Emotional awareness and expression therapy for chronic pain

1. Introduction

Version followed: Lumley & Schubiner's EAET as set out in their group therapist manual (EAET for Fibromyalgia and Related Centralized Pain Disorders, v2 2012, file updated 2017; the manual used in the Lumley et al. 2017 fibromyalgia RCT) and their 2022 Principles and Procedures for Practitioners. It is adapted for individual practice using their 2019 integrative assessment-and-treatment model (Psychosomatic Medicine), with the 1 individual + 8 group format of the Yarns older-veteran trials, and with Schubiner's Unlearn Your Pain self-help program as an adjunct. The 2019 Current Rheumatology Reports review is cited only through these companion documents [uncertain].

Emotional Awareness and Expression Therapy (EAET) is a brief, emotion-focused, exposure-based psychotherapy for chronic pain that is primarily centralized (also called primary, nociplastic or neuroplastic pain), such as fibromyalgia, many back and neck pains, IBS, tension headache and pelvic pain. Its model of change has four parts. First, the pain is real but generated and maintained by brain processes that overlap with emotion circuitry. Second, adversity, trauma and conflict sensitize those pathways, and above all so does avoiding the emotions they evoke (usually anger and assertion, or closeness, grief, guilt and love). Third, because the brain learns through emotionally powerful experience, new corrective emotional experiences can revise the danger and pain pathways. These are approaching, experiencing and expressing the avoided feelings to the right person (first imaginally in a safe setting, then in balanced form in real relationships). Fourth, re-attributing pain to the brain and reducing fear of it remove the remaining threat. [source: Lumley & Schubiner manual 2012; Principles & Procedures 2022; Lumley & Schubiner 2019 Psychosom Med]

2. Framework

Components, usually delivered in order [source: Lumley & Schubiner 2019 Psychosom Med]:

Assessment and education. Establish that the pain is primarily centralized, take a life-stress history, and give a personalized brain-based explanation of the pain.
Reducing perceived danger. Re-attribute pain to the brain, use health-affirming self-talk, notice sensations mindfully, and challenge fear beliefs.
Increasing adaptive behaviour. Graded return to avoided physical and social activities.
Emotional awareness and expression (emotional processing). Disclosure, finding the avoided primary emotions, experiencing and expressing them in chair or imagery work, written disclosure, then guilt, sadness and compassion.
Interpersonal change. Balanced assertion and connection, rehearsed and then enacted in real life.

The authors say emotional and interpersonal work can start earlier for patients with classic centralized syndromes, unresolved trauma or prominent conflict [source: Psychosom Med 2019].

Formats and dose actually tested

Group (canonical manual). 8 weekly 90-minute sessions with 5–7 patients and 30–60 minutes a day of home practice [source: manual 2012].
Yarns older-veteran trial. One 90-minute individual preparatory session (a life-stress/pain-history and psychodiagnostic interview), then 8 weekly 90-minute groups of about 8 [source: NCT03918642 protocol].
Other tested formats. A single assessment-and-education interview, 3–5 individual sessions, a 4-week class, internet-delivered EAET (9 weeks, therapist-supported, in the Swedish trials), and a 2-hour telehealth class. The authors note individual therapy is easier to implement and many patients need more than the trial dose [source: Psychosom Med 2019; Principles & Procedures 2022; Maroti et al. 2021].
Schubiner's clinic program. Prior reading of Unlearn Your Pain, a detailed medical and emotional history, then 4 weekly group sessions plus about an hour a day of writing, affirmations and meditation [source: Detroit Jewish News 2012 profile].

Group manual session map (each session runs check-in and pre-ratings → homework review → brief didactic → in-vivo experiential exercise → short worksheet → homework → post-ratings) [source: manual 2012; NCT03918642]:

Session	Focus	Key exercises
1	Rationale: stress, emotions and brain pain	Ground rules; strengths introduction; life events–symptoms timeline; stress–pain examples
2	Triangle model; anger and closeness	Defenses; anger practice; connecting-feelings practice
3	Avoidance in daily life; two fear beliefs; conflicted relationships	Avoidance record; experience–express–release (chair)
4	Self-blame, guilt and core beliefs	Self-compassion and self-forgiveness chair; release work
5	Letting go and forgiveness	Letting-go chair; release work
6	Shame, mistrust, intimacy, secrets	Intimacy exercises; sharing private experiences
7	Healthy communication	Connection + protection rehearsal; communication plan
8	Identity, barriers, future plan, ending	Planning for the future; ending feelings

Individual adaptation (recommended default for a solo practitioner) [synthesis, built from Psychosom Med 2019 and Yarns 2020]:

Session 1 (60–90 min). Medical status check, life-stress and pain-history interview, personalized education.
Sessions 2–3. Danger reduction, avoidance mapping, first anger and connecting-feeling work, writing homework.
Sessions 4–8 or more. Experience–express–release chair work on the key relationships (anger → guilt → sadness and love → compassion), then guilt, forgiveness, shame and secrets themes.
Final 1–3 sessions. Assertive communication rehearsal and real-life experiments, then identity and relapse planning.

Criteria for moving on. These are mostly not specified in the sources.

Education → emotional work. The patient provisionally accepts that the pain may be brain-generated and can name stress–symptom links. The authors note patients drift back to peripheral explanations, so education is repeated throughout [source: Psychosom Med 2019]. Requiring provisional acceptance as a gate is [synthesis].
Within an anger sequence. Move from anger to guilt, sadness and compassion when the anger is spent: the patient sighs or relaxes, reports lightness, says it is complete, or expression has stalled and you move on to avoid getting stuck [source: manual 2012; Principles & Procedures 2022].
Private/imaginal → real-life expression. Move on once the feeling has been fully experienced in the safe setting and the patient has a written, balanced plan [source: manual 2012].
Referral elsewhere. Patients with mainly peripheral pain, or little benefit, are referred to CBT or ACT. Those who decline the model get basic education and an open door [source: Psychosom Med 2019].

