Alexithymia and emotion regulation

Enhancing emotion expression (3E): A novel virtual reality tool for improving alexithymia and its psychological outcomes from a multi-dimensional perspective

BACKGROUND

Alexithymia is characterized by an impaired ability in emotion awareness, expression, and regulation, associated with deficits in social and mental functioning. This study aims to develop a tool for addressing alexithymia and its psychological outcomes.

METHOD

In this paper, 102 subjects were recruited to investigate the relationship between alexithymia and psychological outcomes, along with the mediating role of emotion awareness, expression, and regulation. Based on these findings, we propose an Enhanced Emotion Expression (3E) system, an interactive VR platform that integrates emotion arousal, mindfulness, open-ended questions, and metaphor, designed to equip users with effective emotional management skills. We present the system's design and implementation, as well as user studies.

RESULTS

We demonstrate the mediating role of emotion awareness, expression and regulation in the relationship between alexithymia and psychological outcomes (anxiety: 95 % CI = 0.002-0.189; depression: 95 % CI = 0.002-0.164). Furthermore, our findings indicate that the proposed 3E system can effectively guide users in becoming aware of, expressing, and regulating their emotions (ts = -2.185-2.860, Ps = 0.009-0.04), thus alleviating alexithymia, anxiety, and depression (ts = 2.404-3.775, Ps = 0.003-0.043).

LIMITATIONS

The limitations of this study include the use of self-reports, the lack of investigation into other mediating variables, a small sample size, and the absence of long-term follow-up.

CONCLUSIONS

We have developed intervention strategies to address alexithymia and proposed an innovative 3E system. This system provides an effective tool for mitigating alexithymia and its adverse psychological outcomes.

Perceived changes in mental health and social engagement attributed to a single psychedelic experience in autistic adults: results from an online survey

RATIONALE

Anecdotal reports suggest that psychedelic drugs can improve psychological wellbeing and social engagement in autistic people. However, there are few contemporary studies on this topic.

OBJECTIVES

To examine autistic participants' experiences with psychedelic drugs and the extent to which they attributed changes in mental health and social engagement to their most 'impactful' psychedelic experience. We also explored associations between these changes and mechanistically important variables (e.g., aspects of the acute psychedelic experience and changes in 'psychological flexibility').

METHODS

Self-selecting autistic participants (n = 233) with high autism quotient scores completed an online survey relating to their most impactful psychedelic experience. Questionnaires assessed the acute psychedelic experience and perceived psychedelic-induced changes in distress, social engagement and psychological flexibility, among other relevant variables.

RESULTS

The majority of participants attributed reductions in psychological distress (82%) and social anxiety (78%) and increases in social engagement (70%) to their most 'impactful' psychedelic experience. A substantial minority (20%) also reported undesirable effects such as increases in anxiety with some describing their psychedelic experience as among the most negatively impactful experiences of their lives. The only substantial predictor of reductions in psychological distress was increased psychological flexibility.

CONCLUSION

Autistic people attributed changes in mental health and social engagement to a single highly impactful psychedelic experience. The results and their implications are discussed with caution considering the use of a non-experimental design and biased sampling.

Predictors of Gambling Severity Among Female Gamblers: Cross-Country Study with Spanish and Italian Clinical Population

A large body of research has evidenced different risk factors associated with the severity of gambling. However, most of the research has been conducted with a male population, and consequently it has been inferred that the female population presents the same experiences and characteristics. Research on female gamblers is limited, with the result that their gambling-related problems are not effectively addressed. In light of this, the study aims were two-fold: (1) to identify differences between Spanish and Italian women seeking treatment for a gambling disorder, and (2) to examine variables associated with gambling severity in a clinical sample of women. For this study, a total of 106 women gamblers (Mage = 48.83; SD = 12.41) completed the assessment, evaluating gambling behavior, alexithymia, hopelessness, and mental health (depression, anxiety, and hostility). Results indicated that Spanish and Italian women showed differences in sociodemographic, psychological, and gambling-related variables. Furthermore, exhibiting higher levels of depressive symptoms, and experiencing difficulties in identifying emotions were related to the increased gambling severity. Also, received the Italian intervention was related to lower gambling severity. These findings emphasize the need to provide evidence-based treatments, as well as to improve existing treatments and develop prevention and intervention strategies adapted to the characteristics of female gamblers.

Alexithymia: Toward an Experimental, Processual Affective Science with Effective Interventions

Alexithymia is a multi-dimensional personality trait involving difficulty identifying feelings, difficulty describing feelings, and an externally oriented thinking style. Poor fantasy life is debated as another facet. For over 50 years, the alexithymia literature has examined how alexithymia-related disturbances in perceiving and expressing feelings contribute to mental and physical disorders. We review the current understanding of alexithymia-including its definition, etiology, measurement, and vulnerabilities for both mental and physical illness-and its treatment. We emphasize the importance of further experimental and processual affective science research that (a) emphasizes facet-level analysis toward an understanding of the nuanced bases of alexithymia effects on neural, cognitive, and behavioral processes; (b) distinguishes between emotion deficits and emotion over-responding, including when over-responding is functional; and (c) clarifies when and how impairments occur for neutral and positively valenced information or contexts. Taken as a whole, a clarification of these issues will provide clear directions for effective and tailored alexithymia interventions.

