Can Pain Reprocessing Therapy and EAET Help With Interstitial Cystitis?

Before we get into these therapies, we need to talk about something that I wish more people with IC understood.

Your brain and nervous system play a role in every pain experience.

Your nervous system is constantly receiving information from your body and determining whether something might be dangerous. When your brain interprets a signal as threatening, it can produce pain to encourage you to protect yourself.

Pretty helpful when you accidentally touch a hot stove, right?

Sometimes, the nervous system becomes overly protective and starts producing or amplifying pain even when there is no ongoing tissue damage explaining the symptoms.

This is sometimes referred to as neuroplastic pain, which overlaps with the clinical concept of nociplastic pain.

For example, someone might develop bladder pain during a urinary tract infection. After the infection resolves, their nervous system may remain sensitized, continuing to interpret certain bladder sensations as threatening.

Over time, fear, hypervigilance, and learned associations can contribute to maintaining these symptoms.

I want to emphasize that this pain is 100% real.

If you’ve ever had a healthcare provider dismiss your symptoms because your tests came back normal, I can understand why hearing that your brain might be involved could make you skeptical.

Pain is a real physical experience produced through the nervous system. It can occur with inflammation, tissue injury, nerve irritation, or changes in how the nervous system processes signals.

IC is also a complex condition, and people can have multiple contributing factors, including pelvic floor dysfunction, hormonal changes, and bladder-related conditions. Appropriate medical evaluation and individualized treatment remain incredibly important.

What Is Pain Reprocessing Therapy (PRT)?

Pain Reprocessing Therapy is a psychological treatment designed to help people with certain types of chronic pain change how their brains interpret pain sensations.

When the nervous system has learned to associate a sensation with danger, PRT helps people gradually develop a sense of safety around that sensation.

One of the techniques used in PRT is called somatic tracking, which involves observing physical sensations with curiosity and a sense of safety.

Let’s say you’ve experienced bladder burning after drinking coffee in the past.

Now, every time you drink coffee, you immediately start monitoring your bladder for symptoms. 

You might even notice yourself feeling anxious before taking the first sip.

Your brain has learned to associate coffee with danger, and that anticipation may contribute to increased nervous system arousal and symptom sensitivity.

For someone whose symptoms have been medically evaluated and are thought to involve learned pain responses, PRT can help address that fear.

Other techniques include pain neuroscience education and gradually returning to activities that have become associated with symptoms, such as exercising, traveling, or eating certain foods when appropriate.

What Does the Research Say About PRT?

A randomized clinical trial published in JAMA Psychiatry studied 151 adults with chronic back pain.

After four weeks of PRT, 66% of participants were pain-free or nearly pain-free, compared with 20% in the placebo group and 10% receiving usual care.

Much of the improvement was maintained one year later, which makes these findings particularly encouraging.

Researchers also observed changes in brain activity associated with pain processing.

You can read the full PRT study here.

This study involved people with chronic back pain. Additional research is needed to determine how effective PRT may be specifically for IC.

What Is Emotional Awareness and Expression Therapy (EAET)?

Another approach I’ve recently completed training in is Emotional Awareness and Expression Therapy (EAET).

EAET explores how emotional experiences, particularly difficult emotions that we may have learned to suppress or avoid, can influence the nervous system and chronic pain.

Have you ever noticed your bladder symptoms getting worse after an argument with your partner? Or during a stressful family situation?

Maybe you’re someone who avoids conflict, struggles to set boundaries, or feels responsible for keeping everyone else happy.

These patterns can sometimes contribute to ongoing emotional stress, which can influence nervous system arousal, muscle tension, and pain sensitivity.

EAET helps people recognize, experience, and express difficult emotions in a safe and supportive environment.

For example, you might feel angry with a family member, but immediately push those feelings aside because you don’t want to upset anyone.

EAET may involve expressive writing, exploring difficult emotional experiences, practicing assertive communication, and learning to tolerate emotions such as anger, sadness, grief, or fear.

And yes, you can love someone and still be angry with them!

