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Fuchs M, Kersting A, Suslow T, Bodenschatz CM. Recognizing and Looking at Masked Emotional Faces in Alexithymia. Behav Sci (Basel) 2024; 14:343. [PMID: 38667139 PMCID: PMC11047507 DOI: 10.3390/bs14040343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
Alexithymia is a clinically relevant personality construct characterized by difficulties identifying and communicating one's emotions and externally oriented thinking. Alexithymia has been found to be related to poor emotion decoding and diminished attention to the eyes. The present eye tracking study investigated whether high levels of alexithymia are related to impairments in recognizing emotions in masked faces and reduced attentional preference for the eyes. An emotion recognition task with happy, fearful, disgusted, and neutral faces with face masks was administered to high-alexithymic and non-alexithymic individuals. Hit rates, latencies of correct responses, and fixation duration on eyes and face mask were analyzed as a function of group and sex. Alexithymia had no effects on accuracy and speed of emotion recognition. However, alexithymic men showed less attentional preference for the eyes relative to the mask than non-alexithymic men, which was due to their increased attention to face masks. No fixation duration differences were observed between alexithymic and non-alexithymic women. Our data indicate that high levels of alexithymia might not have adverse effects on the efficiency of emotion recognition from faces wearing masks. Future research on gaze behavior during facial emotion recognition in high alexithymia should consider sex as a moderating variable.
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Affiliation(s)
| | | | - Thomas Suslow
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, 04103 Leipzig, Germany; (M.F.); (A.K.); (C.M.B.)
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Zahid A, Taylor GJ, Lau SCL, Stone S, Bagby RM. Examining the Incremental Validity of the Perth Alexithymia Questionnaire (PAQ) Relative to the 20-Item Toronto Alexithymia Scale (TAS-20). J Pers Assess 2024; 106:242-253. [PMID: 37144843 DOI: 10.1080/00223891.2023.2201831] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/28/2023] [Indexed: 05/06/2023]
Abstract
The 20-item Toronto Alexithymia Scale (TAS-20) is the most widely used instrument for assessing alexithymia, with more than 25 years of research supporting its reliability and validity. The items that compose this scale were written to operationalize the components of the construct that are based on clinical observations of patients and thought to reflect deficits in the cognitive processing of emotions. The Perth Alexithymia Questionnaire (PAQ) is a recently introduced measure and is based on a theoretical attention-appraisal model of alexithymia. An important step with any newly developed measure is to evaluate whether it demonstrates incremental validity over existing measures. In this study using a community sample (N = 759), a series of hierarchical regression analyses were conducted that included an array of measures assessing constructs closely associated with alexithymia. Overall, the TAS-20 showed strong associations with these various constructs to which the PAQ was unable to add any meaningful increase in prediction relative to the TAS-20. We conclude that until future studies with clinical samples using several different criterion variables demonstrate incremental validity of the PAQ, the TAS-20 should remain the self-report measure of choice for clinicians and researchers assessing alexithymia, albeit as part of a multi-method approach.
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Affiliation(s)
- Aqsa Zahid
- Department of Psychological Clinical Science, University of Toronto
| | | | | | | | - R Michael Bagby
- Department of Psychological Clinical Science, University of Toronto
- Department of Psychiatry, University of Toronto
- Department of Psychology, University of Toronto
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Yu L, Wang W, Li Z, Ren Y, Liu J, Jiao L, Xu Q. Alexithymia modulates emotion concept activation during facial expression processing. Cereb Cortex 2024; 34:bhae071. [PMID: 38466112 DOI: 10.1093/cercor/bhae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Abstract
Alexithymia is characterized by difficulties in emotional information processing. However, the underlying reasons for emotional processing deficits in alexithymia are not fully understood. The present study aimed to investigate the mechanism underlying emotional deficits in alexithymia. Using the Toronto Alexithymia Scale-20, we recruited college students with high alexithymia (n = 24) or low alexithymia (n = 24) in this study. Participants judged the emotional consistency of facial expressions and contextual sentences while recording their event-related potentials. Behaviorally, the high alexithymia group showed longer response times versus the low alexithymia group in processing facial expressions. The event-related potential results showed that the high alexithymia group had more negative-going N400 amplitudes compared with the low alexithymia group in the incongruent condition. More negative N400 amplitudes are also associated with slower responses to facial expressions. Furthermore, machine learning analyses based on N400 amplitudes could distinguish the high alexithymia group from the low alexithymia group in the incongruent condition. Overall, these findings suggest worse facial emotion perception for the high alexithymia group, potentially due to difficulty in spontaneously activating emotion concepts. Our findings have important implications for the affective science and clinical intervention of alexithymia-related affective disorders.
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Affiliation(s)
- Linwei Yu
- Department of Psychology, Ningbo University, Ningbo 315211, China
| | - Weihan Wang
- Department of Psychology, Ningbo University, Ningbo 315211, China
| | - Zhiwei Li
- Department of Psychology, Ningbo University, Ningbo 315211, China
| | - Yi Ren
- Department of Psychology, Ningbo University, Ningbo 315211, China
| | - Jiabin Liu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Lan Jiao
- Department of Psychology, Ningbo University, Ningbo 315211, China
| | - Qiang Xu
- Department of Psychology, Ningbo University, Ningbo 315211, China
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Ruan QN, Liu L, Shen GH, Wu YW, Yan WJ. Alexithymia and peer victimisation: interconnected pathways to adolescent non-suicidal self-injury. BJPsych Open 2024; 10:e46. [PMID: 38344860 PMCID: PMC10897695 DOI: 10.1192/bjo.2023.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND The prevalence of non-suicidal self-injury (NSSI) among adolescents underscores the importance of understanding the complex factors that drive this behaviour. Framed within broader constructs of emotional regulation theories, alexithymia and peer victimisation are thought to interact to influence NSSI behaviours. AIM This research addresses whether alexithymia and peer victimisation serve as risk factors for NSSI and, if so, how these factors interact with each other. METHOD This quantitative study analysed data from 605 adolescents, using a range of validated self-report measures including the Toronto Alexithymia Scale. Statistical analyses including one-way analysis of variance, multiple regression and structural equation modelling were employed to scrutinise the relationships among the variables. RESULTS Alexithymia and peer victimisation significantly predicted NSSI behaviours. Specifically, the 'difficulty in identifying feelings' subscale of alexithymia emerged as a noteworthy predictor of NSSI (P < 0.001). Peer victimisation mediated the relationship between alexithymia and NSSI, explaining approximately 24.50% of alexithymia's total effect on NSSI. In addition, age was a significant predictor of NSSI, but gender and education years were not (P > 0.05). These relationships were found to be invariant across genders. CONCLUSIONS This study enriches our understanding of the interplay between alexithymia, peer victimisation and NSSI, particularly within the Chinese context. Its findings have significant implications for a rethinking of alexithymia's theoretical construct and interventions targeting emotional literacy and peer dynamics among adolescents. Future research could benefit from a longitudinal design to establish causality.
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Affiliation(s)
| | - Linhui Liu
- Lishui Second People's Hospital, Affiliated to Wenzhou Medical University, Lishui, China
| | | | - Yu-Wei Wu
- Student Affairs Division, Wenzhou Business College, Wenzhou, China
| | - Wen-Jing Yan
- Wenzhou Medical University, Wenzhou, China; and Zhejiang Provincial Clinical Research Centre for Mental Illness, Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, China
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Marazzi F, Orlandi M, De Giorgis V, Borgatti R, Mensi MM. The impact of family alexithymia on the severity of restrictive eating disorders in adolescent patients. Child Adolesc Psychiatry Ment Health 2023; 17:139. [PMID: 38115116 PMCID: PMC10731864 DOI: 10.1186/s13034-023-00692-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Alexithymia is the inability to identify and describe one's own emotions. Adolescents who suffer from Restrictive Eating Disorders (REDs) show a higher prevalence of alexithymia than the general population. METHODS The study explored the correlation between levels of alexithymia in mothers, fathers, and adolescents affected by REDs and patients' ability to recognize their emotions. The study also aimed to evaluate if patients' emotional distress can significantly impact the severity of their disorder and functioning measured by the Clinical Global Impression Scale - Severity (CGI-S) and the Children's Global Assessment Scale (CGAS). We enrolled 67 families of adolescents affected by REDs. Parents and patients' levels of alexithymia were assessed through the Toronto Alexithymia Scale (TAS-20). Spearman's correlation shows a statistically significant correlation between mothers and patients' levels of alexithymia. RESULTS Our findings also suggest that fathers and mothers' TAS scores correlate with each other. However, there is no statistically significant relationship between the influence of the TAS scores of fathers and sons/daughters. CONCLUSIONS In conclusion, mothers' level of alexithymia could influence both fathers and patients' difficulty in identifying and describing their own emotions. This relationship can be investigated further when considering externally oriented thinking. However, the severity of the disease and overall functioning do not appear to be affected by patients' levels of alexithymia.
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Affiliation(s)
- Francesca Marazzi
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Marika Orlandi
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.
| | - Valentina De Giorgis
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Renato Borgatti
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
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Koppelberg P, Kersting A, Suslow T. Alexithymia and interpersonal problems in healthy young individuals. BMC Psychiatry 2023; 23:688. [PMID: 37735376 PMCID: PMC10515237 DOI: 10.1186/s12888-023-05191-z] [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: 03/02/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Alexithymia refers to a multidimensional personality trait with the facets difficulties identifying feelings (DIF), difficulties describing feelings (DDF), and externally orientated thinking (EOT). Alexithymia is a risk factor for mental and somatic disorders. Previous research with patients suffering from various disorders showed positive relationships between alexithymia and interpersonal problems. Only one study analyzed the link between alexithymic features and interpersonal difficulties in healthy individuals but yielded inconclusive findings because participants' negative affects were not controlled. A widely accepted conceptualization of interpersonal problems relies on the interpersonal circumplex, which is defined by two orthogonal dimensions, agency and communion. In the present study, we analyzed which facets of alexithymia are associated with the two interpersonal problem dimensions and the global severity of interpersonal distress, after adjusting for negative affect. METHODS Two-hundred healthy young individuals (100 women) participated in the study. Alexithymic features were assessed using the 20-Item Toronto Alexithymia Scale (TAS-20). Interpersonal problems were measured with the Inventory of Interpersonal Problems (IIP-D). Participants' state and trait anxiety, depressive symptoms, and verbal intelligence were also assessed. RESULTS All alexithymia scales were positively correlated with general interpersonal distress. Regression results suggested that the TAS-20 subscale DIF was the primary predictor of general interpersonal distress after controlling for negative affectivity. The scale DDF correlated negatively with the IIP-D dimension agency. According to our regression analysis, DDF was a predictor of (low) agency controlling for negative affects. Moreover, DDF correlated negatively with the IIP-D dimension communion. Our regression results indicate that DDF was a predictor of (low) communion independent of negative affect. Correlations between alexithymia facets and IIP-D subscales did not differ between genders. CONCLUSIONS Difficulties identifying feelings seem to be linked to a high level of general interpersonal distress. Difficulties in recognizing one's feelings may disrupt emotion regulation, which could heighten the general risk of interpersonal problems. Difficulties describing feelings could be a central factor contributing to interpersonal problems related to low communion as well as low agency, since emotion expression and communication are crucial in establishing experiences of social closeness and directing other people's behavior.
