Talk therapies are some of the most effective psychotherapies. Therapies like dialectical-behavioural therapy, cognitive-behavioural therapy, MANTRa, and cognitive-processing therapy have been shown to lead to huge improvements in mental health symptoms for many young people, from adolescents living with personality disorders to young people with eating disorders or depression.
But talk therapy alone isn’t always the answer. Our psychological well-being is rooted in both our minds and bodies; trauma is stored physically, and we learn through doing and creating as well as listening. Recovery and healing often require experiences, movement, and creativity alongside talking, listening, and introspection.
The importance of alternative therapies may be especially pronounced for young people with high levels of alexithymia – the inability to identify and express emotions with words. Alexithymia is more common among young people with mental health disorders than in the general population, and it can impact the treatment and recovery process. Since many talk therapies are reliant on understanding and expressing emotions verbally, young people with alexithymia may not benefit from these therapies as well as others.
This means that engaging in alternative, adjunct therapies as well as or instead of talk therapy can make a big difference. This might involve creative therapies that promote non-verbal expression of emotions or role-play where coping mechanisms can be developed through action.
This blog offers some information about alexithymia and its impact on treatment outcomes. It also explores some creative therapies that offer an alternative to verbal emotional expression.
What Is Alexithymia?
Young people with alexithymia find it difficult to identify and describe their emotions. They may also find it hard to distinguish emotions from bodily sensations like hunger or tiredness.
Alexithymia is related to both emotional processing and language. People with alexithymia may not recognise emotional expressions on faces as well as other people. They may find it hard to talk about interpersonal relationships or other people’s feelings, and describe their own emotional experiences with simple language without vivid descriptions. They may be less sensitive to the emotional meaning of language and tend towards concretist thinking and avoidance of metaphors.
Alexithymia is connected to the concept of mentalisation. Mentalisation refers to the ability to understand one’s own and others’ mental states. Identifying and describing emotions is one aspect of this.
Alexithymia isn’t a diagnosis, but a dimension that describes processes of thinking, feeling, and relating. It’s dimensional rather than dichotomous, meaning that different people experience it to different levels.
A prevalence study in Canada suggests that over 10% of the population had high levels of alexithymia. Alexithymia was around twice as common among men as women. It’s likely that alexithymia is influenced by the way we are socialised and by social norms around expressing emotions. This means that levels of alexithymia may vary between cultures.
How Is Alexithymia Related to Mental Health?
Research shows that alexithymia is linked to a range of mental health disorders, including depression, eating disorders, and schizophrenia. Difficulties in identifying emotions may make it harder to manage and modulate them, leading to longer-lasting and more intense emotional distress. This may push young people towards maladaptive (harmful) coping mechanisms for the distress they experience.
Likewise, difficulties communicating emotions and distinguishing between one’s own emotions and another person’s can create challenges in relationships with others.
Research suggests that alexithymia is especially associated with depressive disorders.
Studies have linked alexithymia to:
- Eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder
- Depression
- Anxiety
- Stress
- Personality disorders
Alexithymia and Eating Disorders
Eating disorders aren’t only about shape and weight. Disordered eating behaviours are shaped by past experiences and underpinned by underlying traits, such as rigid thinking, emotional dysregulation, and interpersonal difficulties.
Alexithymia is common among young people with eating disorders. It’s an aspect of emotional dysregulation (difficulty in managing emotions) that can lead to ongoing emotional distress without effective coping mechanisms. Without the ability to adequately identify, describe, and address difficult emotions, young people with eating disorders may use disordered eating behaviours as a way to cope with distress. Emotional avoidance may also lead to interpersonal difficulties and social isolation as their eating disorder starts to dominate their life.
As the role of emotional dysregulation in causing and maintaining eating disorders becomes clearer, treatments for eating disorders increasingly emphasise the connection between emotional experiences and ED symptoms, supporting young people to develop alternative, positive coping mechanisms. For example, radically open dialectical behavioural therapy and standard dialectical behavioural therapy both focus on emotional regulation as a core module.
However, these treatments don’t work for everyone: some research suggests that emotion-focused treatments are only effective for about half of young people. While it’s not clear exactly what causes variation in treatment outcomes, alexithymia may play an important role. Young people with high levels of alexithymia may benefit less from emotion-focused talk therapies, which rely on identifying and understanding emotional responses.
Research suggests that among people with eating disorders, binge eating disorder and anorexia nervosa, higher levels of alexithymia are associated with less effective treatment.
