Therapy for high achievers with chronic pain, migraine or burnout

Who I work with

The people I see are good at pushing through almost everything, until their bodies stop cooperating. Many have spent years living with pain, fatigue or symptoms that have no clear explanation, and many are tired of being told that everything looks normal. Often they have read the books and tried the treatments, and they understand that stress affects the body, yet the symptoms persist. If that sounds like you, the same determination that built your career can serve you well in this work.

How pushing through can show up in the body

Pain researchers have studied burnout, pushing through and perfectionism, and their findings help explain why the body sometimes pushes back.

Burnout and stress

Burnout and pain are linked. A 2017 systematic review in PLoS ONE by Salvagioni and colleagues analyzed 36 studies that followed workers over time, and job burnout predicted later musculoskeletal pain. In one of those studies, which followed 1,704 healthy employees for about three years, Armon and colleagues (2010) found that rising burnout went with about twice the risk of developing musculoskeletal pain.

Migraine can follow stress in a surprising way. In a 2014 diary study in Neurology by Lipton and colleagues, adults with episodic migraine were more likely to have an attack within 6 hours after their stress dropped from one evening to the next. The researchers were testing what they called the "let-down headache," the idea that a migraine can follow a drop in stress, such as when a deadline passes or a vacation begins.

Pushing through

Pushing through has a name in pain research. The avoidance-endurance model, reviewed in 2010 by Hasenbring and Verbunt in the Clinical Journal of Pain, describes two ways of enduring pain. In distress endurance, a person suppresses thoughts about the pain and keeps going with tasks, often while anxious or low; in eustress endurance, a person ignores or minimizes the pain, stays upbeat and keeps going. The model expects both patterns to bring more pain over time, and both are patterns we can look at together.

Perfectionism

Perfectionism is linked with headaches too. In a 2004 survey of 291 university students by Bottos and Dewey in the journal Headache, the students with chronic headache reported more perfectionism and more daily hassles than students with less frequent headaches. Higher perfectionism also went with more frequent and more intense headaches.

Perfectionism is also my own research subject. My doctoral dissertation at Fuller Graduate School of Psychology, Types and Implications of Perfectionism Among Minority Groups (2019), set out to identify types of perfectionists. What it pointed to is that the psychological process that matters most is not whether you objectively meet your standards, but whether you perceive that you have met them. Many high achievers meet every standard on paper and still feel they have fallen short, and that gap is something we can work on together.

How therapy with me works

I combine three methods: Emotional Awareness and Expression Therapy (EAET) leads, Pain Reprocessing Therapy adds tools for working with pain sensations, and attachment-oriented psychodynamic therapy informed by ISTDP (intensive short-term dynamic psychotherapy) runs through the work. Work begins with a 60-minute initial consultation, in which we go through your symptoms and the medical care you have had and then agree on a plan that fits alongside that care.

I trained in EAET with its co-developers, Mark Lumley and Howard Schubiner, and I start with it because, in my clinical experience, many high-achieving people have learned to override internal signals in favor of performance, and EAET works directly with the emotions that get overridden. Its sessions combine three kinds of work: understanding symptoms in ways that make them less frightening; experiencing and expressing emotions such as anger, guilt, grief and the wish for closeness; and practicing assertiveness and connection with the people in your life.

In a 2024 randomized trial in JAMA Network Open by Yarns and colleagues, 126 older veterans who had lived with chronic pain for an average of 23 years were randomly assigned to EAET or cognitive behavioral therapy (CBT). After treatment, average pain severity had fallen 2.18 points on a 0 to 10 scale with EAET and 0.60 points with CBT, and EAET's advantage was still there six months later.

The second method works more directly with pain sensations, and its aim is to help you reappraise them so that they provoke less fear. I completed the Pain Reprocessing Therapy Center's Foundational (Level I) training. In a 2022 randomized trial in JAMA Psychiatry by Ashar and colleagues, 151 adults who had lived with chronic back pain for an average of 10 years were assigned to this therapy, an open-label placebo injection or usual care. After treatment, 66% of the therapy group (33 of 50) were pain-free or nearly pain-free, compared with 20% in the placebo group and 10% in the usual-care group.

The third method looks at how self-reliance, self-criticism and perfectionism took shape in your relationships, and at how an identity built around endurance and performance can leave little room for vulnerability. In a 2026 article in Psychotherapy Bulletin, I argued that "the attachment system is fundamentally a threat-regulation system," so persistent pain can be read as the nervous system signaling danger. I want our sessions to be a place where it is safe to be uncertain, unproductive and human.

Sessions that fit a demanding schedule

Sessions take place by secure video for adults anywhere in Washington, and ongoing sessions are structured, focused and 60 minutes long. In person, I see clients on Fridays at my Lynnwood office, 5108 196th St SW, Suite 103, Lynnwood, WA 98036. The initial consultation is $325 for 60 minutes and each ongoing session is $265, and Services and fees lists every option, including the free discovery call.

