My Approach

How I Understand Pain and Stress-Related Symptoms

All pain involves the brain and nervous system, and pain without visible tissue damage is just as real as pain from an injury. The International Association for the Study of Pain (IASP) defines pain as "an unpleasant sensory and emotional experience." Its term for pain that arises from altered processing of pain signals, without clear evidence of tissue damage or nerve disease, is nociplastic pain. According to a 2021 review in The Lancet by Fitzcharles and colleagues, it can occur on its own, as in fibromyalgia and tension-type headache, or alongside other pain. Pain like this is real, it has a neurological explanation, and it can be treated.

Emotion and relationships shape pain too. In "Danger, Not Damage," a 2026 article in Psychotherapy Bulletin, I argue that attachment is a system for regulating threat and that persistent pain can be one way the nervous system signals danger. Much of our work together aims to ease that sense of danger.

Emotional Awareness and Expression Therapy (EAET)

EAET is my lead method, and I trained in it with its developers, Mark Lumley, PhD, and Howard Schubiner, MD, and later with Brandon Yarns. Lumley and Schubiner developed it on the understanding that past stress, unresolved conflict and held-back emotions can keep the nervous system in a state of threat, as a 2025 overview by Maroti and colleagues explains. We first build an understanding of your symptoms that makes them less frightening. We then turn to feelings that have been pushed aside, often anger first and then guilt, grief and the longing for closeness, with self-compassion throughout. Finally, we practice saying what you feel and need to the people who matter to you.

EAET reduced pain more than cognitive behavioral therapy (CBT) in a 2024 randomized trial in JAMA Network Open by Yarns and colleagues. The trial assigned 126 older veterans, who had lived with chronic pain for an average of 23 years, to one therapy or the other. On a 0-to-10 scale, pain severity fell 1.59 points more with EAET after treatment, and EAET's advantage was still there six months later. By the trial's estimates, nearly two in three of the veterans who received EAET had their pain drop by at least 30% after treatment, compared with fewer than one in five of those who received CBT.

An earlier trial, published in Pain in 2017 by Lumley and colleagues, compared eight group sessions of EAET, CBT or education in 230 adults with fibromyalgia. EAET led to greater improvement than CBT in overall fibromyalgia symptoms and widespread pain, and more people in the EAET groups had cut their pain at least in half six months later: 22.5%, compared with 8.3% with CBT.

Pain Reprocessing Therapy

PRT helps people reappraise chronic pain as a signal from the brain and nervous system and meet it with less fear. It combines education about the brain's role in pain with guided practice in that reappraisal. One of its practices is somatic tracking, and in my sessions that means learning to approach physical sensations with safety and curiosity. Alan Gordon and colleagues developed the method, and I completed the Pain Reprocessing Therapy Center's Foundational (Level I) training.

The method's landmark test was a 2022 randomized trial in JAMA Psychiatry by Ashar and colleagues. It assigned 151 adults in Boulder, Colorado, who had lived with chronic back pain for an average of 10 years, to the therapy, an open-label placebo injection or usual care. The therapy consisted of one evaluation and education session with a physician and eight individual one-hour therapy sessions over four weeks. Afterward, 66% of the therapy group (33 of 50) were pain-free or nearly pain-free, compared with 20% with placebo and 10% with usual care. Brain imaging also showed changes after the therapy in how regions involved in pain, such as the anterior insula and anterior midcingulate cortex, responded to back pain.

Attachment-Oriented Psychodynamic Therapy Informed by ISTDP

The psychodynamic strand of my work attends to longstanding patterns in how you relate to yourself and others, such as self-criticism, perfectionism and hiding vulnerability, and to how those patterns shape the way your body carries stress. Our working relationship becomes a place where it is safe to be uncertain, unproductive and human.

I trained in ISTDP with Allan Abbass and in several three-day immersive trainings with Joel Town, including training in treating physical (somatic) symptoms. In session, this means close attention to the feelings that arise in the room, to the anxiety they stir and to the automatic ways we have learned to hold them back. Those habits were often protective once, but they can cost us closeness and keep symptoms going, so we approach the feelings beneath them gradually, at a pace your body can manage.

