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Carvalho T, Gomes C, Rodrigues A, da Motta C. Neuropathic pain, cognitive fusion, and alexithymia in patients with multiple sclerosis: Cross-sectional evidence for an explanatory model of anxiety symptoms. J Clin Psychol 2023; 79:1342-1356. [PMID: 36651192 DOI: 10.1002/jclp.23483] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/06/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023]
Abstract
Multiple sclerosis (MS) presents a high prevalence, a marked increase worldwide, and a relevant impact on patients, public health, and society. Anxiety often cooccurs with MS and can contribute to the worsening of MS symptoms. However, knowledge about predictors of anxiety in Patients with MS (PwMS) is scarce. OBJECTIVE This preliminary study explored a novel model for anxiety symptoms in PwMS, including neuropathic pain (NeP), cognitive fusion (CF), experiential avoidance (EA), and alexithymia as explanatory factors. METHOD This cross-sectional study integrated two independent convenience samples: 107 PwMS recruited from the Portuguese Society for Multiple Sclerosis and 97 age- and gender-matched participants without the MS diagnosis (no-MS sample) recruited from the Portuguese general population. Self-report questionnaires that measured the constructs included in the model were administered to both groups. RESULTS PwMS showed significantly higher values regarding anxiety symptoms and their explanatory variables (NeP, CF, EA, alexithymia) in comparison to non-MS participants. In the MS sample, no correlations were found between anxiety symptoms and sociodemographic and clinical characteristics. NeP, CF, and alexithymia showed significant correlations with anxiety symptoms and significantly explained this symptomatology in simple linear regression models. Thus, these variables were retained in the multiple linear regression model and emerged as significant regressors that together explained 38% of the variance in anxious symptomatology in PwMS. CONCLUSIONS This preliminary study provides novel evidence on NeP and some maladaptive emotion regulation strategies related to EA/psychological inflexibility, as vulnerability to anxiety in PwMS can be considerably increased by CF and alexithymia. Clinical implications were discussed.
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Affiliation(s)
- Teresa Carvalho
- Instituto Superior Miguel Torga, Coimbra, Portugal.,Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | | | | | - Carolina da Motta
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Lusófona University, HEI-Lab: Digital Human-Environment Interaction Lab, Lisbon, Portugal
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Chan J, Becerra R, Weinborn M, Preece D. Assessing Alexithymia across Asian and Western Cultures: Psychometric Properties of the Perth Alexithymia Questionnaire and Toronto Alexithymia Scale-20 in Singaporean and Australian Samples. J Pers Assess 2022; 105:396-412. [PMID: 35900047 DOI: 10.1080/00223891.2022.2095641] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Alexithymia refers to difficulties identifying feelings (DIF), describing feelings (DDF), and externally orientated thinking (EOT). Originally conceptualized by American psychiatrists, some researchers have since questioned the validity and application of this construct in Asian cultures. However, to date, there is little empirical work formally assessing the invariance of alexithymia across Asian and Western cultures. The present study aimed to help address this gap, by examining the psychometric properties and measurement invariance of two alexithymia measures, the Perth Alexithymia Questionnaire (PAQ) and Toronto Alexithymia Scale-20 (TAS-20), across samples from Singapore (n = 434) or Australia (n = 489). The same theoretically congruent factor structure was supported across both samples; this structure was fully invariant across samples for the PAQ, and partially invariant for the TAS-20. Both measures had good internal consistency and concurrent validity across samples, except the TAS-20 EOT subscale which had low internal consistency and factor loadings in both samples. The Singaporean sample reported higher DIF and DDF for positive emotions than the Australian sample. Overall, our results support the cross-cultural validity and application of the alexithymia construct. The PAQ and TAS-20 both appear to have good utility in this respect, though the PAQ may provide a more detailed facet-level profile.
