for Physicians and Therapists
Practical How-to Articles about Pain reprocessing Therapy (PRT) and Emotional Awareness and expression therapy (EAET)
“Neural Pathway Pain: A Call for More Accurate Diagnosis” by Gordon, Alan, LCSW, Howard Schubiner, MD, Mark Lumley, PhD, Practical Pain Management
“How the Brain Causes Chronic Pain & How to Stop It” by Yoni K. Ashar, Ph.D., Alan Gordon, LCSW, Practical Pain Management
“Internal Family Systems and Chronic Pain,” by Richard Schwartz, Ronald Siegel, and Howard Schubiner, Psychotherapy Networker, February 2021
“EAET for Chronic Pain. Rationale, Principles and Techniques, Evidence, and Review,” Current Rheumatology Reports, 2019
“Psychological therapy for centralized pain. Integrative assessment and treatment model,” Lumley & Schubiner, 2019
More about the randomized controlled trials investigating both of these treatments can be discovered on our page, Evidence-Based Medicine.
MANUALS FOR CLINICIANS AND WORKBOOKS FOR PATIENTS
EAET Therapist Manual [pdf download], authored by Mark Lumley, PhD and Howard Schubiner, MD
EAET Patient Workbook [PDF download], authored by Mark Lumley PhD, and Howard Schubiner, MD
VIDEOS FOR MEDICAL & PSYCHOTHERAPY PROFESSIONALS
Practical Introduction to Practicing EAET by Howard Schubiner:
A discussion of how to combine cognitive and emotional therapies for maximum effect when helping patients:
How ISTDP helps patients access anger in the here-and-now to transform their mind-body symptoms:
FOR PHYSICIANS WHO ARE NEW TO THIS WORK
“Fifteen years into my practice I was seeing so many medical problems that our traditional medical paradigm was not able to help, and I just thought there must be other information out there about how we can help in a different way.”
“I still work in primary care, and I have this conversation with 3 new patients every *single* day of every clinic that I do. It’s very common. And for 50% of patients when I explain the model, they’re with me, they get it. On a daily basis, patients were so thankful. It’s been really exciting, and rejuvenated my passion for working with patients—I’ve seen some incredible changes in patients who have had symptoms for years and decades. ”
FOR THERAPISTS
“There is no medication for attachment trauma. [...] For every medication I’ve started, I’ve stopped 20.
”
For psychotherapists: Allan Abbass, MD, who originally trained as a family and emergency medicine physician, went back to train as a psychiatrist when he realized how many patients had illnesses driven by stress, trauma, and underlying emotions. Dr. Abbass has studied somatic symptoms, anxiety, and emotional processing for decades, and he teaches around the world. Here he presents a succinct overview of experiential dynamic therapy (umbrella term for ISTDP and AEDP):
Dr. Abbass presents at Weill Cornell University Grand Rounds, April 2022
PODCASTS
“Dr. Yoni Ashar: Pain Reprocessing Therapy” on the CBT podcast “Thoughts on Record.” This is a great introduction to PRT from the lead author of the JAMA Psychiatry study.
Dr. Lorimer Moseley, Alan Gordon, LCSW appear on Spotify Original podcast “Chronic Pain: Can Our Brains Fix It?” — and one of the staff members of the show reports on trying out Pain Reprocessing Therapy for their widespread pain symptoms:
PRACTICAL HOW-TO handbooks for doctors AND THERAPISTS
FOR CHILDREN AND TEENS
Books For therapists
DEFINING THE THERAPIES IN THE FILM
Emotional Awarenss and Expression Therapy (EAET) — This therapy is officially recognized by the Department of Health and Human Services as a “best practice” to help people with chronic pain in order to combat the opioid epidemic on the strength of multiple RCTs. In a trial with fibromyalgia patients published in the journal PAIN, people randomly assigned to EAET had a 50% reduction of pain at more than twice the rate as people randomly assigned to CBT (cognitive behavior therapy, the standard treatment). This study, presented in the film, can be read in full here.
The change principles in EAET can easily be adopted by CBT, ACT, and MBSR practitioners. The five steps for unlearning pain from an EAET framework can be found here. The most important principle that CBT is often missing, is differentiating structural-damage symptoms from brain-generated (or mind-body-caused) symptoms. A more detailed description of how the EAET treatment works can be found here.
Pain Reprocessing Therapy (PRT) is a new diagnosis and treatment paradigm that helps patients unlearn chronic pain by retraining their brains. A primary method is to work directly with the fear of pain, which is often a major driver of symptoms.
