COUNSELING FRAMEWORK, SPECIFICALLY AIMED AT ALEXITHYMIA, AND TAILORED TO AFFECTIVE VALENCE: PRECISE ASSESSMENT AS A KEY
- counseling and therapy,
- Perth Alexithymia Questionnaire (PAQ),
- Toronto Alexithymia Scale (TAS-20)
How to Cite
Copyright (c) 2023 Psychological Research (in the Balkans)
This work is licensed under a Creative Commons Attribution 4.0 International License.
There are numerous studies regarding therapy for high alexithymia, however, they share two limitations: the interventions studied are usually not specifically targeting alexithymia and those mentioning the valence of the emotion are rare. This could be partially due to the lack of precise measurement and diagnostics procedure. This paper aims to fill this gap by focusing on diagnostics as a fundamental first step and building on it a counseling framework specifically aimed at alexithymia and tailored to the affective valence.
This is the first research in Bulgaria that, through confirmatory factor analyses, studies two of the most widely used alexithymia self-reports – PAQ and TAS-20, comparing the psychometric properties of the Bulgarian translations and analyzing their applicability in terms of mental health and therapy.
The sample (N=360) filled PAQ, TAS-20, anxiousness, anhedonia, depression, and life satisfaction scales. Data suggest that PAQ and TAS-20 are valid and reliable instruments. Both may have wide application in screening and research, but as far as clinical decision making, PAQ seems to posses better psychometric properties. Furthermore PAQ`s more differentiated assessment might be of higher contribution since it was found that affective valence is an independent predictor of anhedonia and depression. Life satisfaction was unrelated to PAQ and negatively correlated to TAS-20, suggesting that the widely accepted assumption that alexithymia is associated with lower life satisfaction might be due to measurement specifics.
Based on literature review and empirical data from this paper, counseling framework specifically aimed at alexithymia and tailored to the affective valence is proposed.
- American Psychological Association (n.d.). Psychology Topics. Retrieved from https://www.apa.org/topics/depression
- Asl, E., Mahaki, B., Khanjani, S., & Mohammadian, Y. (2020). The assessment of alexithymia across positive and negative emotions: The psychometric properties of the Iranian version of the Perth Alexithymia Questionnaire. Iranian Journal of Psychiatry and Behavioral Sciences, 14(4):e102317. https://doi.org/10.5812/ijpbs.102317
- Bagby, R., Parker, J., & Taylor, G. (1994). The twenty-item Toronto alexithymia scale-I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38(1), 23-32. https://doi.org/10.1016/0022-3999(94)90005-1
- Bagby, R., Taylor, G., & Parker, J. (1994). The twenty-item Toronto alexithymia scale-II. Convergent, discriminant, and concurrent validity. Journal of Psychosomatic Research, 38(1), 33-40. https://doi.org/10.1016/0022-3999(94)90006-X
- Becerra, R., Baeza, C., Fernandez, A., & Preece, D. (2021). Assessing alexithymia: Psychometric properties of the Perth Alexithymia Questionnaire in a Spanish-speaking sample. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.710398
- Bernard, J. (2014). Coping strategies mediate the relationship between alexithymia and health (doctoral dissertation). Retrieved from https://digitalrepository.unm.edu/psy_etds/10
- Bilge, Y. & Bilge, Y. (2020). The measurement of Attention-appraisal model of alexithymia: Psychometric properties of the Perth Alexithymia Questionnaire in Turkish. Anadolu Psikiyatri Dergisi, 2(2), 71-79. doi: 10.5455/apd.133183
- Dimitrova, T. (2021). Alexithymia and high-risk professions – psychological care and counseling practices. Yearbook of Sofia University "St. Kliment Ohridski". Faculty of Philosophy. Psychology, 111, 75-123. https://research.uni-sofia.bg/bitstream/10506/2471/1/Annual_Psychology_T-111-2021.pdf
- Dimitrova, T. (2022). Alexithymia: Accurate measurement and specialized interventions. Perth alexithymia questionnaire in Bulgarian sample. Proceedings of the National School for Doctoral Students and Young Researchers in the Social Sciences, 3, 43-54. https://www.iphs.eu/n/images/journals/SBOR-DOKL3-FF.pdf
- Dubey, A., & Pandey, R. (2013). Mental health problems in alexithymia: Role of positive and negative emotional experiences. Journal of Projective Psychology & Mental Health, 20(2), 128–136. Retrieved from https://rpandeybhu.webs.com/Publications/Alx_PANAS.pdf
- Farhoumandi, N., Mollaey, S., Heysieattalab, S., Zarean, M., & Eyvazpour, R. (2021). Facial emotion recognition predicts alexithymia using machine learning. Hindawi: Computational Intelligence and Neuroscience, Article 2053795. https://doi.org/10.1155/2021/2053795
- Groth-Marnat, G. (2009). Handbook of psychological assessment. John Wiley & Sons.
