CoChat
Sign Up
Cited by 78Psychosomatic Disorders and Their TreatmentsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

Impact of Alexithymia on Treatment Outcome: A Naturalistic Study of Short-Term Cognitive-Behavioral Group Therapy for Panic Disorder

Open access
Rufer, Michael, Albrecht, Renate, Zaum, Johanna, Schnyder, Ulrich, Mueller-Pfeiffer, Christoph, Hand, Iver, Schmidt, Oliver·2010·Psychopathology
DOI 10.1159/000288639
Open this paper in CoChat — free accountOpen PDF

Abstract

Background: It is often suggested in the literature that alexithymic patients are less responsive to psychotherapy than nonalexithymic patients. However, few empirical studies have examined this issue. Furthermore, it is unclear whether or not alexithymia itself may improve during psychotherapy. Methods: Fifty-five consecutive outpatients with panic disorder received short-term cognitive-behavioral group therapy (CBGT) and were followed up 6 months later. Nineteen patients (35%) were on concomitant antidepressant medication. Alexithymia was measured using the 20-item Toronto Alexithymia Scale (TAS-20). Both completers and intention-to-treat analyses were calculated, taking into consideration the potentially confounding effect of comorbid conditions. Results: Baseline alexithymia did not predict outcome of CBGT, neither at posttreatment nor at follow-up. The presence of comorbid axis I disorders predicted nonresponse at posttreatment but not at follow-up. TAS-20 total scores decreased over time, with the TAS-20 factors 1 (difficulty identifying feelings) and 2 (difficulty describing feelings) decreasing significantly, while factor 3 (externally oriented thinking) remained largely stable. Conclusions: These findings are encouraging for cognitive-behavioral therapists working with patients with alexithymia who suffer from panic disorder: CBGT outcome does not appear to be negatively affected by alexithymia, and some alexithymic characteristics may even be reduced following CBGT. Assessing alexithymia at treatment onset may be useful for individually tailoring therapeutic interventions.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1159/000288639

Cites

8 of 8 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Group therapy sessions seem to reduce self-reported alexithymia in a range of clinical groups, such as those with heart disease, bulimia nervosa, and panic disorder.

    “Attempts have been made to reduce alexithymia through therapeutic intervention, with group therapy sessions seeming to reduce self-reported alexithymia in a range of clinical groups, such as those with heart disease (Beresnevaite, 2000) and bulimia nervosa (de Groot et al., 1995), and panic disorder (Michael Rufer et al., 2010).”

    From Atypical interoception as a common risk factor for psychopathology: A review (2021) · cites this paper as Michael Rufer et al., 2010

