The Perth Alexithymia Questionnaire-Short Form (PAQ-S): A 6-item measure of alexithymia.

BACKGROUND: Alexithymia is a trait characterized by difficulties identifying feelings, difficulties describing feelings, and externally orientated thinking. It is widely regarded as an important transdiagnostic risk factor for a range of psychopathologies, including depressive and anxiety disorders. Whilst several well-validated psychometric measures of alexithymia exist, these are relatively lengthy, thus limiting their utility in time-pressured settings. In this paper, we address this gap by introducing and validating a brief 6-item version of the Perth Alexithymia Questionnaire, called the Perth Alexithymia Questionnaire-Short Form (PAQ-S). METHOD: Across two studies with adult samples (Study 1 N = 508 United States community; Study 2 = 378 Australian college students), we examined the psychometric properties of the PAQ-S in terms of its factor structure, reliability, and concurrent/criterion validity. RESULTS: In exploratory and confirmatory factor analyses, all PAQ-S items loaded well on a single general alexithymia factor. The PAQ-S total score had high reliability, and correlated as expected with the long-form of the PAQ, as well as other established markers of alexithymia, emotion regulation, and affective disorder symptoms. LIMITATIONS: Our samples were general community or college student samples from two Western countries; future validation work in clinical samples and more diverse cultural groups is thus needed. CONCLUSIONS: The PAQ-S retains the psychometric strengths of the PAQ. As such, the PAQ-S can be used as a quick, robust measure of overall alexithymia levels. The introduction of the PAQ-S hence enables valid assessments of alexithymia in a more diverse range of settings and research designs.

The impact of voluntariness of apologies on victims' responses in restorative justice: findings of a quantitative study.

Apologies are ordered in law without certainty about whether or not recipients perceive ordered and voluntary apologies differently. This exploratory study investigates whether or not the voluntariness of apologies influences recipients' perceptions of their sincerity, acceptance of apologies, willingness to forgive and intended retributive behaviour. We manipulated the voluntariness of apologies whilst considering offender (age, gender, ethnicity and prior wrongful behaviour) and offence (seriousness) characteristics in 3 studies (ns = 164, 121, 236). Participants adopting the role of a hypothetical victim received either a voluntary or an ordered apology. The voluntary apologies were found to have a significantly more positive impact than the ordered apologies on acceptance and perception of sincerity in all 3 studies and on forgiveness in 2 studies, but did not significantly change participants' retributive behaviour in any study. Age was the only other variable found to make a significant difference, with younger offenders' apologies being rated as sincerer.

Critical review of the use of the Rorschach in European courts.

In relation to the admissibility of evidence obtained using projective personality tests arose in F v. Bevándorlási és Állampolgársági Hivatam (2018). The Court of Justice of the European Union has held that an expert's report can only be accepted if it is based on the international scientific community's standards, but has refrained from stipulating what these standards are. It appears timely for European psychologists to decide what standards should be applied to determine whether or not a test is appropriate for psycholegal use. We propose standards and then apply them to the Rorschach because it was used in this case and is an exemplar of projective tests. We conclude that the Rorschach does not meet the proposed standards and that psychologists should abstain from using it in legal proceedings even in the absence of a clear judicial prohibition.

Assessing alexithymia in adults with acquired brain injury: Psychometric properties of the Perth Alexithymia Questionnaire.

BACKGROUND: Alexithymia is a multidimensional personality trait comprised of difficulty identifying feelings, difficulty describing feelings, and externally orientated thinking. The assessment of alexithymia in people with acquired brain injury (ABI) is of clinical interest because alexithymia is linked to poor psychosocial functioning and community reintegration after ABI. To date, alexithymia measures have not been psychometrically investigated/validated in an ABI sample, restricting confident empirical work in this area. We aimed to fill this gap by assessing the psychometric properties of the Perth Alexithymia Questionnaire (PAQ) in adults with ABI and determining whether the alexithymia construct manifests similarly in ABI samples compared to the general community. METHODS: The PAQ and Depression Anxiety Stress Scales-21 were administered to an ABI sample (N = 350) and a community sample (N = 1012). Factor structure, measurement invariance, internal consistency reliability, and concurrent/discriminant validity were explored. RESULTS: Our confirmatory factor analysis of the PAQ supported the intended five-factor correlated model as the best solution, where items loaded well onto the five intended subscales. This factor structure was invariant across ABI and community samples. Good reliability and concurrent and discriminant validity were also established. LIMITATIONS: The PAQ is a self-report measure and may be impacted by insight deficits known to occur after ABI. CONCLUSION: Our data suggests that the PAQ has good validity and reliability as a measure of alexithymia. The latent structure of alexithymia manifests similarly in ABI and community samples. This study provides the first psychometric foundation for confident assessment of alexithymia in ABI.

