Alexithymia and interpersonal problems: A study of natural language use

Literally or prosodically? Recognising emotional discourse in alexithymia

Alexithymia is characterised by difficulties in identifying, recognising, and describing emotions. We studied alexithymia in the context of speech comprehension, specifically investigating the incongruent condition between prosody and the literal meaning of words in emotion-based discourse. In two experiments, participants were categorised as having high or low alexithymia scores based on the TAS-20 scale and listened to three-sentence narratives where the emotional prosody of a key phrase or a keyword was congruent or incongruent with its literal meaning. The incongruent condition resulted in slower reaction times and lower accuracy in recognition of emotions. This incongruence effect was also evident for individuals with high alexithymia, except for anger. They recognised anger as accurately in both congruent and incongruent conditions. Contrary to our hypothesis, however, individuals with high alexithymia did not show an overall difference in emotion recognition compared to the low alexithymia group. These findings highlight the nuanced relationship between emotional prosody and literal meaning, offering insights into how individuals with varying levels of alexithymia process emotional discourse. Understanding these dynamics has implications for both cognitive research and clinical practice, providing valuable perspectives on speech comprehension, especially in situations involving incongruence between prosody and word meaning.

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

PURPOSE

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

METHOD

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

RESULTS

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

Experiments on real-life emotions challenge Ekman's model

Ekman's emotions (1992) are defined as universal basic emotions. Over the years, alternative models have emerged (e.g. Greene and Haidt 2002; Barrett 2017) describing emotions as social and linguistic constructions. The variety of models existing today raises the question of whether the abstraction provided by such models is sufficient as a descriptive/predictive tool for representing real-life emotional situations. Our study presents a social inquiry to test whether traditional models are sufficient to capture the complexity of daily life emotions, reported in a textual context. The intent of the study is to establish the human-subject agreement rate in an annotated corpus based on Ekman's theory (Entity-Level Tweets Emotional Analysis) and the human-subject agreement rate when using Ekman's emotions to annotate sentences that don't respect the Ekman's model (The Dictionary of Obscure Sorrows). Furthermore, we investigated how much alexithymia can influence the human ability to detect and categorise emotions. On a total sample of 114 subjects, our results show low within subjects agreement rates for both datasets, particularly for subjects with low levels of alexithymia; low levels of agreement with the original annotations; frequent use of emotions based on Ekman model, particularly negative one, in people with high levels of alexithymia.

Attentional Processing of Unpleasant Stimuli in Alexithymia

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.

Alexithymia, social inhibition, affectivity, and knowledge hiding

Purpose

This paper aims to examine the impact of adverse personality traits (alexithymia, social inhibition, negative affectivity) and supervisor knowledge hiding on individual knowledge hiding. This study also explores the moderating role of positive affectivity.

Design/methodology/approach

Partial least squares path modeling and data collected from 518 Polish employees with higher education and extensive professional experience recruited via an Ariadna survey panel were used to test the research hypotheses.

Findings

Two dimensions of alexithymia were considered: difficulty identifying feelings (DIF) and difficulty describing feelings (DDF). DIF has a direct impact on individual hiding, whereas DDF has an indirect impact, via social inhibition. Negative affectivity is a predictor of social inhibition, which enhances knowledge hiding. Positive affectivity slightly weakens the positive and strong effect of supervisor knowledge hiding on subordinate knowledge hiding.

Practical implications

Because alexithymia, social inhibition and negative affectivity may predispose employees to knowledge hiding, managers should identify these personality traits among job applicants and hired employees to make appropriate employment decisions. Moreover, managers should be aware that hiding knowledge by a supervisor may be imitated by subordinates.

Originality/value

Based on conservation of resources theory, this study investigates previously unexplored relationships among alexithymia, social inhibition, affectivity and knowledge hiding.