Psychological Treatments for Alexithymia: A Systematic Review

Alexithymia, a psychological condition characterized by emotional suppression, is positively correlated with depression and anxiety and can develop into various mental disorders. Although alexithymia affects 10% of the symptomatic population and 25% of psychiatric patients, there has been a paucity of intervention studies. Even though several effective psychological treatments, including cognitive behavioral therapy (CBT), have been tested in recent years, there is a lack of comprehensive reviews on their efficacy. The objectives of this systematic review were to explore and synthesize findings from recent randomized controlled trials (RCTs) about psychological treatments, with the following inclusion criteria: (1) published from 2010 to 2024; (2) full text being available in English; (3) peer-reviewed journals; and (4) baselines and outcomes measured by TAS-20 and raw data were provided. We excluded non-psychological studies and studies involving mindfulness and DBT. We searched electronic databases (PubMed, PsycInfo, and Google Scholar) and found 18 RCTs and 21 arms for alexithymia, with a combined total of 1251 participants. Fourteen arms (67%) investigated the effect of CBT on alexithymia, including acceptance and commitment therapy (seven arms), behavioral activation therapy (two arms), schema therapy, and compassion-focused therapy. The results indicated that most psychological interventions significantly decreased TAS-20, illustrating a showcase of treatments from each trial with different effect sizes (within-intervention group, ranging from 0.41 to 13.25). However, due to the heterogeneity between the studies, this review study may not be conclusive enough to make each intervention standardized. Further high-quality RCTs with larger sample sizes and more consistent methodologies are needed, and corrective findings from such studies should be applied to produce more robust evidence-based psychological interventions for treating alexithymia.

Emotion processes in voice-hearers: Understanding differences in emotional reactivity, emotion regulation and alexithymia

OBJECTIVES

Disrupted emotion processes are commonly linked to the onset and maintenance of auditory verbal hallucinations. However, a comprehensive approach using an extended emotion model has not previously been applied to voice-hearers to distinguish impairments in emotion processes from non-clinical populations. The present study hypothesised voice-hearers, as compared to controls, would have (1) higher reactivity to negative emotions and lower reactivity to positive emotions, (2) more difficulties regulating negative and positive emotions, (3) more maladaptive strategy use, and (4) higher alexithymia.

METHOD

T-tests tested these hypotheses, comparing self-report measures of emotional reactivity, emotion regulation and alexithymia in voice-hearers (n = 50) to controls (n = 53).

RESULTS

There were no group differences in emotional reactivity to positive or negative emotions. Compared to controls, voice-hearers showed difficulties in both positive and negative emotion regulation, were more likely to use expressive suppression, and were more likely to be alexithymic.

CONCLUSIONS

These findings may help researchers and clinicians identify difficulties in voice-hearers' emotion processing, providing better direction for case formulation and treatment.

Neurodivergence, intersectionality, and eating disorders: a lived experience-led narrative review

Autistic people and those with attention deficit hyperactivity disorder are at a high risk of developing an eating disorder. While there is limited evidence on the relationship between other forms of neurodivergence and eating disorders, research suggests associations between giftedness, intellectual disability, obsessive-compulsive disorder, psychosis, Tourette's syndrome, and disordered eating. Factors underlying disordered eating and/or eating disorder risk for neurodivergent people are multifaceted and complex, encompassing a wide range of intertwined psychosocial, environmental, and biological processes. Moreover, research shows that neurodivergent individuals experience poorer treatment outcomes compared to neurotypical individuals. However, there is a paucity of research in this area overall. More specifically, lived experience-led research remains rare, despite its critical role for improving individualised eating disorder care, as well as mental healthcare more broadly. Indeed, the importance of eating disorder care individuation is increasingly being recognised, particularly within the context of neurodivergence, given the heterogeneous experiences and support needs of neurodivergent people affected by disordered eating and/or eating disorders. Furthermore, despite documented overlaps between various forms of neurodivergence (e.g., co-occurring autism and attention deficit hyperactivity disorder), research looking at eating disorders in the context of neurodivergence through a transdiagnostic perspective is scarce. This lived experience-led narrative review aims to shed light on the intersectional factors underlying elevated disordered eating and/or eating disorder risk for neurodivergent individuals. First, an overview of prevalence data is provided, followed by a thematic framework identifying factors underlying disordered eating and/or eating disorder risk in relation to neurodivergence. A critical appraisal of current eating disorder research and care is then offered before suggestions for neurodiversity-affirming eating disorder care are made. In this view, this paper offers a foundation for future empirical work in this nascent field of inquiry by providing a lived experience-led, transdiagnostic, and intersectional account of eating disorders in the context of neurodivergence.

Unraveling the relationships among pandemic fear, cyberchondria, and alexithymia after China's exit from the zero-COVID policy: insights from a multi-center network analysis

Objective

China's abrupt exit from the zero-COVID policy in late 2022 led to a rapid surge in infections, overwhelming healthcare systems and exposing healthcare providers to intensified psychological pressures. This sudden shift exacerbated pandemic-related psychological issues, including fear, health anxiety, and emotional processing difficulties. This study aimed to unravel the relationships among pandemic fear, cyberchondria, and alexithymia following China's exit from the zero-COVID policy.

