Emotional Awareness and Expression Therapy (EAET), Online in Washington

What EAET is and who developed it

Mark Lumley of Wayne State University and physician Howard Schubiner developed EAET for chronic pain, especially the kind researchers call primary or centralized pain. Their 2019 review in Current Rheumatology Reports describes that kind of pain as linked to more trauma and inner emotional conflict. A 2025 overview by Maroti, Frisch and Lumley sets out the model behind the method. Unresolved trauma and conflict can trigger and maintain persistent physical symptoms, because the emotions a person has learned to avoid keep the nervous system in a state of threat. In that model, feeling and expressing those emotions eases the threat, and that is the change EAET works toward. I trained in EAET with Lumley and Schubiner at their introductory course in Michigan in 2019, and I later studied its theory and technique with Brandon Yarns, who led the veterans trial described below.

Part of my own research concerns anger, one of the emotions EAET works with most. In a 2024 study I led in The Journal of Pain, we surveyed 673 Black, Latine and Asian American adults who reported chronic pain. In our analysis, anger and perceived injustice (a sense of having been wronged) accounted for the whole link between stressful life events and pain intensity. In that paper, my coauthor and I proposed that treatment for pain work with anger and perceived injustice, which is what EAET's anger work does.

How a course of EAET works

EAET is an active therapy, and the 2025 overview groups its work into three processes. The first is reframing your symptoms, which means understanding how they connect with stress so that they become less frightening. The second is emotional work, in which you notice feelings you have held back, experience them in the session, express them and work toward resolving them. The sequence often moves from anger to guilt and grief and then to a longing for closeness, with self-compassion along the way. The third is practice in telling the important people in your life what you feel, in a way that is both assertive and connected.

In my sessions, the work stays close to what you are feeling in the moment. We often start with a specific recent event, such as a conversation with your boss, your partner or your kids, and as you describe who was there and what was said, the feelings come alive in the room. I watch for small signs that a feeling is rising, such as a change in your breathing, a sigh, a gesture or a shift in eye contact, and I ask what you are feeling right now and how you feel it in your body. Avoiding feelings is usually automatic, a protective habit learned long ago rather than a choice, so we approach them gradually, and if anxiety climbs too high, we slow down until you feel steady again.

EAET can work in a short time. In a 2017 trial by Thakur and colleagues with 106 adults who had irritable bowel syndrome (IBS), three weekly individual 50-minute sessions of EAET reduced IBS symptom severity compared with a waitlist at 10 weeks. I work with each person individually, and we set the length of treatment together.

What the research shows

EAET has been tested in randomized trials in chronic musculoskeletal pain, fibromyalgia and irritable bowel syndrome, with encouraging results, and its first randomized trial in migraine was published in 2026.

Older veterans: EAET compared with CBT

In older veterans with chronic pain, EAET reduced pain more than cognitive behavioral therapy (CBT), a widely used psychological treatment for pain, in a 2024 trial in JAMA Network Open by Yarns and colleagues. It randomized 126 veterans at VA Greater Los Angeles, who had lived with chronic pain for an average of 23 years, to EAET or CBT. 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, 63.5% of the EAET group had at least a 30% reduction in pain after treatment, compared with 17.1% of the CBT group, and 35.7% cut their pain at least in half, compared with 7.4%. The EAET group also improved more in anxiety, depression and life satisfaction. A 2020 pilot in 53 older veterans with chronic musculoskeletal pain pointed the same way.

Fibromyalgia

In fibromyalgia, EAET stood out on several measures. A 2017 trial in Pain by Lumley and colleagues assigned 40 groups of adults with fibromyalgia, 230 people in all, to eight 90-minute group sessions of EAET, CBT or fibromyalgia education. Average pain severity with EAET ended up similar to CBT and education at six months, and compared with CBT, EAET led to lower overall fibromyalgia symptoms and less widespread pain. More people in the EAET groups also had at least a 50% reduction in pain at six months: 22.5%, compared with 8.3% with CBT and 12.0% with education.

Headache and migraine

EAET's roots in headache research go back more than a decade. A 2013 randomized trial by Slavin-Spenny and colleagues tested anger awareness and expression training, a short precursor of EAET, in 147 college students with frequent headaches. Three weekly one-hour group sessions of the training reduced headache days more than a waitlist, about as much as relaxation training did. In 2026, Kaufmann and colleagues, a team that includes EAET's co-developer Mark Lumley, published the first randomized trial of EAET for migraine.

Who EAET suits

EAET suits adults with chronic pain or other persistent physical symptoms who want to explore how stress, emotions and relationships may be connected with what their bodies are doing. The University of Michigan's pain guide lists fibromyalgia, irritable bowel syndrome, pelvic pain, jaw (temporomandibular) pain and head pain, along with many cases of back pain and other localized pain, among the conditions where EAET may help. You do not need to know in advance how your feelings and your symptoms are connected, because finding that out is part of the work.

