Carty JN, Ziadni MS, Holmes HJ, et al. The Effects of a Life Stress Emotional Awareness and Expression Interview for Women with Chronic Urogenital Pain: A Randomized Controlled Trial. Pain Med. 2018 Sep 24. pii: 5106409. doi: 10.1093/pm/pny182. (Original study)

Objective: Women with chronic urogenital pain (CUP) conditions have elevated rates of lifetime trauma, relational stress, and emotional conflicts, but directly assessing and treating psychological stress is rarely done in women's health care settings. We developed and tested the effects on patients' somatic and psychological symptoms of a life stress interview that encourages disclosure about stressors and uses experiential techniques to increase awareness of links between stress, emotions, and symptoms.

Methods: In this randomized trial, women with CUP recruited at a multidisciplinary women's urology center received either a single 90-minute life stress interview (N = 37) or no interview (treatment-as-usual control; N = 25). Self-report measures of pain severity (primary outcome), pain interference, pelvic floor symptoms, and psychological symptoms (anxiety and depression) were completed at baseline and six-week follow-up.

Results: Differences between the life stress interview and control conditions at follow-up were tested with analyses of covariance, controlling for baseline level of the outcome and baseline depression. Compared with the control condition, the interview resulted in significantly lower pain severity and pelvic floor symptoms, but the interview had no effect on pain interference or psychological symptoms.

Conclusions: An intensive life stress emotional awareness expression interview improved physical but not psychological symptoms among women with CUP seen in a tertiary care clinic. This study suggests that targeting stress and avoided emotions and linking them to symptoms may be beneficial for this complex group of patients.

Discipline Area Score
Physician 5 / 7
Comments from MORE raters

Physician rater

Life stress vs stress from the condition should clearly be delimited.

Physician rater

This article is useful for gynecologists and urologists. The results provide evidence that emotion-focused and experientially based techniques may be effective for chronic urogenital pain. Targeting and resolving the underlying emotional and relational problems that appear to contribute to somatic symptoms in some patients may lead to meaningful and enduring benefits for these patients. This study suggested that targeting stress and avoiding emotions and linking them to symptoms may be beneficial for the group of patients with chronic urogenital pain. Obviously, the time for clinicians to attend to the emotional issues of patients with various chronic pain problems is approaching. Conducting a brief emotional awareness and expression interview could be an effective treatment option in some patients, in particular those with urogenital problems. Further investigations in this field should to be continued.

Physician rater

This intervention seems to offer very little support while bringing difficult issues to the forefront. It could be dangerously destabilizing.
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