Changes In Alexithymia Research Articles

Reducing alexithymia and increasing interoceptive awareness: A randomized controlled trial comparing mindfulness with dyadic socio-emotional app-based practice

BackgroundEmotion processing deficits of alexithymia are a transdiagnostic risk factor. While such deficits are malleable, the differential efficacy of brief scalable digital mental trainings remains understudied. MethodsThis randomized controlled trial probed the efficacy of mindfulness-based (MB) and partner-based socio-emotional Affect Dyad (SE) practice, both supported by weekly coaching sessions, in reducing alexithymia in 285 adult participants. We investigated the predictive role of interoceptive awareness assessed a) before and after daily practice, b) in ecological momentary assessment (EMA) before and after the intervention, and c) weekly during the 10-week intervention. ResultsBoth interventions reduced emotion processing difficulties on the Toronto Alexithymia Scale (TAS-20). Similarly, both interventions improved interoceptive awareness immediately after daily practice and after the intervention period, yet SE outperformed MB training in EMA assessments. Further, only Dyad practice led to increases in body listening and self-regulatory aspects of the Multidimensional Assessment of Interoceptive Awareness (MAIA) over time, with the latter explaining a decrease in alexithymia. LimitationsGiven the subclinical study sample, findings are limited in their generalizability to clinical samples. ConclusionsFindings suggest that app-based socio-emotional and mindfulness-based practices, supported by online coaching sessions, are effective in reducing emotion processing deficits. Dyad training showed advantages on some measures of body awareness, which predicted observed changes in alexithymia. This highlights the potential of using app-based dyadic approaches in the development of emotion awareness and regulation.

Exploring changes in alexithymia throughout intensive dialectical behavior therapy for eating disorders.

Alexithymia is proposed as a prominent clinical feature of eating disorders (EDs). However, despite theoretical reason to believe that alexithymia could interfere with the success of treatments, few studies have tested whether alexithymia changes over the course of treatment. The goals of the current study were to evaluate (a) changes in alexithymia over the course of intensive Dialectical Behaviour Therapy (DBT) for EDs, and (b) associations between alexithymia and ED symptoms over time. A mixed-diagnostic group of patients with EDs (N=894) completed the Eating Disorders Examination-Questionnaire (EDE-Q) and the Toronto Alexithymia Scale (TAS-20) throughout intensive treatment and at various lengths of follow-up (6, 12, 24months). Results suggested that even after controlling for relevant covariates, there were significant decreases in alexithymia from intake to discharge and discharge to follow-up. Models exploring changes in self-reported ED symptoms indicated that TAS-20 scores significantly related to ED symptoms across timepoints, such that greater alexithymia was associated with greater severity of symptoms. Altogether, findings support an association between alexithymia and ED symptoms over treatment and suggest that emotion-focussed therapies like DBT may result in decreases in alexithymia. Future research should explore whether this effect is consistent across therapies without an emotional focus.

Alexithymic traits can explain the association between puberty and symptoms of depression and anxiety in adolescent females.

Symptoms of internalizing disorders such as depression and anxiety increase in adolescence, especially in females. However, gender differences in depression and anxiety symptoms emerge only after puberty onset. Levels of alexithymia, characterized by difficulties identifying and describing one’s emotions, are elevated in depression and anxiety, and fluctuate across adolescence in a gender-specific manner. This study investigated changes in alexithymia across adolescence, and explored the potential role of alexithymia in the development of depression and anxiety, separately for females and males. Accordingly, 140 adolescents aged 11 to 21 years (77 female) completed self-report measures of alexithymia, depression and anxiety, and pubertal development. For females alone, pubertal maturation was associated with alexithymic traits (specifically difficulties identifying and describing feelings), as well as symptoms of depression and anxiety. After accounting for alexithymia, the relationship between puberty and depression and anxiety was absent or reduced in females. Thus, alexithymic traits may have differential consequences for males and females, and possibly contribute towards increased depression and anxiety symptoms in females during adolescence. We propose that developmental changes in alexithymia should be considered when studying the onset and development of internalizing psychological disorders during adolescence.

