Externally Oriented Thinking Research Articles

Level, prevalence and sociodemographic correlates of alexithymia in a physician population in Ankara

Objective: Alexithymia is a thinking style that emphasizes external stimuli rather than internal emotional experiences, it is characterized by externally oriented thinking (EOT). Alexithymia is associated with depression and many psychiatric disorders. It directly affects mental health but is rarely emphasized in clinical practice. Physicians are at risk of psychiatric disorders. Alexithymia and EOT may contribute to their psychiatric problems. Our aim was to examine alexithymia levels and their sociodemographic correlates in a physician population. Methods: Participants were 83 physicians employed in five hospitals (three education and research hospitals, one state hospital and one university hospital) in Ankara. Participants completed the Toronto Alexithymia Scale (TAS-20) and a sociodemographic questionnaire. Results: The mean TAS-20 score was 44.1±6.3 and 13.25% of the participants were found to be alexithymic. Participants with a psychiatric patient in their family were statistically more likely to have difficulty describing their feelings. EOT was associated with female gender, greater age, seniority in the medical profession, being married, and being born and mostly living in the western region of Turkey. Discussion: EOT may be associated with depression, cultural values and stigmatization. Physicians must be encouraged to discuss and be aware of their EOT to maintain their mental health.

Recognition of Emotional Facial Expressions in Alexithymia

The term Alexithymia (from Greek: lack of words for emotions), refers to a specific disturbance in affective-emotional processing that is manifested through following salient features: 1) difficulty in identifying and describing feelings and emotions verbally, 2) difficulty in distinguishing between feelings and somatic sensations that accompany emotional arousal, and 3) externally-oriented thinking and impaired symbolic activity (Taylor & Bagby, 2004). The most recent research has stressed point that in alexithymia there is not only a difficulty in expressing emotions verbally but also a deficit in cognitive processing of emotions (Berenbaum & Prince, 1994; Jessimer & Markham, 1997; Lundh & Simonsson-Sarnecki, 2002; Parker, Taylor, & Bagby, 1993; Roedema & Simons, 1999; Suslow, 1998; Suslow & Junghanns, 2002); as a consequence, emotions remain undifferentiated and poorly regulated (Taylor, Bagby, & Parker, 1991) and those afflicted are more likely to misinterpret their emotions as being symptoms of illness (Taylor & Bagby, 2004).First studied in classical psychosomatic or somatic disorders, alexithymia is known today as a personality trait (Martinez-Sanchez, Ato, Corcoles, Huedo, & Selva, 1998; MartinezSanchez, Ato, & Ortiz, 2003), normally distributed in general population with significantly higher levels in male subjects (Franz et al., 2008; Schimmenti, 2016). A high level of alexithymia is considered as a possible vulnerability factor for a variety of psychiatric disorders and physical illnesses (Taylor, Bagby, & Parker, 1997), such as substance use disorders, somatization, anxiety and depression, and even schizophrenia (Lumley, Neely, & Burger, 2007).Alexithymics appear to be less able to recognize their emotion signals and regulate emotions effectively (Taylor et al., 1997). Several studies demonstrated that alexithymic individuals are impaired in their ability to recognize emotion when both stimulus and response are non-verbal, suggesting that alexithymia, the lack of words for emotion, is not just a verbal phenomenon. Several authors hypothesized that hampered regulation of emotion in alexithymia might be based on deficits in perception and further processing of emotional stimuli (Aleman, 2005; Martinez-Sanchez, Montero, & de la Cerra, 2002; Lane, Sechrest, Reidel, Shapiro, & Kaszniak, 2000). This statement has been empirically supported by imaging data (Kano et al., 2003; Mantani, Okamoto, Shirao, Okada, & Yamawaki, 2005; Moriguchi et al., 2006) and event-related potentials (Pollatos & Gramann, 2011).One of most fruitful areas of investigation that has occupied investigation of alexithymia is study of patterns of recognition of facial expressions of emotion. It is well established that facial emotion recognition has an important place in emotion regulation, interpersonal communication skills, and in development of psycho-pathologies (Ozturk, Kilic, Deveci, & Kirpinar, 2016).In this line, previous studies have shown a significant correlation between alexithymia and a lack of ability to recognize emotions in photographs of facial expressions (Allerdings, 1997; Lane et al., 1996, 2000; Mann, Wise, Trinidad, & Kohanski, 1994; McDonald & Prkachin, 1990; Pandey & Mandal, 1997; Parker et al., 1993; Parker, Prkachin, & Prkachin, 2005; Prkachin, Casey, & Prkachin, 2009). These deficits have been found with tasks in which participants were required to reply in a very short period of time (Pedrosa et al., 2009), as well as in those with masked stimuli to make it difficult to recognize them (Kugel et al., 2008; Reker et al., 2010), and with static emotional stimuli, such as FACS, and dynamic videos (Katsyri, Saalasti, Tiippana, von Wendt, & Sams, 2008; Ridout, Thomas, & Wallis, 2010) (for a review, see Grynberg et al., 2012).Despite interest in studying relationship between alexithymia and emotion recognition, there are only a few studies addressing role of alexithymia in facial recognition tasks with parts of face, such as work of Swart, Kortekaas, and Aleman (2009) and Schimmenti (2016). …

