Alexithymia--state or trait?

Alexithymia refers to a specific disturbance in emotional processing that is manifested by difficulties in identifying and verbalizing feelings and a tendency to focus on and amplify the somatic sensations that accompany emotional arousal. Alexithymia is conceptualized both as an affect-deficit disorder and a continuous personality variable. The main purpose of the present study was to investigate the stability levels of alexithymia with regard to changes in emotional distress levels caused by university exams. We tested 20 university students at four different times, before and after the exams. Alexithymic features and self-reported emotional distress (trait anxiety and physical symptoms) were measured. Whereas emotional distress measures changed significantly during the diverse phases, the level of alexithymia remained unchanged. We therefore conclude that alexithymia represents a constant trait.     

Alexithymia, emotion, and somatic complaints

Alexithymia, by definition, involves difficulties in identifying and describing emotions and has been assumed to be associated with somatization (i.e., a tendency to express psychological distress in somatic rather than emotional form). Empirical research so far, however, has produced no convincing evidence that alexithymia is more associated with somatic complaints than with emotional complaints or that alexithymia correlates with somatic complaints when negative affect is controlled for. In the present study, alexithymia, as measured by the TAS-20, showed no association with somatic complaints in a community sample of 137 individuals when trait anxiety and depression were controlled. Alexithymia did correlate negatively with positive affect, and positively with negative affect. The former association, however, was much more robust, whereas the latter association was found mainly on subjective trait measures of negative affect (as distinct from state measures and more objective trait measures derived from daily recordings during an 8-week period). It is suggested that the association between alexithymia and lack of positive affect deserves more attention in future research.     

Genetic testing for hereditary cancer: effects of alexithymia and coping strategies on variations in anxiety before and after result disclosure

This study assessed the impact of the results of genetic testing for hereditary cancer from a multifactorial health psychology perspective, considering that emotional expression plays a key role in psychological adjustment. Measures of dispositional and transactional coping strategies, anxiety and alexithymia were filled out by 77 participants in a longitudinal study design. Statistical analyses were performed using general linear models and partial least squares path modelling, low-constraint methods that are particularly useful in the behavioural sciences. While anxiety levels prior to the result announcement were predictive of the distress experienced by noncarriers, considerable variability was observed for mutation carriers. Some subjects who had lower anxiety levels before the test displayed greater anxiety afterwards, but others seemed to anticipate the distress they would experience with the result that they showed a decrease in anxiety. The mutation carriers behaved as though their adaptive functioning were reshaped by the test result, independent of their disposition and previous emotional state, except in the case of alexithymia. Difficulty expressing emotions prior to genetic testing contributed to a similar difficulty after receiving the result, adding to the latter's emotional impact by promoting emotion-focused coping strategies and increasing distress.     

Relationships Between Physical Symptoms,Emotional Distress,and Pain Appraisal in Fibromyalgia: The Moderator Effect of Alexithymia

Alexithymia is a personality construct that is frequently identified in fibromyalgia (FM). Previous studies have explored the relationship between alexithymia and emotional distress in this disease. Yet, the additional link with factors of pain appraisal is unknown. This study examined the moderating effect of alexithymia in the relationship between emotional distress and pain appraisal in 97 FM women. A control group of 100 healthy women also participated in the study. All participants completed several self-reports about pain experience, sleep quality, impairment, emotional distress, pain appraisal, and alexithymia. FM women showed significantly more difficulty in identifying and describing feelings, but less externally oriented thinking than healthy women. In the clinical group, difficulty in identifying feelings and difficulty in describing feelings significantly correlated with lower sleep quality, higher anxiety and depression, and increased pain catastrophizing and fear of pain. Difficulty in describing feelings significantly correlated with higher pain experience and vigilance to pain. Externally oriented thinking was not correlated with any of the clinical variables. Difficulty in identifying feelings moderated the relationship between anxiety and pain catastrophizing, and difficulty in describing feelings moderated the relationship between anxiety and fear of pain. Implications of the findings for the optimization of care of FM patients are discussed.     

