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Chmiel J, Wiażewicz-Wójtowicz P, Stępień-Słodkowska M. Neural Correlates of Alexithymia Based on Electroencephalogram (EEG)-A Mechanistic Review. J Clin Med 2025; 14:1895. [PMID: 40142703 PMCID: PMC11943194 DOI: 10.3390/jcm14061895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2025] [Revised: 03/06/2025] [Accepted: 03/08/2025] [Indexed: 03/28/2025] Open
Abstract
Introduction: Alexithymia is a multidimensional construct characterized by difficulties in identifying and describing emotions, distinguishing emotional states from bodily sensations, and an externally oriented thinking style. Although the prevalence in the general population is around 10%, it is significantly higher in clinical groups, including those with autism spectrum disorders, depression, anxiety, and neurological conditions. Neuroimaging research, especially using magnetic resonance imaging, has documented structural and functional alterations in alexithymia; however, electroencephalography (EEG)-an older yet temporally precise method-remains less comprehensively explored. This mechanistic review aims to synthesize EEG-based evidence of the neural correlates of alexithymia and to propose potential neurophysiological mechanisms underpinning its affective and cognitive dimensions. Methods: A thorough literature search was conducted in December 2024 across PubMed/Medline, ResearchGate, Google Scholar, and Cochrane using combined keywords ("EEG", "QEEG", "electroencephalography", "alexithymia") to identify English-language clinical trials or case studies published from January 1980 to December 2024. Two reviewers independently screened the titles and abstracts, followed by a full-text review. Studies were included if they specifically examined EEG activity in participants with alexithymia. Of the 1021 initial records, eight studies fulfilled the inclusion criteria. Results: Across the reviewed studies, individuals with alexithymia consistently demonstrated right-hemisphere dominance in EEG power and connectivity, particularly in the theta and alpha bands, during both neutral and emotion-eliciting tasks. Many exhibited reduced interhemispheric coherence and disrupted connectivity in the frontal and parietal regions, potentially contributing to difficulties in cognitive processing and emotion labeling. Some studies have also reported diminished gamma band activity and phase synchrony in response to negative stimuli, suggesting impaired higher-order integration of emotional information. Crucially, subjective reports (e.g., valence ratings) often do not differ between alexithymic and non-alexithymic groups, highlighting that EEG measures may capture subtle emotional processing deficits not reflected in self-reports. Conclusions: EEG findings emphasize that alexithymia involves specific disruptions in cortical activation and network-level coordination, rather than merely the absence of emotional experiences. Right-hemisphere over-reliance, reduced interhemispheric transfer, and atypical oscillatory patterns in the alpha, theta, and gamma bands appear to be central to the condition's pathophysiology. Understanding these neural signatures offers avenues for future research-particularly intervention studies that test whether modulating these EEG patterns can improve emotional awareness and expression. These insights underscore the potential clinical utility of EEG as a sensitive tool for detecting and tracking alexithymic traits in both research and therapeutic contexts.
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Affiliation(s)
- James Chmiel
- Faculty of Physical Culture and Health, Institute of Physical Culture Sciences, University of Szczecin, Al. Piastów 40B blok 6, 71-065 Szczecin, Poland
- Doctoral School, University of Szczecin, Mickiewicza 16, 70-384 Szczecin, Poland
| | | | - Marta Stępień-Słodkowska
- Faculty of Physical Culture and Health, Institute of Physical Culture Sciences, University of Szczecin, Al. Piastów 40B blok 6, 71-065 Szczecin, Poland
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Li X, Wang X, Peng C, Ren Z, Shan J, Luo Q, Wei D, Qiu J. Alexithymia shapes intersubject synchrony in brain activity during interoceptive sensation representations. Cereb Cortex 2025; 35:bhaf060. [PMID: 40111180 DOI: 10.1093/cercor/bhaf060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Revised: 02/17/2025] [Accepted: 02/19/2025] [Indexed: 03/22/2025] Open
Abstract
Alexithymia is a subclinical condition that affects individuals' processing of emotions. Emerging evidence suggests that alexithymia results from a multidomain and multidimensional interoceptive failure. Although extensive research has examined the relationship between alexithymia and interoception, less is known about how alexithymia modulates the brain activity evoked by interoceptive sensations. In this study, we used task-based functional magnetic resonance imaging (fMRI) to assess intersubject correlations in response to interoceptive sensation words in individuals with high alexithymia and low alexithymia. Participants with high alexithymia (n = 29) and low alexithymia (n = 28) were instructed to view words during MRI scanning, each word corresponding to a specific emotional category related to interoceptive sensations. Intersubject correlation analysis identified several brain regions exhibiting increased synchronization in individuals with high alexithymia, including those involved in cognitive control. Follow-up analyses revealed that the left middle occipital gyrus and the right inferior frontal gyrus (orbital part) were more active during interoceptive sensation events in individuals with high alexithymia. Validation analyses revealed that the amygdala and insula are also crucial in representing interoceptive sensations. These findings shed light on the neural basis of interoceptive deficits in high alexithymia and have significant implications for the mechanisms regulating these differences.
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Affiliation(s)
- Xianrui Li
- Department of Special Inspection, Shandong Daizhuang Hospital, Jining, 272051, Shandong Province, China
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing, 400715, China
- Faculty of Psychology, Southwest University, Chongqing, 400715, China
| | - Xueyang Wang
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing, 400715, China
- Faculty of Psychology, Southwest University, Chongqing, 400715, China
| | - Chuyao Peng
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing, 400715, China
- Faculty of Psychology, Southwest University, Chongqing, 400715, China
| | - Zhiting Ren
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing, 400715, China
- Faculty of Psychology, Southwest University, Chongqing, 400715, China
| | - Junlai Shan
- Department of Special Inspection, Shandong Daizhuang Hospital, Jining, 272051, Shandong Province, China
| | - Qian Luo
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing, 400715, China
- Faculty of Psychology, Southwest University, Chongqing, 400715, China
- West China Institute of Children's Brain and Cognition, Chongqing University of Education, Chongqing, 400065, China
| | - Dongtao Wei
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing, 400715, China
- Faculty of Psychology, Southwest University, Chongqing, 400715, China
| | - Jiang Qiu
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing, 400715, China
- Faculty of Psychology, Southwest University, Chongqing, 400715, China
- West China Institute of Children's Brain and Cognition, Chongqing University of Education, Chongqing, 400065, China
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Desmedt O, Luminet O, Maurage P, Corneille O. Discrepancies in the Definition and Measurement of Human Interoception: A Comprehensive Discussion and Suggested Ways Forward. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2025; 20:76-98. [PMID: 37642084 DOI: 10.1177/17456916231191537] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Interoception has been the subject of renewed interest over the past 2 decades. The involvement of interoception in a variety of fundamental human abilities (e.g., decision-making and emotional regulation) has led to the hypothesis that interoception is a central transdiagnostic process that causes and maintains mental disorders and physical diseases. However, interoception has been inconsistently defined and conceptualized. In the first part of this article, we argue that the widespread practice of defining interoception as the processing of signals originating from within the body and limiting it to specific physiological pathways (lamina I spinothalamic afferents) is problematic. This is because, in humans, the processing of internal states is underpinned by other physiological pathways generally assigned to the somatosensory system. In the second part, we explain that the consensual dimensions of interoception are empirically detached from existing measures, the latter of which capture loosely related phenomena. This is detrimental to the replicability of findings across measures and the validity of interpretations. In the general discussion, we discuss the main insights of the current analysis and suggest a more refined way to define interoception in humans and conceptualize its underlying dimensions.
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Affiliation(s)
- Olivier Desmedt
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
- The Swiss National Science Foundation, Berne, Switzerland
| | - Olivier Luminet
- Psychological Science Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
- Fund for Scientific Research, Brussels, Belgium
| | - Pierre Maurage
- Psychological Science Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
- Fund for Scientific Research, Brussels, Belgium
| | - Olivier Corneille
- Psychological Science Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
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Rzeszutek M, Kowalkowska J, Drabarek K, Van Hoy A, Schier K, Lis-Turlejska M, Dragan M, Holas P, Maison D, Litwin E, Wawrzyniak J, Znamirowska W, Szumiał S, Desmond M. Adverse childhood experiences and alexithymia intensity as predictors of temporal dynamics of functioning in individuals with irritable bowel syndrome: A three-wave latent transition analysis. J Psychosom Res 2024; 187:111904. [PMID: 39298867 DOI: 10.1016/j.jpsychores.2024.111904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 08/21/2024] [Accepted: 08/21/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVE Despite high prevalence of irritable bowel syndrome (IBS) and its significant negative impact on individuals' quality of life, its etiology remains poorly understood. This prospective study explored whether early life factors (adverse childhood experiences; ACEs) and alexithymia intensity, could explain IBS symptom severity and its effects on psychological functioning over time. We also compared the studied variables between an IBS sample and a healthy control group. METHOD Based on the Rome III Diagnostic Criteria for IBS, 245 individuals with a diagnosis of IBS were recruited from a national sample of Poles. The IBS sample completed the following psychometric questionaries in three waves, one month apart: Adverse Childhood Experiences Questionnaire, Toronto Alexithymia Scale, IBS Symptom Severity Score, Short Form Perceived Stress Scale, and Ultra-Brief Patient Health Questionnaire for Anxiety and Depression. Latent transition analysis was used to identify distinct profiles of IBS symptom dynamics. RESULTS The IBS group reported a significantly higher number of ACEs, greater alexithymia severity, and more intense levels of stress, anxiety, and depressive symptoms compared to the healthy controls. Four profiles of IBS individuals with distinct dynamics of IBS symptoms, stress, anxiety, and depressive symptoms were extracted, which correlated with the baseline number of ACEs and alexithymia intensity among participants. CONCLUSION Childhood adversity and associated problems in emotional processing affect IBS symptom severity. ACEs should be included in IBS screening and considered in the design of individualized multidisciplinary treatment approaches for IBS patients.
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Affiliation(s)
| | - Joanna Kowalkowska
- Faculty of Food Science, University of Warmia and Mazury in Olsztyn, Poland
| | | | | | | | - Maja Lis-Turlejska
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | | | - Paweł Holas
- Faculty of Psychology, University of Warsaw, Poland
| | | | | | | | | | | | - Małgorzata Desmond
- Great Ormond Street Institute of Child Health, University College London, United Kingdom
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Ismaiel A, Foucambert P, Ismaiel M, Leucuta DC, Popa SL, Baban A, Dumitrascu DL. Silent Struggles Within: Alexithymia Unveiled in Irritable Bowel Syndrome: A Systematic Review and Meta-analysis. J Neurogastroenterol Motil 2024; 30:387-396. [PMID: 39397617 PMCID: PMC11474551 DOI: 10.5056/jnm23159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/24/2023] [Accepted: 01/18/2024] [Indexed: 10/15/2024] Open
Abstract
Background/Aims In recent years, the presence of alexithymia in patients with irritable bowel syndrome (IBS) has gained more attention, and several studies have evaluated this relationship. However, no clear conclusion has been reported yet. Therefore, we conducted a systematic review and meta-analysis to better understand the association between IBS and alexithymia. Methods We performed a systematic search on the medical databases PubMed, EMBASE, and Scopus using predefined keywords to identify observational studies assessing the association between IBS and alexithymia. The included studies diagnosed IBS using the Rome criteria, and alexithymia was evaluated using the 20-item Toronto Alexithymia Scale (TAS-20) score. We used The Newcastle-Ottawa Scale to evaluate the quality of included studies. The primary summary outcome was the mean difference in TAS-20 scores. Results We included 7 studies involving 1,513 individuals in our qualitative analysis, with 6 of them included in our quantitative analysis. All studies were considered to be of satisfactory quality according to the Newcastle-Ottawa Scale criteria. We found significantly higher TAS-20 scores in IBS patients compared to controls (8.063 [95% CI, 2.554-13.572]). However, no significant mean difference in TAS-20 scores was observed in IBS vs inflammatory bowel disease patients (0.884 [95% CI -2.536-4.304]). Conclusions We demonstrated that IBS is associated with an increased risk of developing alexithymia. However, our study did not show a significant difference in TAS-20 scores between patients with IBS compared to inflammatory bowel disease.
