Table 1.
Studies investigating the impact of alexithymia on treatment outcome in mood disorders.
| Reference | Objectives | Study design | Sample size | Standardized assessment of alexithymia | Treatment | Assessment tools | Diagnosis | Results |
|---|---|---|---|---|---|---|---|---|
| Ozsahin et al., (26) | To investigate the influence of alexithymic features on depression treatment outcome, along with the eventual change in alexithymia burden over the course of treatment. | Prospective design with patients evaluated before beginning treatment (T0), and post-treatment (T1) after 10 weeks. | 65 (32 alexithymic and 33 non-alexithymic) | TAS-20 | Antidepressant (i.e. Paroxetine) | SCID for DSM-IV, HAM-D | MDD | At T1 a positive correlation was described between HAM-D and TAS-20, with a significantly greater HAM-D score reduction among non-alexithymic individuals. |
| Ogrodniczuk et al. (27) | To investigate the association between alexithymia and residual symptoms among short-term psychotherapy responders in the outpatient setting. | A 20-week RCT including individuals randomly assigned to receive either interpretative or supportive psychotherapy | 33 | TAS-20 DIF, DDF, EOT | 20 weekly sessions of either interpretative or supportive psychotherapy (17/33 concomitantly received antidepressant medication, either a SSRI or a tricyclic; these individuals were equally distributed between the 2 study groups) | Computer assisted SCID I and II for DSM-III R, BID assessed pre- and post-treatment, STAI | MDD | No association was found between baseline alexithymia and baseline depression severity; DIF was significantly associated with residual depressive symptoms. |
| Spek et al. (28) | To investigate the interplay between alexithymia and CBT outcome at 12 months follow-up | Prospective design with 1-year follow-up | 119 | TAS-20 | CBT psychotherapy | BDI | Subthreshold MDD | Changes in alexithymia were significantly correlated with BDI changes, however no significant association was found between pre-treatment alexithymia and treatment outcome. |
| Gunther et al. (29) | To study the relationship between alexithymia and symptom severity after a course of | Prospective design with assessments performed after an average of 2 weeks from admission (T0) and at 7 weeks after starting therapy (T1) | 45 | TAS-20 DIF, DDF, EOT | Psychodynamic interactional psychotherapy (at T1 33/45 individuals were also taking antidepressants) | BDI-II, HAM-D, SCID for DSM-IV, STAI | MDD | Baseline EOT (T0) predicted depressive symptom burden at T1. |
| Bressi et al. (32) | A 12-month follow-up study exploring the effectiveness of STMBP in MDD (1), the possible correlation among alexithymia and reflective functioning (2), the correlation among clinical variables and their eventual impact on TAS-20 and HAM-D | Prospective design with assessments (GAF, HAM-D, TAS-20) at baseline (T0), after 40 weeks (T1) and at 12 months follow-up (T2) | 24 | TAS-20 | 40 weekly session of STMBP; all study participants were taking antidepressant medications (SSRI, SNRI); during the follow-up no medication allowed except for occasional BDZs administration | AAI-RF, GAF, HAM-D | MDD | A reduction in HAM-D and TAS-20 scores was described, along with a negative correlation between RF and TAS-20 score. |
| Quilty et al. (33) | To test the role of alexithymia in influencing CBT and IPT treatment outcome in MDD affected individuals. | An 16-week RCT with patients randomized either to IPT or CBT (38 to IPT, 37 to CBT) | 75 | TAS-20 DIF, DDF, EOT at baseline | 16 weekly sessions of either IPT or CBT (no antidepressant medication was allowed during the trial) | BDI-II and CALPAS at 3-8 and 13 weeks; SCID for DSM-IV, HAM-D | MDD | A negative correlation was described for EOT and 13-week depression burden; an increased alexithymia level was also associated with lower alliance score |
AAI-RF, Adult Attachment Interview-RF; BDZ, benzodiazepine; BID, Beck Depression Inventory; CALPAS, California Psychotherapy Alliance Scale; CBT, cognitive behavioral therapy; DIF, TAS-20 factor 1 Difficulty Describing Feelings; DDF, TAS-20 factor 2 Difficulty Identifying Feelings; DSM-III, Diagnostic and Statistical Manual of Mental Disorders III edition; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders IV-edition; HAM-D, Hamilton Depression Rating Scale; IPT, Interpersonal Therapy; MDD, major depressive disorder; RCT, randomized controlled trial; RF, reflective functioning; SCID, Structured Clinical Interview for DSM-IV; SNRI, serotonin norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor; STAI, Spielberger State Trait Anxiety Inventory; STMBP, Short-Term Psychodynamic Psychotherapy with Mentalization-Based Techniques; TAS-20, Toronto Alexithymia Scale 20 items.