Effects of DBT-based Interventions on Alexithymia: A Systematic Review

Alexithymia [from the Greek a (not) – lexis (words) – thymos (emotion); “no words for emotions”] is a term developed to describe people with marked restriction in experiencing emotions, difficulties in identifying and distinguishing their feelings from physical sensations, and a particular struggle to find appropriate words to verbalize what they feel. Furthermore, alexithymic individuals also have reduced imaginative abilities, showing a paucity of dreams and fantasies, as well as an outward-oriented thinking style with marked avoidance of inner experiences. Alexithymia has prevalence rates ranging from 7% to 13% in community samples, although it is estimated to be several times higher in clinical samples.

Research has shown that alexithymia is a transdiagnostic risk factor as it is found in a variety of mental health problems such as depression, eating disorders, panic disorder, alcohol abuse, and dependence on other substances. It is estimated that at least 50% of individuals with autism are alexithymic. Furthermore, alexithymia has been shown to impair quality of life by hindering the formation of close and meaningful relationships. Psychotherapy is expected to help patients with alexithymia develop some ability to recognize their feelings and communicate them to others, and to use emotional information to guide adaptive behavior. However, patients with high alexithymic traits can be particularly challenging for psychotherapeutic treatment, as their inability to communicate emotions can induce negative reactions in therapists.

Scientific literature has shown that alexithymia improves with psychological interventions that directly target the symptoms of alexithymia, such as poor fantasy and attention to internal experiences, difficulty identifying and differentiating feelings and bodily sensations, inability to express emotions, reduced emotion regulation, and interpersonal problems. Although to date there is no gold standard intervention to treat alexithymia, evidence suggests that emotional-focused therapeutic approaches, such as third-wave cognitive behavioral therapies (CBT) that include mindfulness interventions and emotional psychoeducation, hold promise for improve the deficits presented in alexithymic patients. Dialectical Behavior Therapy (DBT) is a third-wave CBT intervention with the potential to improve emotional awareness in alexithymia as it encourages patients to get in touch with their feelings to identify, describe and regulate their emotions.

Although DBT is promisingly useful for difficulties experienced by alexithymic individuals, empirical evidence on its effectiveness for alexithymia is still diffuse in the literature. Gathering the findings on the subject is essential to clarify whether DBT-based interventions can be indicated to treat alexithymia. Due to this gap in the literature, the present study aimed to perform a systematic review of DBT-based interventions in alexithymia. We identified eight studies. Overall, the results were inconclusive due to the heterogeneity of the studies, but suggest that DBT-based interventions may be associated with self-reported reductions in alexithymia and increases in the ability to identify emotional states. The literature is limited by significant methodological problems, such as the low number of controlled trials, small sample sizes, and high variability among DBT programs, which increases the risk of bias in study results. More research is needed to reach conclusions about the effectiveness of DBT in improving alexithymia. Future studies should conduct randomized controlled trial designs (mostly with active treatment control conditions), greater standardization of DBT-based interventions, and further examination of the level of participant involvement in long-term DBT-based interventions may help to understand whether DBT improves alexithymia difficulties.

Read the full paper: Salles, B. M., Maturana de Souza, W., dos Santos, V. A., & Mograbi, D. C. (2022). Effects of DBT-based interventions on alexithymia: A systematic review. Cognitive Behaviour Therapy, 1-22. https://doi.org/10.1080/16506073.2022.2117734

Photo by: Jens-Christian Fischer

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