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 50

  1. 1 Sifneos PE: The prevalence of alexithymic characteristics in psychosomatic patients. Psychother Psychosom 1973; 22: 255-262.
  2. Taylor GJ, Bagby RM, Parker JDA: Disorders of Affect Regulation: Alexithymia in Medi- cal and Psychiatric Illness. Cambridge, Cambridge University Press, 1997.
  3. Bankier B, Aigner M, Bach M: Alexithymia in DSM-IV disorder. Psychosomatics 2001; 42: 235-245.
  4. Taylor GJ, Bagby RM, Parker JDA: The alex- ithymia construct: a potential paradigm for psychosomatic medicine. Psychosomatics 1991; 32: 153-164.
  5. Mueller J, Alpers GW: Two facets of being bothered by bodily sensations: anxiety sen- sitivity and alexithymia in psychosomatic patients. Compr Psychiatry 2006; 47: 489- 495.
  6. Devine H, Stewart SH, Watt MC: Relations between anxiety sensitivity and dimensions of alexithymia in a young adult sample. J Psy- chosom Res 1999; 47: 145-158.
  7. Zeitlin SB, McNally RJ: Alexithymia and anxiety sensitivity in panic disorder and ob- sessive-compulsive disorder. Am J Psychia- try 1993; 150: 658-660.
  8. Parker JD, Taylor GJ, Bagby RM, Acklin MW: Alexithymia in panic disorder and simple phobia: a comparative study. Am J Psychiatry 1993; 150: 1105-1107.
  9. Marchesi C, Fonto S, Balista C, Cimmino C, Maggini C: Relationship between alexi- thymia and panic disorder: a longitudinal study to answer an open question. Psycho- ther Psychosom 2005; 74: 56-60.
  10. Fukunishi I, Kikuchi M, Wogan J, Takubo M: Secondary alexithymia as a state reaction in panic disorder and social phobia. Compr Psychiatry 1997; 38: 166-170.
  11. Iancu I, Dannon PN, Poreh A, Lepkifker E, Grunhaus L: Alexithymia and suicidality in panic disorder. Compr Psychiatry 2001; 42: 477-481.
  12. Cox BJ, Swinson RP, Shulman ID, Bourdeau D: Alexithymia in panic disorder and social phobia. Compr Psychiatry 1995; 36: 195-198.
  13. De Berardis D, Campanella D, Gambi F, La Rovere R, Sepede G, Core L, Canfora G, San- tilli E, Valchera A, Mancini E, Salerno RM, Moschetta FS, Ferro FM: Alexithymia, fear of bodily sensations, and somatosensory am- plification in young outpatients with panic disorder. Psychosomatics 2007; 48: 239-246.
  14. Galderisi S, Mancuso F, Mucci A, Garra- mone S, Zamboli R, Maj M: Alexithymia and cognitive dysfunctions in patients with pan- ic disorder. Psychother Psychosom 2008; 77: 182-188.
  15. Kosten TR, Krystal JH, Giller EL, Dan E: Alexithymia as a predictor of treatment re- sponse in post-traumatic stress disorder. J Trauma Stress 1992; 5: 41-50.
  16. Porcelli P, Bagby RM, Taylor GJ, De Carne M, Leandro G, Todarello O: Alexithymia as predictor of treatment outcome in patients with functional disorders. Psychosom Med 2003; 65: 911-918.
  17. Speranza M, Loas G, Wallier J, Corcos M: Predictive value of alexithymia in patients with eating disorders: a 3-year prospective study. J Psychosom Res 2007; 63: 365-371. 19 Sifneos PE: Problems of psychotherapy of patients with alexithymic characteristics and physical disease. Psychother Psychosom 1975; 26: 65-70.
  18. Krystal H: Alexithymia and psychotherapy. Am J Psychother 1979; 33: 17-31.
  19. Ogrodniczuk JS, Piper WE, Joyce AS: The negative effect of alexithymia on the out- come of group therapy for complicated grief: what role might the therapist play? Compr Psychiatry 2005; 46: 206-213.
  20. Rufer M, Jenewein J: Alexithymie und Psy- chotherapie. Psychodyn Psychother 2009; 8: 34-46.
  21. Sifneos PE: Alexithymia, clinical issues, pol- itics and crime. Psychother Psychosom 2000; 69: 113-116.
  22. Taylor GJ, Bagby RM: New trends in alexi- thymia research. Psychother Psychosom 2004; 73: 68-77.
  23. Lumley MA, Neely LC, Burger AJ: The as- sessment of alexithymia in medical settings: implications for understanding and treating health problems. J Pers Assess 2007; 89: 230- 246.
  24. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The Mini-Internation- al Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998; 59: 22- 33.
  25. A lsleben H, Weiss A, Rufer M: Psychoedu ka- tion Angst-und Panikstörungen. Manual zur Leitung von Patienten-und Angehöri- gengruppen. München, Elsevier Urban & Fischer, 2004. 32 Hand I: Group exposure in vivo for agora- phobics (1974): a multifaceted pilot study and its impact on subsequent agoraphobia research. Behav Cognit Psychother 2000; 28: 335-351.
  26. Rufer M, Albrecht R, Schmidt O, Zaum J, Schnyder U, Hand I, Mueller-Pfeiffer C: Changes in quality of life following cogni- tive-behavioral group therapy for panic dis- order. Eur Psychiatry, in press.
  27. Bach M, Bach D, de Zwaan M, Serim M, Böh- mer F: Validierung der deutschen Version der 20-Item Toronto-Alexithymie-Skala bei Normalpersonen und psychiatrischen Pati- enten. Psychother Psychosom Med Psychol 1996; 46: 23-28.
  28. Taylor GJ, Bagby RM, Parker JDA: The 20- item Toronto Alexithymia Scale. IV. Reli- ability and factorial validity in different lan- guages and cultures. J Psychosom Res 2003; 55: 277-283.
  29. Bandelow B: Assessing the efficacy of treat- ments for panic disorder and agoraphobia. II. The Panic and Agoraphobia Scale. Int Clin Psychopharmacol 1995; 10: 73-81.
  30. Bandelow B, Brunner E, Broocks A, Bein- roth D, Hajak G, Pralle L, Ruther E: The use of the Panic and Agoraphobia Scale in a clin- ical trial. Psychiatry Res 1998; 77: 43-49.
  31. Hamilton M: The assessment of anxiety states by rating. Br J Med Psychol 1959; 32: 50-55. 44 Derogatis LR: Scl-90: Administration, Scor- ing and Procedures Manual. Clinical Psy- chometric Research. Baltimore, Johns Hop- kins University School of Medicine, 1977. 45
  32. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring de- pression. Arch Gen Psychiatry 1961; 4: 561- 571.
  33. F r a n z M , P o p p K , S c h a e f e r R , S i t t e W , Schneider C, Hardt J, Decker O, Braehler E: Alexithymia in the German general popula- tion. Soc Psychiatry Psychiatr Epidemiol 2008; 43: 54-62.
  34. Craske MG, Farchione TJ, Allen LB, Barrios V, Stoyanova M, Rose R: Cognitive behav- ioral therapy for panic disorder and comor- bidity: more of the same or less of more? Be- hav Res Ther 2007; 45: 1095-1109.
  35. Friedlander L, Lumley MA, Farchione T, Doyal G: Testing the alexithymia hypothe- sis: physiological and subjective responses during relaxation and stress. J Nerv Ment Dis 1997; 185: 233-239.
  36. Subic-Wrana C, Bruder S, Thomas W, Lane RD, Kohle K: Emotional awareness deficits in inpatients of a psychosomatic ward: a comparison of two different measures of alexithymia. Psychosom Med 2005; 67: 483- 489.
  37. Simson U, Martin K, Schafer R, Franz M, Janssen P: Changes in alexithymia and emo- tional awareness during psychotherapeutic inpatient treatment. Psychother Psychosom Med Psychol 2006; 56: 376-382.
  38. Stingl M, Bausch S, Walter B, Kagerer S, Leichsenring F, Leweke F: Effects of inpa- tient psychotherapy on the stability of alexi- thymia characteristics. J Psychosom Res 2008; 65: 173-180.
  39. Luminet O, Rokbani L, Ogez D, Jadoulle V: An evaluation of the absolute and relative stability of alexithymia in women with breast cancer. J Psychosom Res 2007; 62: 641-648.
  40. Lane RD, Ahern GL, Schwartz GE, Kaszniak AW: Is alexithymia the emotional equivalent of blindsight? Biol Psychiatry 1997; 42: 834- 844.
  41. Bagby RM, Taylor GJ, Parker JDA, Dickens SE: The development of the Toronto Struc- tured Interview for Alexithymia: item selec- tion, factor structure, reliability and concur- rent validity. Psychother Psychosom 2006; 75: 25-39.
  42. McCallum M, Piper WE, Ogrodniczuk JS, Joyce AS: Relationships among psychologi- cal mindedness, alexithymia and outcome in four forms of short-term psychotherapy. Psychol Psychother 2003; 76: 133-144.
  43. Ogrodniczuk JS, Piper WE, Joyce AS: Alexi- thymia as a predictor of residual symptoms in depressed patients who respond to short- term psychotherapy. Am J Psychother 2004; 58: 150-161.
  44. Spitzer C, Siebel-Jurges U, Barnow S, Grabe HJ, Freyberger HJ: Alexithymia and inter- personal problems. Psychother Psychosom 2005; 74: 240-246.
  45. Simson U, Martin K, Schafer R, Franz M, Janssen P: Veränderung der Wahrnehmung von Emotionen im Verlauf stationärer psy- chotherapeutischer Behandlung. Psychother Psychosom Med Psychol 2006; 56: 376-382.
  46. Grabe HJ, Frommer J, Ankerhold A, Ulrich C, Groger R, Franke GH, Barnow S, Frey- berger HJ, Spitzer C: Alexithymia and out- come in psychotherapy. Psychother Psycho- som 2008; 77: 189-194.
  47. Leweke F, Bausch S, Leichsenring F, Walter B, Stingl M: Alexithymia as a predictor of outcome of psychodynamically oriented in- patient treatment. Psychother Res 2009; 13: 323-331.
  48. Rosenblum A, Foote J, Cleland C, Magura S, Mahmood D, Kosanke N: Moderators of ef- fects of motivational enhancements to cog- nitive behavioral therapy. Am J Drug Alco- hol Abuse 2005; 31: 35-58.
  49. Spek V, Nyklicek I, Cuijpers P, Pop V: Alexi- thymia and cognitive behaviour therapy out- come for subthreshold depression. Acta Psy- chiatr Scand 2008; 118: 164-167.
  50. Grabe HJ, Löbel S, Dittrich D, Bagby RM, Taylor GJ, Quilty LC, Spitzer C, Barnow S, Mathier F, Jenewein J, Freyberger HJ, Rufer M: The German version of the Toronto Structured Interview for Alexithymia: factor stucture, reliability, and concurrent validity in a psychiatric patient sample. Compr Psy- chiatry 2009; 50: 424-430.