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Affiliation(s)
- Abdulrahman Ismaiel
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Paul Foucambert
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mohamed Ismaiel
- Department of General Surgery, Altnagelvin Hospital, Londonderry, United Kingdom
| | - Daniel C Leucuta
- Department of Medical Informatics and Biostatistics, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Stefan-Lucian Popa
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adriana Baban
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Dan L Dumitrascu
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Ścigała DK, Fabris MA, Zdankiewicz-Ścigała E, Kuc K, Longobardi C. Interoceptive sensibility and alcohol craving in Polish prisoners: the role of alexithymia and emotional dysregulation. Front Psychol 2024; 15:1356024. [PMID: 39434915 PMCID: PMC11493100 DOI: 10.3389/fpsyg.2024.1356024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 09/11/2024] [Indexed: 10/23/2024] Open
Abstract
Introduction Alcohol craving, characterized by a strong desire or compulsion to consume alcohol, is a prominent symptom of substance dependence syndrome. Research indicates that alcohol craving is a significant factor leading to the termination of abstinence. The mechanisms underlying the activation of alcohol craving remain not fully understood. The urge to reach for alcohol may be stimulated by emotions, memories, thoughts, or bodily sensations, as well as external factors. It has been postulated that individuals with high levels of interoceptive sensibility tend to exhibit a high degree of alexithymia and emotion dysregulation in the context of alcohol craving. Deficits in identifying and verbalizing emotions, along with an operational thinking style, facilitate alcohol consumption by impeding accurate insight into one's mental state, thereby hindering the comprehension of bodily states, emotions, and the regulation of self. Method This study involved 160 inmates incarcerated in a prison in Poland, awaiting participation in therapy for individuals with substance dependence following psychiatric diagnosis. Four questionnaires were used in the study: multidimensional Assessment of Interoceptive Sensibility (MAIA) for interoceptive sensibility, Toronto Alexithymia Scale (TAS-20) for alexithymia, Difficulties in Emotion Regulation Scale (DERS) for emotional dysregulation, and the Penn Alcohol Craving Scale (PACS) for alcohol craving assessment. Results The results of the study are as follows: the study findings indicated that alexithymia and emotional dysregulation significantly mediates the relationship between interoceptive sensibility and alcohol craving. The indirect effect for both factors was found to be significant, similar to the indirect effect observed for alexithymia as an mediator. However, in the case of emotional dysregulation, no significant indirect effect was observed. Conclusion Our study provides insights into the potential contribution of interoceptive sensibility to the heightened risk of alcohol dependence. Specifically, impaired interoceptive sensibility may be associated with the development of alexithymia and emotional dysregulation, potentially rendering individuals more susceptible to alcohol craving. Interoceptive sensibility could serve as a prerequisite for the cultivation of positive emotional processing skills.
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Affiliation(s)
| | | | | | - Krystian Kuc
- Institute of Psychology, The Maria Grzegorzewska University, Warsaw, Poland
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Bodart A, Invernizzi S, De Leener M, Lefebvre L, Rossignol M. The duration discrimination respiratory task: A new test to measure respiratory interoceptive accuracy. Psychophysiology 2024; 61:e14632. [PMID: 38886914 DOI: 10.1111/psyp.14632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 05/17/2024] [Accepted: 06/04/2024] [Indexed: 06/20/2024]
Abstract
Interoception, which refers to the perception of body's internal state, is implicated in emotional processes and psychopathological disorders. Over the last decades, different tools have been developed to measure interoceptive accuracy, or the ability to accurately perceive physiological signals. Most of these tools have focused on cardiac interoception, but respiratory interoception has been less investigated due to the more complex and less portable equipment required. In this study, we suggest a new duration discrimination respiratory (DDR) task that does not require complex equipment. Using an adaptive staircase procedure, this task aims to determine an individual's ability to detect exhalation longer than their resting reference duration. One hundred and twenty-three healthy subjects completed the DDR task, an interoceptive task of heart rate discrimination, and filled out questionnaires on interoceptive awareness (Multidimensional Assessment of Interoceptive Awareness), alexithymia (Toronto Alexithymia Scale [TAS]), affects (Positive and Negative Affect Scale [PANAS]), and anamnestic. Results demonstrated a good internal consistency (Cronbach's alpha = .93) of the DDR task. On average, subjects needed 99.22% (SD = 36.38) of their reference exhalation time in addition to reference exhalation to detect a prolonged exhalation. Higher self-reported fitness levels, not counting during the DDR task and lower difficulty in describing feelings (TAS subscale), predicted higher respiratory discrimination duration. In conclusion, this study demonstrates the utility of the DDR task as a valid measure of interoception.
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Affiliation(s)
- Alice Bodart
- Cognitive Psychology and Neuropsychology Laboratory, Department of Psychology and Educational Sciences, University of Mons, Mons, Belgium
| | - Sandra Invernizzi
- Cognitive Psychology and Neuropsychology Laboratory, Department of Psychology and Educational Sciences, University of Mons, Mons, Belgium
| | - Mélanie De Leener
- Cognitive Psychology and Neuropsychology Laboratory, Department of Psychology and Educational Sciences, University of Mons, Mons, Belgium
| | - Laurent Lefebvre
- Cognitive Psychology and Neuropsychology Laboratory, Department of Psychology and Educational Sciences, University of Mons, Mons, Belgium
| | - Mandy Rossignol
- Cognitive Psychology and Neuropsychology Laboratory, Department of Psychology and Educational Sciences, University of Mons, Mons, Belgium
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Shafiei F, Dehghani M, Lavasani FF, Manouchehri M, Mokhtare M. Intensive short-term dynamic psychotherapy for irritable bowel syndrome: a randomized controlled trial examining improvements in emotion regulation, defense mechanisms, quality of life, and IBS symptoms. Front Psychol 2024; 15:1293150. [PMID: 38605838 PMCID: PMC11008577 DOI: 10.3389/fpsyg.2024.1293150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/24/2024] [Indexed: 04/13/2024] Open
Abstract
Studies have provided evidence for the effectiveness of intensive short-term dynamic psychotherapy (ISTDP) in treating medically unexplained symptoms (MUS). This study aimed to examine the effectiveness of ISTDP on individuals living with irritable bowel syndrome (IBS) in terms of, emotion regulation (ER) abilities, defense mechanisms, quality of life (QOL), and IBS symptoms. A total of 30 patients diagnosed with IBS were recruited and randomly assigned to either the intervention (n = 15) or control (n = 15) group. Pre- and post-treatment assessments were conducted, along with a follow-up assessment after ten weeks. Repeated measures analyses of variance were employed to analyze the data. The findings revealed that ISTDP led to significant improvements in ER, defense mechanisms, and QOL, as well as a reduction in the severity and frequency of IBS symptoms. These results provide further support for the efficacy of ISTDP as a treatment modality for individuals with IBS.
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Affiliation(s)
- Faezeh Shafiei
- Department of Clinical Psychology, School of Behavioral Science and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Mahmood Dehghani
- Department of Clinical Psychology, School of Behavioral Science and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Fathali Lavasani
- Department of Clinical Psychology, School of Behavioral Science and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Manouchehri
- Department of Psychology, Faculty of Medical, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Marjan Mokhtare
- Gastroenterology and Hepatology, Internal Medicine Department, Iran University of Medical Sciences, Tehran, Iran
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Fazia G, Carbone EA, Rania M, Quirino D, Aloi M, de Filippis R, De Fazio P, Colloca L, Segura-García C. Pain experience in eating disorders: The mediating role of depression, alexithymia and interoceptive awareness. EUROPEAN EATING DISORDERS REVIEW 2024; 32:148-160. [PMID: 37676995 DOI: 10.1002/erv.3020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/02/2023] [Accepted: 08/03/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE Evidence suggests reduced sensitivity to pain due to high pain threshold in anorexia and bulimia nervosa and a possible role of depression, alexithymia and interoceptive awareness on pain experience. This study examined whether self-report and real-time evoked pain experience were mediated by depression, alexithymia and interoceptive awareness in a comprehensive sample of patients with eating disorders (ED). METHOD 145 participants (90 ED, 55 healthy controls (HC)) underwent a real-time evoked examination of pain and completed self-report questionnaires for pain (Pain Detect Questionnaire (PD-Q), PD-Q VAS, Leeds Assessment of Neuropathic Symptoms and Signs), depression (BDI-II), interoceptive awareness Multidimensional Assessment of Interoceptive Awareness (MAIA), and alexithymia (TAS-20). Three mediation models, with ED diagnosis as independent variable, and BDI, MAIA and TAS-20 as mediators, were tested. RESULTS Participants with ED and HC exhibited similar pain type and intensity (self-report and real-time). Eating disorders diagnosis was associated with lower self-report pain intensity and non-neuropathic like pain experience (model 1-2). Depressive symptoms partially (model 1-2) or fully (model 3) mediated the association between ED diagnosis and pain experience, alone (model 1) or via alexithymia (model 3). Interoceptive awareness did not influence pain symptomatology. DISCUSSION ED diagnosis is associated with non-neuropathic and lower pain experience. However, concurrent depression and alexithymia are associated with higher pain symptoms and neuropathic features. These results could inform clinicians about the influence of psychopathology on pain experience in ED.
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Affiliation(s)
- Gilda Fazia
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital Mater Domini, Catanzaro, Italy
| | - Elvira Anna Carbone
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital Mater Domini, Catanzaro, Italy
- Psychiatry Unit, Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Marianna Rania
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital Mater Domini, Catanzaro, Italy
| | - Daria Quirino
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital Mater Domini, Catanzaro, Italy
| | - Matteo Aloi
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Renato de Filippis
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital Mater Domini, Catanzaro, Italy
- Psychiatry Unit, Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Luana Colloca
- Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, Maryland, USA
- Departments of Anesthesiology and Psychiatry, School of Medicine, University of Maryland, Baltimore, Maryland, USA
- Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Maryland, USA
| | - Cristina Segura-García
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital Mater Domini, Catanzaro, Italy
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
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Cerebellum, Embodied Emotions, and Psychological Traits. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1378:255-269. [DOI: 10.1007/978-3-030-99550-8_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Influence of Catechol-O-Methyltransferase Gene Polymorphism on the Correlation between Alexithymia and Hypervigilance to Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413265. [PMID: 34948872 PMCID: PMC8704340 DOI: 10.3390/ijerph182413265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022]
Abstract
The psychological characteristic of having difficulty expressing emotions, known as alexithymia, is associated with hypervigilance to pain and is considered one of the risk factors for chronic pain. The correlation between alexithymia and hypervigilance to pain can be observed even in healthy individuals. However, the factors influencing this correlation remain unknown. We explored the dopamine system, which is known to be involved in emotion and pain. The dopamine-degrading enzyme catechol-O-methyltransferase (COMT) has a genetic polymorphism known to influence dopamine metabolism in the prefrontal cortex. COMT polymorphism reportedly affects various aspects of pain and increases pain sensitivity in Met allele carriers. Therefore, we investigated whether the correlation between alexithymia and hypervigilance to pain is influenced by COMT polymorphism in healthy individuals. The results revealed a significant positive correlation between the "difficulty describing feelings" of the 20-item Toronto Alexithymia Scale and the "attention to changes in pain" of the pain vigilance and awareness questionnaire in COMT Met carriers but not in Val/Val individuals. This finding suggests that the correlation between alexithymia and hypervigilance to pain is influenced by COMT polymorphism.
