Impact of Alexithymia on Treatment Outcome: A Naturalistic Study of Short-Term Cognitive-Behavioral Group Therapy for Panic Disorder

Abstract

Background: It is often suggested in the literature that alexithymic patients are less responsive to psychotherapy than nonalexithymic patients. However, few empirical studies have examined this issue. Furthermore, it is unclear whether or not alexithymia itself may improve during psychotherapy. Methods: Fifty-five consecutive outpatients with panic disorder received short-term cognitive-behavioral group therapy (CBGT) and were followed up 6 months later. Nineteen patients (35%) were on concomitant antidepressant medication. Alexithymia was measured using the 20-item Toronto Alexithymia Scale (TAS-20). Both completers and intention-to-treat analyses were calculated, taking into consideration the potentially confounding effect of comorbid conditions. Results: Baseline alexithymia did not predict outcome of CBGT, neither at posttreatment nor at follow-up. The presence of comorbid axis I disorders predicted nonresponse at posttreatment but not at follow-up. TAS-20 total scores decreased over time, with the TAS-20 factors 1 (difficulty identifying feelings) and 2 (difficulty describing feelings) decreasing significantly, while factor 3 (externally oriented thinking) remained largely stable. Conclusions: These findings are encouraging for cognitive-behavioral therapists working with patients with alexithymia who suffer from panic disorder: CBGT outcome does not appear to be negatively affected by alexithymia, and some alexithymic characteristics may even be reduced following CBGT. Assessing alexithymia at treatment onset may be useful for individually tailoring therapeutic interventions.

A systematic review of predictors and moderators of improvement in cognitive-behavioral therapy for panic disorder and agoraphobia

“…Four of five studies examining the presence of a comorbid clinical (Axis I) disorder on symptom improvement at post-treatment found that this did not predict improvement in treatment (Aaronson et al, 2008;Bitran et al, 2008;Rufer, Albrecht, Zaum et al, 2010;Schmidt & Telch, 1997; see Table 1). The presence of a comorbid clinical disorder was also non-predictive of improvement in a meta-analysis (OR = 1.17, 95% CI [0.72, 1.91], z = 0.65, p = .52), though data from only two of the aforementioned five studies could be included in the meta-analysis.…”

The Effect of an Early Rehabilitation on Alexithymia among First Ever Depressive Occupational Health Care Clients

“…Subsequent studies have shown that subjects with alexithymia may benefit from different therapies or interventions: multimodal cognitive behavioral therapy in Obsessive Compulsive Disorder [43], multimodal psychodynamic treatment [44,45], compherensive integrated group therapy [46][47][48][49], intensive Short Term psychotherapy [50], mentalization based therapy [51], cognitive behavior therapy [52], Affect School-Intervention [53] among others. In the EERIP the group working methods were based on eclectic practice including both cognitive behavioral and psychodynamic principles.…”

Effektivität und Erfolgsprädiktoren in der kognitiven Verhaltenstherapie unter Praxisbedingungen

“…Dies entspricht anderen Studien [Spek et al, 2008;Rufer et al, 2010] [Bohart und Wade, 2013]. Eine Verzerrung der Ergebnisse kann unter diesem Gesichtspunkt nicht ausgeschlossen werden.…”

“…So erwies sich eine erhöhte Ausprägung an Alexithymie bei psychodynamischen Therapien als prognostisch ungünstig [McCallum et al, 2003;Leweke et al, 2009], während für kognitive Verhaltenstherapien überwiegend kein Einfluss auf das Behandlungsergebnis zu finden war [Spek et al, 2008;Rufer et al, 2010].…”