A study of psychological factors in fibromyalgia patients found an association between alexithymia — a self-awareness personality disposition — and coping strategies that coincide with patients’ perceived social support.
The researchers argue for a need to assess and deal with alexithymia as part of a treatment strategy for fibromyalgia patients.
The study, “Coping strategies and perceived social support in fibromyalgia syndrome: Relationship with alexithymia,” was published in the Scandinavian Journal of Psychology.
Alexithymia is defined as a self-awareness problem that makes it difficult for some people to recognize their own emotions and feelings. These individuals have a hard time understanding their own self-experience or the nuances of how others feel. They also tend to pay too much attention to other events.
In the study, researchers used the Toronto Alexithymia Scale, a questionnaire that measures three aspects of alexithymia: difficulty identifying feelings (DIF); difficulty describing feelings (DDF); and externally-oriented thinking (EOT) — the tendency to focus on outside events and not on their inner emotional experience.
A battery of tests assessing coping strategies, perceived social support, alexithymia, psychological distress, and pain intensity was completed by 153 fibromyalgia patients.
High levels of psychological distress (mainly anxiety and depression) and alexithymia were observed in the fibromyalgia patients who participated in the study.
The Coping Orientations to Problems Experienced scale (Brief COPE), a questionnaire that assesses coping techniques in a variety of stressful situations, was used to measure coping strategies.
Fibromyalgia patients scored higher on problem-focused coping, which includes active coping, instrumental support, and planning. They scored lower on two other coping strategies: emotion-focused coping, which includes acceptance, emotional support, humor, positive reframing, and religion; and dysfunctional coping, which involves behavioral disengagement, denial, self-distraction, self-blame, substance use, and venting.
The higher the alexithymia score (total and EOT), the lower the problem-focused coping score, and vice versa.
Likewise, those scoring high on the alexithymia assessment (total, DDF, and EOT) had lower emotion-focused coping scores, and vice versa. Total and DIF scores were also associated with dysfunctional coping.
All the scores (total, DIF, DDF and EOT) coincided with psychological distress scores — mainly anxiety and depression.
The Multidimensional Scale of Perceived Social Support (MSPSS), a self-report measure of social support, showed that lower scores on perceived social support were associated with higher alexithymia scores (total, DIF and DDF).
The researchers noted that each of the three different aspects of the dysfunction had specific effects on coping strategies and social support in the patients studied, making it important to take all three aspects into account when treating patients.
“Psychological interventions should take into account the specific dimensions of alexithymia which appear to be more compromised in each FM [fibromyalgia] patient,” the researchers wrote. The results showed a specific relationship between factors in the emotional dysfunction “and the coping strategies or the perceived social support,” they added.
“A psychological intervention focusing on the specific alexithymic features should thus be considered a key clinical aspect in the treatment of [fibromyalgia], in order to improve both their coping strategies and the levels of social support,” the authors said.