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Terasawa Y, Oba K, Motomura Y, Katsunuma R, Murakami H, Moriguchi Y. Paradoxical somatic information processing for interoception and anxiety in alexithymia. Eur J Neurosci 2021; 54:8052-8068. [PMID: 34766398 PMCID: PMC9298728 DOI: 10.1111/ejn.15528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 11/28/2022]
Abstract
The concept of alexithymia has garnered much attention in an attempt to understand the psychological mechanisms underlying the experience of feeling an emotion. In this study, we aimed to understand how the interoceptive processing in an emotional context relates to problems of alexithymia in recognizing self‐emotions. Therefore, we prepared experimental conditions to induce emotional awareness based on interoceptive information. As such, we asked participants to be aware of interoception under an anxiety‐generating situation anticipating pain, having them evaluate their subjective anxiety levels in this context. High alexithymia participants showed attenuated functional connectivity within their ‘interoception network’, particularly between the insula and the somatosensory areas when they focused on interoception. In contrast, they had enhanced functional connectivity between these regions when they focused on their anxiety about pain. Although access to somatic information is supposed to be more strongly activated while attending to interoception in the context of primary sensory processing, high alexithymia individuals were biased as this process was activated when they felt emotions, suggesting they recognize primitive and unprocessed bodily sensations as emotions. The paradoxical somatic information processing may reflect their brain function pathology for feeling emotions and their difficulty with context‐dependent emotional control.
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Affiliation(s)
- Yuri Terasawa
- Department of Psychology, Faculty of Letters, Keio University, Tokyo, Japan.,Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Kentaro Oba
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan.,Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Yuki Motomura
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Human Science, Faculty of Design, Kyusyu University, Fukuoka, Japan
| | - Ruri Katsunuma
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Hiroki Murakami
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Psychology, Oita University, Oita, Japan
| | - Yoshiya Moriguchi
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
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13
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Brewer R, Murphy J, Bird G. Atypical interoception as a common risk factor for psychopathology: A review. Neurosci Biobehav Rev 2021; 130:470-508. [PMID: 34358578 PMCID: PMC8522807 DOI: 10.1016/j.neubiorev.2021.07.036] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/09/2021] [Accepted: 07/31/2021] [Indexed: 02/06/2023]
Abstract
The inadequacy of a categorial approach to mental health diagnosis is now well-recognised, with many authors, diagnostic manuals and funding bodies advocating a dimensional, trans-diagnostic approach to mental health research. Variance in interoception, the ability to perceive one's internal bodily state, is reported across diagnostic boundaries, and is associated with atypical functioning across symptom categories. Drawing on behavioural and neuroscientific evidence, we outline current research on the contribution of interoception to numerous cognitive and affective abilities (in both typical and clinical populations), and describe the interoceptive atypicalities seen in a range of psychiatric conditions. We discuss the role that interoception may play in the development and maintenance of psychopathology, as well as the ways in which interoception may differ across clinical presentations. A number of important areas for further research on the role of interoception in psychopathology are highlighted.
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Affiliation(s)
- Rebecca Brewer
- Department of Psychology, Royal Holloway, University of London, United Kingdom
| | - Jennifer Murphy
- Department of Psychology, Royal Holloway, University of London, United Kingdom.
| | - Geoffrey Bird
- Department of Experimental Psychology, University of Oxford, United Kingdom; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
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14
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Personalized behavior management as a replacement for medications for pain control and mood regulation. Sci Rep 2021; 11:20297. [PMID: 34645900 PMCID: PMC8514566 DOI: 10.1038/s41598-021-99803-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 09/29/2021] [Indexed: 12/12/2022] Open
Abstract
A lack of personalized approaches in non-medication pain management has prevented these alternative forms of treatment from achieving the desired efficacy. One hundred and ten female patients with fibromyalgia syndrome (FMS) and 60 healthy women without chronic pain were assessed for severity of chronic or retrospective occasional pain, respectively, along with alexithymia, depression, anxiety, coping strategies, and personality traits. All analyses were conducted following a ‘resource matching’ hypothesis predicting that to be effective, a behavioral coping mechanism diverting or producing cognitive resources should correspond to particular mechanisms regulating pain severity in the patient. Moderated mediation analysis found that extraverts could effectively cope with chronic pain and avoid the use of medications for pain and mood management by lowering depressive symptoms through the use of distraction mechanism as a habitual (‘out-of-touch-with-reality’) behavior. However, introverts could effectively cope with chronic pain and avoid the use of medications by lowering catastrophizing through the use of distraction mechanism as a situational (‘in-touch-with-reality’) behavior. Thus, personalized behavior management techniques applied according to a mechanism of capturing or diverting the main individual ‘resource’ of the pain experience from its ‘feeding’ to supporting another activity may increase efficacy in the reduction of pain severity along with decreasing the need for pain relief and mood-stabilizing medications.
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15
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Zdankiewicz-Ścigała E, Ścigała D, Sikora J, Kwaterniak W, Longobardi C. Relationship between interoceptive sensibility and somatoform disorders in adults with autism spectrum traits. The mediating role of alexithymia and emotional dysregulation. PLoS One 2021; 16:e0255460. [PMID: 34428238 PMCID: PMC8384168 DOI: 10.1371/journal.pone.0255460] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 07/16/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The purpose of the study is to analyses the relationship between interoceptive sensibility and somatoform disorders among persons with Autism Spectrum Disorder (ASD). It has been assumed that the interoceptive sensibility is accompanied by a high level of alexithymia and emotion dysregulation in somatoform disorders. METHODS Persons under the care of the foundation helping people with ASD were asked to participate in the study. In total, 205 people took part in the research. The participants aged from 18 to 63 (M = 34.91; SD = 8.44). The ASD group comprised 79 persons (38.5% of subjects). The control group comprised 126 individuals (61.5% of subjects). Participants completed self-report questionnaires measuring autism (AQ), interoceptive sensibility (BPQ), alexithymia (TAS20), emotional dysregulation (DERS), and somatoform disorder (SDQ). RESULTS The analyses showed a moderation effect of the group, which indicates the existence of a relationship between interoceptive sensibility and somatoform disorders to the greater extent in the clinical group than in the control group. In addition, the serial multiple mediation model analysis allowed to verify the mediating effect of emotion dysregulation and alexithymia on the abovementioned relationship. The indirect effect, which assumed the mediating role of alexithymia turned out to be significant, contrary to the indirect effect where emotion dysregulation was a mediator in a situation where both variables were applied simultaneously. CONCLUSIONS Interoceptive sensibility correlated with level of alexithymia, in particular, difficulties in identifying and verbalizing emotions and emotion dysregulation in the lack of emotional awareness and lack of emotional clarity and is associated with somatoform disorders in the investigated group regardless of participants' belonging to the ASD or control group.
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Affiliation(s)
| | - Dawid Ścigała
- Institute of Psychology, The Maria Grzegorzewska University, Warsaw, Poland
| | - Joanna Sikora
- Institute of Psychology, The Maria Grzegorzewska University, Warsaw, Poland
| | - Wanda Kwaterniak
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
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16
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Terock J, Hannemann A, Weihs A, Janowitz D, Grabe HJ. Alexithymia is associated with reduced vitamin D levels, but not polymorphisms of the vitamin D binding-protein gene. Psychiatr Genet 2021; 31:126-134. [PMID: 34074948 DOI: 10.1097/ypg.0000000000000283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Alexithymia is a personality trait characterized by difficulties in identifying and describing emotions, which is associated with various psychiatric disorders, including depression and posttraumatic stress disorder (PTSD). Its pathogenesis is incompletely understood but previous studies suggested that genetic as well as metabolic factors, are involved. However, no results on the role of vitamin D and the polymorphisms rs4588 and rs7041 of the vitamin D binding protein (VDBP) have been published so far. METHODS Serum levels of total 25(OH)D were measured in two general-population samples (total n = 5733) of the Study of Health in Pomerania (SHIP). The Toronto Alexithymia Scale-20 (TAS-20) was applied to measure alexithymia. Study participants were genotyped for rs4588 and rs7041. Linear and logistic regression analyses adjusted for sex, age, waist circumference, physical activity, season and study and, when applicable, for the batch of genotyping and the first three genetic principal components, were performed. In sensitivity analyses, the models were additionally adjusted for depressive symptoms. RESULTS 25(OH)D levels were negatively associated with TAS-20 scores (β = -0.002; P < 0.001) and alexithymia according to the common cutoff of TAS-20>60 (β = -0.103; P < 0.001). These results remained stable after adjusting for depressive symptoms. The tested genetic polymorphisms were not significantly associated with alexithymia. CONCLUSIONS Our results suggest that low vitamin D levels may be involved in the pathophysiology of alexithymia. Given that no associations between alexithymia and rs4588 as well as rs7041 were observed, indicates that behavioral or nutritional features of alexithymic subjects could also explain this association.
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Affiliation(s)
- Jan Terock
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald
- Department of Psychiatry and Psychotherapy, HELIOS Hanseklinikum Stralsund, Rostocker Chaussee, Stralsund
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald
- German Centre for Cardiovascular Research DZHK, Partner Site Greifswald, University Medicine Greifswald
| | - Antoine Weihs
- Department of Psychiatry and Psychotherapy, HELIOS Hanseklinikum Stralsund, Rostocker Chaussee, Stralsund
| | - Deborah Janowitz
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald
- Department of Psychiatry and Psychotherapy, HELIOS Hanseklinikum Stralsund, Rostocker Chaussee, Stralsund
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, HELIOS Hanseklinikum Stralsund, Rostocker Chaussee, Stralsund
- German Center for Neurodegenerative Diseases DZNE, Site Rostock/Greifswald, Greifswald, Germany
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17
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Terock J, Frenzel S, Wittfeld K, Klinger-König J, Janowitz D, Bülow R, Hosten N, Völzke H, Grabe HJ. Alexithymia Is Associated with Altered Cortical Thickness Networks in the General Population. Neuropsychobiology 2021; 79:233-244. [PMID: 32146473 DOI: 10.1159/000504983] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/24/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Alexithymia is a personality trait characterized by difficulties in identifying and describing emotions and associated with various psychiatric disorders. Neuroimaging studies found evidence for morphological and functional brain alterations in alexithymic subjects. However, the neurobiological mechanisms underlying alexithymia remain incompletely understood. METHODS We study the association of alexithymia with cortical correlation networks in a large community-dwelling sample of the Study of Health in Pomerania. Our analysis includes data of n = 2,199 individuals (49.4% females, age = 52.1 ± 13.6 years) which were divided into a low and high alexithymic group by a median split of the Toronto Alexithymia Scale. Cortical correlation networks were constructed based on the mean thicknesses of 68 regions, and differences in centralities were investigated. RESULTS We found a significantly increased centrality of the right paracentral lobule in the high alexithymia network after correction for multiple testing. Several other regions with motoric and sensory functions showed altered centrality on a nominally significant level. CONCLUSIONS Finding increased centrality of the paracentral lobule, a brain area with sensory as well as motoric features and involvement in bowel and bladder voiding, may contribute to explain the association of alexithymia with functional somatic disorders and chronic pain syndromes.