The mediating effects of cognitive emotion regulation strategies on the relationship between alexithymia and physical symptoms: Evidence from Iranian asthmatic patients.

Asthma is a chronic and episodic psychosomatic disease whose symptoms include coughing, wheezing, chest tightness, and shortness of breath. The present study aimed to investigate the effects of cognitive emotion regulation strategies (CERS) as mediators on the relationships between alexithymia subscales and physical symptoms (PS). 300 asthmatic patients (males=42.7%, females=57.3%, age range=16-65, mean age=29.40) and 100 normal controls participated in the study and completed the demographic questionnaire, the Cognitive Emotion Regulation Questionnaire (CERQ), the Persian version of the Toronto Alexithymia Scale (FTAS-20), and the Powell & Enright Physical Symptoms Inventory (PSI). Asthmatic patients showed higher scores on all three alexithymia subscales including difficulty in identifying feelings (DIF), difficulty in describing feelings (DDF), and externally oriented thinking (EOT) as well as non-adaptive CERS than normal controls. On the other hand, normal controls earned higher means in adaptive CERS. Results revealed that each of the three alexithymia subscales had indirect effects on PS through the non-adaptive cognitive emotion regulation strategy of catastrophizing. It is concluded that alexithymia can intensify PS through catastrophizing in asthmatic patients.

Deployment of attention to emotional pictures varies as a function of externally-oriented thinking: An eye tracking investigation

Background and objectivesAlexithymia is a multidimensional personality construct including the components difficulties identifying feelings (DIF), difficulties describing feelings (DDF), and externally oriented thinking (EOT). Different features of alexithymia are thought to reflect specific deficits in the cognitive processing and regulation of emotions. The aim of the present study was to examine for the first time patterns of deployment of attention as a function of alexithymia components in healthy persons by using eye-tracking technology. It was assumed that EOT is linked to avoidance of negative images. Methods99 healthy adults viewed freely pictures consisting of anxiety-related, depression-related, positive, and neutral images while gaze behavior was registered. Alexithymia was assessed by the 20-Item Toronto Alexithymia Scale. Measures of anxiety, depression, and (visual-perceptual) intelligence were also administered. ResultsA main effect of emotion condition on dwell times was observed. Viewing time was lowest for neutral images, longer for depression-related and happy images, and longest for anxiety-related images. Gender and EOT had significant effects on dwell times. EOT correlated negatively with dwell time on depression-related (but not anxiety-related) images. There were no correlations of dwell times with depression, trait anxiety, intelligence, DIF, or DDF. LimitationsAlexithymia was assessed exclusively by self-report. ConclusionsOur results show that EOT but not DIF or DDF influences attention deployment to simultaneously presented emotional pictures. EOT may reduce attention allocation to dysphoric information. This attentional characteristic of EOT individuals might have mood protecting effects but also detrimental impacts on social relationships and coping competencies.