La gestion des émotions et ses déficits,chez les personnes atteintes de douleur chronique : une revue systématisée des études relatives à l’alexithymie, à l’intelligence émotionnelle, à la régulation émotionnelle et au coping

The goal of this review is to synthesize the data of scientific literature on emotional management and its deficits in chronic pain. We used terms referenced in databases and MesH terms (of the United States National Library of Medicine) to perform a literature search in a powerful online search engine (EBSCOhost research databases). Four hundred and forty-nine papers, taken from international reviews and published of 1994 (because it is in the middle of the 1990s that this theme begins to be handle) to the end of January, 2015, are identified by a total 5 electronic databases with predefined keywords about emotions and chronic pain. Forty-six of which met the inclusion criteria, according to their title, their summary and their complete text. The findings suggest that some emotional management strategies and its deficits can maintain a vicious circle of negative emotional states with physiological and psychopathological consequences. Several studies show that alexithymia, emotional ambivalence and emotional suppression have a deleterious impact on pain, emotional distress (depression, anxiety) and disability. In spite of some contradictions concerning the nature of this effect (sensory or affective pain intensity or even duration of pain), it seems that alexithymia is a major variable implied in chronic pain. Inversely, experiential acceptance has a beneficial effect on psychological distress (depression, anxiety and stress). Emotional disclosure (of stressful or traumatic events) can decrease pain intensity but not disability and mental health. Likewise, emotional expression in daily life seems beneficial, but when the expression of the positive and negative feelings are distinguished, emotional expression of negative feelings increases pain, disability and distress. The whole of these findings emphasize the need to further research about emotional management in chronic non-cancer pain. It is necessary to identify and control the source of potential bias. Some hypotheses have been proposed to explain these findings. In the future, it would be interesting to use a multifactorial approach to investigate the interactions between various processes of emotional management in chronic pain patients.     

Prediction of symptoms of emotional distress by mood regulation expectancies and affective traits

Three studies examined negative mood regulation expectancies (NMRE) and affective traits as independent predictors of self‐reported symptoms of emotional distress. NMRE represent individuals' beliefs that they can alleviate unpleasant emotional states. Stronger NMRE are associated with more adaptive coping, more positive cognition during negative moods, more effective responses under stress and less emotional distress. Affective traits represent long‐term tendencies toward particular affective experiences; they confer risk for specific symptoms of emotional distress. In Study 1, NMRE, trait negative affect (TNA) and trait positive affect (TPA) were all independently associated with depression among students and staff of a German university. In Study 2, in prospective analyses among U.S. college students traits exhibited hypothesised relationships with anxiety and depressive symptoms, and NMRE uniquely predicted anhedonic depression. Study 3 revealed independent prediction of change in symptoms over time by NMRE among U.S. college students, whereas traits were not associated with change in distress, anxiety and depression symptoms. Results suggest independent roles for NMRE and traits in the development of depression and anxiety symptoms and highlight the importance of NMRE as a potential target of therapeutic intervention in the process of symptom change.     

Coping strategies and perceived social support in fibromyalgia syndrome: Relationship with alexithymia

Fibromyalgia (FM ) is a chronic pain syndrome characterized by high levels of psychological distress and alexithymia, a personality disposition affecting emotional self‐awareness. The main aim of the present study was to investigate for the first time the relationship between alexithymia and coping strategies on the one hand, and alexithymia and perceived social support on the other, in a sample of FM patients. To reach this aim, 153 FM patients completed a battery of tests assessing coping strategies, perceived social support, alexithymia, psychological distress and pain intensity. Four regression analyses were performed to assess whether alexithymia was still a significant predictor of coping strategies and perceived social support, after controlling for psychological distress. High levels of both psychological distress and alexithymia were found in our sample of FM patients. Regarding coping strategies, FM patients reported higher scores on problem‐focused coping, with respect to the other two coping strategies. The regression analyses showed that the externally‐oriented thinking factor of alexithymia significantly explained both problem‐ and emotion‐focused coping, while the difficulty‐describing feelings factor of alexithymia proved to be a significant predictor of perceived social support. Only the variance of dysfunctional coping ceased to be uniquely explained by alexithymia (difficulty identifying feelings factor), after controlling for psychological distress, particularly anxiety. These results highlight a negative relationship between alexithymia and both the use of effective coping strategies and the levels of perceived social support in FM patients. An adequate assessment of both alexithymia and psychological distress should therefore be included in clinical practice with these patients.     

Alexithymia in the interpersonal domain: A general deficit of empathy?

