TAS-20 Factor Research Articles

The relationship study on alexithymia and interoception in patents with panic disorder

Objective To explore the characteristics of alexithymia and interoception in patients with panic disorder(PD) and its relationship. Methods Thirty-seven patients with PD and 45 healthy controls who met the diagnostic criteria of DSM-Ⅳ were selected.Toronto Alexithymia Scale (TAS) and state-trait anxiety inventory (STAI) were used to assess the characteristics of alexithymia and anxiety symptoms respectively.The heartbeat perception levels were tested by the Mental Tracking Paradigm. Results The detection rate of alexithymia in patients with panic disorder was 37.83%(14/37), but the rate in the normal control group was only 4.44%(2/45), and the difference was statistically significant (χ2=14.42, P<0.05). The total score of TAS (55.11±10.99), factor Ⅰ (20.62±6.78) and factor Ⅱ (14.68±3.70) in the PD group were higher than those in the control group (42.93±9.25, 12.82±4.99, 11.42±3.04; F=20.72, 31.08, 15.31, P<0.01). The levels of the heartbeat perception were higher in the PD group than that in the control group (0.75±0.15, 0.58±0.19; t=4.13, P<0.05). In PD group, the score of STAI were positively correlated with TAS total score and factor Ⅰ and Ⅱ scores(r=0.57, 0.61, 0.47; r=0.54, 0.62, 0.39, P<0.05). There was no significant correlation between the scores of STAI and the level of interoception.The mediating effect of interoception level on alexithymia and state anxiety was not significant while the mediating effect on alexithymia and trait anxiety was also not significant. Conclusions The alexithymia detection rate and interoception sensitivity in patients with panic disorder were higher than those of healthy people.There may be interaction between alexithymia and anxiety symptoms.Interoception may be a clinical feature of panic disorder. Key words: Panic disorder; Alexithymia; Interoception; Heartbeat perception

Determining the relationship between alexithymia, skin sensitivity, and disgust

Alexithymia represents an individual's inability to recognize their own or someone else's emotions and also the inability to communicate them. It has a documented influence on many cognitive and emotional activities of human life. Skin and touch are two of the primary vehicles for conveying emotions between individuals. It is on account of the connection between these elements that this study has focused on determining more precisely the relation between skin related satisfaction and disgust and alexithymia. In total 357 students participated in the survey, 286 (82.9%) were female and the average participant age was 20.54 (min=19; max=26; SD=1.24). Apart from this demographical information, the survey consisted of the Skin Satisfaction Questionnaire (TSD-Q 30), the Toronto Alexithymia Questionnaire (TAS-20), and the Disgust Propensity and Sensitivity Questionnaire (DPSS). Based on an analysis of the survey results, Alexithymia was shown to correlate strongly with the shame aspect of skin satisfaction, but only with TAS-20 factors 1 and 2. A weak correlation was demonstrated between positive disgust and alexithymia. Though only a weak correlation, or no correlations as all, between touch satisfaction and alexithymia was established, touch satisfaction and shame accounted for 21.2% of alexithymia variance, while disgust measurement scales accounted for only 1.3%. Out of skin satisfaction parameters, alexithymia appeared to be most strongly connected with shame. Disgust parameters were shown to have a very weak influence on alexithymia variance. Although skin is one of the primary sense organs and touch is capable of conveying emotion, there was found only a weak correlation between, and measured influence of, satisfaction with skin and alexithymia.

An Initial Study of Alexithymia and Its Relationship With Cognitive Abilities Among Mild Cognitive Impairment, Mild Alzheimer's Disease, and Healthy Volunteers.

