Review To feel is to heal—introduction to Emotional Awareness and Expression Therapy 2025 Maroti et al

Andy

Andy

Retired committee member
Abstract

Background
Persistent physical symptoms (PPS), including (primary) pain, can, according to Emotional Awareness and Expression Therapy (EAET), be precipitated, perpetuated, and prolonged by emotional processes related to unresolved trauma and psychosocial conflicts. EAET is a novel, short-term, psychodynamic- and emotion-focused psychological treatment that targets these etiological factors, intending to substantially reduce or eliminate pain and/or somatic symptoms.

Objective
This article provides an overview of EAET’s theoretical background, core treatment principles, and empirical evidence from randomized controlled trials (RCTs) in alleviating somatic symptoms in people with PPS. Moreover, the potential of EAET and future research directions are discussed.

Methods
We report a selective literature review synthesizing the foundations and treatment characteristics of EAET and the findings from RCTs investigating EAET since 2017.

Results
Grounded in psychodynamic theory, with influences from affective neuroscience and emotion-focused therapy, the core treatment principles are reframing symptom explanations, fostering emotional processing, and facilitating corrective interpersonal experiences. EAET has been implemented in various formats, including individual therapy, group therapy, and internet-administered self-help. Since 2017, seven RCTs have been published, demonstrating efficacy in reducing symptoms, which appears superior to cognitive–behavioral therapy.

Conclusion
EAET is particularly effective for treating chronic (primary) pain conditions such as fibromyalgia and musculoskeletal pain. However, further studies are required to evaluate its long-term efficacy, determine patient characteristics associated with positive outcomes, and better understand its most active mechanisms.

Open access
 
Andy said:
the core treatment principles are reframing symptom explanations, fostering emotional processing, and facilitating corrective interpersonal experiences.
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Please, psychologists, leave us alone.

The last thing we need is some useless therapist thinking they know better than we do. Why reframe reality to suit some crackpot theorising? Why do we need our emotions processed according to someone else who has no conception of our reality? And what on this or any other planet are corrective interpersonal experiences? Is that a euphemism for punishment?
 
Trish said:
And what on this or any other planet are corrective interpersonal experiences? Is that a euphemism for punishment?
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Google gave me this:
A corrective emotional experience, or CEE, is an event that disproves the negative beliefs about oneself that are formed by trauma.

An example would be someone experiencing that somebody wants to spend time with them despite their belief that nobody likes them due the childhood bullying.
 
Here’s an overview of EAET (my bolding except for titles)

Core treatment processes of EAET
EAET is guided by three interdependent core treatment processes. These are reframing symptom explanations to reduce fear, fostering emotional processing, and facilitating corrective interpersonal experiences (Fig. 1).
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Treatment process 1
Gaining a new explanatory model for symptoms to reduce fear and instead experiencing safety will reduce somatic symptoms.

EAET involves helping patients adopt a new explanatory model. Patients with PPS often attribute their somatic symptoms to bodily causes, and their emotional problems to the noxious and disruptive character of these symptoms. As a result, patients routinely avoid their somatic symptoms and emotions, leading to a rather “inhibited life.” Therefore, EAET helps patients see that—although their somatic symptoms are undoubtedly real and experienced bodily—they are driven primarily by the brain’s top-down processes (as described above), rather than somatic causes [18]. Moreover, patients are assisted to see that their emotions—and how they avoid them—are the main drivers of their brain’s symptom activation processes.

By providing psychoeducation and experiential exercises such as imaginal activation of painful behaviors, emotional provocation, and somatic symptom tracking, patients begin to understand that their potentially frightening symptoms can even be helpful—alerting the person to identify and express their feelings and needs. Creating experiences that alter fear-based beliefs and predictions of danger is central to this approach.
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The first part is mostly just make-believe and gaslighting.

Treatment process 2
Intrapsychic work: avoided emotions contribute to physical symptoms; experienced and expressed emotions heal.

EAET aims to facilitate emotional awareness, experiencing, labeling, expression, and eventually, resolution. The “experiencing, expressing, resolving” (EER) technique is central to this process and involves different structured steps (Fig. 2):
  • Exploring and expressing anger in conflictual relationships, while dismantling defenses against this emotion.