Why is alexithymia a risk factor for affective disorder symptoms? The role of emotion regulation.

BACKGROUND: Ever since alexithymia was defined in the 1970s, robust associations have been observed between alexithymia and a variety of symptoms of psychopathology. Alexithymia is now widely regarded as an important transdiagnostic risk factor, and it is frequently assessed in clinical and research settings. However, despite this strong interest, it remains unclear exactly why (i.e., by which mechanisms) alexithymia is linked to psychopathology. In this paper, we hypothesise that alexithymia is linked to affective disorder symptoms because alexithymia impairs people's ability to regulate their emotions, and we empirically test this hypothesis. METHOD: We administered a battery of psychometric measures to 501 adults in the United States, and examined the direct and indirect effects between alexithymia (Perth Alexithymia Questionnaire), emotion regulation ability (Perth Emotion Regulation Competency Inventory), and affective disorder symptoms (Depression Anxiety Stress Scales-21). RESULTS: In the Pearson bivariate correlation matrix, alexithymia, emotion regulation difficulties, and affective disorder symptoms were all significantly correlated. In the modelling of direct and indirect effects, alexithymia was indirectly associated with affective disorder symptoms through emotion regulation difficulties (no significant direct effect). LIMITATIONS: Our online survey data were all self-report data and cross-sectional. Future longitudinal work would be beneficial. CONCLUSIONS: Our findings support contemporary theorising that alexithymia is linked to affective disorder symptoms via emotion regulation difficulties. These results help to clarify the mechanisms by which alexithymia may predispose people to affective disorder symptoms, and highlight the importance of considering the roles of alexithymia and emotion regulation in case conceptualisations and treatment planning.

Alexithymia in nonviolent offenders.

BACKGROUND: Alexithymia is a trait involving difficulties processing emotions. Existing data suggest it is associated with violent offending. In violent offender programmes, therefore, violent offenders are screened for alexithymia and it is attended to if necessary. No studies have, however, examined alexithymia levels in nonviolent offenders and it is, therefore, unknown whether it is also a criminogenic factor in this population. AIMS: To investigate alexithymia levels among incarcerated nonviolent offenders and compare them with a community comparison group. METHOD: The 20-item Toronto Alexithymia Scale was used to compare the alexithymia levels of 67 incarcerated nonviolent offenders with a group of 139 people from the general public living in the community. RESULTS: Alexithymia levels did not differ between the groups. CONCLUSION: It appears that alexithymia is not a criminogenic factor for nonviolent offenders and screening of such offenders appears unnecessary.

Assessing alexithymia in forensic settings: Psychometric properties of the 20-item Toronto Alexithymia Scale among incarcerated adult offenders.

BACKGROUND: Alexithymia is a trait involving difficulty identifying feelings (DIF), difficulty describing feelings (DDF) and externally orientated thinking (EOT). It is a risk factor for criminal behaviour. It is commonly assessed with the Toronto Alexithymia Scale (TAS-20), but the psychometrics of the TAS-20 have not been tested across the range of offender populations, and it has been suggested it might be unsuitable in incarcerated offenders. AIM: To establish the psychometrics of the TAS-20 among incarcerated offenders. METHODS: Factorial validity was examined using confirmatory factor analyses, and the invariance of this factor structure was tested against a published community sample. Reliability coefficients were calculated. RESULTS: One hundred and forty six incarcerated offenders were recruited. The factor structure of the TAS-20 was invariant across the samples. The intended factor structure composed of DIF, DDF and EOT factors performed well overall (with a reverse-scored method factor added), but six EOT items had low factor loadings. The total scale score and DIF and DDF subscales had acceptable reliability, but EOT did not. CONCLUSIONS: Our results suggest that the TAS-20 functions similarly in offender and community samples. Its total scale score, and DIF and DDF subscale scores can be used confidently, but the assessment of externally oriented thinking may not be adequate with this scale alone. In sum, the TAS-20 can facilitate robust assessment of alexithymia in closed criminal justice settings as well as in the wider community.

Forensic Experts' Perspectives on Australian Indigenous Sexual Offenders and Factors Important in Evaluating the Risk of Recidivism.

