Investigating Alexithymia as a Moderator of Outcomes in a Randomized Controlled Trial of an Online Intervention for Co-Occurring Depression and Hazardous Alcohol Use: Enquête sur l'alexithymie en tant que modérateur des résultats dans un essai randomisé contrôlé d'une intervention en ligne pour la dépression concomitante et la consommation dangereuse d'alcool

Christina Schell; Lena C. Quilty; John A. Cunningham

doi:10.1177/07067437241249412

Investigating Alexithymia as a Moderator of Outcomes in a Randomized Controlled Trial of an Online Intervention for Co-Occurring Depression and Hazardous Alcohol Use: Enquête sur l'alexithymie en tant que modérateur des résultats dans un essai randomisé contrôlé d'une intervention en ligne pour la dépression concomitante et la consommation dangereuse d'alcool

Christina Schell, Lena C. Quilty, John A. Cunningham^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

Abstract

Objective

Alexithymia is characterized by difficulty identifying and/or describing emotions, reduced imaginal processes, and externally oriented thinking. High levels of alexithymia may increase the challenge of supporting individuals with co-occurring depression and hazardous alcohol use. This secondary analysis sought to investigate whether or not alexithymia moderated the outcomes of an online intervention for depression and alcohol use.

Method

As part of a randomized controlled trial, 988 participants were randomly assigned to receive an intervention dually focused on depression and alcohol use, or an intervention only focused on depression. The pre-specified mediation hypothesis was that changes in drinking at 3 months follow-up would effect the association between the intervention and change in depression at 6 months. This secondary analysis extends the investigation by adding alexithymia as a moderator.

Results

The current analysis demonstrated that including alexithymia as a moderator resulted in a conditional direct effect. Specifically, there was an intervention effect where participants who received the combined depression and alcohol intervention had larger improvements in their depression scores at 6 months, but this was only when their alexithymia score at baseline was also high (60.5 or higher).

Conclusion

These results suggest that treatment planning and intervention effectiveness could be informed and optimized by taking alexithymia severity into consideration. This is especially merited as alexithymia can contribute to the weaker therapeutic alliance, more distress and dysphoria, shorter periods of abstinence, and more severe depression, compounding the complexity of supporting individuals with comorbid conditions. More research is needed to systematically investigate these possible modifying effects.

Original language	English
Pages (from-to)	65-73
Number of pages	9
Journal	Canadian Journal of Psychiatry
Volume	70
Issue number	1
Early online date	29 Apr 2024
DOIs	https://doi.org/10.1177/07067437241249412
Publication status	Published - 2 Jan 2025

Keywords

alexithymia
brief internet intervention
comorbidity
depression
hazardous alcohol use
moderated mediation analysis

Access to Document

10.1177/07067437241249412

Fingerprint

Dive into the research topics of 'Investigating Alexithymia as a Moderator of Outcomes in a Randomized Controlled Trial of an Online Intervention for Co-Occurring Depression and Hazardous Alcohol Use: Enquête sur l'alexithymie en tant que modérateur des résultats dans un essai randomisé contrôlé d'une intervention en ligne pour la dépression concomitante et la consommation dangereuse d'alcool'. Together they form a unique fingerprint.

Cite this

Schell, C., Quilty, L. C., & Cunningham, J. A. (2025). Investigating Alexithymia as a Moderator of Outcomes in a Randomized Controlled Trial of an Online Intervention for Co-Occurring Depression and Hazardous Alcohol Use: Enquête sur l'alexithymie en tant que modérateur des résultats dans un essai randomisé contrôlé d'une intervention en ligne pour la dépression concomitante et la consommation dangereuse d'alcool. Canadian Journal of Psychiatry, 70(1), 65-73. https://doi.org/10.1177/07067437241249412

Schell, Christina ; Quilty, Lena C. ; Cunningham, John A. / Investigating Alexithymia as a Moderator of Outcomes in a Randomized Controlled Trial of an Online Intervention for Co-Occurring Depression and Hazardous Alcohol Use : Enquête sur l'alexithymie en tant que modérateur des résultats dans un essai randomisé contrôlé d'une intervention en ligne pour la dépression concomitante et la consommation dangereuse d'alcool. In: Canadian Journal of Psychiatry. 2025 ; Vol. 70, No. 1. pp. 65-73.