3. Guiding principles

[source: Principles & Procedures 2022; manual 2012; Psychosom Med 2019 unless tagged]

Pain is real and brain-generated. Never imply that the pain is imagined, that the patient is weak or mentally ill, or that they are to blame. Say so explicitly and often.
Avoidance, not stress itself, is the problem. Look for what the patient isn't feeling, saying or doing, rather than measuring how much stress they have.
Experience shapes the brain, and new experience can reshape it. Aim every session at a corrective emotional experience, not insight alone.
Agency and communion are the two core drives. Check both sides: blocked anger, pride and assertion, and blocked sadness, love, longing and healthy guilt.
Right emotion, right target. Direct the feeling at the person who caused it (in imagery or a chair), not at the therapist, symptoms or substitutes.
Re-experience rather than talk about. Detailed, present-tense, eyes-closed, embodied expression beats narrative. Lengthy storytelling is treated as avoidance.
Typical sequence: anger → guilt → sadness and longing → love, compassion and letting go. Don't let the patient stay in a single emotion. Intensity should match the severity of the violation and the closeness of the relationship. Don't force connecting feelings toward non-relational perpetrators.
Express fully in private, balanced in public. Full intensity, including fantasy, belongs in session, writing or imagery. In real life, combine assertion with care.
Challenge the two fear beliefs by experience. The beliefs are "something bad will happen" and "I won't be able to handle it". Test them through new experience, not debate.
Supportively push. One hand pushes toward the avoided experience while the other supports and validates. More push is usually needed, but the patient sets the pace through negotiation [source: manual 2012].
Be an "avoidance detective". Track defenses in the moment (smiling, tears in place of anger, intellectualizing, questions, vagueness, gut or leg sensations) and interrupt them quickly.
Be non-defensive. Invite complaints and anger at the therapist, and treat them as practice in direct expression.
Emotions are safe. You must believe emotional activation is safe yourself, or you will collude with the patient's fear (especially of anger).
Hold the 4 Cs: commitment, curiosity, creativity, courage. Keep inventing new routes to the avoided feeling and stay with discomfort [source: Principles & Procedures 2022].
Patient control and consent. The patient can stop at any time, may skip any exercise or disclosure, and is not made to feel guilty for missed homework.
Optimism and normalization. Convey that the pain is changeable, but say honestly that the work is effortful and continues after therapy ends. Brief self-disclosure of your own stress–body reactions is permitted.
Medical stewardship. Use EAET for pain that is primarily centralized, not for untreated disease. Coordinate with the patient's physician [source: Psychosom Med 2019; Schubiner profile 2012; NCT03918642]. The operational detail is [synthesis].

4. Intervention inventory

What follows is grouped as: A assessment and education; B danger reduction and avoidance; C emotional processing; D writing and imagery; E guilt, forgiveness, shame, intimacy and secrets; F interpersonal change and ending. Group-format exercises are given with notes on adapting them for individual therapy, and those adaptations are [synthesis]. All example language is illustrative unless it is quoted and cited.

A. Assessment and education

A1. Medical evaluation and coordination

Purpose. Make sure that disease or structural pathology needing medical treatment has been evaluated before you frame pain as brain-generated, and set up a channel to the patient's physician. Schubiner took a detailed medical and emotional history to rule out biomedical causes and did not dismiss surgery or medication when disease or structural damage was present [source: Schubiner profile 2012]. The Yarns trial excluded inflammatory and autoimmune disease, cancer, sickle cell, neuralgias, infection-related pain, cauda equina, gout and isolated OA or radicular pain, and sent participants with physical worsening back to primary care [source: NCT03918642].
Steps [synthesis unless tagged]:
1. Before or at intake, get the patient's consent to contact their physician. Obtain recent records on diagnoses, imaging and investigations.
2. If there has been no medical evaluation for the current pain, or new symptoms have appeared since the last one, refer before starting the emotional work.
3. Screen for red flags and refer urgently if any are present: new neurological deficit, bowel or bladder change, fever, unexplained weight loss, history of cancer, night pain unrelieved by position, recent significant trauma, or signs of inflammatory disease.
4. Note structural findings but explain that imaging abnormalities such as disc degeneration are common in pain-free people and do not prove cause [source: Psychosom Med 2019].
5. Where a peripheral condition coexists (for example OA), agree with the physician which component is targeted. The authors describe pain as often mixed and EAET as aimed at the centralized part [source: Psychosom Med 2019].
6. Agree a re-referral rule: any new, changed or qualitatively different symptom goes back to the physician, and you can pause therapy if the patient prefers [source: NCT03918642 safety procedures].
7. Do not advise on medication. Leave tapering and changes to the prescriber.
Example language (illustrative): "Before we treat this as your nervous system turning the volume up, I want to be sure your doctor has looked for anything that needs medical treatment. Can I have your permission to talk with them?"
Watch for. Patients using EAET to avoid needed medical care, or using endless testing to avoid the emotional work. Physicians who frame pain as "all in your head"; correct this to "real, brain-generated". It is working when you have a shared understanding with the physician and the patient can name what would warrant re-evaluation.

A2. Assessing whether pain is primarily centralized

Purpose. Decide whether EAET fits, and gather personalized evidence for the education step [source: Psychosom Med 2019].
Steps:
1. Pain pattern. Ask whether onset came without injury or the pain persisted beyond healing, whether it is distributed non-anatomically, moves or spreads, is symmetrical or occurs at several sites, varies across days, and flares with stress, emotions or non-mechanical triggers [source: Psychosom Med 2019; Gordon appendix (secondary)].
2. History. Ask about other centralized conditions (headache, IBS, pelvic pain, TMJ, fatigue, insomnia), sensory sensitivity, adverse childhood experiences, and traits such as people-pleasing, perfectionism and self-criticism.
3. Onset context. Ask what was happening in the patient's life and relationships in the months before the pain started.
4. Exam and records. Note the absence of objective neurological deficit, and the presence of allodynia or hyperalgesia (from the physician's exam).
5. In-session test. Ask the patient to imagine a pain-triggering movement without doing it, and note whether the pain appears. Also note whether pain changes as emotional topics come up. The authors treat both as strong evidence [source: Psychosom Med 2019].
6. Optional measures. The Central Sensitization Inventory, the Survey for the Assessment of Fibromyalgia, and the Nijs criteria [source: Psychosom Med 2019].
Example language (illustrative): "Close your eyes and just imagine bending to pick up the laundry, without moving. What happens in your back?"
Watch for. Indicators are not diagnostic, and their absence doesn't rule out centralized pain [source: Gordon appendix (secondary)]. Mixed pain is common. When the indicators are mostly peripheral, refer to CBT or ACT [source: Psychosom Med 2019].