The present study examined the degree to which alexithymia is greater in mild Alzheimer's disease (AD) and mild cognitive impairment (MCI) relative to healthy volunteers (healthy comparison [HC]), and investigated relationships between alexithymia and cognition. Eighty-five participants (MCI = 30, AD = 21, HC = 34) underwent a comprehensive neuropsychological examination and completed the 20-item Toronto Alexithymia Scale (TAS-20). Relative to HC, MCI and AD reported greater alexithymia total scores and higher scores on the TAS factor difficulty in identifying feelings (DIF). The remaining two factors, difficulty in describing feelings (DDF) and externally oriented thinking showed no significant group differences. In MCI, TAS-20 and DIF were negatively correlated with working and long-term verbal memory. In AD, TAS-20 was negatively correlated with general cognition, attention, memory, and visual spatial constructive and executive abilities. Also in AD, DIF was negatively correlated with general cognition, memory, and executive abilities. The correlation between DIF and long-term verbal memory in both MCI and AD suggests a potential common mechanism for alexithymia in these neurocognitive disorders. Declines in verbal memory may hinder a patient's ability to recall an association between a given sensation and the episodic experience of that sensation, thus leading to difficulty identifying feelings, as measured by the DIF factor of the TAS-20.

Alexithymia in chronic and episodic migraine: a comparative study

Background: Alexithymia is a term used to describe a disorder where patients have difficulty in expressing their own feelings in words.Aims: The analysis of alexithymia in patients suffering from chronic migraine (CM) or episodic migraine (EM) compared to healthy controls.Methods: Two clinical samples formed by 80 CM patients (21 males and 59 females, mean age: 44.65) and 44 EM patients (8 males and 36 females, mean age: 42.18) were enrolled. A group of 67 healthy subjects served as controls (26 males and 41 females, mean age: 41.21). All subjects were requested to fill in the 20-item version of the Toronto Alexithymia Scale (TAS-20).Results: We found a statistically significant difference between groups in Factor 1 (difficulty in describing feelings), F(2, 191) = 7.96, p < 0.001, and in TAS total, F(2, 191) = 5.37, p = 0.005. Post-hoc analyses revealed that CM patients had higher scores in TAS factor 1 and in TAS total than healthy controls. There were no significant differences between CM and EM patients, even if CM sufferers reported a trend towards higher scores in each TAS factor as well as in TAS total.Conclusions: Alexithymia emerges as a potential characteristic trait of migraine, regardless of disease severity.

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.

The role of alexithymia in predicting incident depression in patients at first acute coronary syndrome

ObjectiveAlexithymia has been considered both to predispose to depression and to worsen cardiac prognosis after an acute coronary syndrome. Nonetheless, no studies have evaluated its role as a risk factor for incident depression, in patients with acute coronary syndrome. MethodsIn 251 consecutive patients, the presence of a first-ever depressive episode was evaluated with the Primary Care Evaluation of Mental Disorders at baseline and 1, 2, 4, 6, 9, 12 and 24months after their first acute coronary syndrome. At baseline, patients completed the Toronto Alexithymia Scale (TAS-20) and the Hospital Anxiety and Depression Scale. ResultsOut of 251 subjects (80.9% males), a first-ever depressive episode was diagnosed in 66 patients. Depressed and never-depressed patients differed in female gender, living status, alexithymic scores at TAS-20 and depressive symptoms. Nonetheless, nor the TAS-20 factors nor its total score were predictive of developing a depressive episode in a Cox regression. Moreover, baseline differences in TAS-20 scores between the two groups, disappeared after controlling for anhedonic symptoms. ConclusionOur results do not support the hypothesis that alexithymia at TAS-20 is a risk factor for incident depression after acute coronary syndrome.

Investigation of health anxiety and its related factors in nursing students.

ObjectiveTo explore health anxiety in a sample of nursing students to determine the relationships between health anxiety and life satisfaction, personality, and alexithymia.MethodsTwo thousand and eighty-six nursing students in junior college, which were divided into five groups, were evaluated by questionnaires, including the Life Satisfaction Scales Applicable to College Students, the Chinese version of the Short Health Anxiety Inventory, the Toronto Alexithymia Scale (TAS-20), and the Eysenck Personality Questionnaire.ResultsThe mean age, whether the individual was an only child, residence (urban or rural), and were significantly different between the groups. The self-assessment scores were also significantly different between the groups. The Short Health Anxiety Inventory total score and the factor of fearing the likelihood of becoming ill were significantly negatively correlated with the Life Satisfaction Scales Applicable to College Students total score and its two factors, but were significantly positively correlated with psychoticism, neuroticism, and TAS-20 total scores and its scores of the three TAS-20 factors. The negative consequence scale of Short Health Anxiety Inventory was not significantly correlated with externally oriented thinking, but was significantly negatively correlated with extraversion. A hierarchical multiple regression analysis indicted that objective satisfaction, subjective satisfaction, neuroticism, and the three factors of TAS-20 were predictors of health anxiety.ConclusionHealth anxiety was correlated with life satisfaction, personality, and alexithymia in junior college nursing students. Subjective and objective satisfaction, neuroticism, and the identification and expression of emotions may be predictors of health anxiety in nursing students.