Mood Disorders Patients Treated in a Day Hospital: Focus on Changes in Alexithymia and Openness to Emotions

Mood Disorders Patients Treated in a Day Hospital: Focus on Changes in Alexithymia and Openness to Emotions

The Effectiveness of Assertiveness Training on Alexithymia and Self-Differentiation in Runaway Girls in the City of Mashhad, Iran

Background: This study evaluates the effect of assertiveness training on alexithymia and self-differentiation in the city of Mashhad, in Iran, about runaway girls. Method: The sample consists of 24 girls (12-20 years old) The tools used in the study were: assertion questionnaire Rathus, self-differentiation scale of DSI and the Toronto alexithymia scale. The study is applied as a Quasi-experimental design with the unequal control group. The plan is similar to the control groups pretest and post-test. Results: Significance indexes Multivariate analysis (f=158.029, p<0.001) indicates that there are changes in alexithymia and self- differentiation with assertiveness training. The average assertion scores in the post-test had increased strongly (M=58.00). As well, the average self-differentiation score of the experimental group had a significant increase. The experimental group also had lower average scores of alexithymia. Conclusions: The results of the research showed that assertiveness training has a significant change in alexithymia and self-differentiation. It should be noted that the participants had run away from home due to various reasons relating to high levels of alexithymia and low levels of self-differentiation and assertiveness. During this training course, the girls with learning assertiveness made changes in the self-differentiation and alexithymia (M=196.00) (M=47).

The role of alexithymia: An 8-year follow-up study of chronic pain patients

ObjectiveThe aim of this 8-year follow-up study was to ascertain changes in alexithymia, depressiveness and pain situation in a sample of chronic pain patients and to explore the impact of alexithymia and depression on the outcome. MethodsParticipants (n=83) were chronic non-malignant pain patients who completed self-report study questionnaires before their first visit to the pain clinic and again 8years later. Study variables consisted of pain intensity measured by the Visual Analogous Scale, the Pain Disability Scale, the Toronto Alexithymia Scale and the Beck Depression Inventory. The moderate improvement in the pain situation was estimated as a decrease of 30% or more in pain intensity or pain disability. ResultsIn the whole sample there was a significant decrease in pain intensity, pain disability and depressiveness, but only some of the patients achieved moderate improvement in their pain situation. Alexithymia remained stable during the 8-year period. The alexithymic patients had poorer pain situation and more depressiveness both at baseline and at follow-up. Unfavorable outcome in the pain situation was connected with male gender and alexithymia at baseline but not with depressiveness. Alexithymia and depressiveness were closely related to each other and the connection strengthened during the follow-up period. ConclusionAlexithymic depressive chronic pain patients represent a special, more disabled subgroup among chronic pain patients. The authors recommend screening for and identifying alexithymia and depression in chronic pain patients. Structural treatment protocols such as cognitive–behavioral therapy may benefit these patients. More research is needed to develop treatment interventions for alexithymic patients.

Mediating Role of Cognitive Emotion Regulation Strategies on the Relationship Between Attachment Styles and Alexithymia

The main objective of the present study was to investigate the mediating role of cognitive emotion regulation strategies on the relationship between attachment styles and alexithymia. Five hundred and thirty six undergraduate students (282 girls, 254 boys) from public universities in Tehran participated in this study. Participants were asked to complete the Adult Attachment Inventory (AAI), the Farsi version of the Toronto Alexithymia Scale (FTAS-20), and Cognitive Emotion Regulation Questionnaire (CERQ). The results illustrated a significant negative correlation between secure attachment style and alexithymia. Moreover, the results revealed a significant positive correlation between avoidant and ambivalent attachment styles with alexithymia. Regression analysis showed that both adaptive and maladaptive cognitive emotion regulation strategies, have a mediating role on the relationship between attachment styles and alexithymia. Secure and insecure attachment styles predicted changes in alexithymia through adaptive and maladaptive cognitive emotion regulation strategies in opposite directions. Based on these findings, it can be concluded that the mediating role of cognitive emotion regulation strategies on the relationship between attachment styles and alexithymia is partial.

Changes in alexithymia following psychological intervention: a review.

Alexithymia, a deficit characterized by difficulties identifying, differentiating, and articulating emotions, is associated with significant physical and mental health impairment. It is generally accepted that alexithymia has a negative impact on a variety of physical and mental health treatments. Less clear is the extent to which alexithymia itself can be modified. In this article we review studies that have examined the effects of psychological interventions on alexithymia. Taken together, findings from investigations included in this review suggest that alexithymia is partly modifiable with therapeutic interventions. Studies that directly targeted alexithymic symptoms tended to report significant reductions in alexithymia scores following treatment, whereas studies that measured changes in alexithymia but did not employ any psychological interventions specifically intended to treat alexithymia had more inconsistent results. We close by considering the practical implications of the findings, and by offering suggestions for future research.