Methods

A multi-center cross-sectional survey was conducted among 4088 nurses from 43 public hospitals in China. The web-based survey comprised the Fear of COVID-19 Scale, Cyberchondria Severity Scale, and Toronto Alexithymia Scale. Network analysis was employed to explore the interconnections and identify central components within these psychological and behavioral constructs.

Results

The analysis revealed a dense network with predominantly positive connections. Specific aspects of cyberchondria and pandemic fear exhibited the highest strength centrality, indicating their critical influence. The externally oriented thinking dimension of alexithymia emerged as a crucial bridge node, linking pandemic fear and cyberchondria. The network structure demonstrated consistency across diverse educational backgrounds and career stages.

Conclusion

These findings highlight the need for targeted interventions focusing on key network components, particularly externally oriented thinking, to disrupt the detrimental cycle of pandemic fear and cyberchondria. Healthcare organizations should promote balanced objective fact-focused and problem-solving approaches while also fostering skills in emotional awareness and expression, thereby mitigating the risk of maladaptive pandemic fear responses and dysfunctional online health information-seeking behaviors.

The effect of alexithymia on self-perceived aging among community-dwelling older adults with multiple chronic conditions: the mediating role of maladaptive cognitive emotion regulation strategies

Objectives

This study investigated the mediating role of maladaptive cognitive emotion regulation strategies in the relationship between alexithymia and self-perceived aging among older adults.

Methods

We surveyed 478 Chinese community-dwelling older adults from November 2022 to May 2023. The Toronto Alexithymia Scale (TAS-20), Cognitive Emotion Regulation Questionnaire (CERQ), and Brief Aging Perceptions Questionnaire (B-APQ) were used. Correlation analyses, multiple linear regression analysis, and structural equation modeling were performed.

Results

The average age of participants was 71.52 ± 7.80 years, and the number of chronic diseases was distributed as follows: 270 (56.49%) had 2 disease conditions, 156 (32.64%) had 3 disease conditions, and 52 (10.88%) had 4 disease conditions or more. Scores for alexithymia 57.83 ± 10.19; maladaptive cognitive emotion regulation strategies 49.63 ± 10.65; and self-perceived aging 58.74 ± 10.23. Alexithymia and maladaptive cognitive emotion regulation strategies were positively correlated with negative self-perceived aging (r=0.665 and r=0.673, respectively), explaining 51.8% of the variance in self-perceived aging. Structural equation modeling results showed that alexithymia had a direct effect (of 0.368) on self-perceived aging, accounting for 44.1% of the total effect. Maladaptive cognitive emotion regulation strategies partially mediated the relationship, with a mediation effect of 0.386, accounting for 51.8% of the total effect.

Conclusion

These findings suggest that addressing maladaptive cognitive emotion regulation strategies can help reduce negative self-perceived aging in elderly individuals with multiple chronic conditions, particularly among those with alexithymia.

A systematic review and meta-analysis of the relationship between subjective interoception and alexithymia: Implications for construct definitions and measurement

Although research indicates that self-reported interoception is associated with deficits in identifying and describing emotional experience, and externally oriented thinking styles (alexithymia), this relationship appears moderated by how interoception is measured. A systematic review and meta-analyses examined the association between self-reported interoception and alexithymia, investigating how different interoceptive questionnaires relate to alexithymia at global and facet levels. PsychINFO, PubMed, Scopus, and Web of Science databases were searched with predefined terms related to self-reported interoception and alexithymia. Three reviewers independently assessed articles, extracted data, and undertook risk of bias assessment. Thirty-two cross-sectional studies published between 1996 and 2023 were included. Random-effects meta-analyses and narrative synthesis indicated that global alexithymia was positively associated with measures of interoceptive confusion, autonomic nervous system reactivity, and heightened interoceptive attention, and inversely associated with interoceptive accuracy and adaptive interoception, indexed by composite Multidimensional Assessment of Interoceptive Awareness scores, but particularly interoceptive trusting, self-regulation, and attention regulation. These patterns were observed for alexithymic facets and stronger in magnitude for difficulty identifying feelings and difficulty describing feelings, relative to externally oriented thinking. Overall, results suggested that the association between self-reported interoception and alexithymia differs as a function of the interoceptive self-report. The review highlighted issues with construct definition and operationalisation and determined that existing interoceptive self-reports broadly capture maladaptive and adaptive sensing, attention, interpretation, and memory. The findings underscore the importance of specifying interoceptive constructs and using appropriate assessments to improve convergence between constructs and measurements, further suggesting potential clinical utility in using existing self-reports to measure interoception and alexithymia, facilitating interventions targeting mind-body connections.