@article{a9b4b41aafd64b1a9acbf67e46453f20,

title = "Investigating Alexithymia as a Moderator of Outcomes in a Randomized Controlled Trial of an Online Intervention for Co-Occurring Depression and Hazardous Alcohol Use: Enqu{\^e}te sur l'alexithymie en tant que mod{\'e}rateur des r{\'e}sultats dans un essai randomis{\'e} contr{\^o}l{\'e} d'une intervention en ligne pour la d{\'e}pression concomitante et la consommation dangereuse d'alcool",

abstract = "ObjectiveAlexithymia is characterized by difficulty identifying and/or describing emotions, reduced imaginal processes, and externally oriented thinking. High levels of alexithymia may increase the challenge of supporting individuals with co-occurring depression and hazardous alcohol use. This secondary analysis sought to investigate whether or not alexithymia moderated the outcomes of an online intervention for depression and alcohol use.MethodAs part of a randomized controlled trial, 988 participants were randomly assigned to receive an intervention dually focused on depression and alcohol use, or an intervention only focused on depression. The pre-specified mediation hypothesis was that changes in drinking at 3 months follow-up would effect the association between the intervention and change in depression at 6 months. This secondary analysis extends the investigation by adding alexithymia as a moderator.ResultsThe current analysis demonstrated that including alexithymia as a moderator resulted in a conditional direct effect. Specifically, there was an intervention effect where participants who received the combined depression and alcohol intervention had larger improvements in their depression scores at 6 months, but this was only when their alexithymia score at baseline was also high (60.5 or higher).ConclusionThese results suggest that treatment planning and intervention effectiveness could be informed and optimized by taking alexithymia severity into consideration. This is especially merited as alexithymia can contribute to the weaker therapeutic alliance, more distress and dysphoria, shorter periods of abstinence, and more severe depression, compounding the complexity of supporting individuals with comorbid conditions. More research is needed to systematically investigate these possible modifying effects.",

keywords = "alexithymia, brief internet intervention, comorbidity, depression, hazardous alcohol use, moderated mediation analysis",

author = "Christina Schell and Quilty, {Lena C.} and Cunningham, {John A.}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2024.",

year = "2025",

month = jan,

day = "2",

doi = "10.1177/07067437241249412",

language = "English",

volume = "70",

pages = "65--73",

journal = "Canadian Journal of Psychiatry",

issn = "0706-7437",

publisher = "Canadian Psychiatric Association",

number = "1",

}

Schell, C, Quilty, LC & Cunningham, JA 2025, 'Investigating Alexithymia as a Moderator of Outcomes in a Randomized Controlled Trial of an Online Intervention for Co-Occurring Depression and Hazardous Alcohol Use: Enquête sur l'alexithymie en tant que modérateur des résultats dans un essai randomisé contrôlé d'une intervention en ligne pour la dépression concomitante et la consommation dangereuse d'alcool', Canadian Journal of Psychiatry, vol. 70, no. 1, pp. 65-73. https://doi.org/10.1177/07067437241249412

Investigating Alexithymia as a Moderator of Outcomes in a Randomized Controlled Trial of an Online Intervention for Co-Occurring Depression and Hazardous Alcohol Use: Enquête sur l'alexithymie en tant que modérateur des résultats dans un essai randomisé contrôlé d'une intervention en ligne pour la dépression concomitante et la consommation dangereuse d'alcool. / Schell, Christina; Quilty, Lena C.; Cunningham, John A.
In: Canadian Journal of Psychiatry, Vol. 70, No. 1, 02.01.2025, p. 65-73.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Investigating Alexithymia as a Moderator of Outcomes in a Randomized Controlled Trial of an Online Intervention for Co-Occurring Depression and Hazardous Alcohol Use

T2 - Enquête sur l'alexithymie en tant que modérateur des résultats dans un essai randomisé contrôlé d'une intervention en ligne pour la dépression concomitante et la consommation dangereuse d'alcool

AU - Schell, Christina

AU - Quilty, Lena C.