Effectiveness of rhythmic movement therapy: Case study of alexithymia

Objective: The aim of this study was to test the effectiveness of rhythmic movement therapy (RMT) for the treatment of alexithymia in healthy, non-clinical population. Methods: A total of 118 subjects seeking psychological counselling (coaching) were selected at random and assessed with the appropriate questionnaires. Two groups were formed (alexithymics (n = 68) vs. non-alexithymics (n = 50)). Alexithymics were divided into an RMT group (n = 51) and a control group (n = 17). Results: The results demonstrated significant improvement in alexithymia level as well as several other personal variables in subjects of the RMT group compared with unimproved subjects of the control group, although the results of between-group comparison did not show any significant changes in extraversion and neuroticism in RMT group. Conclusion: Substantial changes in alexithymia and psychological state were observed as a result of RMT intervention.

Alexithymia is not a stable personality trait in patients with substance use disorders

The construct of alexithymia as a vulnerability factor for substance use disorders (SUD) is under debate, because of conflicting research results regarding alexithymia as a state or trait phenomenon. The absolute and relative stability of alexithymia were evaluated in a pre-post design as part of a randomised controlled trial, controlling for several co-variates. Assessments were done with the Toronto Alexithymia Scale (TAS-20) and the Addiction Severity Index (EuropASI) at baseline and follow-up of a 3-month trial of inpatient Cognitive Behavioural Therapy (CBT) with or without a Shared Decision Making intervention for 187 SUD patients. Paired sample t-tests and analyses of variance were performed to assess absolute stability, intraclass correlation coefficients were calculated for relative stability and multivariate linear regression models were used to evaluate the relation between co-variates and change in alexithymia. Mean level reduction of total TAS-20 and two subfactors demonstrated no absolute stability, but change in alexithymia differed for patients with low, moderate and high alexithymia scores. Relative stability of alexithymia was moderate to high for the total population, but differed according to low, moderate and high alexithymia scores. The EuropASI “psychiatry” domain, covering anxiety and depression, was related to alexithymia, but CBT-related variables were not. In conclusion, alexithymia is partly a state-dependent phenomenon, but not a stable personality trait in this SUD population.

A naturalistic study of alexithymia among psychiatric outpatients treated in an integrated group therapy program

Alexithymia is common among psychiatric outpatients and can complicate treatment. There has been little research into whether alexithymia can be modified by psychological intervention, and whether change in alexithymia is related to other areas of improvement. The purpose of the present study was to examine whether participation in an integrated group therapy program could effect change in alexithymia, and whether such change is related to improvement in interpersonal functioning. Sixty-eight consecutively admitted psychiatric outpatients to a comprehensive group therapy program were evaluated at baseline, post-therapy, and 3-month follow-up using the Toronto Alexithymia Scale 20, the Beck Depression Inventory, and the Inventory of Interpersonal Problems-28. Associations among variables were evaluated with correlations and among group comparisons with t test, ANOVA, chi-square tests, and logistic regression. Change in alexithymia was examined using repeated measures ANOVA, controlling for change in depressive symptoms. Alexithymia, particularly difficulty identifying feelings, decreased significantly during the treatment period. Post-therapy levels of alexithymia were maintained during the 3 months following treatment completion. Changes in alexithymia were significantly associated with changes in interpersonal problems, both during therapy and during the follow-up period. The results of our study suggest that a comprehensive, integrated group therapy program can affect change in alexithymia, and that such change can be maintained once therapy is completed. Also, modifying alexithymia may contribute to improvement in interpersonal functioning.

Does CBT Facilitate Emotional Processing?

Cognitive Behavioural Therapy (CBT) is not primarily conceptualized as operating via affective processes. However, there is growing recognition that emotional processing plays an important role during the course of therapy. The Emotional Processing Scale was developed as a clinical and research tool to measure emotional processing deficits and the process of emotional change during therapy. Fifty-five patients receiving CBT were given measures of emotional functioning (Toronto Alexithymia Scale [TAS-20]; Emotional Processing Scale [EPS-38]) and psychological symptoms (Brief Symptom Inventory [BSI]) pre- and post-therapy. In addition, the EPS-38 was administered to a sample of 173 healthy individuals. Initially, the patient group exhibited elevated emotional processing scores compared to the healthy group, but after therapy, these scores decreased and approached those of the healthy group. This suggests that therapy ostensibly designed to reduce psychiatric symptoms via cognitive processes may also facilitate emotional processing. The Emotional Processing Scale demonstrated sensitivity to changes in alexithymia and psychiatric symptom severity, and may provide a valid and reliable means of assessing change during therapy.

