Emotional disclosure

While recently researching the topic of fibromyalgia, I came across literature related to the phrase "emotional disclosure." I thought that the phrase is a perfect way of describing what often happens when we are in the clinic working with patients. I know that all of you, regardless of your caseload in pelvic rehabilitation, have worked with patients who have symptoms of fibromyalgia or chronic fatigue syndrome (I mean them as separate entities although research questions if they are one and the same.) And regardless of the patient having a diagnosis of fibromyalgia, the fact that so many of our patients emotionally break down in our presence once they recognize that first, we believe them, and second, we have some strategies to offer towards healing, makes this an interesting topic.

Back to the research. One article describes the relationship between depression, anxiety, and the tendency to "engage in diminished emotional disclosure." The authors found that in the college students who participated in the study, depression was tied to the tendency to avoid emotional disclosure. From a psychological stance, increased disclosure in a counseling session was found to lead to a "deeper" session. Interestingly, not all patients benefit from emotional disclosure, and there is limited evidence in randomized, controlled trials to know which patients should be encouraged to share.

While most pelvic rehabilitation providers are not licensed psychologists or other mental health and behavioral specialists, disclosure happens. We should not be engaged in trying to get a patient to discuss prior trauma or emotional issues unless he or she initiates the dialog or unless we are screening the patient for adverse events so that we can be sensitive to the patient's needs. As the patient is often discussing intimate and emotionally-charged symptoms with us, it is very typical that trust develops quickly in the therapeutic relationship. It is this trust that may allow the patient to feel safe enough to share information about life stress, prior injuries (emotional or physical), and to share feelings of how their physical symptoms impact other domains in life.

The founders of the Pelvic Rehabilitation Institute, Holly Herman and Kathe Wallace, have always instructed students to inquire of the patient if she has a counselor, psychologist, or trusted friend who can be a listening ear if the pelvic rehabilitation process should bring up some challenging emotional issues. They have also encouraged therapists to keep a list of counselors so that if a patient is interested in talking to a specialist, the list can be easily shared.

Lastly, I wanted to share an article with you from PubMed Central (free, full text!) that discusses the prior 10 years of research on pain and emotion- what a rich topic! The research concludes that emotions are critical in the understanding of, assessment, and treatment of pain, and we need to know more about when to facilitate the sharing of the emotions versus when to encourage the release of the emotions to be replaced by more positive ones. This is an area of health research that I believe will continue to grow dramatically and that will offer us new insights as well as confirm what we observe clinically.

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