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Kurihara K, Enoki H, Shinzato H, Takaesu Y, Kondo T. Cluster analysis of patients with alcohol use disorder featuring alexithymia, depression, and diverse drinking behavior. Neuropsychopharmacol Rep 2024. [PMID: 38773706 DOI: 10.1002/npr2.12449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/18/2024] [Accepted: 05/05/2024] [Indexed: 05/24/2024] Open
Abstract
AIM This study aimed to identify subgroups of alcohol use disorder (AUD) based on a multidimensional combination of alexithymia, depression, and diverse drinking behavior. METHOD We recruited 176 patients with AUD, which were initially divided into non-alexithymic (n = 130) and alexithymic (n = 46) groups using a cutoff score of 61 on the Toronto Alexithymia Scale (TAS-20). Subsequently, the profiles of the two groups were compared. Thereafter, a two-stage cluster analysis using hierarchical and K-means methods was performed with the Z-scores from the TAS-20, the Quick Inventory of Depressive Symptomatology Self-Report Japanese Version, the 12-item questionnaire for quantitative assessment of depressive mixed state, and the 20-item questionnaire for drinking behavior pattern. RESULTS In the first analysis, Alexithymic patients with AUD showed greater depressive symptoms and more pathological drinking behavior patterns than those without alexithymia. Cluster analysis featuring alexithymia, depression, and drinking behavior identified three subtypes: Cluster 1 (core AUD type) manifesting pathological drinking behavior highlighting automaticity; Cluster 2 (late-onset type) showing relatively late-onset alcohol use and fewer depressive symptoms or pathological drinking behavior; and Cluster 3 (alexithymic type) characterized by alexithymia, depression, and pathological drinking behavior featuring greater coping with negative affect. CONCLUSION The multidimensional model with alexithymia, depression, and diverse drinking behavior provided possible practical classification of AUD. The alexithymic subtype may require more caution, and additional support for negative affect may be necessary due to accompanying mood problems and various maladaptive drinking behaviors.
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Affiliation(s)
- Kazuhiro Kurihara
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hiroyuki Enoki
- Major in Clinical Psychology, Graduate School of Psychological Sciences, Hiroshima International University, Hiroshima, Japan
| | - Hotaka Shinzato
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tsuyoshi Kondo
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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2
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Nixon SJ, Garcia CC, Lewis B. Age as a potential modulator of alcohol-related deficits. Alcohol 2023; 107:12-18. [PMID: 35940507 DOI: 10.1016/j.alcohol.2022.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/15/2022] [Accepted: 07/17/2022] [Indexed: 12/16/2022]
Abstract
Although their individual significance is well-documented, the interaction effects of age, sex, and alcohol use disorder (AUD) have undergone little systematic investigation. Here, we extend prior work interrogating sex and group (AUD vs. community comparison [CC]) by probing the main and interaction effects of age on emotion processes as well as two conventional neuropsychological tests. Main effects for age and group were anticipated; however, interaction effects comprise our primary focus. While sex differences in AUD prevalence are commonly reported, sex differences within AUD samples are inconsistently found. Therefore, we pose our inquiry regarding sex as exploratory. In this study, 54 CC (n = 30 women) and 55 AUD (n = 14 women) subjects completed a battery that included an emotional face discrimination task, the Trail-Making Test-B (TMT-B), and the Digit Symbol Substitution Test (DSST). The initial/full models included the main and interaction effects of age (as a continuous variable; 25-59 years of age), sex, and group (AUD, CC). In analysis of the emotional face discrimination task, performance on a non-affective face discrimination task was entered as a covariate. Analysis of emotion identification revealed group and age main (p = .02; d = .53 & .003; d = .50, respectively) and interaction effects (p = .05; d = .41). The latter suggested that age and emotion processing performance were positively correlated in the AUD group, but unrelated in the CC group. Notably, neither sex, main, nor interaction effects achieved significance. Using the full model, analysis of the TMT-B and DSST failed to show sex effects or reveal expected performance decrement in the AUD group. To clarify the latter, simple models including only group as well as correlations between age and performance by group for each task were conducted. These analyses demonstrated the expected AUD-related deficits and suggested differential relationships between age and neurocognitive performance as a function of both group and task. Outcomes across tasks emphasize the need to reframe aging effects, particularly in the context of AUD.
