1
|
Taxer B, de Castro-Carletti EM, von Piekartz H, Leis S, Christova M, Armijo-Olivo S. Facial recognition, laterality judgement, alexithymia and resulting central nervous system adaptations in chronic primary headache and facial pain-A systematic review and meta-analysis. J Oral Rehabil 2024. [PMID: 38803203 DOI: 10.1111/joor.13742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/01/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Patients with chronic headaches and chronic oro-facial pain commonly present psychosocial issues that can affect social interactions. A possible reason could be that patients with these disorders might present impairments in facial recognition, laterality judgement and also alexithymia. However, a systematic review summarizing the effects of facial emotion recognition, laterality judgement and alexithymia in individuals with headaches and oro-facial pain is still not available. AIM The main objective of this systematic review (SR) and meta-analysis (MA) was to compile and synthesize the evidence on the occurrence of alexithymia, deficits in laterality or left-right (LR) recognition and/or facial emotion recognition (FER) in patients with chronic headache and facial pain. METHODS Electronic searches were conducted in five databases (up to September 2023) and a manual search to identify relevant studies. The outcomes of interest were alexithymia scores, speed and accuracy in LR and/or FER, or any other quantitative data assessing body image distortions. The screening process, data extraction, risk of bias and data analysis were performed by two independent assessors following standards for systematic reviews. RESULTS From 1395 manuscripts found, only 34 studies met the criteria. The overall quality/certainty of the evidence was very low. Although the results should be interpreted carefully, individuals with chronic headaches showed significantly higher levels of alexithymia when compared to healthy individuals. No conclusive results were found for the other variables of interest. CONCLUSION Although the overall evidence from this review is very low, people with chronic primary headaches and oro-facial pain could be regularly screened for alexithymia to guarantee appropriate management.
Collapse
Affiliation(s)
- Bernhard Taxer
- FH JOANNEUM University of Applied Sciences Graz, Graz, Austria
- Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Harry von Piekartz
- Faculty of Business and Social Sciences, University of Applied Sciences Osnabrück, Osnabrück, Germany
| | - Stefan Leis
- Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Monica Christova
- FH JOANNEUM University of Applied Sciences Graz, Graz, Austria
- Department of Physiology, Medical University of Graz, Graz, Austria
| | - Susan Armijo-Olivo
- Faculty of Business and Social Sciences, University of Applied Sciences Osnabrück, Osnabrück, Germany
- Faculty of Rehabilitation Medicine, Department of Physical Therapy and Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
2
|
Westbomke S, Schag K, Derntl B, Zipfel S, Stengel A. The impact of emotional stimuli on response inhibition in an inpatient and day-hospital patient psychosomatic cohort. Front Psychiatry 2023; 14:1176721. [PMID: 37457765 PMCID: PMC10347415 DOI: 10.3389/fpsyt.2023.1176721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/08/2023] [Indexed: 07/18/2023] Open
Abstract
Objectives To correctly recognize and respond to your counterpart's emotion is essential for a successful get-together. To ensure this, emotional processes and inhibitory control are linked and interact with each other. However, this interaction can be altered in several mental disorders. In a group of psychosomatic patients, we investigated possible differences in the response inhibition between neutral and emotional stimuli and whether a psychosomatic inpatient and day-hospital patient treatment influences response inhibition profiles. Methods One hundred and one patients, diagnosed with different psychiatric diagnoses (77 women, 41.43 ± 13.13 years), completed an emotional stop-signal task (ESST) and an impulsive behavior scale upon admission in an inpatient and day-hospital patient treatment on a psychosomatic ward (T0) and at discharge (T1). Patients with depressive disorders completed the test again after 1 year (follow-up measurement T2, n = 22). Emotional stimuli were angry and neutral faces. Stop-signal reaction time (SSRT) and stop-signal delay (SSD) were calculated as the main behavioral parameters. Results We found a significantly higher SSRT for neutral than angry faces at both admission (8.538 ms, p < 0.001) and discharge (11.142 ms, p < 0.001), with a matching higher SSD for angry than neutral faces at both timepoints (T0: 8.360 ms, p < 0.001, T1: (6.950 ms, p < 0.001). The SSRT for angry faces significantly decreased after treatment (-8.485 ms, p = 0.0110). For neutral faces, the decrease failed to reach significance (-5.881 ms, p = 0.250). A significant decrease in SSRT for neutral faces in patients with depressive disorders was found 1 year after discharge compared with admission (-19.040 ms, p = 0.0380). Conclusion Our data demonstrate a decreased response inhibition for neutral compared with emotional stimuli and an improved response inhibition for angry faces after discharge in a psychosomatic inpatient and day-hospital patient cohort. Additionally, patients with depressive disorders displayed a significantly better response inhibition for neutral faces 1 year after discharge compared with the baseline measurement. With this study, we provide more evidence for altered emotional response inhibition in different mental disorders and a hint that psychosomatic inpatient and day-hospital patient treatment may help to normalize it, even if the effects remained small and it needs further research to prove causality.