A3. Life-stress and emotional awareness interview (intake)

Purpose. Link stressful events and avoided emotions to pain onset and maintenance, start emotional exposure from session 1, and build the patient's personal model. This is the individual preparatory session in Yarns, also tested as a stand-alone single-session intervention [source: NCT03918642; Principles & Procedures 2022].
Steps:
1. Take the pain history: onset, course, treatments, triggers, good periods.
2. Take the life history alongside it: childhood family climate, adversity, losses, trauma, key relationships now.
3. Lay them on a shared timeline and ask what was happening emotionally when the pain began or worsened.
4. For each key event, ask what the patient felt, what they did with the feeling, and what they did not say.
5. Watch in real time for symptom changes, defenses and affect, then name them gently [source: Psychosom Med 2019].
6. Summarize the hypothesized links between events, avoided emotions and symptoms, framed as a working hypothesis.
7. Do a psychodiagnostic screen, including suicide and violence risk, substance use, psychosis and dissociation, and cognitive status [source: NCT03918642].
Example language (illustrative): "Your back went out the month your father moved in with you. What did you feel about that arrangement that you never said out loud?"
Watch for. Pain rising or easing as you discuss particular people (useful evidence). Flat narrative with no affect. Signs of exclusion-level risk (see section 5). It is working when the patient spontaneously notices a link.

A4. Personalized pain education (brain-generated pain)

Purpose. Replace a tissue-damage explanation with a brain-pathway explanation, reduce threat, and give the rationale for emotional work [source: manual 2012 S1; Psychosom Med 2019].
Steps:
1. Normalize bodily stress reactions; brief self-disclosure of your own is allowed.
2. Explain that pain is produced by the brain, that pain pathways overlap with emotion and danger circuitry, and that pathways can be sensitized by early stress and later triggered.
3. Describe the manual's three-factor picture: biological predisposition, psychological sensitization from earlier stress, and a triggering event.
4. Explain that held-in emotions keep the alarm system active, while new emotional experiences and safety signals can reverse it.
5. Personalize the account with the patient's own timeline, triggers and in-session symptom shifts.
6. Repeat and re-personalize in later sessions, because patients drift back to peripheral explanations [source: Psychosom Med 2019].
7. Assign reading. In the trial manual this was the program and patient stories plus how the brain learns and unlearns pain. Schubiner's Unlearn Your Pain serves for individual work [source: manual 2012; Schubiner profile 2012].
Example language (illustrative): "Your pain is completely real. The good news is that the evidence points to a learned alarm in the brain, not damage, and what the brain has learned it can unlearn."
Watch for. "So it's in my head" (correct this: real, brain-generated, not imagined). Fear that the explanation means the doctors missed something (return to A1). It is working when the patient uses the model to explain a flare.

A5. Life events–symptoms–core issues timeline

Purpose. A visual map tying life events to symptom onset and flares, and pointing to the core emotional issues [source: manual 2012 S1].
Steps:
1. Draw a lifeline from birth to now.
2. Mark major events above the line and the onset and worsening of symptoms below it.
3. Ask what emotional issues run through clusters of events.
4. Have the patient describe one occasion when stress clearly worsened pain.
5. Keep the timeline and add to it during therapy.
Example language (illustrative): "Look at where the migraines start and where your divorce is. What do you notice?"
Watch for. Patients minimizing events ("that was nothing"). A blank childhood. Both are leads for later work.

A6. Triangle model (feelings–defenses–anxiety/symptoms)

Purpose. A shared map showing how a feeling or need triggers anxiety and symptoms, which defenses then shut down [source: manual 2012 S2; based on Malan].
Steps:
1. Draw an inverted triangle: important feelings and needs at the bottom, defenses at the top left, anxiety and symptoms at the top right.
2. Use a recent episode to fill in each corner.
3. Review a list of common defenses and have the patient tick their own. Frame defenses as once adaptive but costly when habitual.
4. Return to the triangle whenever a defense or symptom appears in session.
Example language (illustrative): "When your sister criticized you, the anger was at the bottom. Your neck tightened over here, and you changed the subject over there. That's the whole triangle in ten seconds."
Watch for. Using the model intellectually, which is itself a defense. It is working when the patient catches their own defense live.

B. Danger reduction and avoidance

B1. Health-affirming self-talk and talking back to symptoms

Purpose. Reduce fear of pain and reinforce the brain attribution [source: Psychosom Med 2019; manual 2012 S3].
Steps:
1. Draft 2–4 short, believable statements with the patient. Examples: the pain comes from the brain; the body is healthy; the brain is processing emotions; symptoms will not stop the patient from living fully.
2. Have the patient say them aloud firmly in session, in an assertive rather than pleading tone.
3. Assign use at the first sign of symptoms, combined with B2.
4. Treat negative thoughts about pain, the past or the future as brain constructions that can be noted and set aside [source: Psychosom Med 2019].
Example language (illustrative): "Say it like you mean it: 'You're a false alarm. I'm safe, and I'm going to the park anyway.'"
Watch for. Use as a magic charm or as pain suppression ("make it stop"). Reframe it as a safety message, not a fight. It is working when there is less fear and checking even if pain persists.

B2. Flare-up protocol

Purpose. Turn flares into prompts for emotional awareness instead of alarm [source: manual 2012 S3].
Steps:
1. When symptoms rise, the patient pauses and asks what happened in the last day or so and which feeling they are blocking.
2. They ask whether they can let themselves experience and express that feeling: privately, in writing, or aloud.
3. They talk back to the symptom (B1).
4. They resume the planned activity.
5. In the next session, debrief the flare at the check-in.
Example language (illustrative): "Next flare, before the heating pad, ask: who am I angry with that I haven't let myself be angry with?"
Watch for. Self-blame ("I caused my flare"). Correct it: flares are information, not failure. Any qualitatively new symptom goes to A1.

B3. Mindful observation of sensations

Purpose. Let the patient experience pain sensations as harmless, which reduces threat appraisal [source: Psychosom Med 2019, brief mention]. Detailed procedure not found in EAET sources [uncertain].
Steps [synthesis]:
1. Invite a curious, non-judging description of the sensation: location, quality, intensity, movement.
2. Pair it with safety cues ("this is the brain's alarm").
3. Notice shifts over 1–2 minutes.
4. Use it briefly and not as a substitute for emotional work.
Example language (illustrative): "Just watch the tightness like a scientist for a minute. Is it constant, or does it change?"
Watch for. Hypervigilant monitoring disguised as mindfulness. Keep it brief.

