The Emotion Mapping Activity: Preliminary evaluation of a mindfulness-informed exercise to improve emotion labeling in alexithymic persons

Alexithymia profiles and depression, anxiety, and stress

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSIONS

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

The Role of Gender in Patients with Borderline Personality Disorder: Differences Related to Hopelessness, Alexithymia, Coping Strategies, and Sensory Profile

Background and Objectives: Gender differences are poorly investigated in patients with borderline personality disorder (BPD), although they could be useful in determining the most appropriate pharmacological and non-pharmacological treatment. The aim of the present study was to compare sociodemographic and clinical characteristics and the emotional and behavioral dimensions (such as coping, alexithymia, and sensory profile) between males and females with BPD. Material and Methods: Two hundred seven participants were recruited. Sociodemographic and clinical variables were collected through a self-administered questionnaire. The Adolescent/Adult Sensory Profile (AASP), Beck Hopelessness Scale (BHS), Coping Orientation to Problems Experienced (COPE), and Toronto Alexithymia Scale (TAS-20) were administered. Results: Male patients with BPD showed more involuntary hospitalizations and greater use of alcohol and illicit substances compared to females. Conversely, females with BPD reported more frequent medication abuse than males. Furthermore, females had high levels of alexithymia and hopelessness. Regarding coping strategies, females with BPD reported higher levels of "restraint coping" and "use of instrumental social support" at COPE. Finally, females with BPD had higher scores in the Sensory Sensitivity and Sensation Avoiding categories at the AASP. Conclusions: Our study highlights gender differences in substance use, emotion expression, future vision, sensory perception, and coping strategies in patients with BPD. Further gender studies may clarify these differences and guide the development of specific and differential treatments in males and females with BPD.

Understanding Emotion Regulation and Humor Styles in Individuals with Callous-Unemotional Traits and Alexithymic Traits

Alexithymia is a personality trait which is characterized by impairments in identifying and describing emotions. Both psychopathic and alexithymic personality traits have been associated with impairments in emotion processing. This study aims to clarify the conceptual overlap between psychopathic traits (focusing on callous-unemotional traits) and alexithymic traits, with emotion regulation strategies and humor styles using a community sample. A battery of self-report measures was distributed through an online platform to 538 male and female participants between the ages of 18 to 65. Hierarchal linear regression analyses demonstrated that emotion regulation strategies were the strongest predictors and accounted for the largest variance of callous-unemotional traits and alexithymic traits. More specifically, expressive suppression arose as a positive predictor while cognitive reappraisal arose as a negative predictor for both personality traits. Aggressive humor (maladaptive) arose as a positive predictor while self-defeating humor (maladaptive) and affiliative humor (adaptive) arose as negative predictors for callous-unemotional traits. In contrast, self-defeating humor arose as a positive predictor for alexithymic traits while affiliative humor and self-enhancing humor arose as negative predictors. Findings indicate that there are similarities and differences between these personality traits. The implications regarding tailoring interventions that target specific deficits associated with each personality trait are discussed.

Why is alexithymia a risk factor for affective disorder symptoms? The role of emotion regulation

BACKGROUND

Ever since alexithymia was defined in the 1970s, robust associations have been observed between alexithymia and a variety of symptoms of psychopathology. Alexithymia is now widely regarded as an important transdiagnostic risk factor, and it is frequently assessed in clinical and research settings. However, despite this strong interest, it remains unclear exactly why (i.e., by which mechanisms) alexithymia is linked to psychopathology. In this paper, we hypothesise that alexithymia is linked to affective disorder symptoms because alexithymia impairs people's ability to regulate their emotions, and we empirically test this hypothesis.

METHOD

We administered a battery of psychometric measures to 501 adults in the United States, and examined the direct and indirect effects between alexithymia (Perth Alexithymia Questionnaire), emotion regulation ability (Perth Emotion Regulation Competency Inventory), and affective disorder symptoms (Depression Anxiety Stress Scales-21).