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Affiliation(s)
- Sara Jo Nixon
- University of Florida, Department of Psychiatry, Gainesville, FL, United States; University of Florida, Department of Psychology, Gainesville, FL, United States; University of Florida, Department of Neuroscience, Gainesville, FL, United States; University of Florida Center for Addiction Research & Education, Gainesville, FL, United States.
| | - Christian C Garcia
- University of Florida, Department of Psychiatry, Gainesville, FL, United States; University of Florida, Department of Psychology, Gainesville, FL, United States; University of Florida Center for Addiction Research & Education, Gainesville, FL, United States
| | - Ben Lewis
- University of Florida, Department of Psychiatry, Gainesville, FL, United States; University of Florida, Department of Psychology, Gainesville, FL, United States; University of Florida, Department of Neuroscience, Gainesville, FL, United States; University of Florida Center for Addiction Research & Education, Gainesville, FL, United States
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3
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Gerhardt S, Berhe O, Moessnang C, Horning M, Kiefer F, Tost H, Vollstädt-Klein S. Lack of amygdala habituation to negative emotional faces in alcohol use disorder and the relation to adverse childhood experiences. Addict Biol 2023; 28:e13251. [PMID: 36577733 DOI: 10.1111/adb.13251] [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: 06/29/2022] [Revised: 10/13/2022] [Accepted: 10/21/2022] [Indexed: 11/17/2022]
Abstract
Aberrant limbic circuit reactivity to negative stimuli might be related to alterations in emotion processing and regulation in alcohol use disorder (AUD). The current study tested for the first time in AUD the hypothesis of aberrant amygdala habituation to repeated aversive stimuli-a robust and reliable neuroimaging marker for emotion processing. We explored the link between deficits in habituation to adverse childhood experience (ACE), a common risk factor for impaired emotion regulation and AUD. AUD individuals (N = 36) and healthy controls (HC; N = 26) participated in an observational case-control functional magnetic resonance imaging (fMRI) study. An established habituation index was used to investigate processing of aversive emotional faces of the amygdala. AUD individuals showed an overall deficit in amygdala habituation (right: t = 4.26, pFWE = 0.004; left: t = 4.79, pFWE ≤ 0.001). Amygdala habituation was significantly related to increased exposure to ACE in HC (t = 3.88, pFWE = 0.012), whereas this association was not observed in AUD individuals (T = 1.80, pFWE = 0.662). Further, a significant association between higher alcohol consumption and reduced amygdala habituation (right: R2 = -0.356, F = 8.736, p = 0.004; left: R2 = -0.309, F = 6.332, p = 0.015) was observed. We found novel evidence for neural alterations in emotion processing in AUD individuals, indexed by deficient amygdala habituation to negative emotional content. We replicated a prior report on a link between ACE and amygdala habituation, a well-established environmental risk factor for mental disorders and emotion dysregulation, in our control sample. Additionally, deficient amygdala habituation related to the amount of alcohol consumption in the overall sample might indicate a short-term substance effect.