Law and ethics require that risk assessment should be cross-culturally valid and fair, but Australian research in this regard is underdeveloped. A logical first step in progressing the work required to build a strong evidence base on culturally sensitive risk assessment in Australia is to determine the expert views of those in the field. We interviewed 13 Australian evaluators who assess Indigenous sexual offenders' recidivism risk to determine their perceptions of the risk assessment instruments they use and the attributes they believe evaluators doing cross-cultural assessments should have. Our central findings are that evaluators use the available instruments because they believe that the same factors predict sexual recidivism for Indigenous and non-Indigenous offenders, but that they do so cautiously knowing the limitations of the instruments. Evaluators nevertheless want more research data to guide them when they use the available instruments to assess people from cultures that differ from those of people in the normative sample. Participants acknowledge that the unique challenges of assessing Indigenous sexual offenders require non-Indigenous evaluators to be culturally competent and confident. These findings should be valuable to evaluators and those who train or supervise evaluators and/or intend to establish or improve the validity of risk instruments in Australia.

Structuring the debate about research ethics in the psychology and law field: an international perspective.

Forensic psychologists' role is well established, and they are rightly well regulated because their decisions and behaviour can have a significant impact on people's rights and interests. Their ethical integrity, however, partly hinges on the psycholegal research products (data, methods and instruments) that they and others use. The ethical regulation of researchers who produce products and their research processes is, however, fragmented, limited and narrow and largely focuses on domestic research. Relatively few scholars have examined the regulation of psycholegal research or commented on the ethical implications of recent court decisions. The purpose of this paper is to start a debate about the ethical regulation of researchers in the psycholegal field and consider methods of improving it to maintain society's trust in the field.

What is alexithymia? Using factor analysis to establish its latent structure and relationship with fantasizing and emotional reactivity.

OBJECTIVE: There is ongoing uncertainty about the structure and definition of alexithymia. Conceptually, alexithymia has traditionally been defined as a multidimensional trait with four components: difficulty identifying feelings, difficulty describing feelings, externally orientated thinking, and difficulty fantasizing. However, some authors suggest that difficulty fantasizing might not be a component, and others suggest low emotional reactivity is a fifth component. In this study, we sought to clarify this issue using factor analysis. METHOD: In a sample of adults (N = 508), we administered a comprehensive battery of psychometric measures and analyzed their latent structure using exploratory factor analysis. RESULTS: Subscales assessing difficulty identifying feelings, difficulty describing feelings, and externally orientated thinking all loaded well together on the alexithymia factor. However, none of the subscales assessing aspects of difficulty fantasizing (i.e., daydreaming frequency, vividness, content, or use of daydreams to regulate emotions) loaded on the alexithymia factor. Similarly, no emotional reactivity subscales loaded on the alexithymia factor, and alexithymia was associated with higher (not lower) levels of emotional reactivity for negative emotions. CONCLUSIONS: Difficulty fantasizing and low emotional reactivity are not components of the latent alexithymia construct. The traditional four-component definition of alexithymia likely warrants refinement to a more parsimonious three-component solution.

Assessing the Risk of Australian Indigenous Sexual Offenders Reoffending: A Review of the Research Literature and Court Decisions.

The assessment of offenders' risk of reoffending, particularly sexual reoffending, is a core activity of forensic mental health practitioners. The purpose of these assessments is to reduce the risk of harm to the public, but they are controversial and become more contentious when Australian practitioners who want to undertake such assessments in an ethically responsible way must use reliable validated instruments, disclose the limitations of their assessment methods, instruments and data to judicial decision-makers and understand how decision-makers might use their reports. The purpose of this systematic literature review was to explore the practices of Australian practitioners and courts in respect of the assessment of Australian Indigenous male sexual offenders' risk of reoffending. We could not identify an instrument that has been developed for the assessment of this population group. Australian courts differ in whether they admit and give weight to practitioners' evidence and opinions based on data obtained with non-validated instruments. We could only identify three possible predictor variables with enough quantitative support to justify including them in an instrument that could be used to assess Indigenous sexual offenders. There is a need for research regarding the validity of the instruments that practitioners use.

Moral Challenges for Psychologists Working in Psychology and Law.

States have an obligation to protect themselves and their citizens from harm, and they use the coercive powers of law to investigate threats, enforce rules and arbitrate disputes, thereby impacting on people's well-being and legal rights and privileges. Psychologists as a collective have a responsibility to use their abilities, knowledge, skill and experience to enhance law's effectiveness, efficiency, and reliability in preventing harm, but their professional behaviour in this collaboration must be moral. They could, however, find their personal values to be inappropriate or there to be insufficient moral guides and could find it difficult to obtain definitive moral guidance from law. The profession's ethical principles do, however, provide well-articulated, generally accepted and profession-appropriate guidance, but practitioners might encounter moral issues that can only be solved by the profession as a whole or society.