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Affiliation(s)
- Jan Terock
- Department of Psychiatry and Psychotherapy, Helios Hanseklinikum Stralsund, Stralsund, Germany.,Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Stefan Frenzel
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany,
| | - Katharina Wittfeld
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany.,German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Johanna Klinger-König
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Deborah Janowitz
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Robin Bülow
- Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Norbert Hosten
- Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Hans Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany.,German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
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18
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Kano M, Oudenhove LV, Dupont P, Wager TD, Fukudo S. Imaging Brain Mechanisms of Functional Somatic Syndromes: Potential as a Biomarker? TOHOKU J EXP MED 2020; 250:137-152. [PMID: 32132323 DOI: 10.1620/tjem.250.137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
When patients present with persistent bodily complaints that cannot be explained by a symptom-linked organic pathology (medically unexplained symptoms), they are diagnosed with 'functional' somatic syndromes (FSS). Despite their prevalence, the management of FSS is notoriously challenging in clinical practice. This may be because FSS are heterogeneous disorders in terms of etiopathogenesis. They include patients with primarily peripheral dysfunction, primarily centrally driven somatic symptoms, and a mix of both. Brain-imaging studies, particularly data-driven pattern recognition methods using machine learning algorithms, could provide brain-based biomarkers for these clinical conditions. In this review, we provide an overview of our brain imaging data on brain-body interactions in one of the most well-known FSS, irritable bowel syndrome (IBS), and discuss the possible development of a brain-based biomarker for FSS. Anticipation of unpredictable pain, which commonly elicits fear in FSS patients, induced increased activity in brain areas associated with hypervigilance during rectal distention and non-distention conditions in IBS. This was coupled with dysfunctional inhibitory influence of the medial prefrontal cortex (mPFC) and pregenual anterior cingulate cortex (pACC) on stress regulation systems, resulting in the activated autonomic nervous system (ANS) and neuroendocrine system stimulated by corticotropin-releasing hormone (CRH). IBS subjects with higher alexithymia, a risk factor for FSS, showed stronger activity in the insula during rectal distention but reduced subjective sensitivity. Reduced top-down regulation of the ANS and CRH system by mPFC and pACC, discordance between the insula response to stimulation and subjective sensation of pain, and stronger threat responses in hypervigilance-related areas may be a candidate brain-based biomarker.
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Affiliation(s)
- Michiko Kano
- Sukawa Clinic, Kirari Health-Coop.,Behavioral Medicine, Tohoku University Graduate School of Medicine
| | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven
| | | | - Tor D Wager
- Cognitive and Affective Neuroscience Lab, Department of Psychological and Brain Sciences, Dartmouth College
| | - Shin Fukudo
- Behavioral Medicine, Tohoku University Graduate School of Medicine.,Department of Psychosomatic Medicine, Tohoku University Hospital
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19
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Faulkner P, Dean AC, Ghahremani DG, London ED. Neural Basis of Smoking-Related Difficulties in Emotion Regulation. Int J Neuropsychopharmacol 2020; 23:409-416. [PMID: 32221527 PMCID: PMC7387763 DOI: 10.1093/ijnp/pyaa015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/05/2020] [Accepted: 03/16/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Negative emotional states contribute to cigarette smoking, and difficulties in regulating these states can hinder smoking cessation. Understanding the neural bases of these difficulties in smokers may facilitate development of novel therapies for Tobacco Use Disorder. METHODS Thirty-seven participants (18 smokers, 19 nonsmokers; 16-21 years old) completed the Difficulties in Emotion Regulation Scale (DERS), which is comprised of 6 subscales (lack of emotional clarity, lack of emotional awareness, limited access to emotion regulation strategies, nonacceptance of emotional responses, difficulties engaging in goal-directed behaviors, and impulse control difficulties) that combine to provide a total score. Participants also underwent functional magnetic resonance imaging to determine resting-state functional connectivity of the amygdala. Separate ANOVAs were used to determine group differences in self-reports on the DERS. Voxel-wise linear mixed models were performed to determine whether group influenced relationships between whole-brain functional connectivity of the amygdala and scores on the DERS. RESULTS Compared with nonsmokers, smokers reported greater difficulties in emotion regulation, denoted by higher total scores on the DERS. Group differences were observed on a subscale of lack of emotional clarity, but no other subscale differences on the DERS were observed. Nonsmokers exhibited a greater negative correlation than smokers between lack of emotional clarity scores and connectivity of the amygdala with the left inferior frontal gyrus. Finally, this amygdala-to-left inferior frontal gyrus connectivity was weaker in smokers than in nonsmokers. CONCLUSIONS These findings suggest that difficulties in emotion regulation in smokers are at least partially due to lack of emotional clarity. Given the role of the inferior frontal gyrus in understanding emotional states, strengthening connectivity between the amygdala and the inferior frontal gyrus may improve emotional clarity to help smokers regulate their negative emotions, thereby improving their ability to quit smoking.
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Affiliation(s)
- Paul Faulkner
- Department of Psychology, University of Roehampton, London, United Kingdom.,Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Andy C Dean
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California.,The Brain Research Institute, Los Angeles, California
| | - Dara G Ghahremani
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Edythe D London
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California.,The Brain Research Institute, Los Angeles, California.,Department of Molecular and Medical Pharmacology, University of California, Los Angeles, California
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20
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Alexithymia in individuals with chronic pain and its relation to pain intensity, physical interference, depression, and anxiety: a systematic review and meta-analysis. Pain 2020; 160:994-1006. [PMID: 31009416 DOI: 10.1097/j.pain.0000000000001487] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Numerous studies have examined how alexithymia (difficulty identifying and describing one's emotions and a preference for externally oriented thinking) relates to chronic pain and associated disability. We conducted a systematic review and meta-analysis to summarize individual studies that either assessed alexithymia in individuals with chronic pain vs controls or related alexithymia to pain intensity, physical interference, depression, and anxiety. We searched MEDLINE, Embase, and PsycINFO from inception through June 2017; 77 studies met the criteria (valid assessment of alexithymia in adults or children with any chronic pain condition) and were included in analyses (n = 8019 individuals with chronic pain). Primary analyses indicated that chronic pain samples had significantly higher mean alexithymia scores compared with nonclinical (d = 0.81) and clinical nonpain (d = 0.55) controls. In chronic pain samples, alexithymia was significantly positively associated with pain intensity (d = 0.20), physical interference (d = 0.17), depression (d = 0.46), and anxiety (d = 0.43). Secondary meta-analyses of 14 studies that conducted partial correlations that controlled for negative affect-related measures revealed that alexithymia was no longer significantly related to pain intensity or interference. Meta-analysis findings demonstrated that alexithymia is elevated in individuals with chronic pain and related to greater pain intensity and physical interference, although the latter relationships may be accounted for by negative affect. Critical future work is needed that examines alexithymia assessed using non-self-report measures, develops a person-centered perspective on this construct, and identifies how alexithymia is relevant to the assessment and treatment of individuals with chronic pain.
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21
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Insula Activity to Visceral Stimulation and Endocrine Stress Responses as Associated With Alexithymia in Patients With Irritable Bowel Syndrome. Psychosom Med 2020; 82:29-38. [PMID: 31609924 DOI: 10.1097/psy.0000000000000729] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Few studies have investigated associations between alexithymia and physiological mechanisms in psychosomatic diseases. We examined associations between alexithymia and 1) perception and brain processing of visceral stimulation and 2) the endocrine responses to corticotrophin-releasing hormone (CRH) in healthy individuals and patients with irritable bowel syndrome (IBS). METHODS The study included 29 patients with IBS and 35 age- and sex-matched healthy controls (HCs). Alexithymia was measured using the 20-item Toronto Alexithymia Scale (TAS-20). Brain responses to rectal distention and its anticipation were measured by functional magnetic resonance imaging and analyzed at a voxel-level threshold of puncorrected < .001 combined with a cluster-level threshold of pFWE-corrected < .05. On a different day, plasma adrenocorticotropic hormone and cortisol responses after intravenous CRH administration were measured. RESULTS TAS-20 scores did not differ significantly between patients with IBS and HCs (p = .18). TAS-20 scores correlated positively with the individual rectal discomfort thresholds (βrobust = 0.49, p = .03) and negatively with the rating of fear before rectal distention (βrobust = -1.63, p = .04) in patients with IBS but not in HCs. Brain responses to rectal distention in the right insula and other brain regions were positively associated with TAS-20 scores to a greater extent in patients with IBS than in HCs. Individuals with higher TAS-20 scores (both patients with IBS and HCs) demonstrated stronger adrenocorticotropic hormone responses to CRH administration (F(4,224) = 3.54, p = .008). CONCLUSION Higher alexithymia scores are associated with stronger physiological responses, but lower anticipatory fear ratings and higher discomfort thresholds, particularly in patients with IBS.
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22
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Nam G, Lee H, Lee JH, Hur JW. Disguised Emotion in Alexithymia: Subjective Difficulties in Emotion Processing and Increased Empathic Distress. Front Psychiatry 2020; 11:698. [PMID: 32765327 PMCID: PMC7379392 DOI: 10.3389/fpsyt.2020.00698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/02/2020] [Indexed: 11/22/2022] Open
Abstract
Despite decades of speculation, many causal aspects that contribute to the heterogeneity of alexithymia still must be clarified. This study examined the extent of the alexithymia phenotype and its contribution to social function in the general population. In total, 200 participants (females = 111) completed the Toronto Alexithymia Scale-20 (TAS-20), multiple self-reporting questionnaires measuring emotion intelligence, empathy, hostility and impulsivity, and the Reading the Mind in the Eyes Test (RMET). In the multivariate analysis, highly alexithymic individuals appeared to report subjective deficits in emotion recognition and regulation as well as increased impulsivity; however, their empathy skills were intact, and even the proneness to experiencing empathic distress with others' suffering was increased among alexithymic individuals. We also compared the clinical and behavioral manifestations of highly alexithymic male and female subjects to those of each gender control group. As a result, in contrast to their subjective self-reports of emotion processing impairment, the RMET performance appeared to be preserved in alexithymic females; however, highly alexithymic males showed actual deficits in the emotion identification task. Future research needs to further refine the constructs of alexithymia to incorporate the phenotypic changes in affected individuals in relation to measuring instruments, the extent of empathic distress, and gender.