Collapse
Affiliation(s)
- Sina Westbomke
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
| | - Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University Hospital, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
- Clinic for Psychosomatic Medicine, Charité Center for Internal Medicine and Dermatology, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charite - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin, Germany
| |
Collapse
|
3
|
Okur Güney ZE, Sattel H, Witthöft M, Henningsen P. Emotion regulation in patients with somatic symptom and related disorders: A systematic review. PLoS One 2019; 14:e0217277. [PMID: 31173599 PMCID: PMC6555516 DOI: 10.1371/journal.pone.0217277] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/08/2019] [Indexed: 12/28/2022] Open
Abstract
Background Somatic symptoms and related disorders (SSD) are prevalent phenomena in the health-care system. Disturbances in emotion regulation (ER) are commonly observed in patients suffering from SSD. Objectives This review aimed to examine ER processes that characterize SSD by a systematic analysis of the available empirical studies. Data sources PsycINFO and PubMed databases for the articles published between January 1985 and June 2018. Search terms “emotion/al regulation” or “affect regulation” and various forms of SSD. Study eligibility criteria Empirical studies that a) assigned adolescent or adult patients suffering from SSD based on a clinical diagnosis, and b) examined the relationship between ER and SSD, were included. Study synthesis methods A tabular summary of the articles was generated according to study characteristics, study quality, variables, and findings. The findings were organized based on ER variables used in the articles and diagnoses of SSD, which were then re-organized under the main constituents of ER (attention, body, and knowledge). Results The findings of the 64 articles largely supported the association between SSD and disturbances in ER, which are usually shared by different diagnoses of SSD. The results indicate that patients show a reduced engagement with cognitive content of emotions. On the other hand, bodily constituents of ER seem to depict an over-reactive pattern. Similarly, the patients tend to encounter difficulties in flexibly disengaging their (spontaneous) attention from emotional material. Limitations There is a scarcity of longitudinal designs, randomized controlled trials, experiments, and diary studies suited to investigate the short- and long-term causal relationship between ER and SSD. Symptoms of SSD and measures to assess emotion regulation are heterogeneous. Conclusions and implications Assessment of ER processes is potentially useful to understand SSD and for treatment planning. Furthermore, a concurrent investigation of the dynamic interaction of the ER modalities promises insights for better understanding of the role of ER in development, course, and maintenance of SSD.
Collapse
Affiliation(s)
- Zeynep Emine Okur Güney
- Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy Technical University of Munich, Munich, Germany
- Johannes Gutenberg University of Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychology, Mainz, Germany
- * E-mail:
| | - Heribert Sattel
- Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy Technical University of Munich, Munich, Germany
| | - Michael Witthöft
- Johannes Gutenberg University of Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychology, Mainz, Germany
| | - Peter Henningsen
- Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy Technical University of Munich, Munich, Germany
| |
Collapse
|
4
|
Suslow T, Kugel H, Rufer M, Redlich R, Dohm K, Grotegerd D, Zaremba D, Dannlowski U. Alexithymia is associated with attenuated automatic brain response to facial emotion in clinical depression. Prog Neuropsychopharmacol Biol Psychiatry 2016; 65:194-200. [PMID: 26482526 DOI: 10.1016/j.pnpbp.2015.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/23/2015] [Accepted: 10/15/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Alexithymia is a clinically relevant personality trait related to difficulties in recognizing and describing emotions. Previous studies examining the neural correlates of alexithymia have shown mainly decreased response of several brain areas during emotion processing in healthy samples and patients suffering from autism or post-traumatic stress disorder. In the present study, we examined the effect of alexithymia on automatic brain reactivity to negative and positive facial expressions in clinical depression. METHODS Brain activation in response to sad, happy, neutral, and no facial expression (presented for 33 ms and masked by neutral faces) was measured by functional magnetic resonance imaging at 3 T in 26 alexithymic and 26 non-alexithymic patients with major depression. RESULTS Alexithymic patients manifested less activation in response to masked sad and happy (compared to neutral) faces in right frontal regions and right caudate nuclei than non-alexithymic patients. CONCLUSIONS Our neuroimaging study provides evidence that the personality trait alexithymia has a modulating effect on automatic emotion processing in clinical depression. Our findings support the idea that alexithymia could be associated with functional deficits of the right hemisphere. Future research on the neural substrates of emotion processing in depression should assess and control alexithymia in their analyses.