"Our similarities are different" The relationship between alexithymia and depression

Alexithymia is a multi-faceted personality trait, which is the inability to recognize and describe emotions. It is associated with a multitude of mental health problems, and its implication for the diagnosis and treatment of depression remains unclear. The current study explored the nuances of the relationship between alexithymia and depression in a sample of 210 patients with depression. We assessed alexithymia with the 20-Item Toronto Alexithymia Scale (TAS-20) and depression with the Beck Depression Inventory (BDI-I). The mean TAS-20 score was 57.47 ± 10.63, and the mean BDI-I score was 49.33±9.24. We explored the network structure of alexithymia and depression. Items related to difficulties in identifying, describing, and expressing feelings were prominent in the alexithymia network. Joy, guilt, and self-dislike stand out in the depression network. In our analysis, we were able to show the crescent relationship between depression and alexithymia, with an inflection point at a TAS-20 score of 53. Although the correlation-concordance index was moderate (0.41; 95 %CI: 0.29-0.51), both scales greatly overlap. In the joint network of alexithymia and depression, we could identify bridge (i.e., connecting) items between alexithymia and depression. These were difficulties understanding and relating feelings to physical and body sensations on the alexithymia side, and self-dislike, crying, and somatic concern on the depression side. Taken together, they point to the pivotal role of alexithymia in the somatization/embodiment of emotions and feelings in depression.

Alexithymia and Personality Pathology

Alexithymia is an important transdiagnostic risk factor for many psychopathologies. To explore its relevance for personality disorders, we examined the association between alexithymia and maladaptive personality traits, as conceptualized within the DSM-5-TR Alternative Model for Personality Disorders (i.e., negative affect, detachment, antagonism, disinhibition, psychoticism). Participants (N = 651) completed a battery of psychometric questionnaires. Regressions revealed that alexithymia facets accounted for a significant 15% of the variance in negative affect, 22% in detachment, 11% in antagonism, 18% in disinhibition, and 25% in psychoticism. Latent profile analysis showed that profiles with more severe personality pathology were generally characterized by more severe levels of alexithymia. Overall, our data highlight that alexithymia is important in understanding personality dysfunction. All facets of alexithymia, across both positive and negative emotions, are linked to each maladaptive personality trait. The assessment and targeting of alexithymia may therefore be of high relevance for the treatment of personality pathology.

Differences in networks of alexithymia and cognitive emotion regulation strategies among older adults with different health statuses in eastern China-A network analysis and network comparison

To identify core and bridge nodes in the network structure of alexithymia and cognitive emotion regulation strategies in community-dwelling older adults, and compare network differences among older adults with different health statuses, we recruited 677 participants and network analysis was performed in R 4.2.0. After including the covariates, the nodes Catastrophizing, Difficulty Identifying feelings, and Refocusing on Planning ranked as the top three. The nodes Externally Oriented Thoughts and Difficulty Identifying Feelings were identified as bridge nodes based on bridge strength values. Significant differences were observed between the healthy and comorbidity groups, and also between the single chronic disease and comorbidity groups (p < 0.05). Catastrophizing, Difficulty Identifying Feelings, and Refocusing on Planning were the core nodes, and Externally Oriented Thoughts and Difficulty Identifying Feelings were the key bridge nodes. The network structure of comorbidity in older adults was characterized by stronger ties to non-adaptive cognitive emotion regulation strategies.

Alexithymia profiles and depression, anxiety, and stress

BACKGROUND

Alexithymia is a multidimensional trait comprised of difficulties identifying feelings, difficulties describing feelings, and externally orientated thinking. It is regarded as an important risk factor for emotional disorders, but there are presently limited data on each specific facet of alexithymia, or the extent to which deficits in processing negative emotions, positive emotions, or both, are important. In this study, we address these gaps by using the Perth Alexithymia Questionnaire (PAQ) to comprehensively examine the relationships between alexithymia and depression, anxiety, and stress symptoms.

METHODS

University students (N = 1250) completed the PAQ and the Depression Anxiety Stress Scales-21. Pearson correlations, hierarchical regressions, and latent profile analysis were conducted.

RESULTS

All facets of alexithymia, across both valence domains, were significantly correlated with depression, anxiety, and stress symptoms (r = 0.27-0.40). Regression analyses indicated that the alexithymia facets, together, could account for a significant 14.6 %-16.4 % of the variance in depression, anxiety, and stress. Difficulties identifying negative feelings and difficulties identifying positive feelings were the strongest unique predictors across all symptom categories. Our latent profile analysis extracted eight profiles, comprising different combinations of alexithymia facets and psychopathology symptoms, collectively highlighting the transdiagnostic relevance of alexithymia facets.

LIMITATIONS

Our study involved a student sample, and further work in clinical samples will be beneficial.

CONCLUSIONS

Our data indicate that all facets of alexithymia, across both valence domains, are relevant for understanding depression, anxiety, and stress. These findings demonstrate the value of facet-level and valence-specific alexithymia assessments, informing more comprehensive understanding and more targeted treatments of emotional disorder symptoms.

The relationship between childhood psychological abuse and depression in college students: a moderated mediation model

BACKGROUND

Childhood psychological abuse (CPA) are highly correlated with depression among college students, but the underlying mechanisms between variables need further exploration. This study aims to investigate internet addiction as a mediating factor and alexithymia as a moderating factor, in order to further elucidate the potential risk factors between CPA and depression among college students.