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Affiliation(s)
- Gieun Nam
- Clinical Neuro-Psychology Lab, Department of Psychology, Chung-Ang University, Seoul, South Korea
| | - Hyerin Lee
- Department of Psychology, Chung-Ang University, Seoul, South Korea
| | - Jang-Han Lee
- Clinical Neuro-Psychology Lab, Department of Psychology, Chung-Ang University, Seoul, South Korea
| | - Ji-Won Hur
- Department of Psychology, Korea University, Seoul, South Korea
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23
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Aaron RV, Fisher EA, Palermo TM. Alexithymia in adolescents with and without chronic pain. Rehabil Psychol 2019; 64:469-474. [PMID: 31393153 DOI: 10.1037/rep0000287] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE/OBJECTIVE Alexithymia refers to reduced emotional awareness and is associated with higher levels of burden and disability in adults with chronic pain. Limited research has examined alexithymia in adolescents with chronic pain. The current study aimed to (a) determine whether alexithymia was higher in adolescents with (vs. without) chronic pain and (b) examine the relationship between alexithymia and pain experiences in youth. Research Method/Design: We assessed alexithymia in 22 adolescents with chronic pain and in 22 adolescents without chronic pain (otherwise healthy), and its relation to pain experiences (i.e., self-reported pain intensity, pain bothersomeness, and pain interference), while controlling for the concomitant effects of psychological distress (i.e., depressive and anxiety symptoms). RESULTS After controlling for psychological distress, adolescents with versus without chronic pain had higher total alexithymia scores (p = .042; η2 = .10), and specifically, greater difficulty identifying feelings (p = .001; η2 = .23). Difficulty identifying feelings was related to worse pain interference (r = .55; p = .015) and pain bothersomeness (r = .55; p = .015). CONCLUSIONS/IMPLICATIONS These preliminary findings suggest that adolescents with chronic pain may have greater difficulty identifying their emotions, and that this might be related to increased pain interference and pain bothersomeness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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24
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Conti C, Di Francesco G, Lanzara R, Severo M, Fumagalli L, Guagnano MT, Porcelli P. Alexithymia and binge eating in obese outpatients who are starting a weight‐loss program: A structural equation analysis. EUROPEAN EATING DISORDERS REVIEW 2019; 27:628-640. [DOI: 10.1002/erv.2696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/27/2019] [Accepted: 05/31/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Chiara Conti
- Department of Psychological, Health, and Territorial SciencesUniversity “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
| | - Giulia Di Francesco
- Department of Psychological, Health, and Territorial SciencesUniversity “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
| | - Roberta Lanzara
- Department of Psychological, Health, and Territorial SciencesUniversity “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
- Department of Dynamic and Clinical Psychology“Sapienza” University of Rome Rome Italy
| | - Melania Severo
- Department of Psychological, Health, and Territorial SciencesUniversity “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
| | - Luna Fumagalli
- Department of Psychological, Health, and Territorial SciencesUniversity “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
| | - Maria Teresa Guagnano
- Department of Medicine and AgingUniversity “G. d'Annunzio” Chieti‐Pescara Chieti Italy
| | - Piero Porcelli
- Department of Psychological, Health, and Territorial SciencesUniversity “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
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Delvecchio G, Rossetti MG, Caletti E, Arighi A, Galimberti D, Basilico P, Mercurio M, Paoli R, Cinnante C, Triulzi F, Altamura AC, Scarpini E, Brambilla P. The Neuroanatomy of Somatoform Disorders: A Magnetic Resonance Imaging Study. PSYCHOSOMATICS 2019; 60:278-288. [DOI: 10.1016/j.psym.2018.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/10/2018] [Accepted: 07/13/2018] [Indexed: 11/16/2022]
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Engel-Yeger B, Bloch B, Gonda X, Canepa G, Pompili M, Sher L, Rihmer Z, Amore M, Serafini G. Sensory profiles in unipolar and bipolar affective disorders: Possible predictors of response to antidepressant medications? A prospective follow-up study. J Affect Disord 2018; 240:237-246. [PMID: 30081295 DOI: 10.1016/j.jad.2018.07.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 05/30/2018] [Accepted: 07/14/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Sensory processing patterns have been proposed as a stable dimension able to characterize individuals with major affective disorders, but to what extent specific impairments in sensory processing may be involved in the pathophysiology of these conditions is poorly understood. We aimed to explore which sensory profiles may better respond to psychoactive medications, with particular regard to antidepressants, according to depression, alexithymia, and hopelessness levels. METHODS A total of 402 outpatients who received maintenance treatment and were in stable psychopathological conditions were recruited and completed the Adolescent/Adult Sensory Profile (AASP), Toronto Alexithymia Scale (TAS-20), second version of the Beck Depression Inventory (BDI-II), and Beck Hopelessness Scale (BHS) according to a longitudinal prospective study design including three time points of measurements. RESULTS Subjects with abnormally reduced sensory seeking, hypersensitivity, enhanced sensory avoidance, and lower ability to register information better responded to antidepressant medications according to their reduced depression levels. Similarly, participants with lower registration better responded to antidepressants as reported by lower hopelessness levels. Regression analyses revealed that the use of antidepressants was the first variable able to predict depression, hopelessness, and alexithymia levels at baseline, and after three and six months of treatment, respectively, but the pattern of sensory sensitivity contribute to the prediction of depression and hopelessness. This pattern together with low registration predicted changes in alexithymia levels. LIMITATIONS The study was limited by the modest sample size at the follow-up assessment points. DISCUSSION Exploring sensory processing patterns may provide intriguing insights into specific illness characteristics and treatment response.
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Affiliation(s)
- Batya Engel-Yeger
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
| | - Boaz Bloch
- Outpatient Psychiatric Unit, The department of Psychiatry, Emek Medical Center, Rapaport Faculty of Medicine, Technion-Israel Institute of Technology, Izhak Rabin Ave, 18000 Afula, Haifa, Israel
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Kutvolgyi Clinical Center, Semmelweis University, Budapest, Hungary; MTA-SE Neuropsychopharmacology Research Group, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary; NAP-2-SE New Antidepressant Target Research Group, Semmelweis University, Budapest
| | - Giovanna Canepa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Section of Psychiatry
| | - Maurizio Pompili
- Department of Neurosciences, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Leo Sher
- James J. Peters Veterans' Administration Medical Center and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zoltan Rihmer
- Department of Psychiatry and Psychotherapy, Kutvolgyi Clinical Center, Semmelweis University, Budapest, Hungary
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Section of Psychiatry; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Section of Psychiatry; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
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Goerlich KS. The Multifaceted Nature of Alexithymia - A Neuroscientific Perspective. Front Psychol 2018; 9:1614. [PMID: 30210420 PMCID: PMC6124373 DOI: 10.3389/fpsyg.2018.01614] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 08/13/2018] [Indexed: 12/11/2022] Open
Abstract
Neuroscientific studies have mostly employed the 20-item Toronto Alexithymia Scale (TAS-20; Bagby et al., 1994a) for the assessment of alexithymia, a self-report scale that assesses the alexithymia facets difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking. These facets can be considered to capture difficulties in the cognitive processing of emotions associated with alexithymia. However, Nemiah and Sifneos' original conceptualization of alexithymia included also an affective component, a lack of imaginative capacities, which cannot be assessed using the TAS-20. Aiming to capture the entire alexithymia construct, the Bermond-Vorst Alexithymia Questionnaire (BVAQ; Vorst and Bermond, 2001) was developed, a self-report scale which assesses two affective facets (difficulty fantasizing and difficulty emotionalizing) in addition to three cognitive facets. Based on these facets, an affective and a cognitive dimension of alexithymia can be distinguished. By now, several neuroscientific studies have investigated the neural signatures of the different facets and dimensions of alexithymia. Here, I provide an overview of the history of the alexithymia facets and dimensions and review findings provided by functional and structural magnetic resonance imaging (MRI) studies that differentiated between the alexithymia facets and/or its affective and cognitive dimensions. I then provide a synopsis of the current neuroscientific evidence for dissociable substrates of alexithymia facets and dimensions. Finally, the scientific value and clinical implications of these findings are discussed.
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Affiliation(s)
- Katharina S Goerlich
- Department of Biomedical Sciences, Behavioural and Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Kano M, Endo Y, Fukudo S. Association Between Alexithymia and Functional Gastrointestinal Disorders. Front Psychol 2018; 9:599. [PMID: 29922191 PMCID: PMC5996925 DOI: 10.3389/fpsyg.2018.00599] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 04/10/2018] [Indexed: 01/12/2023] Open
Affiliation(s)
- Michiko Kano
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai, Japan
- Behavioral Medicine, Graduated School of Medicine, Tohoku University, Sendai, Japan
- Psychosomatic Medicine, Tohoku University Hospital, Tohoku University, Sendai, Japan
| | - Yuka Endo
- Psychosomatic Medicine, Tohoku University Hospital, Tohoku University, Sendai, Japan
| | - Shin Fukudo
- Behavioral Medicine, Graduated School of Medicine, Tohoku University, Sendai, Japan
- Psychosomatic Medicine, Tohoku University Hospital, Tohoku University, Sendai, Japan
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Carrozzino D, Porcelli P. Alexithymia in Gastroenterology and Hepatology: A Systematic Review. Front Psychol 2018; 9:470. [PMID: 29681874 PMCID: PMC5897673 DOI: 10.3389/fpsyg.2018.00470] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/21/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Alexithymia is a multifaceted personality construct that represents a deficit in the cognitive processing of emotions and is currently understood to be related to a variety of medical and psychiatric conditions. The present review aims to investigate the relationship of alexithymia with gastrointestinal (GI) disorders as functional gastrointestinal disorders (FGID, as irritable bowel syndrome (IBS) and functional dyspepsia) and inflammatory bowel disease (IBD) [ulcerative colitis (UC) and Crohn's disease (CD)] and liver diseases as chronic hepatitis C (CHC), cirrhosis, and liver transplantation. Methods: The articles were selected from the main electronic databases (PsycInfo, Medline, PubMed, Web of Science, Scopus, Cochrane, and ScienceDirect) using multiple combinations of relevant search terms (defined GI and liver diseases, articles in English, use of the Toronto scales [TAS] for alexithymia). The TAS was selected as inclusion criterion because it is the most widely used measure, thus allowing comparisons across studies. Results: Forty-eight studies met the inclusion criteria, of which 38 focused on GI disorders (27 on FGID and 11 on IBD) and 10 on liver diseases. Most studies (n = 30, 62%) were cross-sectional. The prevalence of alexithymia was higher in FGID (two third or more) than IBD and liver diseases (from one third to 50% of patients, consistent with other chronic non-GI diseases) than general population (10-15%). In functional disorders, alexithymia may be viewed as a primary driver for higher visceral perception, symptom reporting, health care use, symptom persistence, and negative treatment outcomes. Also, it has been found associated with psychological distress and specific GI-related forms of anxiety in predicting symptom severity as well as post-treatment outcomes and is associated with several psychological factors increasing the burden of disease and impairing levels of quality of life. A number of critical issues (small sample sizes, patients referred to secondary and tertiary care centers, cross-sectional study design, use of one single scale for alexithymia) constitutes a limitation to the generalization of findings. Conclusions: Alexithymia showed to play different roles in gastroenterology according to the clinical characteristics and the psychological burden of the various disorders, with main relevance in increasing subjective symptom perception and affecting negatively post-treatment outcomes.
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Affiliation(s)
- Danilo Carrozzino
- Department of Psychological, Health and Territorial Sciences, University “G.d'Annunzio” of Chieti-Pescara, Chieti, Italy
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Piero Porcelli
- Department of Psychological, Health and Territorial Sciences, University “G.d'Annunzio” of Chieti-Pescara, Chieti, Italy
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Davydov DM, Naliboff B, Shahabi L, Shapiro D. Asymmetries in reciprocal baroreflex mechanisms and chronic pain severity: Focusing on irritable bowel syndrome. Neurogastroenterol Motil 2018; 30. [PMID: 28834014 DOI: 10.1111/nmo.13186] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 07/20/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Objective measures of pain severity remain ill defined, although its accurate measurement is critical. Reciprocal baroreflex mechanisms of blood pressure (BP) control were found to impact differently on pain regulation, and thus their asymmetry was hypothesized to also connect to chronic pain duration and severity. METHODS Seventy-eight female patients with irritable bowel syndrome (IBS) and 27 healthy women were assessed for IBS severity and chronicity, negative affect, and various measures of resting autonomic function including BP, heart rate and its variability (HRV), baroreceptor-sensitivity to activations and inhibitions, gains of brady- and tachy-cardiac baro-responses, gains of BP falls/rises, and BP start points for these spontaneous baroreflexes. KEY RESULTS IBS directly and indirectly (through increased negative affect) was associated with asymmetry between baroreceptor activations/inhibitions compared to symmetrical baroreflex reciprocity in the healthy women. In the IBS group, independently of specific IBS symptoms, pain chronicity was associated with (i) decreased BP falls coupled with either (a) decreased tachycardia associated with lower disease severity (earlier "pain resilience" mechanism), or (b) decreased bradycardia associated with higher disease severity (later "pain decompensation" mechanism), or (ii) increased BP start point for baroreceptor activations coupled with either (a) BP increase (delayed "pain adaptation" mechanism) or (b) affect-related HRV decrease (delayed "pain aggravation" mechanism). CONCLUSION AND INFERENCES We anticipate the findings to be a starting point for validating these autonomic metrics of pain suffering and pain coping mechanisms in other chronic pain syndromes to suggest them as biomarkers of its severity and duration for profiling and correct management of chronic pain patients.
