Predicting symptoms in major depression after inpatient treatment: the role of alexithymia

Abstract

Alexithymia has been considered to have a negative influence on the course of symptoms in various psychiatric disorders. Only a few studies of depressed patients have examined whether alexithymia predicts the outcome of therapeutic interventions or the course of symptoms in naturalistic settings. This prospective study investigated whether alexithymia is associated with depressive symptoms after a multimodal inpatient treatment. Forty-five inpatients suffering from acute major depression were examined in the initial phase of treatment and then again after seven weeks. Patients took part in a multimodal treatment programme comprising psychodynamic-interactional oriented individual and group therapy. The majority of patients were taking antidepressants during study participation. To assess alexithymia and depressive symptoms, the 20-item Toronto Alexithymia Scale (TAS-20), the Beck Depression Inventory II (BDI-II) and the Hamilton Depression Scale (HAMD) were administered at baseline and follow-up. When controlling for baseline depressive symptoms along with trait anxiety, high scores in the externally oriented thinking (EOT) facet of alexithymia at baseline predicted high severity of depressive symptoms at follow-up (for self-reported as well as interviewer-based scores). Inpatients suffering from major depression with a more pronounced external cognitive style might benefit less from a routine multimodal treatment approach (including psychodynamic interactional therapy, antidepressant medication, and complementary therapies). Intervention programmes might modify or account for alexithymic characteristics to improve the course of depressive symptoms in these patients.

The Impact of Alexithymia on Treatment Response in Psychiatric Disorders: A Systematic Review

“…Accordingly, a difficulty in identifying feelings may, hypothetically, impinge on the ability of the individual to gain effective benefit from psychotherapy. Conversely, in a study in hospital inpatients affected by major depression, Gunther et al (29) detected a predictive role for the severity of depressive symptoms at follow-up solely for the EOT factor. Indeed, higher EOT scores at baseline correlated with more severe depressive symptoms, even once the potential influence of confounding factors, such as baseline levels of anxiety and depression had been accounted for.…”

“…The authors hypothesized that this finding, at variance with other studies using different forms of psychotherapy, may be related to the possibility that CBT represents a less problematic treatment option in alexithymia patients. Gunther et al (29) carried out a prospective study to evaluate the association between pre-treatment alexithymia levels (TAS-20) and depressive symptoms at follow-up (7 weeks) following multimodal inpatient treatment. Forty-five patients admitted for acute MD who had taken part in a multimodal treatment program comprising both individual therapy and psychodynamic-interactional oriented group therapy were studied.…”

Relations of mindfulness facets with psychological symptoms among individuals with a diagnosis of obsessive–compulsive disorder, major depressive disorder, or borderline personality disorder

“…It could be hypothesized that the increase in the ability of describing one's own emotions, supported by the ability to act with awareness, have an impact on the level of alexithymia, and this relationship is strongest where alexithymia is a distinctive clinical feature, such as in depression (Honkalampi, Hintikka, Saarinen, Lehtonen, & Viinam€ aki, 2000). Furthermore, alexithymia is a predictor of the level of depressive symptoms after psychotherapy (G€ unther, Rufer, Kersting, & Suslow, 2016). Mindfulness, and in particular the ability to describe, might be an important strategy to improve an important clinical aspect that contributes to perpetuate the depressive symptomatology.…”

Alexithymia and psychopathological symptoms in adolescent outpatients and mothers suffering from migraines: a case control study

“…Alexithymia has been recognized as associated with several somatic illnesses and mental disorders [ 21 ]. Furthemore studies detected that the presence of alexithymia has a negative influence on the course of symptoms in psychiatric disorders [ 22 ]. In particular some authors have suggested that alexithymia could be considered a vulnerability factor in the development of psychiatric disorders such as depression [ 22 – 24 ].…”