How Do Self-Assessment of Alexithymia and Sensitivity to Bodily Sensations Relate to Alcohol Consumption?

Bodily confusion: Lower differentiation of emotional and physiological states in student alcohol users

BACKGROUND

Alexithymia, difficulty in recognising and naming emotions, is common among people who use alcohol. There is also emerging evidence that people with alexithymia are unable to distinguish emotions from non-emotional physiological states. The project aimed to test if alcohol use is related to the way student drinkers experience emotions and physiological states in the body.

METHODS

We employed a novel method to study bodily sensations related to emotions and physiological states in the context of alcohol use: the emBODY tool, which allowed participants to mark areas of the body in which they experience various emotions and physiological states.

RESULTS

Students who showed a hazardous pattern of alcohol use (alcohol use disorders identification test [AUDIT] score ≥ 7, N = 91), overall, presented higher alexithymia levels and coloured larger areas for emotions and physiological states (showed less specificity) than those who show low-risk alcohol consumption (AUDIT ≤ 4, N = 90). Moreover, statistical classifiers distinguished feeling-specific maps less accurately for hazardous drinkers than low-risk drinkers [F(1,1998) = 441.16; p < 0.001], confirming that higher alcohol use is related to higher confusion of emotional and non-emotional bodily feelings.

CONCLUSIONS

Plausibly, this increased bodily confusion drives alcohol consumption: alcohol may serve as a means of dealing with undifferentiated changes in psychophysiological arousal accompanying emotional states.

Assessment of the mind-body connection: preliminary psychometric evidence for a new self-report questionnaire

OBJECTIVES

While interoceptive self-report scales provide a foundation for measuring the mind-body connection, they variably consider other important factors that could influence interpretations of internal bodily sensations and perceptions related to mind-body integration. The proposed Body-Mind Connection Questionnaire (BMCQ) aimed to operationalise the notion that this construct involves three major components: (a) Interoceptive Attention, (b) Sensation-Emotion Articulation, and (c) Body-Mind Values.

METHODS

Following panel review and piloting with the target population, the developed BMCQ was evaluated in 316 participants (189 identifying as female) aged 18-50 (MAge=30.78), alongside established self-report measures of interoceptive sensibility, body awareness, sensory processing sensitivity, and alexithymia. We examined the BMCQ factor structure through exploratory factor analysis and analysed convergent and discriminant validity.

RESULTS

Exploratory factor analysis supported three scales of the BMCQ, which explained 54.03% of variance. Factor loadings (>0.44) and reliability indices (0.74 to 0.85) were acceptable. Inter-scale correlations suggested that the scales are distinct but related (rs=0.38 to 0.59). BMCQ scales were supported by convergent (r=0.33 to 0.67) and discriminant evidence (rs=0.01 to 0.39, p range n.s. to <.05).

CONCLUSIONS

Preliminary psychometric properties indicate that the BMCQ is multidimensional and consists of three constructs that differentially relate to theoretically associated measures. Interoceptive Attention, Sensation-Emotion Articulation, and Body-Mind Values may serve as a basis for efficiently assessing the mind-body connection more holistically, which could be useful for developing interventions aimed at enhancing mind-body integration.

Interoception, alexithymia, and anxiety among individuals with alcohol use disorder

Background

Interoception (i.e., the ability to recognize bodily signals), alexithymia (i.e., the inability to recognize emotional states) and negative affect (i.e., unpleasant feelings such as anxiety) have been associated with alcohol use disorder (AUD). Previous research suggests that interoception may underlie alexithymia, which in turn may be associated with negative affectivity. However, this remains to be empirically tested. This study investigates whether alexithymia mediates the association between interoception and anxiety and whether this association differs across individuals with AUD and a healthy control (HC) comparison group.

Methods

The AUD group consisted of 99 participants enrolled in an 8-week abstinence-based inpatient treatment program. The HC group included 103 healthy individuals. The heartbeat counting task (HCT) was used to assess interoception (cardiac interoceptive accuracy). The Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia. The Brief Symptom Inventory (BSI) was used to assess anxiety.