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Affiliation(s)
- D M Davydov
- Laboratory of Neuroimmunopathology, Institute of General Pathology and Pathophysiology, Russian Academy of Sciences, Moscow, Russia.,Department of Medical Development, GLMED Longevity & Beauty Residence, Moscow, Russia
| | - B Naliboff
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - L Shahabi
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - D Shapiro
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Borhani K, Làdavas E, Fotopoulou A, Haggard P. "Lacking warmth": Alexithymia trait is related to warm-specific thermal somatosensory processing. Biol Psychol 2017; 128:132-140. [PMID: 28735971 PMCID: PMC5595273 DOI: 10.1016/j.biopsycho.2017.07.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 07/16/2017] [Accepted: 07/16/2017] [Indexed: 01/24/2023]
Abstract
Alexithymia is a personality trait involving deficits in emotional processing. The personality construct has been extensively validated, but the underlying neural and physiological systems remain controversial. One theory suggests that low-level somatosensory mechanisms act as somatic markers of emotion, underpinning cognitive and affective impairments in alexithymia. In two separate samples (total N=100), we used an established Quantitative Sensory Testing (QST) battery to probe multiple neurophysiological submodalities of somatosensation, and investigated their associations with the widely-used Toronto Alexithymia Scale (TAS-20). Experiment one found reduced sensitivity to warmth in people with higher alexithymia scores, compared to individuals with lower scores, without deficits in other somatosensory submodalities. Experiment two replicated this result in a new group of participants using a full-sample correlation between threshold for warm detection and TAS-20 scores. We discuss the relations between low-level thermoceptive function and cognitive processing of emotion.
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Affiliation(s)
- Khatereh Borhani
- Institute of Cognitive Neuroscience, University College London, London, UK; Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy; CSRNC, Centre for Studies and Research in Cognitive Neuroscience, University of Bologna, Viale Europa 980, 47521 Cesena, Italy; Institute of Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | - Elisabetta Làdavas
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy; CSRNC, Centre for Studies and Research in Cognitive Neuroscience, University of Bologna, Viale Europa 980, 47521 Cesena, Italy
| | | | - Patrick Haggard
- Institute of Cognitive Neuroscience, University College London, London, UK.
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Scarpazza C, Sellitto M, di Pellegrino G. Now or not-now? The influence of alexithymia on intertemporal decision-making. Brain Cogn 2017; 114:20-28. [PMID: 28334633 DOI: 10.1016/j.bandc.2017.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/29/2017] [Accepted: 03/13/2017] [Indexed: 01/16/2023]
Abstract
Optimal intertemporal decisions arise from the balance between an emotional-visceral component, signaling the need for immediate gratification, and a rational, long-term oriented component. Alexithymia, a personality construct characterized by amplified sensitivity to internal bodily signals of arousal, may result in enhanced activation of the emotional-visceral component over the cognitive-rational one. To test this hypothesis, participants with high- and low-alexithymia level were compared at an intertemporal decision-making task, and their choice behavior correlated with their interoceptive sensitivity. We show that high-alexithymic tend to behave more impatiently than low-alexithymic in intertemporal decisions, particularly when the sooner reward is immediately available. Moreover, the greater their sensitivity to their own visceral sensations, the greater the impatience. Together, these results suggest a disproportionate valuation of reward available immediately in high alexithymia, possibly reflecting heightened perception of bodily physiological signals, which ultimately would bias their intertemporal decision-making.
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Affiliation(s)
- Cristina Scarpazza
- Department of Psychology, University of Bologna, Bologna, Italy; CsrNC, Center for Studies and Research in Cognitive Neuroscience, University of Bologna, Cesena, Italy; Department of General Psychology, University of Padova, Padova, Italy
| | - Manuela Sellitto
- Department of Psychology, University of Bologna, Bologna, Italy; CsrNC, Center for Studies and Research in Cognitive Neuroscience, University of Bologna, Cesena, Italy; Department of Biological Psychology, Justus-Liebig-Universität Giessen, Gieβen, Germany
| | - Giuseppe di Pellegrino
- Department of Psychology, University of Bologna, Bologna, Italy; CsrNC, Center for Studies and Research in Cognitive Neuroscience, University of Bologna, Cesena, Italy; School of Psychology, Bangor University, United Kingdom.
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Extreme sensory processing patterns show a complex association with depression, and impulsivity, alexithymia, and hopelessness. J Affect Disord 2017; 210:249-257. [PMID: 28064114 DOI: 10.1016/j.jad.2016.12.019] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 10/11/2016] [Accepted: 12/17/2016] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The involvement of extreme sensory processing patterns, impulsivity, alexithymia, and hopelessness was hypothesized to contribute to the complex pathophysiology of major depression and bipolar disorder. However, the nature of the relation between these variables has not been thoroughly investigated. AIMS This study aimed to explore the association between extreme sensory processing patterns, impulsivity, alexithymia, depression, and hopelessness. METHODS We recruited 281 euthymic participants (mean age=47.4±12.1) of which 62.3% with unipolar major depression and 37.7% with bipolar disorder. All participants completed the Adolescent/Adult Sensory Profile (AASP), Toronto Alexithymia Scale (TAS-20), second version of the Beck Depression Inventory (BDI-II), Barratt Impulsivity Scale (BIS), and Beck Hopelessness Scale (BHS). RESULTS Lower registration of sensory input showed a significant correlation with depression, impulsivity, attentional/motor impulsivity, and alexithymia. It was significantly more frequent among participants with elevated hopelessness, and accounted for 22% of the variance in depression severity, 15% in greater impulsivity, 36% in alexithymia, and 3% in hopelessness. Elevated sensory seeking correlated with enhanced motor impulsivity and decreased non-planning impulsivity. Higher sensory sensitivity and sensory avoiding correlated with depression, impulsivity, and alexithymia. LIMITATIONS The study was limited by the relatively small sample size and cross-sectional nature of the study. Furthermore, only self-report measures that may be potentially biased by social desirability were used. CONCLUSION Extreme sensory processing patterns, impulsivity, alexithymia, depression, and hopelessness may show a characteristic pattern in patients with major affective disorders. The careful assessment of sensory profiles may help in developing targeted interventions and improve functional/adaptive strategies.
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Porcelli P, De Carne M, Leandro G. The role of alexithymia and gastrointestinal-specific anxiety as predictors of treatment outcome in irritable bowel syndrome. Compr Psychiatry 2017; 73:127-135. [PMID: 27940317 DOI: 10.1016/j.comppsych.2016.11.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/24/2016] [Accepted: 11/25/2016] [Indexed: 02/08/2023] Open
Abstract
In a previous investigation irritable bowel syndrome (IBS) was associated more to alexithymia than gastrointestinal-specific anxiety (GSA). In this study their independent contribution in predicting treatment outcome was longitudinally investigated. Consecutive 150 IBS patients were evaluated for IBS symptoms, alexithymia, GSA, and psychological distress with validated scales after as-usual treatment for 6-12months. The primary treatment outcome was improvement measured with the IBS-Severity Scoring System that showed 111 patients who improved and 39 who did not improve. Improvement was associated to both alexithymia (d=1.27) and GSA (d=4.63) but only alexithymia showed overtime stability by hierarchical regression, controlled for co-variables. A series of logistic and linear regressions showed that baseline alexithymia, but not GSA, independently predicted both post-treatment improvement status (Cox & Snell R2=0.15; overall classification rate=74%) and symptom change (23% of explained variance). Although alexithymia and GSA were closely related IBS symptoms, only alexithymia was found to be a stable trait and a stronger predictor of treatment outcome than GSA. Since no treatment was established to be definitely effective for IBS, clinicians might improve treatment outcome by identifying patients with high alexithymia, attempting to improve their coping skills, emotional regulation, and affective awareness.
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Affiliation(s)
- Piero Porcelli
- Psychosomatic Unit, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Castellana Grotte, Italy.
| | - Massimo De Carne
- Department of Gastroenterology 2, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Castellana Grotte, Italy.
| | - Gioacchino Leandro
- Department of Gastroenterology 1, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Castellana Grotte, Italy; Department of Liver and Digestive Health, University College of London, UK.
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Alexithymia in Adolescents with Autism Spectrum Disorder: Its Relationship to Internalising Difficulties, Sensory Modulation and Social Cognition. J Autism Dev Disord 2016; 46:1354-67. [PMID: 26659552 DOI: 10.1007/s10803-015-2670-8] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Alexithymia is a personality trait frequently found in adults with autism spectrum disorder (ASD), and has been linked to impairments in emotion recognition and empathy. The presentation of alexithymia within ASD at younger ages remains unexplored, and was examined in the present study. Alexithymia rates were significantly elevated in ASD (55%; 31/56 scoring above cut-off) versus non-ASD adolescents (16%; 5/32 scoring above cut-off). Within individuals with ASD, alexithymia was associated with increased self-reported anxiety, parent-reported emotional difficulties, self-reported sensory processing atypicalities, and poorer emotion recognition, but was not associated with theory of mind ability. Overall, our results suggest that alexithymia is highly prevalent, and has selective cognitive correlates in young people with ASD.
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Goerlich KS, Votinov M, Lammertz SE, Winkler L, Spreckelmeyer KN, Habel U, Gründer G, Gossen A. Effects of alexithymia and empathy on the neural processing of social and monetary rewards. Brain Struct Funct 2016; 222:2235-2250. [DOI: 10.1007/s00429-016-1339-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
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Brewer R, Cook R, Bird G. Alexithymia: a general deficit of interoception. ROYAL SOCIETY OPEN SCIENCE 2016; 3:150664. [PMID: 27853532 PMCID: PMC5098957 DOI: 10.1098/rsos.150664] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 09/09/2016] [Indexed: 05/22/2023]
Abstract
Alexithymia is a sub-clinical construct, traditionally characterized by difficulties identifying and describing one's own emotions. Despite the clear need for interoception (interpreting physical signals from the body) when identifying one's own emotions, little research has focused on the selectivity of this impairment. While it was originally assumed that the interoceptive deficit in alexithymia is specific to emotion, recent evidence suggests that alexithymia may also be associated with difficulties perceiving some non-affective interoceptive signals, such as one's heart rate. It is therefore possible that the impairment experienced by those with alexithymia is common to all aspects of interoception, such as interpreting signals of hunger, arousal, proprioception, tiredness and temperature. In order to determine whether alexithymia is associated with selectively impaired affective interoception, or general interoceptive impairment, we investigated the association between alexithymia and self-reported non-affective interoceptive ability, and the extent to which individuals perceive similarity between affective and non-affective states (both measured using questionnaires developed for the purpose of the current study), in both typical individuals (n = 105 (89 female), mean age = 27.5 years) and individuals reporting a diagnosis of a psychiatric condition (n = 103 (83 female), mean age = 31.3 years). Findings indicated that alexithymia was associated with poor non-affective interoception and increased perceived similarity between affective and non-affective states, in both the typical and clinical populations. We therefore suggest that rather than being specifically associated with affective impairment, alexithymia is better characterized by a general failure of interoception.
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Affiliation(s)
- Rebecca Brewer
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London SE5 8AF, UK
- School of Psychology, University of East London, University Way, London E16 2RD
- Author for correspondence: Rebecca Brewer e-mail:
| | - Richard Cook
- Department of Psychology, City University London, London EC1V OHB, UK
| | - Geoffrey Bird
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London SE5 8AF, UK
- Institute of Cognitive Neuroscience, University College London, London WC1N 3AR, UK
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Muscatello MRA, Bruno A, Mento C, Pandolfo G, Zoccali RA. Personality traits and emotional patterns in irritable bowel syndrome. World J Gastroenterol 2016; 22:6402-15. [PMID: 27605876 PMCID: PMC4968122 DOI: 10.3748/wjg.v22.i28.6402] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 05/26/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
The review focuses on those personality traits (neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness), constructs (alexithymia and distressed - Type D personality) and emotional patterns (negative and positive) that are of particular concern in health psychology, with the aim to highlight their potential role on the pathogenesis, onset, symptom clusters, clinical course, and outcome of irritable bowel syndrome (IBS). Personality traits and emotional patterns play key roles in affecting autonomic, immune, inflammatory, and endocrine functions, thus contributing not only to IBS clinical expression and symptomatic burden, but also to disease physiopathology. In this sense, psychological treatments should address those personality traits and emotional features that are constitutive of, and integral to IBS. The biopsychosocial model of illness applied to IBS acknowledges the interaction between biological, psychological, environmental, and social factors in relation to pain and functional disability. A holistic approach to IBS should take into account the heterogeneous nature of the disorder, and differentiate treatments for different types of IBS, also considering the marked individual differences in prevalent personality traits and emotional patterns. Beyond medications, and lifestyle/dietary interventions, psychological and educational treatments may provide the optimal chance of addressing clinical symptoms, comorbid conditions, and quality of life in IBS patients.