Alexithymie et victimation chronique au sein du couple

ObjectiveChronicity of victimization phenomena within the couple may be associated with risky behavior, the risk of being injured or killed. Engagement in types of behavior is maintained in part by emotional factors, the inability to deal with subjective states would lead to risk-taking. The aim of this study is to support the existence of emotional vulnerability such as alexithymia and negative emotional awareness in the chronic process of domestic violence. It was hypothesized that the victims’ restriction in the expression of their emotions lead to the implementation of avoidance and psychic adjustment when confronted to domestic violence. The presence of alexithymia associated with a low level of emotional awareness allows violence to continue and suffering to express itself by somatic symptoms. Patients and methodsThe sample consisted of 80 women (age=34.5±12.18 years) who were divided into two groups: victims of domestic violence (n=40) and non-victims (n=40). The sample completed self-report measures of emotional dimensions and somatic symptoms. The Toronto Alexithymia Scale (TAS-20) was used to assess the level of alexithymia. In addition, this 20-items scale is composed of three specific subscales that allowed the measurement of the Difficulty in Identifying Emotions (DIE), the difficulty in Differentiating Emotions (DDE) and the Externally Oriented Thinking (EOT). The emotional awareness was assessed by the Level of Emotional Awareness (LEAS). This scale poses evocative interpersonal situations and elicits description of the emotional responses of self and others, which are scored. Finally, the subscale of the SCL90-R was used to assess the somatic symptoms. All these internationally validated scales were chosen because of their good psychometric qualities. Statistical analysisWe performed descriptive analysis, correlational analysis and hierarchical regression using SPSS.22 software. ResultsResults suggested that victims demonstrate a bigger difficulty at differentiating emotions (M=14.95±5.17; P<0.05) as well as a lower level of emotional awareness (M=48.45±7.82; P<0.0001) than non-victims (mean difficulty differentiating emotions=12.12±4.65; mean level of emotional awareness=56.37±11.70). The regression analysis reveals the existence of several significant connections in the victim's group. A strong and negative correlation has been shown between the level of emotional awareness and alexithymia (r>50; R2=26.5; P<0.0001). Moreover, a moderate and negative correlation was proven between the level of emotional awareness and three emotional components of alexithymia which are the difficulty at identifying feeling, the difficulty at differentiation emotions and the externally oriented thinking (r>30; P<0.05). Finally, this study suggested a moderate and positive correlation between somatic symptoms and alexithymia (r>30; R2=8.5; P<0.05) on one hand, and between somatic symptoms and the externally oriented thinking dimension of alexithymia (r>30; R2=10.6; P<0.05). The research has not found any significant results for the non-victim group of participants. ConclusionsThe difficulty at differentiating emotions, resulting from a lower level of emotional awareness, was shown to be a protective strategy against internal and external attacks. This adjustment would be permeable unconscious emotional discharges that would comprise the emotion regulation process and therefore, would allow the violence to continue. The question of chronicity in the victimation process as well as all the results of this study lead us to question the position of the victims of domestic violence in front of risk-taking behaviors. The risk confrontation in domestic violence could lead to secondary alexithymia, which in such situation could be qualified as an adaptive adjustment. The lack of emotional differentiation allows a better management of the situation where the risk is controlled.

Le questionnaire d’alexithymie pour enfants (QAE) : étude sur une population clinique de 105 adolescents hospitalisés en pédopsychiatrie

