Emotion differentiation among individuals in a randomized clinical trial for alcohol use disorder: Within- and between-person associations with affect, craving, and alcohol use in daily life.

Emotion differentiation refers to cognitively distinguishing among discrete, same-valenced emotions. Negative emotion differentiation (NED) is a transdiagnostic indicator of emotional functioning. The role of positive emotion differentiation (PED) in clinical disorders, including alcohol use disorder (AUD), is less understood. Further, despite consensus that emotions are highly variable, little is known about within-person fluctuations in NED/PED. The current study leveraged 84 consecutive daily smartphone surveys from participants (N = 181) in a clinical trial of cognitive behavioral therapy for AUD to investigate whether between-person differences in overall NED/PED, or within-person variability in daily NED/PED, were associated with affect intensity, craving, drinking, and heavy drinking in daily life. Subsequent analyses explored whether associations were moderated by baseline alexithymia. At the between-persons level, greater average PED, but not NED, was associated with lower heavy drinking odds. At the within-persons level, higher-than-usual PED was associated with lower negative affect and odds of any drinking. Individuals with baseline alexithymia had stronger negative within-person associations between daily NED and both any and heavy drinking. PED is a skill linked to less alcohol use between- and within-persons irrespective of baseline alexithymia, whereas greater daily NED appears especially important for reduced alcohol use among individuals with co-morbid AUD and alexithymia.

Estudio piloto sobre la eficacia de un tratamiento transdiagnóstico para trastornos emocionales en Atención Primaria / A Pilot Study of the Effectiveness of a Transdiagnostic Treatment for Emotional Disorders in Primary Care

Este estudio tuvo como objetivo evaluar y determinar la eficacia de un tratamiento transdiagnóstico breve en formato grupal para personas con trastornos emocionales leves y moderados y establecer correlaciones entre los cambios tras el tratamiento en las diferentes variables. Para ello, se usó un diseño experimental de grupo único (n=11) con medidas pre-post. Los participantes fueron evaluados antes y después de la intervención con las siguientes medidas: PHQ-15, PHQ-9, GAD-7, PSQW-A, RRS-B y CERQ-18. Se encontró que la terapia transdiagnóstica breve fue efectiva para reducir los síntomas depresivos (p =.005), síntomas ansiosos (p =.011) y preocupación (p = .020) con tamaños del efecto alto. Además, se encontraron correlaciones significativas positivas entre los cambios de las variables de síntomas depresivos y preocupación y entre los cambios en síntomas ansiosos y rumiación. Se concluyó que los tratamientos transdiagnóticos breves pueden ser una opción a tener en cuenta para los pacientes con trastornos emocionales leves y moderados en atención primaria debido a su eficacia en algunos síntomas y sus características. (AU)

This study aimed to evaluate and determine the efficacy of a brief transdiagnostic treatment in group format for people with mild and moderate emotional disorders, and to establish correlations between the changes after treatment in the different variables. We use a single experimental group (n=11) design with pre-post measures. Participants were assessed pre- and post-intervention with the following measures: PHQ-15, PHQ-9, GAD-7, PSQW-A, RRS-B, and CERQ-18. Brief transdiagnostic therapy was found to be effective in reducing depressive symptoms (p =.005), anxious symptoms (p=.011), and worry (p=.020) with high/moderate effect sizes. In addition, significant positive correlations were found between changes in depressive symptoms and worry variables, and between changes in anxious symptoms and rumination. In conclusion, brief transdiagnostic treatments can be a treatment to consider for patients with mild and moderate emotional disorders in primary care due to their efficacy in some symptoms and their characteristics. (AU)

Estudio piloto sobre la eficacia de un tratamiento transdiagnóstico para trastornos emocionales en Atención Primaria / A Pilot Study of the Effectiveness of a Transdiagnostic Treatment for Emotional Disorders in Primary Care

Este estudio tuvo como objetivo evaluar y determinar la eficacia de un tratamiento transdiagnóstico breve en formato grupal para personas con trastornos emocionales leves y moderados y establecer correlaciones entre los cambios tras el tratamiento en las diferentes variables. Para ello, se usó un diseño experimental de grupo único (n=11) con medidas pre-post. Los participantes fueron evaluados antes y después de la intervención con las siguientes medidas: PHQ-15, PHQ-9, GAD-7, PSQW-A, RRS-B y CERQ-18. Se encontró que la terapia transdiagnóstica breve fue efectiva para reducir los síntomas depresivos (p =.005), síntomas ansiosos (p =.011) y preocupación (p = .020) con tamaños del efecto alto. Además, se encontraron correlaciones significativas positivas entre los cambios de las variables de síntomas depresivos y preocupación y entre los cambios en síntomas ansiosos y rumiación. Se concluyó que los tratamientos transdiagnóticos breves pueden ser una opción a tener en cuenta para los pacientes con trastornos emocionales leves y moderados en atención primaria debido a su eficacia en algunos síntomas y sus características. (AU)

This study aimed to evaluate and determine the efficacy of a brief transdiagnostic treatment in group format for people with mild and moderate emotional disorders, and to establish correlations between the changes after treatment in the different variables. We use a single experimental group (n=11) design with pre-post measures. Participants were assessed pre- and post-intervention with the following measures: PHQ-15, PHQ-9, GAD-7, PSQW-A, RRS-B, and CERQ-18. Brief transdiagnostic therapy was found to be effective in reducing depressive symptoms (p =.005), anxious symptoms (p=.011), and worry (p=.020) with high/moderate effect sizes. In addition, significant positive correlations were found between changes in depressive symptoms and worry variables, and between changes in anxious symptoms and rumination. In conclusion, brief transdiagnostic treatments can be a treatment to consider for patients with mild and moderate emotional disorders in primary care due to their efficacy in some symptoms and their characteristics. (AU)

Alexithymia and treatment response for prolonged exposure therapy: An evaluation of outcomes and mechanisms.

Alexithymia is the inability to identify and recognize emotions. The present study examined the impact of alexithymia on prolonged exposure (PE) therapy. Participants (n = 68) with PTSD underwent 10 PE sessions. Alexithymia was assessed via the Toronto Alexithymia Scale (TAS-20) and the emotional clarity and awareness subscales of the Difficulties in Emotion Regulation Scale. Treatment outcomes were assessed via the PTSD checklist and Clinician-Administered PTSD Scale for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition at posttreatment and 6-month follow-up. Those with high alexithymia were more likely to endorse experiencing a full PTSD diagnosis immediately posttreatment, χ²(1) = 12.53, p = .002, and at 6-month follow-up, χ²(1) = 11.21, p = .004. Alexithymia was associated with delayed treatment effects on avoidance, with a significant reduction in symptomology observed from pre- to follow-up, t(51) = 4.52, p < .001, and not from pre- to posttreatment. Although both the low and high alexithymia groups showed significant changes in negative changes in thinking and mood, F(2, 14) = 9.18, p = .001, d = 1.57 and F(2, 50) = 13.86, p = .001, d = 1.49, respectively, the high alexithymia group exhibited a marginally lesser magnitude of treatment effect. Although those with significantly greater difficulties with emotional clarity were more likely to drop out of PE treatment, emotional clarity and awareness did not moderate treatment response. Our results confirm the efficacy of PE but also highlight that those with alexithymia show a delayed treatment response and may be at greater risk of pathology after treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Reducing alexithymia and increasing interoceptive awareness: A randomized controlled trial comparing mindfulness with dyadic socio-emotional app-based practice.

BACKGROUND: Emotion processing deficits of alexithymia are a transdiagnostic risk factor. While such deficits are malleable, the differential efficacy of brief scalable digital mental trainings remains understudied. METHODS: This randomized controlled trial probed the efficacy of mindfulness-based (MB) and partner-based socio-emotional Affect Dyad (SE) practice, both supported by weekly coaching sessions, in reducing alexithymia in 285 adult participants. We investigated the predictive role of interoceptive awareness assessed a) before and after daily practice, b) in ecological momentary assessment (EMA) before and after the intervention, and c) weekly during the 10-week intervention. RESULTS: Both interventions reduced emotion processing difficulties on the Toronto Alexithymia Scale (TAS-20). Similarly, both interventions improved interoceptive awareness immediately after daily practice and after the intervention period, yet SE outperformed MB training in EMA assessments. Further, only Dyad practice led to increases in body listening and self-regulatory aspects of the Multidimensional Assessment of Interoceptive Awareness (MAIA) over time, with the latter explaining a decrease in alexithymia. LIMITATIONS: Given the subclinical study sample, findings are limited in their generalizability to clinical samples. CONCLUSIONS: Findings suggest that app-based socio-emotional and mindfulness-based practices, supported by online coaching sessions, are effective in reducing emotion processing deficits. Dyad training showed advantages on some measures of body awareness, which predicted observed changes in alexithymia. This highlights the potential of using app-based dyadic approaches in the development of emotion awareness and regulation.