  • Examining guilt related to the anger and grief about the relationship’s state.

  • Identifying and expressing longing for closeness and love toward the significant other.
Commonly, the therapist follows the above-mentioned approach. In some cases, it is necessary to start with attachment feelings and then focus on anger, and in other cases, only processing anger, or only grief is to be preferred. Sometimes the entry into the EER process is facilitated by expressing positive self-feelings (e.g., compassion), which may also be used at the end, if there is residual guilt, self-criticism, or sadness.

This stepwise approach in EER aims to help individuals process complex emotional experiences, foster emotional clarity, and develop constructive strategies for addressing relational conflicts, and ultimately reduce PSS. Recent studies on EAET show that greater emotional processing is linked to reduced somatic symptoms [19], even when accounting for depressive symptoms as an alternative mediator [20].
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I can see how it could be useful to get some help going through your complex emotional experiences, gain increased emotional clarity and develop strategies for addressing conflicts. If they only did this - I would have no objections to this approach.

It only becomes (very) problematic when they are tying this to a decrease in persistent physical symptoms.

Treatment process 3
Interpersonal work: communication of adaptive feelings to significant others may lead to corrective emotional experiences.

The third process focuses on fostering corrective emotional experiences in relationships, a concept introduced by Franz Alexander [21]. EER (second principle) leads to increased awareness of one’s interpersonal needs and motivates the person to modify their relationships. This involves expressing both needs of assertiveness and connection. Patients have to find some healthy point, which could range from firmer boundaries (to the point of ending relationships) to investing in increased closeness and intimacy. Doing so helps to unlearn fears of these emotions, thereby further reducing somatic symptoms, as well as potentially changing core sources of stress or conflict. This principle involves both intrapsychic work (resolving inner conflicts) and interpersonal work (engaging with significant others).

When patients desire to try to heal a relationship, they are encouraged to confront and express avoided emotions—such as anger and love—toward important figures in their lives, but do so in a thoughtful, balanced manner and in consideration of the needs and feelings of the other person. In-session EER exercises are often emotionally intense, which not only reduces fear of emotions but can foster the patients’ awareness of their feelings and needs, and consequently increase their motivation to communicate them in relationships. Homework exercises, like writing unsent letters, can facilitate this process, too. Patients can also practice this by interacting with their therapist in new ways, such as asserting their needs and expressing feelings of gratitude [22], where, it is hoped, they will create new relational patterns and further reduce their PPS.
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As for the second process, the third also include some reasonable elements like trying to help them solve conflicts in their important relationships.

Where they go wrong, is when they again tie this to a decrease in persistent physical symptoms.
 
For those who are not aware, Daniel Maroti of the Department of Psychology at Stockholms University is collaborating with the Swedish members of the Oslo Consortium (Anna Andreasson, Martin Jonsjö, Mats Lekander and Elin Lindsäter and others). More info on this in season 2 episode 6 of the podcast Maran by @MittEremltage. Full transcript available on her blog:
https://mitteremitage.wordpress.com/2024/09/20/maran-s2a6-den-svenska-grenen-av-natverket/

More forum threads about some of Maroti's work:

https://www.s4me.info/threads/inter...zed-controlled-trial-2022-maroti-et-al.30326/

https://www.s4me.info/threads/istdp-for-patients-with-treatment-resistance-pps-maroti-et-al.42259/

https://www.s4me.info/threads/the-mind-body-syndrome-study-2019-maroti-et-al.10769/

https://www.s4me.info/threads/emoti...ally-unexplained-symptoms-maroti-et-al.36715/

https://www.s4me.info/threads/is-co...tic-syndrome-2021-maroti-and-johansson.23448/
 
Utsikt said:
As for the second process, the third also include some reasonable elements like trying to help them solve conflicts in their important relationships.
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Though if the conflicts come from various forms of abuse, being asked to take the abusers feelings into considerations could easily cause retraumatizing. In those lines one could easily find oneself at fault for the problems although that might not be the case.
 
I have personal experience with parts of process two and three in a therapy setting, but my therapist never claimed that she could do anything for my physical symptoms.