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Affiliation(s)
- Sarah Gerhardt
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Oksana Berhe
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Carolin Moessnang
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,SRH University Heidelberg, Heidelberg, Germany
| | - Maibritt Horning
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Falk Kiefer
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Feuerlein Center on Translational Addiction Medicine, Heidelberg University, Heidelberg, Germany
| | - Heike Tost
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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4
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Melby K, Spigset O, Gråwe RW, Aamo TO, Quintana DS. The effect of intranasal oxytocin on processing emotional stimuli during alcohol withdrawal: A randomized placebo-controlled double-blind clinical trial. Horm Behav 2022; 146:105268. [PMID: 36242831 DOI: 10.1016/j.yhbeh.2022.105268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 09/15/2022] [Accepted: 09/24/2022] [Indexed: 11/04/2022]
Abstract
Alcohol dependence is associated with difficulties in processing emotional stimuli, which can lead to interpersonal problems. The neuropeptide oxytocin has been shown to modulate the processing of emotional stimuli, however, oxytocin treatment has not yet been examined in patients with withdrawal symptoms during alcohol detoxification. The aim of the present study was to investigate the effect of oxytocin on the reading the mind in the eyes test (RMET), which indexes theory of mind ability, during a three-day period of alcohol detoxification at an addiction treatment centre in Norway. We performed a randomized, double-blind, placebo-controlled trial in 39 patients fulfilling criteria for ICD-10 diagnosis of alcohol dependence admitted for alcohol detoxification and withdrawal treatment. Participants were randomized to receive either intranasal oxytocin (24 IU) or placebo, twice daily for three days. We evaluated RMET performance on day 2 and day 3 of detoxification and differences in RMET scores between day 2 and day 3 of detoxification. Frequentist and Bayesian statistical inference suggested that oxytocin administration during alcohol withdrawal in alcohol-dependent patients did not improve RMET performance. However, exploratory analyses provided preliminary evidence that oxytocin might improve performance on the RMET negative emotion subscale (uncorrected p value = 0.038), and that oxytocin treatment might show the most promise for those with high levels of alcohol consumption (i.e., ≥20 alcohol units per day; uncorrected p value = 0.023). Moreover, alcohol consumption levels significantly predicted RMET performance on day 2, but not on day 3, of withdrawal.
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Affiliation(s)
- Katrine Melby
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway.
| | - Olav Spigset
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology - NTNU, Trondheim, Norway
| | - Rolf W Gråwe
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology - NTNU, Trondheim, Norway; Department of Research and Development, Division of Psychiatry, St. Olav University Hospital, Trondheim, Norway
| | - Trond O Aamo
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway; Blue Cross Lade Addiction Treatment Centre, Trondheim, Norway
| | - Daniel S Quintana
- Department of Psychology, University of Oslo, Oslo, Norway; NevSom, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway; Norwegian Centre for Mental Disorders Research (NORMENT) and KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
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5
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Honkalampi K, Jokela M, Lehto SM, Kivimäki M, Virtanen M. Association between alexithymia and substance use: A systematic review and meta-analysis. Scand J Psychol 2022; 63:427-438. [PMID: 35436351 PMCID: PMC9790486 DOI: 10.1111/sjop.12821] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 11/11/2021] [Accepted: 01/12/2022] [Indexed: 12/31/2022]
Abstract
Alexithymia has been associated with substance use, but the magnitude of the association has not been evaluated and sub-group differences, if any, are unknown. The aim of this meta-analysis is to systematically review the association between alexithymia and substance use (alcohol or illicit drugs). We identified studies through a systematic review of PubMed and Web of Science and obtained a total of 52 publications using the Toronto Alexithymia Scale-20 scale. Random effects meta-analysis was used to evaluate the overall and sub-group associations. Of the studies, 50 were cross-sectional and two longitudinal. Alexithymia was associated with any substance use (Cohen's d = 0.62, 95% confidence interval [CI] 0.49-0.76), with little difference between estimates for use of alcohol or illicit drugs. A stronger association was observed for the alexithymia dimension "Difficulty in Identifying Feelings" (d = 0.64, 95% CI = 0.47-0.81) and "Difficulty in Describing Feelings" (d = 0.44, 95% CI = 0.32-0.55) than for "Externally Oriented Thinking" (d = 0.19, 95% CI = 0.09-0.28). The association was stronger in studies with clinical patient populations (d = 0.83, 95% CI = 0.62-1.05) than in those investigating general or student populations, and in studies with a majority of male rather than female participants. These findings suggest a strong overall association between alexithymia and substance use and a very strong association among clinical patient populations. The association may be stronger with the emotion-related dimensions than with the cognition-related dimension of alexithymia. As nearly all the studies were cross-sectional, more longitudinal studies are needed.
