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Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial

Lumley, Mark A.a,*; Schubiner, Howardb; Lockhart, Nancy A.a; Kidwell, Kelley M.c; Harte, Steven E.d,e; Clauw, Daniel J.d,e,f; Williams, David A.d,e,f,g

doi: 10.1097/j.pain.0000000000001036
Research Paper

Patients with fibromyalgia (FM) experience increased lifetime levels of psychosocial adversity, trauma, and emotional conflict. To address these risk factors, we developed emotion awareness and expression therapy (EAET) and tested its benefits against an active control condition, FM education, and the field's gold standard intervention for FM, cognitive behavioral therapy (CBT) for symptom management. Adults with FM (N = 230) formed 40 treatment groups, which were randomized to EAET, CBT, or education and given 8, 90-minute sessions. Patient-reported outcomes were assessed at baseline, posttreatment, and 6-month follow-up (primary end point). Retention of patients to follow-up was excellent (90.4%). Intent-to-treat analyses indicated that although EAET did not differ from FM education on pain severity (primary outcome), EAET had significantly better outcomes than FM education on overall symptoms, widespread pain, physical functioning, cognitive dysfunction, anxiety, depression, positive affect, and life satisfaction (between-condition d's ranging from 0.29-0.45 SD) and the percentage of patients reporting being “very much/much” improved (34.8% vs 15.4%). Emotional awareness and expression therapy did not differ from CBT on the primary or most secondary outcomes, but compared to CBT, EAET led to significantly lower FM symptoms (d = 0.35) and widespread pain (d = 0.37) and a higher percentage of patients achieving 50% pain reduction (22.5% vs 8.3%). In summary, an intervention targeting emotional awareness and expression related to psychosocial adversity and conflict was well received, more effective than a basic educational intervention, and had some advantages over CBT on pain. We conclude that EAET should be considered as an additional treatment option for FM.

Emotional awareness and expression therapy targets stress and psychosocial adversity. In fibromyalgia, emotional awareness and expression therapy was more effective than fibromyalgia education and surpassed cognitive behavioral therapy on pain reduction.

aDepartment of Psychology, Wayne State University, Detroit, MI, USA

bDepartment of Internal Medicine, Providence Hospital/Ascension Health, Southfield, MI, USA, and Michigan State University, East Lansing, MI, USA

Departments of cBiostatistics



fPsychiatry, and

gPsychology, The University of Michigan, Ann Arbor, MI, USA

Corresponding author. Address: Department of Psychology, Wayne State University, 5057 Woodward Ave, Suite 7908, Detroit, MI 48202, USA. Tel.: 313-577-2838; fax: 313-577-7636. E-mail address: (M. A. Lumley).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received June 23, 2017

Received in revised form July 28, 2017

Accepted July 31, 2017

© 2017 International Association for the Study of Pain
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