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Affiliation(s)
- Pauline Koppelberg
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Semmelweisstr, 10, 04103, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Semmelweisstr, 10, 04103, Leipzig, Germany
| | - Thomas Suslow
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Semmelweisstr, 10, 04103, Leipzig, Germany.
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Taylor GJ, Bagby RM, Porcelli P. Revisiting the Concept of Pensée Opératoire: Some Conceptual, Empirical, and Clinical Considerations. Psychodyn Psychiatry 2023; 51:287-310. [PMID: 37712663 DOI: 10.1521/pdps.2023.51.3.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
The concept of pensée opératoire (operational thinking) was introduced by French psychoanalysts in 1963 and a decade later was included as an essential component of the alexithymia construct as formulated by the U.S. analysts John Nemiah and Peter Sifneos. Despite a large body of research on alexithymia, the pensée opératoire component is not well understood, especially among clinicians and researchers who are not familiar with French psychoanalytic literature. In this article we clarify the definition and metapsychological conceptualization of the concept, review findings from some relevant empirical studies, and critique a recent proposal for redefining the alexithymia construct that departs from the original understanding of pensée opératoire. We also discuss some clinical implications of the concept and some strategies that psychotherapists can employ in the treatment of patients with this mode of thinking.
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Affiliation(s)
- Graeme J Taylor
- Professor Emeritus of Psychiatry, University of Toronto, Canada
| | - R Michael Bagby
- Professor of Psychology and Psychiatry, University of Toronto, Canada
| | - Piero Porcelli
- Professor of Clinical Psychology, Department of Psychological, Health, and Territorial Sciences, University of Chieti, Italy
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Lee SH, Lee KT. The impact of pandemic-related stress on attentional bias and anxiety in alexithymia during the COVID-19 pandemic. Sci Rep 2023; 13:6327. [PMID: 37072486 PMCID: PMC10112327 DOI: 10.1038/s41598-023-33326-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 04/11/2023] [Indexed: 05/03/2023] Open
Abstract
The COVID-19 pandemic had negative consequences for mental health, yet it is unknown how and to what extent the psychological outcomes of this stressful event are moderated by individual traits. Alexithymia is a risk factor for psychopathology, and thus likely predicted individual differences in resilience or vulnerability to stressful events during the pandemic. This study explored the moderating role of alexithymia in the relationships of pandemic-related stress with anxiety levels and attentional bias. The participants were 103 Taiwanese individuals who completed a survey during the outbreak of the Omicron wave. Additionally, an emotional Stroop task including pandemic-related or neutral stimuli was used to measure attentional bias. Our results demonstrate that pandemic-related stress had a lesser impact on anxiety in individuals with a higher level of alexithymia. Moreover, we found that in individuals with higher exposure to pandemic-related stressors, a higher level of alexithymia indicated less attentional bias toward COVID-19-related information. Thus, it is plausible that individuals with alexithymia tended to avoid pandemic-related information, which could temporarily relieve stressors during the pandemic.
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Affiliation(s)
- Shu-Hui Lee
- Center for General Education, National Tsing Hua University, Hsinchu, Taiwan.
- Department of Educational Psychology and Counseling, National Tsing Hua University, Hsinchu, Taiwan.
| | - Kuan-Te Lee
- Department of Educational Psychology and Counseling, National Tsing Hua University, Hsinchu, Taiwan
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Díaz R, Prinz J. The role of emotional awareness in evaluative judgment: evidence from alexithymia. Sci Rep 2023; 13:5183. [PMID: 36997616 PMCID: PMC10063600 DOI: 10.1038/s41598-023-32242-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
AbstractEvaluative judgments imply positive or negative regard. But there are different ways in which something can be positive or negative. How do we tell them apart? According to Evaluative Sentimentalism, different evaluations (e.g., dangerousness vs. offensiveness) are grounded on different emotions (e.g., fear vs. anger). If this is the case, evaluation differentiation requires emotional awareness. Here, we test this hypothesis by looking at alexithymia, a deficit in emotional awareness consisting of problems identifying, describing, and thinking about emotions. The results of Study 1 suggest that high alexithymia is not only related to problems distinguishing emotions, but also to problems distinguishing evaluations. Study 2 replicated this latter effect after controlling for individual differences in attentional impulsiveness and reflective reasoning, and found that reasoning makes an independent contribution to evaluation differentiation. These results suggest that emotional sensibilities play an irreducible role in evaluative judgment while affording a role for reasoning.
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Veirman E, Crombez G, Van Ryckeghem DML. The importance of measurement content and study design. Comment on Habibi Asgarabad et al. (2023). The relationship of alexithymia to pain and other symptoms in fibromyalgia: A systematic review and meta-analysis. Eur J Pain 2023. [PMID: 36883870 DOI: 10.1002/ejp.2106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/01/2023] [Accepted: 03/04/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Elke Veirman
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Dimitri M L Van Ryckeghem
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium.,Department of Behavioural and Cognitive Sciences, Faculty of Humanities, Education and Social Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg.,Experimental Health Psychology, Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
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Alexithymia as a Risk Factor for Social Indifference: A Quantitative Study with a Large Sample of Female Adolescents. SCHOOL MENTAL HEALTH 2023. [DOI: 10.1007/s12310-023-09568-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Lee SH, Lee KT. Attentional Processing of Unpleasant Stimuli in Alexithymia. Psychol Rep 2022:332941221146917. [PMID: 36527407 DOI: 10.1177/00332941221146917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Alexithymia is a multi-faceted personality trait defined by difficulties in identifying and describing emotions and is considered a risk factor for multiple psychiatric disorders. Current alexithymia research debates the type of attention bias involved in the processing of negative emotional information, especially in anxiety-evoking situations that are frequently associated with stress states. Relatedly, this study aims to examine the role of emotional influence on the attentional processing of Taiwanese alexithymic individuals. Using the Chinese version of the Toronto Alexithymia Scale-20 (TAS-20), individuals with high alexithymia (HA: TAS > 60, n = 26; Mage = 23.36) and individuals with low alexithymia (LA: TAS < 39, n = 26; Mage = 25.76) were recruited. Participants performed an emotional counting Stroop task preceded by anxiety-evoking (threatening and aversive pictures) or neutral pictures. Reaction times (RTs) of the emotional Stroop task were compared between HA and LA groups. Our results demonstrate that compared to individuals with LA, individuals with HA show early avoidance tendency (i.e., allocate less attentional resources to anxiety-evoking stimuli), and that negative affect therefore does not interfere with subsequent attention processing during the Stroop task, resulting in faster RT for unpleasant stimuli (Mthreatening = 683.87, Maversive = 685.87) than neutral stimuli (Mneutral = 695.64) (ps < .05). In addition, the attentional bias toward specific types of negative emotion was not differentiated in individuals with HA (p < .05), suggesting that alexithymic individuals' emotion schemas may be underdeveloped in terms of ability to specify exact emotions. This study provides evidence regarding early sensitization to negative stimuli during information processing, consistent with the notion that alexithymia is related to avoidant emotion regulation processes.
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Affiliation(s)
- Shu-Hui Lee
- Center for General Education, 34881National Tsing Hua University, Hsinchu, Taiwan
| | - Kuan-Te Lee
- Department of Educational Psychology and Counseling, 34881National Tsing Hua University, Hsinchu, Taiwan
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A cross-modal component of alexithymia and its relationship with performance in a social cognition task battery. J Affect Disord 2022; 298:625-633. [PMID: 34763032 DOI: 10.1016/j.jad.2021.11.012] [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] [Received: 04/15/2021] [Revised: 07/24/2021] [Accepted: 11/05/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The personality trait alexithymia describes an altered emotional awareness that is associated with a range of social impairments and constitutes a transdiagnostic risk factor for various psychopathologies. Despite the characteristic interoceptive deficits in alexithymia, it is predominantly assessed via self-reports. This can result in unreliable measurements and arguably contributes to the prevailing uncertainty regarding its components, including constricted imaginal processes and emotional reactivity. METHODS The current study employed an interview and two validated questionnaires to derive a shared component of multi-modally assessed alexithymia in a German non-clinical sample (n = 78) via prinicipal component analysis. This component was used as a predictor for performance in four behavioural social cognition tasks. The relative importance of this predictor against related variables was assessed via dominance analysis. RESULTS The identified component reflected cognitive alexithymia. Higher cognitive alexithymia scores were associated with less affective distress in an ostracizing task. Dominance analysis revealed the dominance of competing autism traits relative to cognitive alexithymia and competing predictors empathy, depression, and anxiety, in predicting affective distress. LIMITATIONS Emotional reactivity was only assessed via self-report and no implicit measures of alexithymia were employed. Due to the low reliability of the self-report measure, no measure of emotional reactivity could be included in the principal component analysis. CONCLUSIONS Our results provide compelling evidence that cognitive interoceptive deficits are at the core of alexithymia across assessment modalities. Behavioural data suggest that these deficits result in diminished emotional sensitivity to high-pressure social situations, which may cause a lack of behavioural adaptation.