B4. Graded re-engagement in avoided activities

Purpose. Reduce pain-related fear and increase flexibility by resuming avoided physical and social activities while believing the body is not being harmed [source: Psychosom Med 2019].
Steps:
1. List avoided activities, physical and social.
2. Rank them from easiest to hardest.
3. Choose the next step with the patient.
4. Before each step, rehearse the expectation that it is safe.
5. Do the activity and record what actually happened.
6. Climb the hierarchy.
7. Coordinate with the physician where there is a real physical limitation [synthesis].
Example language (illustrative): "Your scans show nothing that walking will harm. What's a walk long enough to be a stretch but not a leap?"
Watch for. Boom-and-bust overdoing. Safety behaviors such as bracing and stopping at the first twinge. It is working when activity rises and anticipatory fear falls.

B5. Daily avoidance record and avoided-experience experiments

Purpose. Make avoidance visible across every domain and practise approach weekly [source: manual 2012 S2–S8].
Steps:
1. Explain the categories of avoided stimuli: people, places, objects, actions, thoughts and memories, feelings, and physical sensations.
2. For one week, the patient logs daily what they avoided. Encourage odd examples, and give your own across the categories.
3. Review the log: for each item, does the patient want to change it?
4. Each week the patient chooses at least one avoided experience to "experiment with", predicts the outcome, does it, and records the result.
5. Celebrate attempts, and use the results to test the fear beliefs (B6).
6. In later weeks, theme the experiments: childhood, intimacy, secrets, communication.
Example language (illustrative): "Pick one thing from this list to experiment with this week. What do you predict will happen?"
Watch for. Only trivial items, or only physical items. Probe for the relational ones. It is working when experiments shift from small to meaningful.

B6. Challenging the two fear beliefs

Purpose. Undermine the beliefs that maintain avoidance: if I have this experience something bad will happen, and I won't be able to handle it [source: manual 2012 S3; Principles & Procedures 2022].
Steps:
1. Name the two beliefs explicitly.
2. Before any exposure (chair, disclosure, real-life assertion), ask what the patient predicts.
3. Afterwards, compare what actually happened with the prediction.
4. When the patient balks, ask what they fear will happen. State your own belief that it won't happen, that they can handle it, and that they will be stronger for it [source: Principles & Procedures 2022].
Example language (illustrative): "You predicted you'd fall apart if you said that to your mother's empty chair. You said it. Are you in pieces?"
Watch for. Debating the beliefs. The sources favour new experience over argument.

C. Emotional processing

C1. Anger experience and expression practice (warm-up, no specific target)

Purpose. Desensitize the patient to the felt and expressed experience of anger in body, face and voice [source: manual 2012 S2].
Steps:
1. The patient privately rates pain from 0 to 10.
2. Build a list of anger words, from mild to intense.
3. Try strong postures: standing tall, hands on hips, arms crossed, pointing. Respect genuine cultural or religious limits, but check whether fear or guilt is the real block.
4. With eyes closed, the patient imagines someone threatening their body, children or autonomy, notices what the body wants to do, and rehearses it (for example pushing or striking, perhaps holding a pen as a symbolic weapon).
5. Work on the face. Demonstrate an angry face. Note that smiling blocks anger and that tears often replace it.
6. Work on the voice: start with "No!" and raise the volume and force, then move to stronger statements of refusal and anger, including the patient's own most feared phrases.
7. Combine voice and posture in one strong statement.
8. Re-rate pain. A drop suggests benefit. A rise usually signals conflicting emotions, so explore them (C2).
Example language (illustrative): "Stand up, plant your feet, and say 'No.' Again, louder. Now let your face match your voice."
Watch for. Smiling, laughing, apologizing, a quiet voice, collapsing posture. It is working when voice and body align and pain or tension falls.
Individual adaptation [synthesis]. Do it one-to-one and model each step yourself first.

C2. Connecting-feelings practice

Purpose. Practise the vulnerable, communion-side emotions (sadness, longing, love, healthy guilt) and notice how they conflict with anger [source: manual 2012 S2].
Steps:
1. After C1, ask what else came up: anxiety, guilt, embarrassment, numbness, symptoms. Treat these as signs of an unexpressed activating or core feeling.
2. Explore guilt, which often reflects sadness or longing toward someone loved.
3. Generate connecting phrases. The manual's examples are along the lines of not wanting to lose someone, wanting to be close, or admitting being wrong.
4. Have the patient deliver the phrases in a soft, genuine tone with an open face and body. In groups, they go round to partners; individually, they speak to you or a chair [synthesis for individual].
5. Re-rate pain. A rise often means anger and connection are in conflict, because closeness feels like being exposed to exploitation.
Example language (illustrative): "Look at the chair as if your son is there and say, softly, 'I miss you.' Notice what happens in your chest."
Watch for. Rushing, sarcasm, avoided eye contact, switching to anger to escape tenderness.

C3. Conflicted-feelings mapping of key relationships

Purpose. Choose targets for processing and expose mixed feelings [source: manual 2012 S3].
Steps:
1. The patient names the two most stressful or conflicted relationships, past or present, in about a minute each.
2. For each, list angry feelings in one column and connecting feelings (love, sadness, guilt, longing) in the other.
3. Note what has never been said.
4. Pick the target for C4. Start with a less difficult relationship if the main one feels too much [source: manual 2012].
Example language (illustrative): "Two columns for your father: everything you resent, and everything you love or miss. Which column is harder to fill?"
Watch for. Long stories in place of naming feelings. Interrupt and redirect.