Theory of Mind and Alexithymia in Deaf and Hard-of-Hearing Young Adults

The aim of the current study was to examine theory of mind (ToM), the ability to infer the mental states of others, in young adults who are deaf and hard-of-hearing (DHH), and to explore the influence of alexithymia, an inability to understand emotions of the self and others, on ToM performance in this group. Compared to participants with typical hearing, DHH participants displayed significantly lower affective ToM skills and greater alexithymia. After accounting for verbal intelligence quotient, hearing status and alexithymia significantly contributed to poorer ToM performance, accounting for over 14% of the variance. Having a parent who is deaf and being part of the Deaf community were associated with better emotion processing and appear to be important protective factors. Findings provide support that ToM difficulties may linger into young adulthood among DHH individuals and that alexithymia may be a contributing factor. Early intervention programs emphasizing emotional understanding, perspective-taking, and communication skills are warranted for DHH children as well as their caregivers.

Trait Emotional Intelligence and School Burnout Discriminate Between High and Low Alexithymic Profiles: A Study With Female Adolescents

Alexithymic traits, which entail finding it difficult to recognize and describe one's own emotions, are linked with poor trait emotional intelligence (TEI) and difficulties in identifying and managing stressors. There is evidence that alexithymia may have detrimental consequences for wellbeing and health, beginning in adolescence. In this cross-sectional study, we investigated the prevalence and incidence of alexithymia in teenage girls, testing the statistical power of TEI and student burnout to discriminate between high- and low-alexithymic subjects. A sample of 884 female high school students (mean age 16.2 years, age range 14-19) attending three Italian academic-track high schools (social sciences and humanities curriculum) completed self-report measures of alexithymia, school burnout, and TEI. Main descriptive statistics and correlational analysis preceded the discriminant analysis. The mean alexithymia scores suggest a high prevalence of alexithymia in female adolescents; as expected, this trait was negatively correlated with TEI and positively associated with school burnout. Participants with high vs. low alexithymia profiles were discriminated by a combination of TEI and burnout scores. High scores for the emotionality and self-control dimensions of TEI were strongly associated with membership of the low alexithymia group; high scores for the emotional exhaustion dimension of school burnout were indicative of membership of the high alexithymia group. These findings suggest crucial focuses for educational intervention: efforts to reduce the risk of emotional exhaustion and school burnout should especially concentrate on enhancing emotional awareness and self-control skills, both strongly associated with low levels of alexithymia.

An investigation of the relationship between alexithymia and empathy tendency in university students receiving health education

PURPOSE

This study aims to identify the relationship between alexithymia and empathy tendency in university students receiving health education.

DESIGN AND METHODS

This descriptive study was conducted with the volunteer participation of 376 students at a unıversity located in the eastern part of Turkey between September and October 2019. Data were collected through the Sociodemographic Form, the Empathy Tendency Scale, and the Toronto Alexithymia Scale.

FINDINGS

The Empathy Tendency Scale was found to be significantly higher in females, in those who lived alone, who did not experience a traumatic event when they were children, whose mother was alive, and who were not subject to violence. As to the Alexithymia Scale, mean scores were significantly higher in males, in those whose mother or father was illiterate, who had a monthly family income of less than 2000₺, who graduated from a Religious Vocational High School, and whose mother was not alive (P %3C .05). A negative, significant relationship was found between the Empathy Tendency Scale mean score and the Toronto Alexithymia Scale (P %3C .001).

PRACTICE IMPLICATIONS

A negative, significant relationship was found between empathy tendency and alexithymia. It is recommended that similar studies should be conducted in different regions as well.

Cognitive-emotional processing in alexithymia: an integrative review

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.