Results

The moderated mediation model with interoception as the predictor, alexithymia as the mediator, and negative affect (i.e., state anxiety) as the dependent variable was tested. The analysis showed that the conditional indirect effect of interoception on anxiety via alexithymia was significant for individuals with AUD [ab = -0.300, bootstrap 95% CI = (-0.618, -0.088)], as well as for HCs [ab = -0.088, bootstrap 95% CI = (-0.195, -0.014)]; however, the conditional indirect effect significantly differed across HCs and individuals with AUD. Namely, the mediated effect was greater among individuals with AUD compared to the HC group.

Conclusion

The results suggests that interoceptive impairment contributes to greater negative affect (i.e., state anxiety) via alexithymia especially for individuals with AUD. Improving emotion recognition via therapeutic methods focused on strengthening interoceptive abilities could improve outcomes for individuals receiving treatment for AUD.

Alexithymia and Alcohol Use: Evaluating the Role of Interoceptive Sensibility with the Revised Multidimensional Assessment of Interoceptive Awareness

Alexithymia has been linked to risky or problematic alcohol use, with a common interpretation invoking deficient emotion regulation and use of alcohol to cope with distress. An alternative explanation positing a general deficit of interoception in alexithymia suggested that poor awareness of internal cues of overconsumption may promote excessive drinking. The present study assessed predictions based on these hypotheses in 337 young adult alcohol users recruited online. Participants completed validated questionnaire indices of alcohol use, alexithymia, emotion regulation, interoceptive sensibility, and sensitivity to reward and punishment. Alcohol use was positively correlated with alexithymia and reward sensitivity, and negatively correlated with emotion regulation as expected, but was uncorrelated with interoceptive sensibility. Alexithymia was not significantly correlated with most dimensions of interoceptive sensibility but was highly negatively correlated with emotion regulation. Hierarchical regression controlling for demographic variables indicated that alexithymia, emotion regulation, sex, and sensitivity to reward and punishment were significant predictors of alcohol use levels. Bootstrapped mediation test controlling for all other variables indicated mediation of the association between alexithymia and alcohol use by deficient emotion regulation but not interoceptive sensibility. Results supported the emotion regulation deficit interpretation of the association of alexithymia with alcohol use. Limitations concerning interoception measurement, online samples, self-report measures, cross-sectional designs, and collection of data during the COVID-19 pandemic are discussed. Future research could follow up on these findings by testing interoceptive accuracy in addition to interoceptive sensibility in relation to alexithymia and alcohol use.

Association between alexithymia and substance use: A systematic review and meta-analysis

Alexithymia has been associated with substance use, but the magnitude of the association has not been evaluated and sub-group differences, if any, are unknown. The aim of this meta-analysis is to systematically review the association between alexithymia and substance use (alcohol or illicit drugs). We identified studies through a systematic review of PubMed and Web of Science and obtained a total of 52 publications using the Toronto Alexithymia Scale-20 scale. Random effects meta-analysis was used to evaluate the overall and sub-group associations. Of the studies, 50 were cross-sectional and two longitudinal. Alexithymia was associated with any substance use (Cohen's d = 0.62, 95% confidence interval [CI] 0.49-0.76), with little difference between estimates for use of alcohol or illicit drugs. A stronger association was observed for the alexithymia dimension "Difficulty in Identifying Feelings" (d = 0.64, 95% CI = 0.47-0.81) and "Difficulty in Describing Feelings" (d = 0.44, 95% CI = 0.32-0.55) than for "Externally Oriented Thinking" (d = 0.19, 95% CI = 0.09-0.28). The association was stronger in studies with clinical patient populations (d = 0.83, 95% CI = 0.62-1.05) than in those investigating general or student populations, and in studies with a majority of male rather than female participants. These findings suggest a strong overall association between alexithymia and substance use and a very strong association among clinical patient populations. The association may be stronger with the emotion-related dimensions than with the cognition-related dimension of alexithymia. As nearly all the studies were cross-sectional, more longitudinal studies are needed.