RESULTS

In the Pearson bivariate correlation matrix, alexithymia, emotion regulation difficulties, and affective disorder symptoms were all significantly correlated. In the modelling of direct and indirect effects, alexithymia was indirectly associated with affective disorder symptoms through emotion regulation difficulties (no significant direct effect).

LIMITATIONS

Our online survey data were all self-report data and cross-sectional. Future longitudinal work would be beneficial.

CONCLUSIONS

Our findings support contemporary theorising that alexithymia is linked to affective disorder symptoms via emotion regulation difficulties. These results help to clarify the mechanisms by which alexithymia may predispose people to affective disorder symptoms, and highlight the importance of considering the roles of alexithymia and emotion regulation in case conceptualisations and treatment planning.

Relationship between alexithymia and depression: A narrative review

Alexithymia has been described as difficulty in expressing as well as experiencing feelings. It has been studied in relation with medical as well as psychological conditions and has been seen to impact treatment outcomes. The current review focuses on the relationship of alexithymia with depression and the role of culture in this relationship. The keywords for literature included terms such as depression, alexithymia, depression and alexithymia, Toronto Alexithymia Scale, assessing alexithymia and depression, and alexithymia as a trait. The main findings of the review were that alexithymia and depression are highly correlated, and severity of depression and gender are independently associated with alexithymia and may interfere with treatment outcomes.

Alexithymia, Affective Lability, Impulsivity, and Childhood Adversity in Borderline Personality Disorder

Long-standing theories of borderline personality disorder (BPD) suggest that symptoms develop at least in part from childhood adversity. Emotion dysregulation may meaningfully mediate these effects. The current study examined three factors related to emotion dysregulation-alexithymia, affective lability, and impulsivity-as potential mediators of the relation between childhood adversity and BPD diagnosis in 101 individuals with BPD and 95 healthy controls. Path analysis compared three distinct models informed by the literature. Results supported a complex mediation model wherein (a) alexithymia partially mediated the relation of childhood adversity to affective lability and impulsivity; (b) affective lability mediated the relation of childhood adversity to BPD diagnosis; and (c) affective lability and impulsivity mediated the relation of alexithymia to BPD diagnosis. Findings suggest that affective lability and alexithymia are key to understanding the relationship between childhood adversity and BPD. Interventions specifically targeting affective lability, impulsivity, and alexithymia may be particularly useful for this population.

Impact of mindfulness-based cognitive therapy on counseling self-efficacy: A randomized controlled crossover trial

OBJECTIVE

To investigate the impact of a structured eight-week mindfulness-based cognitive therapy (MBCT) program on counseling self-efficacy among counseling trainees.

METHODS

Undergraduate counseling trainees were randomized to an MBCT group (n = 25) or a waitlist control group (n = 25) with a crossover trial design. Psychological measurements regarding mindfulness, empathy, self-compassion, psychological distress, counseling self-efficacy as well as neuro-physiological measures including frontal midline theta activity, respiration rate, and skin conductance were taken at baseline (T1), after intervention (T2), and six-month follow-up (T3).

RESULTS

Mindfulness training could make significant positive changes in empathy, self-compassion, stress reduction, and counseling self-efficacy with this being backed up by both psychological and neuro-physiological evidence at T2. However, such differences between the two groups had greatly subsided after crossover in which carry-over effect and marked improvement were noted in the study and control group, respectively, at T3. In addition, mindfulness was the most significant determinant that contributed to counseling self-efficacy, followed by psychological distress reduction and self-compassion according to the regression models.

CONCLUSION

Integrating mindfulness into counseling training is beneficial for helping profession trainees.

PRACTICE IMPLICATION

Incorporating mindfulness into counseling training can enhance the necessary "being mode" qualities in counseling and address self-care issues during training.

