1
|
Périard IAC, Dierolf AM, Lutz A, Vögele C, Voderholzer U, Koch S, Bach M, Asenstorfer C, Michaux G, Mertens VC, Schulz A. Frontal alpha asymmetry is associated with chronic stress and depression, but not with somatoform disorders. Int J Psychophysiol 2024; 200:112342. [PMID: 38614440 DOI: 10.1016/j.ijpsycho.2024.112342] [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] [Received: 01/18/2024] [Revised: 04/04/2024] [Accepted: 04/07/2024] [Indexed: 04/15/2024]
Abstract
Cardinal characteristics of somatoform disorders (SFDs) are worry of illness, and impaired affective processing. We used relative frontal alpha asymmetry (FAA), a method to measure functional lateralization of affective processing, to investigate psychobiological correlates of SFDs. With alpha activity being inversely related to cortical network activity, relative FAA refers to alpha activity on the right frontal lobe minus alpha activity on the left frontal lobe. Less relative left frontal activity, reflected by negative FAA scores, is associated with lower positive and greater negative affectivity, such as observed in depression. Due to its negative affective component (illness anxiety), we expected to find less relative left frontal activity pattern in SFDs, and positive associations with self-reported chronic stress and depression symptoms. We recorded resting-state EEG activity with 64 electrodes, placed in a 10-10 system in 26 patients with a primary SFD, 23 patients with a major depressive disorder and 25 healthy control participants. The groups did not differ in FAA. Nevertheless, across all participants, less relative left frontal activity was associated with chronic stress and depression symptoms. We concluded that FAA may not serve as an indicator of SFDs. As the relationship of FAA and depressive symptoms was fully mediated by chronic stress, future studies have to clarify whether the association between FAA and chronic stress may represent a shared underlying factor for the manifestation of mental health complaints, such as depression.
Collapse
Affiliation(s)
- Isabelle Anne-Claire Périard
- Research Group 'Brain-Body Interaction', Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg; Institute of Medical Psychology, Charité University Medical Center Berlin, Berlin, Germany; Department of Developmental and Cognitive Psychology, University of Regensburg. Regensburg, Germany
| | - Angelika Margarete Dierolf
- Research Group 'Brain-Body Interaction', Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Annika Lutz
- Research Group 'Brain-Body Interaction', Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Claus Vögele
- Research Group 'Brain-Body Interaction', Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany; Clinic for Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Stefan Koch
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Michael Bach
- Practice for Psychosomatics and Stress Medicine, Vienna, Austria
| | | | - Gilles Michaux
- Research Group 'Brain-Body Interaction', Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg; GesondheetsZentrum, Fondation Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - Vera-Christina Mertens
- Research Group 'Brain-Body Interaction', Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - André Schulz
- Research Group 'Brain-Body Interaction', Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg; Institute for Cognitive and Affective Neuroscience, Trier University, Trier, Germany.
| |
Collapse
|
2
|
Park B, Lee S, Jang Y, Park HY. Affective dysfunction mediates the link between neuroimmune markers and the default mode network functional connectivity, and the somatic symptoms in somatic symptom disorder. Brain Behav Immun 2024; 118:90-100. [PMID: 38360374 DOI: 10.1016/j.bbi.2024.02.017] [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: 09/26/2023] [Revised: 01/16/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE Somatic symptom disorder (SSD) is characterized by physical symptoms and associated functional impairments that are often comorbid with depression and anxiety disorders. In this study, we explored relationships between affective symptoms and the functional connectivity of the default mode network (DMN) in SSD patients, as well as the impact of peripheral inflammation. We employed mediation analyses to investigate the potential pathways between these factors. METHODS We recruited a total of 119 individuals (74 unmedicated SSD patients and 45 healthy controls), who were subjected to comprehensive psychiatric and clinical evaluations, blood tests, and resting-state functional magnetic resonance imaging scanning. We assessed neuroimmune markers (interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), tryptophan, serotonin, and 5-hydroxyindoleacetic acid (5-HIAA)), clinical indicators of somatic symptoms, depression, anxiety, anger, alexithymia, and functional connectivity (FC) within the DMN regions. Data were analyzed using correlation and mediation analysis, with a focus on exploring potential relations between clinical symptoms, blood indices, and DMN FCs. RESULTS Patients with SSD had higher clinical scores as well as IL-6 and TNF-α levels compared with those in the control group (P < 0.05). The SSD group exhibited lower FC strength between the left inferior parietal lobule and left prefrontal cortex (Pfalse discovery rate (FDR) < 0.05). Exploratory correlation analysis revealed that somatic symptom scores were positively correlated with affective symptom scores, negatively correlated with the FC strength between the intra prefrontal cortex regions, and correlated with levels of IL-6, TNF- α, and tryptophan (uncorrected P < 0.01). Mediation analysis showed that levels of anxiety and trait anger significantly mediated the relations between DMN FC strength and somatic symptoms. In addition, the DMN FC mediated the level of trait anger with respect to somatic symptoms (all PFDR < 0.05). The levels of depression and trait anger exhibited significant mediating effects as suppressors of the relations between the level of 5-HIAA and somatic symptom score (all PFDR < 0.05). Further, the level of 5-HIAA had a mediating effect as a suppressor on the relation between DMN FC and state anger. Meanwhile, the levels of hs-CRP and IL-6 had full mediating effects as suppressors when explaining the relations of DMN FC strengths with the level of depression (all PFDR < 0.05). The patterns of valid mediation pathways were different in the control group. CONCLUSIONS Affective symptoms may indirectly mediate the associations between DMN connectivity, somatic symptoms, and neuroimmune markers. Inflammatory markers may also mediate the impact of DMN connectivity on affective symptoms. These results emphasize the importance of affective dysregulation in understanding the mechanisms of SSD and have potential implications for the development of tailored therapeutic approaches for SSD patients with affective symptoms. Furthermore, in SSD research using DMN FC or neuroimmune markers, considering and incorporating such mediating effects of affective symptoms suggests the possibility of more accurate prediction and explanation.
Collapse
Affiliation(s)
- Bumhee Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea; Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea
| | - Seulgi Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea; Department of Biomedical Sciences, Graduate School of Ajou University, Suwon, Republic of Korea
| | - Yuna Jang
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Hye Youn Park
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
3
|
Nehme A, Moussa S, Fekih-Romdhane F, Yakın E, Hallit S, Obeid S, Haddad G. Expressive suppression moderates the relationship between PTSD from COVID-19 and somatization and validation of the Arabic version of Patient Health Questionnaire-15 (PHQ-15). PLoS One 2024; 19:e0293081. [PMID: 38271356 PMCID: PMC10810523 DOI: 10.1371/journal.pone.0293081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 10/01/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Lebanese adults have been crippled for years by several crises, including the lately COVID-19 pandemic. These massive civilian traumas have increased the risk of post-traumatic stress disorder (PTSD) in this population. Extensive literature pointed to the association between PTSD and somatization; however, the nature of this relationship remains unknown. We sought to contribute further to work in this area by testing the moderating role of emotion regulation in the relationship between COVID-19- related PTSD and somatization. As a secondary objective, we aimed to examine the psychometric properties of an Arabic translation of the somatization measure Patient Health Questionnaire-15 (PHQ-15) in terms of factorial validity and internal consistency before its use in the present study. METHODS This cross-sectional study was conducted between September and October 2021. A total of 403 Lebanese adults residing in Lebanon were recruited. Eligible participants received an online link to the survey. The Patient Health Questionnaire-15 was used to assess somatization, PTSD Checklist-Civilian Version for PTSD and Emotion Regulation Questionnaire for emotion regulation. RESULTS The results of the exploratory factor analysis (EFA) revealed a three-factor solution explaining 48.79% of the common variance. Confirmatory Factor Analysis results of the three-factor model obtained in the EFA indicated a good fit with a significant CFI of 0.98, TLI 0.98 and a GFI of .97, a RMSEA of .04 [90% CI .01, .06]. Higher PTSD symptoms were associated with somatization. In addition, we found that one specific ER component, i.e. expressive suppression, significantly moderated the relationship between PTSD from the COVID pandemic and somatization. In particular, the interaction PTSD from the COVID-19 pandemic by expressive suppression was significantly associated with somatization; at low, medium and high levels of expressive suppression, higher PTSD from the COVID-19 pandemic was significantly associated with higher somatization scores. As for our secondary objective, findings revealed that the Arabic version of the PHQ-15 exhibited good psychometric properties. In particular, the scale yielded a three-factor structure, and good internal consistency (Cronbach's alpha = 0.87). CONCLUSION The moderating role of expressive suppression on the link between PTSD and somatization presents a novel finding in the field of trauma. Additionally, making a psychometrically sound Arabic version of the PHQ-15 available is a valuable addition to the literature.
Collapse
Affiliation(s)
- Antonio Nehme
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Sara Moussa
- Faculty of Medicine, University of Balamand, Koura, Lebanon
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry “Ibn Omrane”, Razi Hospital, Manouba, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Ecem Yakın
- Centre d’Études et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse-Jean Jaurès, UT2J, Toulouse, France
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Georges Haddad
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| |
Collapse
|
4
|
Li W, Liu Y, Qiu J, Li Y. Bidirectional relationship between insular grey matter volume and alexithymia: Evidence from a longitudinal study. J Affect Disord 2023; 339:799-806. [PMID: 37442449 DOI: 10.1016/j.jad.2023.07.041] [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: 03/15/2023] [Revised: 06/17/2023] [Accepted: 07/08/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND The insula is considered to be involved in emotional cognitive processes, and may be structurally altered in people with alexithymia. However, it remains unclear how the relationship between the insula and alexithymia changes over time. This study aimed to investigate whether alexithymia has longitudinal relationship with the insular structure. METHODS Having processed structural MRI data via FreeSurfer, the insula was divided into five sub-regions, and the Toronto Alexithymia Scale was administered to assess alexithymia in the general population. Subsequently, we established the latent change score models between insular sub-regions and the alexithymia (N = 252). RESULTS The TAS-20 mean value of the sample at Time 1 was not significantly different by sex (t = -0.993, df = 250, p = 0.321), while the TAS-20 mean value at Time 2 was slightly different by sex (t = 2.025, df = 250, p = 0.044). Most insular grey matter volumes at Time 1 and Time 2 were significantly associated with TAS-20 at Time 2. The baseline alexithymia and insular grey matter volume positively predicted the other's rate of change between Time 1 and Time 2 in a bidirectional way. LIMITATIONS This study had a limited number of measurement time points, potential bias due to smaller sample sizes and gender imbalance, as well as the potential for inaccuracy in the self-report measure of alexithymia. CONCLUSIONS Time-lagged alexithymia changes and insular grey matter volume changes occur in coupled manner over time, which might improve our understanding of the neurological underpinnings of alexithymia, and shed light on clinical and psychological treatment for alexithymia.