Alexithymia mediates the association between childhood trauma and adolescent E-cigarette use

BACKGROUND

Adolescent electronic cigarette use (e-cigarette) is a public health concern and factors associated with vaping remain to be understood. Childhood emotional abuse/neglect is a risk factor for e-cigarettes. Yet, pathways by which trauma impacts use remain unclear. Alexithymia (i.e., difficulties identifying and describing feelings) is one possible link. Indeed, emotional abuse/neglect leads to difficulties identifying and verbalizing emotions. This impairment may lead to distress and promote e-cigarette use as a coping strategy.

METHODS

Using parallel mediation, this study examined the degree to which alexithymia, assessed using the Toronto Alexithymia Scale, mediates the link between emotional abuse/neglect, assessed using the Child and Adolescent Trauma Screen, and e-cigarette use. The sample (n = 166) consisted of adolescents from a larger multi-wave study.

RESULTS

Emotional abuse/neglect predicted difficulty describing feelings (effect = 0.23, p = 0.001), which in turn predicted e-cigarette use (effect = 0.30, p = 0.004). Moreover, difficulty describing feelings mediated the link between emotional abuse/neglect and e-cigarette use (sum of indirect 95% CI [1.68, 16.48]). Difficulty identifying feelings was not a significant mediator and the externally-oriented thinking subscale was excluded due to low reliability.

CONCLUSIONS

As e-cigarettes are often used in social contexts, teens who experience difficulty describing feelings may vape as a means of connecting emotionally with others. Moreover, nicotine, found in most e-cigarettes, releases dopamine and noradrenaline in the brain modulating action, learning, and memory processes; plausibly, improving verbalization of emotions. Programming which identifies nuances in alexithymia among adolescents with emotional abuse/neglect could mitigate e-cigarette use or delay initiation.

Relationship of Interoceptive Accuracy With Risky Decision-Making and Treatment Outcomes in Male Patients With Alcohol Use Disorder

Abstract. Lower levels of interoceptive awareness (IA) may be present in individuals with substance use disorder (SUD), and damage to related brain regions caused by substance use may disrupt IA. Disturbance in the bodily feedback system may fail to engage in effective decision-making. This study focused on the premise that interoceptive accuracy (IAc), as the primary construct of IA, is implicated in SUD and that poor IAc is linked to risky decision-making and adversely affects treatment outcomes. Eighty-five patients with alcohol use disorder (AUD) (current severity: moderate or severe) and 87 healthy control subjects were enrolled in the present study. All participants performed the heart rate tracking task and a computerized version of the Iowa gambling task (IGT). Characteristics of patients’ addiction profiles were assessed with the Addiction Profile Index (API) Clinical Form. IAc and IGT scores of patients with AUD were lower than healthy controls. IGT scores of patients with low IAc were lower than those of patients with high IAc and decreased IAc is predictive of decreased IGT scores. No significant differences were determined in treatment outcomes at 3, 6, and 12 months after hospitalization between the low-IAc and high-IAc patient groups. Our results suggest that IAc is implicated in AUD and that poor IAc is predictive of increased risky decision-making. Risky decision-making that results in substance use may be partly related to a deficit in the interoceptive ability to guide behavior. Focus on IAc without reference to complex clinical case presentations in AUD makes it difficult to draw any definitive conclusions about the role of IAc in clinical outcomes.

A network analysis of interoception, self-awareness, empathy, alexithymia, and autistic traits

Altered interoception has been consistently found in people with autism spectrum disorder (ASD), and this impairment may contribute to social cognitive dysfunctions. However, little is known regarding the intercorrelations between interoceptive sensibility, autistic, alexithymic, empathic, and self-related traits. We recruited 1360 non-clinical college students and adults to investigate the complex inter-relationship between these variables using network analysis. The resultant network revealed patterns connecting autistic traits to interoceptive sensibility, empathy, alexithymia, and self-awareness, with reasonable stability and test-retest consistency. The node of alexithymia exhibited the highest centrality and expected influence. As revealed by the network comparison test, networks constructed in high- and low-autistic subgroups were comparable in global strength and structure. Our findings suggested that alexithymia serves as an important node, bridging interoceptive deficits, self-awareness, and empathic impairments of autism spectrum disorder. The co-morbidity of alexithymia should be considered carefully in future studies of interoceptive impairments and social deficits in ASD.

