Approaching persistent pain and emotion dysregulation : Development of the hybrid emotion-focused exposure treatment

Persistent pain, one of the most common reasons for suffering and health care seeking, often co-occurs with emotional problems such as depression and anxiety. Within the Center for Health and Medical Psychology at Örebro University, Sweden, we have developed a new treatment aimed at addressing co-occurring persistent pain and emotional problems: hybrid emotion-focused exposure treatment. The overarching idea behind the treatment is that patients who struggle with comorbid pain and emotional problems need to develop skills in dealing with emotions as well as pain. With better skills in tolerating and soothing difficult emotions, patients will be more able to approach previously avoided stimuli and situations, such as movements, activities and social interaction.

This review aims to delineate the development of the hybrid emotion-focused exposure treatment. It begins by outlining the theoretical background, then proceeds to describe the techniques, discuss the evidence and conclude with an illustrative case example.

Thus far, the treatment has been tested in a single-case study and a randomized controlled trial with promising outcomes. Overall, the hybrid treatment seems to have a good effect on patients' depressive symptoms and pain interference. The treatment is currently being implemented, and the implementation process evaluated, in primary and specialist care across Sweden.

The hybrid emotion-focused exposure treatment seems to be a well-suited treatment for people with a high burden of persistent pain and emotional difficulties. There is good reason to implement the treatment in clinical practice and continue evaluating treatment effects across different contexts.