Collapse
Affiliation(s)
- Wenjing Li
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing, China; Department of Psychology, Southwest University, Chongqing, China
| | - Yuan Liu
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing, China; Department of Psychology, Southwest University, Chongqing, China.
| | - Jiang Qiu
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing, China; Department of Psychology, Southwest University, Chongqing, China
| | - Yu Li
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing, China; Department of Psychology, Southwest University, Chongqing, China; Faculty of Education, Southwest University, Chongqing, China.
| |
Collapse
|
5
|
Joos A, Herrmann C, Lahmann C, Flottman M, Jansen T, Schede C, Maner P, Schörner K, von Husen DK, Jöbges M, Hartmann A. Biopsychosocial complexity in functional neurological disorder. Gen Hosp Psychiatry 2023; 84:44-46. [PMID: 37379722 DOI: 10.1016/j.genhosppsych.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Functional Neurological Disorder (FND) is considered a biopsychosocial disorder nowadays, with chronicity in >50% of cases. The INTERMED Self-Assessment Questionnaire (IMSA) assesses the various domains and indicates biopsychosocial complexity. OBJECTIVE FND patients were compared with a sample of psychosomatic (PSM) patients as well as post-stroke patients. METHODS The three samples (N = 287 altogether) were largely in inpatient and day clinic psychotherapeutic treatment or inpatient neurological rehabilitation. The IMSA covers all three biopsychosocial domains as well as health care utilisation in the time frame of the past, the present and the future. In addition, affective burden (GAD-7, PHQ-9), somatoform symptoms (PHQ-15), dissociation (FDS) and quality of life (SF-12) were evaluated. RESULTS FND and PSM patients scored highly in the IMSA, with ≥70% regarded as complex, compared to 15% of post-stroke patients. Affective, somatoform and dissociation scores were high in FND and PSM patients. Mental and somatic quality of life were lower in these groups compared to post-stroke patients. DISCUSSION FND patients showed high biopsychosocial strain, similar to a typical sample of inpatient and day clinic, i.e. severely affected, PSM patients, and they were more affected than post-stroke patients. These data emphasize that FND should be evaluated with a biopsychosocial perspective. The IMSA likely represents a valuable tool, which has to be assessed by further longitudinal studies.
Collapse
Affiliation(s)
- Andreas Joos
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Psychosomatic Medicine and Psychotherapy, Ortenau Klinikum, Lahr, Germany.
| | - Christoph Herrmann
- Kliniken Schmieder, Clinics for Neurologic Rehabilitation and Psychotherapeutic Neurologic Rehabilitation, Gailingen, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Merle Flottman
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Theresa Jansen
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Corinna Schede
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp Maner
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kai Schörner
- Kliniken Schmieder, Clinics for Neurologic Rehabilitation and Psychotherapeutic Neurologic Rehabilitation, Gailingen, Germany
| | - Dominik Klaasen von Husen
- Kliniken Schmieder, Clinics for Neurologic Rehabilitation and Psychotherapeutic Neurologic Rehabilitation, Konstanz, Germany
| | - Michael Jöbges
- Kliniken Schmieder, Clinics for Neurologic Rehabilitation and Psychotherapeutic Neurologic Rehabilitation, Konstanz, Germany
| | - Armin Hartmann
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
6
|
Zamani S, Hasani J, Hatami M, Tadros E. Emotion Dysregulation and Alexithymia within Marital Burnout through an Emotion-Focused Therapy Lens. JOURNAL OF COUPLE & RELATIONSHIP THERAPY 2023. [DOI: 10.1080/15332691.2023.2165206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Solaleh Zamani
- Department of Clinical Psychology, Kharazmi University of Tehran, Tehran, Iran
| | - Jafar Hasani
- Department of Clinical Psychology, Kharazmi University of Tehran, Tehran, Iran
| | - Mohammad Hatami
- Department of Clinical Psychology, Kharazmi University of Tehran, Tehran, Iran
| | - Eman Tadros
- IMFT, Governors State University, University Park, Illinois, USA
| |
Collapse
|
7
|
Micheli N, Porcelli P, Barrault-Couchouron M, Dantzer C. Does the practice of mindfulness reduce somatic symptoms and COVID-19-related anxiety? A community-based survey. Front Psychol 2022; 13:996559. [PMID: 36571039 PMCID: PMC9784913 DOI: 10.3389/fpsyg.2022.996559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Objective Since the beginning of COVID-19 pandemic, several studies have shown an increase of psychological distress in the general population. Previous research demonstrated that high levels of anxiety are associated with reporting more somatic symptoms. The ability to adaptively regulate emotions is essential to deal with stressful situations, and it is one of the main components of mindfulness practice. The aim of the present study was to document the effect of mindfulness practice on somatic symptoms and psychological distress in the context of COVID-19 pandemic. Methods The study has a descriptive cross-sectional design. During the second wave of COVID-19 pandemic, between November 2020 and January 2021 participants living in France responded to an online survey on the impact of COVID-19 on psychological distress and physical health. The questionnaire included the assessment of COVID-19-related anxiety, mindfulness practice and experience, dispositional mindfulness, somatization, depression, generalized anxiety, and emotion regulation. Results A total of 569 people (mean age = 39.8 years, 90% women) were included in the study. COVID-19 related anxiety was associated with higher levels of somatic symptoms, generalized anxiety, and depression. About half of the sample (n = 318, 56%) reported moderate to severe somatic symptoms that were associated with higher levels of depression and anxiety, lower levels of dispositional mindfulness and to the use of maladaptive emotion regulation strategies. Overall, 164 subjects (28.8%) reported practicing meditation. No differences were found in dispositional mindfulness (MAAS score) between beginners and advanced practitioners, regardless of the type, years, frequency, and length of practice. Participants with less experience in mindfulness practice reported a significant higher number of somatic symptoms than non-practitioners and a higher use of rumination. Moreover, mindfulness experience was associated with the use of more adaptive emotion regulation strategies. Conclusion Mindfulness meditation has been promoted as a practice enhancing well-being and helping to cope with the psychological impact of stressful events. However, in a distressing situation as COVID-19 pandemic, a limited experience in mindfulness practices might result in the development or endurance of somatic symptoms. Adequate training and a focus on mindful acceptance, may contribute to enhance the effectiveness of mindfulness practice.
Collapse
Affiliation(s)
- Noemi Micheli
- Univertité de Bordeaux, LabPsy UR 4139, Bordeaux, France,*Correspondence: Noemi Micheli,
| | - Piero Porcelli
- Department of Psychological, Health and Territorial Sciences, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | | | - Cécile Dantzer
- Univertité de Bordeaux, LabPsy UR 4139, Bordeaux, France
| |
Collapse
|
8
|
Ryan C, Cogan S. Eliciting Expressions of Emotion: An Exploratory Analysis of Alexithymia in Adults with Autism Utilising the APRQ. J Autism Dev Disord 2022; 53:2499-2513. [PMID: 35394243 DOI: 10.1007/s10803-022-05508-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Abstract
This study examined alternative methods for detecting alexithymia to the Toronto Alexithymia Scale-20 (TAS-20) by comparing the emotional linguistic performance of ASD and NT samples (n = 32 in each) on the Alexithymia Provoked Responses Questionnaire (APRQ). We utilised both the LIWC and tidytext approaches to linguistic analysis. The results indicate the ASD sample used significantly fewer affective words in response to emotionally stimulating scenarios and had less emotional granularity. Affective word use was correlated with ASD symptomatology but not with TAS-20 scores, suggesting that some elements of alexithymia are not well detected by the TAS-20 alone. The APRQ, in combination with the tidytext package, offers significant potential for sophisticated exploration of emotional expression in ASD.
Collapse
Affiliation(s)
- Christian Ryan
- School of Applied Psychology, University College Cork, Distillery House, North Mall, Cork, T23 TK30, Ireland.
| | - Stephen Cogan
- Aspect, Cork Association for Autism, Carrigtwohill, Cork, Ireland
| |
Collapse
|
9
|
Park J, Zhan X, Gainey KN. Meta-Analysis of the Associations Among Constructs of Intrapersonal Emotion Knowledge. EMOTION REVIEW 2022. [DOI: 10.1177/17540739211068036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To better define the boundaries of conceptually overlapping constructs of intrapersonal emotion knowledge (EK), we examined meta-analytic correlations among five intrapersonal EK-related constructs (affect labelling, alexithymia, emotional awareness, emotional clarity, emotion differentiation) and attention to emotion. Affect labelling, alexithymia, and emotional clarity were strongly associated, and they were moderately associated with attention to emotion. Alexithymia and emotional awareness were weakly associated, and emotion differentiation was unrelated with emotional clarity. Sample characteristics and measures moderated some of the associations. Publication bias was not found, except for the alexithymia-emotional awareness association. This study helped to clarify the extent to which similarly defined constructs overlap or are distinct, which can inform our decision to adequately label important constructs and employ corresponding measures.
Collapse
Affiliation(s)
- Juhyun Park
- Department of Psychology, University at Buffalo, The State University of New York, USA
| | - Xinyi Zhan
- Department of Psychology, University at Buffalo, The State University of New York, USA
| | | |
Collapse
|
10
|
Effectiveness of Positive Psychotherapy on Depression and Alexithymia in Women Applying for a Divorce. DEPRESSION RESEARCH AND TREATMENT 2022; 2022:8446611. [PMID: 35223096 PMCID: PMC8865992 DOI: 10.1155/2022/8446611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 01/19/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The new therapeutic approach of positive psychotherapy has successfully treated severe mental disorders such as depression and mood disorders. However, existing research has not sufficiently measured the usefulness of this treatment in reducing depression and alexithymia. OBJECTIVES This study thus examined the effectiveness of positive psychotherapy in reducing these two conditions in a specific population: Iranian women applying for the divorce. METHODS A total of 40 participants aged 20-40 with a high score in the Beck Depression Inventory and Toronto Alexithymia Questionnaire were recruited from women referred to a psychology clinic for divorce-related problems. The pretest, posttest, and follow-up were conducted with all participants, who were randomly placed in two groups: the experimental and control groups, which each consisted of 20 people. We provided eight positive psychotherapy sessions for only the experimental group. RESULTS After MANCOVA was conducted, the results showed that positive psychotherapy significantly decreased alexithymia and depression in the test population.
Collapse
|
11
|
Lane RD, Smith R. Levels of Emotional Awareness: Theory and Measurement of a Socio-Emotional Skill. J Intell 2021; 9:42. [PMID: 34449662 PMCID: PMC8395748 DOI: 10.3390/jintelligence9030042] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 12/13/2022] Open
Abstract
Emotional awareness is the ability to conceptualize and describe one's own emotions and those of others. Over thirty years ago, a cognitive-developmental theory of emotional awareness patterned after Piaget's theory of cognitive development was created as well as a performance measure of this ability called the Levels of Emotional Awareness Scale (LEAS). Since then, a large number of studies have been completed in healthy volunteers and clinical populations including those with mental health or systemic medical disorders. Along the way, there have also been further refinements and adaptations of the LEAS such as the creation of a digital version in addition to further advances in the theory itself. This review aims to provide a comprehensive summary of the evolving theoretical background, measurement methods, and empirical findings with the LEAS. The LEAS is a reliable and valid measure of emotional awareness. Evidence suggests that emotional awareness facilitates better emotion self-regulation, better ability to navigate complex social situations and enjoy relationships, and better physical and mental health. This is a relatively new but promising area of research in the domain of socio-emotional skills. The paper concludes with some recommendations for future research.
