Four decades of research on alexithymia: moving toward clinical applications

Virtually everyone has experienced from time to time how hard it can be to put one’s feelings into words. Yet, for some individuals, this task is especially daunting. Such individuals are characterized by high levels of alexithymia (“no words for feelings”). Alexithymia is a personality dimension that involves both cognitive deficits, including difficulties in recognizing, describing, and distinguishing feelings from bodily sensations of emotional arousal, and affective deficits, including difficulties in emotionalizing and fantasizing (Bermond et al., 2007). Alexithymia is implicated in a wide variety of psychological problems, such as depression (Honkalampi et al., 2000) and schizophrenia (Rotenberg, 1994). Moreover, emotional deficits in autism spectrum disorder may be largely driven by alexithymia (Bird and Cook, 2013). Finally, alexithymia is associated with suicidality (Hintikka et al., 2004), increased psychosomatic complaints (Lane, 2008) and elevated mortality rates (Tolmunen et al., 2010). Since the term “alexithymia” was introduced some four decades ago by Sifneos (1973), individual differences in alexithymia have been the focus of considerable research efforts. Indeed, at the time of writing this article (October 14, 2013), we counted more than 1400 articles in the PsychInfo database with “alexithymia” in the title or abstract. This research has analyzed many different facets of alexithymia, including its behavioral, linguistic, physiological, and neurological correlates (for recent reviews, see Taylor and Bagby, 2004; Kano and Fukudo, 2013; Nowakowski et al., 2013; van der Velde et al., 2013) as well as its assessment techniques (for a review, see Lumley et al., 2007). The accumulated knowledge based on the formation and assessment provides valuable insights into alexithymia. Nevertheless, researchers have so far taken few steps to translate these insights into treatments and interventions. The current lack of translational work in alexithymia research seems highly unfortunate, considering that epidemiological studies indicate that as many as 10% of the general population may be characterized by levels of alexithymia that are sufficiently high to qualify as pathological (Salminen et al., 1999). Basic research remains necessary to answer unresolved questions about alexithymia. Nevertheless, a number of empirical findings on alexithymia now seem sufficiently well-established to consider their clinical application. Ogrodniczuk et al. (2011) found that high-alexithymic individuals seeking a treatment are as open as low-alexithymic individuals to receiving psychotherapy. Moreover, several studies have shown that alexithymia scores may decline during psychotherapy and such changes are correlated with improvement in therapy. For instance, high-alexithymic individuals may benefit from cognitive behavioral therapy (Spek et al., 2008) and also seem responsive to group therapy (e.g., Beresnevaite, 2000; Ogrodniczuk et al., 2011). As Ogrodniczuk et al., concluded, “This implies that alexithymic patients can at least partly develop some capacity to recognize their feelings and to communicate them to other people, thus enhancing their ability to use emotional information to guide adaptive behavior.” Nevertheless, to the best of our knowledge, there exists no treatment specifically designed to overcome the problems associated with alexithymia. Furthermore, many existing forms of psychotherapy may be less than optimal for helping highalexithymic individuals, given that they typically achieve poorer outcomes in psychotherapy than low-alexithymic individuals (Bach and Bach, 1995; McCallum et al., 2003; Ogrodniczuk et al., 2011). It therefore seems prudent to develop treatments that are specifically designed to overcome the problems associated with alexithymia. Offering such treatments to high-alexithymic individuals may significantly boost the effectiveness of psychotherapy within this group. We therefore call upon researchers to consider more systematically how basic research findings may be translated into tools for improving the fate of alexithymic individuals. To facilitate the translation process, we briefly describe some promising ways in which alexithymia research may be converted into clinical interventions. Notably, our discussion is selective rather than exhaustive. We aim to identify the “low hanging fruit” that can be profitably explored by researchers who are interested in developing more effective evidence-based treatments for alexithymia.