Two Measures of Interoceptive Sensibility and the Relationship With Introversion and Neuroticism in an Adult Population

Interoception, the ability to detect internal bodily signals, is vital for an individual's well-being and is increasingly connected to mental health disorders. Research investigating relationships between individual differences in interoception and personality types is limited, and mixed results are reported across a variety of interoceptive tasks, measures, and conceptualisations. Guided by biological theories, this study contributed further to the understanding of the relationship between interoception and personality by utilising two interoceptive measures. A sample of adults (N = 114) completed three questionnaires online questionnaire, two assessing interoceptive sensibility (Body Perception Questionnaire, BPQ; and the Multidimensional Assessment of Interoceptive Awareness, MAIA) and one that assessed personality (Eysenck Personality Inventory, EPI). Multiple regression and correlational analyses showed no significant relationship between interoceptive sensibility and introversion, whereas a predictive relationship was demonstrated between interoceptive sensibility and neuroticism. Furthermore, the BPQ and subscales of the MAIA predicted neuroticism in different directions suggesting the two measures assess different constructs and thus strengthened support for a multidimensional consideration of interoception. The results have clinical implications, including the targeting of contemplative training approaches for individuals demonstrating high interoceptive sensibility and neurotic traits to improve the mental well-being of healthy individuals and clinical populations.

The moderating effect of alexithymia on the relationship between stress and cyberchondria

OBJECTIVES

The pandemic has increased the level of perceived stress and provided a fertile soil for Cyberchondria. This study aims to investigate the relationship between stress, cyberchondria, and alexithymia.

METHODS

This cross-sectional study used convenience sampling to carried out on a total 1,117 college students (female/male:536/581; mean age: 19.95 ± 1.32). Cyberchondria Severity Scale (CSS), Toronto Alexithymia Scale (TAS) and Short Depression Anxiety Stress Scales (DASS-21) were used to assessed the present study variables.

RESULTS

Significant differences emerged for CSS scores by gender (t = 3.74, p < 0.01) and had any comorbid disease (t = 2.47, p < 0.05), The Pearson correlation showed Cyberchondria has a significant positive correlation with stress and alexithymia (r = 0.50, p < 0.01, r = 0.36, p < 0.01). Furthermore, the regression analysis described that stress (β = 0.50, p < 0.01) and alexithymia (β = 0.36, p < 0.01) were the significant positive predictors of cyberchondria. Moreover, moderation analysis showed that alexithymia significantly strengthened the association between stress and cyberchondria (F = 107.20, p < 0.01).

CONCLUSION

The study will help medical practitioners to understand how stress and alexithymia can cause an increase in cyberchondria. This will help them to elaborate operational indications for prevention and psychological support.

Prefrontal contributions to the stability and variability of thought and conscious experience

The human prefrontal cortex is a structurally and functionally heterogenous brain region, including multiple subregions that have been linked to different large-scale brain networks. It contributes to a broad range of mental phenomena, from goal-directed thought and executive functions to mind-wandering and psychedelic experience. Here we review what is known about the functions of different prefrontal subregions and their affiliations with large-scale brain networks to examine how they may differentially contribute to the diversity of mental phenomena associated with prefrontal function. An important dimension that distinguishes across different kinds of conscious experience is the stability or variability of mental states across time. This dimension is a central feature of two recently introduced theoretical frameworks-the dynamic framework of thought (DFT) and the relaxed beliefs under psychedelics (REBUS) model-that treat neurocognitive dynamics as central to understanding and distinguishing between different mental phenomena. Here, we bring these two frameworks together to provide a synthesis of how prefrontal subregions may differentially contribute to the stability and variability of thought and conscious experience. We close by considering future directions for this work.

