- Online Therapy For Toronto And Throughout Ontario
- 865 York Mills Rd #20, Toronto, ON M3B 1Y6
- Online Therapy For Toronto And Throughout Ontario
- 865 York Mills Rd #20, Toronto, ON M3B 1Y6
Save Time on Commute
No Waitlist
Evenings and Weekends Availability
Affordable Therapy Available
Therapists are also available in BC, Edmonton, Saskatchewan, and Manitoba
The premise
What is Emotion Awareness and Expression Therapy (EAET)?
A short-term, emotion-focused psychotherapy for pain and physical symptoms that stress, trauma and unresolved conflict help drive. It starts from a different premise than most pain therapies: that this kind of pain is not only manageable, it is often reversible.
Where it came from
EAET was developed by psychologist Mark A. Lumley at Wayne State University with physician Howard Schubiner, building on the mind-body work of Dr. John Sarno and on short-term psychodynamic therapy. It draws on affective neuroscience and emotion-focused therapy, and it has been tested in randomized trials since 2017. It is also written Emotional Awareness and Expression Therapy, which is the spelling used in the published trials.
Why emotions and pain are connected
In centralized or primary pain, the nervous system has learned the pain signal. Learning can be unlearned. Avoided anger, grief, guilt and fear keep the alarm switched on, so EAET goes after the avoidance rather than teaching you to cope around it.
This is the same territory as Pain Reprocessing Therapy and somatic mind-body therapy, approached from the emotional side.
What it is not
It is not a claim that your pain is imagined. It is not pacing, distraction or acceptance training. And it is not open-ended: the published research protocols run from a single session to eight.
It also treats trauma symptoms
Because EAET works on unresolved trauma directly, the trauma symptoms tend to move with the pain. In the 2024 trial it outperformed CBT on PTSD symptoms, anxiety and depression as well as on pain, and people who started with more of those symptoms responded better, not worse. See also trauma therapy and trauma and chronic pain.
“Psychotherapy may achieve substantial pain reduction if pain neuroscience principles are emphasized and avoided emotions are processed.”
Yarns et al., Pain Medicine, 2020
The evidence
What the research shows
EAET is young, but it has been tested against the field’s gold standard rather than against nothing. According to PubMed, these are the trials that matter most.
JAMA Network OpenYarns et al., 2024126 older adults, chronic pain
Randomized against CBT. EAET was superior on pain at post-treatment and six months, and on PTSD symptoms, anxiety and depression. People with higher baseline symptoms responded better, not worse.DOI: 10.1001/jamanetworkopen.2024.15842
63%reached at least 30% pain reduction, against 17% on CBT
PainLumley et al., 2017230 adults, fibromyalgia
The largest EAET trial to date, against CBT and an active control, 90.4% retention at six months. EAET beat education across symptoms, function, anxiety and depression, and beat CBT on widespread pain.DOI: 10.1097/j.pain.0000000000001036
22.5%reached 50% pain reduction, against 8.3% on CBT
SchmerzMaroti, Frisch & Lumley, 2025Review of the field
A synthesis concluding EAET is particularly effective for chronic primary pain, with efficacy that appears superior to CBT. Long-term efficacy and who responds best still need study.DOI: 10.1007/s00482-025-00878-6
7randomized controlled trials published since 2017
Also: Yarns et al., 2020, Pain Medicine, 41.7% exceeded 30% pain reduction against one CBT patient in the trial (DOI); Krohner et al., 2024, The Journal of Pain, a single session by videoconference reduced pain interference (DOI); Maroti et al., 2022, J. Psychosomatic Research, internet-delivered EAET held out to four months (DOI).
Trial results describe averages across groups, not a promise about any individual. We do not diagnose medical conditions.
How we work
EAET here is integrative
The trials tested EAET as a standalone protocol, and that is how the evidence should be read. In practice we rarely work in one modality alone. EAET is the spine of the work, and these are the approaches most often woven through it with you.
When a specific memory keeps re-firing, reprocessing it directly is often faster than talking around it. EMDR does the memory work; EAET does the emotion and relationship work that memory sits inside.
The emotions EAET goes looking for usually belong to a much younger version of you. Inner child work gives those parts somewhere to be heard instead of overridden.
Useful when the feeling is clearly in the body but will not come into words. Eye position holds the activation steady long enough for it to move.