Working through my emotions really helped my mental health and it also reduced some transient physical symptoms that were cause by anxiety in specific contexts. If I had experienced constant anxiety, those physical symptoms would probably have been within the scope or PPS.

I started therapy shortly after getting Covid (which caused my ME/CFS), and the only thing my therapist did wrong was when she talked about trying to avoid developing an activity aversion as a result of my prolonged illness.

That being said, she was very open about how she didn’t know anything about my physical illness, and she let it be up to me to hold back if that was correct for me. So I believe it was mostly a way of trying to avoid a worsening of my (then) depression. She never pushed me to do things and made sure that I always was comfortable saying no.

This is in no way an endorsement of EAET, but I just want to highlight how parts of the method could potentially lower some physical symptoms. Although probably not through the mechanisms that the methods says it works through.

So some positive results might not mean that the underlying assumptions are correct. It might be that the results were gained despite of those assumptions and the steps derived from them.
 
Midnattsol said:
Though if the conflicts come from various forms of abuse, being asked to take the abusers feelings into considerations could easily cause retraumatizing. In those lines one could easily find oneself at fault for the problems although that might not be the case.
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Good point. It doesn’t seem like it should be applied to abuse cases.

Edit for context: Part of my anxiety that I describe above stems from bullying. My therapist never asked me to consider what the bullies thought or felt.
 
The paper said:
Persistent physical symptoms (PPS), including (primary) pain, can, according to Emotional Awareness and Expression Therapy (EAET)
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They're quoting the thing about what the thing does as evidence of what the thing does? Damn. Races to the bottom really look plain silly when you're sober. I especially love that they point out that it's novel/new, which it isn't but whatever. So, according to this new thing, this thing can do this evidence-based thing. Good grief.

Basically:
Me said:
I can do this
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Imagine how silly it must feel to have done so much homework for so long, to get some advanced diploma, and they could have pulled the trick of just writing down the grade they feel they must have on every exam, instead of actually answering it.

Somehow, "according to neuroscience" has basically become a joke. Neuroscience shows no such things, but it clearly doesn't matter, because it feels like it could be true, and when you believe in your heart of hearts, it's the same thing as being true.

Also notable that they included some BS narrative review of "RCTs", by which they simply mean clinical studies but it sounds more legitimate to pretend otherwise, and found 7 such trials. Meanwhile a review of exercise trials for LC published yesterday 'found' only 8, even though there have easily been 50+.

They keep using systematic, and it literally never is. Just like with holistic, never is. Same with patient-centered. Hell, is there even a single actual label they use correctly in this entire corrupt industry?
Trish said:
Why reframe reality to suit some crackpot theorising? Why do we need our emotions processed according to someone else who has no conception of our reality? And what on this or any other planet are corrective interpersonal experiences? Is that a euphemism for punishment?
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I don't think it's much complicated than a simple: because they can. Because there is no adult supervision, no accountability or oversight. Random nonsense is just what people naturally do when they're encouraged to do random nonsense. It's easy, no one ever expects anything out of you, and you can just ride out your entire career never doing any real work. It's a perfect grift for people who aren't interested in putting any effort.
 
Never let anyone tell you that LLMs aren't useful. They can produce... this:
Folks, gather 'round! Tired of those aches and pains the so-called "experts" can't fix? Let me introduce you to the revolutionary Emotional Awareness and Expression Therapy! Yes, you heard right! That nagging backache? Unexpressed anger! That splitting headache? Repressed sadness! For too long, they've treated the body like a machine. But we know the truth: your physical woes are just your trapped emotions screaming for release!

And wouldn't you know it, the medical establishment, after years of scoffing, is finally catching on! Suddenly it's all "mind-body connection" this and "well-being" that. Seems they've figured out that if you can't beat the power of emotions, you might as well call it therapy and cash in!

EAET unlocks your inner potential, letting those toxic feelings flow, washing away your physical ailments. Don't waste another day suffering! Embrace EAET – the healing truth they tried to hide! Step right up and feel the difference!
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@Utsikt, thank you for sharing your experience of therapy. I'm glad it was helpful. I have no problem with therapy used carefully and appropriately for mental health problems.

It's all this false theorising about causes of physical symptoms and applying that theorising inappropriately I have problems with.
 
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