Improvement in binge eating and alexithymia predicts weight loss at 9-month follow-up of the lifestyle modification program.

PURPOSE: The aim of this longitudinal study was to examine the extent to which improved levels of binge eating (BE) behaviors, alexithymia, self-esteem, and psychological distress would predict a reduction in body mass at 9-month follow-up, following a lifestyle modification program for weight loss in obese or overweight patients. METHODS: A convenience sample of 120 obese or overweight patients were recruited. Body mass index (BMI), binge eating (BES), levels of alexithymia (TAS-20), perceived stress (PSS), depressive symptoms (SDS), and self-esteem (RSE) were assessed during their first medical examination (T1), and after a weight-loss treatment period of 9 months (T2). RESULTS: Compared with unimproved patients, improved patients reported a significant decrease in binge eating (p = 0.04) and perceived stress symptoms (p = 0.03), and a significant improvement in self-esteem (p = 0.02) over time. After controlling for gender, self-esteem, depressive symptoms, and perceived stress, baseline BMI (OR = 1.11, 95% CI [1.04,1.19]), ΔBES (OR = 0.99, 95% CI [0.98,0.99]), and ΔTAS-20 (OR = 1.03, 95% CI [1.01,1.05]) significantly and independently predicted a ≥ 5% reduction in body mass from baseline. CONCLUSIONS: Our finding supports the suggestion to consider psychological outcomes such as emotional aspects and dysfunctional eating behaviors when planning a weight loss programs to prevent a negative outcome. LEVEL OF EVIDENCE:  Level III, case-control analytic study.

Revisión de revisiones sobre la eficacia de los tratamientos psicológicos para adolescentes con trastorno de la personalidad límite / Review of reviews on the efficacy of psychological treatments for adolescents with borderline personality disorder

La literatura científica señala que es importante llevar a cabo una intervención psicológica temprana en el trastorno de la personalidad límite (TPL)debido a que en la adolescencia es cuando se observa un mayor auge de los síntomas graves. Sin embargo, existe poca literatura científica sobrequé tratamientos psicológicos son más eficaces para esta población. El objetivo de este trabajo es realizar una revisión de revisiones sobre losdatos de eficacia de los tratamientos psicológicos para adolescentes con rasgos o diagnóstico de TPL o desregulación emocional. Se seleccionaron revisiones que evaluaran la eficacia de tratamientos psicológicos en adolescentes (entre 12 y 19 años) con esta problemática. Se realizó unabúsqueda de literatura científica en diversas bases de datos (Web of Science, PsycInfo, Pubmed, Dialnet) y se incluyeron un total de 5 revisiones.Resultados: La Terapia Dialéctica Comportamental para adolescentes (DBT-A) y la Terapia Basada en la Mentalización para adolescentes (MBT-A)han demostrado su eficacia para reducir la ideación suicida, los síntomas de TPL, los niveles de ansiedad y depresión, así como mejorar la adaptación social y la calidad de vida después de la intervención. Sin embargo, algunas revisiones sugieren que la MBT-A podría no ser tan efectiva debidoa las altas tasas de abandonos. Las intervenciones psicológicas con más evidencia consiguen reducir los síntomas más graves y mejorar la calidadde vida de los adolescentes con este problema. Es fundamental intervenir lo antes posible, lo que ayudará a prevenir el desarrollo y cronicidad deun trastorno grave y difícil de tratar. (AU)

The scientific literature indicatesthat it is important to carry out early psychological intervention in borderline personality disorder (BPD) due to the fact that adolescence is when agreater upsurge of the most severe symptoms is observed. However, there is little scientific literature on which psychological treatments are mosteffective for this population. The aim of this paper is to conduct a review of reviews on the efficacy data of psychological treatments for adolescentswith traits or diagnosis of BPD or emotional dysregulation. We selected reviews that evaluated the efficacy of psychological treatments in adolescents (between 12 and 19 years old) with this problem. A search of scientific literature was carried out in various databases (Web of Science,PsycInfo, Pubmed, Dialnet) and a total of 5 reviews were included. Dialectical Behavior Therapy for Adolescents (DBT-A) and Mentalization-BasedTherapy for Adolescents (MBT-A) have demonstrated efficacy in reducing suicidal ideation, BPD symptoms, anxiety and depression levels, as wellas improving social adjustment and quality of life after the intervention. However, some reviews suggest that MBT-A may not be as effective due tohigh dropout rates. Psychological interventions with more evidence achieve to reduce the most severe symptoms and improve the quality of life ofadolescents with this problem. It is essential to intervene as early as possible, which will help prevent the development and chronicity of a severeand difficult-to-treat disorder. (AU)

Psychotherapy motivation in refugees: The role of alexithymia, stigmatization, self-esteem, and psychotherapy expectations.