Short-term psychodynamic therapy reduced physical symptoms more than usual care, minimal treatment or a waitlist in a 2020 meta-analysis by Abbass and colleagues. It pooled 17 randomized trials, with 2,004 participants, in functional somatic disorders such as functional gut disorders, fibromyalgia and mixed chronic pain.

How the Three Methods Fit Together

I balance the three methods with you after the initial consultation, based on your history, what you have tried and what you want from treatment. Most often I start with EAET, bring in PRT's tools when fear of the pain itself has become part of the problem, and keep the psychodynamic work running through every session. Each of these methods has been tested in randomized trials, and we adjust the balance as we learn what helps you most.

Migraine and Chronic Headache

Migraine and chronic headache are an important part of my practice, and therapy for them works alongside care from your physician or neurologist, who manages diagnosis and medication. With headache I rely most on EAET and keep the psychodynamic thread throughout. EAET is now being studied specifically in migraine, beginning with the first randomized trial of EAET for migraine, published in 2026 by Kaufmann and colleagues.

High-Achieving Professionals

With high-achieving professionals, the work often turns to patterns such as pushing through, self-reliance, perfectionism and overriding the body's signals in favor of performance. EAET makes room for the feelings those patterns hold back, and the psychodynamic work looks at where they came from and what they protect.

How CBT and ACT Relate to This Work

CBT is the psychological therapy that guidelines most often recommend for chronic pain, and England's NICE guideline (2021) advises clinicians to consider either CBT or acceptance and commitment therapy (ACT) for chronic primary pain. The University of Michigan's pain guide describes CBT and ACT as generally helping people manage pain, and EAET as helping them work through past stressors and avoided emotions. I lead with EAET because it works directly with the stress and emotion that may be keeping pain going, and in the 2024 veterans trial it reduced pain more than CBT.

What Treatment Looks Like

Treatment begins with a 60-minute initial consultation, by secure video or in person on a Friday in Lynnwood, in which we review your symptoms, past treatment and their emotional and relational context, and then build a plan together. Ongoing sessions are 60 minutes, structured and focused. The length of treatment depends on your goals, and we review your progress together regularly. The practice is private pay and does not bill insurance, and fees are on Services and Fees. Treatment with me works alongside your medical care.

Frequently Asked Questions

What type of therapy is good for chronic pain?

Several psychological therapies have helped people with chronic pain in randomized trials, including CBT, ACT, mindfulness-based stress reduction, EAET and PRT. The best fit depends on your symptoms, what you have tried and the kind of work that suits you, and a discovery call is a good place to talk it through.

What is the new treatment for chronic pain?

EAET and PRT are two of the newer psychological treatments for chronic pain, and both aim to change how the brain and nervous system respond to pain, stress and emotion. In a 2024 randomized trial, EAET reduced pain more than CBT, and in a 2022 randomized trial, PRT reduced pain far more than placebo or usual care.

Will chronic pain ever go away?

Chronic pain can ease a great deal, and some people become pain-free. Five years after the Boulder back pain trial, a 2025 follow-up by Ashar and colleagues found that 55% of the PRT group who took part in the follow-up (21 of 38) were pain-free or nearly pain-free. The figures were 26% (10 of 39) for placebo and 36% (13 of 36) for usual care.

What happens to your brain when you have chronic pain?

Chronic pain involves changes across the nervous system. A 2025 review I co-wrote in Biology describes changes from the spinal cord to brain regions such as the amygdala, insula and prefrontal cortex, along with the body's stress-hormone and natural pain-control systems.

How do I know if my pain is psychological?

All pain is real, and all pain involves the brain and nervous system, whether or not tissue damage is present. Finding out what drives yours starts with your physician's evaluation, and the initial consultation then explores how stress, emotion and learning may be keeping symptoms going.

Book a Free Discovery Call

The next step is a free discovery call, a conversation about what brings you in and how I work. Book a free discovery call.