Collapse
Affiliation(s)
- Richard D. Lane
- Department of Psychiatry, University of Arizona, 1501 N. Campbell Ave., Tucson, AZ 85724, USA
| | - Ryan Smith
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA;
| |
Collapse
|
12
|
Abstract
This is the first controlled study regarding personality and psychopathology in adults with Noonan syndrome (NS). Anxiety, depression, alexithymia and symptoms of Attention Deficit-Hyperactivity Disorder and Autism Spectrum Disorder, have been previously described in NS. More information regarding personality and psychopathology in NS could improve mental health care for this population. Therefore, scores on the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF), a widely used self-report questionnaire of personality and psychopathology, were compared between patients with NS (n = 18) and matched, healthy controls (n = 18). Furthermore, correlations between MMPI-2-RF scores and alexithymia, measured by the Toronto Alexithymia Scale-20, were investigated. Patients with NS showed significantly higher scores, with medium effect sizes, on MMPI-2-RF scales reflecting infrequent responses (F-r), somatic and cognitive complaints (FBS-r and RBS-r), internalizing problems (EID), demoralization (RCd) and introversion (INTR-r), although the overall profile in both groups was within the non-clinical range. Alexithymia correlated with internalizing problems and negative emotionality in the patient group. In conclusion, patients with NS showed higher levels of introversion, which may predispose them to internalizing problems. These problems were indeed more frequent in patients with NS, especially higher levels of demoralization. Patients may benefit from psychological interventions aimed to decrease internalizing problems, introversion and alexithymia.
Collapse
|
13
|
Grigaitytė I, Söderberg P. Why does perceived social support protect against somatic symptoms: Investigating the roles of emotional self-efficacy and depressive symptoms? NORDIC PSYCHOLOGY 2021. [DOI: 10.1080/19012276.2021.1902845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
14
|
Roberton T, Daffern M, Bucks RS. Oral administration of the Levels of Emotional Awareness Scale. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Terri Roberton
- Centre for Forensic Behavioural Science, School of Psychology & Psychiatry, Monash University, Melbourne,
| | - Michael Daffern
- Centre for Forensic Behavioural Science, School of Psychology & Psychiatry, Monash University, Melbourne,
- Victorian Institute of Forensic Mental Health, Fairfield, Victoria,
| | - Romola S. Bucks
- School of Psychology, The University of Western Australia, Crawley, Western Australia, Australia,
| |
Collapse
|
15
|
Lane RD. The construction of emotional experience: State‐related emotional awareness and its application to psychotherapy research and practice. COUNSELLING & PSYCHOTHERAPY RESEARCH 2020. [DOI: 10.1002/capr.12331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Richard D. Lane
- Department of Psychiatry University of Arizona Tucson AZ USA
| |
Collapse
|
16
|
The effect of alexithymia and depressive feelings on pain perception in somatoform pain disorder. J Psychosom Res 2020; 133:110101. [PMID: 32224345 DOI: 10.1016/j.jpsychores.2020.110101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/08/2020] [Accepted: 03/20/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the relationship between alexithymia and depression and their influence on the subjective versus experimental pain perception in somatoform pain disorder. METHODS Three groups consisting of 40 patients with somatoform pain disorder, 40 patients with depression, and 40 healthy controls were matched. They completed questionnaires regarding alexithymia (TAS26) and depressive feelings (BDI-II). In addition, pain patients rated their subjective pain intensity (NRS). Quantitative sensory testings were conducted in all participants examining temperature (CPT, HPT) and mechanical (MPT, PPT) thresholds. RESULTS Analysis of variance showed that alexithymia was significantly increased in both patient groups compared to healthy controls, but with the highest amount in somatoform pain. Regression analyses confirmed that this finding was in part due to a high comorbidity of depressive feelings in both patient groups. We found a discrepancy between increased clinical pain ratings and elevated pressure pain thresholds, indicating a less intense mechanical pain perception in somatoform pain. Correlation analyses demonstrated a significant connection of subjective pain ratings and pressure pain thresholds with depressive feelings. CONCLUSION Contrary to the results of other experimental pain studies on chronic muskuloskeletal pain syndromes, we could not confirm central sensitization in somatoform pain disorder. Our findings place the somatoform pain disorder more in the direction of affective disorder such as depression. These findings may improve a better understanding of the disease and also have direct therapeutic implications. The high occurrence of alexithymia and depressive feelings in somatoform pain should be considered in diagnostic and therapeutic regimens of these patients.
Collapse
|
17
|
Henker J, Keller A, Reiss N, Siepmann M, Croy I, Weidner K. Early maladaptive schemas in patients with somatoform disorders and somatization. Clin Psychol Psychother 2019; 26:418-429. [PMID: 30836437 DOI: 10.1002/cpp.2363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 02/15/2019] [Accepted: 02/21/2019] [Indexed: 12/26/2022]
Abstract
Maladaptive schemas are stable relational patterns that develop through harmful childhood experiences with primary caregivers. Schemas within somatoform disorders are rarely explored even though these disorders are clinically important due to high prevalence, co-morbidity, and cost for the health care system. This study investigates schemas according to Young's schema theory in patients with somatoform disorders in comparison with healthy controls and patients with depressive or anxiety disorders. Further associations between schemas and somatization were explored. We included 134 patients with a somatoform disorder and 39 age-matched healthy controls, 83 patients with a unipolar depression, and 34 patients with an anxiety disorder. The clinical sample consists of day care patients, diagnosed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, but without a personality disorder. Primary measures were the Young Schema Questionnaire (YSQ-S2), the Screening for Somatoform Disorders (SOMS-7T), the Beck Depression Inventory, Second Edition, and the Childhood Trauma Questionnaire. Analyses of variance indicated that somatoform patients scored higher on almost all schemas than do healthy controls (p < 0.001, η2 = 0.148). The highest mean scores were reached for the schemas "self-sacrifice" and "unrelenting standards," with significant higher values in the patient sample. However, when compared with patients with depressive or anxiety disorders, somatoform patients scored equally or even lower. High somatization was associated with generally higher schema activation. This effect was to a great extent mediated by depressive symptoms. Only the schema "vulnerability to harm or illness" was exclusively related to somatization. These findings suggest that schemas should be systematically assessed within psychotherapy of somatoform patients.
Collapse
Affiliation(s)
- Jana Henker
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Dresden, Dresden, Germany
| | - Andrea Keller
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Dresden, Dresden, Germany
| | - Neele Reiss
- Institute for Psychotherapy in Mainz (ipsti-mz), Mainz, Germany
| | - Martin Siepmann
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Dresden, Dresden, Germany.,Psychosomatic Clinic, Rhön-Klinikum AG, Bad Neustadt, Germany
| | - Ilona Croy
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Dresden, Dresden, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Dresden, Dresden, Germany
| |
Collapse
|
18
|
Thamby A, Desai G, Mehta UM, Chaturvedi SK. Deficits in Theory of Mind and Emotional Awareness in Somatoform Disorders. Indian J Psychol Med 2019; 41:368-374. [PMID: 31391671 PMCID: PMC6657473 DOI: 10.4103/ijpsym.ijpsym_382_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Emotions develop from a less differentiated to a highly differentiated level, and their arrest at a lower level is hypothesized to result in somatization. The present study aimed at investigating the Theory of Mind and emotional awareness in patients with somatoform disorders. MATERIALS AND METHODS Twenty patients with somatoform disorders, along with 20 healthy controls matched for age, sex, and education, were recruited after obtaining informed consent. Assessments included semi-structured proforma for sociodemographic and clinical details; Scale for Assessment of Somatic Symptoms (SASS) for somatic symptoms; and Patients Health Questionnaire (PHQ) to assess somatic symptoms, depression, and anxiety. Emotional awareness was measured using the Levels of Emotional Awareness Scale (LEAS), in which the participants had to provide descriptions of feelings of self and the other person in 20 imaginary situations. The responses were scored using a standardized manual. The Theory of Mind was measured using the Social Cognition Rating Tool in Indian Settings (SOCRATIS). RESULTS The two groups did not differ on any demographic parameters. Patients with somatoform disorders scored significantly lower on emotional awareness (t = -3.74; P < 0.001) and the Theory of Mind (t = -3.56; P < 0.001). The above differences remained significant even after controlling for comorbid depressive and anxiety symptoms. CONCLUSION Patients with somatoform disorders are likely to have Theory of Mind and emotional awareness deficits independent of mood states. Future studies are needed to assess whether these deficits are trait- or state-dependent and whether they are cause or effect.
Collapse
Affiliation(s)
- Abel Thamby
- Department of Psychiatry NIMHANS, Bengaluru, Karnataka, India
| | - Geetha Desai
- Department of Psychiatry NIMHANS, Bengaluru, Karnataka, India
| | | | | |
Collapse
|
19
|
Okur Güney ZE, Sattel H, Witthöft M, Henningsen P. Emotion regulation in patients with somatic symptom and related disorders: A systematic review. PLoS One 2019; 14:e0217277. [PMID: 31173599 PMCID: PMC6555516 DOI: 10.1371/journal.pone.0217277] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/08/2019] [Indexed: 12/28/2022] Open
Abstract
Background Somatic symptoms and related disorders (SSD) are prevalent phenomena in the health-care system. Disturbances in emotion regulation (ER) are commonly observed in patients suffering from SSD. Objectives This review aimed to examine ER processes that characterize SSD by a systematic analysis of the available empirical studies. Data sources PsycINFO and PubMed databases for the articles published between January 1985 and June 2018. Search terms “emotion/al regulation” or “affect regulation” and various forms of SSD. Study eligibility criteria Empirical studies that a) assigned adolescent or adult patients suffering from SSD based on a clinical diagnosis, and b) examined the relationship between ER and SSD, were included. Study synthesis methods A tabular summary of the articles was generated according to study characteristics, study quality, variables, and findings. The findings were organized based on ER variables used in the articles and diagnoses of SSD, which were then re-organized under the main constituents of ER (attention, body, and knowledge). Results The findings of the 64 articles largely supported the association between SSD and disturbances in ER, which are usually shared by different diagnoses of SSD. The results indicate that patients show a reduced engagement with cognitive content of emotions. On the other hand, bodily constituents of ER seem to depict an over-reactive pattern. Similarly, the patients tend to encounter difficulties in flexibly disengaging their (spontaneous) attention from emotional material. Limitations There is a scarcity of longitudinal designs, randomized controlled trials, experiments, and diary studies suited to investigate the short- and long-term causal relationship between ER and SSD. Symptoms of SSD and measures to assess emotion regulation are heterogeneous. Conclusions and implications Assessment of ER processes is potentially useful to understand SSD and for treatment planning. Furthermore, a concurrent investigation of the dynamic interaction of the ER modalities promises insights for better understanding of the role of ER in development, course, and maintenance of SSD.