C4. Experience–express–release protocol (chair/imaginal work)

Purpose. EAET's core in-session corrective emotional experience: full imaginal experience and expression of anger at the right target, then guilt, sadness, compassion and new statements [source: manual 2012 S3–S5].
Steps:
1. Set the scene. Keep the description brief, then have the patient go back to the time and place in the present tense, eyes closed if helpful. They may speak as their younger self ("what does the little boy want to say?"). Place the other person in an empty chair.
2. Experience anger. Invite direct expression to the offender, letting the patient lead. Interrupt defenses quickly (intellectualizing, questions, vagueness, gut or leg sensations) and return to direct words. Ask where the anger is felt. Keep going until it reaches the chest, arms, hands, face or head.
3. Express anger with words and muscles. Ask what the anger would do if it were fully powerful, framed as the anger acting rather than the patient attacking. Keep asking what it would do next, prompting as needed. Match intensity to the violation: firm words for minor conflicts, rage-level imagery for severe victimization.
4. Check for completion. When the patient pauses, ask whether anger remains. If it does, ask what else it needs to do. Spent anger typically shows as a sigh or relaxation. Then ask how the body feels; light or even giddy is typical.
5. Inquire about guilt. Is there regret, or guilt about the anger? Guilt is expected only in proportion to how valued the relationship was. Don't seek it with strangers.
6. Inquire about sadness and loss. What did you want from this person that you lost or never had?
7. Talk to three people. First the younger self (it wasn't your fault, you did nothing wrong, you'll be okay). Then the offender now (you can't hurt me any more; or, if a relationship is wanted, I still care but won't let you hurt me). Then the present adult self (I'm strong and can act for myself).
8. Explore actions. What steps now, and how might the relationship be repaired safely, if at all?
9. Assess the current state. Body sensations and pain rating.
10. If stuck, move to the next step rather than staying stuck. Repeat the protocol with the same or another relationship in later sessions [source: manual 2012].
Example language. The manual's sample prompt asks what the anger would do if fully powerful [source: manual 2012]. Illustrative: "Don't ask him why. Tell him. 'You had no right.' Louder… What does the anger want to do now?" Steering from questions to statements is from Principles & Procedures 2022.
Watch for. Fear or helplessness taking over (redirect; see C5f). Crying in place of anger. Questions to the offender ("why did you…"). Self-pity narratives ("look how damaged I am"); redirect to what the other did wrong. It is working when the patient has a felt release, pain or tension drops, there is spontaneous movement into grief or compassion, and they report feeling lighter.

C5. Schubiner's rescripting sequence (memory-reconsolidation variant, individual)

Purpose. An individual-therapy variant in which the patient returns to a formative memory as their older, wiser self to change the memory rather than relive it [source: Principles & Procedures 2022, Schubiner section].
Steps:
- a. Explain the model. Memories can be revised. Early fear and powerlessness built a hypervigilant alarm, and held-in anger, guilt and sadness keep it on. New corrective emotional memories can overlay old ones.
- b. Get consent. The patient controls the process and can stop at any time.
- c. Handle ambivalence. Normalize conflicting parts of the self. Schubiner allows speaking to and honoring each part, drawing on IFS.
- d. Enter the scene as an observer-helper. The patient goes back as the adult who can help the younger self. If they slide into fear or helplessness, gently redirect.
- e. If sadness comes first, let it be felt briefly. Then the adult self sits by the younger self and offers comfort and compassionate statements, for example that the child didn't deserve this, that it isn't their fault, and that they will be protected [source: Principles & Procedures 2022]. Ask whether the younger self can hear these messages.
- f. Access anger. Let it build uncensored, perhaps sitting up, standing or clenching the fists, and affirm that it is justified. Ask what the anger would say to protect the child, and move from questions to forceful statements. Praise each statement. Then ask what the anger would do (stop the abuse, push away, bring others to witness, impose consequences). The aim is to stop the abuse, get the child to safety, and let the abuser feel something of what they caused. Continue until the patient says it is complete. Then the patient breathes, lets the anger go, "wipes their hands", and walks away with head held high.
- g. Search for guilt. Guilt about anger: treat it as a sign of caring, and ask what the person beneath the anger might feel and say. Undeserved guilt: the patient recognizes they did nothing wrong. Deserved guilt: self-forgiveness and amends.
- h. Return to grief and self-compassion.
- i. Wrap up. Check emotional and physical state. Lightness is common. If tension remains, repeat; several rounds may be needed. Between-session practice uses Schubiner's workbooks.
Example language (illustrative): "You're 50 now, standing in that kitchen. Go stand next to eight-year-old you. What does she need to hear from you?"
Watch for. Re-traumatization through reliving from the child's position rather than as the adult. Re-anchor in the adult self, here and now. It is working when the patient describes the memory as feeling different.

C6. Deepening techniques: moving from talking about to re-experiencing

Purpose. Shift from narrative to live emotion whenever processing stalls [source: Principles & Procedures 2022].
Steps (use whichever is needed):
1. Ask for concrete details of a vague story: where, who, words said, what they saw.
2. Have the patient tell it in the present tense with eyes closed.
3. Move to speaking directly to the person in the empty chair.
4. Activate the voice (louder, firmer), the language (statements, not questions; "I" not "you know") and the body (posture, hands, face).
5. Name "holding back" when you see it in voice or body.
6. Model a fuller version, then have the patient say it in their own words.
7. If the patient can't name a feeling, offer a hypothetical: what you might feel in that situation.
8. Use the probes: What feelings aren't you expressing? What do you honestly want to say? What do your feelings want to do to that person?
Example language (illustrative): "Stop for a second. You just smiled while describing him hitting you. What's under the smile?"
Watch for. Over-modelling, where the patient parrots your words. Hand the words back to them.

D. Written emotional disclosure and guided imagery (home practice)

The manual targets about 30–60 minutes a day of home practice and tells patients not to feel guilty about skipping [source: manual 2012]. Written disclosure in the form of free writing and unsent letters brought to session is described as core in the integrative model [source: Psychosom Med 2019]. It is not listed as an EAET component in the Yarns protocol [source: NCT03918642].

D1. Unsent letters

Purpose. Private, full-intensity expression to a specific person, later read aloud in session to deepen it [source: manual 2012 S3; Principles & Procedures 2022].
Steps:
1. The patient writes about four times in a week, each a letter to a person they have unexpressed feelings toward. The letter is not sent.
2. Instruct them to write everything without censoring: anger first, then whatever follows (hurt, longing, guilt, love).
3. In session, they read it aloud to the empty chair, and you coach voice and statements (C6).
4. Ask what was hardest to write and what was left out.
Example language (illustrative): "Write it as if he will never see it, because he won't. Then bring it in and we'll read it to his chair."
Watch for. Letters that explain or justify rather than express. Letters written but not read aloud. The patient sending the letter impulsively; agree beforehand that real-life communication is planned separately (F2).

D2. Childhood stressors writing with a letter to the child self

Purpose. Expressive writing about early adversity, ending in self-compassion [source: manual 2012 S2, S4].
Steps:
1. Preparatory worksheet investigating childhood: family climate, rules, what feelings were allowed.
2. Over four days, the patient writes about childhood stressors and their feelings about them.
3. On the last day they write a letter to themselves as a child.
4. Review the writing in session, and use content for C4 or C5.
Watch for. Writing that is purely descriptive with no feelings, or self-blaming. It is working when the patient feels warmth toward the child self.