Collapse
Affiliation(s)
- Thomas Suslow
- Department of Psychosomatic Medicine, University of Leipzig, Leipzig, Germany.
| | - Harald Kugel
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - Michael Rufer
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ronny Redlich
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Katharina Dohm
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Dominik Grotegerd
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Dario Zaremba
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Udo Dannlowski
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany; Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| |
Collapse
|
5
|
Okur Güney Z, Sattel H, Cardone D, Merla A. Assessing embodied interpersonal emotion regulation in somatic symptom disorders: a case study. Front Psychol 2015; 6:68. [PMID: 25713544 PMCID: PMC4322612 DOI: 10.3389/fpsyg.2015.00068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 01/13/2015] [Indexed: 12/28/2022] Open
Abstract
The aim of the present study was to examine the intra- and interpersonal emotion regulation of patients with somatic symptom disorders (SSDs) during interactions with significant others (i.e., romantic partners). We presented two case couples for analysis. The first couple consisted of a patient with SSD and his healthy partner, whereas the second couple consisted of two healthy partners. The couples underwent an interpersonal experiment that involved baseline, anger and relaxation tasks. During each task, partners' cutaneous facial temperature, heart rate and skin conductance levels were measured simultaneously. Participants' trait-emotion regulation, state-affect reports for self and other, and attachment styles were also examined. The experimental phases were successful in creating variations in physiological processes and affective experience. As expected, emotion regulation difficulties predicted higher increase in the course of temperature at each phase. Besides, the patient showed restricted awareness and reflection to emotions despite his higher autonomic activity compared to healthy controls. Both partners of the first couple revealed limited ability in understanding the other's emotions, whereas the second couple performed relatively better in that domain. The temperature variations between the patient and his partner were significantly correlated while the correlations of temperature changes between the second couple were negligible except anger task. The study supported the merits of an embodied interpersonal approach in clinical studies. The tentative results of the cases were discussed in the light of findings in emotion regulation and attachment research.
Collapse
Affiliation(s)
- Zeynep Okur Güney
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich Germany ; Department of Psychology, University of Kassel, Kassel Germany
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich Germany
| | - Daniela Cardone
- Institute of Advanced Biomedical Technologies, G. d'Annunzio University Foundation, Chieti Italy ; Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University, Chieti-Pescara Italy
| | - Arcangelo Merla
- Institute of Advanced Biomedical Technologies, G. d'Annunzio University Foundation, Chieti Italy ; Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University, Chieti-Pescara Italy
| |
Collapse
|
6
|
Yürümez E, Akça ÖF, Uğur Ç, Uslu RI, Kılıç BG. Mothers' alexithymia, depression and anxiety levels and their association with the quality of mother-infant relationship: a preliminary study. Int J Psychiatry Clin Pract 2014; 18:190-6. [PMID: 24994481 DOI: 10.3109/13651501.2014.940055] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the relationship between mothers and their developmentally normal infants in terms of maternal alexithymia, depression and anxiety, and marital satisfaction. METHODS Fifty children between 18 and 48 months of age, and their mothers, were referred consecutively to the Infant Mental Health Unit of Ankara University School of Medicine, Department of Child and Adolescent Psychiatry. The sociodemographic features of the families and the depressive symptoms, anxiety, marital satisfaction and alexithymia levels of the mothers were assessed. The relationships between children in normal developmental stages and their mothers were evaluated and rated using a structured clinical procedure. RESULTS There was a negative correlation between the mothers' alexithymia scores and the quality of the mother-infant relationship (p < 0.05). Mothers with high alexithymia showed higher depression and lower relationship qualities than mothers with low alexithymia, according to the correlation analysis. When depression and anxiety were controlled, high alexithymia levels were predictive of a low, impaired mother-infant relationship. CONCLUSION Since alexithymia is a trait-like variable which has a negative correlation with impairment in a mother-infant relationship, it must be investigated in the assessment of mothers' interactions with their babies.