Collapse
Affiliation(s)
- Zeynep Emine Okur Güney
- Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy Technical University of Munich, Munich, Germany
- Johannes Gutenberg University of Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychology, Mainz, Germany
- * E-mail:
| | - Heribert Sattel
- Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy Technical University of Munich, Munich, Germany
| | - Michael Witthöft
- Johannes Gutenberg University of Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychology, Mainz, Germany
| | - Peter Henningsen
- Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy Technical University of Munich, Munich, Germany
| |
Collapse
|
20
|
Ballespí S, Vives J, Alonso N, Sharp C, Ramírez MS, Fonagy P, Barrantes-Vidal N. To know or not to know? Mentalization as protection from somatic complaints. PLoS One 2019; 14:e0215308. [PMID: 31048857 PMCID: PMC6497236 DOI: 10.1371/journal.pone.0215308] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 03/29/2019] [Indexed: 01/29/2023] Open
Abstract
Somatization processes are usually associated with a lack of insight or with emotional unawareness, especially in adolescents where the ability for self-reflection is beginning to mature. However, the extent to which different levels of insight explain variations in somatization remains understudied. This study aimed to evaluate whether high-level emotional awareness (comprehension) but not low-level awareness (only attention) is needed to psychologically cope with suffering, thus leading to lower somatization. Specific predictions were: 1) High attention along with High comprehension will be associated with significantly lower frequency of somatic complaints than other combinations (Low attention and Low comprehension, or High attention but Low comprehension); 2) In absence of comprehension, no attention will be more optimal than attention only, because only-attention might work as an amplificatory of suffering without the possibility of processing it. Self-reports of meta-cognitive processes, somatization, and control variables were obtained from 264 adolescents from a non-clinical population (54.5% female; aged 12-18, M = 14.7, SD = 1.7). In line with expectations, results revealed significant differences in the effects of insight positions on somatization: Attention+Comprehension (M = 4.9, SE = 0.9) < Nothing (M = 7.1, SE = 0.3) < Only attention (M = 8.9, SE = 0.7). Compared to Nothing, Attention+comprehension was associated with significantly reduced somatic complaints (B = -2.2, p = 0.03, 95% CI -4,1 to 0.2). However, Only attention was associated with increased somatic complaints compared to the other two conditions (B = 1.8, p = 0.03, 95% CI 0.2 to 3.4; B = 4, CI 95% 1.6-6.3, p = 0.001, respectively). This highlights the role of higher-order awareness (i.e., comprehension or clarity) in the processing of suffering and stresses its value in the adaptive coping of emotional distress.
Collapse
Affiliation(s)
- Sergi Ballespí
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Jaume Vives
- Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Naida Alonso
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, United States of America
| | - María Salvadora Ramírez
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Peter Fonagy
- Department of Psychology & Lang Sciences, University College London, London, United Kingdom
| | - Neus Barrantes-Vidal
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
- Department of Mental Health, Fundació Sanitària Sant Pere Claver, Barcelona, Catalonia, Spain
- Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
21
|
Effectiveness of a 5-Week Inpatient Dialectical Behavior Therapy for Borderline Personality Disorder. J Psychiatr Pract 2019; 25:192-198. [PMID: 31083031 DOI: 10.1097/pra.0000000000000383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The goal of this study was to evaluate whether symptoms are reduced and emotion regulation improves when patients with borderline personality disorder (BPD) receive a 5-week course of inpatient dialectical behavioral therapy (DBT) and if changes in emotion regulation are associated with changes in symptoms. METHODS Forty-four patients with BPD receiving a 5-week course of DBT in a German psychiatry clinic participated. The short version of the "Borderline Symptom List" (BSL-23) was the patient-reported outcome. To measure emotion regulation, the "Self-Report Measure for the Assessment of Emotion Regulation Skills" (SEK-27) was administered. Wilcoxon tests were performed to evaluate whether pre-post changes in the BSL-23 and SEK-27 reached statistical significance. Effect sizes (d) were calculated and correlations between the pre-post differences for both measures were computed to test associations between changes in emotion regulation and changes in symptoms. Completer (n=33) and intention-to-treat (n=43) analyses were performed. RESULTS Symptoms (BSL-23) were reduced and emotion regulation (SEK-27) improved during the 5-week inpatient DBT treatment (completer and intention-to-treat analysis: P<0.001). Effect sizes reached d=0.47 for the BSL-23 and d=0.84 for the SEK-27 in the completer analysis, and d=0.38 for the BSL-23 and d=0.68 for the SEK-27 in the intention-to-treat analysis. Improvements in emotion regulation (SEK-27) were correlated with reductions in symptoms (BSL-23) in both the completer (r=0.54; P=0.001) and the intention-to-treat (r=0.59; P<0.001) analyses. CONCLUSIONS These findings indicate that a 5-week course of inpatient DBT can effectively reduce symptoms in patients with BPD and that the more patients' emotion regulation improves, the more the patients benefit from the therapy.
Collapse
|
22
|
Limburg K, Schmid-Mühlbauer G, Sattel H, Dinkel A, Radziej K, Gonzales M, Ronel J, Lahmann C. Potential effects of multimodal psychosomatic inpatient treatment for patients with functional vertigo and dizziness symptoms - A pilot trial. Psychol Psychother 2019; 92:57-73. [PMID: 29603590 DOI: 10.1111/papt.12177] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 02/26/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Functional vertigo and dizziness (VD) are frequent and severely distressing complaints that are often described as hard to treat. Our aim was to provide preliminary data on potential effects of multimodal psychosomatic inpatient therapy for patients with functional VD symptoms in reducing vertigo-related handicap and related psychopathology, and to evaluate the role of symptom burden and body-related locus of control in predicting vertigo-related handicap at follow-up. DESIGN We conducted an uncontrolled clinical pilot trial. METHODS We included data of n = 72 inpatients with functional VD as a primary symptom and various psychopathological and/or physical comorbidities admitted for multimodal psychosomatic inpatient treatment. Patients completed self-report questionnaires assessing vertigo-related handicap (VHQ), somatization (PHQ-15), depression (BDI-II), anxiety (BAI), health-related quality of life (HRQOL; SF-36), and body-related locus of control (KLC) at admission (T0), discharge (T1), and 6 months after discharge (T2). RESULTS We observed medium effects for the change of vertigo-related handicap (T0-T1: g = -0.60, T0-T2: g = -0.67) and small effects for the change of somatization (T0-T1: g = -0.29, T0-T2: g = -0.24), mental HRQOL (T0-T1: g = 0.43, T0-T2: g = 0.49), and depression (T0-T1: g = -0.41, T0-T2: g = -0.28) from admission to discharge and admission to follow-up. Body-related locus of control did not predict vertigo-related handicap at follow-up. CONCLUSIONS Findings provide preliminary evidence for the beneficial role of psychosomatic inpatient treatment for patients with functional VD symptoms. Potentially relevant predictors of outcome at follow-up are discussed. PRACTITIONER POINTS The change of vertigo-related handicap and related variables through multimodal psychosomatic inpatient treatment was evaluated in a clinical pilot trial in patients with functional vertigo and dizziness. We observed medium effects for the change of vertigo-related handicap and small effects for the change of somatization, mental health-related quality of life, and depression. Internal body-related locus of control at admission did not predict vertigo-related handicap at follow-up.
Collapse
Affiliation(s)
- Karina Limburg
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of the Technical University of Munich, Germany
| | | | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of the Technical University of Munich, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of the Technical University of Munich, Germany
| | - Katharina Radziej
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of the Technical University of Munich, Germany
| | - Melanie Gonzales
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of the Technical University of Munich, Germany
| | - Joram Ronel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of the Technical University of Munich, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Germany
| |
Collapse
|
23
|
Abraham E, Hendler T, Zagoory-Sharon O, Feldman R. Interoception sensitivity in the parental brain during the first months of parenting modulates children's somatic symptoms six years later: The role of oxytocin. Int J Psychophysiol 2019; 136:39-48. [DOI: 10.1016/j.ijpsycho.2018.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 01/25/2018] [Accepted: 02/01/2018] [Indexed: 12/17/2022]
|
24
|
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.
Collapse
Affiliation(s)
| | - Paola Surcinelli
- University of Bologna, Department of Psychology, BOLOGNA, Bologna 40127, Italy
| |
Collapse
|
25
|
Koops TU, Briken P. Prevalence of Female Sexual Function Difficulties and Sexual Pain Assessed by the Female Sexual Function Index: A Systematic Review. J Sex Med 2018; 15:1591-1599. [PMID: 30327264 DOI: 10.1016/j.jsxm.2018.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/10/2018] [Accepted: 09/06/2018] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Sexual difficulties, and sexual pain in particular, represent a global health issue for women, and their prevalence has been shown to differ across countries. AIM To review the existing literature on the prevalence of female sexual difficulties and sexual pain worldwide measured by the Female Sexual Function Index (FSFI). METHODS We conducted a systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included were peer-reviewed publications indicating prevalence rates of female sexual difficulties based on the FSFI and cutoff values. Studies with samples limited to a certain age group or health condition were excluded. MAIN OUTCOME MEASURE The outcome measure includes cutoff values and prevalence rates for sexual difficulties and sexual pain, as well as sample characteristics. RESULTS 22 studies conducted in 11 countries were included. These examined samples from the community, patient records, health care staff, or the Internet. Various prevalence cutoff values were applied. Prevalence rates of overall sexual difficulties ranged between 5.5% and 77%. For sexual pain, rates from 3% to 95.5% were found. A comparison between countries was restricted due to differences in sample size, sample type, and applied cutoffs. Representative community samples using comparable cutoffs found that 5.8-63.3% of women experience general sexual difficulty and 6-31.6% experience sexual pain. CLINICAL IMPLICATIONS Sexual difficulties and sexual pain are prevalent in all examined countries, and despite restrictions to interpretability, the large prevalence rates point to the necessity of further clinical research. STRENGTH & LIMITATIONS Many studies had to be excluded because of missing data. The comparison of studies is descriptive, and not all regions worldwide are represented. Nevertheless, results of the review were useful to derive recommendations for reporting of future studies using the FSFI. CONCLUSION This review is the first comparison of prevalence studies based on the FSFI. It reflects the extent of available research and limitations in comparability. Koops TU, Briken P. Prevalence of Female Sexual Function Difficulties and Sexual Pain Assessed by the Female Sexual Function Index: A Systematic Review. J Sex Med 2018;15:1591-1599.