Investigating the relationship between emotional granularity and cardiorespiratory physiological activity in daily life

Emotional granularity describes the ability to create emotional experiences that are precise and context-specific. Despite growing evidence of a link between emotional granularity and mental health, the physiological correlates of granularity have been under-investigated. This study explored the relationship between granularity and cardiorespiratory physiological activity in everyday life, with particular reference to the role of respiratory sinus arrhythmia (RSA), an estimate of vagal influence on the heart often associated with positive mental and physical health outcomes. Participants completed a physiologically triggered experience-sampling protocol including ambulatory recording of electrocardiogram, impedance cardiogram, movement, and posture. At each prompt, participants generated emotion labels to describe their current experience. In an end-of-day survey, participants elaborated on each prompt by rating the intensity of their experience on a standard set of emotion adjectives. Consistent with our hypotheses, individuals with higher granularity exhibited a larger number of distinct patterns of physiological activity during seated rest, and more situationally precise patterns of activity during emotional events: granularity was positively correlated with the number of clusters of cardiorespiratory physiological activity discovered in seated rest data, as well as with the performance of classifiers trained on event-related changes in physiological activity. Granularity was also positively associated with RSA during seated rest periods, although this relationship did not reach significance in this sample. These findings are consistent with constructionist accounts of emotion that propose concepts as a key mechanism underlying individual differences in emotional experience, physiological regulation, and physical health.

Alexithymia and self-harm: A review of nonsuicidal self-injury, suicidal ideation, and suicide attempts

INTRODUCTION

Suicide attempts are a significant global public health concern. Research into non-traditional factors, such as the presence of alexithymia, may shed light on the prediction of suicidal behaviours, which can aid intervention and prevention strategies. To ascertain whether alexithymia is a unique risk factor for suicide attempts, this article reviews the evidence on alexithymia related to suicidal ideation, attempts, and non-suicidal self-injury (NSSI).

METHODS

A literature search was conducted for original articles examining the general and psychiatric populations.

RESULTS

There is consistent evidence linking alexithymia with suicidal ideation and NSSI, but inconsistent evidence linking it to suicide attempts.

CONCLUSION

The relationship between alexithymia and suicidality seems to differ based on whether the research focuses on suicidal ideation, suicide attempts, or NSSI. The relationship between alexithymia and suicidality can be understood within the context of multiple code theory and childhood trauma. Future research should explore the whether alexithymia can reliably distinguish between those with a single attempt and those with multiple suicide attempts as well as alexithymia levels pre- and post-intervention with suicide-related behavior as outcomes in treatment studies.

Lack of Emotional Awareness is Associated with Thwarted Belongingness and Acquired Capability for Suicide in a Military Psychiatric Inpatient Sample

OBJECTIVE

To examine potential links between facets of impulsivity and emotion dysregulation to components of the Interpersonal-Psychological Theory of Suicide (thwarted belongingness, perceived burdensomeness, and acquired capability) among U.S. military personnel.

METHOD

The current study performed secondary data analysis from a randomized control trial testing the efficacy of a cognitive therapy for 134 service members (71.64% male, 68.66% Caucasian; mean age: 30.14) admitted to a psychiatric inpatient unit for a suicide-related crisis. We utilized the Difficulties in Emotion Regulation Scale, the Barratt Impulsivity Scale, the Acquired Capability for Suicide Scale, and the Interpersonal Needs Questionnaire.

RESULTS

All emotion dysregulation dimensions and one impulsivity facet (attentional) were positively correlated with perceived burdensomeness and thwarted belongingness. Lack of emotional awareness was positively associated with acquired capability. After controlling for depression, hopelessness, and demographic covariates, lack of emotional awareness was significantly associated with both thwarted belongingness and acquired capability, but not perceived burdensomeness, and impulsivity dimensions did not link to any variable of interest.

CONCLUSIONS

Findings imply that individuals with reduced emotional awareness may have difficulty cultivating interpersonal bonds and be more vulnerable to elevated acquired capability. Lack of emotional awareness may be a potential contributor to both suicidal desire and capability.