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Taylor GJ, Bagby RM. Examining Proposed Changes to the Conceptualization of the Alexithymia Construct: The Way Forward Tilts to the Past. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:145-155. [PMID: 33285546 DOI: 10.1159/000511988] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Graeme J Taylor
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,
| | - R Michael Bagby
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
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15
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Schiewer V, Dietz T, Tavenrath S, Öztürk-Arenz H, Jäger RS, Klein A, Labouvie H, Kusch M. [Common foundation of alexithymia and expressive suppression]. PSYCHOTHERAPEUT 2021; 67:166-175. [PMID: 34720437 PMCID: PMC8549590 DOI: 10.1007/s00278-021-00546-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/10/2022]
Abstract
Hintergrund Internationale Studien konnten bereits einen Zusammenhang zwischen Alexithymie und expressiver Suppression belegen. Im deutschsprachigen Raum wurde dieser Zusammenhang bisher nur sehr selten betrachtet. Übergeordnetes Ziel der vorliegenden Studie war die Untersuchung eines korrelativen und faktoriellen Zusammenhangs von Alexithymie und expressiver Suppression. Material und Methoden Insgesamt 317 Personen nahmen einer Onlinebefragung teil. Mithilfe der deutschsprachigen Versionen der Toronto Alexithymia Scale-26 (TAS-26) und des Emotion Regulation Questionnaire (ERQ) wurden Daten zu Alexithymie und expressiver Suppression erfasst. Ergebnisse Es bestanden signifikante Korrelationen zwischen der Subskala „Schwierigkeit bei der Identifikation von Gefühlen“ der TAS-26 und der Skala „Unterdrückung“ des ERQ (r = 0,5; p < 0,001) sowie zwischen der Subskala „Schwierigkeit bei der Beschreibung von Gefühlen“ der TAS-26 und der Skala „Unterdrückung“ des ERQ (r = 0,64; p < 0,001). Die Ergebnisse einer explorativen Faktorenanalyse ergaben eine Zwei-Faktoren-Lösung mit einem gemeinsamen Faktor für die TAS-26-Subskalen „Schwierigkeit bei der Identifikation von Gefühlen“ und „Schwierigkeit bei der Beschreibung von Gefühlen“ und der Skala „Unterdrückung“ des ERQ mit einer gemeinsamen Varianz von 38,2 % (χ2 = 363,843; p < 0,001; Kaiser-Meyer-Olkin[KMO]-Wert = 0,699). Schlussfolgerung Die Ergebnisse legen nahe, dass den Skalen der TAS-26 in den Komponenten „Schwierigkeit bei der Identifikation von Gefühlen“ und „Schwierigkeit bei der Beschreibung von Gefühlen“ sowie der Skala „Unterdrückung“ des ERQ in der Komponente der „expressiven Suppression“ ein gemeinsames Konstrukt zugrunde liegt, das mit dem Begriff der Sprachlosigkeit belegt werden kann.
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Affiliation(s)
- Vera Schiewer
- Psychoonkologische Versorgungsforschung, Klinik I für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - Thilo Dietz
- Psychoonkologische Versorgungsforschung, Klinik I für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - Sally Tavenrath
- Psychoonkologische Versorgungsforschung, Klinik I für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - Hülya Öztürk-Arenz
- Psychoonkologische Versorgungsforschung, Klinik I für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - Reinhold S Jäger
- Zentrum für Empirische Pädagogische Forschung, Universität Koblenz-Landau, Campus Landau, Landau, Deutschland
| | - Anne Klein
- Psychoonkologische Versorgungsforschung, Klinik I für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - Hildegard Labouvie
- Psychoonkologische Versorgungsforschung, Klinik I für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - Michael Kusch
- Psychoonkologische Versorgungsforschung, Klinik I für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
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16
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Alexithymia and metabolic syndrome: the mediating role of binge eating. Eat Weight Disord 2021; 26:1813-1823. [PMID: 32920774 PMCID: PMC8292257 DOI: 10.1007/s40519-020-00964-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/11/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Alexithymia, a personality trait characterized by difficulties in emotional processing, has been associated with unhealthy behaviors and chronic medical conditions. This study aimed to further develop our understanding of this complex relationship by investigating whether alexithymia increases the risk of metabolic syndrome (MetS) in participants with obesity or overweight through the mediating role of binge eating (BE). METHODS A consecutive sample of 238 treatment-seeking patients with obesity or overweight were recruited. Alexithymia (TAS-20), binge eating symptoms (BES), body mass index (BMI), and depression and anxiety symptoms (HADS) were concurrently assessed. RESULTS Almost half of the participants met the criteria for MetS (44.12%). Compared to patients without MetS, those with MetS were older, had a longer duration of overweight, and had a higher BMI (p < 0.01). Individual with MetS also had higher HADS, BES, and TAS-20 scores, particularly difficulty identifying and describing feelings. The structural equation modeling (SEM) analysis revealed that BES levels exerted a significant direct effect on MetS (p < 0.01), and that TAS-20 levels exerted a significant direct effect on BES (p < 0.01), anxiety (p < 0.001) and depression (p < 0.001). Moreover, psychological distress (anxiety, p = 0.01, and depression, p = .05) indirectly affected MetS through the mediating effect of BES, and TAS-20 (p = 0.01) indirectly affected MetS through the mediating effect of HADS and BES. Finally, age had a significant direct effect on MetS (p < 0.001). CONCLUSION Our findings indicate that alexithymia is a concurrent causative factor to the development of MetS through the mediating role of BE and psychological distress. LEVEL OF EVIDENCE Level III, case-control analytic study.
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17
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Veirman E, Van Ryckeghem DML, Verleysen G, De Paepe AL, Crombez G. What do alexithymia items measure? A discriminant content validity study of the Toronto-alexithymia-scale-20. PeerJ 2021; 9:e11639. [PMID: 34249500 PMCID: PMC8253111 DOI: 10.7717/peerj.11639] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/28/2021] [Indexed: 12/22/2022] Open
Abstract
Background Questions have been raised about whether items of alexithymia scales assess the construct alexithymia and its key features, and no other related constructs. This study assessed the (discriminant) content validity of the most widely used alexithymia scale, i.e., the Toronto Alexithymia Scale (TAS-20). Methods Participants (n = 81) rated to what extent TAS-20 items and items of related constructs were relevant for assessing the constructs ‘alexithymia’, ‘difficulty identifying feelings’, ‘difficulty describing feelings’, ‘externally-oriented thinking’, ‘limited imaginal capacity’, ‘anxiety’, ‘depression’, and ‘health anxiety’. Results Results revealed that, overall, the TAS-20 did only partly measure ‘alexithymia’. Only the subscales ‘difficulty identifying feelings’ and ‘difficulty describing feelings’ represented ‘alexithymia’ and their intended construct, although some content overlap between these subscales was found. In addition, some items assessed (health) anxiety equally well or even better. Conclusions Revision of the TAS-20 is recommended to adequately assess all key features of alexithymia. Findings with the TAS-20 need to be interpreted with caution in people suffering from medical conditions.
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Affiliation(s)
- Elke Veirman
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Dimitri M L Van Ryckeghem
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium.,Department of Behavioural and Cognitive Sciences, Faculty of Humanities, Education and Social Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg.,Experimental Health Psychology, Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Gregory Verleysen
- Centre for Research and Innovation in Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,End-of-Life Care Research group, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Annick L De Paepe
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
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18
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Scarpazza C, Zangrossi A, Huang YC, Sartori G, Massaro S. Disentangling interoceptive abilities in alexithymia. PSYCHOLOGICAL RESEARCH 2021; 86:844-857. [PMID: 34097132 PMCID: PMC8182733 DOI: 10.1007/s00426-021-01538-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 05/25/2021] [Indexed: 12/20/2022]
Abstract
In recent years, research on interoceptive abilities (i.e., sensibility, accuracy, and awareness) and their associations with emotional experience has flourished. Yet interoceptive abilities in alexithymia—a personality trait characterized by a difficulty in the cognitive interpretation of emotional arousal, which impacts emotional experience—remain under-investigated, thereby limiting a full understanding of subjective emotional experience processing. Research has proposed two contrasting explanations thus far: in one model, the dimensions of interoceptive sensibility and accuracy in alexithymia would increase; in the other model, they would decrease. Surprisingly, the contribution of interoceptive awareness has been minimally researched. In this study (N = 182), the relationship between participants’ level of alexithymia and the three interoceptive dimensions was tested. Our results show that the higher the level of alexithymia is, the higher interoceptive accuracy and sensibility (R2 = 0.29 and R2 = 0.14); conversely, the higher the level of alexithymia is, the lower interoceptive awareness (R2 = 0.36). Moreover, an ROC analysis reveals that interoceptive awareness is the most accurate predictor of alexithymia, yielding over 92% accuracy. Collectively, these results support a coherent understanding of interoceptive abilities in alexithymia, whereby the dissociation of interoceptive accuracy and awareness may explain the underlying psycho-physiological mechanisms of alexithymia. A possible neurocognitive mechanism is discussed which suggests insurgence of psychosomatic disorders in alexithymia and related psychotherapeutic approaches.
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Affiliation(s)
- Cristina Scarpazza
- Department of General Psychology, University of Padua, Via Venezia 8, 35131, Padua, PD, Italy.
| | - Andrea Zangrossi
- Department of Neuroscience, University of Padua, Via Giustiniani, 5, 35128, Padua, Italy.,Padova Neuroscience Center (PCN), University of Padua, Via Giustiniani, 5, 35128, Padua, Italy
| | - Yu-Chun Huang
- The Organizational Neuroscience Laboratory, 27 Old Gloucester Street, London, WC1N 3AX, UK.,Department of Psychology, University of Warwick, University Road, Coventry, CV4 7AL, UK
| | - Giuseppe Sartori
- Department of General Psychology, University of Padua, Via Venezia 8, 35131, Padua, PD, Italy
| | - Sebastiano Massaro
- The Organizational Neuroscience Laboratory, 27 Old Gloucester Street, London, WC1N 3AX, UK.,Surrey Business School, University of Surrey, Guildford, Rik Medlik Building (MS), Guildford, GU2 7XH, UK
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19
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Lane RD, Solms M, Weihs KL, Hishaw A, Smith R. Is the concept of affective agnosia a useful addition to the alexithymia literature? Neurosci Biobehav Rev 2021; 127:747-748. [PMID: 34004243 DOI: 10.1016/j.neubiorev.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/11/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Richard D Lane
- From the Department of Psychiatry, University of Arizona, 1501 N. Campbell Ave., Tucson, AZ, 85724-5002, United States; From the Department of Psychology, University of Arizona, 1503 E. University Blvd., Tucson, AZ, 85721, United States; From the Department of Neuroscience, University of Arizona, 1040 E. 4th St., P.O. Box 210077, Tucson, AZ, 85721, United States.
| | - Mark Solms
- Department of Psychology, University of Cape Town, Rondebosch, South Africa.
| | - Karen L Weihs
- From the Department of Psychiatry, University of Arizona, 1501 N. Campbell Ave., Tucson, AZ, 85724-5002, United States; From the Department of Family and Community Medicine, University of Arizona, 1450 N. Cherry Ave., #101, Tucson, AZ, 85719, United States.
| | - Alex Hishaw
- From the Department of Psychiatry, University of Arizona, 1501 N. Campbell Ave., Tucson, AZ, 85724-5002, United States; From the Department of Neurology, University of Arizona, 1501 N. Campbell Ave., Tucson, AZ, 85724-5023, United States.
| | - Ryan Smith
- Laureate Institute for Brain Research, 6655 S. Yale Ave., Tulsa, OK, 74136, United States.