Alexithymia and cognitive behaviour therapy outcome for subthreshold depression

Alexithymia is hypothesized to be a stable trait that hinders favourable outcomes of psychotherapy. We tested two hypotheses: i) alexithymia is not stable but changes along with a change in depressive symptoms and ii) pretreatment alexithymia hinders gaining benefits from psychotherapy. A total of 201 participants (mean age = 54 years, SD = 4.4) with subthreshold depression were treated with cognitive behaviour therapy. Outcome was defined as the change in depressive symptoms from pretreatment to post-treatment and to 1-year follow-up. Changes in depressive symptoms were significantly correlated with changes in alexithymia. Baseline alexithymia scores were not correlated with treatment outcome. Alexithymia is less stable than hypothesized: changes in alexithymia were associated with change in depressive symptoms. Furthermore, alexithymia does not hinder cognitive behaviour therapy outcome.

An evaluation of the absolute and relative stability of alexithymia in women with breast cancer

Objectives In the controversy for alexithymia as a state or a trait dimension, recent studies showed that, whereas absolute changes (i.e., extent of alexithymia scores change over time) were observed, alexithymia was relatively stable (i.e., extent to which relative differences among individuals remain the same over time). The present study extended this question by investigating a disease with highly threatening outcomes (breast cancer), by looking at changes in depression and anxiety, and by examining stability for total and factor alexithymia scores. Methods One hundred twenty-two women in treatment for a first instance of breast cancer were assessed for alexithymia (TAS-20), depression, and anxiety (HADS) the day before surgery (T1) and six months later (T2). Results Alexithymia scores changed from baseline to follow-up (lack of absolute stability). Strong evidence of relative stability was also demonstrated, as alexithymia scores at baseline correlated significantly with alexithymia scores at follow-up and were also a significant predictor of follow-up alexithymia scores, after partialling the effects of depression and anxiety severity. Changes in alexithymia were explained only to a small extent by changes in depression and anxiety from T1 to T2. Results at the factor level revealed that “difficulty identifying feelings” follow-up and change score accounted for the highest variations in depression and anxiety, and “externally oriented thinking” for the lowest ones. Conclusions The finding of relative stability of alexithymia supports the view that this construct is a stable personality trait rather than a state-dependent phenomenon, even in a context of high threat for physical and psychological integrity.

Alexithymia, Risk Factor or Consequence of Work-Related Stress?

Background: Primary alexithymia has been proposed as a trait-like risk factor for various psychiatric disorders. Alternatively, secondary alexithymia has been conceptualized as an inadequate coping reaction to a stressful situation. This study investigated the level and the type of alexithymia associated with occupational stress. Method: On 2 occasions, 69 patients with work-related stress and 62 healthy participants completed self-report instruments to measure alexithymia (20-item Toronto Alexithymia Scale), burnout complaints (Maslach Burnout Inventory) and general distress complaints (Depression Anxiety Stress Scales, Checklist Individual Strength). Group differences in alexithymia were analyzed using ANOVAs. The type of alexithymia was investigated by (a) determining absolute and relative stability, (b) exploring state dependence by adjusting alexithymia for burnout and distress complaints and (c) associating recovery of complaints with change in alexithymia. Results: Alexithymia was significantly elevated among patients. In the patient group, absolute stability of two alexithymia dimensions (identifying feelings, describing feelings) and relative stability of one alexithymia dimension (identifying feelings) was lower than in the healthy group. Cross-sectional group differences became small and nonsignificant after adjustment for distress complaints. Among patients, change in alexithymia was moderately associated with symptom recovery. Conclusion: Elevated alexithymia among patients with occupational stress is highly state dependent, which indicates the presence of secondary alexithymia.

A prospective long-term follow-up study of alexithymia in obsessive-compulsive disorder