Clarifying the relationship between alexithymia and subjective interoception

The long-standing hypothesis that emotions rely on bodily states is back in the spotlight. This has led some researchers to suggest that alexithymia, a personality construct characterized by altered emotional awareness, reflects a general deficit in interoception. However, tests of this hypothesis have relied on heterogeneous assessment methods, leading to inconsistent results. To shed some light on this issue, we administered a battery of self-report questionnaires of interoception and alexithymia to three samples from Italy, the U.S., and Singapore (N = 814). Correlation and machine learning analyses showed that alexithymia was associated with deficits in both subjective interoceptive accuracy and attention. Alexithymics' interoceptive deficits were primarily related to difficulty identifying and describing feelings. Interoception showed a weaker association with externally-oriented thinking as operationalized by the Toronto Alexithymia Scale (TAS-20) and no association with the affective dimension of alexithymia later introduced by the Bermond-Vorst Alexithymia Questionnaire (BVAQ). We discuss our results with reference to the theoretical and psychometric differences between these two measures of alexithymia and their shortcomings. Overall, our results support the view that interoceptive deficits are a core component of alexithymia, although the latter cannot be reduced to the former.

Alexithymia disrupts emotion regulation processes and is associated with greater negative affect and alcohol problems

OBJECTIVE

Alexithymia is common among people who abuse alcohol, yet the mechanisms by which alexithymia exerts its influence remain unclear. This analysis tested a model whereby the three subscales of the Toronto Alexithymia Scale exert an indirect effect on alcohol problems through difficulties with emotion regulation and psychological distress.

METHOD

Men and women (n = 141) seeking alcohol use disorder (AUD) treatment completed the Toronto Alexithymia Scale, the Difficulties with Emotion Regulation Scale, the Brief Symptom Inventory, the Short Inventory of Problems, and the Alcohol Dependence Scale.

RESULTS

The Difficulty Identifying Feelings subscale of the Toronto Alexithymia Scale was positively associated with alcohol problems through emotion dysregulation and psychological distress. The other two subscales, Difficulty Describing Feelings and Externally oriented Thinking, were not associated with any other variables.

CONCLUSION

People with alexithymia may consume alcohol to help regulate undifferentiated states of emotional arousal. Given the prevalence of alexithymia among people who abuse alcohol, treatment supplements that enhance the identification of emotions are needed.

Atypical interoception as a common risk factor for psychopathology: A review

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.

Evidence toward the potential absence of relationship between temporal and spatial heartbeats perception

Many interoceptive tasks (i.e. measuring the sensitivity to bodily signals) are based upon heartbeats perception. However, the temporal perception of heartbeats-when heartbeats are felt-varies among individuals. Moreover, the spatial perception of heartbeats-where on the body heartbeats are felt-has not been characterized in relation to temporal. This study used a multi-interval heartbeat discrimination task in which participants judged the timing of their own heartbeats in relation to external tones. The perception of heartbeats in both time and spatial domains, and relationship between these domains was investigated. Heartbeat perception occurred on average ~ 250 ms after the ECG R-wave, most frequently sampled from the left part of the chest. Participants' confidence in discriminating the timing of heartbeats from external tones was maximal at 0 ms (tone played at R-wave). Higher confidence was related to reduced dispersion of sampling locations, but Bayesian statistics indicated the absence of relationship between temporal and spatial heartbeats perception. Finally, the spatial precision of heartbeat perception was related to state-anxiety scores, yet largely independent of cardiovascular parameters. This investigation of heartbeat perception provides fresh insights concerning interoceptive signals that contribute to emotion, cognition and behaviour.

Interoceptive Awareness, Decision-Making and Impulsiveness in Male Patients with Alcohol or Opioid Use Disorder

BACKGROUND

The present study was prepared on the assumption that interoceptive awareness (IA) and decision-making processes are implicated in addiction, and that somatic feedback plays an important role in decision-making.