Developing a short version of the Toronto Structured Interview for Alexithymia using item response theory

The Toronto Structured Interview for Alexithymia (TSIA) was developed to provide a structured interview method for assessing alexithymia. One drawback of this instrument is the amount of time it takes to administer and score. The current study used item response theory (IRT) methods to analyze data from a large heterogeneous multi-language sample (N = 842) to investigate whether a subset of items could be selected to create a short version of the instrument. Samejima's (1969) graded response model was used to fit the item responses. Items providing maximum information were retained in the short model, resulting in the elimination of 12-items from the original 24-items. Despite the 50% reduction in the number of items, 65.22% of the information was retained. Further studies are needed to validate the short version. A short version of the TSIA is potentially of practical value to clinicians and researchers with time constraints.

Alexithymia and Autism Spectrum Disorder: A Complex Relationship

Alexithymia is a personality construct characterized by altered emotional awareness which has been gaining diagnostic prevalence in a range of neuropsychiatric disorders, with notably high rates of overlap with autism spectrum disorder (ASD). However, the nature of its role in ASD symptomatology remains elusive. Here, we distill research at the intersection of alexithymia and ASD. After a brief synopsis of the studies that plaid a pioneering role in the identification of the overlapping fields between alexithymia and ASD, we comb the literature for evidence of its overlap with ASD in terms of prevalence, etiology, and behaviors. Through a formalized framework of the process of emotional interpretation and expression, we explore evidence for where and how deficits arise in this complex network of events. We portray how these relate to the dynamic interplay between alexithymic and autistic traits and find emerging evidence that alexithymia is both a cause and consequence of autistic behaviors. We end with a strategic proposal for future research and interventions to dampen the impacts of alexithymia in ASD.

Alexithymia, Assertiveness and Psychosocial Functioning in HIV: Implications for Medication Adherence and Disease Severity

Psychosocial function and adherence to antiretroviral regimen are key factors in human immunodeficiency virus (HIV) disease management. Alexithymia (AL) is a trait deficit in the ability to identify and describe feelings, emotions and bodily sensations. A structural equation model was used to test whether high levels of AL indirectly relate to greater non-adherent behavior and HIV disease severity via psychosocial dysfunction. Blood draws for HIV-1 viral load and CD4 T-lymphocyte, along with psychosocial surveys were collected from 439 HIV positive adults aged 18-73 years. The structural model supports significant paths from: (1) AL to non-active patient involvement, psychological distress, and lower social support, (2) psychological distress and non-active involvement to non-adherent behavior, and (3) non-adherence to greater HIV disease severity (CFI = .97, RMSEA = .04, SRMR = .05). A second model confirmed the intermediary effect of greater patient assertiveness on the path from AL to social support and non-active patient involvement (CFI = .94, RMSEA = .04, SRMR = .05). Altogether, AL is indirectly linked with HIV disease management through it's association with poor psychosocial function, however greater patient assertiveness buffers the negative impact of AL on relationship quality with healthcare providers and members of one's social support network.

Alexithymia level and response to computer-based training in cognitive behavioral therapy among cocaine-dependent methadone maintained individuals

BACKGROUND

Alexithymia, a characteristic marked by poor ability to identify, define and communicate emotions, has been associated with poorer treatment outcome, including traditional clinician delivered CBT. Computerized cognitive behavioral therapy (CBT4CBT), an effective adjunct to treatment, may provide a means of conveying skills without requiring interaction with a clinician.

METHODS

Seventy-three methadone maintained, cocaine dependent individuals participating in an 8-week randomized clinical trial comparing standard methadone maintenance to methadone maintenance plus CBT4CBT completed the Toronto Alexithymia Scale (TAS-20) at pretreatment, post-treatment, and follow-ups conducted one, two, and 6 months after treatment.