Background Studies evaluating the stability of alexithymia over long follow-up periods are rare. We examined the temporal stability of alexithymia in patients with obsessive-compulsive disorder (OCD) over 6 years and the association of alexithymia with the long-term outcome of OCD. Sampling and Methods Of 42 patients with OCD, 34 (81%) could be reassessed 6 years after inpatient treatment. The 20-item Toronto Alexithymia Scale, Yale-Brown Obsessive-Compulsive Scale, and Hamilton Depression Rating Scale were used at pretreatment, posttreatment, and follow-up. Results The 20-item Toronto Alexithymia Scale total scores and its factors 1 and 2 decreased significantly during follow-up, whereas factor 3 remained stable. High correlations of the 20-item Toronto Alexithymia Scale total scores ( r = 0.84, P < .001) and its 3 factors emerged between posttreatment and follow-up, suggesting relative stability over several years. Regression analyses (with and without controlling for depressive symptoms) showed that higher alexithymia scores did not predict a worse long-term outcome of OCD. Conclusions Relative stability over such a very long follow-up period strongly supports the view that alexithymia is a stable psychologic characteristic in patients with OCD. The result that higher alexithymia scores were not associated with poorer long-term outcome of OCD might be explained with the decrease of alexithymia during treatment and follow-up. However, our sample size was small, and further research is clearly required to evaluate the impact of changes in alexithymia and its association with the course of OCD.

Predictores psicosociales de alexitimia estudiados durante un período de 12 meses en una población femenina de "no casos"

Conclusions in previous studies on the stability of alexithymia and its relation to anxiety and depression have been drawn without differentiating the concept of relative stability regarding individual differences from the concept of stability in absolute scores. Furthermore previous studies have not explicitly modeled absolute change in alexithymia scores as a function of absolute change in scores on psychosocial symptom severity. Against this background, we wanted to examine the absolute stability of alexithymia over a 1-year period in a non-patient population. We also wanted to investigate whether psychosocial variables explain changes in alexithymia over time. In a 12-month follow-up study, changes in the level of alexithymia, feelings of well-being, somatic anxiety, depressive symptoms, and social disability were examined in a sample of nursery workers. Two hundred and fifty-three subjects were reported for the investigation. Our findings show that although absolute changes in alexithymia may be observed, a high degree of relative stability can also be observed. Changes in alexithymia were found to be independent of changes in symptom severity and demographic characteristics. The results may indicate that alexithymia is not merely a direct concomitant of psychosocial symptom severity or the result of a common cause, that is also responsible for the onset of psychosocial symptoms.

Do stressful life-events or sociodemographic variables associate with depression and alexithymia among a general population?—a 3-year follow-up study

This 3-year follow-up study examined background factors, stressful life-events, and changes in alexithymia and depression scores in four groups of subjects from a general population (N = 1,339): alexithymic (A), depressed (D), simultaneously alexithymic/depressed (AD), and non-alexithymic/non-depressed (O). Alexithymia was assessed using the 20-item version of the Toronto Alexithymia Scale (TAS) and depression using the 21-item Beck Depression Inventory (BDI). A questionnaire screening sociodemography and stressful life-events was also used. The results showed that alexithymia was associated with male gender and blue-collar working, whereas depressive symptoms associated with female gender, older age, poor subjective health, poor financial situation, and low life satisfaction. During the follow-up the sum of stressful life-events was higher among groups AD and D than in groups A and O. The most common stressful life-events were the death of a close relative or friend, a negative change in the health of a family member, and financial problems. The TAS scores decreased only in groups A and AD. The BDI scores decreased in group AD but remained relatively unchanged in group D. Interestingly, if only those without depressive symptoms are considered, alexithymia appears to be a rarer phenomenon than has been reported previously. Furthermore, it seems that depressive symptoms were chronic and long-lasting among the general population.

Secondary alexithymia as a state reaction in panic disorder and social phobia

In a 6-month follow-up study, a change in alexithymia was examined in two samples of 26 patients with panic disorder and 24 patients with social phobia. Before psychiatric treatment, the prevalence rate of alexithymia, measured by the 20-Item Toronto Alexithymia Scale (TAS-20), was higher for both panic disorder (54%) and social phobia (58%) groups than for healthy persons (15%). After treatment, scores on the alexithymia constructs of difficulty identifying feelings and difficulty describing feelings significantly decreased in panic disorder and social phobia patients. The overall decrease in measures of alexithymia in both groups was significantly related to reduction in anxiety, but not depression. The results suggest that secondary alexithymia related to anxiety exists as a state reaction in patients with panic disorder and social phobia.

Changes in scores on alexithymia over a period of psychiatric treatment.

We examined changes in alexithymia over a period of psychiatric treatment. Scores on a measure of alexithymia construct (affect awareness but not externally oriented thinking) decreased significantly after psychiatric treatment, suggesting that alexithymia or affect awareness for patients with psychiatric disorders or psychosocial problems is a state reaction rather than a personality trait. As for an association of reactions to stress with alexithymia, a group on high extrapunitiveness demonstrated significant decrease in scores on affect awareness compared to a group on low extrapunitiveness both before and after psychiatric treatment.