Howard Schubiner: “We created a simpler version of ISTDP”

In this interview with Howard Schubiner, MD, we discuss the development of Emotional Awareness and Expression Therapy, EAET, and its relationship to ISTDP. Howard has dedicated many years to developing treatments for psychophysiological disorders. In mid november, Howard is giving his first presentation in Sweden.

How do you feel about meeting a Swedish audience for the first time? 
I’m very excited to conduct a workshop in Sweden. I am a big fan of the Nordic countries having visited Norway, Sweden and Finland in the past. My wife’s family is from Norway so we have relatives there and she had an exchange student from Finland, so we have visited them as well.

Howard Schubiner interview
Howard Schubiner

This will be my first workshop in Europe, so that is very exciting. I have been very jealous of Allan Abbass, my colleague and co-author, as he has done so much teaching on the continent. I hope I can offer something of value!

How come you have such a big interest in psychophysiologic disorders?
I was introduced to mind body medicine back in the early 1970s, when I was in my university training. I read several books at the time and was influenced by several authors. However, I put those interests aside for several years while I was a young medical school and university faculty member at Wayne State University in Detroit.

In 1999, I became interested in mindfulness meditation for personal use and got some training in that modality. Soon thereafter, I began teaching mindfulness and continued doing that up until last year. In 2002, I was introduced to the writings of Dr. John Sarno, a physical medicine and rehabilitation physician in New York City. He had some radical ideas about the source of most cases of low back pain as being due to repressed emotions. His books resonated with me and reminded me of my interest in the mind body connection from my earlier years. I started seeing patients who had chronic pain and spent a long time talking to them about their illnesses and their lives. Some very interesting patterns emerged and I have been fully engaged in this work since then.

How did you end up developing EAET? 
In 2009, my colleague, Mark Lumley, and I attended a 4-day immersion workshop given by Allan Abbass on ISTDP. To put it mildly, we were “blown away” by the simplicity and power of this work. Allan and I began a friendship back then, which culminated in the publication of our book, Hidden From View, in 2019. After the workshop, I began experimenting with ISTDP and found it to be very useful in my patients with chronic pain.

A year later, Mark Lumley and I decided to write a grant to study ISTDP in patients with fibromyalgia. We were not able to find therapists in our area who had training in ISTDP and we didn’t feel it was possible to train therapists in this area in a short time frame. We decided to create a simpler version of ISTDP that could be used in a research trial. This led us to develop EAET.

What are some of the central features of EAET?
As I mentioned, EAET is based on ISTDP, so they are similar in most ways. EAET is based upon the premise that chronic pain is usually caused by neural circuits in the brain. The genesis of these circuits has to do with the danger signal in the brain. Everyone has a danger signal that creates an alarm when activated, just like a smoke alarm. People who grow up with adverse childhood events are more likely to have a danger signal that is overly sensitive and more likely to be activated later in life. That is why people with histories of trauma commonly present with chronic pain and other associated neural circuit disorders.

EAET is based upon the concept that it is often necessary to process emotions that were present at stressful and traumatic times in a person’s life. Of course, some of these events are likely to date back to childhood. During this process, we help patients to recognize, access and feel emotions such as anger, guilt, sadness and compassion. They are guided to express the emotions in fantasy in order to process them. The process usually does not use transference as with ISTDP.

There’s been some very interesting data coming out of your group, showing that EAET might have slightly stronger effects than CBT in the treatment of fibromyalgia and musculoskeletal pain. In psychotherapy research it’s uncommon to find robust differences between treatment models. Why do you think EAET has shown such impressive effects? 
We are proud of the large randomized, controlled trial we conducted in Detroit. It was funded by the NIH and is the first large scale study to show that one psychological intervention was actually superior to another psychological treatment for pain reduction. The actual difference on fibromyalgia symptoms between the EAET group and the CBT group was quite substantial. There are several reasons that we think explain this effect. First, in EAET we help the patient link stressful life events and the emotions connected to them with their painful symptoms. Second, we help them to experience, express and release powerful emotions that have been driving continued emotional distress and chronic neural circuit-based pain.

What are some of the things that we ISTDP clinicians can learn from studying EAET? 
Since EAET was developed as a brief intervention without the use of transference, it can be an attractive option for therapists in certain situations. It can be more easily learned than ISTDP and is suitable for many patients who may have lower rates of trauma. It is often used in a relatively brief time format as well. There is less emphasis on micro-observations of body language and patient feedback. EAET is more standardized and there are defined steps in the process that are useful guides.

Psychotherapy can be a hard thing to learn. Can you tell us something about what you’re learning right now as a therapist and what you’re struggling to learn? 
It seems that I am constantly learning from my patients and from others. It’s hard to say exactly what though. I am so appreciative of the privilege of working with people as they put their trust in me. It is an awesome obligation and honor.

How do you envision the future of health care when it comes to psychophysiologic disorders? 
You cannot keep good ideas down forever. The work we are doing seems so clear, so helpful, so necessary, so simple, and so powerful. There will come a tipping point when more and more convergence occurs around the mind body connection and the critical role of the subconscious mind in so many areas of medicine and psychology. I just don’t know how soon that will be.

Anything you’d like to tell the Swedish audience ahead of the event in November? 
We conducted a small randomized, controlled trial of Pain Reprocessing Therapy (PRT) for people with chronic low back pain. It was recently submitted for publication. PRT is the cognitive and behavioral version that we have developed in order to interrupt the neural circuits of pain. This therapy is based upon recognizing that the pain neural circuits are reversible, that there is no structural damage in the body, and that reduction of fear, focus and frustration with the symptoms can train the brain to decrease the activation of pain. We demonstrated remarkable success in this study.

Currently, a team of researchers at Stockholm University and Karolinska Institute are studying the effects of EAET in the treatment of medically unexplained symptoms via the internet. The research is led by Robert Johansson and Daniel Maroti.

Make sure to check out the online event with Howard Schubiner taking place on November 13th. You can also visit the webpage of the Swedish society for EAET.
If you enjoyed this Howard Schubiner interview you might have an interest in our other articles in english or other interviews. Here’s the list of our most recent interviews: