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Keating CT, Cook JL. Facial Expression Production and Recognition in Autism Spectrum Disorders: A Shifting Landscape. Psychiatr Clin North Am 2021; 44:125-139. [PMID: 33526234 DOI: 10.1016/j.psc.2020.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Social "difficulties" associated with ASD may be a product of neurotypical-autistic differences in emotion expression and recognition. Research suggests that neurotypical and autistic individuals exhibit expressive differences, with autistic individuals displaying less frequent expressions that are rated lower in quality by non-autistic raters. Autistic individuals have difficulties recognizing neurotypical facial expressions; neurotypical individuals have difficulties recognizing autistic expressions. However, findings are mixed. Task-related factors (e.g., intensity of stimuli) and participant characteristics (e.g., age, IQ, comorbid diagnoses) may contribute to the mixed findings. The authors conclude by highlighting important areas for future research and the clinical implications of the discussed findings.
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Affiliation(s)
- Connor Tom Keating
- School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. https://twitter.com/ConnorTKeating
| | - Jennifer Louise Cook
- School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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2
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Briot K, Pizano A, Bouvard M, Amestoy A. New Technologies as Promising Tools for Assessing Facial Emotion Expressions Impairments in ASD: A Systematic Review. Front Psychiatry 2021; 12:634756. [PMID: 34025469 PMCID: PMC8131507 DOI: 10.3389/fpsyt.2021.634756] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/25/2021] [Indexed: 11/13/2022] Open
Abstract
The ability to recognize and express emotions from facial expressions are essential for successful social interactions. Facial Emotion Recognition (FER) and Facial Emotion Expressions (FEEs), both of which seem to be impaired in Autism Spectrum Disorders (ASD) and contribute to socio-communicative difficulties, participate in the diagnostic criteria for ASD. Only a few studies have focused on FEEs processing and the rare behavioral studies of FEEs in ASD have yielded mixed results. Here, we review studies comparing the production of FEEs between participants with ASD and non-ASD control subjects, with a particular focus on the use of automatic facial expression analysis software. A systematic literature search in accordance with the PRISMA statement identified 20 reports published up to August 2020 concerning the use of new technologies to evaluate both spontaneous and voluntary FEEs in participants with ASD. Overall, the results highlight the importance of considering socio-demographic factors and psychiatric co-morbidities which may explain the previous inconsistent findings, particularly regarding quantitative data on spontaneous facial expressions. There is also reported evidence for an inadequacy of FEEs in individuals with ASD in relation to expected emotion, with a lower quality and coordination of facial muscular movements. Spatial and kinematic approaches to characterizing the synchrony, symmetry and complexity of facial muscle movements thus offer clues to identifying and exploring promising new diagnostic targets. These findings have allowed hypothesizing that there may be mismatches between mental representations and the production of FEEs themselves in ASD. Such considerations are in line with the Facial Feedback Hypothesis deficit in ASD as part of the Broken Mirror Theory, with the results suggesting impairments of neural sensory-motor systems involved in processing emotional information and ensuring embodied representations of emotions, which are the basis of human empathy. In conclusion, new technologies are promising tools for evaluating the production of FEEs in individuals with ASD, and controlled studies involving larger samples of patients and where possible confounding factors are considered, should be conducted in order to better understand and counter the difficulties in global emotional processing in ASD.
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Affiliation(s)
- Kellen Briot
- Medical Sciences Department, University of Bordeaux, Bordeaux, France.,Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier Charles-Perrens, Bordeaux, France.,Aquitaine Institute for Cognitive and Integrative Neuroscience (INCIA), UMR 5287, CNRS, Bordeaux, France
| | - Adrien Pizano
- Medical Sciences Department, University of Bordeaux, Bordeaux, France.,Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier Charles-Perrens, Bordeaux, France.,Aquitaine Institute for Cognitive and Integrative Neuroscience (INCIA), UMR 5287, CNRS, Bordeaux, France
| | - Manuel Bouvard
- Medical Sciences Department, University of Bordeaux, Bordeaux, France.,Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier Charles-Perrens, Bordeaux, France.,Aquitaine Institute for Cognitive and Integrative Neuroscience (INCIA), UMR 5287, CNRS, Bordeaux, France
| | - Anouck Amestoy
- Medical Sciences Department, University of Bordeaux, Bordeaux, France.,Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier Charles-Perrens, Bordeaux, France.,Aquitaine Institute for Cognitive and Integrative Neuroscience (INCIA), UMR 5287, CNRS, Bordeaux, France
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3
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Keating CT, Cook JL. Facial Expression Production and Recognition in Autism Spectrum Disorders: A Shifting Landscape. Child Adolesc Psychiatr Clin N Am 2020; 29:557-571. [PMID: 32471602 DOI: 10.1016/j.chc.2020.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Social "difficulties" associated with ASD may be a product of neurotypical-autistic differences in emotion expression and recognition. Research suggests that neurotypical and autistic individuals exhibit expressive differences, with autistic individuals displaying less frequent expressions that are rated lower in quality by non-autistic raters. Autistic individuals have difficulties recognizing neurotypical facial expressions; neurotypical individuals have difficulties recognizing autistic expressions. However, findings are mixed. Task-related factors (e.g., intensity of stimuli) and participant characteristics (e.g., age, IQ, comorbid diagnoses) may contribute to the mixed findings. The authors conclude by highlighting important areas for future research and the clinical implications of the discussed findings.
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Affiliation(s)
- Connor Tom Keating
- School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. https://twitter.com/ConnorTKeating
| | - Jennifer Louise Cook
- School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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4
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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: 50] [Impact Index Per Article: 10.0] [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.