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20
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Luminet O, Nielson KA, Ridout N. Having no words for feelings: alexithymia as a fundamental personality dimension at the interface of cognition and emotion. Cogn Emot 2021; 35:435-448. [PMID: 33900884 DOI: 10.1080/02699931.2021.1916442] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This special issue brings together two important reviews and seven cutting-edge empirical papers concerning the influence of alexithymia on cognitive and emotional processing. Alexithymia is a multifaceted construct that is characterised by difficulties identifying one's feelings; difficulties describing one's feelings to others; and an externally focused, utilitarian cognitive style. In this paper, we begin by considering how emotion science has evolved in its understanding of personality traits, before highlighting the potential importance of alexithymia research for the field of cognition and emotion. After summarising the historical context of alexithymia research, we consider the contributions of the featured papers to the literature of cognition and emotion. The collected works highlight that alexithymia influences several aspects of how one perceives and responds to neutral and emotional situations, by impacting upon multiple processes (attention, appraisals, memory, language and behaviour), showing the importance of drawing better connections amongst multiple processes, toward disentangling the effects of early processes on later ones. A lack of correspondence between processes, as well as amongst alexithymia facets, is another central finding of the special issue. This pattern is thought to lead to ineffective and inflexible emotion regulation and to pose significant risks for physical and mental illness.
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Affiliation(s)
- Olivier Luminet
- Research Institute for Psychological Sciences, UCLouvain, Louvain-la-Neuve, Belgium.,Fund for Scientific Research (FRS-FNRS), Brussels, Belgium
| | - Kristy A Nielson
- Department of Psychology, Marquette University, Milwaukee, WI, USA.,Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nathan Ridout
- Department of Psychology, School of Life & Health Sciences, Aston University, Birmingham, UK
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21
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Luminet O, Nielson KA, Ridout N. Cognitive-emotional processing in alexithymia: an integrative review. Cogn Emot 2021; 35:449-487. [PMID: 33787442 DOI: 10.1080/02699931.2021.1908231] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Alexithymia is a multifaceted personality construct characterised by difficulties identifying one's feelings and distinguishing them from bodily sensations, difficulties describing one's feelings to others, and an externally oriented cognitive style. Over the past 25 years, a burgeoning body of research has examined how alexithymia moderates processing at the cognition-emotion interface. We review the findings in five domains: attention, appraisals, memory, language, and behaviours. The preponderance of studies linked alexithymia with deficits in emotion processing, which was apparent across all domains, except behaviours. All studies on behaviours and a proportion of studies in other domains demonstrated emotional over-responding. Analysis at the facet level revealed deficits in memory and language that are primarily associated with externally oriented thinking, while over-responding was most often linked to difficulty identifying feelings and difficulty describing feelings. The review also found evidence for contextual modulation: The pattern of deficits and over-responding was not restricted to emotional contexts but also occurred in neutral contexts, and in some circumstances, emotional over-responding in alexithymia was beneficial. Taken together, this review highlights alexithymia as a central personality dimension in the interplay between cognition and emotion.
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Affiliation(s)
- Olivier Luminet
- Research Institute for Psychological Sciences, UCLouvain, Louvain-la-Neuve, Belgium.,Fund for Scientific Research (FRS-FNRS), Belgium
| | - Kristy A Nielson
- Department of Psychology, Marquette University, Milwaukee, WI, USA.,Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nathan Ridout
- Department of Psychology, School of Life & Health Sciences, Aston University, Birmingham, UK
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22
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Preece DA, Parry CL, Allan MM, Allan A. Assessing alexithymia in forensic settings: Psychometric properties of the 20-item Toronto Alexithymia Scale among incarcerated adult offenders. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2021; 31:31-43. [PMID: 33200532 DOI: 10.1002/cbm.2176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Alexithymia is a trait involving difficulty identifying feelings (DIF), difficulty describing feelings (DDF) and externally orientated thinking (EOT). It is a risk factor for criminal behaviour. It is commonly assessed with the Toronto Alexithymia Scale (TAS-20), but the psychometrics of the TAS-20 have not been tested across the range of offender populations, and it has been suggested it might be unsuitable in incarcerated offenders. AIM To establish the psychometrics of the TAS-20 among incarcerated offenders. METHODS Factorial validity was examined using confirmatory factor analyses, and the invariance of this factor structure was tested against a published community sample. Reliability coefficients were calculated. RESULTS One hundred and forty six incarcerated offenders were recruited. The factor structure of the TAS-20 was invariant across the samples. The intended factor structure composed of DIF, DDF and EOT factors performed well overall (with a reverse-scored method factor added), but six EOT items had low factor loadings. The total scale score and DIF and DDF subscales had acceptable reliability, but EOT did not. CONCLUSIONS Our results suggest that the TAS-20 functions similarly in offender and community samples. Its total scale score, and DIF and DDF subscale scores can be used confidently, but the assessment of externally oriented thinking may not be adequate with this scale alone. In sum, the TAS-20 can facilitate robust assessment of alexithymia in closed criminal justice settings as well as in the wider community.
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Affiliation(s)
- David A Preece
- School of Psychology, Curtin University, Perth, Australia
| | - Cate L Parry
- School of Arts and Humanities, Edith Cowan University, Perth, Australia
| | - Maria M Allan
- School of Arts and Humanities, Edith Cowan University, Perth, Australia
| | - Alfred Allan
- School of Arts and Humanities, Edith Cowan University, Perth, Australia
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23
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Arroyo-Anlló EM, Souchaud C, Ingrand P, Chamorro Sánchez J, Melero Ventola A, Gil R. Alexithymia in Alzheimer's Disease. J Clin Med 2020; 10:jcm10010044. [PMID: 33375608 PMCID: PMC7795069 DOI: 10.3390/jcm10010044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022] Open
Abstract
Alexithymia is widely recognized as the inability to identify and express emotions. It is a construct which consists of four cognitive traits such as difficulty in identifying feelings, describing feelings to others, externally oriented thinking, and limited imaginative capacity. Several studies have linked alexithymia to cognitive functioning, observing greater alexithymia scores associated with poorer cognitive abilities. Despite Alzheimer's disease (AD) being a neurodegenerative pathology characterized by cognitive troubles from the early stages, associated to behavioral and emotional disturbances, very few investigations have studied the alexithymia in AD. These studies have shown that alexithymia scores-assessed with Toronto Alexithymia Scale (TAS)-were greater in AD patients than healthy participants. The objective of the study was to investigate if the alexithymia was present in patients with mild AD. We hypothesized that the AD group would show more alexithymia features than the control group. We evaluated 54 subjects, including 27 patients diagnosed with mild AD and 27 normal healthy controls, using the Shalling Sifneos Psychosomatic Scale (SSPS-R) and a neuropsychological test battery. Using non-parametric statistical analyses-Wilcoxon and Mann-Whitney U tests-we observed that the SSPS-R scores were similar in the AD and control groups. All participants showed SSPS-R scores below to 10 points, which means no-alexithymia. We did not find significant correlations between SSPS-R scores and cognitive variables in both groups (p > 0.22), but we observed a negative association between name abilities and alexithymia, but it does not reach to significance (p = 0.07). However, a significant correlation between SSPS-R score and mood state, assessed using Zerssen Rating Scale, was found in both groups (p = 0.01). Because we did not find a significant difference in the alexithymia assessment between both subject groups, pot hoc analyses were computed for each item of the SSPS-R. We made comparisons of alexithymic responses percentages in each SSPS-R item between AD and control groups, using Fisher's test. We observed that AD patients produced more alexithymic responses in some items of SSPS-R test than the control group, particularly about difficulties to find the words to describe feelings, as well as difficulties of imagination capacity and externally oriented thinking. The present results do not confirm our hypothesis and they do not support the results of previous studies revealing great alexithymia in AD.
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Affiliation(s)
- Eva Mª Arroyo-Anlló
- Department of Psychobiology, Neuroscience Institute of Castilla-León, University of Salamanca, 37007 Salamanca, Spain
- Correspondence: ; Tel.: +34-629460944
| | - Corinne Souchaud
- Department of Neurology and Neuropsychology, University Hospital, CHU La Milétrie, 86000 Poitiers, France;
| | - Pierre Ingrand
- Department of Biostatistics, University of Poitiers, 86000 Poitiers, France;
| | - Jorge Chamorro Sánchez
- Faculty of Psychology, Pontifical University of Salamanca, 37002 Salamanca, Spain; (J.C.S.); (A.M.V.)
| | - Alejandra Melero Ventola
- Faculty of Psychology, Pontifical University of Salamanca, 37002 Salamanca, Spain; (J.C.S.); (A.M.V.)
| | - Roger Gil
- Department of Neurology, University Hospital, 86000 Poitiers, France;
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24
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Silva AN, Branco Vasco A, Watson JC. Alexithymia and change process: Contributions of a phase model. COUNSELLING & PSYCHOTHERAPY RESEARCH 2020. [DOI: 10.1002/capr.12303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ana Nunes Silva
- Faculdade de Psicologia Universidade de Lisboa Lisboa Portugal
| | | | - Jeanne C. Watson
- Ontario Institute for Studies in Education University of Toronto Toronto ON Canada
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25
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Jonsson G, Franzén L, Nyström MBT, Davis PA. Integrating yoga with psychological group-treatment for mixed depression and anxiety in primary healthcare: An explorative pilot study. Complement Ther Clin Pract 2020; 41:101250. [PMID: 33113486 DOI: 10.1016/j.ctcp.2020.101250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 08/29/2020] [Accepted: 10/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Yoga has shown promise as a treatment for depression and anxiety. The present pilot study investigated the feasibility of an eight-week grouptreatment integrating emotion-focused psychoeducation, compassion-focused therapy, and Virya yoga for depression and anxiety in primary healthcare. MATERIALS AND METHODS Patients seeking treatment for depression and anxiety in a primary healthcare centre completed either an integrative group-treatment (N = 14) or treatment as usual (TAU, N = 17). Outcome measures were analysed pre- and posttreatment. Correlations in the intervention group were investigated between treatment outcomes and amount of yoga practice between sessions. RESULTS Large within-group effect sizes on all outcome measures were found at posttreatment. Symptom reduction did not differ between groups (p = 0.155). Improvement in alexithymia correlated significantly (p < 0.05) with amount of yoga practice between sessions. CONCLUSION Integrating yoga with a psychological group-treatment is a somewhat feasible approach to treatment for depression and anxiety in primary healthcare.
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Affiliation(s)
- Gustav Jonsson
- Department of Psychology, Umeå University, 901 87, Umeå, Sweden.
| | - Lisa Franzén
- Department of Psychology, Umeå University, 901 87, Umeå, Sweden.
| | | | - Paul A Davis
- Department of Psychology, Umeå University, 901 87, Umeå, Sweden.