- Hancheva, C. (in press). Bulgarian adaptation of the DSM-5 Personality Inventory, full version for adults, normative sample. Yearbook of Sofia University. Psychology book, 2023
- Kjell, O. & Diener, E. (2021). Abbreviated three-item versions of the satisfaction with life scale and the harmony in life scale yield as strong psychometric properties as the original scales. Journal of Personality Assessment, 103(2), 183-194. https://doi.org/10.1080/00223891.2020.1737093
- Kolev, D., & Deinovich-Velichkov, A. (2016). Diagnostic and therapeutic possibilities of neuro-biofeedback therapy in the neurosciences [Abstract]. Second International Congress of Clinical Psychology. Retrieved from https://www.native4native.com/images/files/33-66-1583398253.pdf
- Kroenke, K., Spitzer, R., & Williams, J. (2001). The PHQ-9. Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.https://doi.org/10.1046/j.1525-1497.2001.016009606.x
- Krueger, R., Derringer, J., Markon, K., Watson, D., & Skodol, A. (2013). The personality inventory for DSM-5 (PID-5)-Adult. American Psychiatric Association. Retrieved from https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_The-Personality-Inventory-For-DSM-5-Full-Version-Adult.pdf
- Lane, A., Luminet, O., Rimé, B., Gross, J., de Timary, P., & Mikolajczak, M. (2013). Oxytocin increases willingness to socially share one's emotions. International Journal of Psychology, 48(4), 676-81. doi: 10.1080/00207594.2012.677540
- Lane, R. (2020). Alexithymia 3.0: Reimagining alexithymia from a medical perspective. BioPsychoSocial Med 14, Article 21. https://doi.org/10.1186/s13030-020-00191-x
- Larionow, P., Preece, D., Khokhlova, O., & Iakovleva, M. (in press). Assessing alexithymia: Psychometric properties of the Russian version of the Perth alexithymia questionnaire. Clinical Psychology and Special Educaction, 12(1).
- Levant, R., Halter, M., Hayden, E., & Williams, C. (2009). The efficacy of alexithymia reduction treatment: A pilot study. The Journal of Men's Studies 17(1), 75–84. Retrieved from https://www.thefreelibrary.com/The+efficacy+of+Alexithymia+Reduction+Treatment%3A+a+pilot+study.-a0197410463
- Lumley, M., Neely, L., & Burger, A. (2007). The assessment of alexithymia in medical settings: Implications for understanding and treating health problems. Journal of Personality Assessment, 89(3), 230-246. doi:10.1080/00223890701629698
- Mattila, A., Poutanen, O., Koivisto, A., Salokangas, R., & Joukamaa, M. (2007). Alexithymia and life satisfaction in primary healthcare patients. Psychosomatics, 48(6), 523-9. https://doi.org/10.1176/appi.psy.48.6.523
- Nemiah, J., & Sifneos, P. (1970). Psychosomatic illness: A problem in communication. Psychotherapy and Psychosomatics, 18(1), 154–60. https://doi.org/10.1159/000286074
- Norman, H., Marzano, L., Oskis, A., & Coulson, M. (2021). The relationship between alexithymia and self-harm: The mediating role of mindfulness. Current Psychology, 1-13. doi: 10.1007/s12144-021-01553-6.
- Ogrodniczuk, J., Sochting, I., Piper, W., & Joyce, A. (2012). A naturalistic study of alexithymia among psychiatric outpatients treated in an integrated group therapy program. Psychology and Psychotherapy: Theory, Research and Practice, 85, 278–291. doi:10.1111/j.2044-8341.2011.02032.x
- Panayiotou, G. (2018). Alexithymia as a core trait in psychosomatic and other psychological disorders. In C. Charis & G. Panayiotou (Eds.), Somatoform and other psychosomatic disorders (pp. 89-106). Springer International Publishing AG. https://doi.org/10.1007/978-3-319-89360-0_5
- Panayiotou, G., Panteli, M., & Vlemincx, E. (2018). Processing emotions in alexithymia: A systematic review of physiological markers. In O. Luminet, R. M. Bagby, & G. J. Taylor (Eds.), Alexithymia: Advances in research, theory, and clinical practice (pp. 291-320). Cambridge University Press. doi:10.1017/9781108241595.018
- Paulus, D., & Zvolensky, M. (2020). Negative Affectivity. In: V. Zeigler-Hill, & T. K. Shackelford (Eds.), Encyclopedia of Personality and Individual Differences (pp. 3146–3152). Springer. https://doi.org/10.1007/978-3-319-24612-3_1255
- Popov, V., Psederska, E. Peneva, E., Bozgunov, K., Vasilev, G., Nedelchev, D., & Vasileva, J. (2016). Psychometric properties of the Bulgarian version of the Toronto alexithymia self-report scale (TAS-20). Psychological Research, 19(2), 25-42. Retrieved from https://journalofpsychology.org/index.php/1/issue/view/18/59
- Preece, D., Becerra, R., Allan, A., Robinson, K., Chen, W., Hasking, P., & Gross, J. (2020). Assessing alexithymia: Psychometric properties of the Perth alexithymia qustionnaire and 20-item Toronto alexithymia scale in United States adults. Personality and Individual Differences, 166, Article 110138, https://doi.org/10.1016/j.paid.2020.110138