Alexithymia and empathy have been related but very little is known on shared variance between their respective affective and cognitive dimensions. We examined this question with correlations, as well as both exploratory and confirmatory analyses, and controlled for anxiety and depression. The responses of 645 young adults to self-report questionnaires of alexithymia (TAS-20), empathy (IRI), anxiety (STAI-T) and depression (BDI-13) were examined. We observed associations between the proposed cognitive components of alexithymia (externally-oriented thinking) and that of empathy (perspective taking, fantasy) as well as empathic concern, which were insensitive to anxiety or depression. In contrast, associations between the proposed affective components of alexithymia (difficulty identifying feelings, difficulty describing feelings) and empathy (personal distress) were largely due to shared covariance with anxiety. A model encompassing an affective and a cognitive (including empathic concern) latent factors emerged, even after controlling for dysphoric affects. These findings suggest specific associations between cognitive and affective components of both constructs that were dissimilarly affected by anxiety and depression. The allocation of empathic concern to the cognitive factor is also discussed.     

Depression and Anxiety in Older and Middle‐aged Adults With Diabetes

This study aims to compare rates of depressive and anxious symptoms among older adults with and without diabetes. The study also examines differences in depression, anxiety, and diabetes‐related emotional distress between middle‐aged and older adults with diabetes. A total of 224 participants completed a range of questionnaires measuring depression, anxiety, and diabetes‐related emotional distress (if applicable). One hundred and three adults with diabetes (55 middle‐aged, mean age = 47 years, range 40–59 years and 48 older, mean age = 69 years, range 60–81 years) were recruited from a tertiary diabetes clinic. One hundred and twenty‐one adults without diabetes (72 middle‐aged, mean age = 52 years, range 40–59 years and 49 older, mean age = 65 years, range 60–76 years) were recruited from either a university student pool or a registry of adults aged 50 and above. Older adults with diabetes had significantly higher levels of depression and comparable levels of anxiety with older adults without diabetes. Older adults with diabetes had significantly lower levels of depression, anxiety, and diabetes‐related distress than middle‐aged adults with diabetes. Diabetes is associated with high rates of depression and anxiety, with middle‐aged adults more adversely affected than older adults.     

Spiritual Bypass: A Preliminary Investigation

The phenomenon of spiritual bypass has received limited attention in the transpersonal psychology and counseling literature and has not been subjected to empirical inquiry. This study examines the phenomenon of spiritual bypass by considering how spirituality, mindfulness, alexithymia (emotional restrictiveness), and narcissism work together to influence depression and anxiety among college students. Results suggested that mindfulness and alexithymia accounted for variance in depression beyond what is accounted for by spirituality and that all 3 factors (mindfulness, alexithymia, and narcissism) accounted for variance in anxiety beyond what is accounted for by spirituality. Implications for counselors are provided.     

Relationship Between Alexithymia and Social Anxiety in Female Outpatients with Dermatological Disorder Presenting for Psychiatric Consultation

The aim of this study was to evaluate the relationship between alexithymia and social anxiety symptoms in female outpatients with dermatological disorder. Fifty consecutive patients sent to a psychiatry outpatient clinic for consultation from a dermatology outpatient clinic were included in the study. Social anxiety symptoms showed significant correlations with depression, trait anxiety, alexithymia and global psychiatric symptom severity. A multivariate analysis of covariance demonstrated that subscales of the Liebowitz Social Anxiety Scale (LSAS) were related to alexithymia and trait anxiety. The “difficulty in describing feelings” (DDF) dimension of alexithymia and trait anxiety appear to be important factors in this relationship between social anxiety and alexithymia. Results of this study suggest that patients with dermatological disorder may benefit from both treatment of social anxiety symptoms and learning how to regulate their affects and emotional expression.     

Differences in alexithymia and emotional awareness in exhaustion syndrome and chronic fatigue syndrome

Symptoms of Exhaustion Syndrome (ES) and Chronic Fatigue Syndrome (CFS) are overlapping and create difficulties of differential diagnosis. Empirical studies comparing ES and CFS are scarce. This study aims to investigate if there are any emotional differences between ES and CFS. This cross‐sectional study compared self‐reported alexithymia and observer‐rated emotional awareness in patients with ES (n = 31), CFS (n = 38) and healthy controls (HC) (n = 30). Self‐reported alexithymia was measured with the Toronto Alexithymia Scale‐20 (TAS‐20) and emotional awareness with an observer‐rated performance test, the Level of Emotional Awareness Scale (LEAS). Additionally, depression and anxiety were scored by the Hospital Anxiety and Depression Scale (HADS). Results show that patients with ES expressed higher self‐reported alexithymia in the TAS‐20 compared to HC, but had similar emotional awareness capacity in the observer‐rated performance test, the LEAS. Patients with CFS expressed more difficulties in identifying emotions compared to HCs, and performed significantly worse in the LEAS‐total and spent more time completing the LEAS as compared to HC. Correlation and multiple regressions analyses revealed that depression and anxiety positively correlated with and explained part of the variances in alexithymia scores, while age and group explained the major part of the variance in LEAS. Findings of this study indicate that emotional status is different in patients with ES and CFS with respect to both self‐reported alexithymia and observer‐rated emotional awareness. Emotional parameters should be approached both in clinical investigation and psychotherapy for patients with ES and CFS.     