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26
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Lane RD, Solms M, Weihs KL, Hishaw A, Smith R. Affective agnosia: a core affective processing deficit in the alexithymia spectrum. Biopsychosoc Med 2020. [DOI: 10.1186/s13030-020-00184-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AbstractAffective agnosia, an impairment in knowing how one feels emotionally, has been described as an extreme deficit in the experience and expression of emotion that may confer heightened risk for adverse medical outcomes. Alexithymia, by contrast, has been proposed as an over-arching construct that includes a spectrum of deficits of varying severity, including affective agnosia at the more severe end. This perspective has been challenged by Taylor and colleagues, who argue that the concept of affective agnosia is unnecessary. We compare these two perspectives by highlighting areas of agreement, reasons for asserting the importance of the affective agnosia concept, errors in Taylor and colleagues’ critique, and measurement issues. The need for performance-based measures of the ability to mentally represent emotional states in addition to metacognitive measures is emphasized. We then draw on a previously proposed three-process model of emotional awareness that distinguishes affective response generation, conceptualization and cognitive control processes which interact to produce a variety of emotional awareness and alexithymia phenotypes - including affective agnosia. The tools for measuring these three processes, their neural substrates, the mechanisms of brain-body interactions that confer heightened risk for adverse medical outcomes, and the differential treatment implications for different kinds of deficits are described. By conceptualizing alexithymia as a spectrum of deficits, the opportunity to match specific deficit mechanisms with personalized treatment for patients will be enhanced.
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27
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Song X, Li D, Hu J, Yang R, Wan Y, Fang J, Zhang S. Moderating Role of Health Literacy on the Association between Alexithymia and Depressive Symptoms in Middle School Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155321. [PMID: 32721998 PMCID: PMC7432623 DOI: 10.3390/ijerph17155321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 12/11/2022]
Abstract
Depression is a common psychological problem in adolescents. At present, few studies have described the moderating role of health literacy on the association between alexithymia and depressive symptoms among adolescents. The purpose of this study was to explore the relation among health literacy, alexithymia, and depressive symptoms and the moderating role of health literacy in middle school students. In December 2017, data were collected from a school in Shenyang by the convenient sampling method using a questionnaire including demographic information, health literacy, alexithymia, and depressive symptoms. A total of 1068 junior and senior high school students were selected as subjects, and 1062 valid questionnaires were retained for analysis. Logistic regression models were used to examine the association between health literacy and alexithymia with depressive symptoms. The prevalence of depressive symptoms was 48.2%, and the prevalence of alexithymia was 17.9%. Low health literacy was significantly associated with depressive symptoms (odds ratio (OR) (95% confidence interval (CI)) = 3.648 (2.493–5.338)). Alexithymia was significantly correlated with depressive symptoms (OR (95% CI) = 3.091 (2.156–4.429)). Low health literacy was related to a greater increase in the risk of depressive symptoms for students with alexithymia (OR (95% CI) = 10.566 (5.175–21.570)). The findings suggest that alexithymia and health literacy are important factors influencing depressive symptoms and health literacy has a moderating role on the association between alexithymia and depressive symptoms. Enhancing health literacy of middle school students with alexithymia may improve their mental health.
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Affiliation(s)
- Xianbing Song
- Department of Human Anatomy, Histology & Embryology, Anhui Medical College, Hefei 230032, China;
| | - Danlin Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China; (D.L.); (J.H.); (R.Y.); (Y.W.)
- MOE Key Laboratory of Population Health Across Life Cycle/Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Jie Hu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China; (D.L.); (J.H.); (R.Y.); (Y.W.)
- MOE Key Laboratory of Population Health Across Life Cycle/Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Rong Yang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China; (D.L.); (J.H.); (R.Y.); (Y.W.)
- MOE Key Laboratory of Population Health Across Life Cycle/Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Yuhui Wan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China; (D.L.); (J.H.); (R.Y.); (Y.W.)
- MOE Key Laboratory of Population Health Across Life Cycle/Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Jun Fang
- MOE Key Laboratory of Population Health Across Life Cycle/Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Faculty of Pharmaceutical Science, Sojo University, Kumamoto 860-0082, Japan
- Correspondence: (J.F.); (S.Z.)
| | - Shichen Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China; (D.L.); (J.H.); (R.Y.); (Y.W.)
- MOE Key Laboratory of Population Health Across Life Cycle/Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
- Correspondence: (J.F.); (S.Z.)
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Preece DA, Becerra R, Robinson K, Allan A, Boyes M, Chen W, Hasking P, Gross JJ. What is alexithymia? Using factor analysis to establish its latent structure and relationship with fantasizing and emotional reactivity. J Pers 2020; 88:1162-1176. [PMID: 32463926 DOI: 10.1111/jopy.12563] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/20/2020] [Accepted: 05/19/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE There is ongoing uncertainty about the structure and definition of alexithymia. Conceptually, alexithymia has traditionally been defined as a multidimensional trait with four components: difficulty identifying feelings, difficulty describing feelings, externally orientated thinking, and difficulty fantasizing. However, some authors suggest that difficulty fantasizing might not be a component, and others suggest low emotional reactivity is a fifth component. In this study, we sought to clarify this issue using factor analysis. METHOD In a sample of adults (N = 508), we administered a comprehensive battery of psychometric measures and analyzed their latent structure using exploratory factor analysis. RESULTS Subscales assessing difficulty identifying feelings, difficulty describing feelings, and externally orientated thinking all loaded well together on the alexithymia factor. However, none of the subscales assessing aspects of difficulty fantasizing (i.e., daydreaming frequency, vividness, content, or use of daydreams to regulate emotions) loaded on the alexithymia factor. Similarly, no emotional reactivity subscales loaded on the alexithymia factor, and alexithymia was associated with higher (not lower) levels of emotional reactivity for negative emotions. CONCLUSIONS Difficulty fantasizing and low emotional reactivity are not components of the latent alexithymia construct. The traditional four-component definition of alexithymia likely warrants refinement to a more parsimonious three-component solution.
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Affiliation(s)
- David A Preece
- School of Psychology, Curtin University, Perth, WA, Australia
| | - Rodrigo Becerra
- School of Psychological Science, The University of Western Australia, Perth, WA, Australia
| | - Ken Robinson
- School of Psychology, Edith Cowan University, Perth, WA, Australia
| | - Alfred Allan
- School of Psychology, Edith Cowan University, Perth, WA, Australia
| | - Mark Boyes
- School of Psychology, Curtin University, Perth, WA, Australia
| | - Wai Chen
- Graduate School of Education, University of Western Australia, Perth, WA, Australia.,School of Medicine, University of Notre Dame Australia, Perth, WA, Australia.,Murdoch University, Perth, WA, Australia.,Mental Health Service, Fiona Stanley Hospital, Perth, WA, Australia
| | | | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, USA
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Tang W, Xu D, Xu J. The mediating role of alexithymia between earthquake exposure and psychopathology among adolescents 8.5 years after the wenchuan earthquake. PERSONALITY AND INDIVIDUAL DIFFERENCES 2020. [DOI: 10.1016/j.paid.2020.109881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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30
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De Berardis D, Fornaro M, Valchera A, Rapini G, Di Natale S, De Lauretis I, Serroni N, Orsolini L, Tomasetti C, Bustini M, Carano A, Vellante F, Perna G, Core L, Alessandrini M, Fraticelli S, Martinotti G, Di Giannantonio M. Alexithymia, resilience, somatic sensations and their relationships with suicide ideation in drug naïve patients with first-episode major depression: An exploratory study in the "real world" everyday clinical practice. Early Interv Psychiatry 2020; 14:336-342. [PMID: 31402575 DOI: 10.1111/eip.12863] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/20/2019] [Accepted: 07/14/2019] [Indexed: 12/15/2022]
Abstract
AIM The present study is aimed at revaluating alexithymia, somatic sensations, resilience and their relationships with suicide ideation in drug naïve adult outpatients suffering from first episode major depression (MD). METHODS Data of 103 adult outpatients (49 men, 56 women) with a diagnostic and statistical manual of mental disorders, 4th edition, text revision (DSM-IV-TR) diagnosis of MD were analysed. Alexithymia was measured using the 20-item Toronto Alexithymia Scale (TAS-20) and resilience with the 25 items Connor-Davidson Resilience Scale (CD-RISC) whereas depression was evaluated using the 17-item Hamilton Depression Rating Scale, somatic sensations with the Body Sensations Questionnaire and suicide ideation with Scale of Suicide Ideation (SSI). RESULTS Gender comparisons between all demographic and clinical variables showed no significant differences in all variables. Subjects who were found positive for alexithymia showed higher scores on all clinical variables controlling for age, gender and duration of the current episode. In a linear regression model, lower scores on CD-RISC and Difficulty in Identifying Feelings dimension of TAS-20 were significantly predictive of higher scores on SSI. CONCLUSIONS Alexithymia and low resilience were significant predictors of increased suicide ideation in a first MD episode. However, study limitations must be considered and future research needs are being discussed.
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Affiliation(s)
- Domenico De Berardis
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini," ASL 4, Teramo, Italy.,Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio", Chieti, Italy
| | - Michele Fornaro
- Neuroscience, Reproductive Science and Odontostolmatology, Section of Psychiatry, University School of Medicine Federico II, Naples, Italy.,Polyedra Research Group, Teramo, Italy
| | - Alessandro Valchera
- Polyedra Research Group, Teramo, Italy.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Villa S. Giuseppe Hospital, Hermanas Hospitalarias, Ascoli Piceno, Italy
| | - Gabriella Rapini
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini," ASL 4, Teramo, Italy
| | - Serena Di Natale
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini," ASL 4, Teramo, Italy
| | - Ida De Lauretis
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio", Chieti, Italy
| | - Nicola Serroni
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio", Chieti, Italy
| | - Laura Orsolini
- Polyedra Research Group, Teramo, Italy.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Villa S. Giuseppe Hospital, Hermanas Hospitalarias, Ascoli Piceno, Italy
| | - Carmine Tomasetti
- Laboratory of Molecular Psychiatry and Psychopharmacotherapeutics, Section of Psychiatry, Department of Neuroscience, University School of Medicine "Federico II", Naples, Italy
| | | | - Alessandro Carano
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "Madonna Del Soccorso", San Benedetto del Tronto, Italy
| | - Federica Vellante
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio", Chieti, Italy
| | - Giampaolo Perna
- Hermanas Hospitalarias, FoRiPsi, Department of Clinical Neurosciences, Villa San Benedetto Menni, Albese con Cassano, Italy.,Department of Psychiatry and Neuropsychology, University of Maastricht, Maastricht, The Netherlands.,Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, University of Miami, Miami, Florida
| | - Laura Core
- NHS, Department of Mental Health, Center of Mental Health, ASL 4, Giulianova, Italy
| | - Marco Alessandrini
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio", Chieti, Italy
| | - Silvia Fraticelli
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio", Chieti, Italy
| | - Giovanni Martinotti
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio", Chieti, Italy
| | - Massimo Di Giannantonio
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. D'Annunzio", Chieti, Italy
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Michael MT. Unconscious Emotion and Free-Energy: A Philosophical and Neuroscientific Exploration. Front Psychol 2020; 11:984. [PMID: 32508725 PMCID: PMC7253622 DOI: 10.3389/fpsyg.2020.00984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 04/20/2020] [Indexed: 11/15/2022] Open
Abstract
Unconscious emotions are of central importance to psychoanalysis. They do, however, raise conceptual problems. The most pertinent concerns the intuition, shared by Freud, that consciousness is essential to emotion, which makes the idea of unconscious emotion seem paradoxical. In this paper, I address this paradox from the perspective of the philosopher R. C. Roberts' account of emotions as concern-based construals. I provide an interpretation of this account in the context of affective neuroscience and explore the form of Freudian repression that emotions may be subject to under such an interpretation. This exploration draws on evidence from research on alexithymia and utilises ideas from free-energy neuroscience. The free-energy framework, moreover, facilitates an account of repression that avoids the homunculus objection and coheres with recent work on hysteria.