METHODS

A self-report survey was conducted among 1196 college students from four universities in three provinces in China. The survey included measures of CPA, internet addiction, alexithymia, and depression. Descriptive and correlational analyses were performed on these variables, and a moderated mediation model was constructed.

RESULTS

CPA was positively correlated with depression among college students, as well as internet addiction with alexithymia. Internet addiction partially mediated the relationship between CPA and depression among college students, while alexithymia strengthened the relationships among the paths in the moderated mediation model.

CONCLUSION

This study provides further insights into the psychological mechanisms underlying the relationship between CPA and depression among college students. Internet addiction serves as a mediating factor in this relationship, while alexithymia may enhance the strength of the relationships among the three variables.

Subscales of alexithymia show unique pathways through reappraisal and suppression to anxiety, depression and stress

The goal of this work was to explore associations of constituent factors of alexithymia on mental health and potential mediating effects of emotion regulation strategies, specifically suppression and reappraisal. Data were collected through the crowd-sourcing platform Amazon Mechanical Turk (MTURK). Three hundred seventy-seven individuals completed questionnaires related to distress (Depression Anxiety Stress Scales [DASS]), emotion regulation (Emotion Regulation Questionnaire [ERQ]) and Alexithymia (Bermond-Vorst Alexithymia Questionnaire [BVAQ]). Three mediation models were constructed for depression, anxiety and stress, with BVAQ subscales (verbalizing, identifying, emotionalizing, fantasizing, and analyzing) as predictors and ERQ subscales (suppression and reappraisal) as mediators. Results indicated 37.3 % variance in depression, 25.2 % variance in anxiety, and 35.3 % variance in stress was explained by each model. Direct associations revealed emotionalizing and fantasizing were negatively associated with depression, anxiety, and stress, while verbalizing was additionally associated with depression, identifying was additionally associated with anxiety, and all four BVAQ subscales were associated with stress. BVAQ subscales demonstrated negative associations with reappraisal and positive associations with suppression that mediated anxiety and depression. However, suppression did not mediate relationships between BVAQ subscales with stress. Findings support the importance of examining multiple factors of alexithymia and associations with emotion regulation strategies and distress.

Alexithymia in the Narratization of Romantic Relationships: The Mediating Role of Fear of Intimacy

PURPOSE

The purpose of the study was to verify the hypothesis concerning the relationship between alexithymia and selected indicators used to describe emotional events, specifically romantic relationships. Alexithymia, due to significant distortions in cognitive processing of emotional content, is demonstrated by poor recognition of emotions in oneself and others and, as a result, by deficits in empathy, avoidance of social relationships, and deficits in the ability to mentalize. Differences in narrations were tested by alexithymia levels (high vs. low) and the relation between specific narration features and individual alexithymia factors, i.e., difficulties in identifying emotions, difficulties in verbalising emotions, and externally oriented thinking.

METHOD

A total of 356 people who had been in a romantic relationship for at least six months participated in the study. The TAS-20 was applied to measure alexithymia, and the FIS questionnaire was used to investigate anxiety in close relationships. Participants were asked to freely describe the romantic relationship they were in at that moment. The Linguistic Inquiry Word Count (LIWCLIWC2015 v1.6-unlimited duration academic licence) software was used for content analysis. The study was conducted online.

RESULTS

On the basis of the analyses conducted, high levels of alexithymia were found to be significantly associated with a lower total number of words used in narrative, a lower number relating to positive emotions, a lower number relating to causation and insight, and a higher number relating to negative emotions. Various results were obtained for individual dimensions of alexithymia in relation to the LIWC categories and the mediating role of fear of intimacy. For the difficulty identifying feelings (DIF), a significant mediating effect was observed only for words associated with negative emotions, whereas for the difficulty describing feelings (DDF), significant mediating effects were found for words relating to negative emotions and causality. In the case of externally oriented thinking (EOT), significant mediating effects were obtained for all analysed categories from LIWC.

Emotion dysregulation in older people: validity and reliability of an 8-item version of the Difficulties in Emotion Regulation Scale

OBJECTIVES

The abbreviated 16-item version of the Difficulties with Emotion Regulation Scale (DERS-16) is widely used to assess individuals' perceived challenges in regulating their emotions, a central aspect of psychological symptoms commonly experienced in old age. However, its psychometric properties have yet to be tested in this population. Furthermore, a shorter version of the DERS-16 could further minimize the assessment burden on older individuals. Thus, we aimed to test the DERS-16's psychometric performance and determine if any items were redundant to develop a psychometrically sound shorter version.

METHODS

We enrolled 302 Portuguese older adults (Mage = 75.22; SD = 8.99 years) in a cross-sectional study.

RESULTS

Exploratory factor analyses indicated a one-factor structure and a four-factor solution with eight items (69.3%-81.9% of the variance observed). The four-factor-8-item solution presented an interpretable structure and demonstrated good reliability values (> 0.70) and construct validity with the Twenty-Item Toronto Alexithymia Scale, Eight-Item Geriatric Depression Scale, and Geriatric Anxiety Inventory (r = 0.66, 0.40, 0.52; p < 0.001).

CONCLUSION

The robust psychometric properties of DERS-8 make it a valuable tool for clinical and longitudinal studies, facilitating targeted interventions in older adults and allowing for precise emotion dysregulation screening.