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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
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5
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Fournier A, Mondillon L, Dantzer C, Gauchez AS, Ducros V, Mathieu N, Faure P, Canini F, Bonaz B, Pellissier S. Emotional overactivity in patients with irritable bowel syndrome. Neurogastroenterol Motil 2018; 30:e13387. [PMID: 29856118 DOI: 10.1111/nmo.13387] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 05/02/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Negativity is often observed in patients with irritable bowel syndrome (IBS). No study has examined their emotional expressiveness as a marker of emotional reactivity. We investigated IBS patients' vulnerability to an emotional load by associating their expressiveness with psychological and neurophysiological assessments. We hypothesized that IBS would be characterized by a lack of expressiveness coupled with high scores in psychological and neurophysiological parameters. METHODS We assessed the emotional facial expressions (EMFACS), psychological (anxiety, depression, alexithymia), and neurophysiological (cortisol, heart rate variability (HRV)) parameters of 25 IBS patients and 26 healthy controls (HC) while they watched fear-eliciting movie extracts. KEY RESULTS Overall, the task elicited an increase in state anxiety and consistent HRV responses. However, IBS patients differed from HC as they displayed more sadness and tended to display more rage. Contrary to HC, IBS patients showed an increase in heart rate and a decrease in parasympathetic regulation, reflecting an enhanced responsiveness corroborated by higher scores in depression and state anxiety. Consistent with their higher difficulty in identifying feelings, a component of alexithymia positively correlated with their expressions of rage, they were not aware of their increase in anxiety during the task, whereas HC were. No linear relationship between patients' expressions and their neurophysiological responses was found. CONCLUSIONS & INFERENCES Irritable bowel syndrome patients displayed greater emotional expressiveness with negative prevalence. This reflects an emotional vulnerability potentially related to low regulation skills and underscores the importance of considering the central dysregulation hypothesis in IBS as a promising avenue of research.
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Affiliation(s)
- A Fournier
- CNRS, LAPSCO, Physiological and Psychosocial Stress, University Clermont Auvergne, Clermont-Ferrand, France
| | - L Mondillon
- CNRS, LAPSCO, Physiological and Psychosocial Stress, University Clermont Auvergne, Clermont-Ferrand, France
| | - C Dantzer
- Laboratory of Psychology, Bordeaux University, Bordeaux, France
| | - A-S Gauchez
- Biology Institute, Grenoble Alpes University Hospital, Grenoble, France
| | - V Ducros
- Biology Institute, Grenoble Alpes University Hospital, Grenoble, France
| | - N Mathieu
- Grenoble Alpes University Hospital, University Clinic of Hepato-Gastroenterology, Grenoble, France
| | - P Faure
- Biology Institute, Grenoble Alpes University Hospital, Grenoble, France.,Grenoble Alpes University Hospital, University Clinic of Hepato-Gastroenterology, Grenoble, France.,Hypoxia Pathophysiology Laboratory (H2P, INSERM U1042), Grenoble, France
| | - F Canini
- Department of Neurosciences and Operational Constraints, Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France.,Ecole du Val de Grâce, Paris, France
| | - B Bonaz
- Grenoble Alpes University Hospital, University Clinic of Hepato-Gastroenterology, Grenoble, France.,Hypoxia Pathophysiology Laboratory (H2P, INSERM U1042), Grenoble, France.,Department of Neurosciences and Operational Constraints, Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France.,Ecole du Val de Grâce, Paris, France.,Grenoble Institute of Neurosciences (GIN), INSERM, University Grenoble Alpes, Grenoble, France
| | - S Pellissier
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, 38000 Grenoble, France
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6
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Edwards E, Shivaji S, Wupperman P. The Emotion Mapping Activity: Preliminary evaluation of a mindfulness-informed exercise to improve emotion labeling in alexithymic persons. Scand J Psychol 2018. [PMID: 29516501 DOI: 10.1111/sjop.12438] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Alexithymia is a psychoemotional trait associated with many treatment-resistant psychological and social difficulties. Research suggests that these difficulties stem primarily from an inability to appropriately apply linguistic labels to emotional experiences and content. The present research introduces and preliminarily evaluates a novel mindfulness-informed exercise to improve emotion-labeling ability in alexithymic persons. Based in culturally universal patterns of somatic experience, the Emotion Mapping Activity (EMA) directs alexithymic persons to reflect on their internal, somatic experiences as a source of information for interpreting and labeling emotional experiences. In the present study, 67 alexithymic persons completed a series of emotion-labeling tasks either with or without assistance of the EMA. Results suggest that completion of the EMA may improve ability to label emotions that would be otherwise misinterpreted - without interfering with labeling that is already intact. Though further research is necessary, the present study suggests that the EMA may hold the potential to be incorporated into psychotherapy protocols as an exercise for improving emotion-labeling ability in alexithymic clients.
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Affiliation(s)
- Emily Edwards
- CUNY Graduate Center, New York, NY, USA.,John Jay College of Criminal Justice, New York, NY, USA
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7
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Verhaeghe P, Vanheule S, Rick A. Actual Neurosis as the Underlying Psychic Structure of Panic Disorder, Somatization, and Somatoform Disorder: an Integration of Freudian and Attachment Perspectives. THE PSYCHOANALYTIC QUARTERLY 2017; 76:1317-50. [DOI: 10.1002/j.2167-4086.2007.tb00306.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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8
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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: 14] [Impact Index Per Article: 2.0] [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.
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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
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9
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Trevisan DA, Bowering M, Birmingham E. Alexithymia, but not autism spectrum disorder, may be related to the production of emotional facial expressions. Mol Autism 2016; 7:46. [PMID: 27895883 PMCID: PMC5106821 DOI: 10.1186/s13229-016-0108-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 10/28/2016] [Indexed: 11/21/2022] Open
Abstract
Background A prominent diagnostic criterion of autism spectrum disorder (ASD) relates to the abnormal or diminished use of facial expressions. Yet little is known about the mechanisms that contribute to this feature of ASD. Methods We showed children with and without ASD emotionally charged video clips in order to parse out individual differences in spontaneous production of facial expressions using automated facial expression analysis software. Results Using hierarchical multiple regression, we sought to determine whether alexithymia (characterized by difficulties interpreting one’s own feeling states) contributes to diminished facial expression production. Across groups, alexithymic traits—but not ASD traits, IQ, or sex—were associated with quantity of facial expression production. Conclusions These results accord with a growing body of research suggesting that many emotion processing abnormalities observed in ASD may be explained by co-occurring alexithymia. Developmental and clinical considerations are discussed, and it is argued that alexithymia is an important but too often ignored trait associated with ASD that may have implications for subtyping individuals on the autism spectrum.
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Affiliation(s)
- Dominic A Trevisan
- Faculty of Education, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - Marleis Bowering
- Linguistics Department, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - Elina Birmingham
- Faculty of Education, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
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10
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Lambert R, Harrison D, Watson M. Complexity, Occupational Therapy, Unpredictability and the Scientific Method: a Response to Creek et al (2005) and Duncan et al (2007). Br J Occup Ther 2016. [DOI: 10.1177/030802260707001206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Two recent articles in this journal have discussed complex systems and differing views of occupational therapy as a complex intervention. This opinion piece develops the discussion of complex adaptive systems and complex interventions further, concluding that all health professions can claim to be complex. Complexity implies a degree of unpredictability. Within patient-centred systems, this means not that complexity cannot and should not be studied, but merely that variability will be experienced and needs to be understood and examined. The Medical Research Council framework provides a rational way of doing so. Research by occupational therapists should grasp this nettle to develop the profession's evidence base.
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11
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Jasinski MJ, Lumley MA, Latsch DV, Schuster E, Kinner E, Burns JW. Assessing Anger Expression: Construct Validity of Three Emotion Expression-Related Measures. J Pers Assess 2016; 98:640-8. [PMID: 27248355 PMCID: PMC5053333 DOI: 10.1080/00223891.2016.1178650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Self-report measures of emotional expression are common, but their validity to predict objective emotional expression, particularly of anger, is unclear. We tested the validity of the Anger Expression Inventory (AEI; Spielberger et al., 1985 ), Emotional Approach Coping Scale (EAC; Stanton, Kirk, Cameron, & Danoff-Burg, 2000 ), and Toronto Alexithymia Scale-20 (TAS-20; Bagby, Taylor, & Parker, 1994 ) to predict objective anger expression in 95 adults with chronic back pain. Participants attempted to solve a difficult computer maze by following the directions of a confederate who treated them rudely and unjustly. Participants then expressed their feelings for 4 min. Blinded raters coded the videos for anger expression, and a software program analyzed expression transcripts for anger-related words. Analyses related each questionnaire to anger expression. The AEI Anger-Out scale predicted greater anger expression, as expected, but AEI Anger-In did not. The EAC Emotional Processing scale predicted less anger expression, but the EAC Emotional Expression scale was unrelated to anger expression. Finally, the TAS-20 predicted greater anger expression. Findings support the validity of the AEI Anger-Out scale but raise questions about the other measures. The assessment of emotional expression by self-report is complex and perhaps confounded by general emotional experience, the specificity or generality of the emotion(s) assessed, and self-awareness limitations. Performance-based or clinician-rated measures of emotion expression are needed.
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Affiliation(s)
| | | | | | - Erik Schuster
- Department of Behavioral Sciences, Rush University Medical Center
| | - Ellen Kinner
- Department of Behavioral Sciences, Rush University Medical Center
| | - John W. Burns
- Department of Behavioral Sciences, Rush University Medical Center
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12
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13
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Cozzolongo R, Porcelli P, Lanzilotta E, Giannuzzi V, Leandro G. The role of alexithymia in quality of life impairment in patients with chronic hepatitis C during antiviral treatment. Compr Psychiatry 2015; 60:17-25. [PMID: 25941158 DOI: 10.1016/j.comppsych.2015.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 01/16/2023] Open
Abstract
This study aimed to investigate the role of alexithymia in the quality of life of patients with chronic hepatitis C treated with antiviral therapy. A consecutive sample of 124 patients were evaluated at baseline, during, and 6months after treatment with interferon and ribavirin. At baseline past mood disorders and alexithymia and, at each index visit, adverse events, psychological distress, and disease-specific quality of life were assessed with validated instruments. Patients with past mood disorders and alexithymia had impaired levels of quality of life, psychological distress, and treatment-related adverse events. However, after controlling for covariates, poor quality of life was independently predicted by alexithymia and psychological distress before (R(2)=0.60) and 6months after (R(2)=0.69) the antiviral treatment while during treatment (at 3months and the end of therapy) by depression and somatic adverse events (R(2)=0.67 and 0.69, respectively). Alexithymia rather than history of mood disorders resulted to be an independent predictor of impaired quality of life not only before but also 6months after the end of treatment. Given the association with proneness to health-compromising behaviors, clinicians are encouraged to pay closer attention to long-term psychological and somatic effects of antiviral treatment in patients with alexithymic characteristics.
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Affiliation(s)
- Raffaele Cozzolongo
- Department of Gastroenterology 1, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Via Turi 27, 70013 Castellana Grotte, Bari, Italy.
| | - Piero Porcelli
- Clinical Psychology Unit, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Via Turi 27, 70013 Castellana Grotte, Bari, Italy.
| | - Elsa Lanzilotta
- Department of Gastroenterology 1, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Via Turi 27, 70013 Castellana Grotte, Bari, Italy.
| | - Vito Giannuzzi
- Department of Gastroenterology 1, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Via Turi 27, 70013 Castellana Grotte, Bari, Italy.
| | - Gioacchino Leandro
- Department of Gastroenterology 1, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Via Turi 27, 70013 Castellana Grotte, Bari, Italy; Department of Liver and Digestive Health, University College of London, UK.