D3. Further structured writing assignments (manual sequence)

Each is assigned as homework and debriefed at the next check-in. Prompts are paraphrased [source: manual 2012 S5–S8].

Forgiveness writing (one session): about a hurt, toward letting go or forgiveness after anger is acknowledged.
Private experiences and secrets writing (three sessions): what is kept hidden, why, and its cost. This is preparation for E4.
Gratitude list and gratitude free writing (three sessions).
"Writing your life story in a new way" (three sessions), which the manual calls the most important writing task: retelling one's life with the new understanding, emphasizing agency and growth.
Written healthy-communication dialogues (two sessions): scripting an assertive and connecting exchange (F1).
"Creating the new you" (after therapy): a description of the person the patient is becoming.
Watch for. Avoidance of a specific assignment, which usually signals the next target.

D4. Guided imagery recordings

Purpose. Repeated private imaginal exposure between sessions [source: manual 2012].
Content. The manual pairs each week with an audio exercise: emotional awareness; anger awareness and expression; imaginal childhood stressors; imaginal sharing of secrets; imaginal positive intimacy; imaginal assertive communication. The recordings are not drawn on [uncertain].
Steps [synthesis]:
1. If you don't have the recordings, record your own short script for each theme. Use 10–15 minutes of relaxed attention, then imagine the scene, notice body feelings, and imagine the full expression.
2. The patient listens repeatedly during the week.
Watch for. Using recordings as relaxation tapes. The goal is activation, then release.

E. Guilt, forgiveness, shame, intimacy and secrets

E1. Core beliefs identification

Purpose. Name the one or two unhealthy rules learned in key relationships, about self, behavior, relationships or health [source: manual 2012 S4].
Steps:
1. Review common unhealthy rules with the patient.
2. The patient picks their central one and the relationship where it was learned.
3. Frame finding out that the belief is wrong as part of growth.
4. Use the belief as material for chair work, directed at the person who taught it.
Example language (illustrative): "Whose voice is 'your needs come last'? Let's put them in the chair."

E2. Self-compassion and self-forgiveness chair

Purpose. Separate healthy guilt (which motivates repair) from unhealthy guilt (imposed for normal needs), and release self-blame [source: manual 2012 S4].
Steps:
1. Pick a relationship that induced unreasonable guilt.
2. The patient tells that person in the chair, assertively, that they were wrong; that the patient is worth it and deserves good things; that taking time for oneself isn't selfish; and that the patient isn't to blame for what that person did.
3. Pick an act the patient genuinely regrets. They say aloud "I forgive myself for…" [source: manual 2012] twice, moving from general to specific.
4. Ask whether the guilt and the "should have done better" messages can now be let go.
Watch for. Instant self-forgiveness without feeling. Deserved guilt that needs amends rather than release (C5g).

E3. Letting go and forgiveness chair

Purpose. Release resentment that keeps the patient tied to the offender, after the anger has been expressed [source: manual 2012 S5].
Steps:
1. Discuss how holding resentment keeps the other person in control.
2. Distinguish letting go, which is always available, from forgiveness, which is an optional, more powerful choice and may fit the patient's religious values.
3. Confirm that the legitimate anger has been expressed first (C4).
4. The patient speaks to the offender in the chair. Statements range from acknowledging the anger but no longer holding it, through refusing the person power any more, to choosing to forgive. The manual also offers a faith-based variant for patients who can't forgive personally.
5. The patient may stay general or be specific.
Watch for. Premature forgiveness used to avoid anger. Pressure to forgive; it is optional.

E4. Shame and mistrust work

Purpose. Name shame (a global sense of being defective, never healthy, usually instilled by critical families, cultures or religions) and generalized mistrust, both of which drive withdrawal [source: manual 2012 S6].
Steps:
1. Brief psychoeducation on shame versus guilt.
2. Identify where the shame came from.
3. Direct assertive anger at the source in the chair (C4).
4. Identify where mistrust has generalized, and the cost of staying guarded.
5. Plan small trust experiments (B5).
Watch for. Shame about being in therapy or about the pain itself. Name it non-judgmentally.

E5. Intimacy exercises

Purpose. Desensitize avoided positive closeness [source: manual 2012 S6].
Steps (group version):
1. List the closeness behaviors the patient finds uncomfortable: eye contact, sitting close, touch, thanks, compliments, saying "I like you" or "I love you".
2. Practise in pairs: sustained eye contact, closing the eyes while being watched, light touch on the arm or hand-holding if comfortable, thanks, and compliments without "but".
3. Use the empty chair: the patient tells someone positive intimate feelings that are hard to say.
4. Homework: one small intimate act a day.
Individual adaptation [synthesis]. Omit touch between therapist and patient. Use eye contact, receiving a sincere compliment from you without deflecting, and chair work. Move physical intimacy practice to the patient's real relationships.
Watch for. Deflection by joking or minimizing. Sexual intimacy is often avoided and tied to trauma; the manual suggests writing first, then considering a conversation with the partner.

E6. Disclosure of secrets and private experiences

Purpose. Reduce the burden of concealment (taxed attention, rumination, pain) through safe disclosure [source: manual 2012 S6].
Steps:
1. Restate confidentiality and its limits. Disclosure is invited, never required.
2. Discuss the categories of secrets (actions, thoughts and fantasies, health, relationships) and why people keep them (shame, fear of losing relationships).
3. Examine the patient's fears about your reaction (B6), and any self-blame or worthlessness beliefs.
4. The patient decides what is safe to share and shares at their own pace.
5. Respond with no surprise, with validation and empathy, and praise their courage.
6. Identify a safe person outside therapy. Role-play first asking whether that person is safe to talk to, then plan the disclosure.
7. Prepare the patient for the typical pattern of fear followed by relief.
Watch for. Disclosures that trigger mandatory reporting; explain the limits at step 1 [synthesis]. A post-disclosure shame hangover; check in within the session and at the next one.

