New directions in alexithymia research

July 11th A1.02
Olivier Luminet (Université catholique de Louvain, Belgium)

Alexithymia is thought to reflect a deficit in the cognitive processing and regulation of emotional states. It involves: 1) difficulty identifying feelings and distinguishing between feelings and the bodily sensations of emotional arousal, 2) difficulty describing feelings to other people, 3) a reduced capacity to engage in fantasy, 4) a stimulus-bound, externally oriented cognitive style. In the past 20 years, there has been a burgeoning of research on the alexithymia construct. This symposium will highlight four important developments. Goerlich reviews neuroimaging studies showing that alexithymia is associated with differences in neural activity of several areas of the brain (amygdala, insula, anterior cingulate cortex and regions of the prefrontal cortex) that are important for the conscious as well as the unconscious perception and experience of emotions, emotional awareness, and the processing of rewards. Panayiotou presents a meta-analysis on autonomic reactivity to emotion in alexithymia. Identifying patterns of physiological reactivity to emotion in alexithymia allows investigating indicators of non-conscious processing of arousal and valence emotional response systems. Ryder examines the extent to which alexithymia is culturally shaped. His data illustrate the challenge to disentangle ethnic group variations that reflect deficits in emotional processing from those that reflect cultural values. Koole investigates linguistic issues by testing how much alexithymia scores can affect the ability of people to project themselves in fiction due to a lower use of first person perspective. The results emphasize that affective deficits involved in alexithymia would impair the capacity to mentally stimulate narrative worlds.

Neuroimaging evidence for different facets, dimensions, and types of alexithymia

Katharina S. Goerlich

Alexithymia is a personality construct at the interface of cognition and emotion that has attracted scientific interest for four decades. Since the first neuroimaging study in the beginning of the millennium, neuroscientific research has continued to reveal the underpinnings of alexithymia in the brain, linking the construct to dysfunction in brain regions mediating cognitive-emotional processing. Here, I provide an overview of the brain regions exhibiting alterations in function and structure in relation to alexithymia and its different facets. Further, neuroimaging evidence for the existence of a cognitive and an affective dimension of alexithymia will be presented, and the usefulness of differentiating between different dimensions and types of alexithymia will be discussed. Finally, the clinical implications of these findings will be addressed and directions for future research will be provided.

Getting Lost in a Story: How Narrative Transportation Emerges from Narrative Perspective and Individual Differences in Alexithymia

Mattie Tops, Dalya Samur & Sander L. Koole

Narrative transportation refers to a psychological process in which people mentally project themselves into the world of a story. In the present research, we examined how narrative transportation emerges from the interplay between narrative perspective and individual differences in alexithymia, or chronic difficulties in emotional processing. We hypothesized that narrative transportation would be higher when people assume a first-person (rather than third-person) perspective and for people lower (rather than higher) on alexithymia. In an online study (N = 541) and a lab study (N = 55), participants with varying levels of alexithymia read first- and/or third-person narrated texts and then rated their narrative transportation. As expected, first-person stories evoked more narrative transportation than third-person stories, and global alexithymia was negatively correlated with narrative transportation. The effects of narrative perspective did not interact with cognitive facets of alexithymia (i.e., difficulties identifying, verbalizing, and understanding feelings). However, narrative perspective did interact with affective facets of alexithymia (i.e., emotionalizing and fantasizing): First-person (rather than third-person) stories elicited more narrative transportation at lower levels of affective alexithymia, but not at higher levels of affective alexithymia. The interaction effect was statistically significant in Study 1 and statistically significant in Study 2 after controlling for trait absorption.Together, these findings suggest the possibility that the emotional problems associated with alexithymia may stem from difficulties in mentally simulating narrative worlds.

Autonomic reactivity to emotion and arousal in Alexithymia: Meta-analytic evidence

Georgia Panayiotou, Maria Panteli, Myria Ioannou, Olivier Luminet & Elke Vlemincx

Research yields mixed findings regarding alexithymia’s association with hyper- vs hypo-arousal responses to emotional stimuli. We present findings from a meta-analysis, addressing two questions a) whether alexithymia is associated with decreased, normal, or increased autonomic reactivity to emotional stimuli, and b) whether it is associated with baseline hyper-arousal. It additionally examines potential moderators of these alexithymia effects including type of emotional stimuli, clinical vs community population, participant age and gender, and alexithymia measure and selection method utilized. The meta-analysis focused on skin conductance and heart rate: Electrodermal responses are sympathetically mediated and reflect activation of the arousal system. Heart rate receives both sympathetic and parasympathetic influences and is sensitive to both arousal and valence emotional response systems. We expected to document the presence of autonomic hypo-reactivity in response to emotional challenges in alexithymia, possibly reflecting physiological blunting and immobilization as found in anxiety, depression and trauma patients. We also predicted baseline hyper-arousal in alexithymia. Indeed preliminary meta-analytic statistics indicate significant hypo-arousal reactivity to emotional tasks and baseline hyper-arousal. Effects of moderators are also discussed. Such findings provide indicative mechanisms that relate alexithymia to physical and mental illnesses: Impaired reactivity can lead to system depletion or intransigence and negatively affect the psychological and physiological flexibility required for mental health. It may also result in chronic hyper-arousal, related to an inability to process safety signals as often found in pathological populations.

The cultural meaning of alexithymia: A mixed-method approach in urban and rural Chinese outpatients

Andrew Ryder & Jie Chang

There is a longstanding cultural critique of alexithymia as a failure to conform to 'Western' emotion norms, a concern addressed empirically in a small research literature. In particular, research conducted in Chinese cultural contexts has shown that higher scores on the TAS-20 (relative to North-American samples) are driven largely by externally-oriented thinking. Moreover, this difference is mediated by endorsement of values reflecting traditionalism vs. modernity. Although there is a danger here of mistaking a culturally normative thinking style with psychopathology, the meaning underpinning this difference and how it plays out in clinical practice are poorly understood. We therefore adopted a mixed-method approach in a subset of urban (n=13) and rural (n=12) Chinese psychiatric outpatients who had scored highly on the TAS-20. These outpatients were administered the Mandarin translation of the Toronto Structured Interview for Alexithymia (TSIA). Despite the small sample (i.e., N=25), quantitative findings showed good agreement between interview and questionnaire measures of alexithymia with similar patterns of correlations with distress. We did have a good-sized sample for qualitative inquiry, applying thematic and conversational analysis techniques to verbatim TSIA transcripts. Chinese respondents often had difficulty responding to the TSIA questions, particularly EOT questions—and did so in ways reflecting local cultural norms rather than emotional processing deficits. This tendency was particularly pronounced in rural participants. This study highlights advantages of mixed methods when studying cultural meaning. Future research should consider how to disentangle cultural group variations in alexithymia reflecting deficits in emotional processing from those reflecting cultural values.