What Does the Research Say About EAET?

A 2017 randomized trial involving 230 adults with fibromyalgia compared EAET with cognitive behavioral therapy (CBT) and fibromyalgia education.

At six months, 22.5% of participants receiving EAET experienced at least a 50% reduction in pain, compared with 8.3% receiving CBT.

EAET also improved several other outcomes compared with education, although the difference in the study’s primary pain-severity outcome was not statistically significant.

A 2024 study involving 126 older veterans with chronic musculoskeletal pain found that 63% of participants receiving EAET experienced at least a 30% reduction in pain after treatment, compared with 17% receiving CBT.

You can read the fibromyalgia study and the 2024 EAET study.

These findings suggest that emotional processing may be an important treatment target for some people with chronic pain. Research specifically examining EAET for IC remains limited, and I hope we’ll see more studies exploring its potential in the chronic pelvic pain population.

My Personal Experience With EAET

I’ve been largely recovered from my chronic bladder symptoms for years, although I still experience an occasional flare.

Recently, I was experiencing bladder symptoms while also dealing with a difficult situation in my personal life.

During a therapy session, we worked through some anger and fear I’d been experiencing using strategies drawn from EAET.

And something pretty incredible happened.

My bladder symptoms disappeared after that session. 

Click here to hear me tell the story.

I can’t say with certainty that emotional processing was solely responsible for my symptoms resolving. However, the timing was striking, and the experience reinforced something I’ve come to appreciate through my own recovery and professional training: Our emotional experiences can have a very real impact on how we feel physically.

How I’m Incorporating PRT and EAET Into My Work With IC Clients

My personal recovery initially sparked my interest in nervous system regulation, and seeing clients make progress after years of struggling with symptoms motivated me to learn even more.

That’s what led me to pursue additional training in both PRT and EAET.

Today, my Road To Remission program includes an extensive, structured nervous system curriculum that draws on principles from these approaches.

We help clients understand how their nervous systems may be contributing to their symptoms and teach practical strategies such as somatic tracking, graded exposure, emotional awareness, and expressive writing.

We also provide ongoing support through our team, including live nervous system coaching with a therapist.

I’ve seen clients become less fearful of bladder sensations, gradually reintroduce foods they once avoided, recognize connections between emotional stress and symptom flares, and experience meaningful improvements in their symptoms and quality of life.

Our approach also addresses pelvic floor dysfunction, nutrition, bowel health, hormones, and other individualized needs because IC can involve multiple contributing factors.

Could PRT or EAET Help With Your IC Symptoms?

If you’ve noticed that your symptoms fluctuate with stress, worsen when you’re anticipating a flare, or seem connected to difficult emotional experiences, I think these approaches are worth learning more about.

PRT and EAET offer promising ways to address nervous system sensitization, learned fear, and emotional stress that may contribute to chronic pain.

They can be incorporated alongside appropriate medical care, pelvic floor physical therapy, and other individualized treatments.

My hope is that more people with IC become aware of these options and have access to providers who understand the relationship between the brain, nervous system, emotions, and chronic bladder symptoms.

I want more people to be able to enjoy a cup of coffee, go out to dinner, travel, and make plans without constantly wondering what their bladder is going to do.

How to Find a PRT or EAET Therapist

If you’re interested in exploring these approaches, you can find PRT-trained practitioners through the Pain Reprocessing Therapy Institute’s directory. For EAET, I recommend looking for a licensed mental health professional who specializes in chronic pain and asking whether they’ve completed EAET training. You can also ask about their experience with chronic pelvic pain and whether they offer virtual sessions.

Want to Learn More About Addressing the Root Causes of Your IC Symptoms?

If you’re curious about how nervous system dysregulation, pelvic floor dysfunction, and other factors may be contributing to your chronic bladder symptoms, I invite you to watch my free masterclass on getting relief from interstitial cystitis.

I’ll walk you through my comprehensive approach to identifying and addressing the factors that may be keeping you stuck, including strategies that have helped my clients experience meaningful symptom improvements.