The Unique Relationship of Emotion Regulation and Alexithymia in Predicting Somatization Versus PTSD Symptoms

Posttraumatic stress disorder (PTSD) has received considerable attention in the field of trauma studies. Yet trauma survivors suffer from other psychological and physical symptoms including somatic complaints, or somatization. The extent to which the same emotional processes that predict PTSD are implicated in somatization has remained relatively unexamined. We contend that emotion regulation difficulties and alexithymia are also implicated in somatization, and the way in which these factors interact differentially place one at risk for somatization or PTSD. Regression analyses revealed that emotion regulation difficulties were more highly correlated with somatization for individuals who also reported greater alexithymia. This interaction was not observed for PTSD symptoms where both alexithymia and emotion regulation difficulties uniquely predicted PTSD symptoms.     

Incidental retrieval of emotional contexts in post-traumatic stress disorder and depression: an fMRI study

In the present study, we used fMRI to assess patients suffering from post-traumatic stress disorder (PTSD) or depression, and trauma-exposed controls, during an episodic memory retrieval task that included non-trauma-related emotional information. In the study phase of the task neutral pictures were presented in emotional or neutral contexts. Participants were scanned during the test phase, when they were presented with old and new neutral images in a yes/no recognition memory task. fMRI results for the contrast between old and new items revealed activation in a predominantly left-sided network of cortical regions including the left middle temporal, bilateral posterior cingulate, and left prefrontal cortices. Activity common to all three groups when correctly judging pictures encoded in emotional contexts was much more limited. Relative to the control and depressed groups the PTSD group exhibited greater sensitivity to correctly recognised stimuli in the left amygdala/ventral striatum and right occipital cortex, and more specific sensitivity to items encoded in emotional contexts in the right precuneus, left superior frontal gyrus, and bilateral insula. These results are consistent with a substantially intact neural system supporting episodic retrieval in patients suffering from PTSD. Moreover, there was little indication that PTSD is associated with a marked change in the way negatively valenced information, not of personal significance, is processed.     

PTSD Symptom Cluster Severity Predicts Momentary Emotion Dynamics During Couple Conversations

This study investigated the associations between momentary emotion dynamics and posttraumatic stress disorder (PTSD) symptoms. Using a sample of 61 couples (N = 122 individuals) in which all individuals were trauma exposed and at least one partner screened positive for PTSD, we examined the intra- and interpersonal regulation of vocally encoded emotional arousal (fundamental frequency [f₀]) and how these momentary emotion regulatory patterns relate to specific PTSD symptoms during two couple conversations: one designed to elicit conflict and one to elicit intimacy. PTSD symptoms were assessed using a gold standard clinical interview. In both conversations, higher reexperiencing symptoms were associated with greater emotional inertia (i.e., more resistance to change in emotional state following deviation from one’s emotional equilibrium), and higher avoidance symptoms were associated with less emotional inertia (i.e., quicker return to emotional equilibrium). In the intimacy conversations, individuals also responded to their partners’ arousal. Furthermore, individuals whose partners exhibited higher emotional numbing symptoms exhibited more emotional inertia, suggesting that emotion regulation may be a function of both one’s own and one’s partner’s PTSD symptoms. Attending to the interpersonal context of emotion dynamics during PTSD treatment may enhance outcomes.     

Altered Cortico-Limbic Functional Connectivity During an Empathy Task in Subjects with Post-Traumatic Stress Disorder

Empathy is a multidimensional construct consisting of cognitive (inferring mental states) and emotional (empathic concern) components. Emotional empathy is severely impaired in individuals affected by Post-Traumatic Stress Disorder (PTSD). Here, we investigated the neural correlates of such an emotional empathy dysfunction to shed light on the neural circuitry responsible for the social and emotional dysfunction in PTSD. We asked a group of PTSD and a group of healthy controls to solve a Multifaceted Empathy Test, measuring both cognitive and emotional empathy, and investigated the functional connectivity of the cortical areas involved in solving the test. The results revealed that, in healthy individuals, increased neural activity in the frontal cortex modulates activity in the insula while subjects perform the emotional empathy task; whereas, in individuals affected by PTSD, increased activity in limbic regions such the insula and the amygdala modulates activity in the frontal cortex while performing the emotional empathy task. These findings suggest that the lack of cortical top-down control of the frontal cortex on the limbic system in PTSD during empathic processing may explain the emotional and social difficulties experienced by individuals suffering from PTSD.     

