Some studies have shown that alexithymic patients respond poorly to pharmacotherapy and that alexithymia may have a negative impact on the naturalistic course of psychiatric illnesses. The view that alexithymic patients are also less responsive to psychotherapy is often described in the literature, but few empirical studies have examined this issue, with inconsistent results.

We conducted two prospective studies (pre/post/follow-up) with patients with panic disorder and obsessive-compulsive disorder, to evaluate alexithymia as a potential predictor of the outcome of cognitive-behavioral therapy (CBT) including exposure response management. A further aim was to examine the absolute and relative stability of alexithymia.

Regression analyses revealed that alexithymia, as measured with the 20-item Toronto Alexithymia Scale, was related neither to the post-treatment nor to the follow-up outcome. The repeated measures ANOVA showed a significant decrease of alexithymia over time, even after controlling for depression. The high test-retest correlations of alexithymia total and factor scores indicated relative stability of this construct, suggesting that it is a stable personality trait rather than a state-dependent phenomenon in these patients.

The results are encouraging for cognitive-behavior therapists working with alexithymic patients with panic disorder and obsessive-compulsive disorder, since the CBT outcome of these patients does not appear to be negatively affected by alexithymia. Furthermore, some alexithymic characteristics may decrease during CBT, even when the therapy program is not specifically directed to alexithymia. Future controlled studies should examine whether these improvements of alexithymia are due to psychotherapeutic interventions, in particular exposure therapy.