How EAET fits with my other methods

EAET leads my work, and I combine it with two other methods that my approach describes in more detail. Pain Reprocessing Therapy helps people approach physical sensations with safety and curiosity, and I completed the Pain Reprocessing Therapy Center's Foundational (Level I) training. I also draw on attachment-oriented psychodynamic therapy informed by ISTDP (intensive short-term dynamic psychotherapy), in which I trained with Allan Abbass and Joel Town. It attends to longer-standing patterns in how you relate to yourself and to other people. EAET itself grew out of short-term psychodynamic therapy, so the two fit together closely.

EAET for migraine, chronic headache and high achievers

Migraine and chronic headache are an important part of my practice, and EAET is one part of how I work with them, always alongside the diagnosis and treatment that your physician or neurologist provides. Therapy for migraine and chronic headache describes that work in more detail.

I work especially with high-achieving professionals, and therapy for high achievers describes that work. EAET offers something that people used to pushing through may have had little room for: noticing a feeling, letting yourself feel it and putting it into words.

Fees and format

I see clients individually, by secure video for adults anywhere in Washington or in person on Fridays at my office at 5108 196th St SW, Suite 103, Lynnwood, WA 98036. After a 60-minute initial consultation, we plan the course of treatment together. The practice is private pay and does not bill insurance; the initial consultation is $325 and ongoing 60-minute sessions are $265, with every other option listed under services and fees.

Questions about EAET

How does emotional awareness and expression therapy work?

EAET helps you notice emotions you may have learned to avoid, experience and express them, and resolve the conflicts they are tied to. In its developers' model, those avoided emotions keep the nervous system in a state of threat that can trigger and maintain pain, and the therapy aims to ease that threat.

Can you give me some examples of emotional awareness?

Emotional awareness means noticing and naming what you feel, including feelings that are uncomfortable to admit. Examples from EAET's focus include recognizing anger at someone important to you, guilt or grief over a loss, or an unspoken longing for closeness, and noticing how stress and these feelings connect with your symptoms.

Is EAET the same as Emotion-Focused Therapy (EFT)?

EAET and Emotion-Focused Therapy, often shortened to EFT, are separate therapies with similar names. EAET was built for chronic pain and other persistent physical symptoms, and it borrows some emotion-focused methods along with techniques from other traditions.

How is EAET different from CBT?

In the University of Michigan pain guide's description, CBT and acceptance and commitment therapy (ACT) generally focus on managing pain, while EAET helps people work through past stressors and avoided emotions. In the 2024 veterans trial, EAET also reduced pain more than CBT.

Can EAET temporarily increase pain or distress?

It can, briefly: in the fibromyalgia trial, some people in the EAET groups had short flares of symptoms, and the developers' 2019 review reports that adverse events across EAET trials were rare.

Where can I find an EAET therapist in Washington?

I offer EAET by secure video to adults anywhere in Washington and in person at my Lynnwood office on Fridays. The University of Michigan's pain guide notes that few providers are specifically trained in EAET, and it is the method I lead with.

Book a free discovery call

If you are wondering whether EAET fits what you are living with, a free discovery call is the simplest place to start. Book a free discovery call, and we will talk about your symptoms and how I work, then decide together whether an initial consultation makes sense.

References

Jin, J., & Yarns, B. C. (2024). The impact of stressful life events on centralized pain and pain intensity: A combined model examining the mediating roles of anger and perceived injustice among racially minoritized adults with chronic pain. The Journal of Pain, 25(11), Article 104642. https://doi.org/10.1016/j.jpain.2024.104642

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. (2019). Emotional awareness and expression therapy for chronic pain: Rationale, principles and techniques, evidence, and critical review. Current Rheumatology Reports, 21, Article 30. https://doi.org/10.1007/s11926-019-0829-6

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

Slavin-Spenny, O., Lumley, M. A., Thakur, E. R., Nevedal, D. C., & Hijazi, A. M. (2013). Effects of anger awareness and expression training versus relaxation training on headaches: A randomized trial. Annals of Behavioral Medicine, 46(2), 181–192. https://doi.org/10.1007/s12160-013-9500-z

Thakur, E. R., Holmes, H. J., Lockhart, N. A., Carty, J. N., Ziadni, M. S., Doherty, H. K., Lackner, J. M., Schubiner, H., & Lumley, M. A. (2017). Emotional awareness and expression training improves irritable bowel syndrome: A randomized controlled trial. Neurogastroenterology and Motility, 29(12). https://doi.org/10.1111/nmo.13143

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), e2415842. https://doi.org/10.1001/jamanetworkopen.2024.15842

Yarns, B. C., Lumley, M. A., Cassidy, J. T., Steers, W. N., Osato, S., Schubiner, H., & Sultzer, D. L. (2020). Emotional awareness and expression therapy achieves greater pain reduction than cognitive behavioral therapy in older adults with chronic musculoskeletal pain: A preliminary randomized comparison trial. Pain Medicine, 21(11), 2811–2822. https://doi.org/10.1093/pm/pnaa145