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14
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Morie KP, Nich C, Hunkele K, Potenza MN, Carroll KM. Alexithymia level and response to computer-based training in cognitive behavioral therapy among cocaine-dependent methadone maintained individuals. Drug Alcohol Depend 2015; 152:157-63. [PMID: 25982006 PMCID: PMC4458169 DOI: 10.1016/j.drugalcdep.2015.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 04/07/2015] [Accepted: 04/08/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Alexithymia, a characteristic marked by poor ability to identify, define and communicate emotions, has been associated with poorer treatment outcome, including traditional clinician delivered CBT. Computerized cognitive behavioral therapy (CBT4CBT), an effective adjunct to treatment, may provide a means of conveying skills without requiring interaction with a clinician. METHODS Seventy-three methadone maintained, cocaine dependent individuals participating in an 8-week randomized clinical trial comparing standard methadone maintenance to methadone maintenance plus CBT4CBT completed the Toronto Alexithymia Scale (TAS-20) at pretreatment, post-treatment, and follow-ups conducted one, two, and 6 months after treatment. RESULTS There were no statistically significant differences on baseline TAS-20 scores by multiple demographic and substance use variables including gender and substance use severity. Higher TAS-20 scores were associated with somewhat higher levels of distress as measured by the Beck Depression Inventory and multiple Brief Severity Index scales. TAS-20 scores remained relatively stable throughout the duration of treatment and follow-up. Indicators of treatment process, including treatment retention, adherence and therapeutic alliance, were not significantly correlated with TAS-20 scores. There was a significant interaction of alexithymia and treatment condition, such that individuals with higher baseline scores on the TAS-20 submitted significantly higher percentages of cocaine-negative urine toxicology specimens and reported a higher percentage of abstinence days, and longer periods of consecutive abstinence within treatment when assigned to CBT4CBT compared with treatment as usual. CONCLUSIONS These findings suggest that individuals with increased alexithymia may benefit from computerized CBT; possibly via reduced demands on interpersonal skills and interactions associated with computerized therapies.
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Affiliation(s)
- Kristen P Morie
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA.
| | - Charla Nich
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Karen Hunkele
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Kathleen M Carroll
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
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Heber E, Lehr D, Riper H, Berking M. Emotionsregulation: Überblick und kritische Reflexion des aktuellen Forschungsstandes. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2014. [DOI: 10.1026/1616-3443/a000265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Die Forschung zum Thema Emotionsregulation erfreut sich auch im Bereich der Klinischen Psychologie einer zunehmenden Beliebtheit. Allerdings stellt sich die Frage, inwieweit die Popularität des Konstrukts im Einklang mit dessen Validität und tatsächlicher heuristischer Fruchtbarkeit steht. Vor diesem Hintergrund ist es Ziel der vorliegenden Arbeit, einen aktuellen Überblick über Konzeptualisierungen, Erfassungsmethoden, Befunde zum Zusammenhang mit psychischen Störungen sowie Möglichkeiten der therapeutischen Nutzung des Konzeptes Emotionsregulation zu geben. Aufbauend auf einer kritischen Reflexion bisheriger Konzepte, Vorgehensweisen und Befunde werden Vorschläge gemacht, wie die Validität und die heuristische Fruchtbarkeit des Emotionsregulationsparadigmas weiter gefördert werden können.
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Affiliation(s)
| | | | - Heleen Riper
- Leuphana Universität Lüneburg
- Freie Universität Amsterdam
| | - Matthias Berking
- Leuphana Universität Lüneburg
- Friedrich-Alexander-Universität Erlangen-Nürnberg
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Lichev V, Rufer M, Rosenberg N, Ihme K, Grabe HJ, Kugel H, Donges US, Kersting A, Suslow T. Assessing alexithymia and emotional awareness: relations between measures in a German non-clinical sample. Compr Psychiatry 2014; 55:952-9. [PMID: 24439560 DOI: 10.1016/j.comppsych.2013.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 12/12/2013] [Accepted: 12/17/2013] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to evaluate psychometric properties and relations between two different methods of measuring alexithymia and one measure of emotional awareness in a German non-clinical sample. The 20-Item Toronto Alexithymia Scale (TAS-20), the Toronto Structured Interview for Alexithymia (TSIA), and the Levels of Emotional Awareness Scale (LEAS), which is a performance-based measure of emotional awareness, were administered to 84 university students. Both internal reliability and inter-rater reliability for the TSIA were acceptable. Results from exploratory factor analysis (EFA) based on all measures supported a three factorial solution previously obtained in an American sample using multiple methods of alexithymia and emotional ability measurement. In our three factor model direct self (TAS-20), direct other (TSIA), and indirect self (LEAS) measures were differentiated. The convergent validity of the TSIA was supported by a significant correlation with the LEAS. Our findings suggest that future research on alexithymia and emotional awareness can benefit from the use of a multi-method approach and should include objective measures.
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Affiliation(s)
- Vladimir Lichev
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Michael Rufer
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland
| | - Nicole Rosenberg
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Klas Ihme
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Hans-Jörgen Grabe
- Department of Psychiatry, University Medicine, Greifswald, Germany; Department of Psychiatry, HELIOS Hospital, Stralsund, Germany
| | - Harald Kugel
- Department of Cinical Radiology, University of Münster, Münster, Germany
| | - Uta-Susan Donges
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Thomas Suslow
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany; Department of Psychiatry, University of Münster, Münster, Germany.
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Ferguson E. Personality is of central concern to understand health: towards a theoretical model for health psychology. Health Psychol Rev 2013; 7:S32-S70. [PMID: 23772230 PMCID: PMC3678852 DOI: 10.1080/17437199.2010.547985] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 12/11/2010] [Indexed: 12/15/2022]
Abstract
This paper sets out the case that personality traits are central to health psychology. To achieve this, three aims need to be addressed. First, it is necessary to show that personality influences a broad range of health outcomes and mechanisms. Second, the simple descriptive account of Aim 1 is not sufficient, and a theoretical specification needs to be developed to explain the personality-health link and allow for future hypothesis generation. Third, once Aims 1 and 2 are met, it is necessary to demonstrate the clinical utility of personality. In this review I make the case that all three Aims are met. I develop a theoretical framework to understand the links between personality and health drawing on current theorising in the biology, evolution, and neuroscience of personality. I identify traits (i.e., alexithymia, Type D, hypochondriasis, and empathy) that are of particular concern to health psychology and set these within evolutionary cost-benefit analysis. The literature is reviewed within a three-level hierarchical model (individual, group, and organisational) and it is argued that health psychology needs to move from its traditional focus on the individual level to engage group and organisational levels.
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Affiliation(s)
- Eamonn Ferguson
- Department of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK
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Ogrodniczuk JS, Sochting I, Piper WE, Joyce AS. A naturalistic study of alexithymia among psychiatric outpatients treated in an integrated group therapy program. Psychol Psychother 2012; 85:278-91. [PMID: 22903919 DOI: 10.1111/j.2044-8341.2011.02032.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Alexithymia is common among psychiatric outpatients and can complicate treatment. There has been little research into whether alexithymia can be modified by psychological intervention, and whether change in alexithymia is related to other areas of improvement. The purpose of the present study was to examine whether participation in an integrated group therapy program could effect change in alexithymia, and whether such change is related to improvement in interpersonal functioning. DESIGN AND METHODS Sixty-eight consecutively admitted psychiatric outpatients to a comprehensive group therapy program were evaluated at baseline, post-therapy, and 3-month follow-up using the Toronto Alexithymia Scale 20, the Beck Depression Inventory, and the Inventory of Interpersonal Problems-28. Associations among variables were evaluated with correlations and among group comparisons with t test, ANOVA, chi-square tests, and logistic regression. Change in alexithymia was examined using repeated measures ANOVA, controlling for change in depressive symptoms. RESULTS Alexithymia, particularly difficulty identifying feelings, decreased significantly during the treatment period. Post-therapy levels of alexithymia were maintained during the 3 months following treatment completion. Changes in alexithymia were significantly associated with changes in interpersonal problems, both during therapy and during the follow-up period. CONCLUSIONS The results of our study suggest that a comprehensive, integrated group therapy program can affect change in alexithymia, and that such change can be maintained once therapy is completed. Also, modifying alexithymia may contribute to improvement in interpersonal functioning.
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Affiliation(s)
- John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
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Mattila AK, Pohjola V, Suominen AL, Joukamaa M, Lahti S. Difficulties in emotional regulation: association with poorer oral health-related quality of life in the general population. Eur J Oral Sci 2012; 120:224-31. [DOI: 10.1111/j.1600-0722.2012.00953.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A K Mattila
- School of Health Sciences, University of Tampere, Tampere, Finland.
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20
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Alexithymia in adolescents with borderline personality disorder. J Psychosom Res 2012; 72:147-52. [PMID: 22281457 DOI: 10.1016/j.jpsychores.2011.11.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 11/09/2011] [Accepted: 11/15/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to explore the relationship between alexithymia and borderline personality disorder (BPD) in adolescents. METHODS The study investigated a sample of 59 consulting or inpatient adolescents with a well-established diagnosis of BPD (SIDP-IV) and a control sample of healthy adolescents individually matched by gender, age and socio-economic status. Alexithymia, depression and trait-anxiety were rated using the Twenty-item Toronto Alexithymia Scale (TAS-20), the Beck Depression Inventory (BDI-II) and the trait-anxiety subscale from the State-Trait Anxiety Inventory (STAI-T), respectively. A confirmatory factorial analysis (CFA) was performed to test the fit of the three-factor structure of the TAS-20 in the adolescent sample (N=140). BPD and control groups were compared on alexithymic scores using ANCOVA analyses controlling for the potential confounding effects of depression and anxiety. RESULTS The ratio of the chi-square to its degrees of freedom, the goodness-of-fit index, the adjusted goodness-of-fit index and Steiger's root-mean-square error of approximation had satisfactory values of 1.54; 0.87; 0.83 and 0.058, respectively. The two ANCOVA demonstrated no significant difference for TAS-20 scores. BPD subjects were more alexithymic than healthy subjects but this difference was mainly explained by the levels of depression or anxiety. LIMITATIONS Since BPD subjects have high comorbidity with depression or anxiety, longitudinal studies examining the absolute and relative stability of TAS-20 scores are necessary to determine whether alexithymia constitutes a state or a trait in BPD. CONCLUSIONS BPD adolescents are characterized by alexithymia, probably of a secondary or state-dependent nature.
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Ogrodniczuk JS, Piper WE, Joyce AS. Effect of alexithymia on the process and outcome of psychotherapy: a programmatic review. Psychiatry Res 2011; 190:43-8. [PMID: 20471096 DOI: 10.1016/j.psychres.2010.04.026] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 03/18/2010] [Accepted: 04/18/2010] [Indexed: 10/19/2022]
Abstract
Most psychotherapeutic approaches assume that individuals have some access to their emotions. Thus, patients who are unable to identify, differentiate, and articulate their emotions present therapists with a difficult challenge. Such patients may suffer from alexithymia. Despite much attention in the clinical literature, research on alexithymia in the treatment setting has been sparse. Thus, many of the assumptions about psychotherapeutic treatment of alexithymic patients remain untested. This article summarizes findings from a series of studies that examined the effect of alexithymia on various aspects of the psychotherapeutic enterprise. Findings indicated that alexithymia has little effect on patients' treatment preferences, yet there was some tendency for alexithymic patients to prefer group therapy. However, alexithymia was associated with poor outcome in both traditional psychodynamic psychotherapy and supportive therapy. This negative effect was found in individual and group psychotherapies. In the context of group therapy, higher levels of alexithymic features elicited negative reactions from one's therapist, which partially contributed to the poor outcome experienced by such patients. Finally, the negative reaction that therapists had toward patients with high alexithymia appeared to be in response to the lack of positive emotion expressed by these patients. Clinical implications and ideas for future research are considered.
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Affiliation(s)
- John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Suite 420 - 5950 University Boulevard, Vancouver, BC, Canada.
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Der Einfluss von Alexithymie auf Behandlungsverlauf und -ergebnis von Psychotherapie: Eine programmatische Überprüfung. GRUPPENPSYCHOTHERAPIE UND GRUPPENDYNAMIK 2011. [DOI: 10.13109/grup.2011.47.2.94] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Alexithymia is a personality trait associated with difficulties in identifying feelings, difficulties in describing feelings to other people, constricted imaginal processes, and an externally oriented cognitive style. It has been found to be associated with personality features that may cause interpersonally avoidant behavior and other interpersonal problems. The present study explored, in a sample of primary care patients (N = 491), whether alexithymia is associated with mobile phone usage, and whether the perceived quality and quantity of human relationships mediate its effect. Even controlling for sociodemographic variables and symptoms of depression, mania and psychoses, alexithymia, measured by the 20-Item Toronto Alexithymia Scale, was associated with less frequent mobile phone use. Not having enough relationships or a close friend, and relationships being less satisfactory mediated the effect of alexithymia on less frequent mobile phone use. The results support the findings of earlier studies that have linked interpersonal problems with alexithymia.
