Neuroplastic TherapyEvidence-based approach to chronic symptoms

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1What is neuroplastic therapy?Definition, mechanism & causes 2The history of the therapySarno, Schubiner, Schechter, Clarke & others 3Are my symptoms neuroplastic?The FIT criteria 4How is it applied?The five steps 5TechniquesBreathing, somatic tracking, imagery 6Conditions that may benefitList with references 7Success storiesRecovery testimonials by condition 8Bibliography & documentationRCTs, neuroscience & references 9Contactinfo@neuroplastictherapy.gr
Section 8

Bibliography & scientific documentation

Neuroplastic therapy is not an "alternative" theory; it is an approach that has been tested in randomized controlled trials (RCTs) and published in leading journals. Below we summarize the key findings, with an emphasis on the prospective and randomized studies, as well as the neuroscience behind the approach.

The landmark studies

The Boulder study — Pain Reprocessing TherapyAshar, 2022

In the best-known randomized trial, 151 adults with chronic back pain were divided into three groups: PRT, a placebo (sham injection) and usual care. After 4 weeks, 66% of the PRT group were pain-free or nearly pain-free, versus 20% for placebo and 10% for usual care — and a later follow-up confirmed that the benefit persisted for five years.[1][4] Functional MRI (fMRI) showed reduced activation of pain-related brain regions.[1] Film about this study: Pain Brain

EAET for fibromyalgiaLumley & Schubiner, 2017

A randomized trial of 230 patients with fibromyalgia compared EAET with Cognitive Behavioral Therapy (CBT) and with education. EAET was superior to education and, on several measures, to CBT as well — with significantly more patients achieving a >50% reduction in pain.[5]

EAET for chronic pain in veteransYarns, 2024

A randomized trial in 126 older veterans (many with PTSD) in JAMA Network Open: 63% of the EAET group achieved a pain reduction of ≥30%, versus only 17% of the CBT group.[2]

PSRT for back pain & for Long COVIDDonnino

Michael Donnino's group at Harvard tested the PSRT method in a pilot randomized trial for chronic back pain, with a significant reduction in bother and disability.[3] The same group applied it to patients with Long COVID, with an encouraging reduction in symptom burden.[6]

The neuroscience: what brain scans show us

How does an emotion, a trauma or a viral infection get "written" into the subconscious of the brain? Imaging studies (fMRI) provide concrete answers:

Pain "migrates" to the emotional circuits. In the classic study by Hashmi & Apkarian (2013), when back pain becomes chronic, its brain "address" moves from the regions of acute, bodily pain (insula, thalamus) toward the emotional circuits — the medial prefrontal cortex, the amygdala and the nucleus accumbens.[25]

Trauma and stress change the "danger threshold". The strength of the connection between the prefrontal cortex and the nucleus accumbens predicts which acute pain will become chronic.[25] Trauma, especially in childhood, up-regulates the "threat" circuits (amygdala) — which is why therapies that target the emotions (EAET, ISTDP) have physical effects.[17]

The brain "predicts" pain (predictive coding). Pain is not a simple "reading" of the sensory signals, but a prediction by the brain of how dangerous a situation is. When the brain "predicts" threat, it produces real pain even when the tissue is healthy.[1]

Viral infections as a "trigger". Infections such as SARS-CoV-2 can activate prolonged neuroinflammation and sensitization of the central nervous system; in a nervous system already "trained" for danger, this perpetuates symptoms even after the virus is gone.[6]

The conclusion of the literature: The idea that the brain "learns" pain and can "unlearn" it is no longer a hypothesis — it has been confirmed in randomized trials with objective imaging changes. The field remains new and larger studies are needed, but the data for chronic musculoskeletal pain and fibromyalgia are already strong.