Collapse
Affiliation(s)
- Thula U Koops
- Institute for Sex Research and Forensic Psychiatry, University Medical Center, Hamburg-Eppendorf, Germany.
| | - Peer Briken
- Institute for Sex Research and Forensic Psychiatry, University Medical Center, Hamburg-Eppendorf, Germany
| |
Collapse
|
26
|
Cooper D, Yap K, Batalha L. Mindfulness-based interventions and their effects on emotional clarity: A systematic review and meta-analysis. J Affect Disord 2018; 235:265-276. [PMID: 29660642 DOI: 10.1016/j.jad.2018.04.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/13/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND An inability to identify or describe internal emotional experience has been linked to a range of affective disorders. Despite burgeoning research on mindfulness-based interventions and their possible effects on emotion regulation, the effects of such interventions on emotional clarity is unclear. This review examines the evidence for the effect of mindfulness-based interventions on self-reported emotional clarity. METHOD Published studies indexed by PsycINFO, PubMed and Scopus, as available in April 2017, were systematically reviewed. Interventions that included mindfulness practice or philosophy, and reported a suitable measure of emotional clarity at pre- and post-intervention were selected. A random-effects meta-analysis was performed. Subgroup comparisons were also conducted to test for differences between clinical and non-clinical samples, between specific and approximate measures of emotional clarity, and between controlled and uncontrolled trials. RESULTS Seventeen studies met the criteria for inclusion. The overall estimated effect size for pre- to post-intervention was small to moderate, Hedges' g = 0.42, 95% CI [0.25, 0.59] and for between groups results was small to large, Hedges' g = 0.52, 95% CI [0.15, 0.90]. LIMITATIONS Studies varied substantially in design quality and study characteristics. Furthermore, while interventions in the reviewed studies all had mindfulness components, many had other components in addition to mindfulness. Consequently, this review is limited by the heterogeneity of studies and results should be interpreted with caution. CONCLUSIONS There is preliminary evidence to suggest that mindfulness-based interventions may increase emotional clarity. However, more homogenous and targeted experiments are required to confirm these initial findings.
Collapse
Affiliation(s)
- David Cooper
- School of Psychology, Australian Catholic University, Strathfield Campus, 25A Barker Road, Strathfield, NSW 2135, Australia
| | - Keong Yap
- School of Psychology, Australian Catholic University, Strathfield Campus, 25A Barker Road, Strathfield, NSW 2135, Australia.
| | - Luisa Batalha
- School of Psychology, Australian Catholic University, Strathfield Campus, 25A Barker Road, Strathfield, NSW 2135, Australia
| |
Collapse
|
27
|
Parolin M, Miscioscia M, De Carli P, Cristofalo P, Gatta M, Simonelli A. Alexithymia in Young Adults With Substance Use Disorders: Critical Issues About Specificity and Treatment Predictivity. Front Psychol 2018; 9:645. [PMID: 29872408 PMCID: PMC5972315 DOI: 10.3389/fpsyg.2018.00645] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 04/16/2018] [Indexed: 11/18/2022] Open
Abstract
Several studies have reported high rates of alexithymia in drug-dependent individuals, but supporting evidence attests association between alexithymia and a variety of psychiatric disorders, raising doubts about its specificity. Moreover, controversies are emerging about alexithymia assessment: self-report measures present shortcomings with respect to discriminant validity and reliability. As regards treatment for substance use disorders (SUDs), alexithymia has been linked to poorer outcomes, but the results are inconsistent. The aim of the present study is to investigate alexithymia in substance-dependent young adults by examining: (a) the specificity of alexithymia in drug-dependent inpatients, compared to healthy individuals and patients with psychiatric disorders (behavioral and emotional disorders) and (b) the predictivity of alexithymia in determining treatment outcomes in terms of relapses, drop-outs from treatment and the rate of relapse per month of treatment. Two studies were conducted to fulfill these aims: Study 1 and Study 2. Study 1 involved 90 late adolescents, aged 17-21. To fulfill the first aim, 30 inpatients diagnosed with SUD were compared with 30 healthy controls and 30 individuals referred to an outpatient neuropsychiatric unit (a). The participants completed the Toronto Alexithymia Scale-20 (TAS-20) and the Symptom Checklist-90-Revised (SCL-90-R). The results indicated that both clinical groups reported higher TAS-20 scores than the non-clinical subjects, but they did not differ from each other (a); moreover, a large correlation was detected between alexithymia and depressive symptoms, as assessed by the SCL-90-R. Study 2 involved 55 inpatients with SUD recruited in a therapeutic community. The participants completed the TAS-20, and clinicians filled out the Observer Alexithymia Scale (OAS). No association was found between self-report and observational measures. Neither self-reported nor observed alexithymia predicted the number of relapses, drop-out from treatment, or the rate of relapses per month of treatment (b). When the interaction with gender was explored, the global score of alexithymia and the "Distant" OAS subscale predicted the number rate relapses only in males. The TAS-20 did not discriminate between the clinical groups. The limited ability of both observed and self-reported measures in predicting treatment outcome raises questions on the specificity of alexithymia among the substance-dependent inpatient population.
Collapse
Affiliation(s)
- Micol Parolin
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - Marina Miscioscia
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Pietro De Carli
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | | | - Michela Gatta
- Department of Women's and Children's Health, University of Padua, Padua, Italy
- Childhood Adolescence Family Unit, Ulss6 Veneto, Padua, Italy
| | - Alessandra Simonelli
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| |
Collapse
|
28
|
Herrmann AS, Beutel ME, Gerzymisch K, Lane RD, Pastore-Molitor J, Wiltink J, Zwerenz R, Banerjee M, Subic-Wrana C. The impact of attachment distress on affect-centered mentalization: An experimental study in psychosomatic patients and healthy adults. PLoS One 2018; 13:e0195430. [PMID: 29672540 PMCID: PMC5908075 DOI: 10.1371/journal.pone.0195430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 03/23/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction We investigated the impact of attachment distress on affect-centered mentalization in a clinical and a non-clinical sample, comparing mentalization in a baseline condition to mentalization under a condition of attachment distress. Methods The sample consisted of 127 adults who underwent inpatient psychosomatic treatment, and 34 mentally healthy adults. Affect-centered mentalization was assessed by analyzing participants’ narratives on interpersonal situations in a baseline condition with the Levels of Emotional Awareness Scale (LEAS), and an experimental condition inducing attachment distress with the Adult Attachment Projective Picture System (AAP). Unlike the LEAS, the AAP is specifically designed to trigger attachment distress. In both conditions, the narratives were evaluated using the LEAS scoring system. Additionally, we assessed the impact of childhood trauma on affect-centered mentalization with the Childhood Trauma Questionnaire (CTQ). Results While the non-clinical sample displayed the same level of affect-centered mentalization in both conditions, the majority of the clinical sample reached higher scores in the attachment distress condition. There was no strong relationship between reported trauma and mentalization scores. Discussion Our findings lend strong empirical support to the assumption that affect-centered mentalization is modulated by attachment-related distress. Several possible explanations for the differences between and within the clinical and the non-clinical sample are discussed.
Collapse
Affiliation(s)
- Anna S Herrmann
- DFG Research Training Group "Life Sciences, Life Writing" (GRK2015/1) / Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Katharina Gerzymisch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Richard D Lane
- Department of Psychiatry, The University of Arizona College of Medicine, Tucson, Arizona, United States of America
| | - Janine Pastore-Molitor
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Mita Banerjee
- Department of English and Linguistics, University of Mainz, Mainz, Germany
| | - Claudia Subic-Wrana
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| |
Collapse
|
29
|
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.
Collapse
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
| |
Collapse
|
30
|
van Dijke A, Hopman JA, Ford JD. Affect dysregulation, adult attachment problems, and dissociation mediate the relationship between childhood trauma and borderline personality disorder symptoms in adulthood. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2018. [DOI: 10.1016/j.ejtd.2017.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
31
|
Aaron RV, Snodgress MA, Blain SD, Park S. Affect labeling and other aspects of emotional experiences in relation to alexithymia following standardized emotion inductions. Psychiatry Res 2018; 262:115-123. [PMID: 29428774 PMCID: PMC5866771 DOI: 10.1016/j.psychres.2018.02.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/29/2018] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
Abstract
Alexithymia is associated with increased risk for mental and physical health disorders but available assessments rely exclusively on self-report. The major aim of the current study was to develop and implement a performance-based task designed to characterize and quantify the relationship between one's description of emotional experience and self-reported alexithymia. Specifically, we examined performance-based measures of affect labeling of one's own emotions, emotional granularity and dialecticism. Healthy participants (N = 108) completed the Toronto Alexithymia Scale-20 Item Questionnaire. Participants viewed a series of film clips standardized to elicit discrete emotional states. After each clip, they indicated the emotion they experienced "the most" and rated a list of non-primary emotions, which formed indices of emotional granularity and dialecticism. Alexithymia was associated with increased tendency to report experiencing "no emotion" following evocative film clips, reduced negative emotional granularity and dialecticism of experienced emotions. TAS-20 subscales were each associated with a unique set of emotional correlates. In a healthy population, alexithymia is associated with reduced awareness of emotional states, and reduced dialecticism and granularity of negative (but not positive) emotions. Our performance-based assessment enriches understanding of the mechanisms underlying alexithymia by underscoring the central importance of emotion awareness, negative emotional granularity and dialecticism.
Collapse
Affiliation(s)
- Rachel V Aaron
- Department of Anesthesiology and Pain Medicine, University of Washington and Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA.
| | - Matthew A Snodgress
- University of Minnesota Twin Cities, Department of Psychology, Minneapolis, MN, USA.
| | - Scott D Blain
- University of Minnesota Twin Cities, Department of Psychology, Minneapolis, MN, USA.
| | - Sohee Park
- Vanderbilt University Department of Psychology, Nashville, TN, USA.
| |
Collapse
|
32
|
Alfasi D, Soffer-Dudek N. Does alexithymia moderate the relation between stress and general sleep experiences? PERSONALITY AND INDIVIDUAL DIFFERENCES 2018. [DOI: 10.1016/j.paid.2017.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
33
|
Gritti P, Lombardi S, Nobile B, Trappoliere P, Gambardella A, Di Caprio EL, Resicato G. Alexithymia and Cancer-Related Fatigue: A Controlled Cross-Sectional Study. TUMORI JOURNAL 2018; 96:131-7. [DOI: 10.1177/030089161009600121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background The study aims to investigate the alexithymia construct in patients with a recent or longtime diagnosis of cancer as well as in healthy people, and whether alexithymia and fatigue are linked in the mentioned groups. Methods A first group, diagnosed less than 3 months previously (n = 63), and a second group whose cancer diagnosis dated back more than 30 months (n = 53), matched for sex, age, educational level and cancer site were assessed. Matched healthy controls (n = 50) were also evaluated. Alexithymia was assessed with the Toronto Alexithymia Scale-20, while fatigue was assessed with the Brief Fatigue Inventory. Results Alexithymia scores were higher in the recently diagnosed group than in the group with a longtime cancer diagnosis (t = 2.18, P <0.05). Both groups had higher scores than controls (t = 4.3, P <0.001; t = 2.01, P <0.05). Alexithymic subjects were 45.6% in the recently diagnosed and 21.4% in the longtime diagnosed group (χ2 = 6.3, P <0.05) and 18% in controls. Fatigue was more severe in patients with a longtime diagnosis compared with recently diagnosed patients (t = 7.079, P = 0.000). A weak but significant association between fatigue and alexithymia was found in recently diagnosed patients (r = 0.27.2; P <0.05). Conclusions Our study confirms that alexithymia scores are higher in cancer patients than in controls. The study suggests that alexithymia could be considered a dynamic reaction to illness in recently diagnosed patients, declining during subsequent phases. High fatigue rates in patients with a longtime diagnosis of cancer underline the role of the long course of illness in the perception of fatigue. The association between fatigue and alexithymia was weak in the recently diagnosed group and not significant in patients with a longtime diagnosis, in whom fatigue was an important complaint.