OBJECTIVE: Despite elevated mental health problems, refugees tend to hold more negative attitudes toward psychological help seeking than residents of receiving countries. Therefore, we examined variables expected to be related to different aspects of psychotherapy motivation (psychological distress, knowledge about therapy, and denial of psychological helplessness) in 202 German residents and 200 refugees in Germany. METHOD: Participants completed measures of psychotherapy motivation, together with alexithymia, stigmatization toward help seeking, self-esteem, and expectations of therapy as variables with an expected relationship with psychotherapy motivation. RESULTS: Refugees reported higher scores of psychological distress, more denial of psychological helplessness, and less knowledge about psychotherapy than residents. Refugees further reported higher levels of alexithymia and lower expectations for interpersonal and intrapersonal change in therapy compared to residents. In a pathway model, alexithymia, perceived stigmatization, self-esteem, and expectations for interpersonal changes emerged as critical variables associated with psychotherapy motivation. Alexithymia and expectations for interpersonal change partly accounted for group differences of reduced psychotherapy motivation in refugees. CONCLUSIONS: We discuss implications for practice and future research with respect to reducing treatment barriers and providing culturally-sensitive treatments for refugees suffering from psychological distress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Patients' response to moments of disappointment with their therapist: the roles of disappointment experience, emotional abilities, and perceived alliance negotiation.

OBJECTIVE: Disappointment has not received sufficient attention in psychotherapy research. I examined how patients experience and respond to disappointment events with their therapist, as a function of patients' emotional abilities and perceived alliance negotiation in their therapy. METHOD: A sample of 119 patients reported their emotional abilities (i.e., emotion dysregulation and alexithymia), perceived level of alliance negotiation, their experience during a specific disappointment event with their therapist and their responses to that event. Responses were conceptualized according to Rusbult's model as exit, voice, loyalty, and neglect, and by whether the therapy was ended following the event. RESULTS: Moments of disappointment were associated with premature termination. Patients' responses were related to the quality of their experience. Alexithymia and emotion dysregulation were positively correlated with passive and destructive responses to disappointment. Patients with high levels of emotion dysregulation or alexithymia perceived the therapeutic alliance as less negotiable and responded passively and destructively in moments of disappointment with their therapist. DISCUSSION: Patients' responses to disappointment moments depend on their emotional experience, emotional abilities, as well as on their perception of the therapist's willingness to discuss the different aspects of the therapeutic relationship. The theoretical and clinical implications of these results are discussed.

Effects of DBT-based interventions on alexithymia: a systematic review.

While dialectical behavior therapy (DBT) appears effective for some psychiatric conditions commonly associated with alexithymia, it is unclear whether DBT improves difficulties experienced by alexithymic individuals. This review investigated the current evidence on the effectiveness of DBT-based interventions in improving alexithymia. A qualitative synthesis of studies that investigated the efficacy of DBT on self-reported alexithymia was performed, identifying eligible studies using EBSCO/Essentials, Google Scholar, PubMed, Web of Science, and PsychINFO databases. Eight studies were identified. Overall, the results were inconclusive due to the heterogeneity of the studies but suggest that DBT-based interventions may be associated with self-reported decreases in alexithymia and increases in the ability to identify emotional states. The literature is limited by significant methodological problems, such as the low number of controlled trials, small samples, and high variability between DBT programs, which increases the risk of bias across study outcomes. More research is needed to reach conclusions regarding the effectiveness of DBT in improving alexithymia. Future studies should conduct randomized controlled trial designs (primarily with active treatment control conditions), greater standardization of DBT-based interventions, and a more in-depth examination of the level of participant involvement in long-term DBT-based interventions may help to understand whether DBT improves alexithymia difficulties.

Implementation of a multi-family intervention for children with behavioural and emotional problems in a semi-rural population.