Stability of emotions for traumatic memories in acute and chronic PTSD

While memory for central factual information regarding an emotional event is considered to be relatively accurate, memory for emotions seem to be quite inaccurate (Christianson & Safer, 1995). We extended this line of research to examine memory for the emotional intensity surrounding a traumatic event (e.g., memory for the fear and horror of the event). We conducted a series of two studies. In Study 1, we examined memory for the emotional intensity of the traumatic event in recent sexual or non-sexual assault victims with acute PTSD at 2 and 12 weeks following the assault. In Study 2, we compared memory for emotional intensity in sexual and non-sexual assault victims with either acute or chronic PTSD at initial assessment and 12 weeks later. For both studies, participants were asked to recall general emotional intensity, fear intensity, and dissociative intensity of the traumatic event. Results suggested that memory for the fear of the traumatic event did not fluctuate over time. However, memory for the general emotional and dissociative intensity did fluctuate over time, decreasing for individuals with acute PTSD and increasing for individuals with chronic PTSD.     

Associations among alexithymia, positive and negative emotions, and self-defeating personality

This study examined the associations among 210 college students' alexithymia scores and three emotional orientation scores. Students completed the following three self-report instruments: 20-item Toronto Alexithymia Scale, 20-item Positive and Negative Affect Scale, and 24-item Self-defeating Personality Scale. As predicted, a linear regression model indicated that alexithymia was associated with negative emotional activation, self-defeating personality, and inversely associated with positive emotional activation. These three affect orientations accounted for 27% of the variance associated with subjects' cognitive-affective communication difficulties expressing their emotions. A second linear regression model indicated that negative emotion activation was significantly associated with self-defeating personality, and positive emotion activation was significantly inversely associated with self-defeating personality.     

Error monitoring is related to processing internal affective states

Detecting behavioral errors is critical for optimizing performance. Here, we tested whether error monitoring is enhanced in emotional task contexts, and whether this enhancement depends on processing internal affective states. Event-related potentials were recorded in individuals with low and high levels of alexithymia—that is, individuals with difficulties identifying and describing their feelings. We administered a face word Stroop paradigm (Egner, Etkin, Gale, & Hirsch, 2008) in which the task was to classify emotional faces either with respect to their expression (happy or fearful; emotional task set) or with respect to their gender (female or male; neutral task set). The error-related negativity, a marker of rapid error monitoring, was enhanced in individuals with low alexithymia when they adopted the emotional task set. By contrast, individuals with high alexithymia did not show such an enhancement. Moreover, in the high-alexithymia group, the difference in the error-related negativities between the emotional and neutral task sets correlated negatively with difficulties identifying their own feelings, as measured by the Toronto Alexithymia Scale. These results show that error-monitoring activity is stronger in emotional task contexts and that this enhancement depends on processing internal affective states.     

Influence of clinical status in the relationship between alexithymia and emotional recognition: a dimensional study

The results of this study are part of an investigation to determine whether the cognitive-emotional process of emotional recognition is deficient as a function of the clinical condition and alexithymia in subjects with somatization. This investigation applied the self-assessment of emotion and used a procedure that minimizes the use of verbal skills and verbal comprehension. The specific goal of this study was to verify whether there were differences in the covariation between alexithymia and self-evaluation of the emotional reaction in clinical and nonclinical subjects. The results of this study highlight the significant differences between clinical and control subjects. There were inverse significant correlations with the affective valence in clinical subjects, whereas in the ratings of the TAS-20 in control subjects, there were direct correlations with activation. In the conclusions, we discuss whether the variability of the results of previous research of the relationship between alexithymia and emotional recognition is a characteristic feature of this relationship or an effect of the different sampling and procedures utilized.     

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.     