AU - Cunningham, John A.

N1 - Publisher Copyright: © The Author(s) 2024.

PY - 2025/1/2

Y1 - 2025/1/2

N2 - ObjectiveAlexithymia is characterized by difficulty identifying and/or describing emotions, reduced imaginal processes, and externally oriented thinking. High levels of alexithymia may increase the challenge of supporting individuals with co-occurring depression and hazardous alcohol use. This secondary analysis sought to investigate whether or not alexithymia moderated the outcomes of an online intervention for depression and alcohol use.MethodAs part of a randomized controlled trial, 988 participants were randomly assigned to receive an intervention dually focused on depression and alcohol use, or an intervention only focused on depression. The pre-specified mediation hypothesis was that changes in drinking at 3 months follow-up would effect the association between the intervention and change in depression at 6 months. This secondary analysis extends the investigation by adding alexithymia as a moderator.ResultsThe current analysis demonstrated that including alexithymia as a moderator resulted in a conditional direct effect. Specifically, there was an intervention effect where participants who received the combined depression and alcohol intervention had larger improvements in their depression scores at 6 months, but this was only when their alexithymia score at baseline was also high (60.5 or higher).ConclusionThese results suggest that treatment planning and intervention effectiveness could be informed and optimized by taking alexithymia severity into consideration. This is especially merited as alexithymia can contribute to the weaker therapeutic alliance, more distress and dysphoria, shorter periods of abstinence, and more severe depression, compounding the complexity of supporting individuals with comorbid conditions. More research is needed to systematically investigate these possible modifying effects.

AB - ObjectiveAlexithymia is characterized by difficulty identifying and/or describing emotions, reduced imaginal processes, and externally oriented thinking. High levels of alexithymia may increase the challenge of supporting individuals with co-occurring depression and hazardous alcohol use. This secondary analysis sought to investigate whether or not alexithymia moderated the outcomes of an online intervention for depression and alcohol use.MethodAs part of a randomized controlled trial, 988 participants were randomly assigned to receive an intervention dually focused on depression and alcohol use, or an intervention only focused on depression. The pre-specified mediation hypothesis was that changes in drinking at 3 months follow-up would effect the association between the intervention and change in depression at 6 months. This secondary analysis extends the investigation by adding alexithymia as a moderator.ResultsThe current analysis demonstrated that including alexithymia as a moderator resulted in a conditional direct effect. Specifically, there was an intervention effect where participants who received the combined depression and alcohol intervention had larger improvements in their depression scores at 6 months, but this was only when their alexithymia score at baseline was also high (60.5 or higher).ConclusionThese results suggest that treatment planning and intervention effectiveness could be informed and optimized by taking alexithymia severity into consideration. This is especially merited as alexithymia can contribute to the weaker therapeutic alliance, more distress and dysphoria, shorter periods of abstinence, and more severe depression, compounding the complexity of supporting individuals with comorbid conditions. More research is needed to systematically investigate these possible modifying effects.

KW - alexithymia

KW - brief internet intervention

KW - comorbidity

KW - depression

KW - hazardous alcohol use

KW - moderated mediation analysis

UR - http://www.scopus.com/inward/record.url?scp=85191690830&partnerID=8YFLogxK

U2 - 10.1177/07067437241249412

DO - 10.1177/07067437241249412

M3 - Article

C2 - 38682315

AN - SCOPUS:85191690830

SN - 0706-7437

VL - 70

SP - 65

EP - 73

JO - Canadian Journal of Psychiatry

JF - Canadian Journal of Psychiatry

IS - 1

ER -

Schell C, Quilty LC, Cunningham JA. Investigating Alexithymia as a Moderator of Outcomes in a Randomized Controlled Trial of an Online Intervention for Co-Occurring Depression and Hazardous Alcohol Use: Enquête sur l'alexithymie en tant que modérateur des résultats dans un essai randomisé contrôlé d'une intervention en ligne pour la dépression concomitante et la consommation dangereuse d'alcool. Canadian Journal of Psychiatry. 2025 Jan 2;70(1):65-73. Epub 2024 Apr 29. doi: 10.1177/07067437241249412

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

Cite this