Affect School for chronic benign pain patients showed improved alexithymia assessments with TAS-20

Abstract

BackgroundAlexithymia is a disturbance associated with psychosomatic disorders, pain syndromes, and a variety of psychiatric disorders. The Affect School (AS) based on Tomkins Affect Theory is a therapy focusing on innate affects and their physiological expressions, feelings, emotions and scripts. In this pilot study we tried the AS-intervention method in patients with chronic benign pain.MethodsThe AS-intervention, with 8 weekly group sessions and 10 individual sessions, was offered to 59 patients with chronic non-malignant pain at a pain rehabilitation clinic in Sweden 2004-2005. Pre and post intervention assessments were done with the Hospital Anxiety and Depression scale (HAD), the Toronto Alexithymia Scale-20 (TAS-20), the Visual Analogue Scale for pain assessment (VAS-pain), the European Quality of Life health barometer (EQoL) and the Stress and Crisis Inventory-93 (SCI-93). After the group sessions we used Bergdahl's Questionnaire for assessing changes in interpersonal relations, general well-being and evaluation of AS.ResultsThe AS intervention was completed by 54 out of 59 (92%) patients. Significant reductions in total TAS-20 post-test scores (p = 0.0006) as well as TAS-20 DIF and DDF factors (Difficulties Identifying Feelings, and Difficulties Describing Feelings) were seen (p = 0.0001, and p = 0.0008) while the EOT factor (Externally Oriented Thinking) did not change. Improvements of HAD-depression scores (p = 0.04), EQoL (p = 0.02) and self-assessed changes in relations to others (p < 0.001) were also seen. After Bonferroni Correction for Multiple Analyses the TAS-20 test score reduction was still significant as well as Bergdahl's test after group sessions. The HAD, EQoL, SCI-93, and VAS-pain scores were not significantly changed. The AS-intervention was ranked high by the participants.ConclusionsThis pilot study involving 59 patients with chronic benign pain indicates that the alexithymia DIF and DDF, as well as depression, social relations and quality of life may be improved by the Affect School therapeutic intervention.

Depression, obesity, and smoking were independently associated with inadequate glycemic control in patients with type 1 diabetes

“…If test results are positive, clinical exploration and decisions regarding treatment should be made. Antidepressant medication (3) and/or psychotherapy can be used, either as cognitive behavioral therapy (42), and in case of alexithymia emotion focused therapy (43), or psycho-educational methods (11,44).…”

“…Hospital Anxiety and Depression Scale Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS) (11,28,29,30). HADS consists of two subscales with seven items reflecting depression (HADS-D) and seven items reflecting anxiety (HADS-A).…”

“…Toronto Alexithymia Scale-20 Alexithymia was assessed by the 20-item Toronto Alexithymia Scale-20 (TAS-20) (11,14,15,16,18,19,20,21,31,32,33) based on three subscales: 'difficulty identifying feelings', 'difficulty describing feelings', and 'externally oriented thinking'. TAS-20 consists of 20 statements rated from 1 to 5.…”

“…Affect dysregulation and absence of conscious awareness of affects have health implications (10,11,12). Alexithymia is defined by four factors: difficulty identifying feelings, difficulty describing feelings, externally oriented thinking (low degree of introspection and reflection), and constricted imaginative processes (10).…”

“…A deficit in the awareness of affects results in abnormal physiological reactions, a propensity for impulsive behavior, and an impaired capacity for self-care and self-regulation (10). Inadequate metabolic control of diabetes (13), altered immune function (14), altered cortisol responses (15), and changes of C-reactive protein and serum lipid levels (16) are associated with alexithymia, which in turn has been linked with depression, anxiety, stress-related disorders, diabetes, and obesity (11,17,18,19,20). Alexithymia has also been associated with reduced social support, which negatively affects the prognosis of disease and health problems (11,21).…”