The Moderating Effects of Mindfulness on Psychological Distress and Emotional Eating Behaviour

Current evidence and theory suggests that emotional eating resulting from attempts to manage psychological distress, such as anxiety, depression, and stress, is considered to be a major contributor to obesity. Mindfulness has been shown to be related to disordered eating behaviours. Employing a non‐clinical sample of 42 males and 115 females, the present study investigated the contribution of mindfulness as a potential moderator between psychological distress and engagement in emotional eating, while controlling for the effects of gender and general nutrition knowledge. Consistent with predictions, psychological distress was positively associated with engagement in emotional eating, while mindfulness was found to share an inverse relationship. Moreover, after controlling for gender and general nutrition knowledge, the interaction between psychological distress and mindfulness was found to significantly predict the tendency to engage in emotional eating over and above the individual effects of these variables. The findings from the current study add to the current literature supporting the use of mindfulness‐based interventions for treatment of emotional eating practices in individuals experiencing anxiety, stress, and lower levels of depression.     

Tracking stress,depression, and anxiety across the final year of secondary school: A longitudinal study

Levels of distress, which include stress, depression, and anxiety, are often heightened during the final year of secondary school and have been linked to major examinations that occur during this time period. However, relatively little is known about how these symptoms change over the course of the year or what moderates symptom severity. Using a longitudinal survey design, we tracked student outcomes and potential moderators (i.e., gender, test anxiety, self-efficacy, connectedness with peers, school and family, perceived use of fear appeals by teachers) associated with stress, depression, and anxiety once per term (i.e., 4 times total) over the final year of high school in seven Australian high schools. We hypothesised that student symptoms would increase over time and that symptom severity would be moderated by individual and environmental factors. Six hundred and thirty-eight unique students (M age = 16.95 years, SD = 0.56, range = 15–18 years, female = 474 [74.29%]) participated in at least one of the four surveys administered during each term of the final year of high school. Linear mixed models indicated that stress (d = 0.2) and anxiety (d = 1.7) increased over time. When all potential moderators of distress were entered into the full model, gender, test anxiety, emotional self-efficacy, and peer connectedness were all significant unique predictors of stress. Similar patterns were found for symptoms of depression and anxiety. Time 3 stress was predicted by unique variance in baseline stress, higher test anxiety, and academic self-efficacy. Overall distress increased over time and was moderated by gender, as well as by test anxiety, self-efficacy, and peer connectedness, which are areas that can then be targeted by interventions designed to maintain distress at optimum levels for wellbeing and academic performance.     

Frustration Intolerance Beliefs as Predictors of Emotional Problems in University Undergraduates

The present study examined the relationship between Frustration Intolerance Beliefs as suggested by the Rational Emotive Behavior Therapy framework and emotional problems. Data were collected from 332 university undergraduate students (age 19–26) who completed Demographic Information Sheet, Frustration Discomfort Scale and three subscales of Brief Symptom Inventory including depression, anxiety and hostility. The current findings confirmed the association between frustration intolerance and irrational beliefs and their respective roles in psychological distress among non-clinical student population. Results indicated that FDS subscales were differently related to specific emotions as entitlement and emotional intolerance sub-scales were significantly positively associated with depression, anxiety, and hostility while achievement was significantly negatively associated with hostility. The study has implications for counsellors, school psychologists and policy makers as it highlights the importance of rational group and individual counselling of rational ideas to reduce the emotional problems of students hindering their educational and personal growth.     

Reducing Psychological Distress in a Genetic Counseling Consultation for Breast Cancer

High levels of cancer specific distress have been found before and after genetic counseling for breast cancer. This study investigated the process of reducing distress during 111 genetic counseling consultations for familial breast cancer. Consultations were audiotaped, transcribed, and a detailed coding system developed to measure cues of emotional distress from the patient, and consultant (clinical geneticist or genetic counselor) behaviors before and after the cues. At least 1 emotional cue was given in 64 consultations, with a median of 1 cue per consultation. More emotional cues of distress occurred when the consultant responded empathetically to the first cue of distress. Satisfaction outcomes were largely positive regardless of the consultant's attentiveness to distress. Postconsultation depression scores were significantly reduced if more empathic responses were given, but anxiety remained the same. These results are discussed and recommendations are made for improving patient care.     

