Evidence & Treatment
Evidence
The science of chronic neuroplastic symptoms has grown rapidly over the past two decades. Researchers now understand that many chronic symptoms are driven by changes in how the brain and nervous system process danger—not ongoing damage to the body.
Below are some of the landmark studies that shaped this understanding, along with the evidence behind
the treatments shown to calm the brain, retrain neural pathways, and help people recover.
Key Studies + Findings
Treatment Approaches
Pain Reprocessing
Therapy (PRT)
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Pain Reprocessing Therapy (PRT) is an evidence-based treatment designed to help the brain unlearn chronic pain. Rather than focusing on damaged tissues, PRT helps retrain the brain's danger detection system so that normal sensations are no longer interpreted as threatening. As the brain learns that the body is safe, the neural pathways that generate pain become less active.
At the heart of Pain Reprocessing Therapy is somatic tracking—a gentle practice that blends mindfulness, safety reappraisal, and positive emotions to teach the brain that painful sensations are safe rather than threatening.
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Help patients understand that their pain is real but often not caused by ongoing tissue damage
Reducing fear around movement and symptoms
Teach the brain to see sensations as safe rather than dangerous
Use techniques like somatic tracking, safety reappraisal, positive affect induction, and graded exposure
Gradually break learned pain pathways and building new, “safety-based” ones
Emotional Awareness & Expression Therapy (EAET)
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Emotional Awareness and Expression Therapy (EAET) is an evidence-based treatment that helps reduce chronic symptoms by addressing unresolved emotional stress that the brain and nervous system may still perceive as threatening. Rather than focusing on symptom management, EAET helps people identify, process, and express emotions that have been avoided, suppressed, or never fully experienced. As the brain learns that these emotions are safe to experience, the need to generate protective symptoms often decreases.
One of the core components of EAET is emotional processing—learning to experience, express, and release difficult emotions in healthy ways. By reducing emotional threat, the brain can begin to turn down symptoms that are no longer needed for protection.
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Expressive writing
Guided emotional exercises
Assertive communication
Self-compassion
Processing unresolved experiences
How Recovery Happens
FAQ
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I encourage you to spend some time on the Resources page before beginning therapy. There you'll find books, podcasts, videos, and research that explain the science behind neuroplastic symptoms. Although it's not required, many people find that learning how the brain creates and maintains symptoms helps them approach treatment with greater confidence and hope.
In some cases, psychoeducation alone is enough to change the brain's predictions and lead to significant improvement—or even complete recovery. While that isn't the norm, it highlights just how powerful understanding can be. For most people, education serves as the first step in the healing process.
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While Pain Reprocessing Therapy (PRT) and Emotional Awareness and Expression Therapy (EAET) draw on elements of CBT, Acceptance and Commitment Therapy (ACT), and mindfulness, they were specifically developed to treat primary (neuroplastic) pain. Rather than focusing primarily on coping with symptoms, these approaches aim to reduce the brain's perception of danger and retrain the neural pathways that generate and maintain chronic pain.
Traditional psychological treatments, such as CBT, can help improve coping, reduce distress, and enhance quality of life. However, research suggests their effects on pain intensity are generally modest. In contrast, studies of PRT and EAET have demonstrated substantially larger reductions in pain for many people with primary (neuroplastic) pain, including meaningful improvements that have persisted over time.⁴
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There is no "right" timeline for recovery. Some people notice significant improvement within days or weeks, while for others healing unfolds over months—or even longer. Every brain learns at its own pace.
It can be tempting to constantly ask, "Am I getting better yet?" But when we become attached to a timeline, the brain can interpret that pressure as evidence that something is still wrong. That sense of urgency can inadvertently reinforce the very danger signals we're trying to turn off.
An important part of recovery is learning to be okay, either way. Instead of measuring every symptom or searching for signs of progress, we practice trusting that the brain is capable of change—even if it isn't happening as quickly as we'd like. Ironically, letting go of the need to recover on a specific schedule often creates the conditions that allow healing to happen.
References
1. Ashar, Y. K., Gordon, A., Schubiner, H., Uipi, C., Knight, K., Anderson, Z., Carlisle, J., Polisky, L., Geuter, S., Flood, T. F., Kragel, P. A., Dimidjian, S., Lumley, M. A., & Wager, T. D. (2022). Effect of pain reprocessing therapy vs placebo and usual care for patients with chronic back pain: A randomized clinical trial. JAMA Psychiatry, 79(1), 13–23. https://doi.org/10.1001/jamapsychiatry.2021.26692. Brinjikji, W., Luetmer, P. H., Comstock, B., et al. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811–816. https://doi.org/10.3174/ajnr.A41733. Lumley, M. A., Schubiner, H., Lockhart, N. A., Kidwell, K. M., Harte, S. E., Clauw, D. J., & Williams, D. A. (2017).Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: A cluster-randomized controlled trial. Pain, 158(12), 2354–2363. https://doi.org/10.1097/j.pain.0000000000001036
4. Cherkin, D. C., Sherman, K. J., Balderson, B. H., Cook, A. J., Anderson, M. L., Hawkes, R. J., Hansen, K. E., & Turner, J. A. (2017). Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain: A randomized clinical trial. JAMA, 315(12), 1240–1249. https://doi.org/10.1001/jama.2016.2323