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32
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Mersin S, İbrahimoğlu Ö, Saray Kılıç H, Bayrak Kahraman B. Social media usage and alexithymia in nursing students. Perspect Psychiatr Care 2020; 56:401-408. [PMID: 31680272 DOI: 10.1111/ppc.12448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 10/14/2019] [Accepted: 10/19/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To determine the relationship between social media usage characteristics and alexithymia in nursing students. DESIGN AND METHODS The study was conducted with 272 nursing students between November and December 2018 in Turkey. Data were collected using an information form to determine the sociodemographic and social media usage characteristics of the students, and the Toronto Alexithymia Scale. FINDINGS According to the results of this study, nursing students use Instagram the most. As time spent on social media increases, the alexithymia score increases and students have difficulty recognizing their feelings. PRACTICE IMPLICATIONS As the use of social media by nursing students affects their mental process and behavior patterns, the results of social media applications, which witness a wide range of feelings, thoughts, attitudes, and behaviors, should be included in the nursing curriculum.
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Affiliation(s)
- Sevinç Mersin
- Department of Psychiatric and Mental Health Nursing, Faculty of Health Sciences, Bilecik Şeyh Edebali University, Bilecik, Turkey
| | - Özlem İbrahimoğlu
- Department of Nursing, Faculty of Health Sciences, Bilecik Şeyh Edebali University, Bilecik, Turkey
| | - Hülya Saray Kılıç
- Department of Nursing, Faculty of Health Sciences, Bilecik Şeyh Edebali University, Bilecik, Turkey
| | - Burcu Bayrak Kahraman
- Department of Nursing, Faculty of Health Sciences, Bilecik Şeyh Edebali University, Bilecik, Turkey
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Do self-report measures of alexithymia measure alexithymia or general psychological distress? A factor analytic examination across five samples. PERSONALITY AND INDIVIDUAL DIFFERENCES 2020. [DOI: 10.1016/j.paid.2019.109721] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bagby RM, Parker JDA, Taylor GJ. Twenty-five years with the 20-item Toronto Alexithymia Scale. J Psychosom Res 2020; 131:109940. [PMID: 32007790 DOI: 10.1016/j.jpsychores.2020.109940] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Twenty-five years ago, this journal published two articles reporting the development and initial validation of the 20-Item Toronto Alexithymia Scale (TAS-20). Since then the literature on alexithymia has burgeoned with the vast majority of this research using the TAS-20, including multiple language translations of the scale. METHOD In this article we review the psychometric literature evaluating various aspects of the reliability and validity of the TAS-20 and examine some of the controversies surrounding the scale and the construct it assesses. We reflect on the ways in which the TAS-20 has advanced the measurement of the construct and theory of alexithymia. We also discuss recent developments and some future directions for the measurement of alexithymia. RESULTS Although not without some controversy, the preponderance of the accumulated evidence over a 25-year period supports various aspects of the reliability and validity of the TAS-20, including findings from confirmatory factor analytic and convergent and discriminant validity studies which are consistent with Nemiah et al.'s (Nemiah et al., 1976 [3]) and Taylor and colleagues (Taylor et al., 1997 [9]) theoretical formulations and definition of the alexithymia construct. CONCLUSIONS Based on the accumulated empirical evidence of 25 years, we conclude that the TAS-20 is a reliable and valid instrument and accurately reflects and measures the construct as it was originally defined by Nemiah et al. Nemiah et al. (1976) [3] as composed of deficits in affect awareness and expression and pensée opératoire (operational thinking). Clinicians and researchers can use the TAS-20 to confidently measure alexithymia, the roots of which have foundations in psychosomatic medicine.
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Affiliation(s)
- R Michael Bagby
- Departments of Psychology and Psychiatry, University of Toronto, Toronto, Ontario, Canada.
| | - James D A Parker
- Department of Psychology, Trent University, Peterborough, Ontario, Canada
| | - Graeme J Taylor
- Department of Psychiatry (Emeritus), University of Toronto, Toronto, Ontario, Canada
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35
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Šago D, Babić G, Bajić Ž, Filipčić I. Panic Disorder as Unthinkable Emotions: Alexithymia in Panic Disorder, a Croatian Cross-Sectional Study. Front Psychiatry 2020; 11:466. [PMID: 32581863 PMCID: PMC7282461 DOI: 10.3389/fpsyt.2020.00466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 05/06/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Previous research on alexithymia has led to controversy over its prevalence in panic disorder. The aim of this study was to assess the difference in the prevalence of alexithymia in panic disorder and other anxiety disorders. DESIGN AND METHODS We performed a cross-sectional study on a sample of 71 patients diagnosed with panic disorder and 113 patients diagnosed with other anxiety disorders; both groups were 18-50 years old. Primary outcome was the 20-item Toronto Alexithymia Scale (TAS) score. Secondary outcome was the prevalence of alexithymia defined as a TAS score ≥61. RESULTS Patients diagnosed with panic disorder had a 25% higher score on the TAS subscale of difficulty identifying feelings than patients diagnosed with other anxiety disorders. The prevalence of alexithymia was 27% in patients with panic disorder and 13% in patients with other anxiety disorders. Patients diagnosed with panic disorder had significantly higher odds for alexithymia. CONCLUSIONS The results of our study support the hypothesis of higher prevalence of alexithymia in individuals with panic disorder than in individuals with other anxiety disorders. In addition, difficulty identifying feelings as a salient feature of alexithymia is higher in panic disorder than in other anxiety disorders.
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Affiliation(s)
- Daniela Šago
- Day Hospital for Psychotic Disorder, Psychiatric Hospital Sveti Ivan, Zagreb, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Goran Babić
- Independent Researcher, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Žarko Bajić
- Day Hospital for Psychotic Disorder, Psychiatric Hospital Sveti Ivan, Zagreb, Croatia
| | - Igor Filipčić
- Day Hospital for Psychotic Disorder, Psychiatric Hospital Sveti Ivan, Zagreb, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia.,Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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36
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De Berardis D, Fornaro M, Orsolini L. Editorial: "No Words for Feelings, Yet!" Exploring Alexithymia, Disorder of Affect Regulation, and the "Mind-Body" Connection. Front Psychiatry 2020; 11:593462. [PMID: 33061929 PMCID: PMC7530238 DOI: 10.3389/fpsyt.2020.593462] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/31/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Domenico De Berardis
- NHS, Department of Mental Health, Psychiatric Service for Diagnosis and Treatment, Hospital "G. Mazzini", Teramo, Italy
| | - Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Sciences, and Dentistry, Federico II University, Naples, Italy
| | - Laura Orsolini
- Section of Psychiatry, Department of Clinical Neurosciences/DIMSC, Polytechnic University of Ancona, Ancona, Italy.,Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
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37
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Nam G, Lee H, Lee JH, Hur JW. Disguised Emotion in Alexithymia: Subjective Difficulties in Emotion Processing and Increased Empathic Distress. Front Psychiatry 2020; 11:698. [PMID: 32765327 PMCID: PMC7379392 DOI: 10.3389/fpsyt.2020.00698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/02/2020] [Indexed: 11/22/2022] Open
Abstract
Despite decades of speculation, many causal aspects that contribute to the heterogeneity of alexithymia still must be clarified. This study examined the extent of the alexithymia phenotype and its contribution to social function in the general population. In total, 200 participants (females = 111) completed the Toronto Alexithymia Scale-20 (TAS-20), multiple self-reporting questionnaires measuring emotion intelligence, empathy, hostility and impulsivity, and the Reading the Mind in the Eyes Test (RMET). In the multivariate analysis, highly alexithymic individuals appeared to report subjective deficits in emotion recognition and regulation as well as increased impulsivity; however, their empathy skills were intact, and even the proneness to experiencing empathic distress with others' suffering was increased among alexithymic individuals. We also compared the clinical and behavioral manifestations of highly alexithymic male and female subjects to those of each gender control group. As a result, in contrast to their subjective self-reports of emotion processing impairment, the RMET performance appeared to be preserved in alexithymic females; however, highly alexithymic males showed actual deficits in the emotion identification task. Future research needs to further refine the constructs of alexithymia to incorporate the phenotypic changes in affected individuals in relation to measuring instruments, the extent of empathic distress, and gender.
