Curable is an online pain psychology program, where users interact with a virtual pain coach called Clara. Through a series of questions during the set-up process Clara gets insight into your pain and its causes. She then sends you lessons and exercises that aims to help you reverse the cycle of pain. Lessons or exercises lasts anywhere from 5 to 20 minutes. In addition, the app has a panic demand for on-demand pain relief. Users can save favourite pain relief tools to use when needed. The app uses the mind-body approach or emotional awareness and expressive therapy (EAET).The free version has limited content. To access most of the content, users have to pay a monthly subscription (NZD $22 per month).For the complete app description, go to Google Play , iTunes and the app website or for a more detailed review, see Reviews.
✔ Can access the app on your phone or computer, which is synced.
✔ 13 free introductory audio lessons covering topics such as basic neuroscience, medical imaging, tissue damage, the pain-fear cycle, and emotions.
✔ Patient pain stories which are presented as interviews. The free version gives you access to a limited number of these.
✔ “Panic button” for access to on-demand pain relief. The free version is limited with only a word-swapping tool and limited guided meditations. The paid version gives you meditation, visualization, identifying emotions, and pep talk.
✔ With paid access there are dozens of hours’ worth of exercises to build skills in four key areas: pain education, brain training, meditation and expressive writing.
✔ Click the star button on tools and exercises to highlight those that are helpful.
✔ Virtual therapist who adjusts the activities provided depending on your responses
✔ Developed in association with a scientific advisory team of 10 specialists in a variety of sub-specialty areas.
✔ The website has an array of free podcasts and blog articles.
✘ Some of the content is based on John Sarno’s 'mind-body' approach who believed that “chronic musculoskeletal pain is a manifestation of ‘tension myositis syndrome’, due to repressed negative emotions” This approach has received a variety of criticisms. Some of the criticisms include:
Discussing suppressed trauma as a means of reducing pain does have some limited support (particularly for fibromyalgia) but some claim more research is needed.
It can fall short of our current understanding of pain.
It can over-emphasise the role of the mind, often ignoring the role of physical pain generators.
✘ Despite claiming to be based on the “biopsychosocial” model of pain, the app’s focus is almost completely on the psychology while largely leaving out the biology.
✘ To access most of the content, users have to pay a monthly subscription (NZD $ 22/month). If you went through the app diligently you could probably get through all the content in 2-3 months. But if you wanted to relook at anything in the future you need to pay.
✘ Transcripts are only available for some audio lectures.
✘ Audio, text and humorous gifs only. There are no schematics to help with education.
✘ No in-built questionnaires. For example, the app discusses the pain catastrophising scale, but doesn’t allow you to complete the tool within the app.
✘ There has been no high-quality research (i.e. a randomised controlled trial) directly evaluating the performance of this app. They mislead readers on their website by presenting research that is only slightly related, and the results of a survey.
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Reviewer: Jeremy Steinberg, GP, RNZCGP Date of review: April 2019 Review: Curable is an app designed to help people with chronic pain by addressing the psychology of pain. A virtual therapist guides you through audio lectures and activities and adjusts recommendations based on your responses. The app would be particularly helpful to those with a history of childhood trauma or stress as there is a strong focus on this area. The app uses the Mind-body approach or Emotional awareness and expressive therapy (EAET) which encourages people to experience their negative emotions and create new corrective experiences. There is some limited research to support the use of this approach, but it is not as mature as other therapies such as cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT). However, there are many aspects of EAET that overlap with components in other therapies with a strong evidence base such as mindfulness and re-engagement with activity. The free version has several hours of content with 13 free introductory pain education lessons and a limited number of other activities. To access most of the content, users have to pay a monthly subscription (NZD $22 per month). The paid version is essentially divided into four sections: pain education, brain training, meditation and expressive writing. After each exercise, you choose one of these four broad topics, and then the virtual therapist chooses a specific activity for you. This helps to remove so-called “choice paralysis” The expressive writing section is a two-part process. You first complete stream of consciousness writing about a specific topic such as about a traumatic event in your childhood and adult life. This is in order to uncover suppressed thoughts and feelings. The next step is finding compassion for the feelings, rationally looking at what you have written, and analysing your own personality traits and dispositional factors. You rip up your paper when done. The brain training section covers practical tools to help with pain. The tools include present moment awareness, progressive relaxation, square/box breathing, panic busting with touch, setting boundaries, incorporating joy and play, gratitude, rubber band trick, breaking habits, visualisation, self-care, and multiple exercises on cognitive reframing of distorted thinking (CBT). The meditation section consists of several guided meditations. The user chooses what duration of guided meditation they want. The topics include present moment awareness, body scan, forgiveness, self-compassion, boundary setting, and surrender. The education section follows on from the free lectures and includes further audio lectures on forgiveness, low self-esteem, catastrophising, inner critic, anxiety, stress from pain, self-compassion, pessimism, relapses, major life events, triggers, expectations, and depression. The panic mode is a particularly nice feature. If the user is experiencing severe pain, there are emergency tools to try and help – meditation, visualization, identifying emotions, and pep talk. The patient interviews could potentially be motivating for some people, and there are a variety to choose from covering different pain conditions. The two areas of caution that users should be aware of are:
Writing about previous traumas can bring about some short-term distress.
The app downplays physical pain generators (such as a prolapsed lumbar disc), which may or may not be appropriate depending on the person.
Overall, curable is a comprehensive pain education tool with a focus on the psychology of pain and emotions. I would highly recommend it to anyone with chronic pain who would like to try tackle the psychology of their pain. There are dozens of hours of content and activities that would keep someone busy for at least 2-3 months if they were diligent. Safety concerns: Writing about trauma can cause a short-term increase in distress.