Reaches the orienting layer that fires before emotion arrives. Often the right tool for attachment wounds and emotional neglect, which is exactly the history EAET keeps surfacing.
Grounding and regulation you can use between sessions, so that feeling more does not mean being flooded.
Works on the pain signal itself and on fear of the sensation. Pairs naturally with EAET, which works on what keeps the alarm switched on.
Fit
Who EAET helps
EAET was built for centralized or primary pain, the kind where investigation comes back clear, or where the findings do not explain how much it hurts.
Tension headache, migraine
Pelvic and urogenital pain
Jaw and TMJ pain
Functional neurological symptoms (FND)
Tinnitus and ear fullness
The randomized trials sit in chronic pain, fibromyalgia and somatic symptom disorder. Functional neurological symptoms and tinnitus belong to the same family of brain-generated symptoms, and are worked with on the same principles, though the direct trial evidence there is thinner. We will tell you which category you are in.
The work
How does EAET work?
This is short-term work and we shape it with you. Sessions run 60 minutes, and we agree the pace together rather than handing you a fixed plan.
Before you book
A 20-minute call
What you are dealing with, what you have already tried, and whether EAET is the right fit. It is a conversation, not an assessment, and no history-taking happens on it.
Session one
Making the link
We look at your symptoms next to your life: stress, relationships, and what was happening when the pain started or worsened. The explanation itself is part of the treatment.
Early sessions
Saying the unsaid
Disclosing the experiences and conflicts that have gone unspoken, often for years, and connecting them to what the body has been doing.
Middle sessions
Feeling it through
Experiential work rather than discussion. Writing exercises, empty-chair dialogue with someone who is not in the room, and letting anger, grief or love move through the body instead of around it.
Later sessions
Changing the relationship
Assertiveness, boundaries and honest expression with the people the emotions actually belong to. Rehearsed in session, then tried in life.
Throughout
Reviewed out loud
Not a fixed plan. We check in on how the work is going, and if something is not helping we change it together. If a different kind of support would suit you better, we will say so.
Benefits
Benefits of EAET
What people come for, and what the trials actually measured. These are the four that show up most often.
Reducing chronic pain
The primary target. EAET works on the emotional and stress-related drivers of centralized pain rather than on coping with it, which is why the trials measured pain intensity and not just distress. According to PubMed, in the 2024 JAMA Network Open trial 63% of EAET participants reached at least 30% pain reduction, against 17% on CBT. It is used for fibromyalgia, back and neck pain, migraine, pelvic pain and gut symptoms.
Healing from trauma
Childhood abuse, emotional neglect, loss and the conflicts that were never spoken out loud. EAET treats these directly rather than as background, so trauma symptoms tend to move alongside the physical ones. In the 2024 trial PTSD symptoms improved more on EAET than on CBT, and people with higher baseline symptoms responded better rather than worse. More on this under trauma therapy and trauma and PTSD.
Improving mental health
Anxiety, depression and chronic stress usually travel with long-standing pain, and treating them as separate problems rarely works. Emotional awareness and expression improves emotional regulation, which is why anxiety and depression scores moved in the same trials that measured pain. See also anxiety therapy and depression therapy.
Fostering emotional expression
The skill you keep afterwards. Naming what you feel, saying it to the person it belongs to, and holding a boundary without apologising for it. We rehearse it together in session and you try it in life, and it is the part people most often say changed things outside the therapy room.
The difference
EAET and CBT are not the same thing
Both are legitimate and you can work in either one with us. They aim at different targets, which is why the head-to-head trials came out the way they did.
Manage the symptom
Cognitive Behavioural Therapy
Treats pain as a chronic condition to be managed. Works on unhelpful thoughts, pacing, activity and coping skills. Well evidenced, widely available and the right choice for many people.
PremiseThe pain stays, your relationship to it changes
TargetThoughts and behaviour around the pain
EvidenceLarge, mature, benefits generally modest for chronic pain
Change the cause
Emotional Awareness and Expression Therapy
Treats centralized pain as potentially reversible. Works on avoided emotion, unresolved trauma and relationship conflict, on the theory that these are what keep the alarm switched on.
PremiseThe pain signal was learned, so it can be unlearned
TargetThe emotion and the relationships underneath it
EvidenceSmaller and newer, but ahead of CBT on pain in every direct comparison so far
Answers
EAET questions
Does EAET mean my pain is not real?+
No, and this is the most common misreading of it. EAET treats the pain as entirely real. What it questions is the assumption that real pain must have a structural cause. In centralized pain the nervous system has learned the signal, and learned signals can change.
