Identifying Psychological Intervention Points for Alexithymia Based on the Process of Emotional Expression

Abstract Background: Alexithymia is a central concept in the field of psychosomatic disease. Patients afflicted with alexithymia have difficulties identifying feelings preventing them from responding well to psychotherapy. This study aims to evaluate in detail which steps of emotional expression (Steps 1–5) proposed by Kennedy-Moore et al. (Kennedy-Moore E and Watson JC. Expressing emotion. In: Salovey P, editor. Expressing Emotion. New York: Guilford; c1999. p. 8-18) are disrupted in alexithymia to enable the administration of effective treatment to such patients and identify appropriate methods of intervention for each step. Methods: To investigate the relationship between the Japanese version of the Difficulties in Emotion Regulation Scale (J-DERS) total score and subscales and the 20-item version of the Toronto Alexithymia Scale (TAS-20) subscales, multiple linear regression was performed using the former as dependent variables. The psychological examination records of eligible patients were retrospectively investigated. To evaluate the effect of alexithymia on each step of the process of emotional expression, the scores on the total and subscale J-DERS of the group that scored high on TAS-20 were compared with those of the group that scored low on TAS-20. Results: Of the 188 total subjects, 106 (56%) were included in the analysis. The median total J-DERS score was significantly different (p < 0.01) between the high-scoring group (defined as 52 points or higher) and the low-scoring group on the TAS-20, with a median score of 42.0 (interquartile range (IQR) 52.8 [upper limit]–31.0 [lower limit]) and 29.5 (IQR 37.3–23.0), respectively. Similarly, a significant difference was seen with each subscale (p < 0.01). Thus, disruption of the process of emotional expression in alexithymic patients is not only observed in Step 3 but also in Steps 4 and 5. Of the three TAS-20 subscales, only difficulty in identifying feelings correlated with the J-DERS total score and subscales (p < 0.01).Conclusions: The results indicate that, when dealing with alexithymic patients individually in a clinical setting, therapeutic intervention should be adapted to Steps 3, 4, and 5 as appropriate for the patient, and that assessing each step using J-DERS may be more clinically useful.