ObjectiveThe 20-item Toronto Alexithymia Scale (TAS-20) is the most widely used measure of alexithymia in non-clinical or clinical populations. The TAS-20 evaluates three dimensions of the alexithymia construct: the difficulty identifying feelings (DIF), the difficulty describing feelings (DDF) and externally oriented thinking (EOT). The TAS-20 is also used in adolescents or children, and the psychometric properties of the scale have not been systematically evaluated in these populations. Recently several studies have shown systematic age differences in the factor structure and a decrease of the quality of the measurement with age. Notably, low reliability measured by the Cronbach α coefficient has been found for the EOT factor. Taking into account the limitations of the TAS-20 in pre-adult populations the Alexithymia Questionnaire for Children (AQC), an adaptation of the TAS-20, has been proposed by a reformulation of the TAS-20 items (Rieffe et al., 2006). Two studies in healthy children found satisfactory psychometric properties with the three-factor structure demonstrating adequate parameters in the confirmatory factorial analyses (CFA). In the two studies low reliabilities of the EOT factor were reported, and recent studies in adolescents using the TAS-20 found that a two-factor model (DDF, DIF) had a better fit than the original three-factor model. Thus, the aim of the present study was firstly to verify the psychometric properties of the AQC in a sample of adolescents presenting various psychiatric disorders and secondly to test the adequacy of the bi- or tridimensional model of the scale. MethodOne hundred and five adolescents (27 males, 78 females) with a mean age of 15.06 years (sd=1.55, range: 12–18 years) were hospitalized in the adolescent psychiatric department of the Erasme Hospital (Bruxelles, Belgium) for various psychiatric disorders. The main diagnoses were: adjustment disorder (n=56, 53.5%), mood or anxiety disorders (n=17, 16.2%), impulse control disorder (n=11, 10.5%). The subjects completed the French version of the AQC. CFA were done testing the adequacy of the three or two-factor structure of the scale. Two indices were considered: the normed χ2 (ratio of χ2 and degrees of freedom) and the root mean square error of approximation (RMSEA). The values for acceptable fit were normed χ2<3 and RMSEA<0.05. Cronbach α were also calculated. ResultsFit indices for the three-factor model were respectively 1.165 and 0.0303 for the normed χ2 and RMSEA. For the two-factor model, the values were respectively 0.819 and 0. Thus, these two well-fitting models were compared using the χ2-difference test, which indicated a significantly better fit for the two-factor model over the three-factor model (χ2-difference=151.447, delta df=114, P<0.05). The values of the Cronbach α coefficients were respectively 0.72, 0.75, 0.18 for DIF, DDF and EOT subscales. Moreover, the values of the Cronbach α coefficients were respectively 0.71 and 0.83 for the full scale and the scale without the EOT items. ConclusionThe Alexithymia Questionnaire for Children had satisfactory psychometric properties found in a sample of adolescent psychiatric inpatients. Taking into account firstly the superiority of the two-factor model over the classical three-factor model and secondly the low value of the Cronbach α for the EOT factor, it is proposed to use only the twelve-item scale by excluding the EOT items.

Alexithymie, intensité émotionnelle et symptomatologie anxieuse/dépressive : dimensions explicatives du tabagisme

ObjectiveThe objective of this study was to support the existence of emotional dimensions like alexithymia and affective intensity and of psychopathological dimensions like anxiety and depressive symptoms in smoking. We think that smoking could be a manifestation of emotional helplessness. Alexithymia and affective intensity associated with anxiety and depressive symptoms could be a model of emotional functioning which is conducive to smoking. Patients and methodsThe study participants consisted of 222 students (37 males and 185 females; mean age=22.6+5.13 years) from 1st to 5th year of Aix-Marseille University. The sample was divided into two groups: smoking (n=86) and no-smoking (n=136). We administered a protocol to the subjects consisting of three self-assessment scales to assess emotional and psychopathological dimensions. The alexithymia was assessed by the scale of the Twenty-items Toronto Alexithymia Scale (TAS-20). It allows an overall assessment of the level of alexithymia, as well as three dimensions as represented by specific sub scales: difficulty identifying emotions (DIE), difficulty differentiating emotions (DDE) and externally oriented thinking (EOT). The emotional intensity was assessed by the Affective Intensity Measure (AIM). The AIM is a 40-items questionnaire designed to measure the characteristic strength or weakness with which one experiences emotion. The anxiety and depressive symptoms were assessed by Hospital Anxiety and Depression scale (HAD). The HAD is a 14-items scale used to determine the levels of anxiety and depression, seven of the items relate to anxiety and seven relate to depression. These scales have been validated internationally. Statistical analysisWe performed descriptive analysis, correlational analysis (Bravais-Pearson's correlation), linear multiple regression and binary logistic regression model using SPSS.17 software. ResultsThe results showing that smoking subjects are more anxious (M=9.10+3.94; P<0.05) and have more difficulty identifying feelings (M=17.02+5.14; P<0.05) than no-smoking subjects (mean anxiety=7.95+3.58; mean difficulty identifying feelings=15.54+5.25). But smokers are less alexithymics, more specifically in difficulty differentiating emotions (M=12.7+4.73; P<0.001) and externally oriented thinking (M=15.27+3.85; P<0.01) dimensions than no-smokers (mean difficulty differentiating emotions=16+3.89; mean externally oriented thinking=17.22+3.38). The analysis of relationships between the different variables shows the existence of several significant connections. We find a moderate and positive correlation between depression/anxiety and alexithymia (r>25; P<0.01), and a strong positive correlation between depression/anxiety and emotional dimensions of alexithymia: difficulty identifying feelings (r>50; P<0.01). However only with no-smoking subjects, we also find a moderate positive correlation between depression/anxiety and emotional dimensions of alexithymia: differentiating emotions (r>25; P<0.01). In smoker group, the regression analysis shows that only emotional dimensions of alexithymia: difficulty identifying feelings and smoking influence positively and significantly anxious and depressive symptoms (P<0.0001). Anxiety about, the daily consumption of cigarettes (β=0.663) is more discriminating than difficulty identifying feeling (β=0.225). We find the same observation for depression (mean Cig/day: β=0.630; mean difficulty identifying feelings: β=0.201). However, we note in no-smoker group that emotional dimensions of alexithymia: difficulty differentiating emotions also contribute significantly anxiety (B=0.411, P<0.0001). But in any case, alexithymia is more discriminated to emotional intensity. Moreover, the regression analysis shows the daily consumption of cigarettes about, that the terms of symptomatic expression are more discriminating than other variables (mean anxiety: β=0.681; mean depression: β=0.641, P<0.0001). Finally, binary logistic regressions show that anxiety symptoms multiply by 1.5 the probability of smoking. ConclusionsOur study reveals the role of smoking to emotional regulation. The fact that smokers differentiate more easily their emotions could be understood as an attempt to express emotions which cannot be psychical work out. Because, smokers however are more anxious and have more difficult to identify emotions than no-smokers. We think smoking would be an attempt to release psychological suffering through acting. The difficult to identify emotions would be defense against anxiety situation caused by smoking. The study limitations are discussed.

