Emotional awareness—the ability to recognize, understand, and process emotions—has long been recognized as essential for mental well-being. Now, a growing body of research suggests that improving emotional awareness may also play a powerful role in reducing chronic pain. A newer psychotherapy approach called emotional awareness and expression therapy (EAET) is drawing attention for its promising results, particularly among older adults and military veterans living with long-term pain.
A study led by UCLA Health and the U.S. Department of Veterans Affairs found that EAET significantly outperformed traditional cognitive behavioral therapy (CBT) in reducing chronic pain and improving mental health outcomes. The findings highlight the benefits of emotional awareness not just for emotional health, but for physical well-being as well.
What Is Emotional Awareness and Expression Therapy?
“EAET is a new type of talk therapy that aims to help people recover from chronic pain (rather than just learning to cope with it or manage it) by working to face and resolve difficult emotions from current stress and past trauma,” explains Brandon Yarns, MD, MS, a UCLA Health psychiatrist. “This ‘emotional processing’ of stress and trauma aims to modulate brain circuits involved in both pain and emotion to reduce or eliminate chronic pain.”
At its core, EAET focuses on improving emotional awareness by helping patients identify emotional stressors, understand how those emotions affect their bodies, and safely express feelings that may have been suppressed for years. Unlike many pain treatments, EAET does not view pain as purely physical. Instead, it recognizes the strong connection between emotional awareness and mental health and how the brain can amplify pain signals when emotional stress remains unresolved.
Emotional Awareness Exercises
Emotional awareness and expression therapy (EAET) uses structured exercises to help people identify, experience, and express emotions that may be contributing to physical pain or stress-related symptoms. Here are a few commonly used practices.
Emotional Body Scan
Participants are guided to focus attention on the body, noticing areas of tension, discomfort, or pain. Rather than trying to relax these sensations, individuals explore what emotions may be connected to them, such as anger, fear, sadness, or guilt, and observe how these feelings show up physically.
Emotional Expression Through Words
Once emotions are identified, individuals practice expressing them out loud or in writing. This process may include speaking directly to an imagined person involved in a stressful or traumatic experience or naming feelings that were previously avoided or suppressed. The goal is honest, uncensored expression rather than problem-solving.
Imaginal Release Exercises
To promote emotional release, participants may use imagery to symbolically let go of distressing emotions—for example, imagining burying a painful memory, casting it out to sea, or placing it in a container and setting it aside. These exercises reinforce a sense of completion and relief.
Benefits of Emotional Awareness for Pain
Traditional pain treatments often focus on physical symptoms or coping strategies. CBT, for example, teaches techniques such as guided imagery, relaxation, cognitive restructuring, and pacing activities. While these practices can help people function better, they usually aim to help patients tolerate pain rather than reduce it.
“There are several reasons we hypothesize that EAET may work better than CBT for chronic pain,” Dr. Yarns says. “First, the goals in EAET are ambitious. The conceptual model for EAET incorporates recent research showing that some cases of chronic pain can be substantially reduced or eliminated, such as many cases of low back pain and neck pain (Ashar et al., JAMA Psychiatry, 2022). Thus, EAET always aims for recovery from chronic pain, whereas CBT for chronic pain usually primarily aims for improving pain-related functioning while pain reduction is only a secondary focus.”
Dr. Yarns also emphasizes that EAET directly addresses emotional factors that other therapies often overlook. “EAET focuses on working through important emotional drivers of chronic pain, including emotions related to trauma, that are not directly addressed by CBT for chronic pain. We have found this to be especially helpful in veterans where there is substantial overlap between PTSD (posttraumatic stress disorder) and chronic pain.”
The Brain, Trauma, and Chronic Pain
One of the most striking insights behind emotional awareness and expression therapy is how little structural damage often explains chronic pain. “Did you know that 93% of 70-year-olds without chronic back pain have degenerative disc disease, and 77% have bulging discs?” Dr. Yarns asks. “Research indicates that the presence of trauma/stress, emotional symptoms (depression, anxiety, PTSD), and brain changes are much more closely related to the presence and severity of chronic pain than any of these findings in the back.”
This understanding reframes how clinicians think about pain. Rather than viewing pain as purely mechanical, EAET recognizes the brain’s role in generating or intensifying physical symptoms. As Dr. Yarns explains: “That is why veterans with PTSD have higher pain on average than people without PTSD. The brain is augmenting or even generating this pain. EAET’s work on emotional drivers of chronic pain is hypothesized to change brain circuits that are shared by pain and emotion, which decreases the brain’s contributions to maintaining bodily pain.”
Emotional Awareness vs. CBT
The study, published June 13, 2024, in JAMA Network Open, followed 126 predominantly male veterans, ages 60 to 95, with at least three months of musculoskeletal pain. More than two-thirds had a psychiatric diagnosis, and about one-third had PTSD.
Participants in the EAET group took part in individual sessions focused on processing difficult emotions linked to trauma or stress. They learned to notice these emotions in their bodies, put them into words, and let them go in healthy ways (for example, imagining the emotions being buried or released into the sea). Group sessions taught how emotions affect pain, continued emotional processing, and encouraged sharing and validating emotional experiences with others. Homework included identifying links between stress and symptoms, expressive writing, and practicing healthy ways to communicate emotions. Participants in the CBT group had an individual session that reviewed their pain and health history and introduced CBT skills. Group sessions taught pain-coping techniques such as muscle relaxation and guided imagery, allowed time to practice these skills, and assigned homework to use the skills in daily life and track progress using worksheets.
The results were striking: 63% of veterans who received EAET reported at least a 30% reduction in pain after treatment, compared with only 17% of those who underwent CBT. Six months later, pain reduction was sustained in 41% of EAET participants, versus 14% of CBT patients. In addition to pain relief, EAET patients reported greater improvements in anxiety, depression, PTSD symptoms, and overall life satisfaction.
Emotional Awareness Beyond Pain
While EAET was developed for chronic pain, its principles extend far beyond medical settings. Improving emotional awareness can help individuals communicate more openly and resolve conflict, reduce stress, improve teamwork, and prevent burnout. Emotional awareness exercises, such as identifying emotional triggers, practicing self-compassion, and expressing emotions through guided dialogue, are increasingly used in therapy, leadership training, and wellness programs. EAET formalizes these emotional awareness techniques within a clinical framework, showing how emotional processing can lead not just to psychological relief, but measurable physical improvement.