Cited by

Sorted by citations

Authors
Rufer, M., Albrecht, R., Zaum, J., Schnyder, U., Mueller-Pfeiffer, C., Hand, I., & Schmidt, O.
Affiliations
  • University Hospital Zurich (CH)
  • Universität Hamburg (DE)
ORCID
Venue
Psychopathology
Publisher
S. Karger AG
Published
2010
Volume
43
Issue
3
Pages
170-179
ISSN
  • 0254-4962 (ISSN-L)
  • 1423-033X
DOI
10.1159/000288639
OpenAlex
W1982787804
Cited by
78
References
8
Citations by year
2026: 3 · 2025: 1 · 2024: 6 · 2023: 3 · 2022: 3 · 2021: 2 · 2020: 8 · 2019: 8 · 2018: 6 · 2017: 3 · 2016: 3 · 2015: 9 · 2014: 8 · 2013: 6 · 2012: 5
FWCI
3.28
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychopathology (publishedVersion)
  • PubMed (publishedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
  • Zurich Open Repository and Archive (University of Zurich)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
alexithymia, panic disorder, group cognitive behavioral therapy, treatment outcomes, Toronto Alexithymia Scale, difficulty identifying feelings, difficulty describing feelings, externally oriented thinking, psychotherapy response, antidepressants
MeSH terms
Adult, Affective Symptoms, Analysis of Variance, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Psychotherapy, Brief, Psychotherapy, Group, Severity of Illness Index, Cognitive Behavioral Therapy, Panic Disorder, Treatment Outcome

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review