The biosocial correlates and predictors of emotion dysregulation in autistic adults compared to borderline personality disorder and nonclinical controls

BACKGROUND

Emotion dysregulation (ED) is a core symptom of borderline personality disorder (BPD), whose aetiology has been attributed to biosocial factors. In autism spectrum condition (ASC), although ED is prevalent and is associated with decreased well-being (e.g. self-harm, suicidality), it has been understudied, especially in adults. It is therefore crucial to further understand ED in autistic adults to improve its treatment. Our study investigates ED, its behavioural correlates (e.g. self-harm, suicidality) and biosocial predictors in autistic adults relative to BPD and nonclinical controls (NC).

METHODS

A total of 724 participants (ASC = 154; BPD = 111; NC = 459) completed 11 self-reported questionnaires assessing ED, ASC and BPD traits, co-occurring disorders, alexithymia, emotional vulnerability and invalidating experiences (e.g. bullying, autistic camouflaging). The occurrence of ED behavioural correlates (i.e. self-harm, history of suicide attempts, and psychiatric hospitalizations) was collected. In addition, between-groups analyses, linear regressions and machine learning (ML) models were used to identify ED predictors in each group.

RESULTS

ED and its behavioural correlates were higher in ASC compared to NC, but milder than in BPD. While gender did not predict ED scores, autistic women had increased risk factors to ED, including sexual abuse and camouflaging. Interestingly, BPD traits, emotional vulnerability and alexithymia strongly predicted ED scores across the groups. Using ML models, sensory sensitivity and autistic camouflaging were associated with ED in ASC, and ADHD symptoms with ED in BPD.

LIMITATIONS

ASC and BPD diagnoses were self-reported, which did not allow us to check their accuracy. Additionally, we did not explore the transactional and the moderating/mediating relationships between the different variables. Moreover, our research is cross-sectional and cannot draw conclusions regarding the direction and causality of relationships between ED and other clinical dimensions.

CONCLUSIONS

ED and its behavioural correlates are heightened in BPD compared to ASC and nonclinical controls. In the ASC group, there were no gender differences in ED, despite the heightened exposure of autistic women to ED risk factors. BPD traits, emotional vulnerability, and alexithymia are core to ED regardless of diagnosis. Although less central, sensory sensitivity and autistic camouflaging seem to be specific predictors of ED in autistic adults.

Prevalence of alexithymia in cancer patients: a systematic review and meta-analysis

PURPOSE

To systematically evaluate the prevalence of alexithymia in cancer patients and to compare the prevalence of alexithymia in different countries, genders, and cancer types.

METHODS

We thoroughly searched PubMed, EMBASE, Web of Science, The Cochrane Library, CINAHL, PsychINFO, China Integrated Knowledge Resource Database, Wanfang Database, Weipu Database, and Chinese Biomedical Database for studies on the prevalence of alexithymia in cancer patients from the inception to April 2, 2023. Based on the Stata 15.0 software package, the prevalence of alexithymia in cancer patients was estimated using a random-effects model in this meta-analysis.

RESULTS

Eighteen studies with a total of 3,196 participants met the eligibility criteria for the meta-analysis. In 18 studies, 37.0% (95% CI: 28.0% - 46.0%) of cancer patients had alexithymia. 13 studies identified that the pooled mean score of alexithymia in cancer patients was 56.91 (95% CI: 54.44% to 59.37%). The prevalence of alexithymia was higher in cancer patients in developing countries (39.7%, 95% CI: 28.7% to 50.7%), males (40.0%, 95% CI: 24.0% to 55.9%), and colorectal cancer patients (47.3%, 95% CI: 21.3% to 93.3%).

CONCLUSIONS

Our study found that the pooled prevalence of alexithymia in cancer patients was 37.0%, and higher in developing countries, males, and patients with colorectal cancer. Understanding the current status of alexithymia in cancer patients, timely identification and treatment by medical practitioners can improve the prognosis of cancer patients.

CLINICAL TRIAL REGISTRATION

The protocol was registered in PROSPERO [CRD42023414665].

Alexithymia, Burnout, and Hopelessness in a Large Sample of Healthcare Workers during the Third Wave of COVID-19 in Italy

In the present study, we aimed to assess the frequency of and the relationships between alexithymia, burnout, and hopelessness in a large sample of healthcare workers (HCWs) during the third wave of COVID-19 in Italy. Alexithymia was evaluated by the Italian version of the 20-item Toronto Alexithymia Scale (TAS-20) and its subscales Difficulty in Identifying Feelings (DIF), Difficulty in Describing Feelings (DDF), and Externally Oriented Thinking (EOT), burnout was measured with the scales emotional exhaustion (EE), depersonalisation (DP), and personal accomplishment (PA) of the Maslach Burnout Test (MBI), hopelessness was measured using the Beck Hopelessness Scale (BHS), and irritability (IRR), depression (DEP), and anxiety (ANX) were evaluated with the Italian version of the Irritability' Depression' Anxiety Scale (IDA). This cross-sectional study recruited a sample of 1445 HCWs from a large urban healthcare facility in Italy from 1 May to 31 June 2021. The comparison between individuals that were positive (n = 214, 14.8%) or not for alexithymia (n = 1231, 85.2%), controlling for age, gender, and working seniority, revealed that positive subjects showed higher scores on BHS, EE, DP IRR, DEP, ANX, DIF, DDF, and EOT and lower on PA than the not positive ones (p < 0.001). In the linear regression model, higher working seniority as well as higher EE, IRR, DEP, ANX, and DDF scores and lower PA were associated with higher hopelessness. In conclusion, increased hopelessness was associated with higher burnout and alexithymia. Comprehensive strategies should be implemented to support HCWs' mental health and mitigate the negative consequences of alexithymia, burnout, and hopelessness.

