163: Feasibility of an Ethically-Guided Digital EFT Application for Alexithymia (Unlexi)

Topic: Clinical Science
Subtopic:

Background and Aims: Alexithymia is psychological trait characterized by difficulty noticing, naming, and understanding emotions [1] and is associated with chronic pain and psychosomatic conditions [2]. Emotion-Focused Therapy (EFT) improves emotional awareness and alexithymia [3,4], yet no digital EFT exists. We developed Unlexi, an EFT mobile application with structured reflective journaling and emotion detection features. We will first evaluate the feasibility of a safety-oriented and risk-mitigated digital framework prior to implementing EFT. The aim is to assess usability, emotional safety, and user acceptability, and whether individuals with alexithymia can engage with digital emotional awareness tasks.

Methods: Our systematic review found that although CBT-based interventions may reduce alexithymia, it is seldom the primary focus of treatment [5]. To address this gap, we developed Unlexi as a clinician-initiated digital EFT application embedded within ongoing treatment, with session-by-session check-ins to ensure clinical oversight and risk monitoring. Safeguards include eligibility screening to exclude acute states, a user-initiated “Pause” function redirecting to a 5-minute breathing exercise, withdrawal options, and consent-controlled data sharing. Using a design science method, we built and iteratively refined a Figma prototype integrating these safety mechanisms. Privacy was addressed under Nova Scotia’s PHIA with a Privacy Impact Assessment.

Results: The prototype delivers 12 EFT-based modules with brief felt-sense pauses (attention to bodily experienced emotion), plus optional free text or voice input analyzed via natural language processing (NLP) to extract emotional tone, providing non-diagnostic sentiment feedback for reflection. The prototype comprises 129 screens, divided into clinician-facing screening and patient-facing sessions. The prototype was reviewed by the originator of EFT and its clinical fidelity was confirmed. A two-phase feasibility study using think-aloud usability testing is planned, with Phase 1 involving computer science students and Phase 2 involving Toronto Alexithymia Scale (TAS-20)–screened alexithymic end-users, using non-personal fictional scenarios to reduce emotional discomfort[6].

Conclusions: Unlexi operationalizes EFT in a digital format while foregrounding ethical safeguards for users who may find emotion-focused work challenging. Our prior evidence synthesis, prototype development, expert fidelity review, and PHIA-informed privacy planning provide an ethical foundation for feasibility testing. The upcoming study will clarify whether end users can engage safely and comfortably with emotional awareness using Unlexi, thereby informing readiness for subsequent pilot evaluation of clinical effectiveness.

References: 1. Sifneos PE. The prevalence of alexithymic characteristics in psychosomatic patients. Psychother Psychosom. 1973;22:255–262.
2. Leweke F, Bausch S, Leichsenring F, Walter B, Stingl M. Alexithymia as a predictor of outcome of psychodynamically oriented inpatient treatment. Psychother Res. 2009;19:323–331.
3. Greenberg LS. Emotion-focused therapy: The transforming power of affect. Journal of Contemporary Psychotherapy. 2007;37(1):25–31.
4. Greenberg LS. Emotion-Focused Therapy. Washington, DC: American Psychological Association; 2011.
5. Tsubaki K, Shimizu E. Psychological treatments for alexithymia: a systematic review. Behav Sci (Basel). 2024;14:1173.
6. Taher R, Hsu CW, Hampshire C, et al. The safety of digital mental health interventions: systematic review and recommendations. JMIR Ment Health. 2023;10:e47433.

Presenting Author: Kanako Tsubaki
Submitting Author: Kanako Tsubaki

Senior Author: Samina Abidi

IASP 2026 Global Year theme of Neuropathic Pain: No

• Samina Abidi: Dr - Community Health and Epidemiology/ Dalhousie University
• Jaber Rad: Dr. - Computer Science/ Dalhousie University