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Affiliation(s)
- Gieun Nam
- Clinical Neuro-Psychology Lab, Department of Psychology, Chung-Ang University, Seoul, South Korea
| | - Hyerin Lee
- Department of Psychology, Chung-Ang University, Seoul, South Korea
| | - Jang-Han Lee
- Clinical Neuro-Psychology Lab, Department of Psychology, Chung-Ang University, Seoul, South Korea
| | - Ji-Won Hur
- Department of Psychology, Korea University, Seoul, South Korea
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Duquette P. More Than Words Can Say: A Multi-Disciplinary Consideration of the Psychotherapeutic Evaluation and Treatment of Alexithymia. Front Psychiatry 2020; 11:433. [PMID: 32523552 PMCID: PMC7261853 DOI: 10.3389/fpsyt.2020.00433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/28/2020] [Indexed: 11/13/2022] Open
Abstract
Alexithymia is a disorder that stands at the border of mind and body, with psychological/affective and physiological/experiential disturbances. The purpose of this article is to propose a new clinical access point for the evaluation and treatment of the deficits in emotional awareness demonstrated in alexithymia. This will be based on insights from recent neuroscientific research, which is adding to the psychodynamic understanding of alexithymia, regarding clinical presentation and etiology. Following a brief review of definitions, forms of measurement, and potential etiologic elements of alexithymia, current neuroscientific theory and research into "predictive processing" approaches to brain function will be outlined, including how "interoception" and "interoceptive inference" underpins emotion and emotional awareness. From this synergistic perspective, I will outline how interoceptive inference provides a key to the link between: problems in early life relational experiences and the patient's long held, but suboptimal models of their inner and outer world. This is reflected in the deficits in affective experiencing and emotional awareness described in alexithymia. Three clinical cases will be presented to illustrate this nuanced consideration of alexithymic etiology and treatment. The implications of the historical, psychological, and somatic aspects of experience will be considered, regarding the patients' diminished ability to: experience and represent emotional experience as distinct feeling states; signify the relevant meaning of affective experience; and incorporate such with cognitions to adaptively guide behavior. These will be addressed using psychometric, psychological, neuro-cognitive, and neurocomputational approaches. Elements from current theory, research, and treatment of alexithymia, will be highlighted that are salient to the clinician, in order to support their understanding of patients against the backdrop of current psychodynamic and neuroscientific research, which will thereby increase treatment options and benefits. The focus, and conclusion, of this article is the role that attention to interoception can play (within the safety of the therapeutic relationship and within any therapeutic process) in allowing updating of the patient's strongly held but dysfunctional beliefs.
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Mehlsen M, Lyby MS, Mikkelsen MB, O'Toole MS. Performance-based assessment of distraction in response to emotional stimuli: Toward a standardized procedure for assessing emotion regulation performance. PERSONALITY AND INDIVIDUAL DIFFERENCES 2019. [DOI: 10.1016/j.paid.2019.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Derks YP, Klaassen R, Westerhof GJ, Bohlmeijer ET, Noordzij ML. Development of an Ambulatory Biofeedback App to Enhance Emotional Awareness in Patients with Borderline Personality Disorder: Multicycle Usability Testing Study. JMIR Mhealth Uhealth 2019; 7:e13479. [PMID: 31617851 PMCID: PMC6913718 DOI: 10.2196/13479] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/13/2019] [Accepted: 07/28/2019] [Indexed: 12/20/2022] Open
Abstract
Background Patients with borderline personality disorder experience great difficulties in regulating their emotions. They often are unable to effectively detect their emotional arousal and struggle to timely apply learned techniques for emotion regulation. Although the use of continuous wearable biofeedback has been repeatedly suggested as an option to improve patients’ emotional awareness, this type of app is not yet available for clinical use. Therefore, we developed an ambulatory biofeedback app named Sense-IT that can be integrated in mental health care. Objective The aim of the study was to develop an ambulatory biofeedback app for mental health care that helps with learning to better recognize changes in personal emotional arousal and increases emotional awareness. Methods Using several methods in a tailored User Centred Design (UCD) framework, we tested the app’s usability and user experience (UX) via a cyclic developmental process with multiple user groups (patients, therapists, and UCD experts; 3-5 per group, per cycle). Results The process resulted in a stable prototype of the app that meets most of the identified user requirements. The app was valued as useful and usable by involved patients, therapists, and UCD experts. On the Subjective Usability Scale (SUS), the patients rated the app as “Good” (average score of 78.8), whereas the therapists rated the app as “OK” (average score of 59.4). The UCD experts judged the app’s overall usability as between “OK” and “acceptable” (average score of 0.87 on a cognitive walkthrough). As most critical usability problems were identified and addressed in the first cycle of the prototyping process, subsequent cycles were mainly about implementing new or extending existing functions, and other adjustments to improve UX. Conclusions mHealth development within a clinical mental health setting is challenging, yet feasible and welcomed by targeted users. This paper shows how new mHealth interventions for mental health care can be met with enthusiasm and openness by user groups that are known to be reluctant to embrace technological innovations. The use of the UCD framework, involving multiple user groups, proved to be of added value during design and realization as evidenced by the complementary requirements and perspectives. Future directions on studying clinical effectiveness of the app, appliance of the app in other fields, and the implications of integration of the app for daily practice in mental health are discussed.
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Affiliation(s)
- Youri Pmj Derks
- Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands.,Scelta, Center for Treatment of Personality Disorders, GGNet, Mental Health Institute, Apeldoorn, Netherlands
| | - Randy Klaassen
- Department of Human Media Interaction, University of Twente, Enschede, Netherlands
| | - Gerben J Westerhof
- Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands
| | - Ernst T Bohlmeijer
- Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands
| | - Matthijs L Noordzij
- Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands
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Berenguer C, Rebôlo C, Costa RM. Interoceptive Awareness, Alexithymia, and Sexual Function. JOURNAL OF SEX & MARITAL THERAPY 2019; 45:729-738. [PMID: 31018783 DOI: 10.1080/0092623x.2019.1610128] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Research in women suggests a relation between sexual difficulties and lower interoceptive awareness, the conscious perception of internal bodily states. Lower interoceptive awareness is theoretically linked to greater alexithymia, which has been related to sexual dysfunctions. Hence, we examined the relations of interoceptive awareness and alexithymia with several dimensions of sexual functioning in a nonclinical sample of both sexes. Methods: Three hundred forty Portuguese (228 women, 112 men) completed the Toronto Alexithymia Scale (TAS-20) and the Multidimensional Assessment of Interoceptive Awareness (MAIA). Women additionally completed the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale-Revised (FSDS-R). Men additionally completed the International Index of Erectile Function (IIEF) and one question on difficulties delaying ejaculation. Greater alexithymia correlated with lesser interoceptive awareness. For women, greater alexithymia and lesser interoceptive awareness correlated with lesser arousal, lesser lubrication, more orgasm difficulties, more dissatisfaction, more pain, and more sexual distress. Higher female desire correlated with greater interoceptive awareness, but was unrelated to alexithymia. In men, lesser interoceptive awareness correlated with more difficulties delaying ejaculation, and greater alexithymia correlated with more erectile difficulties. The present investigation corroborates that awareness of emotions and internal bodily states is important for sexual functioning.
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Affiliation(s)
| | | | - Rui Miguel Costa
- William James Center for Research, ISPA-Instituto Universitário , Lisbon , Portugal
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42
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Grzegorzewski P, Kulesza M, Pluta A, Iqbal Z, Kucharska K. Assessing self-reported empathy and altruism in patients suffering from enduring borderline personality disorder. Psychiatry Res 2019; 273:798-807. [PMID: 30819534 DOI: 10.1016/j.psychres.2018.12.109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 11/29/2022]
Abstract
Self-report studies on empathy in adults with borderline personality disorder (BPD) have based upon the Interpersonal Reactivity Index (IRI) and generally identified deficits in perspective taking abilities in this group, but indicated less coherent results regarding empathic concern. These two constructs are considered subcomponents of cognitive (CE) and affective empathy (AE), respectively. However, the IRI does not enable for valid investigation of overall levels of these empathy types. Surprisingly, although some findings from the general population suggest that empathy types may be positively related to altruism, neither this link nor general altruism have been examined in BPD. Additionally, these constructs have not been sufficiently studied in this group in the context of alexithymia or potential clinical confounders. Hence, women with BPD (N = 30) and healthy women (N = 38) completed, i.a., the Questionnaire of Cognitive and Affective Empathy, Self-Report Altruism Scale, TAS-20, STAI, and CESD-R. Patients with BPD reported significantly decreased overall CE (including worse online simulation abilities - conceptually similar to perspective taking from the IRI), but a similar level of overall AE. They also demonstrated lower altruism. Taken together, these results suggest that BPD patients have difficulties with imagining what emotions others are feeling and with altruistic responding to their needs.
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Affiliation(s)
- Piotr Grzegorzewski
- Department of Neuroses, Personality Disorders, and Eating Disorders, Institute of Psychiatry and Neurology, 9 Sobieskiego Street, 02-957 Warsaw, Poland
| | - Maria Kulesza
- Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | | | - Zaffer Iqbal
- NAViGO Health Care and Social Care CIC, Grimsby, United Kingdom; Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Katarzyna Kucharska
- Department of Neuroses, Personality Disorders, and Eating Disorders, Institute of Psychiatry and Neurology, 9 Sobieskiego Street, 02-957 Warsaw, Poland.
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van der Cruijsen R, Murphy J, Bird G. Alexithymic traits can explain the association between puberty and symptoms of depression and anxiety in adolescent females. PLoS One 2019; 14:e0210519. [PMID: 30650139 PMCID: PMC6334924 DOI: 10.1371/journal.pone.0210519] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/22/2018] [Indexed: 12/21/2022] Open
Abstract
Symptoms of internalizing disorders such as depression and anxiety increase in adolescence, especially in females. However, gender differences in depression and anxiety symptoms emerge only after puberty onset. Levels of alexithymia, characterized by difficulties identifying and describing one's emotions, are elevated in depression and anxiety, and fluctuate across adolescence in a gender-specific manner. This study investigated changes in alexithymia across adolescence, and explored the potential role of alexithymia in the development of depression and anxiety, separately for females and males. Accordingly, 140 adolescents aged 11 to 21 years (77 female) completed self-report measures of alexithymia, depression and anxiety, and pubertal development. For females alone, pubertal maturation was associated with alexithymic traits (specifically difficulties identifying and describing feelings), as well as symptoms of depression and anxiety. After accounting for alexithymia, the relationship between puberty and depression and anxiety was absent or reduced in females. Thus, alexithymic traits may have differential consequences for males and females, and possibly contribute towards increased depression and anxiety symptoms in females during adolescence. We propose that developmental changes in alexithymia should be considered when studying the onset and development of internalizing psychological disorders during adolescence.
