For a long time, much of chronic pain treatment has focused on helping people cope better with symptoms that are expected to remain. There is absolutely value in that. If you are in pain, limiting activities, and feeling increasingly discouraged, learning skills that help you function and suffer less can matter a great deal. But Emotional Awareness and Expression Therapy, or EAET, starts from a somewhat different question: What if at least some of the pain or other symptoms are being generated or maintained by learned brain and nervous-system processes—and what if emotional experiences are part of what the brain has learned to treat as dangerous?
That does not mean your symptoms are “caused by stress,” that you need to uncover some hidden trauma, or that every person with chronic pain needs emotional work. It means that the brain’s danger system responds to more than physical threats. Conflict, rejection, grief, anger, shame, pressure, loss, and feeling unable to protect or express yourself can all matter to a nervous system too. EAET is designed to help people become more aware of emotions they may have learned to avoid, experience those emotions more safely, express them in adaptive ways, and sometimes change how they communicate in important relationships.
And despite the name, this is not simply sitting in a room and talking about your feelings.
EAET asks a different question about emotions
One of the things I appreciated most in my EAET training was how much broader the model is than “you have repressed anger.” That version would be much easier to explain. It would also be wrong. EAET looks at the patterns people develop around emotions and relationships over time. Maybe anger wasn’t safe in your family, so you learned to swallow it. Maybe sadness was met with discomfort, so you became very good at functioning while upset. Maybe asking for what you needed created conflict, so keeping everyone else happy became easier than risking disappointment. Maybe you learned to be the responsible one, the agreeable one, the strong one, or the person who understands everybody else.
Those adaptations can make a lot of sense. If expressing anger caused a parent to withdraw, shutting down anger may have protected the relationship. If vulnerability was mocked, staying composed protected you. If conflict felt dangerous, people-pleasing may have helped you stay connected to the people you depended on. EAET doesn’t treat those patterns as character flaws. In many cases, they worked.
The question is whether they are still working now.
Sometimes an emotion begins to come up, the nervous system responds with anxiety or tension, and an automatic strategy quickly moves us away from it. We explain instead of feel. We make a joke. We change the subject. We blame ourselves. We immediately see the other person’s point of view. We stay positive. We take care of everyone else. None of those behaviors is inherently unhealthy; what matters is the function it is serving in that moment.
Even crying can sometimes be part of this pattern. Someone may have very easy access to sadness but almost no access to anger. Another person may sound angry constantly but have a much harder time acknowledging hurt, fear, guilt, or longing underneath it. So EAET isn’t simply asking, What are you feeling? It is also asking: What feelings are easy for you to have? Which ones feel dangerous? And what do you automatically do when one of those emotions starts to appear?
Experience, express, resolve
One of the simplest ways EAET is taught is through three words: Experience. Express. Resolve. The first step is actually experiencing the emotion rather than only discussing it intellectually. If someone tells me, “I was really angry,” but says it in the same tone they might use to tell me what they had for breakfast, we may slow down. What did the anger feel like? Where do you notice it in your body? What does that part of you want to say? What would it be like to let yourself feel it without immediately correcting, explaining, minimizing, or judging it?
Then comes expression. Sometimes that means saying something out loud in session that was never said at the time. Sometimes the person imagines the other person in the room and speaks directly to them. Sometimes we practice a boundary or an assertive statement. The expression can also be more embodied: noticing clenched hands, an urge to push something away, the desire to stand taller, or another action impulse that usually gets shut down. The point isn’t necessarily to act on that impulse in real life. It’s to safely experience an emotion that the person may have learned they shouldn’t have.
And then we follow what comes next, because EAET is not about getting someone as angry as possible and stopping there. Anger may shift into grief. Grief may uncover love or longing. Someone who finally lets themselves feel angry may notice guilt immediately afterward. Another person may access self-compassion and realize how unfairly they have been treating themselves. Resolution can mean letting something go, understanding what an emotion is asking you to do, grieving something that cannot be changed, setting a boundary, or integrating seemingly contradictory feelings.