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Koelkebeck K, Pedersen A, Suslow T, Kueppers KA, Arolt V, Ohrmann P. Theory of Mind in first-episode schizophrenia patients: correlations with cognition and personality traits. Schizophr Res 2010; 119:115-23. [PMID: 20060686 DOI: 10.1016/j.schres.2009.12.015] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 12/08/2009] [Accepted: 12/14/2009] [Indexed: 11/18/2022]
Abstract
INTRODUCTION There is substantial evidence for Theory of Mind (ToM) deficits in patients with schizophrenia. Many psychotic symptoms may best be understood in light of an impaired capacity to infer one's own and other persons' mental states and to relate those to executing behavior. The aim of our study was to investigate ToM abilities in first-episode schizophrenia patients and to analyze them in relation to neuropsychological and psychopathological functioning. MATERIALS AND METHODS A modified Moving Shapes paradigm was used to assess ToM abilities in 23 first-episode patients with schizophrenia and 23 matched healthy controls. Participants had to describe animated triangles which moved (1) randomly, (2) goal-directed, or (3) in complex, socially interactive ways (ToM video sequences). Neuropsychological functioning, psychopathology, autistic and alexithymic features as well as empathetic abilities were correlated with ToM performance. RESULTS Compared to healthy controls, first-episode schizophrenia patients gave more incorrect descriptions and used less ToM-related vocabulary when responding to socially complex ToM video sequences. No group differences were revealed for videos with random movements. ToM abilities correlated significantly with positive symptoms, reasoning, verbal memory performance and verbal IQ, but not with empathetic abilities or autistic and alexithymic features. When controlling for reasoning, verbal memory performance and verbal IQ, the correctness of video descriptions was still significantly worse in schizophrenia patients. DISCUSSION The results of our study in first-episode schizophrenia patients underline recent findings on ToM deficits in the early course of schizophrenia. Only a moderate influence of neurocognitive deficits on ToM performance was observed. Impairment in ToM abilities seems to be predominantly independent of clinical state, alexithymia and empathy.
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Affiliation(s)
- Katja Koelkebeck
- Department of Psychiatry, University of Muenster, School of Medicine, Albert-Schweitzer-Strasse 11, 48149 Muenster, Germany.
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25
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Speranza M, Loas G, Guilbaud O, Corcos M. Are treatment options related to alexithymia in eating disorders? Results from a three-year naturalistic longitudinal study. Biomed Pharmacother 2010; 65:585-9. [PMID: 20359851 DOI: 10.1016/j.biopha.2010.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 01/25/2010] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Longitudinal studies have shown that alexithymic features can interfere with treatment response in eating disorders. However, an alternative hypothesis could be that clinicians faced with alexithymic patients chose different treatment options according to their perceptions of these patients. The aim of this investigation was to explore the relationships between alexithymic features and treatment options provided by professionals in a naturalistic prospective study of eating disorders. METHODS We conducted a 3-year longitudinal study exploring a sample of 102 DSM-IV Eating Disorder patients with the Toronto Alexithymia Scale (TAS-20). All treatments received during follow-up were recorded and recoded dichotomously, and crossed with the variation of alexithymic categories (cut-off≥56) between inclusion and follow-up. RESULTS Patients received different treatments according to their alexithymic profile, in terms both of number and type of treatment received. Patients with high, stable levels of alexithymia received overall more treatments, and significantly more antidepressants, than non-alexithymic patients. Patients who became alexithymics during follow-up were more often rehospitalized and received fewer regular psychotherapies than the non-alexithymic patients. CONCLUSIONS Professionals should carefully monitor these personality features and be aware of the potential impact of alexithymic features on treatment compliance and on treatment choice for eating disordered patients.
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Affiliation(s)
- Mario Speranza
- Inserm U669, Department of Child Psychiatry, université Paris-Sud, université Paris-V, centre hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France.
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Mattila AK, Saarni SI, Salminen JK, Huhtala H, Sintonen H, Joukamaa M. Alexithymia and health-related quality of life in a general population. PSYCHOSOMATICS 2009; 50:59-68. [PMID: 19213974 DOI: 10.1176/appi.psy.50.1.59] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Alexithymia is thought to reflect a deficit in the cognitive processing of emotion, and, therefore, it may predispose individuals to both psychological and somatic symptoms. OBJECTIVE The authors investigated the relationship between alexithymia and health-related quality of life (HRQoL) in a nationally representative population sample of 5,418 subjects, age 30 to 97 years. METHOD Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20) and HRQoL measured with the 15D, a generic HRQoL measure. RESULTS Alexithymia was significantly associated with lower HRQoL independently of other variables. The TAS-20 subfactor Difficulties Identifying Feelings was the strongest common denominator between alexithymia and HRQoL. CONCLUSION Alexithymia may be a predisposing factor to poorer HRQoL.
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Affiliation(s)
- Aino K Mattila
- Tampere School of Public Health, FIN-33014, University of Tampere, Tampere, Finland.
