Could interventions that focus on emotions provide relief for clients who suffer from chronic back pain?
That’s the idea behind Psychophysiologic System Relief Therapy (PSRT). And research is beginning to emerge that supports this approach as an effective, evidence-based treatment for chronic pain.
But what exactly is it?
PSRT, a term coined by Michael Donnino, MD, is a combination of two of the primary therapies that have been showing the most promise in treating chronic pain that has no clear physical cause: Pain Reprocessing Therapy (PRT) and Emotional Awareness and Expression Therapy (EAET).
Both approaches target the stress, emotions, and learned responses in the brain that can generate pain.
Drawing on this, Dr, Donnino and his colleagues at the Beth Israel Deaconess Medical Center (affiliated with Harvard University) developed the PSRT treatment protocol to include psychoeducation about pain and its psychological contributors. It also involves desensitization to conditioned pain responses, emotional expression techniques, and mindfulness training.
To evaluate its effectiveness, Dr. Donnino and his colleagues conducted a pilot randomized control trial.
They designed the study to evaluate PSRT’s potential to reduce disability, the degree to which pain was interfering with a participant’s daily life, and pain-related anxiety in adults with chronic back pain.
Researchers randomized 35 participants into three groups. The first group participated in a 12-week PSRT program. The second engaged in an 8-week Mindfulness-Based Stress Reduction (MBSR) intervention. And the third group received standard pain relief care.
Starting at baseline and continuing at intervals of 4, 8, 13, and 26 weeks, participants completed a questionnaire designed to assess how much their back pain was interfering with their daily functioning.
So, what did the findings show?
Participants who received PSRT reported significantly greater reductions in disability than those in the MBSR and usual care groups. In addition, the PSRT intervention group described significant reductions in the degree to which pain interfered with their daily lives.
Not only that, but the PSRT group also reflected significant reductions in pain-related anxiety.
However, it’s important to keep in mind that this was a pilot study made up of a small sample. I’d be interested to see a larger randomized trial confirming similar results.
Even so, these results should be encouraging for clients who suffer from chronic pain, and for practitioners who work with them.
And later this week, we’ll be hosting a live workshop with Howard Schubiner, MD, that takes a deep dive into Emotional Expression and Awareness Therapy (EAET) — one of the foundational building blocks of PSRT.
You can find out more about Howard’s upcoming workshop here.
And, if you’re interested in reading the PSRT study on your own, you can find it right here.
But now I’d like to hear from you: how might you integrate approaches like these in your work with clients? Please leave a comment below.
As a patient of Dr John Sarno’s over 25 years ago, I have long been aware that the mind-body connection, emotional dysregulation and trauma can keep the body in a pain loop. I’ve watched Schubiner’s work with interest and know how my own journey in remission from 6 autoimmune diseases for over 15 years now (including Crohn’s and Ulcerative Colitis) has been from decoupling my experiences of pain from medical/physical diagnoses and addressing the pain as parts (IFS). It’s why I learned to use IFS as a coach and have seen great results in slowing degenerative disease and allaying many of my clients’ symptoms with parts work.
Is someone doing a larger study to look at this? I am a family doctor and would be interested in learning more about that study and possibly participating. I have research experience.
I work for a pain management clinic with a growing behavioral health department. We complete the clearance for STIM procedures and see some patients for counseling. There’s a lot of emotional trauma among the patients. I need all the education I can get in this area.
I use Pain Reprocessing Therapy (PRT) based on the work of Alan Gordon, which is based on Schubiner’s work, which is based on John Sarno’s theories – “it’s turtles all the way down!” Thanks for bringing these ideas so we can help out patients.
It would help reach a wider audience if things like the study were turned into a video, even if all it is is a person saying the main points of the study. But better still would be a set of different types of people (male, female, different ages and ethnicities) saying it. This is now possible with AI at low cost, ideally AI powered with renewable energy, and it would take no skill that your team doesn’t already possess to generate these videos.
Thank you for this thought provoking article. Dr John Sarno writing in the 1980’s and 1990’s believed that emotional stress, rather than physical structural damage, causes most chronic back pain. In my own journey as someone with Crohn’s disease, I learned yogic breathing which significantly reduced abdominal pain. However we package it, we’ve known for decades that pain is not merely a physiologic response. In my work with clients who have chronic pain, it’s important to address their beliefs about pain, what it means to them, and how they can find freedom in their response. From a Buddhist perspective, the first arrow of pain is what it is; the second arrow is how we relate to it, and this is where agency, mindfulness, and attention can help.
Lavinia Magliocco MS, LPC, CRC