Alexithymia in fibromyalgia syndrome

The study compared alexithymia in fibromyalgia syndrome (FMS) patients and healthy individuals, and analyzed its association with clinical, emotional, and functional variables. Forty-five FMS patients and 31 healthy individuals completed the Toronto Alexithymia Scale, which includes the dimensions: Difficulty Identifying Feelings (DIF), Difficulty Describing Feelings (DDF), and Externally-Oriented Thinking (EOT). Participants also completed instruments assessing Eysenck's personality dimensions, pain, fatigue, sleep, anxiety, depression, health-related quality of life (HRQL) and coping with pain. FMS patients exhibited higher scores in DIF and DDF than healthy individuals; group differences were markedly lower when depression and anxiety were statistically controlled. Patients furthermore displayed greater depression-anxiety, fatigue, sleep problems and neuroticism, lower HRQL and dysfunctional coping. Alexithymia was overall more closely related to clinical variables in healthy individuals than in patients; in patients, many associations disappeared when anxiety and depression were controlled. The data corroborate the high prevalence of alexithymia in FMS; however, they also suggest that alexithymia may play a less important role in symptom experience in patients vs. healthy individuals. This result may be discussed by considering the distinction between state and trait alexithymia; the weaker associations in patients may be ascribed to specific enhancement of state alexithymia due to illness-related affective distress.

ALEXITHYMIA IN PATIENTS WITH HAEMOPHILIA. COMPARATIVE STUDY WITH THE HEALTHY POPULATIONALEXITHYMIA IN PATIENTS WITH HAEMOPHILIA. COMPARATIVE STUDY WITH THE HEALTHY POPULATION

Introduction. Haemophilia is “a genetic transmitted disorder”, it belongs to the category of rare diseases, illnesses that face devastating and incapacitating developments affecting each person beyond physical problems. Material and method. 200 subjects were part of the study, they were divided into two equal groups (patients with hemophilia A and B – 50% and healthy population – 50%), aged between 16 and 45 years. We used the medical history and measuring alexithymia with TAS-20 (Toronto Alexithymia Scale). Results. The study conducted shows that there are statistically significant differences between hemophiliacs and non-hemophiliacs, hemophiliacs have higher levels of alexithymia compared to non-hemophiliacs. Conclusions. The overall level of alexithymia was higher in patients with haemophilia than the other groups, including three subscales DIF (difficulty identifying emotions), DDF (difficulty in describing feelings) and EOT (externally oriented thinking).