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Beutel ME, Michal M, Subic-Wrana C. Psychoanalytically-oriented inpatient psychotherapy of somatoform disorders. ACTA ACUST UNITED AC 2008; 36:125-42. [PMID: 18399750 DOI: 10.1521/jaap.2008.36.1.125] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Somatoform disorders have been neglected in psychoanalytic publications. Unlike the descriptive approach of DSM-IV and ICD-10, sophisticated psychoanalytical models have been proposed for many years explaining the development of physical symptoms without definable medical cause. Based on a review of the psychoanalytic models of somatization and conversion, this article explores difficulties in the medical and psychotherapeutic treatments of somatoform disorders. The unique tradition of psychosomatic inpatient treatment in Germany is illustrated by the psychoanalytic treatment setting at the University of Mainz. A case report of a somatoform patient shows how childhood trauma is activated and integrated in the course of inpatient treatment. In a multimodal approach, psychoanalytic individual and group therapy may interact beneficially with body-oriented, art therapy, and other treatment elements to gain therapeutic access to chronic somatoform patients, activate and work through trauma and conflict. Regardless of the specific setting, analytic treatments need to do justice to the specific deficits (e.g., symbolization of affect, mentalization) and defences of somatoform patients.
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Affiliation(s)
- Manfred E Beutel
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Mainz, Mainz, Germany.
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29
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Wagner H, Lee V. Alexithymia and individual differences in emotional expression. JOURNAL OF RESEARCH IN PERSONALITY 2008. [DOI: 10.1016/j.jrp.2007.04.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ogrodniczuk JS, Piper WE, Joyce AS. Alexithymia and therapist reactions to the patient: expression of positive emotion as a mediator. Psychiatry 2008; 71:257-65. [PMID: 18834276 DOI: 10.1521/psyc.2008.71.3.257] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study examined patient's expression of emotion as a mediator of the relationship between patient alexithymia and therapist reactions to the patient. We analyzed data from 107 psychiatric outpatients who participated in a randomized controlled trial of two forms of group therapy for complicated grief. Patient alexithymia was assessed using the Toronto Alexithymia Scale-20. Patient's expression of emotion was assessed via sociometric ratings provided by other group members. Therapist reactions to the patient were assessed via therapist's ratings of each member in the group. Patient's expression of positive emotion met all the requirements for being considered a mediator. The findings indicated that the higher the level of alexithymia (specifically, greater difficulty communicating feelings and greater tendency to engage in externally oriented thinking), the less expression of positive emotion by the patient, and the more negative the therapist's reactions to the patient. The mediation provided by expression of positive emotion accounted for over half of the direct effect of alexithymia on therapist reactions to the patient. Future work needs to consider whether a therapist's awareness of a patient's limited capacity to express positive emotions and the negative influence that this can have on his/her reactions to his/her patients can help improve the therapeutic experience with alexithymic patients.
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Affiliation(s)
- John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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The performance of diagnostic measures of depression in alexithymic and nonalexithymic subjects. Gen Hosp Psychiatry 2008; 30:77-9. [PMID: 18164945 DOI: 10.1016/j.genhosppsych.2007.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Revised: 08/15/2007] [Accepted: 08/21/2007] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective of this study was to examine how the outcomes of a structured diagnostic interview for depression are related to the results of a self-report scale in alexithymic and nonalexithymic groups. MATERIALS AND METHODS Subjects (N=389) recruited from primary care and psychiatric care completed the Depression Scale (DEPS) and the 20-item Toronto Alexithymia Scale. Major depression was diagnosed using the Composite International Diagnostic Interview-Short-Form by telephone. RESULTS In the group without major depression, the DEPS scores of the alexithymic subjects were significantly higher than those of the nonalexithymic subjects. In the group with major depression, the ideal cutoff points of the DEPS, assessed by receiver operating characteristic analyses, were essentially higher for the alexithymic patients. CONCLUSIONS Alexithymic subjects without major depression may be rated as depressive if the only criterion is the score on a self-report scale. Furthermore, alexithymic patients may require higher cutoff points in a self-report depression scale.
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Mattila AK, Salminen JK, Nummi T, Joukamaa M. Age is strongly associated with alexithymia in the general population. J Psychosom Res 2007; 61:629-35. [PMID: 17084140 DOI: 10.1016/j.jpsychores.2006.04.013] [Citation(s) in RCA: 214] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Revised: 04/10/2006] [Accepted: 04/25/2006] [Indexed: 01/12/2023]
Abstract
OBJECTIVE We studied the prevalence of alexithymia, its distribution in different age groups in a wide age range, its association with sociodemographic and health-related variables, and its co-occurrence with depression. METHODS The study forms part of the Health 2000 Study. The original sample comprised 8028 subjects representing the general adult population of Finland. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20), and depression was measured with the 21-item Beck Depression Inventory. Altogether, 5454 participants filled in TAS-20 in their mother tongue. RESULTS The prevalence of alexithymia was 9.9%. Men (11.9%) were more commonly alexithymic than women (8.1%). Alexithymia was associated with male gender, increasing age, low educational level, poor perceived health, and depression. CONCLUSIONS The findings were in line with earlier population studies. For the first time, it was possible to analyze the prevalence of alexithymia in a wide age range (30-97 years). International comparative studies are needed.
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Affiliation(s)
- Aino K Mattila
- Tampere School of Public Health, University of Tampere, Tampere, Finland.
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Vanheule S, Desmet M, Rosseel Y, Verhaeghe P, Meganck R. Relationship patterns in alexithymia: a study using the core conflictual relationship theme method. Psychopathology 2007; 40:14-21. [PMID: 17057420 DOI: 10.1159/000096385] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Accepted: 11/07/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Alexithymia is a disturbance in regulating affective states. Clinical observations suggest that alexithymic patients relate to others in a specific way. This paper explores whether specific relationship or transference patterns are typical of alexithymia. SAMPLING AND METHODS Relationship patterns were assessed by means of the Core Conflictual Relationship Theme method, standard categories version. This method examines transference patterns and was applied to clinical interview data collected from a sample (n = 31) of mental health outpatients. Alexithymia was assessed by means of a score on the 20-item Toronto Alexithymia Scale corrected for the degree of depression (measured by the Beck Depression Inventory-II). Data were analysed by means of the leaps and bounds regression algorithm for selecting optimal subsets of indicators and by bootstrapping to determine 95% confidence intervals. RESULTS First, we observed that alexithymia can be meaningfully explained by typical wishes, typical subjective perceptions of how others respond and one's own typical responses to others. This result indicates that the more marked a patient's alexithymic traits are, the more probable it is that specific transference themes come to the fore. Second, a set of three core indicators of trait alexithymia was mapped: little concern about being good to others, a strong perception of others as cooperative, and weak levels of reacting to others and to conflict by means of somatic symptoms. CONCLUSION Alexithymia is related to a double interpersonal indifference: not much is expected from others, nor is there a personal urge to fulfill the expectations of others. Moreover, in alexithymia somatic symptoms proved to be non-reactive to interpersonal situations. Implications for diagnosis and treatment are highlighted. Limitations of our study are that alexithymia was only assessed with a self-report measure and that conclusions are based only upon data from a heterogeneous mental health sample.