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Affiliation(s)
- Kirsi Honkalampi
- School of Educational Sciences and PsychologyUniversity of Eastern FinlandJoensuuFinland
| | - Markus Jokela
- Department of Psychology and LogopedicsUniversity of HelsinkiHelsinkiFinland
| | - Soili M. Lehto
- Department of Psychology and LogopedicsUniversity of HelsinkiHelsinkiFinland,Institute of Clinical MedicineUniversity of OsloOsloNorway,R&D department, Division of Mental Health ServicesAkershus University HospitalLørenskogNorway,Department of PsychiatryUniversity of HelsinkiHelsinkiFinland
| | - Mika Kivimäki
- Clinicum, Faculty of MedicineUniversity of HelsinkiHelsinkiFinland,Department of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Marianna Virtanen
- School of Educational Sciences and PsychologyUniversity of Eastern FinlandJoensuuFinland,Division of Insurance MedicineKarolinska InstitutetStockholmSweden
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6
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Reichl D, Enewoldsen N, Weisel KK, Saur S, Fuhrmann L, Lang C, Berking M, Zink M, Ahnert A, Falkai P, Kraus T, Hillemacher T, Müller FN, Lins S, Bönsch D, Kerkemeyer L, Steins-Loeber S. Lower Emotion Regulation Competencies Mediate the Association between Impulsivity and Craving during Alcohol Withdrawal Treatment. Subst Use Misuse 2022; 57:649-655. [PMID: 35142599 DOI: 10.1080/10826084.2022.2034878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
There is evidence that craving mediates the relationship between Impulsive Personality Traits (IPTs) and relapse during the treatment of an Alcohol Use Disorder (AUD). To provide tailored interventions, a deeper understanding of the relation between IPTs and craving, namely mediating processes, is important. Based on previous literature, we proposed that lower emotion regulation competencies mediate the relation between attentional as well as non-planning IPTs and craving. To investigate these interrelations, we used data from the baseline assessment (n = 320) of the SmartAssistEntz project (pre-registered in the German Clinical Trials Register [DRKS00017700]). Inpatients with a primary AUD diagnosis were interviewed using standardized self-report measures (IPTs: BIS-15, emotion regulation competencies: ERSQ, craving: OCDS-G short version) during their withdrawal treatment. Indirect effects were calculated using the SPSS macro PROCESS v3.5. Attentional as well as non-planning, but not motor, IPTs were associated with craving. Emotion regulation competencies mediated the relationship between attentional as well as non-planning IPTs and craving. Given their mediating role in the present study, it is interesting to investigate if addressing emotion regulation competencies can mitigate the negative influences of attentional and non-planning IPTs. The direct effect of attentional IPTs implicates alternate mediating processes, which should also be investigated in future research.
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Affiliation(s)
- Daniela Reichl
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University Bamberg, Bamberg, Germany
| | - Niklas Enewoldsen
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University Bamberg, Bamberg, Germany
| | - Kiona K Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Sebastian Saur
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Lukas Fuhrmann
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Klinik für Psychiatrie, Sucht, Psychotherapie und Psychosomatik, Klinikum am Europakanal, Erlangen, Germany
| | - Catharina Lang
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Mathias Zink
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirksklinikum Ansbach, Ansbach, Germany
| | - Andreas Ahnert
- Klinik für Psychiatrie, Sucht, Psychotherapie und Psychosomatik, Klinikum am Europakanal, Erlangen, Germany
| | - Peter Falkai
- Klinik für Psychiatrie und Psychotherapie, LMU-Klinikum, München, Germany
| | | | - Thomas Hillemacher
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nürnberg, Germany
| | - Felix-N Müller
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nürnberg, Germany
| | - Stephan Lins
- Psychiatrische und Psychotherapeutische Klinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Dominikus Bönsch
- Krankenhaus für Psychiatrie, Psychotherapie und Psychosomatische Medizin, Bezirkskrankenhaus Lohr, Lohr am Main, Germany
| | - Linda Kerkemeyer
- inav - Institute for Applied Health Services Research, Berlin, Germany
| | - Sabine Steins-Loeber
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University Bamberg, Bamberg, Germany
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7