F. Interpersonal change, process tools and ending

F1. Healthy communication framework (connection + protection)

Purpose. Carry the processed emotions into real relationships in a balanced, assertive form [source: manual 2012 S7; Principles & Procedures 2022].
Steps:
1. Teach the spectrum. At one end is connection (affection, closeness, reassurance, apology). At the other is protection (saying no, asking for what you want, disagreeing, criticizing, distancing, and ending relationships that are unhealthy).
2. Show that the healthiest communication usually combines both in one message. Doing neither is a common outcome of conflict.
3. Contrast this with the full-intensity expression used in session: real-life expression is moderated and mindful of consequences.
4. Tell the patient that the communication may not change the other person, but it will change the patient's stress.
Example language (illustrative): "Two sentences: one that says 'I care about you', one that says 'and this isn't okay with me.'"

F2. Communication rehearsal and real-life experiments

Purpose. Practise, then enact, assertion plus connection with real people [source: manual 2012 S7–S8; Psychosom Med 2019].
Steps:
1. Choose a moderate situation first (a friend, neighbor or coworker). Draft the connecting words and the assertive words.
2. Rehearse the full phrases with the therapist role-playing the other person [synthesis for individual]; in groups, members rehearse in pairs.
3. Move to a major relationship and rehearse to the empty chair. Push for both parts and for direct, genuine delivery, and name defenses as they appear.
4. Write a detailed plan: who, when, where, opening words, likely responses, what to do if it goes badly.
5. The patient carries it out.
6. Debrief, judging success by the patient's own effort and skill, not by the other person's response.
7. Consider boundaries or distancing where the relationship is harmful.
Example language (illustrative): "I'll be your husband. Say it to me the way you wrote it. I'll push back a bit, and you hold your ground."
Watch for. Bringing session-level rage into real life. Safety where the other person is abusive (see section 5). Plans that never get enacted.

F3. Session check-in, ratings and symptom monitoring

Purpose. Track change, catch flares and risk, and use symptom shifts as evidence of the brain's role [source: manual 2012; NCT03918642].
Steps:
1. Take brief before-session and after-session ratings of pain, symptoms and emotions.
2. In the opening check-in, ask about symptom worsening and suicidal ideation (as in the Yarns protocol).
3. Take pain ratings before and after each experiential exercise.
4. Review homework and avoidance experiments.
5. Plot change across sessions [synthesis].
Watch for. Pain rising after an exercise. This is information about conflicting emotions, not failure.

F4. Process interventions for in-session obstacles

These are taken from Lumley's prompts for specific situations [source: Principles & Procedures 2022].

"Why did you…?" questions to the offender: redirect the patient to tell the person their feelings.
Long storytelling: ask what they feel and what should be said directly.
Dwelling on how damaged they are: redirect to what the other person did wrong.
Unable to name a feeling: offer your own hypothetical feeling.
Questions to the therapist about the therapy: invite them to say directly what they feel and want.
Balking: ask about the feared outcome, then voice confidence that it won't happen, that they can handle it, and that they'll be stronger.
Anger or pushback at you: accept it non-defensively and invite fuller, direct expression toward you.
Example language (illustrative): "You're asking me whether this works. I'm guessing there's a feeling under that question. Say it to me straight."

F5. Identity, barriers to change and planning for the future

Purpose. Address what holds the illness identity in place, and plan continued growth [source: manual 2012 S8].
Steps:
1. Identity labels: what the patient calls themselves (pain survivor, caretaker, supermom) and what others call them.
2. External barriers, such as family invested in stability, or disability status.
3. Internal barriers, such as fear of change, pride in the identity, and loss of safety nets.
4. Hard questions: Who would I be without pain? Which parts am I willing to change? Which feel safer staying the same?
5. Planning-for-my-future sheet: key growth areas, continued practices and specific commitments. Give your own honest view of what remains.
Example language (illustrative): "If the pain were gone tomorrow, what would people expect of you that they don't now?"
Watch for. Disability or compensation stakes; litigation was an exclusion criterion in Yarns [source: NCT03918642]. Handle these with explicit, non-judgmental discussion [synthesis].

F6. Ending the therapy

Purpose. Use termination as a final emotional-awareness exercise [source: manual 2012 S8].
Steps:
1. Invite the full range of feelings about ending. The manual has the leader cover relief, gratitude, disappointment at limited improvement, anger at the therapist or program for ending, sadness, and fear of continuing alone.
2. Each person states how they changed and what they will keep doing.
3. Frame the work as substantial change but not complete recovery: work on avoidance, beliefs and relationships continues.
4. Say goodbye directly.
Watch for. Avoiding anger or disappointment at you. Invite it explicitly.

5. Handling problems

Items tagged [source] come from the EAET documents. Items tagged [synthesis] are my own guidance and not found in primary sources. The group manual itself contains no safety-screening or crisis procedure; the safety items below draw on the Yarns protocol and standard practice.

Rejection of the brain-pain model ("you're saying it's in my head")

Say again that the pain is real and that "brain-generated" is not "imagined" [source: Principles & Procedures 2022].
Gather the patient's own evidence: symptoms shifting during the interview, the imagined-movement test, stress-linked flares [source: Psychosom Med 2019].
Frame the work as an experiment and repeat the education throughout [source: manual 2012; Psychosom Med 2019].
If they still decline, give basic education, offer CBT or ACT, and leave the door open [source: Psychosom Med 2019].
[synthesis] Ask what it would mean if the model were true. Patients often fear it implies blame or that years of treatment were wasted. Address that feeling directly.

Fear the doctors missed something / repeated reassurance-seeking

[synthesis] Go back to A1 once, with the physician. Agree specific criteria for re-evaluation, then treat further checking as avoidance (B5) rather than re-arguing each time.

Stuck: only talking about, no affect

Use the C6 ladder: detail, present tense, empty chair, voice and body, modelling, hypotheticals [source: Principles & Procedures 2022].
Ask "what are you not saying?" and name the holding back.
If expression stalls in the protocol, move to the next step rather than staying stuck [source: manual 2012].
[synthesis] Switch target to a less loaded relationship, or switch modality to an unsent letter read aloud.

Alexithymia / "I don't feel anything"

Offer the therapist's hypothetical feeling [source: Principles & Procedures 2022].
Use body location and posture (C1 steps 3–7) [source: manual 2012].
[synthesis] Start with the anger words list and rate each one for "fit". Use pain changes as the emotion signal.

Smiling, tears or fear instead of anger

Name smiling and tears as possible blocks to anger [source: manual 2012].
If the patient goes to fear or helplessness, gently cut it off and reframe that fear was the only option back then. They are the adult now [source: Principles & Procedures 2022].
If sadness genuinely comes first, honor it briefly with compassion for the younger self, then move to anger [source: Principles & Procedures 2022, Schubiner section].