Apologies in a Legal Setting: Insights from Research into Injured Parties' Experiences of Apologies after an Adverse Event.

There is scholarly support for the use of apologies in the settlement of legal disputes and anecdotal evidence of their effectiveness in mediation and other dispute resolution processes. There is also a growing body of empirical psychological research regarding the use and effectiveness of apologies available to inform and guide the practice of lawyers, mediators and other professionals, and judicial officers when apologies arise in legal proceedings. This article critically reviews the research literature concerning the experience of apology recipients and offers a framework for understanding the circumstances in which an apology may contribute to the resolution of a legal dispute.

Adolescent bystanders' perspectives of aggression in the online versus school environments.

Researchers' understanding of bystanders' perspectives in the cyber-environment fails to take young people's perceptions into account and remains imperfect. Interventions encouraging adolescents to help targets of cyber-aggression are therefore typically based upon traditional school-based aggression research. Twenty-four in-depth interviews with Australian 13-16 year-olds revealed two themes that reflect how young bystanders perceive differences between aggression online and at school. The physical presence theme suggests that young bystanders struggle to determine online intentions in the absence of body language, leading to hesitancy in reactions and furthermore make it easier for them to ignore online transgressions and avoid becoming involved. The authority theme indicates young bystanders perceive that, compared to the school environment, the online environment lacks clearly established rules, authority figures and formal reporting mechanisms. These differences indicate that unique strategies should be developed to encourage young bystanders to intervene in cyber-aggression situations.

A case study of the neuropsychological outcomes following microsurgery, conventional radiotherapy and stereotactic radiotherapy for an adult's recurrent craniopharyngioma.

OBJECTIVE: To examine the neuropsychological outcomes for an adult patient, 2 years after receiving microsurgery and conventional radiotherapy for a recurrent craniopharyngioma; and the impact of a further intervention, stereotactic radiotherapy, on this level of neuropsychological functioning. PARTICIPANT: JD, a 30 year old male whose recurrent craniopharyngioma had 2 years earlier been treated with two operations and conventional radiotherapy. DESIGN: JD was assessed (using standardized clinical tests) before and after a course of stereotactic radiotherapy. RESULTS: Prior to stereotactic radiotherapy (and 2 years after microsurgery and conventional radiotherapy) JD's IQ was intact, but considerable impairments were present in executive functioning, memory, theory of mind and processing speed. Fifteen months after stereotactic radiotherapy, all neuropsychological domains remained largely static or improved, supporting the utility of this treatment option in the neuropsychological domain. However, deficits in executive functioning, memory and processing speed remained. CONCLUSION: These findings suggest that, even after multiple treatments, substantial cognitive impairments can be present in an adult patient with a recurrent craniopharyngioma. This profile of deficits underlines the inadequacy of relying purely on IQ as a marker for cognitive health in this population and emphasizes the need to include neuropsychological impairments as a focus of rehabilitation with these patients.

Emotion regulation and Residual Depression Predict Psychosocial Functioning in Bipolar Disorder: Preliminary Study / Regulación de las emociones y la depresión residual predicen el funcionamiento psicosocial en el trastorno bipolar: estudio preliminar

This study explores the predictive value of various clinical, neuropsychological, functional, and emotion regulation processes for recovery in Bipolar Disorder. Clinical and demographic information was collected for 27 euthymic or residually depressed BD participants. Seventy one percent of the sample reported some degree of impairment in psychosocial functioning. Both residual depression and problems with emotion regulation were identified as significant predictors of poor psychosocial functioning. In addition, to residual depression, the results of the current study introduce a variable of emotion dysregulation to account for poor psychosocial functioning among BD populations. Improving emotion regulation strategies, in particular, concentration and task accomplishment during negative emotional states could have important consequences for improving overall psychosocial functioning among this population, helping to reduce both the economic burden and high costs to personal wellbeing associated with BD.

Este estudio explora el valor predictivo de los diversos procesos de regulación clínicos, neuropsicológicos, funcionales y emocionales para la recuperación en el Trastorno Bipolar. La información clínica y demográfica se recogió de 27 participantes de TB eutímicos o residualmente deprimidos. Setenta y uno por ciento de la muestra reportó algún grado de deterioro en el funcionamiento psicosocial. Tanto la depresión residual y problemas con la regulación de las emociones fueron identificados como predictores significativos de mal funcionamiento psicosocial. Además de la depresión residual, los resultados del presente estudio introducen una variable de disregulación emocional para dar cuenta del pobre funcionamiento psicosocial en las poblaciones de TB. La mejora de las estrategias de regulación emocional, en particular, la concentración y la realización de tareas durante los estados emocionales negativos podrían tener consecuencias importantes para mejorar el funcionamiento psicosocial global en esta población ayudando a reducir tanto la carga económica y los altos costos para el bienestar personal asociado con TB.

