Emotional Awareness and Expression Therapy for Patients With Persistent Physical Symptoms in Routine Psychiatric Care: A Pilot Study (EAET for PPS)

Emotional Awareness and Expression Therapy (EAET) has emerged as a promising approach for addressing persistent physical symptoms (PPS). Investigating EAET within the context of routine psychiatric care is crucial for several reasons:

Many patients with PPS experience significant distress and functional impairment, yet traditional medical treatments often fail to provide adequate relief. Integrating EAET into routine care could offer a valuable therapeutic option for this population.

Preliminary studies suggest that EAET can lead to significant reductions in pain and other somatic symptoms. Investigating its effectiveness in routine care settings could enhance treatment outcomes for patients who have not responded to conventional therapies.

There is often a disconnect between mental health and physical health treatment in routine care. Investigating EAET can help bridge this gap, fostering collaboration between mental health professionals and primary care providers to address the complexities of patients' health issues.

Study Overview

• Status: Terminated
• Conditions: Persistent Physical Symptoms (PPS); Somatic Symptom Disorder (DSM-5); Functional Somatic Disorder; Functional Somatic Syndromes
• Intervention / Treatment: Behavioral: Emotional Awareness and Expression Therapy (EAET)

• Study Type: Interventional
• Enrollment (Actual): 20
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Sweden
  • Stockholm, Sweden, 10691
    • Stockholm University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• The participant certifies that they have undergone a medical assessment for their physical symptoms (see separate certificate).
• The participant rates either moderate distress from physical symptoms on the PHQ-15 questionnaire (over 10 points) or significant distress from a single physical symptom (at least 2 points for that symptom).
• The participant expresses interest in exploring whether emotional factors, such as stress, may contribute to their symptom profile.
• Any prescribed medications must have been stable for at least one month.

Exclusion Criteria:

• Participants suffer from ongoing substance abuse (alcohol or drugs) or are assessed to have severe mental health issues (psychotic disorders, moderate to high suicide risk, antisocial personality disorder, etc.).
• Participants are currently prescribed medications that are clearly addictive and sedative in nature (e.g., benzodiazepines).
• Participants are involved in other psychological treatments focused on physical symptoms. However, other psychological treatments are permitted as long as the supportive therapy does not occur more than once a month.
• Participants do not have sufficient proficiency in the Swedish language.

Please note that it is the chief physician of each respective research sponsor who, based on collected anamnesis and self-assessment information, makes the final decision regarding whether a participant should be included or excluded from the research project.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Other: Emotional Awareness and Expression Therapy; Please see description for intervention