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Affiliation(s)
- Renske van der Cruijsen
- Department of Developmental Psychology, Leiden University, the Netherlands, Leiden, The Netherlands
| | - Jennifer Murphy
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Geoffrey Bird
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
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Montebarocci O, Surcinelli P. Correlations between TSIA and TAS-20 and their relation to self-reported negative affect: A study using a multi-method approach in the assessment of alexithymia in a nonclinical sample from Italy. Psychiatry Res 2018; 270:187-193. [PMID: 30261408 DOI: 10.1016/j.psychres.2018.09.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/02/2018] [Accepted: 09/16/2018] [Indexed: 11/17/2022]
Abstract
The 20 item Toronto Alexithymia Scale (TAS-20) has been set as the golden standard in assessing alexithymia despite its limitation due to its self-report structure. Overcoming this bound is the main reason that in 2006 brought Bagby, Taylor and Parker to develop the Toronto Structured Interview for Alexithymia (TSIA): a structured interview composed of 24 questions with the purpose of assessing four dimensions of alexithymia: Identifying emotional feelings (DIF), Describing emotional feelings (DDF), Imaginal processes (IMP), and Externally oriented thinking (EOT). The present study aimed to confirm the validity of the TSIA in the assessment of alexithymia, using internal consistency (alpha) and convergent validity (comparing TSIA and TAS-20). Since it has been demonstrated an association between alexithymia, measured with the TAS-20, and negative affect, an additional goal was to evaluate the correlation of TSIA with two measures of depression and anxiety (BDI-II and STAI-Y2). Our results showed a significant capability of the TSIA in assessing alexithymia while clearing the limitation of the TAS-20 in keeping aside partially overlapping construct such as depression and anxiety. The final suggestion is that a reliable assessment of alexithymia might come from the application of both a self-report and an observer-rated instrument.
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Affiliation(s)
| | - Paola Surcinelli
- University of Bologna, Department of Psychology, BOLOGNA, Bologna 40127, Italy
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Costa RM, Oliveira G, Pestana J, Costa D, Oliveira RF. Do Psychosocial Factors Moderate the Relation between Testosterone and Female Sexual Desire? The Role of Interoception, Alexithymia, Defense Mechanisms, and Relationship Status. ADAPTIVE HUMAN BEHAVIOR AND PHYSIOLOGY 2018. [DOI: 10.1007/s40750-018-0102-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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da Silva ACN, Vasco AB, Watson JC. Alexithymia and therapeutic alliance: a multiple case study comparing good and poor outcome cases. RESEARCH IN PSYCHOTHERAPY (MILANO) 2018; 21:313. [PMID: 32913763 PMCID: PMC7451330 DOI: 10.4081/ripppo.2018.313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 07/10/2018] [Indexed: 11/23/2022]
Abstract
Alexithymia has been associated with poor outcomes in psychotherapy. This association has been attributed to a difficulty in patients expressing emotions, engaging in emotional tasks and also poor therapeutic alliances. This study aims to better understand alexithymic patients in psychotherapy. A multiple case study design was used. Cases were selected from a larger research project considering their alexithymia level and outcome status, based on the reliable change index and the client perspective on change. Four cases are presented: with and without alexithymia with good and poor outcome. The therapeutic alliance was included as a process measure, evaluated from both client and therapist. At the end a semi structured interview was conducted with both participants, individually. The analysis concerned the integration and triangulation of the therapist and client experience for each case. Each patient was briefly presented and then a focus was made regarding the perception of both participants on the therapeutic alliance and the emotional processing and change process of the client. Both alexithymic cases and the non-alexithymic poor outcome case showed difficulties in the therapeutic alliance, especially from the perspective of the therapist. In these cases, emotional impairments may have contributed to a poor therapeutic alliance, impacting on the outcome. We suggest that a great focus on the therapeutic alliance with alexithymic patients may increase the quality of treatment and it may be more useful for case conceptualization to consider each feature of the alexithymia construct individual.
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Affiliation(s)
- Ana Catarina Nunes da Silva
- Department of Cognitive, Behavioral and Integrative Psychotherapy, Faculty of Psychology, University of Lisbon, Portugal
| | - Antonio Branco Vasco
- Department of Cognitive, Behavioral and Integrative Psychotherapy, Faculty of Psychology, University of Lisbon, Portugal
| | - Jeanne C. Watson
- Ontario Institute for Studies in Education, University of Toronto, Canada
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Eboni ACB, Cardoso M, Dias FM, da Gama PD, Gomes S, Goncalves MVM, Machado SCN, da Nobrega AW, Parolin MFK, Paz SC, Ruocco HH, Scorcine C, Siquineli F, Spessotto CV, Tauil CB, Fragoso YD. High levels of alexithymia in patients with multiple sclerosis. Dement Neuropsychol 2018; 12:212-215. [PMID: 29988322 PMCID: PMC6022982 DOI: 10.1590/1980-57642018dn12-020015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Alexithymia is a personality trait characterized by difficulties identifying and describing feelings. Some researchers describe high levels of alexithymia among patients with multiple sclerosis (MS) but literature data on this subject are scarce.
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Affiliation(s)
| | - Mariana Cardoso
- Department of Neurology, Universidade Metropolitana de Santos, Santos, SP, Brazil
| | - Felipe Moreira Dias
- Department of Neurology, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil
| | - Paulo Diniz da Gama
- Department of Neurology, Pontificia Universidade Catolica de Sao Paulo, campus Sorocaba, Sorocaba, SP, Brazil
| | - Sidney Gomes
- Department of Neurology, Hospital Beneficencia Portuguesa and Hospital Paulistano, Sao Paulo, SP, Brazil
| | | | | | | | | | - Sonia Castedo Paz
- Department of Neurology, Universidade Metropolitana de Santos, Santos, SP, Brazil
| | | | - Claudio Scorcine
- Department of Neurology, Universidade Metropolitana de Santos, Santos, SP, Brazil
| | - Fabio Siquineli
- Department of Neurology, Universidade Regional de Blumenau, Blumenau, SC, Brazil
| | | | | | - Yara Dadalti Fragoso
- Department of Neurology, Universidade Metropolitana de Santos, Santos, SP, Brazil
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Maroti D, Lilliengren P, Bileviciute-Ljungar I. The Relationship Between Alexithymia and Emotional Awareness: A Meta-Analytic Review of the Correlation Between TAS-20 and LEAS. Front Psychol 2018; 9:453. [PMID: 29713295 PMCID: PMC5911526 DOI: 10.3389/fpsyg.2018.00453] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/19/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Alexithymia and emotional awareness may be considered overlapping constructs and both have been shown to be related to psychological and emotional well-being. However, it is not clear how the constructs relate to each other empirically or if they may overlap more or less in different populations. The aim of this review was therefore to conduct a meta-analysis of correlations between the most commonly used measures of alexithymia (i.e., the self-report instrument Toronto Alexithymia Scale; TAS-20) and emotional awareness (i.e., the observer-rated instrument Level of Emotional Awareness Scale; LEAS) and to explore potential moderators of their relationship. Methods: Electronic databases were searched for studies published until the end of February 2018. Study samples were coded as medical conditions, psychiatric disorders and/or healthy controls and sample mean age and gender distribution were extracted. Correlations between the TAS-20 and the LEAS were subjected to a random effect of meta-analysis and moderators were explored in subgroup analyses and meta-regressions. Publication bias was considered. Results: 21 studies reporting on 28 independent samples on correlation analysis were included, encompassing a total of 2857 subjects (57% women). The aggregated correlation between TAS-20 and LEAS was r = −0.122 (95% CI [−0.180, −0.064]; Z = −4.092; p < 0.001), indicating a significant, but weak, negative relationship between the measures. Heterogeneity was moderate, but we found no indication of significant differences between patients with medical conditions, psychiatric disorders or healthy controls, nor that mean age or percentage of female subjects moderated the relationship. The overall estimate became somewhat weaker after adjusting for possible publication bias. Conclusions: Our results indicate that TAS-20 and LEAS measure different aspects of emotional functioning. The small overlap suggests that alexithymia and emotional awareness are distinct constructs of emotional well-being. Clinicians need to assess both aspects when considering treatment options for individual patients. Moreover, from the clinical standpoint, an easy reliable and valid way of measuring emotional awareness is still needed. More research should be focus on the differences between alexithymia and emotional awareness in specific conditions, but also how to integrate self-report instrument and observed based measures in a clinical situation.
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Affiliation(s)
- Daniel Maroti
- Department of Clinical Sciences, Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Peter Lilliengren
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Indre Bileviciute-Ljungar
- Department of Clinical Sciences, Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
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Ogrodniczuk JS, Kealy D, Joyce AS, Abbass AA. Body talk: Sex differences in the influence of alexithymia on physical complaints among psychiatric outpatients. Psychiatry Res 2018; 261:168-172. [PMID: 29309955 DOI: 10.1016/j.psychres.2017.12.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/19/2017] [Accepted: 12/30/2017] [Indexed: 11/16/2022]
Abstract
This study investigated the relationship between alexithymia and physical complaints among psychiatric outpatients, and whether sex moderated this relationship. Participants (N = 185) completed measures of physical complaints (bodily symptom burden, pain severity, pain interference), alexithymia, current symptom (depression, anxiety) distress, and somatosensory amplification (i.e., a person's tendency to be bothered by physical sensations). Hierarchical regression analyses were conducted, controlling for the influence of current psychiatric symptom distress and somatosensory amplification. Findings revealed differential relationships between alexithymia and physical complaints (pain interference) for women and men, in addition to main effects for sex and alexithymia. The findings suggest that the negative influence of alexithymia on bodily-related problems may not be universal.
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Affiliation(s)
- John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Anthony S Joyce
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Allan A Abbass
- Department of Psychiatry, Dalhousie University, Halifax, Canada
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Han D, Li M, Mei M, Sun X. The functional and structural characteristics of the emotion network in alexithymia. Neuropsychiatr Dis Treat 2018; 14:991-998. [PMID: 29695908 PMCID: PMC5905825 DOI: 10.2147/ndt.s154601] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Alexithymia is a multifaceted personality trait characterized by emotional dysfunction. METHODS In this study, the functional and structural features of the emotion network in alexithymia were investigated using resting-state functional MRI (rsfMRI), voxel-based morphometry (VBM), functional connectivity (FC) analysis, and diffusion tensor imaging (DTI). Alexithymic and non-alexithymic students were recruited from the local university. The intrinsic neural activity and gray matter density of the brain regions in the emotion network were measured using rsfMRI and VBM; the FC and structural connectivity of the brain regions in the emotion network were measured using FC analysis and DTI. RESULTS The altered intrinsic neural activity in V1, rostral dorsal anterior cingulate cortex, and left amygdala, and the weak FC between V1 and left superior temporal gyrus and V1 and left paracentral lobule in alexithymia subjects were identified. However, no alteration of the structure and structural connectivity of the emotion network was identified. CONCLUSION The results indicated that the development of alexithymia might have been caused only by slight alteration of the neural activity. Furthermore, the results suggest that noninvasive treatment technologies for improving the brain activity are suitable for alexithymic individuals.
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Affiliation(s)
- Dai Han
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, Zhejiang, China.,Children and Adolescents Mental Health Joint Clinic, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, China
| | - Mei Li
- Mental Health Education and Counseling Center, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Minjun Mei
- Mental Health Education and Counseling Center, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Xiaofei Sun
- Mental Health Education and Counseling Center, Hangzhou Normal University, Hangzhou, Zhejiang, China
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