Alexithymia level and response to computer-based training in cognitive behavioral therapy among cocaine-dependent methadone-maintained individuals

Abstract

Background-Alexithymia, a characteristic marked by poor ability to identify, define and communicate emotions, has been associated with poorer treatment outcome, including traditional clinician delivered CBT. Computerized cognitive behavioral therapy (CBT4CBT), an effective adjunct to treatment, may provide a means of conveying skills without requiring interaction with a clinician.Methods-Seventy-three methadone maintained, cocaine dependent individuals participating in an 8-week randomized clinical trial comparing standard methadone maintenance to methadone maintenance plus CBT4CBT completed the Toronto Alexithymia Scale (TAS-20) at pretreatment, post-treatment, and follow-ups conducted one, two, and 6 months after treatment.Results-There were no statistically significant differences on baseline TAS-20 scores by multiple demographic and substance use variables including gender and substance use severity. Higher TAS-20 scores were associated with somewhat higher levels of distress as measured by the Beck Depression Inventory and multiple Brief Severity Index scales. TAS-20 scores remained relatively stable throughout the duration of treatment and follow-up. Indicators of treatment process, including treatment retention, adherence and therapeutic alliance, were not significantly correlated with TAS-20 scores. There was a significant interaction of alexithymia and treatment condition, such that individuals with higher baseline scores on the TAS-20 submitted significantly higher percentages of cocaine-negative urine toxicology specimens and reported a higher © 2015 Published by Elsevier Ltd. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.Conflict of Interest Dr. Carroll is a consultant to CBT4CBT LLC, which makes CBT4CBT available to qualified clinical providers and organizations on a commercial basis. Dr. Carroll works with Yale University to manage any potential conflicts of interest. The other authors report no financial relationships with commercial interests. percentage of abstinence days, and longer periods of consecutive abstinence within treatment when assigned to CBT4CBT compared with treatment as usual. HHS Public AccessConclusions-These findings suggest that individuals with increased alexithymia may benefit from computerized CBT; possibly via reduced demands on interpersonal skills and interactions associated with computerized therapies.

Role of Alexithymia and Self-Concealment in Predicting Readiness to Change Among Patients with Substance Use Disorders

“…Other empirical research shows no connection between alexithymia and abstinence, length of treatment, and adherence to treatment. (De Haan et al, 2011 ;Morie, Nich, Hunkele, Potenza, & Carroll, 2015). The absence of correlation can be attributed to the fact that dropout and recurrence of substance use depend on numerous factors rather than a single element.…”

Alexithymia and Addiction

“…Thus, such individuals may seek to relieve depression or anxiety brought about by alexithymia by consuming alcohol or other drugs [16]. However, alexithymia may represent a separate entity, [17] consistent with observations that not all individuals with co-occurring alexithymia and substance dependence exhibit affective disorders [18]. Reports on alexithymia have shown a link between alexithymia and a chronically elevated stress response [19], perhaps because an inability to identify negative emotion makes such emotions harder to regulate.…”

“…A prospective study on subjects with alcohol dependence by Junghanns et al [32] in 2005 found that alexithymia scores were not associated with the risk of relapse at 6-week follow-up [32]. A recent research confirmed that alexithymia was not associated with treatment adherence or retention in an 8-week randomized clinical trial by Morie et al [18] in 2015 [18]. Thus, evidence on the relationship between alexithymia and treatment outcome is limited and non-univocal.…”