Youth at Stake: Alexithymia, Cognitive Distortions, and Problem Gambling in Late Adolescents

The purpose of this study was to examine the role of alexithymia and cognitive distortions in adolescent gambling. Five hundred and forty-six Italian high school students, between the ages of 17 and 19 years, were administered the South Oaks Gambling Screen Revised for Adolescents (SOGS-RA), the Toronto Alexithymia Scale (TAS-20), and the Gambling Related Cognitions Scale (GRCS). Results showed that problem gamblers scored highest on the GRCS and the TAS-20 scales. First-order correlations indicated strong positive associations among SOGS-RA and all GRCS subscales, as well among SOGS-RA and the TAS-20 factors, Difficulty Identifying Feelings and Difficulty Describing Feelings. The results of hierarchical regression analysis showed also that, along with gender, the most powerful predictors of gambling involvement were the GRCS subscales, Inability to Stop gambling and Interpretative Bias, and that SOGS-RA scores were moderately associated with the TAS-20 factor, Difficulty Identifying Feelings only. Mediation analyses revealed a significant indirect effect on the relation between alexithymia and gambling severity through specific gambling-related biases.

Is alexithymia linked with marital satisfaction or attachment to the partner? A study in a pregnancy cohort of parents-to-be

ObjectiveTo investigate possible associations of alexithymia with marital satisfaction and mutual attachment between the partners in a group of parents-to-be during pregnancy. MethodsThe present study was conducted in a pregnancy cohort. Cross-sectional data were available for 151 mothers and 106 fathers, and altogether 102 couples. The 20-item Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia, the Index of Marital Satisfaction (IMS) to assess romantic relationship satisfaction and the Experiences in Close Relationships Scale (ECR) to evaluate attachment-related anxiety and avoidance. Kruskal–Wallis test was used for categorized variable comparisons. For continuous variables, Spearman correlation analyses and linear regression analyses were conducted. ResultsThe TAS-20 total score, as well as, two of its dimensions, difficulties in identifying and describing feelings, were significantly correlated (p<0.01) with both the IMS scores and the ECR anxiety and avoidance scores. In the regression analyses, the most significant predictive factor for the subjects' IMS scores was their partners' corresponding scores, although among fathers the IMS scores were partly explained by their own TAS-20 factor 1 scores (p=0.004). The subjects' own TAS-20 scores explained the ECR anxiety and avoidance scores to a significant extent, but the fathers' TAS-20 factor 3 scores were also associated with the mothers' avoidance scores (p=0.037). ConclusionAlexithymia was not directly related to marital satisfaction. However, alexithymia appears to have a significant effect on relationship-related anxiety and avoidance. This association should be further studied in parents and their offspring in a longitudinal setting.

Psychometric properties of a revised Spanish 20-item Toronto Alexithymia Scale adaptation in multiple sclerosis patients

There have been a small number of investigations of alexithymia in multiple sclerosis (MS) using the 20-item Toronto Alexithymia Scale (TAS-20). However, the TAS-20 factor structure has not yet been evaluated in a MS patient sample, and earlier Spanish translations of this instrument require some improvement. We aimed to evaluate the factorial validity and reliability of an improved Spanish translation of the TAS-20 (the TAS-20-S). The TAS-20-S was completed by 221 MS patients. Confirmatory factor analysis was used to compare the fit of six different factor models. Internal consistency and retest reliability coefficients were also computed. The correlated three-factor model and the higher-order factor model made up of Difficulty Identifying Feelings, Difficulty Describing Feelings, and Externally Oriented Thinking achieved the best fit. Alpha coefficients ranged between .87 and .67; mean inter-item correlations ranged between .48 and .20; and retest correlations after 6 months ranged between .61 and .52. A high degree of alexithymia was present in 18.1% of the sample. Reliability and the traditional three-factor structure were demonstrated for the TAS-20-S, which can now be recommended for assessing an aspect of emotional processing in MS patients.

