2 The body as a (muffled) sound box for emotion 61 sensation and action) to a conceptual representational level (a world of feelings and thoughts) where they can be used as signals of information, thought about, and sometimes communicated to others (p. 252).” For patients at the lowest level of emotional awareness, this implies they first need to learn to become aware of changes in the heart rate, breathing, muscle tone, posture, use of voice, small movements, and so on. Next, the therapist needs to help patients to interpret and integrate these outcomes of this ‘training in interoception’ in the context of encountered social events and help them to describe these experiences in terms of emotions. Overall, a more structured, skill-based approach has proven to be the most effective in treating alexithymia and improving emotional awareness [114, 124]. This is especially true when the therapist provides explicit help in describing the patient’s experiences early on in therapy. This requires the therapist to be wary of stepping into the trap of telling the patient what he is experiencing, but to instead stay one pace behind the patient, helping him to discover how his perceived physical sensations could be signs of one or more emotions and aid him in articulating any relevant and plausible explanations. In the iterative process that follows, the goal is not for the patient to simply learn how to ‘label’ physical sensations in a new way. Instead, the goal is to gradually raise the patient’s levels of emotional awareness by deliberately combining and integrating experiences from different modalities and perspectives and, step-by-step with the help of the therapist, discover different levels of emotional awareness whenever possible. Ultimately, the aim is for the patient to be able to experience new ways of being in relationship – with himself and others [8, 125, 126]. To date, there have been few publications about the development of treatment and/or training programs aimed at increasing emotional awareness. Most of them report preliminary or early versions of such programs, most often developed for select target groups. For example, Farnam et al. [127] developed emotional awareness training for people with irritable bowel syndrome, in which participants received psychoeducation in two 30-minute sessions and practiced recognizing eight basic emotions, through the use of the making of schematically depicted faces, role play, (spoken) examples and a conversation with a psychiatrist. They were also asked to keep a diary of their emotional experiences. Edwards, Shivaji, and Wupperman [128], in turn, developed the Emotion Mapping Activity (EMA), a short mindfulnessbased exercise in which patients with alexithymia learned to recognize, pinpoint, and link their bodily sensations to emotions through a computer program. Although it was an exploratory study, its results were encouraging. A third example is Farrell and Shaw's Emotional Awareness Training, specifically developed for patients with
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