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Affiliation(s)
- Joan Chan
- University of Western Australia, Perth, Australia
| | | | | | - David Preece
- University of Western Australia, Perth, Australia.,School of Psychology, Curtin University, Perth, Australia
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Cherry KM, Hoeven EV, Patterson TS, Lumley MN. Defining and measuring "psychological flexibility": A narrative scoping review of diverse flexibility and rigidity constructs and perspectives. Clin Psychol Rev 2021; 84:101973. [PMID: 33550157 DOI: 10.1016/j.cpr.2021.101973] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 12/16/2022]
Abstract
Psychological flexibility (PF) is a popular construct in clinical psychology. However, similar constructs have existed since the mid-20th century, resulting in different terms, definitions and measures of flexibility, hindering the advancement of the field. The main measure of PF - the Acceptance and Action Questionnaire (AAQ-II; Bond et al., 2011) - has also been heavily criticized. To move towards definitional consensus and improved measurement, we surveyed the literature to map PF and related-terms, examine definitional overlaps, and assessthe psychometric quality of prominent flexibility measures. A scoping review was conducted in two databases (PsycNET and SCOPUS). Twenty-three flexibility constructs appeared across 220 articles, and twelve measures were included and rated for quality. PF, psychological inflexibility (PI), and cognitive flexibility (CF) were most prominent. Definitional similarities among prominent flexibility constructs emerged, namely handling distress or interference, taking action, and meeting goals or values. The Personalized Psychological Flexibility Index (PPFI; Kashdan, Disabato, Goodman, Doorley, & McKnight, 2020) appears to be the best measure available to assess PF. Problems with the current use of the AAQ-II were apparent, hindering current knowledge of PF. Definitional consensus and measurement development are vital to advance the field. To this end, recommendations and next steps for researchers and practitioners are outlined.
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Affiliation(s)
- Kathlyn M Cherry
- Psychology Department, University of Guelph, Guelph, ON, Canada.
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How are Experiential Avoidance and Cognitive Fusion Associated with Alexithymia? JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2020. [DOI: 10.1007/s10942-020-00359-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hochheiser J, Lundin NB, Lysaker PH. The Independent Relationships of Metacognition, Mindfulness, and Cognitive Insight to Self-Compassion in Schizophrenia. J Nerv Ment Dis 2020; 208:1-6. [PMID: 31738223 PMCID: PMC8106243 DOI: 10.1097/nmd.0000000000001065] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The debilitating nature of psychosis may be exacerbated by societal stigma and feelings of social isolation over and above positive (e.g., hallucinations) and negative (e.g., flat affect) symptoms. Thus, recovery may be facilitated by increasing self-compassion, the ability to respond with a nonjudgmental attitude of kindness toward oneself as a result of connecting with one's own inadequacies and suffering. We conducted a stepwise regression in individuals with schizophrenia-spectrum disorders (n = 92) to determine the unique contributions of cognitive variables in predicting self-compassion, such as metacognition (the ability to form complex and integrated ideas about oneself and others), mindfulness, and cognitive insight. Results indicated that increased metacognitive awareness of others and mindfulness uniquely predicted greater self-compassion (i.e., self-kindness), whereas increased cognitive insight predicted greater lack of self-compassion (i.e., self-judgment). These findings suggest the potential for mindfulness and metacognitive interventions to increase positive self-compassion and promote recovery in psychosis.
