Table 3.
Studies investigating the impact of alexithymia on treatment outcome in diverse psychiatric disorders.
| Reference | Objectives | Study design | Sample size | Standardized assessments of alexithymia | Treatment | Assessment tools | Diagnosis | Results |
|---|---|---|---|---|---|---|---|---|
| Kosten et al. (44) | To explore the complex interplay between alexithymia and treatment outcome in PTSD | An 8-week double blind RCT with randomization to either imipramine, phenelzine or placebo | 57 | APRQ | 8-week course of either imipramine, phenelzine or placebo | IES | PTSD | Alexithymia level was significantly associated with a worse treatment outcome |
| Bach and Bach (45) | To evaluate pre-treatment alexithymia as a potential outcome predicting factor among individuals affected by SD, along with the assessment of alexithymia level heterogeneity among different diagnostic categories | Prospective design with assessments performed at baseline and at 2-years follow-up | 30 | TAS-26 | Integrated behavioral therapy over a minimum of 8 weeks including exposure, group cognitive therapy, muscle relaxation and assertiveness training | WI, SCID, SCL-90R | SD, PD, HY, USD | A non-significant correlation between higher pre-treatment TAS-26 score and USD persistence at follow-up was described |
| McCallum et al. (46) | To explore the predicting value of alexithymia and PM | Reanalysis of two previously published clinical trials | 251 | TAS-20 DIF, DDF, EOT | Either 12 weeks of weekly STGT or 20 weeks of STIT | PMAP | CG, MDD, AVO, DEP, BPD, DST, OCD, PAR | A modest portion of improvement variance was linked to alexithymia and PM in both treatment group. |
| Rufer et al. (47) | To test the predicting value of alexithymia among OCD patients undergoing CBT | Prospective design with assessment before and after treatment | 39 | TAS-20 DIF, DDF, EOT | Multimodal CBT (25 individuals received concomitant antidepressant) | Y-BOCS, HAM-D | OCD | Alexithymia level did not predict treatment outcome |
| Rufer et al. (48) | To investigate alexithymia outcome predicting value for OCD in the long term | A 6-year prospective design with assessments before, after treatment and at 6 years follow-up | 34 | TAS-20 DIF, DDF, EOT | Multimodal CBT (25 individuals received concomitant antidepressant) | Y-BOCS, HAM-D | OCD | Alexithymia level did not predict treatment outcome at follow-up |
| Grabe et al. (49) | To explore alexithymia persistence in the inpatient setting and its influence on the outcome | Prospective analysis with assessments at T0 at baseline, T1 at 4 weeks and at discharge T2 | 297 | TAS-20 | Treatment duration varied from 8 up to 12 weeks administered in the inpatient setting and included: 3 weekly sessions of psychodynamic STGT and 1 weekly session of individual psychotherapy; daily art, sport, movement and relaxation therapy (medications were administered as needed) | SCL-90R, GSI | AUD, MDD, ADD, SFD, DIS, ED, PED | Higher levels of psychological stress were described among alexithymic individuals as compared with non-alexithymic individuals; alexithymia was not associated with a higher likelihood of early withdrawal from therapy, nor with a higher degree of treatment resistance. Nonetheless, a higher post-treatment GSI was described among alexithymic |
| Leweke et al. (50) | To investigate baseline alexithymia influence on treatment outcome in an inpatient setting | Prospective design with a 4 or an 8-week treatment course depending on the underlying condition | 480 | TAS-26 DIF, DDF, EOT, RD | Multimodal treatment including psychodynamic oriented individual psychotherapy, associated with art, group body and music therapy; pharmacotherapy was offered as needed | SCL-90R, GSI | DD, ADS, ASD, PTSD, ADJ, SFD, ED | Alexithymia was associated with a small risk for worse outcome as compared with non-alexithymic. |
| Löf et al., (51) | To investigate the complex interplay between alexithymia, self-image and treatment outcome among BPD undergoing MBT. | Prospective design with a 12-month treatment course; assessments were performed at baseline, at 6, 12, and 18 months. | 75 | TAS-20 DIF, DDF, EOT, RD | Multimodal treatment comprising individual and group MBT; pharmacotherapy was administered as needed. | DSHI-9, KABOSS-S, MINI, RQ, SASB, SCID-II, SCL-90-R, ZAN-BPD | BPD | No correlation was described between treatment outcome and alexithymia. |
| Rufer et al. (43) | To test alexithymia predictive value on treatment outcome among PD individuals receiving a course of CBT (1), and the eventual change of alexithymia over time (2). | Prospective | 55 | TAS-20 total score, DIF, DDF, EOT | 5 sessions of GCBT (19 patients received concomitant pharmacotherapy) | MINI, BDI, PAS-20 | PD with and without agoraphobia | Alexithymia level decreased over time, but it did not predict GCBT outcome. The EOT factor remained more stable over time. |
| Ogrodniczuk et al. (45) | To test the potential efficacy of a group therapy among outpatient psychiatric users, and the impact eventual alexithymia changes in interpersonal functioning | Prospective 2-year observational study with assessments at baseline, post-therapy and at 3 months follow-up | 68 | TAS-20 DIF, DDF, EOT | 5 weekly sessions of group therapy for 3 months | BDI, IIP-28 | AD, DD, PED | Alexithymia level was associated with greater interpersonal difficulties at follow-up, with higher alexithymia changes corresponding to greater improvement in interpersonal functioning |
