The effects of a novel psychological attribution and emotional awareness and expression therapy for chronic musculoskeletal pain: A preliminary, uncontrolled trial

J Psychosom Res. 2016 Feb;81:1-8. doi: 10.1016/j.jpsychores.2015.12.003. Epub 2015 Dec 11.


Objective: Current psychological and behavioral therapies for chronic musculoskeletal pain only modestly reduce pain, disability, and distress. These limited effects may be due to the failure of current therapies: a) to help patients learn that their pain is influenced primarily by central nervous system psychological processes; and b) to enhance awareness and expression of emotions related to psychological trauma or conflict.

Methods: We developed and conducted a preliminary, uncontrolled test of a novel psychological attribution and emotional awareness and expression therapy that involves an initial individual consultation followed by 4 group sessions. A series of 72 patients with chronic musculoskeletal pain had the intervention and were assessed at baseline, post-treatment, and 6-month follow-up.

Results: Participation and satisfaction were high and attrition was low. Intent-to-treat analyses found significant improvements in hypothesized change processes: psychological attributions for pain, emotional awareness, emotional approach coping, and alexithymia. Pain, interference, depression, and distress showed large effect size improvements at post-treatment, which were maintained or even enhanced at 6 months. Approximately two-thirds of the patients improved at least 30% in pain and other outcomes, and one-third of the patients improved 70%. Changes in attribution and emotional processes predicted outcomes. Higher baseline depressive symptoms predicted greater improvements, and outcomes were comparable for patients with widespread vs. localized pain.

Conclusion: This novel intervention may lead to greater benefits than available psychological interventions for patients with chronic musculoskeletal pain, but needs controlled testing.

Trial registration: NCT00861302.

Keywords: Attribution; Chronic pain; Clinical trial; Emotional awareness; Emotional expression; Registered at (NCT00861302).

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Psychological
  • Adult
  • Affective Symptoms / etiology
  • Aged
  • Aged, 80 and over
  • Awareness*
  • Behavior Therapy* / methods
  • Depression / etiology
  • Educational Status
  • Emotions*
  • Employment
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Marital Status
  • Middle Aged
  • Musculoskeletal Pain / psychology*
  • Musculoskeletal Pain / therapy*
  • Pain Measurement
  • Psychophysiologic Disorders / psychology*
  • Psychophysiologic Disorders / therapy*
  • Treatment Outcome

Associated data