References

Abbass, A., Town, J., Holmes, H., Luyten, P., Cooper, A., Russell, L., Lumley, M. A., Schubiner, H., Allinson, J., Bernier, D., De Meulemeester, C., Kroenke, K., & Kisely, S. (2020). Short-term psychodynamic psychotherapy for functional somatic disorders: A meta-analysis of randomized controlled trials. Psychotherapy and Psychosomatics, 89(6), 363–370. https://doi.org/10.1159/000507738

Ashar, Y. K., Gordon, A., Schubiner, H., Uipi, C., Knight, K., Anderson, Z., Carlisle, J., Polisky, L., Geuter, S., Flood, T. F., Kragel, P. A., Dimidjian, S., Lumley, M. A., & Wager, T. D. (2022). Effect of pain reprocessing therapy vs placebo and usual care for patients with chronic back pain: A randomized clinical trial. JAMA Psychiatry, 79(1), 13–23. https://doi.org/10.1001/jamapsychiatry.2021.2669

Ashar, Y. K., Low, E. L., Knight, K., Schubiner, H., Gordon, A., LeRoux, A., Lumley, M. A., & Wager, T. D. (2025). Pain reprocessing therapy vs placebo and usual care for patients with chronic back pain: 5-year follow-up of a randomized clinical trial. JAMA Psychiatry, 82(10), 1049–1051. https://doi.org/10.1001/jamapsychiatry.2025.1844

Fitzcharles, M.-A., Cohen, S. P., Clauw, D. J., Littlejohn, G., Usui, C., & Häuser, W. (2021). Nociplastic pain: Towards an understanding of prevalent pain conditions. The Lancet, 397(10289), 2098–2110. https://doi.org/10.1016/S0140-6736(21)00392-5

International Association for the Study of Pain. (n.d.). Terminology. Retrieved October 31, 2026, from https://www.iasp-pain.org/resources/terminology/

Jin, J. (2026, July). Danger, not damage: Attachment, emotion, and the somatic language of relational threat. Psychotherapy Bulletin, 61(4). https://societyforpsychotherapy.org/danger-not-damage-attachment-emotion-and-the-somatic-language-of-relational-threat/

Kaufmann, D., Sturgeon, J. A., Mirow, S., Zinkhan, G., Schlesinger, N., Yarns, B. C., Kommit, K., Miller, A., & Lumley, M. A. (2026). Emotional awareness and expression therapy for migraine: A preliminary randomized controlled trial. Pain Medicine, 27(8), 948–951. https://doi.org/10.1093/pm/pnag034

Lumley, M. A., Schubiner, H., Lockhart, N. A., Kidwell, K. M., Harte, S. E., Clauw, D. J., & Williams, D. A. (2017). Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: A cluster-randomized controlled trial. Pain, 158(12), 2354–2363. https://doi.org/10.1097/j.pain.0000000000001036

Maroti, D., Frisch, S., & Lumley, M. A. (2025). To feel is to heal: Introduction to Emotional Awareness and Expression Therapy. Der Schmerz, 39(4), 256–262. https://doi.org/10.1007/s00482-025-00878-6

National Institute for Health and Care Excellence. (2021). Chronic pain (primary and secondary) in over 16s: Assessment of all chronic pain and management of chronic primary pain (NICE guideline NG193). https://www.nice.org.uk/guidance/ng193

Raja, S. N., Carr, D. B., Cohen, M., Finnerup, N. B., Flor, H., Gibson, S., Keefe, F. J., Mogil, J. S., Ringkamp, M., Sluka, K. A., Song, X.-J., Stevens, B., Sullivan, M. D., Tutelman, P. R., Ushida, T., & Vader, K. (2020). The revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises. Pain, 161(9), 1976–1982. https://doi.org/10.1097/j.pain.0000000000001939

University of Michigan. (n.d.). Emotional awareness and expression therapy (EAET). Tailored Pain Guide. Retrieved October 31, 2026, from https://tailored.painguide.med.umich.edu/professional-care/therapies/eaet

Yarns, B. C., Jackson, N. J., Alas, A., Melrose, R. J., Lumley, M. A., & Sultzer, D. L. (2024). Emotional awareness and expression therapy vs cognitive behavioral therapy for chronic pain in older veterans: A randomized clinical trial. JAMA Network Open, 7(6), Article e2415842. https://doi.org/10.1001/jamanetworkopen.2024.15842

Young, G., Thielen, H., Samuelson, K., & Jin, J. (2025). Neurobiology of chronic pain, posttraumatic stress disorder, and mild traumatic brain injury. Biology, 14(6), Article 662. https://doi.org/10.3390/biology14060662