RESULTS

There were no statistically significant differences on baseline TAS-20 scores by multiple demographic and substance use variables including gender and substance use severity. Higher TAS-20 scores were associated with somewhat higher levels of distress as measured by the Beck Depression Inventory and multiple Brief Severity Index scales. TAS-20 scores remained relatively stable throughout the duration of treatment and follow-up. Indicators of treatment process, including treatment retention, adherence and therapeutic alliance, were not significantly correlated with TAS-20 scores. There was a significant interaction of alexithymia and treatment condition, such that individuals with higher baseline scores on the TAS-20 submitted significantly higher percentages of cocaine-negative urine toxicology specimens and reported a higher percentage of abstinence days, and longer periods of consecutive abstinence within treatment when assigned to CBT4CBT compared with treatment as usual.

CONCLUSIONS

These findings suggest that individuals with increased alexithymia may benefit from computerized CBT; possibly via reduced demands on interpersonal skills and interactions associated with computerized therapies.

Alexithymia in anorexia nervosa: the mediating role of depression

The role of depression in the expression of alexithymia in anorexia nervosa (AN) has been controversially explained and several variables that may mask or increase the presence of emotional difficulties have scant examination in previous studies. This study aims to analyze the associations between alexithymia and state variables, such as age, BMI, illness duration, treatment duration, and medication status in AN participants, and to test the mediating role of depression in emotional difficulties. The Toronto Alexithymia Scale (TAS-20) and the Zung Self-Rating Depression Scale were administrated to 160 females: 80 participants with AN and 80 healthy controls. High levels of alexithymia were not a function of state variables. The mediating role of depression differed by the alexithymia dimension, with total mediation found for the TAS-DDF and partial mediation found for the TAS-DIF. Alexithymia is a relevant feature throughout the spectrum of AN and does not seem to be related to developmental maturation and some clinical features. Depression is probably the variable that best accounts for the variance in alexithymia, but is not a complete explanation for the known cognitive-affective disturbances in AN. Specific emotional competencies require scrutiny during psychiatric treatment.

Assessing alexithymia and emotional awareness: relations between measures in a German non-clinical sample

The aim of this study was to evaluate psychometric properties and relations between two different methods of measuring alexithymia and one measure of emotional awareness in a German non-clinical sample. The 20-Item Toronto Alexithymia Scale (TAS-20), the Toronto Structured Interview for Alexithymia (TSIA), and the Levels of Emotional Awareness Scale (LEAS), which is a performance-based measure of emotional awareness, were administered to 84 university students. Both internal reliability and inter-rater reliability for the TSIA were acceptable. Results from exploratory factor analysis (EFA) based on all measures supported a three factorial solution previously obtained in an American sample using multiple methods of alexithymia and emotional ability measurement. In our three factor model direct self (TAS-20), direct other (TSIA), and indirect self (LEAS) measures were differentiated. The convergent validity of the TSIA was supported by a significant correlation with the LEAS. Our findings suggest that future research on alexithymia and emotional awareness can benefit from the use of a multi-method approach and should include objective measures.

A naturalistic study of alexithymia among psychiatric outpatients treated in an integrated group therapy program

OBJECTIVES

Alexithymia is common among psychiatric outpatients and can complicate treatment. There has been little research into whether alexithymia can be modified by psychological intervention, and whether change in alexithymia is related to other areas of improvement. The purpose of the present study was to examine whether participation in an integrated group therapy program could effect change in alexithymia, and whether such change is related to improvement in interpersonal functioning.

DESIGN AND METHODS

Sixty-eight consecutively admitted psychiatric outpatients to a comprehensive group therapy program were evaluated at baseline, post-therapy, and 3-month follow-up using the Toronto Alexithymia Scale 20, the Beck Depression Inventory, and the Inventory of Interpersonal Problems-28. Associations among variables were evaluated with correlations and among group comparisons with t test, ANOVA, chi-square tests, and logistic regression. Change in alexithymia was examined using repeated measures ANOVA, controlling for change in depressive symptoms.

RESULTS

Alexithymia, particularly difficulty identifying feelings, decreased significantly during the treatment period. Post-therapy levels of alexithymia were maintained during the 3 months following treatment completion. Changes in alexithymia were significantly associated with changes in interpersonal problems, both during therapy and during the follow-up period.

