Affective Self Awareness


Affective self-awareness is a treatment approach based on the theory that many chronic pain states, such as Fibromyalgia, respond effectively to treatments that promote self-awareness of negative emotional tension which is functioning as a causal factor.

We report here on a randomized, wait list controlled trial demonstrating post-treatment and 6-month follow-up effectiveness of an Affective Self-Awareness (ASA) intervention, placing primary emphasis on the awareness and expression of emotions underlying the initiation and exacerbation of Fibromyalgia symptoms.1

The hypothesis of the study was that weekly group therapy combined with a daily journal and meditation will enhance affective self-awareness, and as a result reduce symptoms and pain associated with Fibromyalgia.

Researchers theorize that when there are chemical abnormalities in the brain it can result in an emotional imbalance and that imbalance can be translated to physical pain. The focus of this study was to test this hypothesis by measuring the symptoms once patients were made specifically aware of their psychological stress and how it was impacting their life, and then having the patients make an effort to reduce their stresses.

The theory is that those suffering from Fibromyalgia may not enjoy maximum benefits from other treatments, because the psychological stress isn’t properly addressed along with other treatments. When the Fibromyalgia patient is only treated in part, the patient may not see a reduction of symptoms or pain. If primary stress is functioning as a key causal factor, unless this factor is addressed other treatment efforts may not realize their true potential.

It is common for Fibromyalgia sufferers to have suffered higher than average trauma, victimization, or stress in their life. This can come in many forms including physical or sexual abuse as a child or adult, bullying, marital problems, work conflicts, a bad accident, etc.

These experiences can cause elevated levels of anxiety and even depression. For example, research data shows that workers who experience emotional bullying at work are four times more likely to develop Fibromyalgia.

Research has also shown that if one inhibits their emotions or avoids dealing with emotional issues; there are negative effects, which can contribute to a person developing Fibromyalgia symptoms.

Studies have shown those who suffer from Fibromyalgia may have more difficulty separating positive emotions from negative emotions, as well as being reluctant to express feeling. This could indicate that stress is a core causal factor or trigger for many suffering from Fibromyalgia.

How the Study Was Conducted

Study participants were recruited through the use of flyers that were distributed to local advertisers, doctors, and Fibromyalgia support groups. Individuals interested in participating were put through a screening interview. There were also required to have a 2 hour evaluation conducted by a medical professional. Medical history was combined with an assessment of tender points to confirm Fibromyalgia.

Exclusions included co-morbid medical conditions such as heart disease or cancer; serious psychiatric disorders such as substance abuse or suicide risk; and individuals who had pain medication changes within one month of enrollment.

Those with PTSD, anxiety, or depression were not excluded, nor were those with autoimmune disorders, IBS, migraines, or other central sensitization disorders.

The computer then created a randomized list of those who would participate in the six month study period. A manual protocol was established in which the doctor conducted a 90 minute consultation investigating each participant’s medical and psychosocial history. Links were then established between the participant’s emotional responses, and stresses in life and how they made Fibromyalgia symptoms worse.

The participants pain medications were confirmed, and then each participant was shown a model to help them better understand their pain from a mind-body perspective of a new therapy called Affective Self Awareness.

Participants were required to participate in 30 minutes of homework daily that included writing about their emotions and how one was feeling. It could be in the form of imagined dialogues, unsent letters, prose, or free writing.

Participants were also required to engage in affective awareness techniques, which included guided exercises that focused on awareness relating to physical and emotional release, and the use of breathing exercises, affirmations, self healing, and self acceptance. Physical exercise was also increased but in conjunction with leisure activities so as to not allow the participant’s pain to stop them from participating in these activities.


This is the first controlled study to clearly demonstrate that affective self awareness yielded benefits within the first 6 weeks, and those benefits were maintained at the 6 month mark. The study documented significant measurable pain threshold and physical function improvements.

The study emphasized that modifying your behavioral and thinking response to your pain while attempting to avoid negative emotional experiences can have a direct impact on reducing pain symptoms. The value of confronting one’s stressful experiences by developing and managing your emotional response and your motivation is tangible.

There has always been speculation that there is a link between psychological factors and physical pain symptoms. This study confirmed this link. Psychological factors can include anxiety, stress, depression, etc. Being aware of your emotional state, managing your stress, and dealing with your emotions in a proactive manner can help to reduce your Fibromyalgia symptoms.

Being aware of negative emotions and consciously taking action to remove these emotions from having a dominant impact on your life can have a direct impact on the severity of Fibromyalgia symptoms. This is especially true with feelings of anger. If you suffer from Fibromyalgia you need to take note and learn how to release your emotions and the stress associated with those emotions, as it can help you to reduce your pain.

Finally, the study also found that there were benefits to Fibromyalgia sufferers who were able to write about their experiences and the stresses they faced, along with the use of meditation.

How Can You Apply This Information

Understanding the link between emotional stress and physical pain is the first step toward taking action to manage stress in an effort to reduce pain.  Emotional stress can function as a triggering event for Fibromyalgia pain in a similar manner to how physical triggers such as physical injury may function. Understanding this triggering or causal relationship and taking positive action to both recognize and manage stress as it may manifest itself in daily life should be an integral part of any Fibromyalgia management strategy.

Tracking symptoms, triggering events and treatment efforts associated with Fibromyalgia will serve to help identify patterns and causal relationships. Since Fibromyalgia typically manifests itself differently in each individual who suffers from this syndrome, understanding your individual triggers and causal factors is crucial in developing an individualized treatment approach. This should include a proactive strategy aimed at managing and reducing stress. An Affective Self Awareness intervention strategy is one option individuals should consider.


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

Michael C. Hsu, MD,1 Howard Schubiner, MD,2,3 Mark A. Lumley, PhD,3,4 John S. Stracks, MD,5 Daniel J. Clauw, MD,6,7,8 and David A. Williams, PhD6,7,8,9

1Department of Physical Medicine & Rehabilitation, Kaiser-Permanente Northwest, Portland, OR USA

2Department of Internal Medicine, St. John Health/Providence Hospital and Medical Centers, 16001 W. Nine Mile Rd, Southfield, MI 48075 USA

3School of Medicine, Wayne State University, Detroit, MI USA

4Department of Psychology, Wayne State University, Detroit, MI USA

5Department of Family Medicine, Northwestern University, Chicago, IL USA

6Department of Anesthesiology, University of Michigan, Ann Arbor, MI USA

7Department of Medicine, University of Michigan, Ann Arbor, MI USA

8Department of Psychiatry, University of Michigan, Ann Arbor, MI USA

9Department of Psychology, University of Michigan, Ann Arbor, MI USA

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