Collapse
Affiliation(s)
- Paolo Gritti
- Department of Psychiatry, Second University of Naples, Naples, Italy
| | | | - Barbara Nobile
- Department of Psychiatry, Second University of Naples, Naples, Italy
| | - Paola Trappoliere
- Department of Psychiatry, Second University of Naples, Naples, Italy
| | - Antonio Gambardella
- Department of Geriatric Medicine and Metabolic Diseases, Second University of Naples, Naples, Italy
| | | | - Gianluca Resicato
- Department of Psychiatry, Second University of Naples, Naples, Italy
| |
Collapse
|
34
|
van Dijke A, Hopman JAB, Ford JD. Affect dysregulation, psychoform dissociation, and adult relational fears mediate the relationship between childhood trauma and complex posttraumatic stress disorder independent of the symptoms of borderline personality disorder. Eur J Psychotraumatol 2018; 9:1400878. [PMID: 29410773 PMCID: PMC5795767 DOI: 10.1080/20008198.2017.1400878] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 10/22/2017] [Indexed: 01/06/2023] Open
Abstract
Objective: Complex posttraumatic stress disorder (CPTSD) as defined by the Disorders of Extreme Stress Not Otherwise Specified (DESNOS) formulation is associated with childhood relational trauma and involves relational impairment, affect dysregulation, and identity alterations. However, the distinct contributions of relational impairment (operationalized in the form fears of closeness or abandonment), affect dysregulation (operationalized in the form of overregulation and under-regulation of affect), and identity alterations (operationalized in the form of positive or negative psychoform or somatoform dissociation) to the relationship between childhood trauma and CPTSD/DESNOS have not been systematically tested. Method and Results: In a clinical sample of adults diagnosed with severe and chronic psychiatric and personality disorders (n = 472; M = 34.7 years, SD = 10.1), structural equation modelling with bootstrap 95% confidence intervals demonstrated that the association between childhood trauma and CPTSD/DESNOS symptoms in adulthood was partially mediated by under-regulation of affect, negative psychoform dissociation, and adult relational fears of closeness and of abandonment. These results also were independent of the effects of borderline personality disorder (BPD) symptoms. Conclusions: Some, but not all, hypothesized components of the DESNOS formulation of CPTSD statistically mediate the relationship between childhood trauma and adult CPTSD/DESNOS. These relationships appear specific to CPTSD/DESNOS and not to the effects of another potential sequelae of childhood trauma BPD. Replication with prospective longitudinal studies is needed.
Collapse
Affiliation(s)
- Annemiek van Dijke
- Yulius Academy/Yulius/COLK Centre for Psychosomatics Yulius, Dordrecht - Zaandam, the Netherlands.,Department of Clinical Psychology, VU University Amsterdam, Rotterdam, the Netherlands.,PsyQ Zaandam & Parnassia Academy, the Netherlands
| | - Juliette A B Hopman
- Yulius Academy/Yulius/COLK Centre for Psychosomatics Yulius, Dordrecht - Zaandam, the Netherlands.,Department of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, the Netherlands
| | - Julian D Ford
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| |
Collapse
|
35
|
Yuruyen M, Akcan FE, Batun GC, Gultekin G, Toprak M, Yavuzer H, Emul M. Alexithymia in people with subjective cognitive decline, mild cognitive impairment, and mild Alzheimer's disease. Aging Clin Exp Res 2017; 29:1105-1111. [PMID: 28110464 DOI: 10.1007/s40520-017-0725-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Behavioral and psychological symptoms are widely accepted as accelerator factors in progression to dementia. Although alexithymia is closely related to normal aging process and poor neurocognitive performance, alexithymia has not been included in these symptoms yet. AIMS Here, we aimed to investigate alexithymia features in people with prominent clinical memory complaints. METHODS The participants (n = 82) were classified into three groups as: subjective cognitive decline (n = 30), mild cognitive impairment (n = 27), and mild Alzheimer's disease (n = 25) after Mini-Mental State Examination, Clinical Dementia Rating Scale, neuropsychological test battery, Geriatric Depression Scale, and Hachinski Ischemic Scale. All participants were assessed with 20-item Toronto Alexithymia Scale. RESULTS The patients with mild Alzheimer's disease and mild cognitive impairment have significantly greater alexithymia features than individuals with subjective cognitive decline in Toronto Alexithymia Scale (p < 0.05 for all). The alexithymia features in patients with mild Alzheimer's disease and mild cognitive impairment did not significantly differ (p > 0.05, for all). DISCUSSION People who have objective cognitive decline seem to have more alexithymia features than people with subjective cognitive decline. Moreover, alexithymia features seem to be similar in people mild Alzheimer's disease and in mild cognitive impairment. CONCLUSION Alexithymia might be an important searching domain of behavioral-psychological symptoms in people with cognitive problems beyond aging.
Collapse
|
36
|
Erkic M, Bailer J, Fenske SC, Schmidt SNL, Trojan J, Schröder A, Kirsch P, Mier D. Impaired emotion processing and a reduction in trust in patients with somatic symptom disorder. Clin Psychol Psychother 2017; 25:163-172. [PMID: 29044807 DOI: 10.1002/cpp.2151] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 08/18/2017] [Accepted: 09/13/2017] [Indexed: 01/10/2023]
Abstract
There is accumulating evidence for deficits in the perception and regulation of one's own emotions, as well as the recognition of others' emotions in somatic symptom disorder (SSD). However, investigations of SSD focusing on specific aspects of emotion processing and how these might interact are missing. We included 35 patients with SSD and 35 healthy controls who completed questionnaires on the perception and regulation of their own emotions, as well as experimental investigations of emotion recognition and trust. In line with previous studies, our results show that SSD patients in comparison to healthy controls have difficulties in the identification and description of own feelings (ηp2 = .381 and ηp2 = .315). Furthermore, we found that patients apply less cognitive reappraisal (ηp2 = .185) but tend to use more expressive suppression (ηp2 = .047). In contrast to previous studies, we found SSD patients to perform superior in emotion recognition, in particular for anger (d = 0.40). In addition, patients with SSD invested less in a trust game (d = 0.73). These results point to a higher sensitivity for negative emotions and less trust in others. Further, these findings suggest a dissociation between the ability to recognize one's own emotions versus others' emotions in SSD. Future interventions targeting emotion processing in SSD might focus on the identification of one's own emotions, prior to the training of emotion regulation.
Collapse
Affiliation(s)
- Maja Erkic
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Josef Bailer
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Sabrina C Fenske
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Stephanie N L Schmidt
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Jörg Trojan
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | - Annette Schröder
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Landau, Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Daniela Mier
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| |
Collapse
|
37
|
Suslow T, Donges US. Alexithymia Components Are Differentially Related to Explicit Negative Affect But Not Associated with Explicit Positive Affect or Implicit Affectivity. Front Psychol 2017; 8:1758. [PMID: 29062297 PMCID: PMC5640715 DOI: 10.3389/fpsyg.2017.01758] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/22/2017] [Indexed: 11/13/2022] Open
Abstract
Alexithymia represents a multifaceted personality construct defined by difficulties in recognizing and verbalizing emotions and externally oriented thinking. According to clinical observations, experience of negative affects is exacerbated and experience of positive affects is decreased in alexithymia. Findings from research based on self-report indicate that all alexithymia facets are negatively associated with the experience of positive affects, whereas difficulties identifying and describing feelings are related to heightened negative affect. Implicit affectivity, which can be measured using indirect assessment methods, relates to processes of the impulsive system. The aim of the present study was to examine, for the first time, the relations between alexithymia components and implicit and explicit positive and negative affectivity in healthy adults. The 20-item Toronto Alexithymia Scale, the Implicit Positive and Negative Affect Test and the Positive and Negative Affect Schedule (PANAS) were administered to two hundred and forty-one healthy individuals along with measures of depression and trait anxiety. Difficulties identifying feelings were correlated with explicit negative trait affect, depressive mood and trait anxiety. Difficulties describing feelings showed smaller but also significant correlations with depressive mood and trait anxiety but were not correlated with explicit state or trait affect as assessed by the PANAS. Externally oriented thinking was not significantly correlated with any of the implicit and explicit affect measures. According to our findings, an externally oriented, concrete way of thinking appears to be generally unrelated to dispositions to develop positive or negative affects. Difficulties identifying feelings seem to be associated with increased conscious negative affects but not with a heightened disposition to develop negative affects at an automatic response level.
Collapse
Affiliation(s)
- Thomas Suslow
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Uta-Susan Donges
- Department of Psychiatry, Psychotherapy and Psychosomatics, Martin Gropius Krankenhaus, Eberswalde, Germany.,Department of Psychiatry and Psychotherapy, Campus Charité Mitte - Universitätsmedizin, Berlin, Germany
| |
Collapse
|
38
|
Probst T, Sattel H, Henningsen P, Gündel H, Lahmann C. Alexithymia as a Moderator of Treatment Outcomes in a Randomized Controlled Trial on Brief Psychodynamic Interpersonal Psychotherapy for Patients with Multisomatoform Disorder. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 86:57-59. [PMID: 27884003 DOI: 10.1159/000448287] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 07/09/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Thomas Probst
- Department for Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
| | | | | | | | | |
Collapse
|
39
|
Derks YPMJ, Westerhof GJ, Bohlmeijer ET. A Meta-analysis on the Association Between Emotional Awareness and Borderline Personality Pathology. J Pers Disord 2017; 31:362-384. [PMID: 27387060 DOI: 10.1521/pedi_2016_30_257] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Theories on borderline personality pathology (BPP) suggest that characteristic emotional dysregulation is due to low levels of emotional awareness or alexithymia. This study is the first meta-analysis to systematically review and analyze the evidence. A systematic search of the literature was performed using PsycInfo, Web of Science/MEDLINE, and Scopus. The term "borderline personality disorder" was searched for in conjunction with "emotional awareness," "emotional self-awareness," "emotion recognition," "alexithymia," "emotional processing," "emotional granularity," "emotional intelligence," or "emotion regulation." All references in the included studies were reviewed for additional relevant articles. Thirty-nine studies were then evaluated in a random effects meta-analysis to assess the association between BPP and emotional awareness. An overall moderate positive association between BPP and emotional awareness was significant (r = 0.359; 95% CI [0.283, 0.431]; Z = 8.678; p < 0.001) along with high heterogeneity (Q(38) = 456.7; p < .001; I2 = 91.7%). Studies comparing borderline personality disorder to healthy controls yielded a strong association (r = 0.518; 95% CI [0.411, 0.611]). No significant difference was found between studies using instruments for emotional awareness and those using alexithymia instruments. The strongest associations with regard to aspects of alexithymia were found for difficulties in identifying and describing emotions rather than externally oriented thinking. The results corroborate a moderate relationship between low emotional awareness and BPP. However, the mono-method self-report used in almost all studies is found problematic and precludes drawing definite conclusions. Since leading psychotherapeutic treatments strongly focus on increasing emotional awareness, future research should address this issue and further examine to what extent low levels of emotional awareness, particularly alexithymia, can be treated.