Impact of Alexithymia on Treatment Outcome: A Naturalistic Study of Short-Term Cognitive-Behavioral Group Therapy for Panic Disorder

Background: It is often suggested in the literature that alexithymic patients are less responsive to psychotherapy than nonalexithymic patients. However, few empirical studies have examined this issue. Furthermore, it is unclear whether or not alexithymia itself may improve during psychotherapy. Methods: Fifty-five consecutive outpatients with panic disorder received short-term cognitive-behavioral group therapy (CBGT) and were followed up 6 months later. Nineteen patients (35%) were on concomitant antidepressant medication. Alexithymia was measured using the 20-item Toronto Alexithymia Scale (TAS-20). Both completers and intention-to-treat analyses were calculated, taking into consideration the potentially confounding effect of comorbid conditions. Results: Baseline alexithymia did not predict outcome of CBGT, neither at posttreatment nor at follow-up. The presence of comorbid axis I disorders predicted nonresponse at posttreatment but not at follow-up. TAS-20 total scores decreased over time, with the TAS-20 factors 1 (difficulty identifying feelings) and 2 (difficulty describing feelings) decreasing significantly, while factor 3 (externally oriented thinking) remained largely stable. Conclusions: These findings are encouraging for cognitive-behavioral therapists working with patients with alexithymia who suffer from panic disorder: CBGT outcome does not appear to be negatively affected by alexithymia, and some alexithymic characteristics may even be reduced following CBGT. Assessing alexithymia at treatment onset may be useful for individually tailoring therapeutic interventions.

Direct and indirect effects of the temperament and character on alexithymia: a pathway analysis with mood and anxiety

Objective We aimed to assess the pathway from personality to alexithymia through mood and anxiety as mediators. Method Three hundred thirty-four subjects (130 male), whose psychiatric health was verified by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I disorders, completed the Toronto Alexithymia Scale-20 (TAS-20), the Temperament and Character Inventory, the State-Trait Anxiety Inventory (STAI), and the Center for Epidemiological Studies-Depression scale (CES-D). The schematic models for the pathway analysis from Temperament and Character Inventory (TCI) to TAS-20 scores were made. Results Low reward dependence (RD), low self-directedness (S-D), and high cooperativeness (CO) had paths to TAS-20 total ( P = .000, P = .000, and P = .042, respectively). S-D had also an indirect path via STAI-state to TAS total. On TAS-20 factor 1, low RD, low S-D, and high self-transcendence (ST) had direct effects ( P = .004, P = .000, and P = .000, respectively). S-D had also an indirect path via STAI-state and (CES-D) on TAS-20 factor 1. On TAS factor 2, low novelty seeking (NS), high harm avoidance (HA), low RD, low S-D, and high cooperativeness (CO) had direct effects ( P = .005, P = .011, P = .000, P = .000, and P = .004, respectively). On TAS-20 factor 3, low RD and S-D had direct effects ( P = .002 and P = .000, respectively). Conclusion Current results suggest that although alexithymia is affected by the personality, state-dependent mood and anxiety may mediate the relationship between alexithymia and personality.