Apologies following an adverse medical event: The importance of focusing on the consumer's needs.

OBJECTIVE: The lack of a theoretical framework limits educators' ability to train health practitioners how to disclose, and apologise for adverse medical events. The multidimensional theory of apology proposes apologies consist of one or more components which can either be self-focused (focused on the apologiser's needs) or other-focused (focused on the needs of the consumer). We investigated whether the inclusion of other-focused elements in an apology enhanced its impact in a health setting. METHODS: 251 participants responded to a video-recording of an actor portraying a surgeon apologising to a patient for an adverse event. In one condition the apology was exclusively self-focused and in the other it was both self and other-focused. RESULTS: The self-focused apology was viewed more positively than negatively, but the apology that included additional other-focused elements elicited a more favourable reaction; it was seen as more sincere and as denoting more sorriness. CONCLUSION AND PRACTICE IMPLICATIONS: Practitioners can enhance the impact of their apologies by including other-focused elements, that is, demonstrate they understand the impact the event had on the consumers, express remorse for causing harm, and offer, or take action, to address the intangible harm caused.

Patients' and family members' views on how clinicians enact and how they should enact incident disclosure: the "100 patient stories" qualitative study.

OBJECTIVES: To investigate patients' and family members' perceptions and experiences of disclosure of healthcare incidents and to derive principles of effective disclosure. DESIGN: Retrospective qualitative study based on 100 semi-structured, in depth interviews with patients and family members. SETTING: Nationwide multisite survey across Australia. PARTICIPANTS: 39 patients and 80 family members who were involved in high severity healthcare incidents (leading to death, permanent disability, or long term harm) and incident disclosure. Recruitment was via national newspapers (43%), health services where the incidents occurred (28%), two internet marketing companies (27%), and consumer organisations (2%). MAIN OUTCOME MEASURES: Participants' recurrent experiences and concerns expressed in interviews. RESULTS: Most patients and family members felt that the health service incident disclosure rarely met their needs and expectations. They expected better preparation for incident disclosure, more shared dialogue about what went wrong, more follow-up support, input into when the time was ripe for closure, and more information about subsequent improvement in process. This analysis provided the basis for the formulation of a set of principles of effective incident disclosure. CONCLUSIONS: Despite growing prominence of open disclosure, discussion about healthcare incidents still falls short of patient and family member expectations. Healthcare organisations and providers should strengthen their efforts to meet patients' (and family members') needs and expectations.

The health implications of apologizing after an adverse event.

Australia is working towards a National Open Disclosure Standard in which all adverse incidents are disclosed to patients in all health-care facilities in the country. Among the many good reasons for this approach, one that has not attracted attention is the possibility that disclosure of an adverse incident may moderate its impact on the recovery and general health of patients. In this article, we discuss this perspective with reference to relevant psychological and physiological literature. In the absence of existing research that pursues this specific hypothesis on disclosure and health effects, we called on the extensive evidence that analogous traumatic events can lead to a prolonged state of negative affect and hyperarousal that are deleterious to recovery and health. This state is called 'unforgiveness' by some psychologists. Research suggests that unforgiveness can be alleviated if people who feel aggrieved forgive those they blame for the harm. Forgiving is a complex process, but there is evidence that it is promoted by an apologetic response that incorporates expressions of responsibility, regret and intended action. With the exception of responsibility, these components are part of open disclosure as envisaged in the Standard. We conclude that there is preliminary support from the psychological and physiological literature for further investigation of the hypothesis that disclosure can moderate the recovery and health of patients after an adverse incident, provided that the disclosure incorporates an admission of responsibility.

Exploration of the association between apology and forgiveness amongst victims of human rights violations.

Forgiving may lead to an improvement of mental health, and from a therapeutic jurisprudence perspective it is important to establish what aspects of judicial procedures can be changed to promote forgiving. The literature suggests that receiving an apology may encourage forgiving. However, there is a dearth of empirical research regarding the association between forgiving and apology in judicial settings. This paper reports the findings of a study that examined the association between forgiving and four restorative situations (i.e. excuse, admission of guilt, apology, and true sorriness) in a group of 134 victims of gross human rights violations who were actual or potential participants in the proceedings of the South African Truth and Reconciliation Commission. The best predictors of forgiveness in this sample were gender and whether victims perceived wrongdoers to be truly sorry.