The associations of parental attitudes and peer bullying with alexithymia in adolescents: A structural equality model

AIM

The aim of this study is to investigate the relationship between parental attitude and peer bullying and alexithymia in adolescents.

METHODS

This cross-sectional descriptive study was conducted with adolescents aged 13-18 years within high schools in eastern Turkey. Cluster sampling method was applied, and the study was completed within four high schools determined by random selection method. Sociodemographic characteristics questionnaire form, Peer Bullying Scale Adolescent Form, and Twenty-item Toronto Alexithymia Scale (TAS-20) were used to collect the data.

RESULTS

Among the adolescents, 52% were female, 60% had a medium income level, 25.3% were in the 11th grade, 83% were living with their parents, 7.4% had chronic illnesses, 9.2% had psychiatric illnesses, 25.3% had suicidal thoughts, 10.1% engaged in suicidal behavior, and 25.3% used TV, smartphones, or tablets for 3-4 h a day. Rejecting and indifferent parental attitudes were found to be a possible risk factor for alexithymia, bullying and victimization.

CONCLUSIONS

This study highlights the connections between parental attitudes, peer bullying, and alexithymia in adolescents. By targeting positive parental attitudes and addressing peer interactions, nurses can effectively contribute to reducing the risk of alexithymia.

PRACTICE IMPLICATIONS

Through collaboration with parents, nurses can establish supportive environments that nurture emotional understanding. Remaining attentive to risk factors, such as chronic illnesses and mental health issues in adolescents, empowers nurses to offer timely support or referrals. Partnerships with educators further enhance emotional awareness and encourage positive peer relationships.

Alexithymia in chronic schizophrenia and its mediating effect between cognitive deficits and negative symptoms

BACKGROUND

Although cognition is known to impact clinical symptoms of schizophrenia, few studies investigate the potential mediators of this relationship. This study aimed to examine the relationship between cognitive deficits and negative symptoms in schizophrenia, considering the mediating role of alexithymia as an important psychological variable. Moreover, the prevalence of alexithymia in patients with schizophrenia was investigated.

METHODS

A total of 689 patients with schizophrenia were recruited from two psychiatric hospitals. All patients completed the Positive and Negative Syndrome Scale (PANSS), 20-item Toronto Alexithymia Scale (TAS-20), and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). We used structural equation modeling to examine the hypothesized mediated model.

RESULTS

In total, 31.5 % of patients with schizophrenia were classified as alexithymia. The path analyses showed that two factors of alexithymia (i.e., the difficulty in identifying feelings and difficulty in describing feelings), played a mediating role in the pathway from cognitive deficits to negative symptoms (all p < .001).

LIMITATIONS

Self-reported measurement for alexithymia may not be sufficiently reliable due to response bias.

CONCLUSION

Our findings demonstrated a high occurrence of alexithymia in patients with schizophrenia. Moreover, the mediating role of alexithymia suggests that targeting emotion processing and cognition may be a feasible way to mitigate negative symptoms.

The Emotion Regulation Questionnaire-Short Form (ERQ-S): A 6-item measure of cognitive reappraisal and expressive suppression

BACKGROUND

Emotion regulation plays a crucial role in affective functioning. One of the most commonly used measures of emotion regulation is the Emotion Regulation Questionnaire (ERQ), a 10-item self-report measure assessing frequency of use of two common emotion regulation strategies: cognitive reappraisal and expressive suppression. In this study, we aimed to optimize the utility of the ERQ for time-pressured settings by introducing and validating a 6-item short form called the Emotion Regulation Questionnaire-Short Form (ERQ-S).

METHOD

General community (N = 508) and college student (N = 245) samples from the United States completed online surveys containing a range of psychometric self-report measures. For each sample, we examined the factor structure, internal consistency, and concurrent validity of the ERQ-S.

RESULTS

Our confirmatory factor analyses supported the intended 2-factor structure of the ERQ-S (cognitive reappraisal and expressive suppression factors), with all items loading well on their intended factor in both samples. As expected, the ERQ-S correlated highly with the ERQ. A profile of low cognitive reappraisal use and high expressive suppression use on the ERQ-S was significantly associated with higher levels of emotion regulation difficulties, alexithymia, and affective symptoms.

LIMITATIONS

We did not examine psychometric performance in a clinical sample, or other cultural groups outside the US. All concurrent validity markers were self-report questionnaires.

CONCLUSIONS

Our data suggest that the ERQ-S successfully retains the psychometric strengths of the ERQ. The shorter format of the ERQ-S should therefore help to optimize the measurement of emotion regulation in time-pressured settings.