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Affiliation(s)
- Stijn Vanheule
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium.
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Benecke C, Krause R. Dyadic facial affective indicators of severity of symptomatic burden in patients with panic disorder. Psychopathology 2007; 40:290-5. [PMID: 17622708 DOI: 10.1159/000104745] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Accepted: 06/13/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Based on the results of research on facial affective behaviour in different psychological disorders, as well as on available findings on the specific behaviour of patients with panic disorder in interaction with their therapists, hypotheses about dyadic facial affective behaviour and its correlation with symptomatic burden of female panic patients are formulated. SAMPLING AND METHODS The facial affective behaviour of 20 patients with panic disorder and their therapists, coded with the Emotional Facial Action Coding System, in the first treatment session is analyzed regarding interactive enmeshment, and for a subgroup of 15 dyads these data are correlated with those on symptomatic burden before treatment. RESULTS A high degree of interactive enmeshment between patient and therapist correlates positively with the severity of symptomatic burden. All dyadic enmeshment indicators show highly significant positive correlations with body-related symptoms, but not with more general variables like global severity index of the SCL-90R or general anxiety (State Trait Anxiety Inventory). CONCLUSIONS These results are discussed against the background of specific psychodynamics of panic patients and show that, on the one hand, therapists practise an interactive abstinence, but on the other hand, they tend to be pulled into a specific interactive enmeshment by patients with greater symptomatic burden. Limitations of the study arise from the small sample and the lack of a comparison group, therefore the question if the results are disorder specific or more general cannot be answered.
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Affiliation(s)
- Cord Benecke
- Department of Psychology, University of Innsbruck, Innsbruck, Austria.
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Richter J, Möller B, Spitzer C, Letzel S, Bartols S, Barnow S, Willert C, Freyberger HJ, Grabe HJ. Transcallosal inhibition in patients with and without alexithymia. Neuropsychobiology 2006; 53:101-7. [PMID: 16557040 DOI: 10.1159/000092218] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2005] [Accepted: 01/04/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Previous results indicated a facilitated transcallosal inhibition via the corpus callosum (CC) in alexithymic male students. This study investigates transcallosal inhibition in alexithymic and nonalexithymic psychiatric inpatients. METHOD Transcallosal inhibition was elicited by means of transcranial magnetic stimulation (TMS) of the primary motor cortex. Seven right-handed male and 12 female psychiatric patients with Toronto Alexithymia Scale (TAS-20) scores of > or = 61 and 12 patients with TAS-20 scores of < 51 were investigated. The transcallosal conduction time (TCT) reflects the TMS-induced inhibitory cortical activity that is mediated via the CC. RESULTS There was a significant effect of alexithymia on TCT (Wilks lambda = 0.76; F = 4.1; d.f. = 2, 26; p = 0.027) indicating that alexithymic patients had shorter bidirectional TCTs than nonalexithymic patients. The in-between models showed a significant impact of alexithymia on both right to left TCT (F = 4.8; d.f. = 1; p = 0.038) and left to right TCT (F = 5.0; d.f. = 1; p = 0.033). Neither gender nor scores of depression (Montgomery-Asberg Depression Rating Scale) had any significant effects on TCT. CONCLUSION Our results confirm and extend the previous findings of a facilitated, bidirectional transcallosal inhibition in alexithymia to male and female psychiatric inpatients. Facilitated transcallosal inhibition should be considered as a neurobiological correlate of alexithymia.
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Affiliation(s)
- Jan Richter
- Department of Psychiatry and Psychotherapy, Ernst-Moritz-Arndt University, Greifswald/Stralsund, Germany.
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van Kerkhoven LAS, van Rossum LGM, van Oijen MGH, Tan ACITL, Witteman EM, Laheij RJF, Jansen JBMJ. Alexithymia is associated with gastrointestinal symptoms, but does not predict endoscopy outcome in patients with gastrointestinal symptoms. J Clin Gastroenterol 2006; 40:195-9. [PMID: 16633119 DOI: 10.1097/00004836-200603000-00005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Alexithymia, where a person has difficulty in distinguishing between emotions and bodily sensations, is considered to be a character trait and a vulnerability factor for various psychosomatic disorders. Assessing alexithymia in patients with gastrointestinal (GI) symptoms before endoscopy might therefore be useful in selecting patients who are more prone to functional GI disorders. GOAL To determine whether alexithymia might be a useful factor in predicting GI endoscopy outcomes. STUDY Patients referred for endoscopy between February 2002 and February 2004 were enrolled. They were asked to report alexithymia on the Toronto Alexithymia Scale-20 2 weeks before endoscopy. Information about endoscopic diagnoses was obtained from medical files. RESULTS A total of 1141 subjects was included (49% male), of whom 245 (21%) reported alexithymia. There was no difference in mean+/-SD alexithymia scores between patients with (51+/-12) and without (50+/-12) an endoscopic organic abnormality at GI endoscopy. When divided into subgroups, according to the most prominent finding at either upper or lower GI endoscopy, there was no association with alexithymia. Patients with alexithymia reported a worse sensation of GI symptoms during the last weeks before enrollment in the study (mean+/-SD symptom severity score: 42+/-34 vs. 34+/-30, respectively; P<0.01). CONCLUSIONS Alexithymia is not associated with endoscopic findings, and has therefore no additive value in predicting endoscopy outcomes. Patients with alexithymia more often present with a higher number and more severe GI symptoms.
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Affiliation(s)
- Lieke A S van Kerkhoven
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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