Investigating the role of alexithymia on the empathic deficits found in schizotypy and autism spectrum traits

Alexithymia, the inability to identify and describe one’s emotional experience, is elevated in many clinical populations, and related to poor interpersonal functioning. Alexithymia is also associated with empathic deficits in individuals with autism spectrum disorders. Accordingly, a better understanding of alexithymia could elucidate the nature of social-cognitive deficits transdiagnostically. We investigated alexithymia and components of empathy in relation to schizotypal and autism spectrum traits in healthy college students. Specifically, we examined higher-order components of empathic processing that involve perspective taking and other-oriented concern, which are reduced in alexithymia.Higher-order empathic processing was inversely correlated with both schizotypal and autism spectrum traits. Bootstrapping techniques revealed that alexithymia had a significant indirect effect on the relationship between higher-order empathy and these personality traits; thus, alexithymia contributes uniquely to their relationship. These findings suggest alexithymia represents one possible mechanism for the development of empathic deficits in these populations.These results are consistent with the perspective that awareness of one’s own emotional state may predicate a successful empathic response to another’s. This work highlights the importance of a consideration of alexithymia in elucidating the nature of empathic deficits in various clinical populations, and points to a potential point of social intervention.     

On the Relationship Between Interoceptive Awareness and Alexithymia: Is Interoceptive Awareness Related to Emotional Awareness?

Interoceptive awareness (IA) is associated with emotional experience, the processing of emotional stimuli, and activation of brain structures that monitor the internal visceral and emotional state of the organism. Alexithymia is characterized by difficulties in identifying and describing one's emotions and externally oriented thinking (EOT) and reflects impairments in emotional awareness and the regulation of emotions. This study examined the relationship between alexithymia and IA in a healthy population of N=155 persons. A well-validated heartbeat perception task to measure interoceptive awareness, the Toronto Alexithymia Scale (TAS-20) and a depression questionnaire (BDI-2) were administered to 88 women and 67 men. IA was inversely associated with all features of alexithymia in the whole sample. When considering sex differences, IA turned out to be a relevant negative predictor for the EOT subscale only in men. This large sample investigation in a nonclinical population indicates that IA represents a relevant negative predictor for alexithymia.     

PTSD个体对创伤相关刺激的情绪标识效应研究

采用三因素混合实验设计,结合情绪标识范式考察创伤后应激障碍（PTSD）个体对创伤相关图与负性情绪面孔的情绪标识效应。结果发现：PTSD组的情绪标识任务抑制了创伤相关图对之后奇偶判断任务的干扰,表现出显著的情绪标识效应;而对负性情绪面孔的情绪标识效应不显著。该研究表明将谈话疗法用于PTSD患者的心理危机干预是有效的。     

Examining the role of emotional avoidance in the relationship between posttraumatic stress disorder symptom severity and worry

A growing body of literature suggests that worry is a cognitive activity functioning to avoid unpleasant internal experiences such as negative thoughts, emotions, and somatic responses. Given the highly aversive internal events associated with posttraumatic stress disorder (PTSD), individuals experiencing PTSD symptoms following exposure to a traumatic event may be particularly motivated to engage in avoidant regulation strategies such as worry. Surprisingly, however, few studies to date have examined the relationship between PTSD and worry as well as potential factors that might explain this association. Therefore, the goal of this study was to examine the association between PTSD symptom severity and worry and the extent to which emotional avoidance explains this relationship. To this end, 207 college students with a history of traumatic exposure (meeting Criterion A for a PTSD diagnosis) completed a series of questionnaires assessing history of exposure to potentially traumatic events, PTSD symptom severity, emotional avoidance tendencies, and worry. Results demonstrated that PTSD symptom severity was positively associated with worry and emotional avoidance. Further, emotional avoidance was found to fully account for this relationship, providing support for the proposed emotionally avoidant function of worry. The implications of these findings for future research and the treatment of worry among individuals with a history of traumatic exposure are discussed.     

Alexithymia and experimentally induced emotion recognition in people with somatizations

This study is part of an investigation aimed at assessing the cognitive-emotional process of emotional recognition in somatizing patients. The specific objective was to verify whether there were differences in the self-assessment of emotional reaction among patients with somatization and non-clinical controls. To obtain the self-assessment of their emotional reaction in the affective dimensions of valence and activation in clinical and control participants, we resorted to a procedure that minimizes the use of verbal skills and comprehension. Participants were 119 people, 47 patients and 72 non-clinical participants. The prevalence of alexithymia in the clinical group was 42.55%, whereas in non-clinical controls, it was 30.55%. Results showed the existence of a deficit in the clinical group's self-assessment of activation in response to the corresponding images with high levels of the affective dimension of activation and high valence images, associated with the clinical condition but not with alexithymia. Alexithymia has a modulatory effect on the clinical participants' and controls' evaluation of the valence of the unpleasant images or of low valence pictures.     