| McMain et al. (52) | To test the relationship between treatment outcome and specific changes in emotion processes and problem-solving | A subset analysis of an RCT | 80 | TAS-20 DIF, DDF, EOT | Either multiple weekly sessions of DBT (individual and group therapy) or GPM (combined psychodynamic and pharmacotherapy) | DABS, SCID-I, SCL-90-R, IIP-64, LIWC | BPD | No significant correlation was described between alexithymia level and treatment outcome; changes on the DDF significantly predicted IIP improvements |
| Terock et al. (53) | To study the relationship between alexithymia, SD and their eventual influence on the outcome | Prospective analysis with assessments at admission and discharge | 716 | TAS-20 DIF, DDF, EOT | 6-8 weeks of psychodynamic oriented therapy with cognitive behavioral elements (pharmacotherapy was offered as needed) | SCL-90R, GSI, TCI | AD, AUD, ED, PED, SFD | The DIF was the only factor in the TAS-20 predicting treatment outcome. |
| Probst et al. (54) | To explore the complex interplay between alexithymia, therapeutic alliance and treatment outcome in MSD | Reanalysis of a 12-week RCT | 83 | TAS-20 DIF, DDF, EOT | 12 sessions of weekly PIT | SCID for DSM-IV, HAQ, PHQ-9, PCS | MSD | No significant relationship was described between alexithymia, therapist alliance and treatment outcome when controlling for depression burden |
| McGillivray (55) | To study the potential influence of alexithymia on treatment outcome | Prospective study with assessments performed at the beginning and at the end of the treatment course | 61 | TAS-20 DIF, DDF, EOT | Integrated group therapy CBT-based | DASS-42 | AD, MD, SFD, PED | No significant correlation was described between alexithymia and treatment outcome either at baseline or after treatment |
| Zorzella et al. (56) | To test the influence of alexithymia on treatment outcome among women with a history of sexual abuse | Prospective study with assessments were performed at baseline (T0), post BRG (T1), post WRAP (T2) | 51 | TAS-20 DIF, DDF, EOT | 4-6 weekly sessions of a group therapy (BRG) followed by a further 8-week course of multimodal trauma therapy WRAP (e.g. CBT, Psychoeducation, IPT) | CTQSF, PTSDC, DES, IIP, MMPI, PSI, WAI-S | PTSD | A significant correlation was described between alexithymia improvements at T1 and T2 and changes in dissociation, PTSD and IP at the same timepoints |
AD, anxiety disorders; ADD, adjustment disorder; ADJ, adjustment disorder; APRQ, Alexithymia Provoked Response Questionnaire; ASD, acute stress disorders; AUD, alcohol use disorder; BDI, Beck Depression Inventory; BPD, borderline personality disorder; BRG, Building Resources Group; CBT, cognitive behavioral therapy; CG, complicated grief; CTSFQ, Childhood Trauma Questionnaire Short Form; DABS, Derogatis Affects Balance Scale; DASS, Depression Anxiety Stress Scale; DD, depressive disorders; DIF, TAS-20 factor 1 Difficulty Identifying Feelings; DDF, TAS-20 factor 2 Difficulty Describing Feelings; DIS, dissociative disorders; DSHI, Deliberate Self-Harm Inventory-9; DSM-III, Diagnostic and Statistical Manual of Mental Disorders III; DST, dysthymia; ED, eating disorders; EOT, TAS-20 factor 3 Externally Oriented Thinking; GSI, Global Severity Index; GPM, general psychiatric management; HAM-A, Hamilton Anxiety Rating Scale; HAM-D, Hamilton Depression Rating Scale; HAQ, Helping Alliance Questionnaire; HC, healthy control; HY, hypochondria; IES, Impact of Events Scale; IIP-64, Inventory of Interpersonal Problems-64 items; IIP-28, Inventory of Interpersonal Problems-28; IPT, Interpersonal Therapy; KABOSS-S, Karolinska Borderline and Symptoms Scales; LIWC, Linguistic Inquiry and Word Count; MBT, Mentalisation-based Therapy; MD, mood disorders; MDD, major depressive disorder; MINI, Mini-International Neuropsychiatric Interview for DSM-IV; MMPI, Minnesota Multiphasic Personality Inventory; MSD, Multisomatoform Disorder; PCS, Physical Component Summary from the SF-36; PD, panic disorder; PED, personality disorders; PHQ-9, Patient Health Questionnaire; PIT, Psychodynamic-Interpersonal Psychotherapy; PM, psychological mindedness; PMAP, Psychological Mindedness Assessment Procedure; PSI, Problem-Solving Inventory; PTSD, posttraumatic stress disorders; PTSDC, Post-Traumatic Stress Disorder Checklist; RD, reduced daydream; RQ, Relationship Questionnaire; SASB, Structural Analysis of Social Behavior; SCID-II, Structured Clinical Interview for DSM-IV Axis-II disorders; SCL-90, Symptoms Checklist 90R; SD, somatization disorder; SED, self-directedness; SFD, somatoform disorder; STGT, Short-Term Group Therapy; STIT, Short-Term Individual Therapy; STP, short-term psychotherapy; TAS-20, Toronto Alexithymia Scale 20 items; TCI, Temperament and Character Inventory; USD, Undifferentiated Somatoform Disorder; WAI-S, Working Alliance Inventory, short form; WI, Whiteley Index; WRAP, Women Recovering From Abuse Program; Y-BOCS, Yale-Brown Obsessive-Compulsive Scale; ZAN-BPD, Zanarini Rating Scale for Borderline Personality Disorder.