Does EAET help trauma symptoms as well as pain?+
Yes. It works on unresolved trauma directly, so the trauma symptoms tend to move alongside the pain. According to PubMed, the 2024 JAMA Network Open trial found EAET outperformed CBT on PTSD symptoms, anxiety and depression as well as on pain severity, and higher baseline depression, anxiety and PTSD symptoms predicted a better response to EAET rather than a worse one.
Does EAET include EMDR or inner child work?+
The researched protocol is EAET on its own. In practice at Sky Therapies it is usually integrative: EMDR for memories that keep re-firing, inner child work for the parts the emotions belong to, Brainspotting or Deep Brain Reorienting when the feeling will not come into words, and somatic regulation so that feeling more does not mean being flooded. What appears in your sessions is decided with you.
Can EAET help functional neurological disorder (FND) or tinnitus?+
It is used for both, on the same reasoning that applies to centralized pain: the symptom is real, and it is generated by a nervous system that has learned a pattern rather than by damage to the organ. FND and tinnitus sit in that family, and unprocessed emotion and stress are recognised drivers in both. Be aware of what the evidence does and does not cover. The randomized trials of EAET are in chronic pain, fibromyalgia and somatic symptom disorder, not in FND or tinnitus specifically, so this is an extension of the method rather than a tested protocol. For FND, keep your neurologist involved. For tinnitus, get your hearing assessed first. We will be straight with you about which category your symptom falls into on the consultation call.
How many sessions does EAET take?+
It is short-term by design, and we decide the length of it together. Sessions run 60 minutes. How many you need is something we work out with you as we go rather than sell you upfront, and many people need more than eight when there is a long history to work through. We review it with you openly.
Is EAET better than CBT for chronic pain?+
In every direct comparison published so far, EAET produced greater pain reduction than CBT. According to PubMed, the 2024 JAMA Network Open trial found 63% of EAET participants achieved at least 30% pain reduction versus 17% on CBT. The evidence base is still smaller than CBT’s, so the honest answer is that it looks more effective for this specific population and needs more replication.
Can EAET be done online?+
Yes. We work entirely over secure video across Ontario. The randomized trial by Krohner and colleagues delivered its intervention by videoconference, and Maroti’s trial tested an internet-administered version.
Do I need a diagnosis before starting?+
No, but keep your medical team involved. We do not diagnose medical conditions or replace medical investigation. EAET works alongside your physician, not instead of them.
Is EAET covered by insurance?+
You would be working with a Registered Psychotherapist or a Registered Social Worker. Many extended health plans cover one and not the other, so we check your coverage with you before you book rather than after. Direct billing is available.
What if talking about emotions makes things worse?+
Temporarily, it can, and we tell people that upfront. Anxiety, anger, sadness or pain can rise while avoided emotion is being processed. If emotional regulation or dissociation is the primary difficulty, we stabilize first or recommend a different starting point.
How do I start EAET at Sky Therapies?+
Book a free 20-minute consultation. It is a short call to hear what you are dealing with and work out together whether we are the right fit. There is no obligation to book afterward, and if a different kind of support would suit you better we will say so.
Begin
Pain with a cause you cannot see is still worth treating
If you have been told the tests are clear and offered nothing but coping strategies, EAET is a different question to ask. A free 20-minute consultation is the easiest place to start. No waitlist, evenings and weekends, anywhere in Ontario.
Sky Therapies provides virtual psychotherapy across Ontario. We do not diagnose medical conditions or prescribe medication, and psychotherapy is not a crisis service. If you are in immediate distress, contact 9-8-8 (Suicide Crisis Helpline, available 24/7 in Canada) or go to your nearest emergency department.
Serving the following areas: Toronto, Ontario, North York, Ontario, Markham, Ontario, Ottawa, Ontario, Vaughan, Ontario, Guelph, Ontario, Brampton, Ontario, Windsor, Ontario, St. Catharines, Ontario, Oshawa, Ontario, Kingston, Ontario, Timmins, Ontario, Scarborough, Ontario, Oakville, Ontario, Peterborough, Ontario, RIchmond Hill, Ontario, Whitby, Ontario, and all of Ontario online