Dental anxiety and alexithymia: Gender differences

Objective. Alexithymia refers to a personality construct that is characterized by impoverishment of imagination, poor capacity for symbolic thought, and inability to experience and describe feelings. Our aim was to investigate the association of alexithymia and dental anxiety in patients attending dental practice. A further aim was to discover whether gender differences exist in this association when adjusting for the effect of age. Material and Methods. The data were collected among adult (18+ years) patients attending the public dental health centers in Pori, Finland. Patients received a questionnaire assessing dental anxiety (Modified Dental Anxiety Scale, MDAS), alexithymia (20-item Toronto Alexithymia Scale, TAS-20), and demographic profile. Total score and scores for three TAS factors: 1) “difficulty identifying with feelings”, 2) “difficulty describing feelings”, and 3) “externally orientated thinking”, were computed. Results. Of 823 patients, 81% correctly completed the questionnaires. Nine percent belonged to the high anxiety (MDAS score 19 or higher) group and 7% reported alexithymia (total score 61 or higher). The prevalence of alexithymia was 15.5% among those reporting high dental anxiety compared with 5.9% among those reporting low dental anxiety (p=0.005). Those with high dental anxiety scored higher in TAS factor 1 than those with lower dental anxiety. No statistically significant bivariate associations with other TAS factors were found. When adjusting for the effect of age and gender, the association between TAS factors and dichotomized MDAS was significant in all TAS scores except TAS factor 3. Conclusions. In a sample representing Finnish adult dental patients, alexithymia was associated with dental anxiety.

Alexithymia and Somatization in General Population

Even though the association between alexithymia and somatization seems plausible according to several studies with selected populations, it has not been verified in carefully controlled and nationally representative population studies. We conducted such a study to find out whether alexithymia is associated with somatization at population level. This study was a part of the Finnish Health 2000 Study. The nationally representative sample comprised 5129 subjects aged 30 to 97 years. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20) and somatic symptom reporting with the 12-item somatization scale derived from the Hopkins Symptom Checklist. Sociodemographic and health-related variables, including depressive and anxiety disorders, and physician verified somatic diagnoses, were treated as confounders in multivariate analyses. Alexithymia was associated with somatization independently of somatic diseases, depression and anxiety and confounding sociodemographic variables. The TAS-20 factor scale "Difficulties Identifying Feelings" was the strongest common denominator between alexithymia and somatization. This was the first time the independent association between alexithymia and somatization was established in a large, nationally representative nonclinical sample of both young and old adults with and without mental disorders and somatic diseases.

Alexithymia and occupational burnout are strongly associated in working population

Objective The relationship between alexithymia and occupational burnout has not previously been studied. We investigated the association between alexithymia and occupational burnout in a representative nationwide population health study. Methods This study was a part of the Finnish Health 2000 Study. The nationally representative sample comprised 3322 employees aged 30–64 years. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20) and occupational burnout with the Maslach Burnout Inventory-General Survey. Sociodemographic and health-related variables including depression were treated as confounders in the logistic regression analyses, which were performed alternately with TAS-20 total score and the scores of the three TAS-20 factor scales as alexithymia variables. Results Alexithymia and its three facets were significantly associated with occupational burnout even when controlled for confounding factors. Conclusions Even though both alexithymia and depression are associated with burnout, alexithymia may be an independent risk factor for occupational burnout.

Alexithymia and anxiety sensitivity in Turkish depressive, anxiety and somatoform disorder outpatients

Objective. To assess the relations between anxiety sensitivity, and dimensions of alexithymia in somatoform, anxiety and depressive disorder patients. Methods. The sample consisted of 124 patients with the diagnosis of depressive, anxiety, or somatoform spectrum disorders (DSM-IV). Toronto Alexithymia Scale (TAS-20), 16-item Anxiety Sensitivity Index (ASI), Hamilton Depression (HDRS), and Anxiety (HAS) scales were used. Results. The total sample (n=124) was divided into three diagnostic categories. There was one Depression Group (n=69). Due to small sample sizes, diagnoses in anxiety and somatoform spectrum disorders were combined in two relatively larger Anxiety (n=42) and Somatoform Groups (n=13) for statistical purposes. No statistically significant difference was found in the TAS-20 total or subscale scores between the three diagnostic groups. In all three diagnostic groups, there was a strong and significant positive correlation between ASI and TAS-20 total scores. In all three groups, there was a significant positive correlation between TAS-20 Factor 1 and ASI. In the Depression and Somatoform Groups, ASI scores were found to be significantly positively correlated with scores on TAS-20 Factor 2. Conclusion. This study reveals that alexithymia does not differentiate depressive, anxiety, or somatoform disorders, yet suggests a functional relation with anxiety sensitivity on a subscale basis.