OBJECTIVE: To determine the feasibility of implementing a community-based, multi-family group intervention in a semi-rural population in Aranzazu, northern Caldas, Colombia. METHODS: Qualitative study. A convenience sample was taken of 10 families with children with affective and behavioural disorders, previously identified by the Child Behaviour Checklist (CBCL). The Multifamily Psychoeducational Psychotherapy (MF-PEP) model was adapted to the culture and needs of the families. RESULTS: The contents of the sessions and the topics and experiences that were most significant for the children and their families are described. CONCLUSIONS: The adaptation to the cultural context of the multi-family intervention had a very good acceptability by all participants: caregivers, children and therapists.

Application of the unified protocol for transdiagnostic treatment of emotional disorders in post-bariatric surgery patients: an effectiveness and feasibility study in group format

La obesidad es un grave problema de salud con implicaciones globales. La cirugía bariátrica (CB) es el tratamiento más utilizado y eficaz, pero hay pacientes que no pierden una cantidad sustancial de peso, hecho que se ha relacionado con la presencia de síntomas de alimentación emocional, ansiedad y depresión. El objetivo de este estudio es analizar la viabilidad y efectividad de una intervención basada en la regulación de las emociones denominada Protocolo Unificado (PU), aplicada en formato grupal a 6 pacientes post-CB que presentan trastornos/síntomas emocionales. Los resultados tras el tratamiento mostraron altas tasas de asistencia y satisfacción con el PU, y mejorías estadísticamente significativas para el neuroticismo, los síntomas de los trastornos alimentarios y la alimentación emocional. En el seguimiento a los 6 meses, se muestran reducciones significativas en los síntomas de ansiedad, neuroticismo, inadaptación y disregulación (d = 0.83-1.46) y el índice de masa corporal se mantuvo estable a lo largo del tiempo. Estos resultados preliminares son esperanzadores sobre la viabilidad y efectividad del PU para tratar la disregulación emocional en pacientes después de la CB.(AU)

Obesity is a serious health problem with global implications. Bariatric surgery (BS) is the most used and effective treatment, but there are patients who do not lose a substantial amount of weight, a fact that has been related with the presence of emotional eating, anxiety and depression symptoms. The aim of this study is to analyze the effectiveness and feasibility of an emotion regulation-based intervention called Unified Protocol (UP), applied in group format to 6 post-BS patients presenting emotional disorders/symptoms. Results at post-treatment shown high attendance rates and satisfaction with the UP scores and significant improvements on neuroticism, eating disorders symptoms and emotional eating. At 6-month follow-up we found significant reductions on anxiety symptoms, neuroticism, maladjustment and dysregulation (d = 0.83-1.46) and the body mass index remained stable over time. These preliminary results are encouraging about the effectiveness and feasibility of the UP to treat emotional dysregulation in patients after BS.(AU)

High-definition transcranial direct current stimulation modulates eye gaze on emotional faces in college students with alexithymia: An eye-tracking study.

BACKGROUND: Atypical eye gaze on emotional faces is a core feature of alexithymia. The inferior frontal gyrus (IFG) is considered to be the neurophysiological basis of alexithymia-related emotional face fixation. Our aim was to examine whether anodal high-definition transcranial direct current stimulation (HD-tDCS) administered to the right (r)IFG would facilitate eye gaze of emotional faces in alexithymia individuals. METHOD: Forty individuals with alexithymia were equally assigned to anodal or sham HD-tDCS of the rIFG according to the principle of randomization. The individuals then completed a free-viewing eye tracking task (including happy, sad, and neutral faces) before and after 5 consecutive days of stimulation (twice a day). RESULTS: The results showed that twice a day anodal HD-tDCS of the rIFG significantly increased the fixation time and fixation count of the eye area on happy and neutral faces, but there was no significant effect on sad faces. According to the temporal-course analysis, after the intervention, the fixation time on neutral faces increased significantly at almost all time points of the eye tracking task. For happy faces, the improvement was demonstrated between 500 and 1000 ms and between 2500 and 3500 ms. For sad faces, the fixation time improved but not significantly. CONCLUSIONS: Applying high-dose anodal HD-tDCS to the rIFG selectively facilitated eye gaze in the eye area of neutral and happy faces in individuals with alexithymia, which may improve their face processing patterns.

Effect of Aerobic Exercise on the Levels of Pain, Quality of Life, and Alexithymia in Alexithymic Individuals With Chronic Pain: A Single-Blinded Randomized Controlled Trial.