Seeking the source of emotional Stroop interference effects in PTSD: A study of P3s to traumatic words

We investigated the source of emotional Stroop interference effects in posttraumatic stress disorder (PTSD) by measuring reaction times and P3 latencies and amplitudes to personal traumatic, personal positive, and neutral words in a modified Stroop paradigm. Individuals with PTSD were slower to indicate word color, especially for traumatic words, thereby replicating emotional Stroop interference in PTSD. Individuals with PTSD also had significantly reduced and delayed P3 components across word types. Across diagnostic groups, frontal P3 amplitudes were larger to personal positive and traumatic words compared to standard neutral words. However, the absence of Diagnosis x Word Type interactions for P3 measures suggests that individuals with PTSD do not differ from individuals without PTSD in the encoding and recognition of the color of traumatic relative to nontraumatic words, and that Stroop interference does not occur during these early stages of processing.     

Emotional-processing in posttraumatic stress disorder II: startle reflex modulation during picture processing

This study examined the impact of a trauma-related stressor on subsequent emotional behavior in veterans with (n = 35) and without (n = 24) posttraumatic stress disorder (PTSD). Self-report and physiological responses, including acoustic startle, were recorded during viewing of emotionally evocative photographs at baseline and following exposure to trauma-related and non-trauma-related stressors. The 2 groups exhibited equivalent patterns of emotional response across self-report and physiological measures at baseline. In contrast, following the trauma challenge, participants with PTSD showed a pattern of startle modulation suggestive of greater defensive reactivity and reduced visual perceptual engagement. These findings, along with augmented corrugator EMG reactivity during the same interval, suggest that trauma-related reexperiencing primes subsequent negative emotional responding in individuals with PTSD.     

Crisis Support and Coping as Mediators of Well-Being in Persons with Spinal Cord Lesion

This study aims to investigate whether crisis support and coping mediate symptoms of posttraumatic stress disorder (PTSD) in individuals with spinal cord lesions (SCL). PTSD, crisis support, and coping were assessed an average of 83 days after the injury (T1), at discharge from the rehabilitation center (T2), and an average of 121 days following discharge (T3). Sixty-nine newly injured paraplegics and tetraplegics completed the questionnaire at T1, 40 (58%) at T2, and 38 (55%) at T3. Individuals with PTSD experienced significantly lower levels of social support, and used more emotional coping than did those without PTSD. On the basis of logistic regression analyses, emotional coping and the interaction between negative response and emotional coping predicted PTSD. Emotional coping is a strong predictor of PTSD in persons with new SCL.     

Feelings you can't imagine: towards a cognitive neuroscience of alexithymia

Alexithymia, or 'no words for feelings', refers to an impairment of the ability to identify and communicate one's emotional state, in addition to diminished affect-related fantasy and imagery. A recent study by Mantani et al. reported reduced activation of the posterior cingulate cortex in people with alexithymia when they imagined a future happy event. This finding augments the emerging understanding of the neural basis of alexithymia, and potentially provides valuable insights into brain systems underlying normal emotion processing.     

Impact of emotional approach coping and hope on PTSD and depression symptoms in a trauma exposed sample of Veterans receiving outpatient VA mental health care services

Abstract

The present investigation evaluates the relationship between coping style, dispositional hope, and posttraumatic stress disorder (PTSD) and depression symptom severity in a trauma-exposed Veteran sample. Specifically, we evaluated the adaptive value of emotional avoidant and approach coping strategies and perceptions of hope in a sample of 209 trauma-exposed Veterans receiving outpatient mental health care at a VA facility. Participants completed a life events questionnaire and inventories assessing coping, dispositional hope, and PTSD and depression symptom severity. Hierarchical regression analyses were conducted controlling for relevant demographic variables. Greater levels of emotional avoidance and lower levels of emotional expression were significantly associated with increased PTSD and depression symptom severity. Dispositional hope was positively associated with depression symptoms only and perceptions of hope moderated the association between emotional avoidance coping and depression symptoms. Findings highlight the value of emotional coping strategies and perceptions of hope in posttraumatic adjustment. Specifically, employing coping techniques that encourage emotional expression may promote improved adjustment among trauma-exposed individuals, while reduced perceptions of hope and the use of avoidant coping strategies may place individuals at greater risk for depression following exposure to traumatic events.