Behavioral: Emotional Awareness and Expression Therapy (EAET); Emotional Awareness and Expression Therapy (EAET) is a manualized, short-term psychodynamic therapy that, in this instance, is delivered in a group format. The core of Emotional Awareness and Expression Therapy (EAET) involves helping individuals identify, understand, and express their emotions in a therapeutic setting. The therapy emphasizes the connection between unprocessed emotions and physical symptoms, encouraging participants to explore the emotional underpinnings of their distress. Through guided discussions, psychoeducation, and expressive exercises, participants learn to recognize patterns of emotional avoidance, develop self-compassion, and improve interpersonal communication. This process aims to reduce somatic symptoms and enhance overall emotional well-being by fostering a greater awareness of emotional experiences.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient Health Questionnaire-15 (PHQ-15)	Somatic symptom severity during the "last week " are assessed with the Patient Health Questionnaire-15 (PHQ-15). Items are rated 0 ("not bothered at all"), 1 ("bothered a little"), or 2 ("bothered a lot"); total scores range from 0 to 30.	Pre-post treatment (at treatment termination)
Visual Analoge Scales	A second primary outcome is the two Visual Analoge Scales suggested by the EURONET-SOMA network (Rief et al., 2017). Somatic symptom intensity is measured from 1 ("No symptom") to 10 ("Symptom as bad as you can imagine") and somatic symptom interference from 1 ("No interference") to 10 ("Maximum interference").	Pre-post treatment (at treatment termination)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Sheehan Disability Scale	SDS consist on three visual analogue scales ranging from 0-10 for symptom interference in daily life. Higher scores indicate worse symptom/functioning, with a maximum score of 30.	1. Pre-post treatment (at treatment termination). 2. Pre-Follow up (12 weeks after intervention).
Post traumatic symptom Check List-5 (PCL-5),	PCL-5 consists of 20 questions with ratings 0-4 on impact of post traumatic symptoms. Higher scores indicate worse symptom/functioning with a maximum score of 80.	1. Pre-post treatment (at treatment termination). 2. Pre-Follow up (12 weeks after intervention).
Patient Health Questionaire-9 (PHQ-9)	PHQ-9 consists of nine questions withs ratings 0-3 (0= "not at all", 3= "almost every day") on impact of depressive symptoms. Higher scores indicate worse symptom/functioning with a maximum score of 27.	1. Pre-post treatment (at treatment termination). 2. Pre-Follow up (12 weeks after intervention).
Generalized Anxiety Disorder 7-item scale (GAD-7)	GAD-7 consists of seven questions with ratings 0-3 (0= "not at all", 3= "almost every day") on impact of anxiety symptoms. Higher scores indicate worse symptom/functioning functioning with a maximum score of 21.	1. Pre-post treatment (at treatment termination). 2. Pre-Follow up (12 weeks after intervention).
Visual Analoge Scales	Visual Analoge Scales suggested by the EURONET-SOMA network (Rief et al., 2017). Somatic symptom intensity is measured from 1 ("No symptom") to 10 ("Symptom as bad as you can imagine") and somatic symptom interference from 1 ("No interference") to 10 ("Maximum interference").	Pre-FU (12 weeks after intervention)
Patient Health Questionaire-15 (PHQ-15)	Somatic symptom severity during the "last week" was assessed with the PHQ-15. Items were rated 0 ("Not bothered at all"), 1 ("Bothered a little"), or 2 ("Bothered a lot"); total scores range from 0 to 30 for women and 0-27 for men.	Pre-FU (12 weeks after intervention)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Credibility and Expectancy Questionaire (CEQ)	The questionnaire consists of several items that participants respond to on a Likert scale (e.g., from 1 to 7), where they rate their level of agreement or belief regarding various statements related to the treatment's credibility and their expected outcomes.	Three weeks into treatment
Negative Effects Questionnaire (NEQ)	The questionnaire includes a series of statements or questions that participants respond to using a Likert scale, where they indicate how often they have experienced these negative effects.	At FU (12 weeks after intervention).
8 visual analgue scales	2 question on 1-10 on symptom intensity and inferference 2 questions on 1-10 on the capacity of self-compassion 2 questions on 1-10 on the capacity of emotional processing 2 question on 1-10 on symptom attribution	Mediational measure: Every week during the 12 week long treatment (i.e. 11 measurement points.)

Collaborators and Investigators

• Sponsor: Daniel Maroti
• Investigators: Principal Investigator: Daniel Maroti, PhD, Department of Psychology, Faculty of Social Sciences, Stockholm University

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2024
• Primary Completion (Actual): December 31, 2025
• Study Completion (Actual): December 31, 2025

Study Registration Dates

• First Submitted: October 1, 2024
• First Submitted That Met QC Criteria: October 7, 2024
• First Posted (Actual): October 8, 2024

Study Record Updates

• Last Update Posted (Actual): July 27, 2026
• Last Update Submitted That Met QC Criteria: July 24, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: routine care; Group psychotherapy; Emotional Awareness and Expression Therapy
• Additional Relevant MeSH Terms: Medically Unexplained Symptoms
• Other Study ID Numbers: EAET for PPS: a pilot study; 1111 (Other Grant/Funding Number: Prima Psychiatry internal research fund); 5631 (Other Identifier: Signe and Ane Gyllenbergs foundation)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: The participants has not agreed to this

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No