Collapse
Affiliation(s)
| | | | - Ernst T Bohlmeijer
- Department of Psychology, Health, and Technology, University of Twente, Enschede, The Netherlands
| |
Collapse
|
40
|
Cerutti R, Spensieri V, Valastro C, Presaghi F, Canitano R, Guidetti V. A comprehensive approach to understand somatic symptoms and their impact on emotional and psychosocial functioning in children. PLoS One 2017; 12:e0171867. [PMID: 28178333 PMCID: PMC5298337 DOI: 10.1371/journal.pone.0171867] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/26/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Somatic symptoms are frequently reported by children with significant impairment in functioning. Despite studies on adult populations that suggest somatic symptoms often co-occur with difficulties in identifying and describing feelings, little research has been done in childhood. This study aimed to investigate the prevalence and frequency of somatic symptoms as well as to investigate the functional impairment in children with high number of self reported somatic symptoms versus those with fewer somatic symptoms. Additionally the parental perception of their children's somatic symptoms and functioning was explored. Finally, we explored the direct and indirect effects of difficulties in identifying feelings in predicting somatic symptoms and functional disability among school-aged children. METHODS 356 Italian school-aged children and their mothers participated in this study. Children (mean age = 11.43; SD = 2.41) completed the Children's Somatization Inventory (CSI-24) to assess somatic symptoms, the Functional Disability Inventory (FDI) to assess physical and psychosocial functioning and the Alexithymia Questionnaire for Children (AQC) to evaluate alexithymic features. Mothers completed the parental forms of the CSI and the FDI. RESULTS Among children, 66.3% did not declare somatic symptoms and 33.7% reported one or more somatic symptoms in the last two weeks. A significant positive correlation emerged between children's and mothers' CSI total scores. Both children's and mothers' FDI total scores were significantly correlated with CSI scores. A significant correlation was observed between somatic symptoms and alexithymic features. Furthermore, the data showed that somatic symptoms mediated the relationship between difficulties in identifying feelings and functional impairment. Finally, it was showed that alexithymia facet of difficulty in identifying feelings contributed in large part to the prediction of the somatic symptomatology (b = 0.978, p < 0.001; R2 = 0.164, F(5, 350) = 10.32, p < 0.001). CONCLUSIONS Findings from this study provide evidence that a higher frequency of somatic symptoms is associated with functional disabilities and alexithymic facets in school-aged children.
Collapse
Affiliation(s)
- Rita Cerutti
- Department of Dynamic and Clinic Psychology, Sapienza University, Rome, Italy
- * E-mail:
| | - Valentina Spensieri
- Department of Dynamic and Clinic Psychology, Sapienza University, Rome, Italy
| | - Carmela Valastro
- Department of Dynamic and Clinic Psychology, Sapienza University, Rome, Italy
| | - Fabio Presaghi
- Department of Psychology of Developmental and Social Processes, Sapienza University, Rome, Italy
| | - Roberto Canitano
- Division of Child and Adolescent Neuropsychiatry, University Hospital of Siena, Siena, Italy
| | - Vincenzo Guidetti
- Department of Paediatrics and Child and Adolescent Neuropsychiatry, Sapienza University, Rome, Italy
| |
Collapse
|
41
|
Fujisato H, Ito M, Takebayashi Y, Hosogoshi H, Kato N, Nakajima S, Miyamae M, Oe Y, Usami S, Kanie A, Horikoshi M, Berking M. Reliability and validity of the Japanese version of the Emotion Regulation Skills Questionnaire. J Affect Disord 2017; 208:145-152. [PMID: 27770644 DOI: 10.1016/j.jad.2016.08.064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/27/2016] [Accepted: 08/31/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND The Emotion Regulation Skills Questionnaire (ERSQ) comprehensively assesses nine aspects of emotion regulation skills: awareness, clarity, sensation, understanding, compassionate self-support, modification, acceptance, tolerance, and readiness to confront. However, it is unknown about the levels of emotion regulation skills in various mental disorders, and its cross-cultural validity. We developed a Japanese version of the ERSQ, then examined its validity and reliability in clinical and non-clinical populations. METHODS In an Internet-based survey, 2684 participants (406 with MDD, 198 with PD, 116 with SAD, 66 with OCD, 636 with comorbid MDD and ≥1 anxiety disorder, and 99 with comorbid anxiety disorders; 1163 non-clinical sample) answered the ERSQ, diagnostic status, and measures of mindfulness, emotion regulation, behavioral activation, psychological distress, and life satisfaction. RESULTS Confirmatory factor analysis (CFA) replicated the theoretical nine-factor structure of the original ERSQ. Higher-order factor analysis model assuming two second-order factors and nine first-order factors also showed adequate fit to the data, suggesting the factorial validity of the scale. Analyses of multi-group CFA indicated the equivalence of factor loadings across clinical and non-clinical subsamples. The levels of internal consistency and time stability were sufficient. Convergent validity of the scale was also confirmed for most of external criteria. Character on the emotion regulation skills for each diagnostic group was depicted. LIMITATIONS Internet survey of samples with limited disorders, with self-reported diagnoses, may limit generalizability. CONCLUSIONS The Japanese version of the ERSQ showed adequate reliability and validity.
Collapse
Affiliation(s)
| | - Masaya Ito
- National Center of Neurology and Psychiatry, Japan
| | | | | | - Noriko Kato
- National Center of Neurology and Psychiatry, Japan
| | | | - Mitsuhiro Miyamae
- National Center of Neurology and Psychiatry, Japan; University of Tsukuba, Japan
| | - Yuki Oe
- National Center of Neurology and Psychiatry, Japan
| | | | - Ayako Kanie
- National Center of Neurology and Psychiatry, Japan
| | | | | |
Collapse
|
42
|
Probst T, Sattel H, Gündel H, Henningsen P, Kruse J, Schneider G, Lahmann C. Moderating Effects of Alexithymia on Associations between the Therapeutic Alliance and the Outcome of Brief Psychodynamic-Interpersonal Psychotherapy for Multisomatoform Disorder. Front Psychiatry 2017; 8:261. [PMID: 29255429 PMCID: PMC5722801 DOI: 10.3389/fpsyt.2017.00261] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 11/14/2017] [Indexed: 12/22/2022] Open
Abstract
This secondary analysis of a trial on brief psychodynamic-interpersonal therapy (PIT) for patients with multisomatoform disorder investigated whether alexithymia moderates the associations between the therapeutic alliance and the outcome of PIT and whether moderating effects of alexithymia remain significant when controlling for depression. Eighty-three patients with multisomatoform disorder receiving PIT were statistically analyzed. Moderation analyses were performed with the SPSS macro PROCESS. The primary outcome (Y), self-reported physical quality of life at 9-month after the end of PIT, was measured with the physical component summary (PCS) of the SF-36 Health Survey. The potential moderator (M) alexithymia was operationalized with the Toronto Alexithymia Scale (TAS-20) at pre-treatment and the predictor (X) the therapeutic alliance was rated by both patients and therapists via the Helping Alliance Questionnaire (HAQ) at the end of PIT. Moreover, the PCS at pre-treatment functioned as covariate in all moderation models. When the patients' alliance ratings were analyzed, alexithymia did not moderate associations between the alliance and the outcome. When the therapists' alliance ratings were evaluated, alexithymia moderated the relationship between the alliance and the outcome (p < 0.05): a stronger alliance in the therapists' perspective was beneficial for the outcome only for patients scoring above 61 on the TAS-20. This moderating effect of alexithymia was, however, not statistically significant anymore when adding the pre-treatment depression scores (PHQ-9) as a covariate to the moderation model. The results underline the importance of a good therapists' view of the alliance when treating alexithymic patients and highlight the complex interaction between alexithymia and depression. Future studies are needed to extend the scope of research regarding which psychotherapeutic mechanisms of change are beneficial for which patients.
Collapse
Affiliation(s)
- Thomas Probst
- Georg-Elias-Müller Institute for Psychology, Georg-August University of Göttingen, Göttingen, Germany.,Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems, Austria
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, University of Giessen, Giessen, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University of Marburg, Marburg, Germany
| | - Gudrun Schneider
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| |
Collapse
|
43
|
Ghorbani F, Khosravani V, Ardakani RJ, Alvani A, Akbari H. The mediating effects of cognitive emotion regulation strategies on the relationship between alexithymia and physical symptoms: Evidence from Iranian asthmatic patients. Psychiatry Res 2017; 247:144-151. [PMID: 27898375 DOI: 10.1016/j.psychres.2016.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 10/19/2016] [Accepted: 11/05/2016] [Indexed: 12/12/2022]
Abstract
Asthma is a chronic and episodic psychosomatic disease whose symptoms include coughing, wheezing, chest tightness, and shortness of breath. The present study aimed to investigate the effects of cognitive emotion regulation strategies (CERS) as mediators on the relationships between alexithymia subscales and physical symptoms (PS). 300 asthmatic patients (males=42.7%, females=57.3%, age range=16-65, mean age=29.40) and 100 normal controls participated in the study and completed the demographic questionnaire, the Cognitive Emotion Regulation Questionnaire (CERQ), the Persian version of the Toronto Alexithymia Scale (FTAS-20), and the Powell & Enright Physical Symptoms Inventory (PSI). Asthmatic patients showed higher scores on all three alexithymia subscales including difficulty in identifying feelings (DIF), difficulty in describing feelings (DDF), and externally oriented thinking (EOT) as well as non-adaptive CERS than normal controls. On the other hand, normal controls earned higher means in adaptive CERS. Results revealed that each of the three alexithymia subscales had indirect effects on PS through the non-adaptive cognitive emotion regulation strategy of catastrophizing. It is concluded that alexithymia can intensify PS through catastrophizing in asthmatic patients.