CONCLUSIONS

The results of our study suggest that a comprehensive, integrated group therapy program can affect change in alexithymia, and that such change can be maintained once therapy is completed. Also, modifying alexithymia may contribute to improvement in interpersonal functioning.

Interpersonal problems and cognitive characteristics of interpersonal representations in alexithymia: a study using a self-report and interview-based measure of alexithymia

In this study, associations between alexithymia, interpersonal problems, and cognitive-structural aspects of internal interpersonal representations were examined. Alexithymia was measured using the Toronto Structured Interview for Alexithymia (TSIA) and the 20-item Toronto Alexithymia Scale (TAS-20). To measure interpersonal problems, the dominance and affiliation dimension scores of the Inventory of Interpersonal Problems were used, and cognitive-structural characteristics of interpersonal representations were measured using the Social Cognition and Object Relations Scale (SCORS). As hypothesized, alexithymia was related to cold and withdrawn, but not to dominant or submissive, interpersonal functioning. In terms of the SCORS, alexithymia was negatively related to complexity of interpersonal representations, both in TAT and in interview narratives, indicating a link between alexithymia and mentalization. However, alexithymia was related only to the dimension of social causality when this dimension was scored on TAT narratives. Overall, the TSIA provides the most consistent and stable results after controlling for negative affectivity.

Changes in natural language use as an indicator of psychotherapeutic change in personality disorders

Word use has been shown to reflect various psychological processes and psychological change. This study examines the self-view in personality disorders (PDs) and its change over the course of therapy using the Linguistic Inquiry and Word Count analysis procedure. A sample of 299 participants with PDs and 108 community control participants wrote short essays about their lives. Patients repeated the assignment three times over two years and completed assessments of PD-pathology, general psychopathology, PD-beliefs, and quality of life. Results show that as hypothesized the use of words in the 1st Person Singular Pronouns, Negative Emotion, Causation, Past and Future Tense Verbs categories significantly declines over the course of treatment, while the use of Present Tense Verbs and Positive Emotion increases. These categories tend to distinguish patients from non-patients prior to treatment. We also found 12 additional word categories changing over time, including Word Count and Negations. Change in word use statistically predicts better treatment outcome on all outcome measures (p < .001). Reductions in the use of Negative Emotion Words and Negations are the strongest predictors of outcome. The non-hypothesized role of Negations was explored and seemed to reflect that PD-patients miss a lot in their lives. Reduction of what they miss seems central to recovery. This issue seems relatively neglected in theoretical and treatment models of PDs. An increased focus on what patients miss in their lives might improve our understanding and treatment of PDs. In sum, Negative Emotion and Negation word categories appear to reflect key treatment targets.

Effect of alexithymia on the process and outcome of psychotherapy: a programmatic review

Most psychotherapeutic approaches assume that individuals have some access to their emotions. Thus, patients who are unable to identify, differentiate, and articulate their emotions present therapists with a difficult challenge. Such patients may suffer from alexithymia. Despite much attention in the clinical literature, research on alexithymia in the treatment setting has been sparse. Thus, many of the assumptions about psychotherapeutic treatment of alexithymic patients remain untested. This article summarizes findings from a series of studies that examined the effect of alexithymia on various aspects of the psychotherapeutic enterprise. Findings indicated that alexithymia has little effect on patients' treatment preferences, yet there was some tendency for alexithymic patients to prefer group therapy. However, alexithymia was associated with poor outcome in both traditional psychodynamic psychotherapy and supportive therapy. This negative effect was found in individual and group psychotherapies. In the context of group therapy, higher levels of alexithymic features elicited negative reactions from one's therapist, which partially contributed to the poor outcome experienced by such patients. Finally, the negative reaction that therapists had toward patients with high alexithymia appeared to be in response to the lack of positive emotion expressed by these patients. Clinical implications and ideas for future research are considered.