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Kopera M, Zaorska J, Trucco EM, Suszek H, Kobyliński P, Zucker RA, Nowakowska M, Wojnar M, Jakubczyk A. Childhood trauma, alexithymia, and mental states recognition among individuals with alcohol use disorder and healthy controls. Drug Alcohol Depend 2020; 217:108301. [PMID: 32979738 PMCID: PMC7736369 DOI: 10.1016/j.drugalcdep.2020.108301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although prior work indicates a link between childhood trauma, alexithymia, and mental states recognition, empirical support is limited. Moreover, findings based on adult samples are mixed. Previous studies demonstrate that childhood trauma might either enhance, preserve, or reduce mental states recognition in selected at-risk populations. The current study investigates whether alcohol use disorder (AUD) status moderates the association between childhood trauma, alexithymia, and mental states recognition in a treatment-seeking AUD sample and non-AUD healthy adults. METHODS Data comes from 255 individuals participating in an ongoing project that compares emotional and behavioral functioning of patients treated in an inpatient setting for AUD and a comparison sample of 172 healthy controls (HCs). Mental states recognition was measured using a computerized version of the Reading the Mind in the Eyes Task (RMET). The presence of childhood trauma was assessed with the Childhood Trauma Questionnaire. Alexithymia was measured with the Toronto Alexithymia Scale (TAS-20). Demographic information, as well as alcohol drinking and psychopathological symptoms were assessed. A moderated mediation model was estimated whereby alexithymia was included as a mediator in the association between childhood trauma and RMET performance, with AUD diagnosis status moderating the link between alexithymia and RMET performance. RESULTS Findings provide support for moderated mediation. Childhood emotional trauma impacted negative mental states recognition performance via difficulty describing feelings, but only among HCs (p < 0.01). CONCLUSIONS Findings highlight the impact that AUD status has on the association between early life emotional trauma and difficulty describing feelings on individual differences in mental states recognition.
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Affiliation(s)
- Maciej Kopera
- Department of Psychiatry, Medical University of Warsaw, 27 Nowowiejska St., 00-665, Warsaw, Poland
| | - Justyna Zaorska
- Department of Psychiatry, Medical University of Warsaw, 27 Nowowiejska St., 00-665, Warsaw, Poland
| | - Elisa M. Trucco
- Department of Psychology, Center for Children and Families, Florida International University, Academic Health Center 1, 11200 Southwest 8th Street, Miami, FL, 33199, USA,Department of Psychiatry, Addiction Center, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
| | - Hubert Suszek
- Department of Psychology, University of Warsaw, 5/7 Stawki St., 00-183, Warsaw, Poland
| | - Paweł Kobyliński
- National Information Processing Institute, Laboratory of Interactive Technologies, 188 b al Niepodległości, 00-608, Warsaw, Poland
| | - Robert A. Zucker
- Department of Psychology, University of Michigan, 530 Church St, Ann Arbor, MI, 48109, USA,Department of Psychiatry, Addiction Center, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
| | - Malwina Nowakowska
- Department of Psychiatry, Medical University of Warsaw, 27 Nowowiejska St., 00-665, Warsaw, Poland
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, 27 Nowowiejska St., 00-665, Warsaw, Poland,Department of Psychiatry, Addiction Center, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
| | - Andrzej Jakubczyk
- Department of Psychiatry, Medical University of Warsaw, 27 Nowowiejska St., 00-665, Warsaw, Poland.
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Greene D, Boyes M, Hasking P. The associations between alexithymia and both non-suicidal self-injury and risky drinking: A systematic review and meta-analysis. J Affect Disord 2020; 260:140-166. [PMID: 31494366 DOI: 10.1016/j.jad.2019.08.088] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/22/2019] [Accepted: 08/28/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI; direct harm to the body without suicidal intent) and risky drinking are two behaviours that serve emotion regulatory functions. When underlying emotional problems are untreated, individuals may shift between NSSI and risky drinking. Both behaviours are associated with alexithymia, difficulties identifying and describing emotions and retaining an externally orientated thinking style. However, it is unknown to what extent the associations are similar and under what circumstances (e.g. sex, age) they may differ. METHOD To compare both associations we conducted an extensive review using several databases. Overall, 20 NSSI-related articles and 33 risky drinking-related articles met the inclusion criteria. RESULTS A meta-analysis revealed significant positive associations between total alexithymia scores, difficulties identifying feelings, difficulties describing feelings and both NSSI and risky drinking. However, these associations appear stronger for NSSI. Further, externally orientated thinking was associated with risky drinking but not NSSI. Age had opposing moderating effects on the relationships, with the association between alexithymia and NSSI being stronger in younger samples and the association between alexithymia and risky drinking being stronger in older samples. Further, the association between alexithymia and NSSI was stronger for female only samples compared to male only samples. LIMITATIONS The review was limited to English articles. High levels of heterogeneity were observed. The majority of the studies included were cross-sectional. CONCLUSION These results imply that NSSI and risky drinking may have both shared and distinguishable correlates. Alexithymia can be targeted in treatment to potentially reduce the likelihood of individuals shifting between behaviours to regulate their emotions.
