EAET Therapy for Chronic Pain: Evidence & Limits

Last updated August 23, 2026 · 9 min read

By Tauri Urbanik, research writer and PainApp founder

What EAET is

EAET was developed for chronic pain presentations in which emotional avoidance, trauma, conflict, or interpersonal patterns may contribute to threat and pain. Treatment commonly includes pain education, emotional awareness, experiencing and expressing avoided emotions, and practicing more direct communication.

It is not simply catharsis, and it does not assume every chronic pain condition has an emotional root. The model is most relevant when a clinical assessment identifies a plausible fit.

EAET versus CBT: different targets, overlapping goals

CBT for pain commonly works on thoughts, behavior, coping, activity, sleep, and fear or avoidance. EAET places more emphasis on approaching emotions and interpersonal conflict. Both are active psychological treatments, and real protocols are more nuanced than “CBT manages pain while EAET eliminates it.”

The useful question is not which brand wins in general. It is which treatment has evidence for the relevant population and outcome, and which model fits the person receiving care.

The 2017 fibromyalgia trial

Intent-to-treat analysis found:

• EAET did not differ from fibromyalgia education on the primary pain-severity outcome;
• EAET did not differ from CBT on the primary or most secondary outcomes;
• selected symptoms, widespread pain, and the proportion reporting major improvement favored EAET over education;
• selected fibromyalgia and widespread-pain outcomes favored EAET over CBT;
• 22.5% of EAET participants achieved at least 50% pain reduction versus 8.3% with CBT (Lumley et al., PAIN, 2017↗).

The responder comparison is meaningful, but it is one outcome among many. Dividing 22.5 by 8.3 and calling EAET “three times better” hides the null primary result and the other nonsignificant comparisons.

The 2024 older-veterans trial

A later randomized trial compared nine sessions of EAET with CBT in 126 veterans aged 60 to 95 with at least three months of musculoskeletal pain. The sample was 92% male and medically and psychiatrically complex.

EAET was superior to CBT for pain severity at post-treatment and six-month follow-up. At post-treatment, 63% of the EAET group versus 17% of the CBT group achieved at least 30% pain reduction (Yarns et al., JAMA Network Open, 2024↗).

That is a stronger head-to-head finding than the fibromyalgia primary outcome. Its scope still matters: older, predominantly male veterans with musculoskeletal pain are not interchangeable with every chronic pain population.

What the trials do not establish

The available evidence does not show that:

• suppressed emotions cause all chronic pain;
• EAET is the best treatment for every nociplastic condition;
• a result in fibromyalgia applies to pelvic pain, IBS, migraine, or chronic fatigue;
• EAET replaces medical evaluation or condition-specific treatment;
• a responder percentage predicts one person’s outcome.

Our chronic pain evidence map places these trials next to PRT, CBT, pain neuroscience education, mindfulness, and long-term evidence.

What a course of EAET may involve

Although protocols vary, treatment may include:

1. developing a biopsychosocial understanding of pain;
2. identifying avoided emotions and relevant interpersonal patterns;
3. experiencing and expressing emotions in a supported setting;
4. practicing direct, adaptive communication;
5. approaching safe activities or situations linked with fear and pain.

Because this work can be emotionally demanding, therapist training, pacing, trauma-informed care, and a clear plan for destabilization or comorbidity matter.

Deciding whether EAET fits

Ask a prospective clinician:

• What EAET training and supervision have you completed?
• What chronic pain populations do you treat?
• What is the working model for my symptoms, and what alternatives were considered?
• What outcome will we track and when will we review progress?
• How do you adapt treatment for trauma, dissociation, depression, or anxiety?
• How will this coordinate with my medical and physical care?

Frequently asked questions

What is EAET therapy?

Emotional Awareness and Expression Therapy is a psychological treatment for some chronic pain presentations. It helps people identify, experience, and communicate emotions and change interpersonal patterns that may contribute to pain-related threat and avoidance.

Is EAET better than CBT for chronic pain?

The answer depends on the population and outcome. A fibromyalgia trial found no difference on the primary or most secondary outcomes, though selected outcomes favored EAET. A trial in older veterans with musculoskeletal pain found EAET superior for pain severity.

What did the fibromyalgia EAET trial find?

Among 230 adults, EAET did not beat education on the primary pain outcome or CBT on the primary and most secondary outcomes. It improved selected symptoms, and 22.5% achieved at least 50% pain reduction versus 8.3% with CBT.

Who should consider EAET?

EAET may be reasonable when chronic pain coexists with emotional avoidance, conflict, trauma symptoms, or difficult interpersonal patterns. A qualified clinician should assess fit, readiness, comorbidities, and alternatives.

References

1. Lumley MA, et al. Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial. PAIN. 2017;158(12):2354-2363.DOI: 10.1097/j.pain.0000000000001036
2. Yarns BC, et al. Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans: A Randomized Clinical Trial. JAMA Network Open. 2024;7(6):e2415842.DOI: 10.1001/jamanetworkopen.2024.15842