Alexithymia and emotional processing: a longitudinal mixed methods research

Abstract

Alexithymia has been associated with poor outcomes in psychotherapy. This association has been attributed to a difficulty in patients processing emotions and engaging in emotional tasks. The possibility of alexithymia being modified by psychotherapy remains a topic of great debate but with little empirical research. In this study a mixed methods longitudinal design was used to better understand alexithymia, emotional processing and change process in psychotherapy. Twelve clients, five with alexithymia, were studied considering the development of alexithymia, emotional awareness, differentiation, regulation and severity of symptoms. The reliable change index was used to interpret the evolution of those emotional variables' scores for each case and thematic analysis was used to analyze individual interviews. Thematic analysis generated several themes, organized in two broad domains: i) perception of emotions and ii) description of change. The three alexithymic patients that changed in alexithymia also changed in at least one of the emotional variables – lack of emotional awareness, emotion differentiation or emotion regulation. Generally, alexithymic patients were able to accomplish change in psychotherapy although they had a tendency to focus on physical complaints, describe changes in a more rational rather than emotional way and present vaguer descriptions of their problems. These results point that alexithymia may change through therapy and reinforces that those changes are associated with improved emotional processing.

Alexithymia and Emotional Processing: A Mediation Model

“…Although alexithymic deficits in processing emotions have been repeatedly examined, neither their exact nature nor the mechanisms that link them to psychological and health problems are well understood (Lumley, Beyer, & Radcliffe, ). Also, alexithymia has been commonly referred as a personality trait, and therefore fairly stable, but it has been found to decrease in response to therapy (e.g., Rufer et al., ), even with a small number of sessions (Silva, Vasco, & Watson, ). In our view, alexithymia must be seen as both a state and a trait phenomenon, and thinking of it in terms of emotional processing gives a great comprehensibility to the construct and its usefulness to psychotherapeutic intervention.…”

A meta-analytic study examining the relationship between alexithymia and dissociation in psychiatric and non-clinical populations

“…Alexithymia and dissociation have been found to negatively impact treatment outcomes (Arntz et al, 2015 ; Corchs, et al, 2008 ; Jepson et al, 2014 ; Kleindienst et al, 2011 ; Prasko et al, 2016 ; Terock et al, 2017 ; Terock et al, 2015 ). Fortunately, both of these factors appear to be partly modifiable through specific psychotherapeutic interventions, although differential effects are observed depending on the nature of the treatment and time of outcome assessment (post-treatment versus follow-up) (Cameron, Ogrodniczuk, & Hadjipavlou, 2014 ; Cloitre, Perkova, Wang, & Lu, 2012 ; Da Silva, Vasco, & Watson, 2018 ). With regards to alexithymia, treatments that directly target this deficit ( e.g ., place therapeutic emphasis on identifying describing and understanding emotional states and associated bodily sensations) appear to more consistently result in positive outcomes (Cameron et al, 2014 ).…”

Alexithymia and therapeutic alliance: a multiple case study comparing good and poor outcome cases

“…Four cases were selected from a larger research project (Silva, Vasco, & Watson, 2018 ). The study was approved by the ethics committee of the Faculty of Psychology of the Lisbon University and by each institution involved.…”

“…The original sample had 12 cases: 10 good outcomes – two alexithymic, two possible alexithymic, six non alexithymic – and two bad outcomes – one alexithymic and one non alexithymic. The cases could be completed, ongoing, prematurely ended or drop outs (for a characterization of the full sample see Silva, Vasco, & Watson, 2018 ).…”