OBJECTIVE: This study aimed to investigate the effects of aerobic exercise on pain, degree of alexithymia, and quality of life in individuals with alexithymia and chronic pain. METHODS: A total of 40 participants who scored 61 or higher on the Toronto Alexithymia Scale-20 (TAS-20) were included in the study. The sample was subdivided into 2 groups using a computerized randomization program: an aerobic exercise group (n = 20) and a control group (n = 20). Participants in the aerobic exercise group underwent a 30-minute jogging protocol at 60% to 90% of maximum heart rate 3 days per week for 8 weeks under the supervision of a physiotherapist. Participants in the control group continued their daily physical activities. Outcome measures were the TAS-20, visual analog scale, Graded Chronic Pain Scale, and 36-Item Short Form Health Survey. RESULTS: There was no statistically significant difference between the demographics of the 2 groups (P > .05). There was a statistically significant improvement in TAS-20, Graded Chronic Pain Scale, visual analog scale, and 36-Item Short Form Health Survey scores of the participants in the aerobic exercise group compared to the control group (P ˂ .05). CONCLUSION: Aerobic exercise had a positive effect on pain, quality of life, and degree of alexithymia in individuals with alexithymia and chronic pain.

Revisiting alexithymia as an important construct in the treatment of anorexia nervosa: a proposal for future research.

Consistent research supports altered emotional processing in adult patients with anorexia nervosa (AN), including elevations in alexithymia, or deficits in identifying and describing emotions and other internal experiences. Despite increasing interest in emotion-focused therapies for AN, alexithymia is often not directly addressed within many existing treatments, and little empirical work has moved beyond descriptive, cross-sectional research. In this paper, we propose that refining the field's understanding of alexithymia may provide insights into poor outcomes in existing psychological treatments for AN. First, we provide a brief overview of existing work exploring alexithymia in AN, and then describe several next steps in treatment-relevant research, including differentiating alexithymia from related constructs, considering neurobiological correlates of alexithymia, testing the link between alexithymia and outcome across treatment modalities, and piloting adjunctive treatment techniques focused on emotional identification and description. Altogether, exploring adjunctive treatment approaches targeting alexithymia may offer one promising possibility for improving long-term outcomes.

Alexithymia, dissociation and emotional regulation in eating disorders: Evidence of improvement through specialized inpatient treatment.

The research into emotional regulation in eating disorders (EDs) has shown specific impairments and maladaptive coping strategies in patients, and there is an increasing interest in the role of the emotional domain in the treatment outcome. This study aims to evaluate the effect of a specialized inpatient treatment characterized by both an intensive and comprehensive standardized multidisciplinary programme based on cognitive-behavioural therapy and a flexible and personalized component implemented by third-wave interventions. A cohort of 67 female ED patients (anorexia nervosa = 28, bulimia nervosa = 28 and binge eating disorder = 11) underwent an evaluation of emotional regulation difficulties, alexithymia and dissociative symptomatology at admission to a specialized ED ward. The psychological modifications were subsequently re-evaluated upon discharge, after an inpatients treatment of 60 days, examining specific changes in the specific psychopathology. A significant improvement after specialized ED treatment was shown in alexithymia, emotional regulation difficulties and dissociation symptoms, with higher effect sizes in patients with higher alexithymia scores. As regards the specific effect of the psychological improvement, changes into alexithymia scores have shown specific correlations with ED psychopathology (p < 0.010) and with difficulties in emotional regulation (p < 0.010) in patients with higher alexithymia levels at admission. Emotional regulation and dissociation should therefore be evaluated in ED patients and may be improved with specific therapeutic approaches, while alexithymia remains a clinical trait, even with a significant reduction.

The effect of alexithymic characteristics on perceived stress and health anxiety during the COVID-19 pandemic.