Full references

  1. Ashar YK, Gordon A, Schubiner H, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2022;79(1):13–23. PubMed
  2. Yarns BC, Jackson NJ, Alas A, et al. Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans: A Randomized Clinical Trial. JAMA Network Open. 2024;7(6):e2415842. PubMed
  3. Donnino MW, Thompson GS, Mehta S, et al. Psychophysiologic symptom relief therapy for chronic back pain: a pilot randomized controlled trial. Pain Reports. 2021;6(3):e959. PubMed
  4. Ashar YK, Low EL, Knight K, et al. Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: 5-Year Follow-Up of a Randomized Clinical Trial. JAMA Psychiatry. 2025;82(10):1049–1051. PubMed
  5. Lumley MA, Schubiner H, Lockhart NA, et al. Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial. Pain. 2017;158(12):2354–2363. PubMed
  6. Donnino MW, Howard P, Mehta S, et al. Psychophysiologic Symptom Relief Therapy for Post-Acute Sequelae of Coronavirus Disease 2019. Mayo Clin Proc Innov Qual Outcomes. 2023;7(4):337–348. PubMed
  7. Andersen TE, Ravn SL, Mejldal A, Roessler KK. Values-based cognitive behavioural therapy for the prevention of chronic whiplash associated disorders: A randomized controlled trial. Eur J Pain. 2022;26(6):1256–1268. PubMed
  8. Sterling M, Smeets R, Keijzers G, Warren J, Kenardy J. Physiotherapist-delivered stress inoculation training integrated with exercise versus physiotherapy exercise alone for acute whiplash-associated disorder (StressModex): a randomised controlled trial of a combined psychological/physical intervention. Br J Sports Med. 2019;53(19):1240–1247. PubMed
  9. Pato U, Di Stefano G, Fravi N, et al. Comparison of randomized treatments for late whiplash. Neurology. 2010;74(15):1223–1230. PubMed
  10. Carty JN, Ziadni MS, Holmes HJ, et al. The Effects of a Life Stress Emotional Awareness and Expression Interview for Women with Chronic Urogenital Pain: A Randomized Controlled Trial. Pain Med. 2019;20(7):1321–1329. PubMed
  11. Thakur ER, Holmes HJ, Lockhart NA, et al. Emotional awareness and expression training improves irritable bowel syndrome: A randomized controlled trial. Neurogastroenterol Motil. 2017 Dec;29(12). PubMed
  12. Kaufmann D, Sturgeon JA, Mirow S, et al. Emotional Awareness and Expression Therapy for Migraine: A Preliminary Randomized Controlled Trial. Pain Med. Published online February 27, 2026:pnag034. PubMed
  13. Crouch TB, Chase SO, Redman T, et al. Feasibility and Preliminary Outcomes of a Brain/Body Intervention for Postural Tachycardia Syndrome (POTS): Pilot Trial of POTS Reprocessing Therapy (PORT). Res Sq [Preprint]. 2026 Jun 22. PubMed
  14. Trauer JM, Qian MY, Doyle JS, et al. Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Ann Intern Med. 2015;163(3):191–204. PubMed
  15. Fuller T, Cima R, Langguth B, et al. Cognitive behavioural therapy for tinnitus. Cochrane Database Syst Rev. 2020;(1):CD012614. PubMed
  16. Waterston J, Chen L, Mahony K, et al. Persistent Postural-Perceptual Dizziness: Precipitating Conditions, Co-morbidities and Treatment With Cognitive Behavioral Therapy. Front Neurol. 2021;12:795516. PubMed
  17. Ziadni MS, Carty JN, Doherty HK, et al. A life-stress, emotional awareness, and expression interview for primary care patients with medically unexplained symptoms: A randomized controlled trial. Health Psychol. 2018 Mar;37(3):282-290. PubMed
  18. Goldstein LH, Robinson EJ, Mellers JDC, et al. Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomised controlled trial. Lancet Psychiatry. 2020;7(6):491–505. PubMed
  19. Shadick NA, Sowell NF, Frits ML, et al. A randomized controlled trial of an internal family systems-based psychotherapeutic intervention on outcomes in rheumatoid arthritis: a proof-of-concept study. J Rheumatol. 2013;40(11):1831–1841. PubMed
  20. Mizrachi N, Rottem M, Rozenkrantz L. Voluntary attention regulates acute immune responses in humans. Nat Hum Behav. Published online August 17, 2026. PubMed
  21. Shields GS, Spahr CM, Slavich GM. Psychosocial Interventions and Immune System Function: A Systematic Review and Meta-analysis of Randomized Clinical Trials. JAMA Psychiatry. 2020;77(10):1031–1043. PubMed
  22. Yao L, Sadeghirad B, Li M, et al. Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials. BMJ. 2023;383:e076226. PubMed
  23. Vaddamanu SK, Alshadidi AFA, Aldosari LI, et al. Integrating multimodal behavioral therapy into temporomandibular disorders management: A randomized attention-controlled trial using DC/TMD axis II outcomes. Behav Res Ther. 2026;198:104964. PubMed
  24. Ferraro MC, O'Connell NE, Sommer C, et al. Complex regional pain syndrome: advances in epidemiology, pathophysiology, diagnosis, and treatment. Lancet Neurol. 2024;23(5):522–533. PubMed
  25. Hashmi JA, Baliki MN, Huang L, et al. Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain. 2013;136(9):2751–2768. PubMed

A full annotated bibliography is available from the Association for the Treatment of Neuroplastic Symptoms (symptomatic.me).