Date of Award

2015

Document Type

Thesis

Publisher

Edith Cowan University

Degree Name

Doctor of Philosophy

School

School of Psychology and Social Science

Faculty

Faculty of Health, Engineering and Science

First Supervisor

Dr Rodrigo Becerra

Second Supervisor

Dr Craig Harms

Third Supervisor

Dr Ricks Allan

Abstract

Alexithymia has been defined as a personality construct that involves difficulties identifying and describing feelings, as well as an externally oriented thinking style and impoverished fantasy life, which places individuals at risk for various psychopathologies. For psychiatric populations, it represents an obstacle to therapeutic success. Despite extensive research, there is no consensus on the prevalence rate of alexithymia in the general psychiatric population and no data on alexithymia prevalence in the Australian general psychiatric population. In addition, there is inconsistency in the literature regarding the role of alexithymia in therapeutic intervention and a lack of robust studies involving control or comparative therapeutic conditions.

Two systematic literature reviews were conducted to evaluate the prevalence rate of alexithymia in the psychiatric and community populations and the role of alexithymia in the therapeutic process, respectively. The first review, comprising 124 studies, revealed that prevalence rates of alexithymia, although extremely varied, were much higher in psychiatric samples compared to community samples. While different psychiatric diagnoses were likely to have contributed to the variation in rates of alexithymia across psychiatric samples, it was unclear whether other sample characteristics may have contributed. The second review, involving 31 studies, identified a balance between studies that found a negative influence of alexithymia on some therapeutic outcomes and studies that found no influence of alexithymia on therapeutic outcomes. In addition, numerous types of therapeutic intervention reduced alexithymic features on average. All of the reviewed studies found a consistent degree of change between individual’s alexithymia scores from before to after treatment (relative stability).

Study 1 examined differences in alexithymia between 166 general psychiatric outpatients and 216 community participants from Australia. Alexithymia was measured with the 20-item Toronto Alexithymia Scale. Analysis of variance indicated that the psychiatric sample, independent of demographic factors, had higher alexithymia scores than the community sample. Chi-Square analysis showed a greater proportion of alexithymic participants in the psychiatric sample compared to the community sample. The strength of the associations between alexithymia and psychological distress (measured with the Depression Anxiety Stress Scale) were found to be similar for both sample groups.

Study 2 examined the role of alexithymia in the therapeutic process in a subset (n = 61) of the original psychiatric sample who were subject to one of two treatment conditions: emotion focused group therapy or cognitive-behavioural focused group therapy. Higher alexithymia scores before treatment were associated with less change in psychological distress severity during treatment. This association was not significant in either treatment condition when examined separately. Analysis of variance showed that mean-level change in alexithymia from before to after treatment was not dependent on treatment condition. Correlation and hierarchical regression analyses showed a high degree of relative stability in alexithymia despite moderate change in psychological distress severity. Regression analysis showed that change in alexithymia could not be directly accounted for by change in psychological distress. Regression analysis also showed that less change in alexithymia severity during treatment significantly predicted higher psychological distress scores after treatment, even after controlling for group therapy type and psychological distress severity before treatment. The theoretical, research, and clinical implications of these research findings are discussed. The importance of identifying alexithymic patients prior to conducting therapeutic intervention was emphasised, as was the need to provide those patients, who were alexithymic after treatment, with further psychiatric care.

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