Sustained Pain Reduction Through Affective Self-awareness in Fibromyalgia: A Randomized Controlled Trial

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Article Synopsis

A team of scientists, including Dr. Howard Schubiner, completed a study that examined pain perception over time in women with fibromyalgia, a condition that causes sufferers to feel chronic fatigue and intense, all-over body pains. The researchers note in the introduction section of their article that current treatment options for patients with fibromyalgia are only moderately successful. Such options include pain medications, exercise, and cognitive-behavioral therapy (CBT). Although these approaches can improve patients’ moods, they are less likely to result in reduced pain. [1]

Because of the shortcomings of current treatment methods, Michael Hsu, MD, and his team wanted to examine the effects of an alternative type of therapy on the long-term well-being of patients with fibromyalgia. The team dubbed their approach, “affective self-awareness (ASA)” therapy. Although both ASA and more traditional therapeutic approaches like CBT help patients examine and change destructive thoughts and behaviors, ASA is unique because it also focuses on patients’ emotional awareness. Specifically, this type of therapy trains patients to be aware and accepting of their emotional responses to stressful situations so that the brain avoids mischaracterizing emotional traumas as physical pains. Hsu et al. (2010) recruited dozens of women with fibromyalgia. The team then screened the women to ensure that they did, in fact, meet the clinical criteria for fibromyalgia. The researchers were careful to exclude from their study all those women who, in addition to fibromyalgia, had serious medical or psychological conditions. All-in-all, 45 women were selected to participate. Half of the women were randomly put into the ASA treatment group and half the women were randomly put into the control group (these women did not receive any therapy or treatment aside from what was recommended by their own physicians).[1]

Women in the ASA treatment group engaged in an intensive course of ASA therapy that included (1) participating in once-weekly small group meetings that lasted for two-hours and were led by a doctor, (2) 30 minutes of daily journaling, and (3) daily meditation exercises. The group meetings focused on educating patients about the current research surrounding pain and emotional processing. As part of their education, the women in the ASA treatment group read The Mindbody Prescription by Dr. John E. Sarno.[1]

At the beginning of the study, the researchers assessed all participants’ self-reported levels of pain using a test called the “Brief Pain Inventory” or BPI. The control and treatment groups did not differ substantially in their levels of pain at the beginning of the study. Nevertheless after six months of treatment, almost half of the ASA treatment group saw large reductions in pain: “at 6 months, 45.8% of treatment participants had at least 30% pain reduction, and 20.8% had at least 50% pain reduction” (p. 1066). In contrast, 0% of the control group patients saw pain reductions of 30% or more. As the researchers note in their discussion, this study is the first randomized, controlled, longitudinal (considered the highest standards for research that aims to demonstrate causal effects) study showing that targeted emotional therapy can result in a significant reduction of pain for many more patients than would be the case if the patients never received such therapy. Compared to other forms of treatment, ASA therapy is low-cost and places low demands on physician time.[1]

The researchers are still uncertain about the specific biological and psychological mechanisms that underpin ASA’s effectiveness but hope to learn more with future study.[1]



  1. 1.0 1.1 1.2 1.3 1.4 Hsu, Michael C., Schubiner, Howard, MD, Lumley, Mark A., Stracks, John S., Clauw, Daniel J., & Williams, David A. (2010). Sustained pain reduction through affective self-awareness in fibromyalgia: a randomized controlled trial. Journal of General Internal Medicine, 25(10), 1064-1070.