A few studies have indicated that about 85% of people with chronic back pain do not have structural damage that explains their pain. And many other symptoms like migraines, digestive disorders, abdominal pain, and fibromyalgia are also not characterized by structural or tissue damage. PRT helps people retrain their nervous systems to unlearn neuroplastic pain pathways that are creating severe, debilitating, and treatment-resistant pain syndromes.
PRT is part of a radical paradigm shift that new neuroscience has enabled, which challenges conventional pain psychology and medicine. It makes use of breakthroughs in understanding how the brain uses predictive coding for sensory processing, which means that by expecting pain, and by fearing injury, the brain can maintain or even create debilitating pain.
After a successful PRT treatment, they know intuitively their chronic pain is not a sign of tissue damage. The pain comes and goes without triggering as much fear, tends to lessen over time, and is no longer mistaken for a structural injury. The primary author of the study on PRT at the University of Colorado-Boulder, Yoni K. Ashar, PhD, and Alan Gordon, LCSW go into more depth in this article. The PRT protocol was published here.
The first major NIH-funded trial of PRT has shown very promising results for people with an average duration of 10 years of back pain. 66% of those who were randomly assigned to PRT became pain-free or nearly pain-free.
Intensive Short-Term Dynamic Psychotherapy (ISTDP) — This treatment has been around since the 1970s and has had dozens of RCTs investigating its effectiveness. One recent publication from 2022, a meta-analysis in the Journal of Anesthesiology & Pain Therapy, found that ISTDP is superior to CBT for helping patients reduce and resolve chronic pain. Dr. Sarno recommended ISTDP especially for people with severe symptoms that are treatment-resistant. His collaborator, Arlene Feinblatt, built a protocol for helping chronic-pain patients process pain, anxiety, and emotions differently so that symptoms lessen over time.
The innovators of EAET (Mark Lumley, PhD, and Howard Schubiner, MD), have referred to their therapy as a “simplified form of ISTDP,” which is easier for clinicians to learn and offer to patients. Yet ISTDP can be a powerful, robust option, especially for patients with stubborn symptoms linked to histories of childhood stress, abuse, or trauma.
*Note: ISTDP falls under the umbrella term “experiential dynamic therapy (EDT)” which includes other popular, effective therapies like Accelerated Experiential Dynamic Psychotherapy (AEDP). In EDT, the goal is to feel sensations of emotions directly in the body, and to overcome internal blocks against anger, guilt, and sadness. After a successful therapy, all feelings, including joy, are experienced more fully.
Here is a detailed, compelling, and accessible article on how ISTDP works: “Their pain is real – and for patients with mystery illnesses, help is coming from an unexpected source” by Erin Anderssen.
Allan Abbass, MD is interviewed in this thoughtful podcast “Emotional Roots of Illness” which details the story of a patient who had disabling multiple chemical sensitivity (aka environmental sensitivity), panic attacks, and agoraphobia.
TMS coaching or mentoring — Sarno’s preferred term for brain-generated pain was Tension Myoneural Syndrome. While most who research his treatment have dropped this term, it is still a favorite by many clinicians and people who recovered from reading his books, and who now offer coaching based on the “Sarno model.” You can find these peer coaches on the TMS wiki.
Other therapies — Of course, there are many therapies that are helpful for people with chronic pain. We limited our list to these therapies because they were all touched on in the film. During our research, these four therapies came up the most frequently by healthcare professionals who emphasize that a large portion of chronic pain patients have no structural damage that explains their pain.
Much more about the film can be discovered in our FAQ.
EXPLORING A NEW DRUG-FREE SCIENCE-BASED TREATMENT
SCIENTIFIC CITATIONS
Lumley, Schubiner, Clauw, “Emotional Awareness and Expression Therapy for Fibromyalgia,” PAIN, 2017.
Lumley, Schubiner, “EAET for Chronic Pain. Rationale, Principles and Techniques, Evidence, and Review,” Current Rheumatology Reports, 2019.
comprehensive training program through ovid dx
Ovid Dx offers training for any health and well-being practitioners who treat clients or patients with mind-body conditions. It consists of four modules: 1) Pain neuroscience and education of patients, 2) Assessment of neural circuit conditions, 3) Treatment of neural circuit conditions, and 4) A module designed for physical therapists and others who do manual medicine. The material is written, audio and video-based and was created by Alicia Batson, MD and me. Physicians can obtain 6 CME credits for viewing the modules and completing the evaluations