Improvements in Emotional Awareness and Menatlizing in Different Diagnostic Groups undergoing Multimodal Psychosomatic In-Treatment

Projektleiter: Dr. C Subic-Wrana, Univ.-Prof. Dr. ME Beutel

Improvements in Emotional Awareness and Menatlizing in Different Diagnostic Groups undergoing Multimodal Psychosomatic In-Treatment

With the Levels of Emotional Awareness Scale (LEAS), we could demonstrate that at the onset of psychoanalytically informed multimodal psychotherapeutic in-treatment patients with psychosomatic disturbances present with lower levels of emotional awareness than patients with other psychiatric disorders; at the end of treatment, only the psychosomatically disturbed patients showed significant improvements in emotional awareness . In another study, we found evidence for an association between decreased emotional awareness and decreased ToM-activity in somatizing psychiatric patients, compared to healthy controls. Purpose of the this study is therefore to investigate if psychoanalytically informed multimodal psychotherapeutic intreatment improves mentalizing in general

The LEAS is a performance measure that assesses emotional awareness within a cognitive-developmental framework . In this model somatization corresponds to lower level awareness; in that affective arousal is experienced mainly as bodily sensation or action tendency. This is consistent with Sifneos´ original definition of alexithymia as a deficit in the capacity for symbolic representation of affective arousal, that characterizes psychosomatically disturbed patients.

Although impairments in mentalization have been described by several psychoanalysts ( e. g. McDougall) in their clinical work with patients with psychosomatic symptoms, a possible association between alexithymia and deficits in mentalizing-activity is a new field of interest in empirically oriented psychosomatic research. To our knowledge we have been the first to demonstrate with approved empirical measures - the LEAS and the Animations-Task that asks to refer intentions to the movements of animated shapes in order to identify the story line of the animated film sequences correctly

In the next step of our research we want to explore if psychoanalytically informed mulimodal intreatment improves mentalizing in general in patients with psychosomatic complaints. Since August 2007 the LEAS and the Animations-Task will be given to all inpatients of the Department of Psychosomatic Medicine of University Mainz at onset and end of treatment for 18 months. This allows to collect a sample of 200 patients, that can be divided into 4 diagnostic groups (depression; anxiety disorders, eating disorders and psychosomatic disorders). We hypothesize that the psychosomatic group will score lower in emotional awareness and ToM-activity at intake and will demonstrate more improvement in these measures than the other diagnostic groups. LEAS and Animations-Task will be related to measures of symptom severity. The projected study aims to collect empirical evidence for the established clinical knowledge that modified psychoanalytic treatment is effective in the reduction of psychosomatic symptoms by approaching the structural deficits that are related to psychosomatic symptomatology.

Literatur:

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 (3): 483-9

Laufzeit: 2007-2010

– operationalized as improvement in emotional awareness and in ToM-activity – in psychosomatically disturbed patients.– that somatization in psychiatric patients is related to deficits in emotional awareness and in mentalizing.