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Treating Alexithymia and SUD Concurrently

Clinician Center
08.21.2020

Throughout my career, I’ve worked with many patients who struggle to talk about their emotions – not because they don’t want to, but because they’re unable to find the accurate words. Alexithymia, while not a medical diagnosis, is a clinical term for the cluster of traits characterized by a person’s struggle to describe emotions.

In the mental health and addiction field, alexithymia can be a debilitating hurdle in recovery. What do you do when you have a patient suffering from mental health disorders, like substance use disorder (SUD), that can’t explain, or even understand, the emotions that they’re feeling? When the key to treating mental health disorders is understanding the complex emotions that drive harmful behaviors, the inability to express those emotions prevents us, as professionals, from getting to the root of those behaviors.

What is Alexithymia?

There are different degrees of alexithymia that range from mild to moderate to severe. While alexithymia manifests differently in individuals, they may experience:

  • Difficulty identifying types of emotions
  • Difficulty expressing emotions
  • Difficulty recognizing emotions in others
  • Limited understanding of emotional triggers
  • Constricted thinking
  • Detached connections to others

We know that addiction affects the brain. And since there are areas of the brain that are dedicated to the recognition of emotion, the changes in these areas impair the individual’s ability to function behaviorally and therefore, emotion becomes unrecognizable. Alexithymia can be recognized in two domains:

  • Cognitive – deficits in identifying, describing and accurately interpreting emotion; and
  • Affective – difficulty recognizing bodily-felt emotions, maladaptive reactivity to emotional experiences and struggle to imagine another person’s emotion.

Treating Alexithymia Concurrently with SUD

There is something unmanageable or uncontrollable about emotion that fuels substance abuse. During treatment for SUD, a major goal of the clinician is to understand how a patient feels and help them find relief. When an individual is unable to identify and describe those feelings, it can be difficult (or even impossible) to establish a helpful understanding and foundation for treatment.

While the goal for treatment doesn’t change because of the barrier of alexithymia, the path to recovery may. The key to overcoming alexithymia is recognizing the underlying role of emotion in SUD, gaining the vocabulary to effectively identify and describe feelings and cultivating a safe pathway to experiencing and reacting to internal sensations. By treating alexithymia and SUD concurrently and as co-existing conditions, we are better able to treat our patients by delivering clarity and insight into the underlying triggers for both.

Expressing Emotions through Creative Arts Therapy

Creative Arts Therapy (CAT) helps accomplish goals of treatment by leveraging creative expression to support patients as they discover, explore and, ultimately, express and evaluate their emotions. When patients don’t have the emotional vocabulary to describe what they are feeling, CAT can open the door and create a safe space for exploring emotions, leading to a better understanding of them.

By engaging all the senses and opening the doors to languages outside of the verbal, CAT modalities can be especially impactful in the treatment of a patient with alexithymia. Arts can be a very vulnerable thing – exposing and frightening – but the creative processes allow space for powerful emotions, permission for feeling and explanation when words can be limiting.

While every patient is different, art therapy is a powerful therapeutic doorway to understanding for patients with alexithymia. By focusing their emotions externally, new perspective, acceptance, and understanding begins taking shape at a safe distance. With support from the therapist, this opening leaves room to process and discover new insights. Patients can also look inward during dance/movement therapy. When someone says they feel “good”, where is it experienced in the body? How might that experience of goodness move physically and creatively? As the feeling of “good” is physically expressed, the therapist offers clarifying questions and reflections, creating new paths to describing emotions in greater detail. The beauty of these processes is that all patients, with or without alexithymia, can benefit and make new self-discoveries.

Creative Arts Therapy at Wellbridge

Following evidence-based practices, we integrate CAT into every patient’s treatment plan, with both structured and organic sessions. If you have a patient that you feel needs more advanced addiction treatment, contact us today.