Adjuvant Psychological Therapy for Alexithymia in Women with Breast Cancer

Many psychological factors play an important role in diagnosis and treatment of cancer. One of the reasons could be due to deficits in emotional processing and affect regulation. These deficits could lead to an inability to verbalize and identify emotions which is known as alexithymia. To this end the objective of the study was to examine the effectiveness of adjuvant psychological therapy in breast cancer in terms of alexithymia (within the intervention group and between the two groups). The study consisted of 20 patients in the intervention and control groups each. They were administered the following scale namely, Toronto Alexithymia Scale (TAS-20). Results indicated that between the intervention and control groups, on total alexithymia, difficulty describing feelings and externally oriented thinking there was a statistically significant difference between the intervention and control groups. On the subscale of difficulty identifying feelings there were no statistically significant differences between the two groups. Within the intervention group too, significant differences were found on alexithymia and subscales both, following therapy and at follow up. This study reveals the effectiveness of psychological interventions in those with breast cancer. It is imperative that psychological care is the need of the hour in oncology settings. Keywords: Alexithymia, Adjuvant Psychological Therapy, Difficulty Identifying Feelings Difficulty Describing Feelings, Externally Oriented Thinking. A host of psychological factors such as sadness, fear and anger characterize people with cancer. Psychologically, they face a life-threatening disease and the impact of surgery, chemotherapy, radiotherapy or endocrine therapy. Fluctuations of emotions is common ranging from hope to feel better and fear of the unknown which is worsened by pre-existing psychological disorders (Griffen & Fentiman, 2002). The negative effects of breast cancer treatment can be long lasting as supported by findings that regardless of improved physical functioning, continual psychological distress can be evident a year following diagnosis (Pinto, Clark, Maruyama, & Feder, 2003). The underlying psychological cause could be a deficit in emotional processing and affect regulation. This could lead to an inability in verbalizing and identifying feelings which is known as alexithymia. 1 (Clinical Psychologist, Department of Psychiatry, Bangalore Medical College and Research Institute, Bangalore, India) 2 (Associate Professor, Department of Psychology, Christ University, Bangalore, India) *Responding Author Received: November 22, 2018; Revision Received: December 19, 2018; Accepted: December 26, 2018 Adjuvant Psychological Therapy for Alexithymia in Women with Breast Cancer © The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 73 The construct of ‘alexithymia’ was originally conceptualized by Nemiah, Freyberger, and Sifneos (1976) as encompassing a cluster of cognitive traits including difficulty identifying feelings, difficulty describing feelings to others, externally oriented thinking, and a limited imaginal capacity. Apart from this alexithymia is also known to be a global impairment in emotional processing resulting in limited emotional expression and recognition (Lane, Sechrest, Riedel, Shapiro, & Kasziak, 2000). Yet what is common in these views is that alexithymia is a deficit, inability, or deficiency in emotional processing rather than a defensive process, and this deficit view is gaining increasing support from basic laboratory research. Alexithymia is hypothesized to be one of several factors that contribute to various physical and mental health problems, including undifferentiated negative moods such as depression and anxiety, compulsive or addictive behaviors, heightened or prolonged physiological arousal, physical symptoms, and potentially somatic disease (Taylor, Bagby, & Parker, 1997). Given the need to study the above mentioned psychological variable the objective of the study was to examine the efficacy of adjuvant psychological therapy in breast cancer in terms of alexithymia (within the intervention group and between the two groups). MATERIALS AND METHODS Study Design The design followed was a quasi experimental, pre and post design with control design. Hypotheses The study had two hypotheses namely: 1. The hypothesis stated that there will be a significant difference among women with breast cancer in the intervention group as compared to the control group on alexithymia, difficulty identifying feelings, difficulty describing feelings and externally oriented thinking. 2. There will be significant differences in pre, post and follow up scores in alexithymia, difficulty identifying feelings, difficulty describing feelings and externally oriented thinking following intervention Tools Toronto Alexithymia Scale (TAS-20) Alexithymia was assessed using Toronto Alexithymia Scale(TAS-20) by Parker, Taylor, and Bagby (2003). This scale consists of 20 items on a 5-point Likert scales ranging from 1 (strongly disagree) to 5 (strongly agree). This sub domains in this scale are: Difficulty Identifying Feelings (DIF), Difficulty Describing Feelings (DDF) and externally oriented thinking (EOT) and total score. Psychometric properties on TAS-20 have shown to have good internal consistency (Cronbach’s alpha = 0.81) and test re-test reliability (r=0.77; p<0.01) over a 3-week period. Adjuvant Psychological Therapy (APT) APT by Moorey and Greer (1989) (as cited in Moorey, Greer, Bliss, & Law, 1998) is a structured, cognitive behaviour therapy for individual patients lasting for 6 sessions 45 minutes each. The therapy comprised of identifying negative automatic thoughts, challenging of cognitions and substituting negative thoughts by adaptive responses, activities of mastery and pleasure and relaxation exercises. Expression of feelings and reflection was a part of the therapy. Adjuvant Psychological Therapy for Alexithymia in Women with Breast Cancer © The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 74 Inclusion Criteria Women with breast cancer in stages I, II and III were chosen. Women stable after surgery Women who were married Women who could give informed consent. Women with breast cancer with minimum 5 standard education. Women with breast cancer who could read and write Kannada, Hindi or English. Exclusion Criteria Primary psychiatric diagnosis. Women with breast cancer who have had an indication of organic brain disorder (this was ruled out by the treating doctor). Patients with other major medical illnesses. Procedure A total of 119 patients were referred by the treating oncologist and nursing staff. Out of those referred, 56 of them fulfilled the criteria. Among the 56, 16 of them did not give consent and therefore 40 of them were sequentially allocated to the intervention and control group (20 each). A total of 40 patients filled the pre and post test measures. The intervention group received therapy for 6 sessions. The control group was assessed at pre test and a gap of 4 weeks was given before post assessment was done. The intervention group alone was followed up. Follow up was done after 6 months following therapy. Ethical committee clearance was obtained from the hospital where the sample was collected.