About this trial
About one in three Veterans lives with long-term (chronic) pain, and many of them also struggle with past trauma and mental health issues like depression, anxiety, or PTSD. Emotional Awareness and Expression Therapy (EAET) is a type of talk therapy that helps people understand and express their emotions, especially those linked to past trauma. This therapy has been shown to help reduce pain and improve mental health.
So far, multiple studies have tested EAET in both Veterans and civilians, and the results have been promising. EAET has helped people feel less pain, move better, and experience fewer mental health symptoms. Because of these strong results, the U.S. Department of Health \& Human Services named EAET a Best Practice for managing pain in 2019.
Two earlier studies at a VA hospital in Los Angeles found that EAET worked even better than another well-known therapy called cognitive behavioral therapy for chronic pain (CBT-CP) for older Veterans. However, those studies were done in tightly controlled settings. Now, researchers want to see if EAET works just as well when it's used in everyday healthcare settings, by different types of doctors and therapists.
This new project will happen in two parts, but we will only focus on the first part in this entry: In the first part (a 1-year phase), doctors and therapists at up to 7 VA hospitals across the country will be trained to use EAET. They will then try it out with Veterans to see how well it works and how easy it is to use in real clinics. Veterans, doctors, and other staff will be asked for feedback to learn what helps or gets in the way of using EAET.
Eligibility criteria
Qualifiers
Veteran at one of 7 VA healthcare systems;
Age 18 years or older;
At least 3 months of musculoskeletal pain, defined using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnostic codes, which include the following M-code diagnoses: back pain, fibromyalgia, limb pain, neck pain; R-code diagnoses: pelvic and perineal pain, jaw pain; and G-code diagnoses: tension headaches; and
Pain of at least moderate severity, defined as ≥4 "on average" on the 0-10 Numeric Pain Rating Scale
Disqualifiers
Poorly controlled major psychiatric illness (e.g., schizophrenia, bipolar I disorder with acute psychotic symptoms, severe manic or depressive episode listed as active in CPRS);
Active suicide or violence risk (e.g., currently suicidal or homicidal ideation, intent, or plans);
Active severe drug/alcohol use disorder (e.g., drinking more than intended, tried to stop but couldn't, spent significant time drinking or being sick from aftereffects, wanted drink so badly you couldn't think of anything else, interference with home or work life, continued to drink despite problems, given up on activities, dangerous situations, withdrawal and/or tolerance); and
Current participation in CBT-CP or EAET, or participation in either intervention in the last 6 months, via clinical care or another research study.
Trial design
Treatments tested in this trial
- Emotional Awareness and Expression Therapy (EAET)
- Cognitive Behavioral Therapy for Chronic Pain (CBT-CP)
Treatment groups
Sponsors and collaborators
University of California, Los Angeles
Lead sponsor
National Center for Complementary and Integrative Health (NCCIH)
Collaborator
University of Texas Health Science Center at San Antonio (South Texas) ADRC
Collaborator
University of Colorado, Denver
Collaborator
University of Utah
Collaborator
VA Greater Los Angeles Healthcare System
Collaborator
Yale University
Collaborator
Greater Los Angeles Veterans Research and Education Foundation
Collaborator