The alexithymia, cognitive emotion regulation, and physical symptoms in Iranian asthmatic patients

The aims of this study were to evaluate alexithymia subscales and cognitive emotion regulation strategies (CERS) of asthmatic patients and to clarify the relations of alexithymia subscales and cognitive emotion regulation strategies (CERS) to physical symptoms (PS) and other clinical variables. 300 patients with asthma and 100 normal controls completed the Demographic Questionnaire, Cognitive Emotion Regulation Questionnaire (CERQ), Persian version of the Toronto Alexithymia Scale (FTAS-20), and Powell and Enright Physical Symptoms Inventory (PSI). Asthmatic patients had significantly higher scores on all three alexithymia subscales including difficulty in identifying feelings (DIF), difficulty in describing feelings (DDF), and externally oriented thinking (EOT) and non-adaptive CERS than normal controls. Asthmatic patients with alexithymia showed higher scores on asthma severity, non-adaptive CERS, and PS. The partial correlation revealed that PS was significantly correlated with DIF, DDF, EOT, and non-adaptive CERS. DIF, EOT, and non-adaptive CERS were significant predictors of PS. It is concluded that alexithymia subscales and non-adaptive CERS were related to PS.

The association between depression and craving in alcohol dependency is moderated by gender and by alexithymia factors

Alexithymia is a multifaceted personality trait that involves difficulties in identifying and describing feelings to others, a poor fantasy life and an externally oriented cognitive style. Alexithymia has been described as a vulnerability factor for mental and physical diseases.We investigated in a group of 158 alcohol-dependent patients (103 men, 55 women) the association between depression and craving for alcohol when these patients were starting a detoxification program, and the moderating impact of gender and alexithymia on this relation.We first found an interaction between depression and gender in the prediction of craving in the sense that only for women an increase in depressive mood was related to an increase in total craving. When examining gender separately, we found that alexithymia factors acted as moderators. For women, the link between depression and craving was strengthened for the ones scoring higher on “difficulties describing feelings”. But for men, the link between depression and craving was reduced for the ones scoring higher on “externally-oriented thinking”. These findings suggest that in some cases that need to be identified more systematically in the future, the “externally-oriented thinking” alexithymia factor can exert – at least in the short term – some protective effects.

Predicting symptoms in major depression after inpatient treatment: the role of alexithymia

abstractAlexithymia has been considered to have a negative influence on the course of symptoms in various psychiatric disorders. Only a few studies of depressed patients have examined whether alexithymia predicts the outcome of therapeutic interventions or the course of symptoms in naturalistic settings. This prospective study investigated whether alexithymia is associated with depressive symptoms after a multimodal inpatient treatment. Forty-five inpatients suffering from acute major depression were examined in the initial phase of treatment and then again after seven weeks. Patients took part in a multimodal treatment programme comprising psychodynamic-interactional oriented individual and group therapy. The majority of patients were taking antidepressants during study participation. To assess alexithymia and depressive symptoms, the 20-item Toronto Alexithymia Scale (TAS-20), the Beck Depression Inventory II (BDI-II) and the Hamilton Depression Scale (HAMD) were administered at baseline and follow-up. When controlling for baseline depressive symptoms along with trait anxiety, high scores in the externally oriented thinking (EOT) facet of alexithymia at baseline predicted high severity of depressive symptoms at follow-up (for self-reported as well as interviewer-based scores). Inpatients suffering from major depression with a more pronounced external cognitive style might benefit less from a routine multimodal treatment approach (including psychodynamic interactional therapy, antidepressant medication, and complementary therapies). Intervention programmes might modify or account for alexithymic characteristics to improve the course of depressive symptoms in these patients.

Predicting symptoms in major depression after inpatient treatment: The role of alexithymia

Introduction Alexithymia has been considered to have a negative influence on the course of symptoms in various psychiatric disorders. Only few studies examined in depressed patients whether alexithymia predicts the outcome of therapeutic interventions or the course of symptoms in naturalistic settings. Aims In the present prospective study, it was investigated whether alexithymia is associated with depressive symptoms after a multimodal inpatient treatment. Methods Forty-five inpatients suffering from acute major depression were examined in the initial phase of treatment and then again after seven weeks. Patients took part in a multimodal treatment program comprising psychodynamic-interactional oriented individual and group therapy. The majority of patients were taking antidepressants during study participation. To assess alexithymia and depressive symptoms, the 20-item Toronto Alexithymia Scale (TAS-20), the Beck Depression Inventory II (BDI-II) and the Hamilton Depression Scale (HAMD) were administered at baseline and follow-up. Results High scores in the Externally Oriented Thinking (EOT) facet of alexithymia at baseline predicted high severity of depressive symptoms at follow-up (for self-reported as well as observer-rated scores). This relationship was not confounded by initial depressive symptoms. Conclusions Inpatients suffering from major depression with a more pronounced external cognitive style might benefit less from multimodal inpatient treatment. Patients high on EOT could avoid reflecting on negative emotions. Psychological interventions might modify or account for alexithymic characteristics to improve the course of depressive symptoms in these patients.

