauma and racism – that underlie physical and psychiatric multimorbidity in older adults, all of which are the topic of this review.

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Section: 'Negative' Psychological Factorsmentioning

confidence: 99%

Section: Psychological and Emotional Factors In Multimorbiditymentioning

confidence: 99%

Managing medical and psychiatric multimorbidity in older patients

Carlson,

Yarns

2023

Therapeutic Advances in Psychopharmacology

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Section: Psychological Interventions For Chronic Pain That Incorporat...mentioning

confidence: 99%

“…In a randomized clinical trial for patients with diverse musculoskeletal pain conditions, some of whom had tension headaches, EAET demonstrated a large effect size and significant advantage in reducing pain intensity and anxiety compared to CBT 84 . EAET has also been successfully tested in a group video telehealth format, in a small uncontrolled trial in which 25% of patients had tension headaches; 85 however, EAET has not been subjected to an adequately powered clinical trial specifically focused on the headache or migraine population.…”

Section: Psychological Interventions For Chronic Pain That Incorporat...mentioning

confidence: 99%

“…EAET has been studied for several chronic pain conditions, including fibromyalgia, musculoskeletal pain conditions (e.g., back pain, neck pain), and pelvic pain, and has demonstrated medium to large effect sizes in reducing pain severity and other related symptoms, such as pain interference with mood and activities, depression, and anxiety. 77,[79][80][81][82][83][84][85] In a randomized clinical trial for patients with diverse musculoskeletal pain conditions, some of whom had tension headaches, EAET demonstrated a large effect size and significant advantage in reducing pain intensity and anxiety compared to CBT. 84 EAET has also been successfully tested in a group video telehealth format, in a small uncontrolled trial in which 25% of patients had tension headaches; 85 however, EAET has not been subjected to an adequately powered clinical trial specifically focused on the headache or migraine population.…”

Section: Emotional Awareness and Expression Therapymentioning

confidence: 99%

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Understanding the gaps in headache and migraine treatment with psychological and behavioral interventions: A narrative review

Zamir,

Yarns,

Lagman‐Bartolome

et al. 2023

Headache

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ObjectiveIn this narrative review, we summarize relevant literature pertaining to psychosocial risk factors for headache and migraine progression, current behavioral and psychological treatments, and consider promising treatments.BackgroundHeadache and migraine are common and associated with significant burden and disability. Current treatments targeting psychosocial risk factors show modest outcomes and do not directly address the impact of early life adversity, including the development of maladaptive emotional processing. An intervention that could address these factors and include components of current evidence‐based interventions may lead to improved outcomes.MethodsWe searched PubMed and Google Scholar for articles through December 2022. Search terms included headache, migraine, psychological interventions, behavioral interventions, cognitive–behavioral therapy, mindfulness, psychiatric comorbidities, adverse childhood experiences, trauma, and emotional processing.ResultsTrauma and childhood adversity show a correlation with headache and migraine progression. Developmental adversity and trauma interfere with adaptive emotional processing, which may worsen headache and migraine symptoms, while adaptive ways of experiencing emotions are shown to improve symptoms. Current behavioral and psychological interventions, such as cognitive–behavioral and mindfulness therapies, are effective treatments for headache, but they produce small to medium effect sizes and do not directly address the impact of trauma and emotional conflicts—common factors that contribute to chronicity and disability, especially among certain subpopulations of headache patients such as those with migraine. Thus, there exists a gap in current treatment.ConclusionThere is a gap in headache and migraine treatment for those patients who have a history of trauma, childhood adversity, and maladaptive emotional processing. We suggest that an integrated psychological treatment that includes components of current evidence‐based interventions and addresses gaps by focusing on processing trauma‐related emotions may improve chronic and debilitating symptoms.

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

Yarns,

Jackson,

Alas

et al. 2024

JAMA Netw Open

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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

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Video telehealth emotional awareness and expression therapy for older U.S. military veterans with chronic pain: A pilot study

Cited by 4 publications

References 37 publications

Managing medical and psychiatric multimorbidity in older patients

Managing medical and psychiatric multimorbidity in older patients

Understanding the gaps in headache and migraine treatment with psychological and behavioral interventions: A narrative review

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

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