Collapse
Affiliation(s)
- Fatemeh Ghorbani
- Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Vahid Khosravani
- Psychosocial Injuries Research Centre, Ilam University of Medical Sciences, Ilam, Iran.
| | | | - Amin Alvani
- Psychosocial Injuries Research Centre, Ilam University of Medical Sciences, Ilam, Iran.
| | - Hedayat Akbari
- Allergist & Asthma Specialist at Private Allergic Office, Shiraz, Iran.
| |
Collapse
|
44
|
The alexithymia, cognitive emotion regulation, and physical symptoms in Iranian asthmatic patients. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2016.05.364] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
45
|
Leonidou C, Panayiotou G, Bati A, Karekla M. Coping with psychosomatic symptoms: The buffering role of psychological flexibility and impact on quality of life. J Health Psychol 2016; 24:175-187. [DOI: 10.1177/1359105316666657] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Individual differences in avoidant coping were hypothesized to exacerbate quality of life impairment associated with somatization and illness anxiety symptoms; psychological flexibility was expected to moderate this impairment. Individuals from a random community sample ( N = 298; 182 females), who met screening criteria for somatization and illness anxiety, reported lower quality of life and psychological flexibility and greater avoidant coping compared to controls. Psychological flexibility significantly moderated the impact of somatization and illness anxiety on quality of life domains. Findings suggest that decreasing avoidant coping through therapy may be promising in mitigating the negative impact of these symptom categories.
Collapse
|
46
|
Bilotta E, Giacomantonio M, Leone L, Mancini F, Coriale G. Being alexithymic: Necessity or convenience. Negative emotionality × avoidant coping interactions and alexithymia. Psychol Psychother 2016; 89:261-75. [PMID: 26454255 DOI: 10.1111/papt.12079] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/03/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVES We aimed to clarify the associations between negative emotionality, avoidant coping, and alexithymia. We hypothesized that negative emotionality and avoidance strategies would interact negatively in associating with alexithymia. DESIGN We examined, in one study conducted in Italy and another in the US (total N = 415), the associations among avoidant coping, negative emotionality, and alexithymia, using cross-sectional designs. METHOD Study 1: Participants completed paper-and-pencil measures of alexithymia, avoidant coping, and negative emotionality. Study 2: Participants completed the above-mentioned measures plus a measure of experiential avoidance (EA), by means of an online questionnaire. RESULTS As expected, an antagonistic avoidant coping × negative emotionality interaction was found to relate to alexithymia in both studies. In Study 2, EA mediated the effects of such interaction on alexithymia (mediated moderation). The interaction found implied that alexithymia would be adopted as a defence against negative affect or as a consequence of avoidant strategies. CONCLUSIONS The studies suggested that two different psychological pathways to alexithymia may be at work: Preference for avoidance and negative emotionality. This result appeared theoretically relevant and may stimulate further research. PRACTITIONER POINTS Alexithymia may develop from habitual avoidance, regardless of negative emotionality. Practitioners could consider addressing negative emotional regulation or automatic and habitual avoidant responses in dealing with alexithymic patients.
Collapse
Affiliation(s)
| | - Mauro Giacomantonio
- Department of Social and Developmental Psychology, Sapienza University of Rome, Italy
| | - Luigi Leone
- Department of Social and Developmental Psychology, Sapienza University of Rome, Italy
| | - Francesco Mancini
- School of Cognitive Psychotherapy, Rome, Italy.,Guglielmo Marconi University, Rome, Italy
| | - Giovanna Coriale
- Department of Clinical Medicine, Sapienza University of Rome, Italy
| |
Collapse
|
47
|
Günther V, Rufer M, Kersting A, Suslow T. Predicting symptoms in major depression after inpatient treatment: the role of alexithymia. Nord J Psychiatry 2016; 70:392-8. [PMID: 26935972 DOI: 10.3109/08039488.2016.1146796] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Alexithymia has been considered to have a negative influence on the course of symptoms in various psychiatric disorders. Only a few studies of depressed patients have examined whether alexithymia predicts the outcome of therapeutic interventions or the course of symptoms in naturalistic settings. This prospective study investigated whether alexithymia is associated with depressive symptoms after a multimodal inpatient treatment. Forty-five inpatients suffering from acute major depression were examined in the initial phase of treatment and then again after seven weeks. Patients took part in a multimodal treatment programme comprising psychodynamic-interactional oriented individual and group therapy. The majority of patients were taking antidepressants during study participation. To assess alexithymia and depressive symptoms, the 20-item Toronto Alexithymia Scale (TAS-20), the Beck Depression Inventory II (BDI-II) and the Hamilton Depression Scale (HAMD) were administered at baseline and follow-up. When controlling for baseline depressive symptoms along with trait anxiety, high scores in the externally oriented thinking (EOT) facet of alexithymia at baseline predicted high severity of depressive symptoms at follow-up (for self-reported as well as interviewer-based scores). Inpatients suffering from major depression with a more pronounced external cognitive style might benefit less from a routine multimodal treatment approach (including psychodynamic interactional therapy, antidepressant medication, and complementary therapies). Intervention programmes might modify or account for alexithymic characteristics to improve the course of depressive symptoms in these patients.
Collapse
Affiliation(s)
- Vivien Günther
- a Vivien Günther, LIFE - Leipzig Research Centre for Civilisation Diseases, University of Leipzig, and Department of Psychosomatic Medicine and Psychotherapy , University of Leipzig , Leipzig , Germany
| | - Michael Rufer
- b Michael Rufer, Department of Psychiatry and Psychotherapy , University Hospital Zürich, University of Zürich , Zürich , Switzerland
| | - Anette Kersting
- c Anette Kersting, LIFE - Leipzig Research Centre for Civilisation Diseases, University of Leipzig, and Department of Psychosomatic Medicine and Psychotherapy , University of Leipzig , Leipzig , Germany
| | - Thomas Suslow
- d Thomas Suslow, LIFE - Leipzig Research Centre for Civilisation Diseases, University of Leipzig, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, and Department of Psychiatry and Psychotherapy , University of Münster , Münster , Germany
| |
Collapse
|
48
|
van Dijke A, van ‘t Wout M, Ford JD, Aleman A. Deficits in Degraded Facial Affect Labeling in Schizophrenia and Borderline Personality Disorder. PLoS One 2016; 11:e0154145. [PMID: 27300727 PMCID: PMC4907495 DOI: 10.1371/journal.pone.0154145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 04/08/2016] [Indexed: 11/18/2022] Open
Abstract
Although deficits in facial affect processing have been reported in schizophrenia as well as in borderline personality disorder (BPD), these disorders have not yet been directly compared on facial affect labeling. Using degraded stimuli portraying neutral, angry, fearful and angry facial expressions, we hypothesized more errors in labeling negative facial expressions in patients with schizophrenia compared to healthy controls. Patients with BPD were expected to have difficulty in labeling neutral expressions and to display a bias towards a negative attribution when wrongly labeling neutral faces. Patients with schizophrenia (N = 57) and patients with BPD (N = 30) were compared to patients with somatoform disorder (SoD, a psychiatric control group; N = 25) and healthy control participants (N = 41) on facial affect labeling accuracy and type of misattributions. Patients with schizophrenia showed deficits in labeling angry and fearful expressions compared to the healthy control group and patients with BPD showed deficits in labeling neutral expressions compared to the healthy control group. Schizophrenia and BPD patients did not differ significantly from each other when labeling any of the facial expressions. Compared to SoD patients, schizophrenia patients showed deficits on fearful expressions, but BPD did not significantly differ from SoD patients on any of the facial expressions. With respect to the type of misattributions, BPD patients mistook neutral expressions more often for fearful expressions compared to schizophrenia patients and healthy controls, and less often for happy compared to schizophrenia patients. These findings suggest that although schizophrenia and BPD patients demonstrate different as well as similar facial affect labeling deficits, BPD may be associated with a tendency to detect negative affect in neutral expressions.
Collapse
Affiliation(s)
- Annemiek van Dijke
- Yulius-academy/ Yulius-COLK, Rotterdam-Dordrecht Area & Department of Clinical Psychology, VU University Amsterdam, Department of Psychiatry, Academic Medical Center, Amsterdam, the Netherlands
- * E-mail: ;
| | - Mascha van ‘t Wout
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, United States of America
| | - Julian D. Ford
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, United States of America
| | - André Aleman
- Department of Neuroscience, University Medical Center Groningen, and Department of Psychology, University of Groningen, Groningen, the Netherlands
| |
Collapse
|
49
|
The association between depression and craving in alcohol dependency is moderated by gender and by alexithymia factors. Psychiatry Res 2016; 239:28-38. [PMID: 27137959 DOI: 10.1016/j.psychres.2016.02.062] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 02/04/2016] [Accepted: 02/27/2016] [Indexed: 01/17/2023]
Abstract
Alexithymia is a multifaceted personality trait that involves difficulties in identifying and describing feelings to others, a poor fantasy life and an externally oriented cognitive style. Alexithymia has been described as a vulnerability factor for mental and physical diseases. We investigated in a group of 158 alcohol-dependent patients (103 men, 55 women) the association between depression and craving for alcohol when these patients were starting a detoxification program, and the moderating impact of gender and alexithymia on this relation. We first found an interaction between depression and gender in the prediction of craving in the sense that only for women an increase in depressive mood was related to an increase in total craving. When examining gender separately, we found that alexithymia factors acted as moderators. For women, the link between depression and craving was strengthened for the ones scoring higher on "difficulties describing feelings". But for men, the link between depression and craving was reduced for the ones scoring higher on "externally-oriented thinking". These findings suggest that in some cases that need to be identified more systematically in the future, the "externally-oriented thinking" alexithymia factor can exert - at least in the short term - some protective effects.
Collapse
|
50
|
Chhatwal J, Lane RD. A Cognitive-Developmental Model of Emotional Awareness and Its Application to the Practice of Psychotherapy. Psychodyn Psychiatry 2016; 44:305-25. [PMID: 27200467 DOI: 10.1521/pdps.2016.44.2.305] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The ability to be aware of one's own emotional states has been a time-honored ingredient of successful psychodynamic psychotherapy. With the rise of cognitive-behavioral therapy (CBT), however, the utility of experiencing and reflecting upon emotional experience has become less certain, and a quantifiable measure of emotional awareness for clinicians has not been previously available. Several recent advances cast the role of emotional awareness in psychotherapy in a different light: (1) a new theory of change in psychotherapy has been formulated that highlights emotional experience as an important ingredient of change in a variety of modalities; (2) new evidence shows that individual differences in the capacity for emotional awareness predict successful psychotherapeutic outcome in the treatment of panic disorder both by manualized psychodynamic psychotherapy and CBT; and (3) a new online version of the electronic Levels of Emotional Awareness Scale (eLEAS) has been created that can be used with individual patients as a guide to psychotherapy treatment. Here we review evidence of a reliable and valid measure of emotional awareness that has been used in both normative and clinical contexts. The psychotherapeutic treatment of three patients is described to illustrate the clinical manifestations of the different levels of emotional awareness and the ways the eLEAS can be useful in the clinical context, including (1) assessment of the patient's current level of emotional functioning and his or her potential for higher levels of functioning, (2) the targeting of interventions to facilitate functioning at the next level, and (3) a possible marker of treatment progress. These observations suggest that the eLEAS has the potential to be a clinically useful tool that may assist clinicians in guiding psychotherapy treatment.
Collapse
|