OBJECTIVE: The anxiety of life that comes with the pandemic process increases the health anxiety and the level of perceived stress. However, there are uncertainties about which individuals are more sensitive. This study aims to investigate the effects of alexithymic characteristics on health anxiety and perceived stress. MATERIALS AND METHODS: The authors invited the participants to study via social media and e-mail. The data of 793 individuals, aged 18-65, collected over the internet (Google Forms) between November and December 2020 were statistically evaluated. Evaluations were made with the sociodemographic data form, the General Health Questionnaire-12 (GHQ-12), the Health Anxiety Scale (HAS), the Toronto Alexithymia Scale (TAS-20), and the Perceived Stress Scale (PSS). RESULTS: In mediation analyzes between TAS subscales and HAS, Difficulty in Identifying Feelings (DIF) most strongly predicted HAS (B=0.469, p<0.001) and indirectly affected HAS only through GHQ (CS: 0.08, B=0.108, SE:0.021, CI: 0.070, 0.153). However, both PSS (CS: 0.0128, B=0.084, SE:0.027, CI: 0.032, 0.139) and GHQ (CS: 0.02, B=0.139, SE:0.028, CI: 0.090, 0.198) played a mediating role between Difficulty Describing Feelings (DDF) and HAS. CONCLUSIONS: The present study suggests that individuals with alexithymic features are more sensitive to stress during periods of health-related increased stress, such as pandemics, and that individuals with alexithymic features should be given priority in psychotherapeutic interventions.

Developing Emotional Skills and the Therapeutic Alliance in Clients with Alexithymia: Intervention Guidelines.

Despite being a longstanding and well-established concept, alexithymia is unfamiliar for many clinicians. This article aimed to address the alexithymia concept from a clinical perspective based on a review of the research on alexithymia intervention. Several strategies are proposed to help clinicians better work with alexithymic clients in psychotherapy. Alexithymia assessment, its impact on the therapeutic alliance, and the difficulties in emotional tasks are highlighted points. Considering alexithymia will inform clinicians' current diagnosis and conceptualization and provide specific targets and venues for intervention, increasing the effectiveness of psychotherapy.

Personalized behavior management as a replacement for medications for pain control and mood regulation.

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.

Parents and peer attachment and their relationship with emotional problems in adolescence: is stress mediating? / Apego a padres e iguales y problemas emocionales en adolescentes: ¿es el estrés un mediador?

Adolescence is a vital stage susceptible to the development of stress and emotional problems that reduce well-being. The aim of this work was to study the relationship between attachment to mother, father, and peers, considering the mediating role of stress, and controlling the influence of gender and age. We also studied the relationship between stress and emotional problems with scholar and familiar variables. 700 Spanish students (54.1% girls) between 12 and 15 years participated (M = 13.59; SD = 1.07). Academic performance, family structure, parents and peer attachment (IPPA), emotional problems (SDQ) and stress (PSS-4) were assessed. Data were collected cross-sectional and analysed using SPSS 24.0 and PROCESS (model 4). Descriptive analyses, t-tests, bivariate correlations, and three mediation models were performed. Results suggest that girls suffer more stress (t = 4.51; p = .000) and more emotional problems (t = 7.31; p = .000) than boys. Age correlates positively with stress (r = .12; p = .000). Lastly, stress is a mediating variable between attachment (to both parents and peers) and emotional problems. The importance of addressing stress and emotional symptoms management in adolescence is discussed, particularly in adolescents with poorer quality relationships with their parents and peers. (AU)

La adolescencia es una etapa vital susceptiblede desarrollar estrés y problemas emocionales que reducen el bienestar. El objetivo de este trabajo fue estudiar la relación entre el apego a la madre, al padre y a los iguales, considerando el papel mediador del estrés, y controlando la influencia del género y la edad. También se estudió la relación entre el estrés y los problemas emocionales con variables escolares y familiares. Participaron 700 estudiantes españoles (54,1% chicas) entre 12 y 15 años (M = 13,59; DT = 1.07). Se evaluaron el rendimiento académico, la estructura familiar, el apego a los padres y a los compañeros (IPPA), los problemas emocionales (SDQ) y el estrés (PSS-4). Los datos se recogieron de forma transversal y se analizaron con SPSS 24.0 y PROCESS (modelo 4). Se realizaron análisis descriptivos, pruebas t, correlaciones bivariadas y tres modelos de mediación. Los resultados sugieren que las chicas sufren más estrés (t = 4.51; p = .000) y más problemas emocionales (t = 7.31; p = .000) que los chicos. La edad de los adolescentes correlaciona positivamente con el estrés (r = .12; p = .000). Por último, el estrés es una variable mediadora entre el apego (tanto a los padres como a los compañeros) y los problemas emocionales. Se discute la importancia de abordar el manejo del estrés y de los síntomas emocionales en laadolescencia, particularmente en los adolescentes con relaciones de peor calidad con sus padres y compañeros. (AU)