Early maladaptive schemas, emotion regulation difficulties and alexithymia: A systematic review and meta-analysis

BACKGROUND

Emotion regulation is an integral part of the schema therapy model. The aim of this systematic review and meta-analysis was to synthesize the evidence on the associations between early maladaptive schemas (EMSs), difficulties with emotion regulation and alexithymia.

METHOD

PsycINFO, PubMed and CINAHL Complete databases were searched on 28 May 2022 and 3 February 2023 in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Included studies were in English, in peer-reviewed journals and reported on the association between one or more of the 18 EMSs or five schema domains and emotion regulation difficulties or alexithymia. Methodological quality was assessed using the Appraisal Tool for Cross-Sectional Studies. Meta-analyses were conducted to examine difficulties with emotion regulation and alexithymia as correlates of each EMS and domain.

RESULTS

A total of 19 studies published between 2008 and 2022 were included (Pooled N = 5957). Difficulties with emotion regulation were positively correlated with all 18 EMSs (range: entitlement r(7) = .28, 95% CI [.13, .42] to negativity pessimism r(5) = .53, 95% CI [.23, .74]) and schema domains (range: impaired limits r(5) = .34, 95% CI [.08, .56] to disconnection rejection r(5) = .44, 95% CI [.33, .73]). Alexithymia was positively correlated with the other-directedness domain (r(2) = .40, 95% CI [.09, .64]) and 16 of the 18 EMSs (range: unrelenting standards r(5) = .21, 95% CI [.12, .28] to emotional inhibition r(5) = .50, 95% CI [.34, .63]).

CONCLUSIONS

The findings suggested that almost all 18 EMSs are implicated in emotion regulation difficulties and alexithymia, particularly those relating to unmet needs for attachment and autonomy.

The generation that lived during/participated in the war and the generation that inherited it: association between veterans PTSD and adult offspring's emotional regulation strategies and alexithymia levels

BACKGROUND

The long-term repercussions that war can have on both war generations and post-war generations lack in the literature. It is imperative to understand the psychological consequences of the Lebanese Civil War that took place from 1975 to 1990, on the offspring of those who took part in it. Accordingly, the objective of this study was to assess the association between paternal/veterans PTSD and adult offspring's emotional regulation strategies and alexithymia levels, 30 years after the end of war.

METHOD

A cross-sectional study was carried out between September 2020 and September 2021 on a sample of 75 fathers of Lebanese former veterans and paramilitary veterans and their adult offspring. For the veterans and paramilitary veterans' population, the PTSD Checklist was used to assess post-traumatic stress disorder, and the Combat Exposure Scale (CES) was used to measure the level of combat exposure. For the offspring population, the Emotional Regulation Questionnaire (ERQ) was used to assess emotional regulation strategies and the Toronto Alexithymia Scale (TAS) was used to measure the levels of alexithymia.

RESULTS

Paternal PTSD (Beta = 10.19) was associated with higher levels of alexithymia in the offspring population. Regarding emotional regulation strategies, results showed that paternal PTSD (Beta = -3.24) was significantly associated with a decrease in the cognitive reappraisal score in the offspring. Also, paternal PTSD (Beta = 4.57) was significantly associated with an increase in expressive suppression score. Additionally, an older father's age (Beta = 1.11) was significantly associated with an increased alexithymia score in the offspring. Moreover, results showed that paternal combat injuries (Beta = -4.24) were significantly associated with a decrease in the alexithymia score in the offspring population and an increase in the expressive suppression score (Beta = 3.28).

CONCLUSION

This study shows that fathers' traumatic experience of war influences emotion regulation and alexithymia levels in their offspring. Longitudinal studies taking into account the age of the offspring at the time of onset of fathers' symptoms may provide us with additional information to understand the influence of paternal PTSD on the emotional functioning of offspring during different phases of emotional development.

The Relationships between Compulsive Internet Use, Alexithymia, and Dissociation: Gender Differences among Italian Adolescents

Internet Gaming Disorder, Internet Addiction, Problematic Internet Use and Compulsive Internet Use cause distress and significant impairment in important areas of a person's functioning, in particular among young people. The literature has indicated that males show higher levels of problematic internet use than females. People can use the internet to avoid or alleviate negative affects; in fact, problematic internet use is associated with alexithymia and dissociation. Few studies have focused on the different stages of adolescence, gender differences, and the relationships between the aforementioned variables. This research aims to fill this gap. Five hundred and ninety-four adolescents aged between 13 and 19 filled in the Compulsive Internet Use Scale, the Toronto Alexithymia Scale, the Adolescents Dissociative Experiences Scale, and other ad hoc measures. Surprisingly, females reported higher compulsive internet use compared with males. Moreover, they referred more difficulties/symptoms and greater levels of alexithymia than males. No differences across the stages of adolescence were found. Different strengths in the relationships between variables were found according to gender. Moderated mediation analyses indicated that dissociation is an important mediator in the relation between alexithymia and Compulsive Internet Use only among females. This study shed new light on gender differences around problematic internet use and some related risk factors, in order to identify and develop prevention and treatment programs to face this topical and relevant issue.