Sometimes the movement from one genuine emotion into another is the resolution. You can love someone and be angry with them. You can understand why someone acted the way they did and still be hurt by it. You can forgive someone and still need a boundary. Real people are inconveniently complicated that way.
But isn’t getting angry bad for my mental health?
This is a concern I think deserves a direct answer because a lot of us have spent years hearing some version of: Don’t dwell on it. Let it go. Stay positive. Getting angry will only make you feel worse. But experiencing anger is not inherently bad for your mental health. Feeling anger is different from staying stuck in angry rumination, feeding resentment indefinitely, or acting aggressively toward someone else. EAET isn’t trying to teach people to become angrier. It’s helping people become less afraid of an emotion that may already be there.
Anger can be an adaptive emotion. It can tell us that a boundary was crossed, something felt unfair, we need protection, or simply that something matters to us. If someone has learned that anger itself is dangerous—Good people don’t get angry. If I’m angry, I’ll lose control. If I express anger, people will leave—they may automatically suppress it before they have even had a chance to understand what it’s communicating. EAET gives us a way to approach that emotion without assuming we need to either get rid of it or act on it.
That means someone can imagine telling a person, I am furious with you, without actually screaming at that person in real life. They can notice the urge to push someone away without physically pushing anybody. They can practice saying, No. That wasn’t okay with me, in a session and later decide what a thoughtful, appropriate real-world conversation might look like. What we express freely in the safety of an exercise does not have to be what we say word-for-word to another human being.
Emotional work can be uncomfortable, though, and I don’t want to pretend otherwise. Anxiety may rise when someone approaches a feeling they have spent years avoiding. They may notice muscle tension, heat, restlessness, or even a temporary increase in symptoms. EAET doesn’t assume all discomfort means something has gone wrong, but the goal isn’t to overwhelm someone either. There is a meaningful difference between challenging and flooding. We can slow down, stop, come back to the present, or work with something smaller. The person’s sense of agency remains important throughout the process.
This distinction is also reflected in EAET research, which has looked not only at pain but at psychological outcomes such as anxiety and depression. I’ll get into that research more below, but the important point here is that EAET isn’t based on the idea that more anger is always better. The goal is to increase someone’s capacity to experience an emotion without being controlled by it, frightened by it, or acting on it destructively.
The learning we’re looking for isn’t, I need to stay angry. It’s closer to: I can experience this emotion and still be safe.
You don’t need a major trauma for EAET to be relevant
Someone does not need a major trauma history for emotional work to matter. Sometimes the important material is grief. Sometimes it’s a relationship in which you never say what you need, chronic self-criticism, fear of disappointing people, shame, a need to please, difficulty being assertive, fear of intimacy, or a loss you never really allowed yourself to grieve. And sometimes emotions aren’t the central issue at all.
One thing I am particularly careful about in this work is not deciding in advance what someone must be feeling. I don’t want to go digging for childhood trauma because I’ve already decided it must be there. I don’t assume that if you have pain, you secretly hate your mother. And if anger isn’t there, the goal isn’t to manufacture it. We follow the person’s actual experience.
I may become curious if someone describes an objectively hurtful situation and immediately explains why the other person was completely justified. I may notice that someone can access sadness easily but becomes uncomfortable the moment anger appears. Or I might notice how quickly someone apologizes to me, agrees with me, worries about doing an exercise “right,” or tries to make sure I’m not disappointed in them. Those are things to become curious about, not proof that I know what someone is feeling better than they do.
This is also where EAET becomes much more experiential than simply talking about emotional patterns. We can talk all day about how you’re a people pleaser. That’s different from noticing that you’re people-pleasing me, right now, and giving you a chance to try something different. Maybe you disagree with something I’ve said but are worried about offending me. Instead of only discussing why disagreement is difficult for you, I might invite you to actually disagree with me.
Now your nervous system gets an experience it couldn’t get from a conversation about assertiveness: I said what I really thought, and the relationship survived.