Alexithymia and Grief Reactions in Bereaved Japanese Women

ABSTRACT To examine the relationship between grief reactions and alexithymia, 54 Japanese women (33 outpatients attending a psychosomatic clinic and 21 normal healthy participants) completed the Texas Inventory of Grief (TIG), the 20-item Toronto Alexithymia Scale (TAS-20), and the Profile of Mood States (POMS). Each woman had experienced the death of a spouse or a first-degree relative. The TIG scores were positively correlated to the scores on the first TAS-20 factor of Difficulty Identifying Feelings and on the POMS tension–anxiety and depression scales. The scores on the first TAS-20 factor were higher in the psychosomatic group than in the normal group. Complicated grief reactions may be closely associated with both alexithymic character and mood states in bereaved Japanese women.

Alexithymia, emotions and PTSD; findings from a longitudinal study of refugees

The objective of the present study was to assess alexithymia by means of the Toronto Alexithymia Scale (TAS-20) and The Emotion Protocol (EP) in a group of refugees. Eighty-six subjects were willing to participate. At last follow-up, 33 non-PTSD and 22 PTSD subjects had complete data. Subjects with PTSD had higher scores on the TAS-20 (F=4.314, df=77, p=0.041), but on the subscale level, this was significant only with regard to Factor I, difficulties identifying feelings (F=5.316, df=77, p=0.024). TAS Factor I and to a lower extent TAS Factor II (difficulties naming feelings) were significantly associated with the self-rated presence of dysphoric affects. At follow-up, an increase in TAS Factor I score was associated with increased prevalence of self-rated symptoms of PTSD, but not depression. Decrease in prolactin was associated with significant increase of TAS Factor I (rho=−0.396, n=54, p=0.003). The present study indicates that alexithymia as measured by TAS-20 is indeed associated with symptoms of PTSD. This association is almost exclusively explained by the TAS Factor I subscale and is in turn associated with a high level of self-reported dysphoric affect. The longitudinal inverse correlation with prolactin points to the possibility of an underlying disturbance in serotonergic and/or dopaminergic systems. The results thus indicate that secondary, or post-traumatic, alexithymia is a measure of suppressed or warded-off negative affects.

Relationship Between Somatosensory Amplification and Alexithymia in a Japanese Psychosomatic Clinic

To examine the relationship between somatosensory amplification and three factors of alexithymia (difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking), 48 outpatients attending a Japanese psychosomatic clinic and 33 comparative outpatients completed the Somatosensory Amplification Scale (SSAS), 20-item Toronto Alexithymia Scale (TAS-20), Profile of Mood States (POMS), and other self-rating questionnaires. The scores on the SSAS and the first and second TAS-20 factors were higher (all P<0.001) in the psychosomatic group than in the comparison group. The SSAS was positively associated (both P<0.01) with these two TAS-20 factors, controlling for the effects of age, sex, group, and POMS tension-anxiety and depression. Somatosensory amplification appears to be associated with difficulties identifying and describing feelings, not externally oriented thinking, in Japanese patients.

Alexithymia and depression: A 1-year follow-up study in outpatients with major depression

Objective: To examine the changes in alexithymic features and depressive and other psychological distress symptoms during a 1-year follow-up among patients with major depression. Methods: The study population comprised 120 outpatients suffering from major depression. Diagnosis was made with Structured Clinical Interview (SCID-I) for DSM-III-R. The severity of depression was evaluated with the 17-item Hamilton Rating Scale for Depression (HAM-D), and self-reported depression with the Beck Depression Inventory (BDI-21). Alexithymic features were assessed with the Twenty-Item Toronto Alexithymia Scale (TAS-20). Self-reported psychological distress symptoms were evaluated with the Brief Symptom Inventory (BSI). Results: Measures of depression and distress were significantly lower at the follow-up than at the baseline, while the total TAS-20 scores did not change significantly during the follow-up. A closer examination revealed that various TAS-20 factors behaved differently. Changes in Factors 1 and 2 were associated with changes in mood, whereas those in Factor 3 were not. Additionally, recovery from depression was associated with decrease in alexithymic features. Conclusion: Difficulties in identifying and in describing feelings are associated with changes in mood, while externally oriented thinking is not.