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Affiliation(s)
- Danyelle Greene
- School of Psychology, Curtin University, Kent St, Bentley, 6845, Australia
| | - Mark Boyes
- School of Psychology, Curtin University, Kent St, Bentley, 6845, Australia
| | - Penelope Hasking
- School of Psychology, Curtin University, Kent St, Bentley, 6845, Australia.
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9
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Orlowski S, Bischof A, Besser B, Bischof G, Rumpf HJ. Deficits in emotion regulation strategies among problematic and pathological gamblers in a sample of vocational school students. J Behav Addict 2019; 8:94-102. [PMID: 30663330 PMCID: PMC7044603 DOI: 10.1556/2006.7.2018.136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND AIMS Deficits in emotion regulation (ER) are associated with mental disorders. To date, there are hardly any studies focusing on the role of ER strategies in the context of gambling behavior. The aim of this study was to investigate the association between specific ER strategies and pathological as well as problematic gambling in a proactively recruited sample. METHODS A large and unselected sample (n = 4,928) has been screened proactively and systematically in vocational schools. We assessed the Affective Style Questionnaire to measure ER strategies and the Stinchfield questionnaire for assessing problematic and pathological gambling. Associations were investigated with linear and multinomial logistic regression analyses. RESULTS The analyses showed a significant negative correlation between the subscales "Adjusting" and "Tolerating" and the Stinchfield sum score. Lower scores on these subscales were associated with a higher number of endorsed Stinchfield items. A lower score on the ER strategies "Adjusting" [conditional odds ratio (COR) = 0.95, confidence interval (CI) = 0.91-0.99] and "Tolerating" [COR = 0.95, CI = 0.92-99] led to a higher chance of being classified as a pathological gambler. In problematic gambling, on a subthreshold level, only "Tolerating" turned out to be significant [COR = 0.96, CI = 0.93-0.99]. DISCUSSION AND CONCLUSIONS For the first time, deficits in specific ER strategies were identified as independent risk factors for problematic and pathological gambling in a large and proactively recruited sample. ER skills, especially acceptance-focused strategies, should be considered in prevention and psychotherapy.
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Affiliation(s)
- Svenja Orlowski
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany,Corresponding author: Svenja Orlowski; Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; Phone: +49 451 500 98759; Fax: +49 451 500 98754; E-mail:
| | - Anja Bischof
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Bettina Besser
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Gallus Bischof
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Hans-Jürgen Rumpf
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
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10
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Jansen JM, van den Heuvel OA, van der Werf YD, de Wit SJ, Veltman DJ, van den Brink W, Goudriaan AE. Emotion Processing, Reappraisal, and Craving in Alcohol Dependence: A Functional Magnetic Resonance Imaging Study. Front Psychiatry 2019; 10:227. [PMID: 31057439 PMCID: PMC6465626 DOI: 10.3389/fpsyt.2019.00227] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 03/26/2019] [Indexed: 12/19/2022] Open
Abstract
Alcohol dependence has long been related to impaired emotion regulation-including reappraisal-but little is known about the performance and associated neural activity of alcohol-dependent patients (ADPs) on an emotion reappraisal task. This study, therefore, compares reappraisal of negative, positive, neutral, and alcohol-related images at a behavioral and neural level between ADPs and healthy controls (HCs). Thirty-nine ADPs and 39 age-, gender-, and education-matched HCs performed an emotion reappraisal task during functional magnetic resonance imaging (fMRI), and craving was measured before and after the reappraisal task. During the emotion reappraisal task, participants were instructed to either attend or reappraise positive, negative, neutral, or alcohol-related images, and to indicate their experienced emotion on a visual analogue scale (VAS). Both ADPs and HCs completed the emotion reappraisal task successfully, showing significant differences in self-reported experienced emotion after attending versus reappraising visual stimuli and in brain activity in emotion processing/reappraisal relevant areas. ADPs were not impaired in cognitive reappraisal at a behavioral or neural level relative to HCs, nor did ADPs indicate any difference in self-reported emotion while attending emotional images. However, ADPs were different from HC in emotion processing: ADPs revealed a blunted response in the (posterior) insula, precuneus, operculum, and superior temporal gyrus while attending emotional images compared neutral images compared to HCs, and in ADPs, higher baseline craving levels were associated with a less blunted response to alcohol-related images than in HCs. These results reveal that ADPs do not show impaired reappraisal abilities when instructed, although future studies should assess voluntary reappraisal abilities in alcohol-dependent patients. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02557815.