Quadratic Relationship Between Alexithymia and Interoceptive Accuracy, and Results From a Pilot Mindfulness Intervention

Alexithymia, or a reduced ability to label and describe one's emotions, is a transdiagnostic construct associated with poor psychosocial outcomes. Currently, the mechanisms underlying affective deficits associated with alexithymia are unclear, hindering targeted treatment delivery. Recent research suggests deficient interoceptive awareness, or reduced awareness of one's internal bodily state, may be key in the etiology of alexithymia. It has long been demonstrated that mindfulness meditation can alter perceptions of one's own emotions and bodily cues. Therefore, it is possible that mindfulness meditation may reduce affective deficits associated with alexithymia by improving interoceptive awareness. In this study, we aimed to (1) elucidate the role of interoceptive accuracy and sensibility, two dimensions of interoceptive awareness, in alexithymia, and (2) test the efficacy of a brief mindfulness meditation for improving interoceptive accuracy, interoceptive sensibility, and emotional awareness. Seventy six young adults completed a baseline heartbeat detection task, to assess interoceptive accuracy and sensibility, and the Toronto Alexithymia Scale-20 item. They were randomly assigned to a brief mindfulness-based body scan meditation intervention or control condition. Afterwards, participants completed tasks assessing emotional awareness (i.e., affect labeling, emotional granularity) and follow-up heartbeat detection task. Relationships between alexithymia and interoceptive accuracy and sensibility were best described as quadratic (p = 0.002) and linear (p = 0.040), respectively. Participants in both conditions showed robust improvements in interoceptive accuracy from baseline to follow-up (p < 0.001; η p 2 = 0.15); however, there were no group (meditation or control) differences in degree of improvement. Similarly, there were no group differences in affect labeling or emotional granularity. These preliminary results suggest that heightened alexithymia may be associated with either relatively high or low interoceptive accuracy. The meditation condition did not result in improved interoceptive accuracy or sensibility above and beyond that of a control group. Improvements in interoceptive accuracy, interoceptive sensibility, and emotional awareness may require longer or more interactive intervention approaches. More research is needed to parse the potentially complex relationship between alexithymia and interoceptive awareness, and to develop targeted treatment approaches to ameliorating associated affective deficits.

Development of an Ambulatory Biofeedback App to Enhance Emotional Awareness in Patients with Borderline Personality Disorder: Multicycle Usability Testing Study

Background

Patients with borderline personality disorder experience great difficulties in regulating their emotions. They often are unable to effectively detect their emotional arousal and struggle to timely apply learned techniques for emotion regulation. Although the use of continuous wearable biofeedback has been repeatedly suggested as an option to improve patients’ emotional awareness, this type of app is not yet available for clinical use. Therefore, we developed an ambulatory biofeedback app named Sense-IT that can be integrated in mental health care.

Objective

The aim of the study was to develop an ambulatory biofeedback app for mental health care that helps with learning to better recognize changes in personal emotional arousal and increases emotional awareness.

Methods

Using several methods in a tailored User Centred Design (UCD) framework, we tested the app’s usability and user experience (UX) via a cyclic developmental process with multiple user groups (patients, therapists, and UCD experts; 3-5 per group, per cycle).

Results

The process resulted in a stable prototype of the app that meets most of the identified user requirements. The app was valued as useful and usable by involved patients, therapists, and UCD experts. On the Subjective Usability Scale (SUS), the patients rated the app as “Good” (average score of 78.8), whereas the therapists rated the app as “OK” (average score of 59.4). The UCD experts judged the app’s overall usability as between “OK” and “acceptable” (average score of 0.87 on a cognitive walkthrough). As most critical usability problems were identified and addressed in the first cycle of the prototyping process, subsequent cycles were mainly about implementing new or extending existing functions, and other adjustments to improve UX.

Conclusions

mHealth development within a clinical mental health setting is challenging, yet feasible and welcomed by targeted users. This paper shows how new mHealth interventions for mental health care can be met with enthusiasm and openness by user groups that are known to be reluctant to embrace technological innovations. The use of the UCD framework, involving multiple user groups, proved to be of added value during design and realization as evidenced by the complementary requirements and perspectives. Future directions on studying clinical effectiveness of the app, appliance of the app in other fields, and the implications of integration of the app for daily practice in mental health are discussed.