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Affiliation(s)
- Jesse Hochheiser
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Nancy B. Lundin
- Department of Psychological and Brain Sciences, Indiana University, Bloomington
| | - Paul H. Lysaker
- Department of Psychiatry, Richard L. Roudebush Veterans Affairs Medical Center,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
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Patrikelis P, Lucci G, Alexoudi A, Korfias S, Messinis L, Nasios G, Papasilekas T, Sakas D, Gatzonis S. Addressing Evidence Linking Secondary Alexithymia to Aberrant Humor Processing. Behav Neurol 2019; 2019:1803624. [PMID: 31396292 PMCID: PMC6668559 DOI: 10.1155/2019/1803624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 05/09/2019] [Accepted: 05/14/2019] [Indexed: 01/06/2023] Open
Abstract
In this review, we explore current literature and assess evidence linking secondary (acquired) alexithymia to aberrant humor processing, in terms of their neurobiological underpinnings. In addition, we suggest a possible common neuropathological substrate between secondary alexithymia and deficits in humor appreciation, by drawing on neurophysiologic and neuroradiological evidence, as well as on a recent and unique single-case study showing the cooccurrence of secondary alexithymia and deficit in humor appreciation. In summary, what emerges from the literature is that the cortical midline structures, in particular the medial prefrontal cortex (mPFC), the anterior cingulate cortex (ACC), and the insular cortex, seem to play a crucial role in the expression of both alexithymia and defective humor processing, while though to a lesser extent, a right hemisphere and bilateral frontoparietal contribution becomes evident. Neurobiological evidence of secondary alexithymia and aberrant humor processing points to the putative role of ACC/mPFC and the insular cortex in representing crucial processing nodes whose damage may produce both the above clinical conditions. We believe that the association of secondary alexithymia and aberrant humor processing, especially humor appreciation deficit, and their correlation with specific brain regions, mainly ACG/mPFC, as emerged from the literature, may be of some heuristic importance. Increased awareness on this topic may be of aid for neurosurgeons when accessing emotion-relevant structures, as well as for neuropsychologists to intensify their efforts to plan evidence-based neurorehabilitative interventions to alleviate the deleterious effects of such interpersonal communication deficits.
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Affiliation(s)
- Panayiotis Patrikelis
- First Department of Neurosurgery, Medical School, National and Kapodistrian University of Athens, Greece
- Department of Technologies, Communication and Society, International University of Rome “G. Marconi”, Italy
| | - Giuliana Lucci
- Department of Technologies, Communication and Society, International University of Rome “G. Marconi”, Italy
| | - Athanasia Alexoudi
- First Department of Neurosurgery, Medical School, National and Kapodistrian University of Athens, Greece
| | - Stefanos Korfias
- First Department of Neurosurgery, Medical School, National and Kapodistrian University of Athens, Greece
| | - Lambros Messinis
- Neuropsychology Section, Departments of Neurology and Psychiatry, University Hospital of Patras and University of Patras Medical School, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Greece
| | - Themistoklis Papasilekas
- First Department of Neurosurgery, Medical School, National and Kapodistrian University of Athens, Greece
| | - Damianos Sakas
- First Department of Neurosurgery, Medical School, National and Kapodistrian University of Athens, Greece
| | - Stylianos Gatzonis
- First Department of Neurosurgery, Medical School, National and Kapodistrian University of Athens, Greece
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Galili-Weinstock L, Lazarus G, Atzil-Slonim D, Bar-Kalifa E, Rafaeli E, Peri T. Self-compassion among psychotherapy clients is in the details of negative, not positive, emotions. THE JOURNAL OF POSITIVE PSYCHOLOGY 2019. [DOI: 10.1080/17439760.2019.1627396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Gal Lazarus
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | | | - Eran Bar-Kalifa
- Departement of Psychology, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Eshkol Rafaeli
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Tuvia Peri
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
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Trindade IA, Duarte J, Ferreira C, Coutinho M, Pinto-Gouveia J. The impact of illness-related shame on psychological health and social relationships: Testing a mediational model in students with chronic illness. Clin Psychol Psychother 2018; 25:408-414. [DOI: 10.1002/cpp.2175] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Inês A. Trindade
- CINEICC-Cognitive-Behavioural Research Centre for Research and Intervention, Faculty of Psychology and Education Sciences; University of Coimbra; Coimbra Portugal
| | - Joana Duarte
- CINEICC-Cognitive-Behavioural Research Centre for Research and Intervention, Faculty of Psychology and Education Sciences; University of Coimbra; Coimbra Portugal
| | - Cláudia Ferreira
- CINEICC-Cognitive-Behavioural Research Centre for Research and Intervention, Faculty of Psychology and Education Sciences; University of Coimbra; Coimbra Portugal
| | - Mariana Coutinho
- Faculty of Psychology and Education Sciences; University of Coimbra; Coimbra Portugal
| | - José Pinto-Gouveia
- CINEICC-Cognitive-Behavioural Research Centre for Research and Intervention, Faculty of Psychology and Education Sciences; University of Coimbra; Coimbra Portugal
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