Collapse
Affiliation(s)
- Esra Yürümez
- Department of Child and Adolescent Psychiatry, Ufuk University Medical School , Ankara , Turkey
| | | | | | | | | |
Collapse
|
7
|
Ridout N, Wallis DJ, Autwal Y, Sellis J. The influence of emotional intensity on facial emotion recognition in disordered eating. Appetite 2012; 59:181-6. [PMID: 22542716 DOI: 10.1016/j.appet.2012.04.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 04/16/2012] [Accepted: 04/19/2012] [Indexed: 01/23/2023]
Abstract
Significant facial emotion recognition (FER) deficits have been observed in participants exhibiting high levels of eating psychopathology. The current study aimed to determine if the pattern of FER deficits is influenced by intensity of facial emotion and to establish if eating psychopathology is associated with a specific pattern of emotion recognition errors that is independent of other psychopathological or personality factors. Eighty females, 40 high and 40 low scorers on the Eating Disorders Inventory (EDI) were presented with a series of faces, each featuring one of five emotional expressions at one of four intensities, and were asked to identify the emotion portrayed. Results revealed that, in comparison to Low EDI scorers, high scorers correctly recognised significantly fewer expressions, particularly of fear and anger. There was also a trend for this deficit to be more evident for subtle displays of emotion (50% intensity). Deficits in anger recognition were related specifically to scores on the body dissatisfaction subscale of the EDI. Error analyses revealed that, in comparison to Low EDI scorers, high scorers made significantly more and fear-as-anger errors. Also, a tendency to label anger expressions as sadness was related to body dissatisfaction. Current findings confirm FER deficits in subclinical eating psychopathology and extend these findings to subtle expressions of emotion. Furthermore, this is the first study to establish that these deficits are related to a specific pattern of recognition errors. Impaired FER could disrupt normal social functioning and might represent a risk factor for the development of more severe psychopathology.
Collapse
Affiliation(s)
- Nathan Ridout
- Cognitive & Affective Neurosciences, School of Life & Health Sciences, Aston University, Birmingham B4 7ET, UK.
| | | | | | | |
Collapse
|
8
|
Maurage P, Grynberg D, Noël X, Joassin F, Hanak C, Verbanck P, Luminet O, de Timary P, Campanella S, Philippot P. The "Reading the Mind in the Eyes" test as a new way to explore complex emotions decoding in alcohol dependence. Psychiatry Res 2011; 190:375-8. [PMID: 21742383 DOI: 10.1016/j.psychres.2011.06.015] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 06/17/2011] [Accepted: 06/18/2011] [Indexed: 10/18/2022]
Abstract
It has been repeatedly shown that alcohol dependence is associated with emotional impairments, particularly for emotional facial expression decoding. Nevertheless, most earlier studies focused on basic emotions and did not explore more subtle affective states. In order to obtain a more accurate evaluation, and in view of earlier results showing impaired performance for this task among high-risk children of alcohol-dependent participants, the "Reading the Mind in the Eyes" test was used here to explore emotional recognition in alcohol dependence. We showed that the deficit described earlier for basic negative emotions is (1) generalizable to complex and positive emotions; and (2) specific for emotional features. This strengthens the proposition of a general face recognition impairment in alcohol dependence.
Collapse
Affiliation(s)
- Pierre Maurage
- Institute of Psychology, Catholic University of Louvain, Louvain-la-Neuve, Belgium.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Nicolò G, Semerari A, Lysaker PH, Dimaggio G, Conti L, D'Angerio S, Procacci M, Popolo R, Carcione A. Alexithymia in personality disorders: correlations with symptoms and interpersonal functioning. Psychiatry Res 2011; 190:37-42. [PMID: 20800288 DOI: 10.1016/j.psychres.2010.07.046] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 05/31/2010] [Accepted: 07/29/2010] [Indexed: 11/15/2022]
Abstract
Impairment in the ability to recognize and make sense of emotions has been hypothesized to be present in a sub-sample of people suffering from personality disorder (PD). In particular it is possible that difficulty recognizing and expressing feelings, or alexithymia, is related to many of the symptoms and problems in making sense of social interactions which are hallmarks of PD. In this study we measured levels of alexithymia with the Toronto Alexithymia Scale-20 and explored its correlations with the overall presence of PD and different PD diagnoses, symptoms, and interpersonal difficulties. Results were largely consistent with the hypothesis. Higher levels of alexithymia were related to high levels of global psychopathology and with dysfunctional representation of interpersonal relations. A sub-sample of patients, mostly suffering from avoidant, dependent, passive-aggressive and depressive PD, had alexithymic features and, in particular reported difficulties describing their feelings to others. A patient with cluster B PD featured no alexithymia. Implications of this study for future research and treatment are discussed.
Collapse
Affiliation(s)
- Giuseppe Nicolò
- SPC Training School of Cognitive Therapy, Terzocentro Psicoterapia Cognitiva, Rome, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|