Severity of Emotional and Behavioral Problems Among Poor and Typical Readers

The purpose of this study was to examine the severity of behavioral and emotional problems among adolescents with poor and typical single word reading ability (N = 188) recruited from public schools and followed for a median of 2.4 years. Youth and parents were repeatedly assessed to obtain information regarding the severity and course of symptoms (depression, anxiety, somatic complaints, aggression, delinquent behaviors, inattention), controlling for demographic variables and diagnosis of ADHD. After adjustment for demographic variables and ADHD, poor readers reported higher levels of depression, trait anxiety, and somatic complaints than typical readers, but there were no differences in reported self-reported delinquent or aggressive behaviors. Parent reports indicated no differences in depression, anxiety or aggression between the two groups but indicated more inattention, somatic complaints, and delinquent behaviors for the poor readers. School and health professionals should carefully assess youth with poor reading for behavioral and emotional symptoms and provide services when indicated.     

Emotional lability, negative affect and emotional regulation in children of anxious mothers

This study examined the role of emotional lability and negative affect and emotional regulation in the relation between maternal trait anxiety and attentional and social problems, and internalizing and externalizing symptoms of 275 six- to eleven-year-old children. The results indicated a direct moderating effect of emotional regulation in the relation between maternal anxiety and externalizing behaviour and that lability and negative affect moderated the relation between maternal anxiety and attention and social problems and somatic complaints. The links between maternal anxiety and withdrawal and anxiety/depression symptoms were also mediated by lability and negative affect. This mediation was independent of emotional regulation in the first case, and it depended on emotional regulation with regard to anxiety/depression symptoms.     

Blunted reward responsiveness prospectively predicts emotional distress when exposed to a naturalistic stressor

Both stress and blunted reward responsiveness have been identified as core risk factors of depression. Whether blunted reward responsiveness increases psychological vulnerability to real-life stress from a dynamic perspective (from stress reactivity to recovery) has not been investigated. By utilizing a real-world stressful event (i.e. the final examination), this study aimed to explore the role of reward responsiveness in the stress-emotional distress relationship during stress reactivity and recovery phases. We followed 57 undergraduates with three assessments, from six weeks before examination weeks (T1, baseline), one day before the examinations (T2) to two weeks after the examinations (T3), therefore, covering stress reactivity (T1 to T2) and recovery (T2 to T3) phases. At baseline, reward responsiveness was measured as the Reward Positivity (RewP) in the doors task. Stress and emotional distress (anxiety and depression) were reported at T1, T2 and T3 to capture their dynamic changes. Results showed that self-report stress levels significantly increased from T1 to T2 (stress reactivity phase) and decreased from T2 to T3 (stress recovery phase). Furthermore, blunted reward responsiveness at baseline prospectively predicted emotional distress during the stress reactivity phase but not the recovery phase. Specifically, during the stress reactivity phase, higher perceived stress was associated with greater anxiety and depression only in participants with relatively smaller residual RewP amplitudes but not in participants with relatively larger residual RewP amplitudes. Our study demonstrated that a blunted reward responsiveness is a vulnerable factor of depression, especially when exposed to stress. Our findings provide insights into prevention and intervention for stress-related disturbance.     

Do I feel sadness,fear or both? Comparing self-reported alexithymia and emotional task-performance in children with many or few somatic complaints

Children with many somatic complaints seem to report problems with emotion identification and communication (‘alexithymia’). The aim of this study was to verify whether children with somatic complaints do indeed show signs of alexithymia. We compared 35 children (M age = 10.99, SD = 13 months) with many somatic complaints with 34 children (M age = 11.03, SD = 12 months) reporting few complaints on the basis of a self-report alexithymia scale and tasks that require the skill to identify and communicate emotions: an emotional attention task, a structured interview about own emotions, and a mixed-emotion task. Children were also asked about the intensity of the reported emotions. Compared to children with few complaints, children with many complaints seemed to have higher self-reports of alexithymia. However, these results were explained by difficulty in communicating negative internal states and experiencing indefinable internal states, rather than difficulty in identifying emotions. In addition, children with many complaints reported higher intensities of fear and sadness. The children did not differ in their attention to emotions or causes of emotions. Children with many somatic complaints more often described previous emotional experiences and showed better abilities in identifying multiple emotions. Children with many somatic complaints thus show more negative emotional processing, but the alexithymia-hypothesis was unsupported.