How Can Alexithymia Affect the Therapeutic Process?
Most types of talk therapy rely on speaking about emotions, at least at a basic level. They tend to assume that an individual has at least some access to their emotional states. However, for young people with alexithymia, this access can be very limited.
This can cause difficulties in therapeutic relationships. Alexithymia is linked to negative reactions from therapists, particularly in response to a lack of expression of positive emotions during treatment sessions.
Young people with high levels of alexithymia are aware they don’t feel good, but find it hard to describe what they are feeling. This means that they are just as likely to seek therapy as others, but may benefit less from the treatment they receive.
Research suggests that while alexithymia may decrease over the course of therapies such as DBT, many young people still have high levels of alexithymia at the end of treatment. On the other hand, alexithymia is associated with lower therapy effectiveness in psychodynamic and supportive therapy.
This means that it’s important to develop therapies that specifically address alexithymia. Improving young people’s ability to identify and describe emotions may help them to benefit more from treatment and recover from the mental health challenges they face.
Equally, it’s necessary to offer complementary treatment approaches that are more effective for young people with alexithymia. This might include non-verbal treatment approaches that rely on other ways of identifying and communicating experience.
Expressive Arts Therapy and Alexithymia
Expressive arts therapy is a type of therapy that uses creative and theatre-based arts to affect how young people feel and think. It creates opportunities for non-verbal emotional expression, emotional regulation, and stress reduction that bypass a person’s usual cognitive or verbal limitations. Creative therapies can also help motivate young people to engage and stay in treatment.
Expressive arts therapy may involve:
- Painting and drawing
- Drama and performance
- Music
- Cultural visits
Expressive arts therapy can use a variety of tools and techniques to support the recovery process. These include exploring emotions and relationships through role play and psychodrama, drawing and painting to convey emotional states, and expressing feelings through dance.
Roleplay and Psychodrama
Psychodrama techniques aim to create a safe space where young people can explore and experiment with different roles and narratives. In these spaces, young people may develop new coping mechanisms, emotional awareness, and interpersonal connections.
Sessions may involve games, movements, and mirroring exercises that aim to build trust and group cohesion, helping young people to recognise and share emotional states. They may engage in scene creation and enactment, exploring emotions, experiences, and relationships through performing improvised scenes. This can be followed by a group discussion that helps young people to recognise emotional experiences and link them to real-life situations.
A 2025 study explored the impact of drama therapy sessions and expressive arts workshops, integrated into a multidisciplinary treatment plan, among a group of adolescents receiving eating disorder treatment. From the start to the end of the program, the proportion of young people with alexithymia decreased from 73.3% to 26.7%. Most adolescents reported mood improvements and improvements in peer relationships.
Dance Movement Therapy
Dance movement therapy is another type of expressive arts therapy that emphasises active participation, self-expression, imagination, and mind-body connection. It uses movement to focus on self-awareness and explore psychological and physical experiences.
Dance movement therapy aims to support young people in expressing emotions and feelings through bodily movements, including unconscious ideas and those that they are unable to express in words. Therapists use specific tools to interpret and give meaning to body language and movements.
A small study looked into the effectiveness of dance movement therapy on body image and alexithymia among people with eating disorders. It found that those taking part in dance therapy experienced significant improvements in body area satisfaction and appearance evaluation. They also became less preoccupied with their appearance.
However, the therapy didn’t have a significant impact on alexithymia levels.
Experiential and Creative Therapies at The Wave Clinic
At the Wave Clinic, we offer a diverse selection of evidence-based modalities, including talk therapies, mind-body approaches, experiential therapies, and creative therapies. We create individualised treatment plans for each individual, combining different treatment approaches to suit each young person’s needs.
We believe in recovery through experience, supporting young people and families to create new memories, rescript dynamics, and develop new ways of relating to themselves and others.
Some of our treatment modalities include:
- Cognitive and dialectical behavioural therapy
- Cognitive-processing therapy
- Somantic experiencing
- Creative arts therapy
- Interpersonal therapy
- Trauma-informed yoga
- Mindfulness
- MANTRa
- EMDR
Alongside our treatment modalities, our residential programs include enriching experiences where young people can develop life skills, discover new passions, and grow in self-confidence. They might build shelters in the jungle, take part in multiday hikes, grow food in the garden, or go white water rafting.
We also offer family and parenting intensives, separately or as part of our residential programs.
Contact Us
At the Wave Clinic, we make a difference in the lives of young people and families. If you’re interested in finding out more about our programs, get in touch today.