How EAET and PRT fit together
This is one of the reasons EAET has become such a natural addition to my work. Pain Reprocessing Therapy often asks, What has the brain learned is dangerous? Maybe it’s a sensation, movement, food, driving, standing, exercise, being far from a bathroom, a particular time of day, or the first twinge of a migraine. PRT gives us ways to work with those learned danger associations and help the brain gather new information.
EAET broadens the same question. What if the thing the nervous system has learned is dangerous is anger? Or conflict? Disappointing someone? Asking for what you need? Remembering something painful? Allowing yourself to grieve? From that perspective, PRT and EAET don’t feel like two unrelated approaches to me. They can be different ways of working with a protective system that has learned to sound an alarm.
With PRT, the new learning might be: This sensation isn’t dangerous. This movement is safe. My body can handle this. With EAET, it may be: I can feel angry and still be safe. I can say no. I can let myself grieve. I can be honest without immediately taking care of everyone else’s feelings. And sometimes those two kinds of learning are intertwined. If someone’s symptoms reliably increase during conflict, for example, we could work with the symptoms themselves. But if every disagreement also activates a long-standing pattern of staying silent, pleasing, and bracing internally, there may be another layer worth exploring.
I don’t move every client from PRT into emotional work on a predetermined schedule. Sometimes PRT is where the work needs to stay. Sometimes emotions become relevant quite early. Sometimes we move back and forth. The approach I learned in my EAET training is much more principle-based than rigidly technique-based, and that fits the way I already like to work: What seems to be keeping this particular person’s brain in danger, and what kind of experience might help it learn something different?
What does the research say?
EAET has a growing research base. In a randomized controlled trial of 230 adults with fibromyalgia, EAET was compared with CBT and fibromyalgia education. EAET wasn’t superior to education on the study’s primary outcome of overall pain severity, but it was superior on several other measures, including overall symptoms, widespread pain, physical functioning, anxiety, depression, positive affect, and life satisfaction. Compared with CBT, most outcomes did not significantly differ, although EAET had advantages on some pain-related measures.
More recently, a randomized clinical trial compared EAET with CBT in 126 older veterans with chronic musculoskeletal pain. EAET produced greater reductions in pain severity at the end of treatment and at six-month follow-up. At the end of treatment, 63% of participants receiving EAET achieved at least a 30% reduction in pain compared with 17% receiving CBT.
I wouldn’t take this research and conclude that every chronic symptom is caused by unresolved emotion, or that EAET is the right approach for every person. I also wouldn’t tell someone that if emotional work doesn’t help, they simply haven’t found the right hidden feeling yet. EAET gives us another place to look when we’re trying to understand why a nervous system may still be operating as though something is dangerous. Sometimes that danger is a physical sensation or activity. Sometimes it is emotional or interpersonal. Often, human beings are messy enough that it’s a combination.
If you’re curious whether emotional patterns may be playing a role in your chronic pain or other persistent symptoms, we can explore that without deciding the answer in advance. I integrate EAET with Pain Reprocessing Therapy when it makes sense for the person in front of me, rather than assuming emotional work belongs in every session. A free 15-minute connect call is a chance to tell me what’s been happening, what you’ve already tried, and where things still aren’t making sense. From there, we can talk about whether PRT, EAET, or some combination of the two might be worth exploring.
Research & Further Reading
If you’d like to explore some of the research behind Emotional Awareness and Expression Therapy:
Lumley MA, et al. (2017). Emotional Awareness and Expression Therapy, Cognitive Behavioral Therapy, and Education for Fibromyalgia: A Cluster-Randomized Controlled Trial. Pain. This study compared EAET with CBT and fibromyalgia education in 230 adults with fibromyalgia.
View the studyYarns BC, et al. (2024). Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans: A Randomized Clinical Trial. JAMA Network Open. This study compared EAET with CBT in 126 older veterans with chronic musculoskeletal pain.
View the study