- Preece, D., Becerra, R., Allan, A., Robinson, K., & Dandy, J. (2017). Establishing the theoretical components of alexithymia via factor analysis: Introduction and validation of the attention-appraisal model of alexithymia. Personality and Individual Differences, 119, 341-352. https://doi.org/10.1016/j.paid.2017.08.003
- Preece, D., Becerra, R., Boyes, M., Northcott, C., McGillivray, L., & Hasking, P. (2020). Do self-report measures of alexithymia measure alexithymia or general psychological distress? A factor analytic examination across five samples. Personality and Individual Differences, 155, Article 109721. https://doi.org/10.1016/j.paid.2019.109721
- Preece, D., Becerra, R., Robinson, K., Allan, A., Boyes, M., Chen, W., … Gross, J. (2020). What is alexithymia? Using factor analysis to establish its latent structure and relationship with fantasizing and emotional reactivity. Journal of Personality, 88(6), 1162-1176. https://doi.org/10.1111/jopy.12563
- Preece, D., Becerra, R., Robinson, K., Dandy, J., & Allan, A. (2018). The psychometric assessment of alexithymia: Development and validation of the Perth Alexithymia Questionnaire. Personality and Individual Differences, 132, 32-44. https://doi.org/10.1016/j.paid.2018.05.011
- Preece, D. & Gross, J. (in press). Conceptualizing alexithymia. Personality and Individual Differences. Retrieved from https://www.researchgate.net/publication/373101551_Conceptualizing_Alexithymia
- Rosenberg, N., Rufer, M., Lichev, V., Ihme, K., Grabe, H-J., Kugel, H., … Suslow, T. (2016). Observer-rated alexithymia and its relationship with the five-factor-model of personality. Psychologica Belgica, 56(2), 118-134. http://dx.doi.org/10.5334/pb.302
- Rufer, M., Albrecht, R., Zaum, J., Schnyder, U., Mueller-Pfeiffer, Ch., Hand, I., & Schmidt, O. (2010). Impact of alexithymia on treatment outcome: A naturalistic study of short-term cognitive-behavioral group therapy for panic disorder. Psychopathology, 43, 170–179. doi: 10.1159/000288639
- Samur, D., Tops, M., Schlinkert, C., Quirin, M., Cuijpers, P., & Koole, S. (2013). Four decades of research on alexithymia: Moving toward clinical applications. Frontiers in Psychology, 4, 861. https://doi.org/10.3389/fpsyg.2013.00861
- Sifneos, P. (1973). The prevalence of 'alexithymic' characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22(2), 255-62. https://doi.org/10.1159/000286529
- Tamarit, A., De la Barrera, U., Schoeps, K., Castro-Calvo, J., & Montoya-Castilla, I. (2022). Analyzing the role of resilience and life satisfaction as mediators of the impact of COVID‐19 worries on mental health. Journal of Community Psychology, 51(1), 234-250. https://doi.org/10.1002/jcop.22900
- Taylor, G., & Bagby, R. (2021). Examining proposed changes to the conceptualization of the alexithymia construct: The way forward tilts to the past. Psychotherapy and Psychosomatics, 90, 145-155. https://doi.org/10.1159/000511988
- Taylor, G., Bagby, R., & Parker, J. (1997). Disorders of Affect Regulation. Alexithymia in Medical and Psychiatric Illness. Cambridge University Press. https://doi.org/10.1017/CBO9780511526831
- Terock, J., Janowitz D., Grabe, H., Freyberger, H., Schneider, W., & Klauer, T. (2017). Alexithymia and psychotherapeutic treatment motivation: Main and interactional effects on treatment outcome. Psychotherapy and Psychosomatics, 86, 185-186. https://doi.org/10.1159/000457961
- Tominaga, Т., Choi, H., Nagoshi, Y., Wada, Y., & Fukui, К. (2013). Relationship between alexithymia and coping strategies in patients with somatoform disorder. Neuropsychiatric Disease and Treatment, 10, 55-62. doi: 10.2147/NDT.S55956
- Veronese, G., Pepe, A., Cavazzoni, F., Obaid, H., & Perez, J. (2019). Agency via life satisfaction as a protective factor from cumulative trauma and emotional distress among Bedouin children in Palestine. Frontiers in Psychology, 10, Article 1674. https://doi.org/10.3389/fpsyg.2019.01674
- White, K., McDonnell, C., & Gervino, E. (2011). Alexithymia and anxiety sensitivity in patients with non-cardiac chest pain. Journal of Behavior Therapy and Experimental Psychiatry, 42(4), 432-439. https://doi.org/10.1016/j.jbtep.2011.04.001
- Yılmaz, O., Mırçık, A., Kunduz, M., Çombaş, M., Öztürk, A., Deveci, E., & Kırpınar, I. (2019). Does psychotherapy improve alexithymia? A comparison study among patients with mild or moderate depression. Revista de Psiquiatria Clínica 46(6), 156-164. https://doi.org/10.1590/0101-60830000000217