Exploring the association between oral health literacy and alexithymia.

Low health literacy and alexithymia have separately been emphasized as barriers to patient-practitioner communication, but the association between the two concepts has not been explored. To test the hypothesis that low oral health literacy and alexithymia are associated. Adults (n=127) aged 21-80 years (56% women) participated in this cross-sectional study. Oral health literacy was assessed using the interview-based Adult Health Literacy Instrument for Dentistry (AHLID) with scores from 1-5. The self-administered Toronto Alexithymia Scale (TAS-20) was used to assess three distinct TAS-20 factors and TAS-20 total score. Significant negative correlations between AHLID scores and TAS-20 factors 2, 3 and TAS-20 total score were found. Regression analyses showed that TAS-20 factor 3, externally-oriented thinking (β=-0.21, SE=0.02, p=0.017), and TAS-20 total score (β=-0.18, SE=0.01, p=0.036) were significant predictors of AHLID level. The hypothesis that low oral health literacy is associated with alexithymia was supported. This finding proposes that alexithymia may be considered as a possible factor for low oral health literacy. However, the correlations are not strong, and the results should be regarded as a first step to provide evidence with additional research on this topic being needed.

Comparative study of alexithymia in institutionalized elderly versus senior classroom

Experience and emotion regulation are issues that are increasingly important in order to understand and promote the welfare and quality of life of elderly. The aim of this study was to conduct a comparative study of the alexithymia in users in an institutionalized center and students enrolled in a senior classroom. Study participants were 43 people hospitalized and 48 from the senior older with an average age of 69.30 years and a standard deviation of 66.50. The instrument used was the adapted version of the TAS-20. The results showed that institutionalized people scored higher on the difficulty in identifying feelings, difficulty in describing feelings and in the pattern of externally-oriented thinking. Sex was indifferent to the difficulty in identifying feelings, difficulty in describing feelings as well as externally-oriented pattern. In terms of age, a relationship was found with the difficulty in identifying feelings and externally oriented thought patterns. The study allows us to conclude that alexithymia is influenced by the fact that the elderly person is in an institutionalized center.

Comparative study of alexithymia in institutionalized elderly versus senior classroom

Experience and emotion regulation are issues that are increasingly important in order to understand and promote the welfare and quality of life of elderly. The aim of this study was to conduct a comparative study of the alexithymia in users in an institutionalized center and students enrolled in a senior classroom. Study participants were 43 people hospitalized and 48 from the senior older with an average age of 69.30 years and a standard deviation of 66.50. The instrument used was the adapted version of the TAS-20. The results showed that institutionalized people scored higher on the difficulty in identifying feelings, difficulty in describing feelings and in the pattern of externally-oriented thinking. Sex was indifferent to the difficulty in identifying feelings, difficulty in describing feelings as well as externally-oriented pattern. In terms of age, a relationship was found with the difficulty in identifying feelings and externally oriented thought patterns. The study allows us to conclude that alexithymia is influenced by the fact that the elderly person is in an institutionalized center.

Comparison of Alexithymia in Athlete and Non-Athlete Students

Today, researchers consider sports as one of the methods of reinforcement in the development of psychological parameters. The aim of the present study was to compare the alexithymia and its components, in athletes and non-athletic adolescents. Its components consist of difficulty in identifying feelings (DIF), difficulty in describing feelings (DDF), and externally oriented thinking (EOT). The statistical sample of the research included 100 athlete students and 100 nonathlete students, who were selected using multistage cluster sampling. They were asked to fill out the Farsi version of the Toronto Alexithymia Scale-20. The obtained results showed that there were significant differences in the mean scores of the alexithymia and its three components: difficulty in identifying feelings, difficulty in describing and externally oriented thinking in both groups (P = 0.001, P = 0.001, P = 0.001 and P = 0.008, respectively). The results revealed that athletic students had less emotional problems than non-athlete students; it is recommended that physical activity be part of the strategies to improve emotional health among non-athletic students.