Privacy and paying privately

Because I do not bill insurance, my practice files no claims with your health plan, so no diagnosis codes, treatment codes or session dates go to your insurer. If you'd like to seek out-of-network reimbursement, I can give you a superbill to submit yourself, so whether your plan hears about your care stays your decision.

For many professionals that privacy matters. A 2015 systematic review in Psychological Medicine by Clement and colleagues covered 144 studies with 90,189 participants, and concern about disclosure was the stigma-related barrier to care that people reported most often. People in health professions and men were among the groups most deterred. My own research points the same way. In a 2025 survey of 679 racially minoritized adults with chronic pain, published in Stigma and Health by VanHouten, Greenway and me, people in the high-stigma group were more often men. They also had less favorable attitudes toward seeking help and more anxiety, depression and pain intensity.

Frequently asked questions

Can chronic pain lead to burnout?

Pain and burnout often travel together. In studies that followed employees over time, rising burnout came before new musculoskeletal pain. In 2019 national survey data analyzed by De La Rosa and colleagues in Pain (2024), 23.9% of US adults with chronic pain had current anxiety or depression symptoms, compared with 4.9% of adults without chronic pain. Therapy can work with the pain and the strain together.

Is going to therapy actually worth it?

For chronic pain, the research is encouraging. In a 2024 randomized trial, nearly two in three older veterans who received EAET had their pain drop by at least 30% after treatment, by the trial's estimates, compared with fewer than one in five who received CBT. In a 2022 trial, 66% of the adults with chronic back pain in the Pain Reprocessing Therapy group were pain-free or nearly pain-free afterward. A free discovery call is a good place to ask how I would approach your situation before you commit to anything.

Can a psychologist help with chronic pain?

Yes. In randomized trials, the methods I use have reduced pain for adults who had lived with it for years, and therapy fits alongside the care you receive from your physician. Working with physicians is familiar ground for me: I was formerly an Acting Assistant Professor in Family Medicine at the University of Washington, in primary care behavioral health, where I worked with family medicine physicians and residents.

What type of therapy is good for chronic pain?

Several types have helped people with chronic pain in randomized trials. EAET reduced pain more than cognitive behavioral therapy in a 2024 trial in older veterans, and I explain how I combine methods under my approach.

How do I pick a psychologist?

Choose someone whose license you can check, whose training fits your problem and who explains fees, format and privacy plainly. I am a licensed psychologist in Washington (license PY61353978) with a PhD in Clinical Psychology from Fuller Graduate School of Psychology, and I am Associate Professor of Counseling Psychology at The Seattle School of Theology & Psychology.

Book a free discovery call

If you are carrying pain, headaches or exhaustion alongside a demanding career, a free discovery call lets you describe what you are dealing with and ask how I work before you decide on an initial consultation.

Book a free discovery call

References

Armon, G., Melamed, S., Shirom, A., & Shapira, I. (2010). Elevated burnout predicts the onset of musculoskeletal pain among apparently healthy employees. Journal of Occupational Health Psychology, 15(4), 399–408. https://doi.org/10.1037/a0020726

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

Bottos, S., & Dewey, D. (2004). Perfectionists' appraisal of daily hassles and chronic headache. Headache, 44(8), 772–779. https://doi.org/10.1111/j.1526-4610.2004.04144.x

Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., Morgan, C., Rüsch, N., Brown, J. S., & Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11–27. https://doi.org/10.1017/S0033291714000129

De La Rosa, J. S., Brady, B. R., Ibrahim, M. M., Herder, K. E., Wallace, J. S., Padilla, A. R., & Vanderah, T. W. (2024). Co-occurrence of chronic pain and anxiety/depression symptoms in U.S. adults: Prevalence, functional impacts, and opportunities. Pain, 165(3), 666–673. https://doi.org/10.1097/j.pain.0000000000003056

Hasenbring, M. I., & Verbunt, J. A. (2010). Fear-avoidance and endurance-related responses to pain: New models of behavior and their consequences for clinical practice. Clinical Journal of Pain, 26(9), 747–753. https://doi.org/10.1097/AJP.0b013e3181e104f2

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/

Lipton, R. B., Buse, D. C., Hall, C. B., Tennen, H., DeFreitas, T. A., Borkowski, T. M., Grosberg, B. M., & Haut, S. R. (2014). Reduction in perceived stress as a migraine trigger: Testing the "let-down headache" hypothesis. Neurology, 82(16), 1395–1401. https://doi.org/10.1212/WNL.0000000000000332

Salvagioni, D. A. J., Melanda, F. N., Mesas, A. E., González, A. D., Gabani, F. L., & Andrade, S. M. de. (2017). Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies. PLoS ONE, 12(10), e0185781. https://doi.org/10.1371/journal.pone.0185781

VanHouten, L. E., Greenway, T. S., & Jin, J. (2025). Stigma of seeking professional psychological help: A person-centered approach to stigma profiles among racially minoritized adults with chronic pain. Stigma and Health. Advance online publication. https://doi.org/10.1037/sah0000615

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