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Kanbara K, Fukunaga M. Links among emotional awareness, somatic awareness and autonomic homeostatic processing. Biopsychosoc Med 2016; 10:16. [PMID: 27175214 PMCID: PMC4863353 DOI: 10.1186/s13030-016-0059-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/11/2016] [Indexed: 11/10/2022] Open
Abstract
Emotional awareness and somatic interoceptive awareness are essential processes for human psychosomatic health. A typical trait of lacking emotional awareness related to psychosomatic symptoms is alexithymia. In contrast, alexisomia refers to the trait of lacking somatic awareness. Links between emotional and somatic awareness and homeostatic processing are also significant for the psychosomatic health. The purpose of the present paper is to review the links among emotional awareness, somatic interoceptive awareness and autonomic homeostatic processing. On the basis of the collected evidence, the following arguments were presented1: (1) The main subcortical neural substrates for these processes are limbic-related systems, which are also responsible for autonomic functions for optimization of homeostatic efficiency. (2) Considerable studies have shown that autonomic activity and/or reactivity to stress correlate with both emotional and interoceptive awareness. A hypothesis was advocated about the links between the two types of awareness and autonomic function: Autonomic dysfunction, especially high sympathetic tone at baseline and/or attenuated reactivity or variability to stress, appears to be involved in disturbance of emotional and interoceptive awareness. (3) Several studies suggest that a link or a cooperative relationship exists between emotional and somatic awareness, and that somatic awareness is the more fundamental of the two types of awareness. Emotional awareness, somatic awareness and autonomic homeostatic processing generally occur in parallel or concurrently. However, some complex features of pathologies include coexistence of reduced interoceptive awareness and somatosensory amplification. The autonomic homeostatic process is fundamentally involved in emotional and somatic awareness. Investigation of these types of awareness with both neuroimaging evaluations and estimation of peripheral autonomic function are required as next steps for exploration of the relationship between awareness and human somatic states including somatic symptoms as well as general psychosomatic health.
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Affiliation(s)
- Kenji Kanbara
- Department of Psychosomatic Medicine, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka 573-1010 Japan
| | - Mikihiko Fukunaga
- Department of Psychosomatic Medicine, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka 573-1010 Japan
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Bibby PA. Loss-Chasing, Alexithymia, and Impulsivity in a Gambling Task: Alexithymia as a Precursor to Loss-Chasing Behavior When Gambling. Front Psychol 2016; 7:3. [PMID: 26834676 PMCID: PMC4719074 DOI: 10.3389/fpsyg.2016.00003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/03/2016] [Indexed: 12/03/2022] Open
Abstract
Objective: To examine the relationship between loss-chasing, the propensity to continue gambling to recover from losses, alexithymia, a personality trait associated poor emotional processing and impulsivity, the tendency to act quickly without reflection or consideration of the consequences. Method: Two experiments are reported (E1: N = 60, Males, 11; Age, 21.6 years. E2: N = 49, Males, 22; Age, 21.1 years). In experiment 1, two groups (low alexithymia, high alexithymia) completed the Cambridge Gambling Task (CGT). Loss-chasing behavior was investigated. In experiment 2, both alexithymia (low, high) and impulsivity (low, high) were examined also using the CGT. A further change was the order of bet proportion from ascending to descending. Results: Experiment 1 shows loss-chasing behavior in participants high in alexithymia but not those low in alexithymia (ηp2=0.09). Experiment 2 shows loss-chasing behavior in participants both low and high in alexithymia but it was greater for participants high in alexithymia (ηp2 = 0.09). The effect of impulsivity was not statistically significant (ηp2 = 0.01). Loss-chasing behavior was correlated with the emotional facets of alexithymia but not the cognitive facet. Conclusions: Alexithymia is a precursor to loss-chasing when gambling and loss-chasing reflects the cognitive and emotional aspects of gambling. Specifically, the tendency to loss-chase depends on the need to recoup previous losses and failure to process the emotional consequences of those losses.
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Affiliation(s)
- Peter A Bibby
- School of Psychology, The University of Nottingham Nottingham, UK
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Viewing the Personality Traits Through a Cerebellar Lens: a Focus on the Constructs of Novelty Seeking, Harm Avoidance, and Alexithymia. THE CEREBELLUM 2016; 16:178-190. [PMID: 26739351 DOI: 10.1007/s12311-015-0754-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The variance in the range of personality trait expression appears to be linked to structural variance in specific brain regions. In evidencing associations between personality factors and neurobiological measures, it seems evident that the cerebellum has not been up to now thought as having a key role in personality. This paper will review the most recent structural and functional neuroimaging literature that engages the cerebellum in personality traits, as novelty seeking and harm avoidance, and it will discuss the findings in the context of contemporary theories of affective and cognitive cerebellar function. By using region of interest (ROI)- and voxel-based approaches, we recently evidenced that the cerebellar volumes correlate positively with novelty seeking scores and negatively with harm avoidance scores. Subjects who search for new situations as a novelty seeker does (and a harm avoiding does not do) show a different engagement of their cerebellar circuitries in order to rapidly adapt to changing environments. The emerging model of cerebellar functionality may explain how the cerebellar abilities in planning, controlling, and putting into action the behavior are associated to normal or abnormal personality constructs. In this framework, it is worth reporting that increased cerebellar volumes are even associated with high scores in alexithymia, construct of personality characterized by impairment in cognitive, emotional, and affective processing. On such a basis, it seems necessary to go over the traditional cortico-centric view of personality constructs and to address the function of the cerebellar system in sustaining aspects of motivational network that characterizes the different temperamental traits.
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Baudic S, Jayr C, Albi-Feldzer A, Fermanian J, Masselin-Dubois A, Bouhassira D, Attal N. Effect of Alexithymia and Emotional Repression on Postsurgical Pain in Women With Breast Cancer: A Prospective Longitudinal 12-Month Study. THE JOURNAL OF PAIN 2015; 17:90-100. [PMID: 26476266 DOI: 10.1016/j.jpain.2015.10.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 09/03/2015] [Accepted: 10/03/2015] [Indexed: 11/12/2022]
Abstract
UNLABELLED Alexithymia, the inability to identify and express emotions, and emotional repression, a defensive mechanism used to avoid unpleasant emotional experience, have been associated with chronic pain and medical illness including breast cancer, but whether these constructs might predict pain after breast cancer surgery has not been assessed. The present study was conducted to assess the predictive value of alexithymia and emotional repression in postoperative pain. Anxiety, depression, catastrophizing, and psychological adjustment were also assessed. Data were collected before surgery, and then at 2 days and 2, 3, 6, and 12 months after surgery. We included 100 pain-free women, 96% of whom were followed for up to 12 months. Separate multivariate analyses identified anxiety as a significant predictor of postsurgical pain at 3 months, alexithymia at 3, 6, and 12 months, and body image and catastrophizing predicted acute or subacute pain at 2 months. In contrast, emotional repression was not predictive of pain. The generalized estimating equation approach was used and identified alexithymia as the only significant predictor of pain during the 12-month period after surgery. Alexithymia, but not emotional repression, predicted the development of persistent pain after breast surgery independently of anxiety and depression. Thus, alexithymia might be involved in mechanisms of pain chronicity. PERSPECTIVE This prospective study, conducted in women with breast cancer surgery, showed that alexithymia but not emotional repression predicted postsurgical pain. These results highlight the role of dysfunction in emotional processing in the development of postsurgical pain.
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Affiliation(s)
- Sophie Baudic
- INSERM U-987, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, France; University of Versailles-Saint-Quentin, Versailles, France.
| | - Christian Jayr
- Department of General Surgery, Rene Huguenin Hospital - Curie Institute, Saint-Cloud, France
| | - Aline Albi-Feldzer
- Department of General Surgery, Rene Huguenin Hospital - Curie Institute, Saint-Cloud, France
| | | | | | - Didier Bouhassira
- INSERM U-987, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, France; University of Versailles-Saint-Quentin, Versailles, France
| | - Nadine Attal
- INSERM U-987, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, France; University of Versailles-Saint-Quentin, Versailles, France
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Scarpazza C, Làdavas E, di Pellegrino G. Dissociation between Emotional Remapping of Fear and Disgust in Alexithymia. PLoS One 2015; 10:e0140229. [PMID: 26462241 PMCID: PMC4604077 DOI: 10.1371/journal.pone.0140229] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/22/2015] [Indexed: 01/08/2023] Open
Abstract
There is growing evidence that individuals are able to understand others' emotions because they "embody" them, i.e., re-experience them by activating a representation of the observed emotion within their own body. One way to study emotion embodiment is provided by a multisensory stimulation paradigm called emotional visual remapping of touch (eVRT), in which the degree of embodiment/remapping of emotions is measured as enhanced detection of near-threshold tactile stimuli on one's own face while viewing different emotional facial expressions. Here, we measured remapping of fear and disgust in participants with low (LA) and high (HA) levels of alexithymia, a personality trait characterized by a difficulty in recognizing emotions. The results showed that fear is remapped in LA but not in HA participants, while disgust is remapped in HA but not in LA participants. To investigate the hypothesis that HA might exhibit increased responses to emotional stimuli producing a heightened physical and visceral sensations, i.e., disgust, in a second experiment we investigated participants' interoceptive abilities and the link between interoception and emotional modulations of VRT. The results showed that participants' disgust modulations of VRT correlated with their ability to perceive bodily signals. We suggest that the emotional profile of HA individuals on the eVRT task could be related to their abnormal tendency to be focalized on their internal bodily signals, and to experience emotions in a "physical" way. Finally, we speculated that these results in HA could be due to a enhancement of insular activity during the perception of disgusted faces.
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Affiliation(s)
- Cristina Scarpazza
- Department of Psychology, University of Bologna, Bologna, Italy
- CsrNC, Center for studies and research in Cognitive Neuroscience, University of Bologna, Cesena, Italy
| | - Elisabetta Làdavas
- Department of Psychology, University of Bologna, Bologna, Italy
- CsrNC, Center for studies and research in Cognitive Neuroscience, University of Bologna, Cesena, Italy
| | - Giuseppe di Pellegrino
- Department of Psychology, University of Bologna, Bologna, Italy
- CsrNC, Center for studies and research in Cognitive Neuroscience, University of Bologna, Cesena, Italy
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Pollatos O, Dietel A, Gündel H, Duschek S. Alexithymic Trait, Painful Heat Stimulation, and Everyday Pain Experience. Front Psychiatry 2015; 6:139. [PMID: 26500561 PMCID: PMC4595777 DOI: 10.3389/fpsyt.2015.00139] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 09/18/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Alexithymia was found to be associated with a variety of somatic complaints, including somatoform pain symptoms. This study addressed the question of whether the different facets of alexithymia are related to responses in heat pain stimulation and its interrelations with levels of everyday pain as assessed by self-report. METHODS In the study, sensitivity to heat pain was assessed in 50 healthy female participants. Alexithymia facets were assessed by the Toronto Alexithymia Scale. Pain threshold and tolerance were determined using a testing the limits procedure. Participants, furthermore, rated subjective intensities and unpleasantness of tonic heat stimuli (45.5-47.5°C) on visual analog scales and on a questionnaire. Possible confounding with temperature sensitivity and mood was controlled. Everyday pain was assessed by self-report addressing everyday pain frequency, intensity, and impairment experienced over the last 2 months. RESULTS Main results were that the facets of alexithymia were differentially associated with pain perception. The affective scale "difficulties in describing feelings" was associated with hyposensitivity to pain as indicated by higher pain tolerance scores. Furthermore, everyday pain frequency was related to increased alexithymia values on the affective scale "difficulties in identifying feelings," whereas higher values on the cognitive alexithymia scale "externally oriented thinking" were related to lower pain impairment and intensity. CONCLUSION We conclude that the different facets of alexithymia are related to alternations in pain processing. Further research on clinical samples is necessary to elucidate whether different aspects of alexithymia act as a vulnerability factor for the development of pain symptoms.