Engagement in dance is associated with emotional competence in interplay with others.

This study has explored the relation between dance achievement and alexithymia in a larger Swedish population sample (Swedish Twin Registry) with a study sample of 5431 individuals. Dance achievement (CAQ) was assessed in relation to Alexithymia (Toronto Alexithymia Scale, TAS-20) including the three subscales: Difficulty Identifying Feelings (DIF), Difficulty Describing Feelings (DDF), and Externally Oriented Thinking (EOT). The results show a significant negative association between the TAS subscale (EOT) and creative achievement in dance. A high EOT score corresponds to poor ability to communicate feelings to the environment. There was no consistent association between the other factors DIF and DDF and dance achievement. Dance activity and training seem to be involved in the body’s emotional interplay with others. Embodied cognition, emotional perception, and action are discussed as factors relevant to measuring the skill of a dancer.

Alexithymia, anxiety and depression in patients with psoriasis: a case-control study.

BackgroundAlexithymia, the difficulty in describing or recognizing emotions, has been associated with various psychosomatic pathologies including psoriasis. The aim of this study was to examine the prevalence of alexithymia and its association with anxiety and depression in patients with psoriasis compared with healthy participants, while taking into consideration demographic and clinical variables.MethodsOne hundred and eight psoriatic patients and 100 healthy participants from the general population completed the Toronto Alexithymia Scale (TAS-20) and the Hospital Anxiety and Depression Scale (HADS). The severity of patients’ psoriasis was clinically assessed using the Psoriasis Area and Severity Index (PASI).ResultsPsoriatic patients had higher levels of alexithymia compared with healthy participants. While a rather high rate of psoriatic patients presented anxiety and depression as defined by the HADS, the differences that were found in comparison with the control group were not significant. Neither alexithymia nor its dimensions, difficulty in identifying feelings (DIF), difficulty in describing feelings (DDF) and externally oriented thinking (EOT), were associated with gender or psoriasis severity. Age was associated only with EOT, which was independent of depression and anxiety. Higher anxiety and depression were connected with higher alexithymia and DIF, while higher anxiety with higher DDF as well.ConclusionsThe alexithymia prevalence was higher in psoriatic patients than that in healthy participants, while it was positively correlated with anxiety and depression. Difficulty in identifying feelings was connected with both anxiety and depression, whereas difficulty in describing them was only with anxiety. Finally, externally oriented thinking was predicted only from age.

The Internet administration version of the 20-item Toronto Alexithymia Scale.

Researchers are increasingly administering tests developed and validated in paper format via the Internet. Yet, the equivalence between paper and Internet concerning administration of tests is not typically demonstrated. We evaluated the reliability, factorial and external validity, and measurement equivalency of the Internet version of the 20-item Toronto Alexithymia Scale (TAS-20; Bagby, Parker, & Taylor, 1994; Bagby, Taylor, & Parker, 1994; Lumley et al., 2007) vis-à-vis the paper version. Participants (N = 621) completed the TAS-20 either on the Internet or on paper. Reliability and item-to-scale homogeneity were evaluated for each format. We used confirmatory factor analyses (CFAs) to evaluate factorial validity and used CFA-based factorial invariance procedures to determine measurement equivalency. Alpha coefficients and mean interitem correlations (MICs) were adequate for the full-scale TAS-20 Internet and paper versions and the difficulty identifying feelings (DIF) and difficulty describing feelings (DDF) factor scale test scores; in both formats, alpha and MICs were poorer for externally oriented thinking (EOT) factor test scores compared to scores for the DIF and DDF. The fit of the 3-factor structure of the TAS-20 was adequate for both formats. Factorial invariance across formats was also demonstrated; mean scores for the total scale and each factor scale were not different across formats. Correlations with the domain and facet scales of the Revised NEO Personality Inventory (Costa & McCrae, 1992b) were mostly similar across formats. The Internet and paper versions of the TAS-20 are comparably reliable and valid. An Internet version of the TAS-20 expands opportunities to collect data and permits generalizing of results across studies using the different modes of administration.