Ambivalence or guilt about anger

Clarify three things [source: Principles & Procedures 2022]. They are imagining, not acting. The anger is aimed at the past person, not the present one. And anger doesn't make them like their abuser, nor does it make them bad.
Treat guilt about anger as evidence of caring, and explore it (C5g).
Respect genuine religious or cultural limits, but check whether fear or guilt is the actual block [source: manual 2012].
Allow parts-based dialogue for conflicting parts [source: Principles & Procedures 2022].

Balking, resistance, "this is too much"

Ask about the feared outcome, then state confidence that they'll handle it and be stronger [source: Principles & Procedures 2022].
Negotiate the pace: push with one hand and support with the other, with the patient as final arbiter [source: manual 2012].
Choose an easier relationship first.
The patient may skip any exercise or disclosure.
[synthesis] Distinguish avoidance, which you push through supportively, from a reasoned "not yet" for a trauma the patient isn't resourced for, which you respect and schedule.

Anger at the therapist / ruptures

Accept it non-defensively, thank the patient, and invite fuller direct expression to you as a live corrective experience [source: Principles & Procedures 2022; manual 2012 ground rules].
[synthesis] Then repair explicitly. Acknowledge any real misstep, such as pushing too fast or seeming to dismiss the pain as "not real", then ask what they need from you now. Ruptures often follow the "in your head" misunderstanding, so revisit A4.

Overwhelm, flooding, dissociation

The authors advise dosing when emotions become overwhelming [source: Psychosom Med 2019]. Intensity should match the violation [source: manual 2012].
In rescripting, keep the patient positioned as the adult helper, not reliving the scene [source: Principles & Procedures 2022].
The manual gives no specific overwhelm protocol [uncertain].
[synthesis] Steps when overwhelm occurs:
1. Stop the exercise and open the eyes.
2. Orient to the room and the present date.
3. Use paced breathing and feet on the floor.
4. Name the feeling and say that it is safe and passing.
5. Resume at a lower intensity, for example writing instead of the chair, or the observer position instead of direct address.
[synthesis] Do not end the session flooded. Allow 10 minutes to settle and debrief.
[synthesis] For complex PTSD or dissociative presentations, build stabilization first or coordinate with a trauma specialist. Dissociative identity disorder was an exclusion in Yarns [source: NCT03918642].

Pain flare after a session

Normalize it as activation of conflicted emotions. Use the flare protocol (B2) and explore what remained unexpressed, typically connecting feelings after anger [source: manual 2012].
[synthesis] Warn the patient in advance that a temporary rise can occur.
Any new or qualitatively different symptom goes back to the physician [source: NCT03918642].

Non-adherence to homework

Patients are told not to feel guilty and to keep attending [source: manual 2012].
[synthesis] Treat the skipped assignment as an avoidance clue: which task was skipped, and what feeling does it touch? Shrink the task, for example from 30 minutes to 10, or writing one sentence. Do the first few minutes of it in session.

Considering dropout or skeptical attendance

Explore it openly, name the fear and discomfort, frame feelings and memories as not truly dangerous, and ask the patient to keep coming even while skeptical [source: manual 2012 S3].

Real-life expression goes wrong

Real-life communication should be balanced and assertive, never the session-level intensity [source: manual 2012; Principles & Procedures 2022].
Judge success by the patient's own skill and effort [source: manual 2012].
[synthesis] Debrief, use the outcome to test the fear beliefs, refine the plan, and re-rehearse.

Current abuse or danger in the target relationship

[synthesis] Do not rehearse confrontation with a currently violent partner. Prioritize a safety assessment and safety plan, and refer to domestic-violence services. Keep chair work imaginal. Distancing and ending the relationship are legitimate protective options [source: manual 2012 S7 on ending unhealthy relationships].

Suicidality, violence risk, psychosis, severe substance use

Yarns screened out active suicide or violence risk in the previous 6 months, psychosis and bipolar I, severe uncontrolled mood disorder, substantial cognitive impairment and active severe substance use. They checked suicidal ideation at each session, suspended therapy and evaluated immediately if suicidal or violent ideation appeared, and kept a suicide safety plan, noting chronic pain's elevated suicide risk [source: NCT03918642].
[synthesis] Run a standard structured risk assessment at intake and when indicated. Pause anger and imaginal work during acute risk. Reassess before resuming.

Fantasy aggression worries ("does imagining violence make me violent?")

Imagined, full expression belongs in the safe setting. It is the anger acting, framed as protection, and it is distinct from real behavior [source: manual 2012; Principles & Procedures 2022].
[synthesis] If there is any history of violence or current intent, do not use aggressive fantasy imagery. Use assertive verbal statements only, and screen as above.

Identity or secondary-gain barriers (disability, caregiving roles, litigation)

Explore fear of change, pride in identity, loss of safety nets and family investment in stability [source: manual 2012 S8].
[synthesis] Name these neutrally. Avoid any implication of malingering, and treat the fears as further avoided material.

Mixed peripheral and centralized pain

[synthesis, consistent with Psychosom Med 2019] Target the centralized component. Set expectations that peripheral pain may persist, and keep medical management of it going in parallel.

Cultural or religious discomfort with anger or touch

Respect genuine limits [source: manual 2012].
[synthesis] Use culturally congruent forms, such as firm statements without shouting. Use non-touch intimacy exercises in individual work.

Pressure to forgive

Letting go is always an option, and forgiveness is an optional choice [source: manual 2012 S5].
With non-relational perpetrators, don't force connecting feelings [source: Principles & Procedures 2022].

Sources

Sources

Further reading (not drawn on) [uncertain]

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, 30.
Lumley, M.A., et al. (2017). Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial. Pain. Its manual is the one opened above.
Yarns, B.C., et al. (2020). Emotional awareness and expression therapy vs cognitive behavioral therapy for chronic pain in older veterans: a pilot randomized clinical trial. Pain Medicine. Its format was taken from the opened NCT03918642 protocol.
Schubiner, H. (with Betzold, M.) (2010; later editions). Unlearn Your Pain. Mind Body Publishing. The 2026 Penguin edition is listed above. Companion workbooks: The Unlearn Your Pain Workbook and The Unlearn Your Anxiety and Depression Workbook.
Gordon, A., & Ziv, A. (2021). The Way Out. Avery. The likely source of the opened PRT appendix [uncertain].

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