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Affiliation(s)
- Olga Pollatos
- Health Psychology, Institute of Psychology, University of Ulm, Ulm, Germany
| | - Anja Dietel
- Department for Endocrinology, Diabetes and Vascular Medicine, Academic Teaching Hospital Munich Bogenhausen, Munich, Germany
| | - Harald Gündel
- Clinic for Psychotherapy and Psychosomatics, University Clinic of Ulm, Ulm, Germany
| | - Stefan Duschek
- Institute of Applied Psychology, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
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Interactions between the salience and default-mode networks are disrupted in cocaine addiction. J Neurosci 2015; 35:8081-90. [PMID: 26019326 DOI: 10.1523/jneurosci.3188-14.2015] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Cocaine dependence is a complex neuropsychiatric disorder manifested as dysregulation of multiple behavioral, emotional, and cognitive constructs. Neuroimaging studies have begun to identify specific neurobiological circuit impairments in cocaine-dependent (CD) individuals that may underlie these symptoms. However, whether, where, and how the interactions within and between these circuits are disrupted remain largely unknown. We used resting-state fMRI and modularity network analysis to identify brain modules of a priori interest (default-mode network [DMN], salience network [SN], executive control network [ECN], medial temporal lobe [MTL], and striatum) in 47 CD and 47 matched healthy control (HC) participants and explored alterations within and between these brain modules as a function of addiction. At the module level, intermodule connectivity decreased between DMN and SN in CD. At the nodal level, several regions showed decreased connections with multiple modules in CD: the rostral anterior cingulate connection strength was reduced with SN and MTL; the posterior cingulate had reduced connections with ECN; and the bilateral insula demonstrated decreased connections with DMN. Furthermore, alexithymia, a personality trait previously associated with addiction, correlated negatively with intramodule connectivity within SN only in cocaine users. Our results indicate that cocaine addiction is associated with disrupted interactions among DMN, MTL, and SN, which have been implicated, respectively, in self-referential functions, emotion and memory, and coordinating between internal and external stimuli, providing novel and important insights into the neurobiological mechanisms of cocaine addiction.
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Longarzo M, D'Olimpio F, Chiavazzo A, Santangelo G, Trojano L, Grossi D. The relationships between interoception and alexithymic trait. The Self-Awareness Questionnaire in healthy subjects. Front Psychol 2015; 6:1149. [PMID: 26300829 PMCID: PMC4528101 DOI: 10.3389/fpsyg.2015.01149] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 07/23/2015] [Indexed: 11/24/2022] Open
Abstract
Interoception is the basic process enabling evaluation of one's own bodily states. Several previous studies suggested that altered interoception might be related to disorders in the ability to perceive and express emotions, i.e., alexithymia, and to defects in perceiving and describing one's own health status, i.e., hypochondriasis. The main aim of the present study was to investigate the relationships between alexithymic trait and interoceptive abilities evaluated by the “Self-Awareness Questionnaire” (SAQ), a novel self-report tool for assessing interoceptive awareness. Two hundred and fifty healthy subjects completed the SAQ, the Toronto Alexithymia Scale-20 items (TAS-20), and a questionnaire to assess hypochondriasis, the Illness Attitude Scale (IAS). The SAQ showed a two-factor structure, with good internal consistency (Cronbach's alpha = 0.88). We observed significant direct correlations between SAQ, TAS-20 and two of its subscales, and the IAS. Regression analysis confirmed that the difficulty in identifying and expressing emotions is significantly related with awareness for one's own interoceptive feelings and with a tendency to misinterpret and amplify bodily sensations. From a clinical point of view, the assessment of interoceptive awareness by the SAQ could be pivotal in evaluating several psychopathological conditions, such as the somatoform disorders.
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Affiliation(s)
- Mariachiara Longarzo
- Laboratory of Neuropsychology, Department of Psychology, Second University of Naples Caserta, Italy
| | - Francesca D'Olimpio
- Laboratory of Neuropsychology, Department of Psychology, Second University of Naples Caserta, Italy
| | - Angela Chiavazzo
- Laboratory of Neuropsychology, Department of Psychology, Second University of Naples Caserta, Italy
| | - Gabriella Santangelo
- Laboratory of Neuropsychology, Department of Psychology, Second University of Naples Caserta, Italy ; Hermitage Capodimonte Napoli, Italy
| | - Luigi Trojano
- Laboratory of Neuropsychology, Department of Psychology, Second University of Naples Caserta, Italy
| | - Dario Grossi
- Laboratory of Neuropsychology, Department of Psychology, Second University of Naples Caserta, Italy
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Wiebking C, Northoff G. Neural activity during interoceptive awareness and its associations with alexithymia-An fMRI study in major depressive disorder and non-psychiatric controls. Front Psychol 2015; 6:589. [PMID: 26074827 PMCID: PMC4444750 DOI: 10.3389/fpsyg.2015.00589] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 04/21/2015] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Alexithymia relates to difficulties recognizing and describing emotions. It has been linked to subjectively increased interoceptive awareness (IA) and to psychiatric illnesses such as major depressive disorder (MDD) and somatization. MDD in turn is characterized by aberrant emotion processing and IA on the subjective as well as on the neural level. However, a link between neural activity in response to IA and alexithymic traits in health and depression remains unclear. METHODS A well-established fMRI task was used to investigate neural activity during IA (heartbeat counting) and exteroceptive awareness (tone counting) in non-psychiatric controls (NC) and MDD. Firstly, comparing MDD and NC, a linear relationship between IA-related activity and scores of the Toronto Alexithymia Scale (TAS) was investigated through whole-brain regression. Secondly, NC were divided by median-split of TAS scores into groups showing low (NC-low) or high (NC-high) alexithymia. MDD and NC-high showed equally high TAS scores. Subsequently, IA-related neural activity was compared on a whole-brain level between the three independent samples (MDD, NC-low, NC-high). RESULTS Whole-brain regressions between MDD and NC revealed neural differences during IA as a function of TAS-DD (subscale difficulty describing feelings) in the supragenual anterior cingulate cortex (sACC; BA 24/32), which were due to negative associations between TAS-DD and IA-related activity in NC. Contrasting NC subgroups after median-split on a whole-brain level, high TAS scores were associated with decreased neural activity during IA in the sACC and increased insula activity. Though having equally high alexithymia scores, NC-high showed increased insula activity during IA compared to MDD, whilst both groups showed decreased activity in the sACC. CONCLUSIONS Within the context of decreased sACC activity during IA in alexithymia (NC-high and MDD), increased insula activity might mirror a compensatory mechanism in NC-high, which is disrupted in MDD.
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Affiliation(s)
- Christine Wiebking
- Cluster of Excellence in Cognitive Sciences, Department of Sociology of Physical Activity and Health, University of PotsdamPotsdam, Germany
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics, Institute of Mental Health Research, University of OttawaOttawa, ON, Canada
- Graduate Institute of Humanities in Medicine, Taipei Medical UniversityTaipei, Taiwan
- Taipei Medical University-Shuang Ho Hospital, Brain and Consciousness Research CenterNew Taipei City, Taiwan
- Department of Psychology, National Chengchi UniversityTaipei, Taiwan
- Center for Cognition and Brain Disorders, Normal University HangzhouHangzhou, China
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Lucci G, Pazzaglia M. Towards multiple interactions of inner and outer sensations in corporeal awareness. Front Hum Neurosci 2015; 9:163. [PMID: 25883564 PMCID: PMC4381648 DOI: 10.3389/fnhum.2015.00163] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/09/2015] [Indexed: 11/13/2022] Open
Abstract
Under normal circumstances, different inner- and outer-body sources are integrated to form coherent and accurate mental experiences of the state of the body, leading to the phenomenon of corporeal awareness. How these processes are affected by changes in inner and outer inputs to the body remains unclear. Here, we aim to present empirical evidence in which people with a massive sensory and motor disconnection may continue to experience feelings of general body state awareness without complete control of their inner and outer states. In these clinical populations, the activity of the neural structures subserving inner and outer body processing can be manipulated and tuned by means of body illusions that are usually based on multisensory stimulation. We suggest that a multisensory therapeutic approach could be adopted in the context of therapies for patients suffering from deafferentation and deefferentation. In this way, these individuals could regain a more complete feeling and control of the sensations they experience, which vary widely depending on their neurological condition.
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Affiliation(s)
- Giuliana Lucci
- IRCCS Fondazione Santa Lucia Rome, Italy ; Department of Psychology, University of Rome "La Sapienza" Rome, Italy
| | - Mariella Pazzaglia
- IRCCS Fondazione Santa Lucia Rome, Italy ; Department of Psychology, University of Rome "La Sapienza" Rome, Italy
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Santarnecchi E, D’Arista S, Egiziano E, Gardi C, Petrosino R, Vatti G, Reda M, Rossi A. Interaction between neuroanatomical and psychological changes after mindfulness-based training. PLoS One 2014; 9:e108359. [PMID: 25330321 PMCID: PMC4203679 DOI: 10.1371/journal.pone.0108359] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 08/14/2014] [Indexed: 01/29/2023] Open
Abstract
Several cross-sectional studies have documented neuroanatomical changes in individuals with a long history of meditation, while a few evidences are available about the interaction between neuroanatomical and psychological changes even during brief exposure to meditation. Here we analyzed several morphometric indexes at both cortical and subcortical brain level, as well as multiple psychological dimensions, before and after a brief -8 weeks- Mindfulness Based Stress Reduction (MBSR) training program, in a group of 23 meditation naïve-subjects compared to age-gender matched subjects. We found a significant cortical thickness increase in the right insula and the somatosensory cortex of MBSR trainees, coupled with a significant reduction of several psychological indices related to worry, state anxiety, depression and alexithymia. Most importantly, an interesting correlation between the increase in right insula thickness and the decrease in alexithymia levels during the MBSR training were observed. Moreover, a multivariate pattern classification approach allowed to identify a cluster of regions more responsive to MBSR training across subjects. Taken together, these findings documented the significant impact of a brief MBSR training on brain structures, as well as stressing the idea of MBSR as a valuable tool for alexithymia modulation, also originally providing a plausible neurobiological evidence of a major role of right insula into mediating the observed psychological changes.
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Affiliation(s)
- Emiliano Santarnecchi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
- Department of Neurological, Neurosurgical and Behavioral Sciences, University of Siena, Siena, Italy
- Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Sicilia D’Arista
- Department of Neurological, Neurosurgical and Behavioral Sciences, University of Siena, Siena, Italy
| | - Eutizio Egiziano
- Department of Neurological, Neurosurgical and Behavioral Sciences, University of Siena, Siena, Italy
| | - Concetta Gardi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Roberta Petrosino
- Department of Neurological, Neurosurgical and Behavioral Sciences, University of Siena, Siena, Italy
| | - Giampaolo Vatti
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Mario Reda
- Department of Neurological, Neurosurgical and Behavioral Sciences, University of Siena, Siena, Italy
| | - Alessandro Rossi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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