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Doctor, I have heard about a new psychological therapy, Emotional Awareness and Expression Therapy, for patients with fibromyalgia. Will that help me manage my symptoms?

Fibromyalgia may benefit from psychological treatment (in addition to or instead of medications). Usually, these psychological treatments consist of simple education or cognitive behavioural therapy. A different psychological approach, Emotional Awareness and Expression Therapy, could be more beneficial for some patients and may be an additional treatment option for people with fibromyalgia.

What is the evidence?

Researchers looked at patients who received Emotional Awareness and Expression Therapy and compared them with patients who received cognitive behavioural therapy and with patients who received education on fibromyalgia. They measured patients’ level of pain, fibromyalgia symptoms, sleep problems, cognitive difficulties, anxiety and depression, fatigue, and physical functioning. They found that::

  • More patients had a reduction in the measure of pain by half or more with Emotional Awareness and Expression Therapy than with cognitive behavioural therapy or with education on fibromyalgia.
  • Similar results were seen when assessing patients self-reporting of improvement in pain
  • Overall, the superiority of Emotional Awareness and Expression Therapy lasted for up to 6 months

What kind of study was this?

This was a randomized controlled trial (RCT). In an RCT, patients are randomly picked to go in one treatment group or the other treatment group.

Who participated in the study? This study included 230 people who had fibromyalgia.

How was the study done? The study compared Emotional Awareness and Expression Therapy with cognitive behavioural therapy and with fibromyalgia education. Patients attended treatment sessions with a psychologist for 90 minutes once weekly for 8 weeks and were followed up again at 6 months.

Emotional awareness and expression therapy


Cognitive behavioural therapy and fibromyalgia education

Emotional awareness and expression therapy assumes that fibromyalgia is an amplification of pain due to stress or conflict, complicated by emotional avoidance (trying to prevent pain by adopting behavior aiming to avoid pain).

Emotional awareness and expression therapy encourages patients to express these emotions. It is a group-based therapy.

In the sessions, patients engaged in role-playing and other techniques to identify and express their emotions. Homework included writing, observing emotions, communicating honestly, and emotionally activating daily activities.

Cognitive behavioural therapy assumes that responses to pain can be influenced by social, environmental, and behavioural factors.

Sessions included a lecture, teaching and practicing a skill, and homework applying the skill to daily life.


Fibromyalgia education: Sessions included the history and diagnosis of fibromyalgia, pain assessment, medications, research, and use of the Internet for health care information.

Why was this research done?

People with fibromyalgia experience widespread pain, fatigue, trouble sleeping, and mood disturbance. Many people don’t experience relief with medication, so doctors have been using psychological therapies such as cognitive behavioural therapy to help people with fibromyalgia manage their symptoms. This study has explored a novel psychological approach to fibromyalgia treatment.

This Evidence Summary is based on the following article:

Lumley MA, Schubiner H, Lockhart NA, et al. Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial. Pain. 2017 Dec;158(12):2354-2363. doi: 10.1097/j.pain.0000000000001036. PubMed

Published: Thursday, August 30, 2018