Treatment & Evidence
Long Term Benefits of Therapy
The goal of Pain Reprocessing Therapy (PRT) and Emotional Awareness and Expression Therapy (EAET) are to significantly reduce—and, when possible, eliminate—symptoms. But the benefits can extend far beyond symptom relief. The skills you gain can also help you navigate life’s inevitable ups and downs differently.
Rather than your sense of safety and wellness depending primarily on things outside of you—providers, treatments, protocols, supplements, and so on—you learn how to cultivate a greater sense of safety from within and spend more of your life in a “rest and digest” state. And when your nervous system is spending more time in a regulated, balanced state—closer to homeostasis—your body is better positioned to benefit from the things that genuinely support health: nutritious food, movement, sleep, massage, physical treatments, and other forms of care. These things can still be valuable; they just don’t have to carry the burden of making you safe or fixing you.
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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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.
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There isn't a one-size-fits-all formula or set of steps for treatment—and that's intentional. PRT and EAET offer a toolbox of evidence-based strategies, rather than a rigid, step-by-step process.
Every person, nervous system, and symptom pattern is different. A tool that works beautifully for one person may not be particularly helpful for another. Throughout treatment, we'll explore different strategies, notice what resonates and creates change, and tailor our approach accordingly.
While there are core principles that guide the work, treatment is individualized, flexible, and often nonlinear. The goal isn't to complete a checklist of steps, but to discover which tools help your brain and nervous system learn safety and create lasting change.
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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
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 by ongoing damage to the body.
Below are some of the landmark studies that shaped this understanding, along with the evidence supporting the treatments shown to calm the brain, retrain neural pathways, and help people recover.
Key Studies
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A landmark review of MRI studies involving 3,110 pain-free adults found that structural changes such as disc degeneration, bulging discs, and arthritis were extremely common—even in people with no back pain.
In fact, these findings became more prevalent with age, suggesting they are often a normal part of aging rather than a sign of injury or disease. The authors concluded that imaging findings should not automatically be blamed for chronic pain but instead interpreted in the context of the whole person.²
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A randomized controlled trial conducted at the University of Colorado Boulder evaluated 151 adults with chronic primary low back pain. Participants were randomly assigned to receive Pain Reprocessing Therapy (PRT), an open-label placebo, or usual care. After just four weeks of treatment, 88% of those receiving PRT experienced meaningful improvement, and 66% were pain-free or nearly pain-free—compared with 20% in the placebo group and 10% receiving usual care. These improvements were largely maintained at the one-year follow-up.¹
The study provides compelling evidence that, for many people with primary (neuroplastic) pain, retraining the brain's danger response can lead to substantial and lasting reductions in pain.
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In a randomized controlled trial of 230 adults with fibromyalgia, researchers compared Emotional Awareness and Expression Therapy (EAET) with Cognitive Behavioral Therapy (CBT) and fibromyalgia education.³
After eight treatment sessions, EAET led to greater improvements than education in pain, overall symptoms, physical functioning, anxiety, depression, and quality of life.
Compared with CBT, EAET produced similar overall outcomes but resulted in greater reductions in widespread pain and nearly three times as many participants achieved a 50% reduction in pain (22.5% vs. 8.3%). These findings suggest that helping people safely process unresolved emotions can be an effective treatment for chronic neuroplastic pain.
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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.2021.2669
2. 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.A4173
3. 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