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Affiliation(s)
- Jochem M Jansen
- Institute for Addiction Research, Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Institute for Criminal Law & Criminology, Faculty of Law, Leiden University, Leiden, Netherlands
| | - Odile A van den Heuvel
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ysbrand D van der Werf
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Stella J de Wit
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Wim van den Brink
- Institute for Addiction Research, Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Anna E Goudriaan
- Institute for Addiction Research, Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Arkin Mental Health, Amsterdam, Netherlands
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11
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Price CJ, Thompson EA, Crowell SE, Pike K, Cheng SC, Parent S, Hooven C. Immediate effects of interoceptive awareness training through Mindful Awareness in Body-oriented Therapy (MABT) for women in substance use disorder treatment. Subst Abus 2018; 40:102-115. [PMID: 29949455 DOI: 10.1080/08897077.2018.1488335] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Sensory information gained through interoceptive awareness may play an important role in affective behavior and successful inhibition of drug use. This study examined the immediate pre-post effects of the mind-body intervention Mindful Awareness in Body-oriented Therapy (MABT) as an adjunct to women's substance use disorder (SUD) treatment. MABT teaches interoceptive awareness skills to promote self-care and emotion regulation. Methods: Women in intensive outpatient treatment (IOP) for chemical dependency (N = 217) at 3 community clinics in the Pacific Northwest of the United States were recruited and randomly assigned to one of 3 study conditions: MABT + treatment as usual (TAU), women's health education (WHE) +TAU (active control condition), and TAU only. At baseline and 3 months post-intervention, assessments were made of interoceptive awareness skills and mindfulness, emotion regulation (self-report and psychophysiological measures), symptomatic distress (depression and trauma-related symptoms), and substance use (days abstinent) and craving. Changes in outcomes across time were assessed using multilevel mixed-effects linear regression. Results: Findings based on an intent-to-treat approach demonstrated significant improvements in interoceptive awareness and mindfulness skills, emotion dysregulation (self-report and psychophysiology), and days abstinent for women who received MABT compared with the other study groups. Additional analyses based on participants who completed the major components of MABT (at least 75% of the intervention sessions) revealed these same improvements as well as reductions in depressive symptoms and substance craving. Conclusions: Findings that interoceptive training is associated with health outcomes for women in SUD treatment are consistent with emerging neurocognitive models that link interoception to emotion regulation and to related health outcomes, providing knowledge critical to supporting and improving SUD treatment.
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Affiliation(s)
- Cynthia J Price
- a Department of Biobehavioral Nursing and Health Informatics , University of Washington , Seattle , Washington , USA
| | - Elaine A Thompson
- b Department of Psychosocial and Community Health Nursing , University of Washington , Seattle , Washington , USA
| | - Sheila E Crowell
- c Department of Psychology , University of Utah , Salt Lake City , Utah , USA
| | - Kenneth Pike
- b Department of Psychosocial and Community Health Nursing , University of Washington , Seattle , Washington , USA
| | - Sunny C Cheng
- d Nursing and Healthcare Leadership Program , University of Washington , Tacoma , Washington , USA
| | - Sara Parent
- a Department of Biobehavioral Nursing and Health Informatics , University of Washington , Seattle , Washington , USA
| | - Carole Hooven
- b Department of Psychosocial and Community Health Nursing , University of Washington , Seattle , Washington , USA
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