From mute emotions to symbolic representation : alexithymia and mentalisation

INTRODUCTION: In this exploratory study our aims are to verify if patients improve their levels of depression after Short term Psychotherapy, check if the Alexithymia level correlates with depression scoring at the end of psychotherapy and verify if there is any correlation between Alexithymia (TAS) and Reflective Functioning (RF). METHODS: The sample was made up of 24 patients, all of whom needed to satisfy the following inclusion criteria: age between 18 and 60, diagnosis of Recurrent Major Depression without maniacal episodes and Q.I major of 70.The exclusion criteria include the presence of severe organic illnesses, cerebral trauma, and Q.I. superior or equal to 70. All the patients were diagnosed after being given a SCID1 for the DSM-IV TR diagnosis. The level of clinical severity was evaluated through the assumption of Hamilton for Depression (HAM-D) at the beginning and at the end of psychotherapy. The Alexithymia was measured by the Toronto Alexithymia Scale-20 (TAS-20). The reflective functioning was evaluated using the method by Fonagy, Target, H Steel and M Steel. We followed up the TAS-20 and HAM-D scores at the patients’ recruitment (T0), and at the end of short psychotherapy (T1). We then measured the clinical outcome, and put this in correlation with social-demographic and clinical variables. RESULTS: Depression decreases with a very good statistical significance from the beginning to the end of psychotherapy (depression mean was 33 at T0 and at T1 was reached 18 (p <0.001)). Moreover the TAS-20 scores decrease with good statistical significance from the beginning to the end of psychotherapy. The Depression scores do not correlate both TAS-20 scores as RF scores. This excludes that depression could be influence the alexithymia value, as presented in scientific literature. Meanwhile the levels of alexithymia was correlated with mentalisation: when we have high alexithymia, this is correlated with low mentalisation and vice-versa (P= .0001). CONCLUSIONS: Our experimental hypothesis show that a severe alexhytimic patient correlate with a low mentalization. Alexhytimia decrease with this specific kind of intervention while increase mentalization. The TAS scores were reduced, and depression was not interfering with these data. The psychotherapy works on the mental process and reduces significantly the depression value