METHODS

The study participants included 80 abstinent male inpatients with alcohol use disorder (n = 40) or opioid use disorder (n = 40) according to DSM-5 criteria (current severity: moderate or severe), along with 40 healthy male volunteers. All participants performed the heart rate tracking task as an objective physiological performance measure of IA and a computerized version of the Iowa gambling task (IGT) as a validated measure of decision-making. Impulsiveness was assessed using the Barratt Impulsiveness Scale 11 (BIS-11). Craving was evaluated with the Penn Alcohol Craving Scale (PACS) or Substance Craving Scale (SCS).

RESULTS

(1) Heartbeat perception (HBP) and IGT scores were similar between the patients with alcohol or opioid addiction, being significantly lower than those in the control group, and the difference remained significant even when controlling for the factors that were significant in bivariate analyses; (2) HBP scores of patients correlated significantly with IGT scores, even when controlling the effect of the related variables; (3) BIS-11 scores of patients negatively correlated significantly with HBP scores and did not correlate significantly with IGT scores; and (4) PACS/SCS scores did not correlate significantly with HBP and IGT scores.

CONCLUSIONS

Our findings support the hypothesis that IA and decision-making processes are implicated in addiction and that decreased IA is associated with impaired decision-making.

Alexithymia

Humans are highly adept at differentiating, regulating, and responding to their emotions. At the core of all these functions is emotional awareness: the conscious feeling states that are central to human mental life. Disrupted emotional awareness-a subclinical construct commonly referred to as alexithymia-is present in a range of psychiatric and neurological disorders and can have a deleterious impact on functional outcomes and treatment response. This chapter is a selective review of the current state of the science on alexithymia. We focus on two separate but related issues: (i) the functional deficits associated with alexithymia and what they reveal about the importance of emotional awareness for shaping normative human functioning, and (ii) the neural correlates of alexithymia and what they can inform us about the biological bases of emotional awareness. Lastly, we outline challenges and opportunities for alexithymia research, focusing on measurement issues and the potential utility of formal computational models of emotional awareness for advancing the fields of clinical and affective science.

Deter the emotions: Alexithymia, impulsivity and their relationship to binge drinking

Introduction

The relevance of both emotion processing and impulsivity to alcohol use and misuse is increasingly recognised, yet there is a scarcity of studies addressing their reciprocal interaction. The present study aimed to examine the role that difficulties in emotion processing and trait impulsivity play in explaining binge drinking pattern of alcohol use in student population. We looked at binge drinking, as it is a risk factor to later alcohol abuse and is a common alcohol drinking habit among students. Alexithymia (from Greek as "deter/repel emotions"), a difficulty in identifying and describing feelings in self and others is increasingly recognised as a feature of alcohol misuse.

Methods

One-hundred and seventy-four student alcohol drinkers were assessed for their drinking habits (Alcohol Use Questionnaire), as well as for alexithymia (Toronto Alexithymia Scale) and impulsivity trait (Barratt Impulsiveness Scale); facial emotional expression judgements were also tested.

Results

A direct relationships between, both, alexithymia and impulsivity, and binge drinking was found. When combined, trait impulsivity partially mediated the relationship between alexithymia and binge drinking. Facial emotional expression judgements also showed a relationship with binge drinking.

Conclusions

These findings highlight the importance of both emotion processing and impulsivity in understanding binge drinking and indicate potential routes for prevention and intervention techniques, especially towards those who may be at risk of later alcohol abuse.

Do interoceptive accuracy and interoceptive sensibility predict emotion regulation?

INTRODUCTION

Interoception refers to awareness, interpretation, and integration of sensations in the body. While interoceptive accuracy has long been regarded as a core component of emotional experience, less is known about the relationship of interoceptive accuracy and related facets of interoception to emotion regulation deficits. This study explores how interoceptive accuracy and interoceptive sensibility relate to emotion regulation in a non-clinical sample.

METHODS

Undergraduate participants completed a heartbeat perception task and the Multidimensional Assessment of Interoceptive Awareness (Noticing and Body Listening sub-scales), and rated their confidence in performance on the heartbeat perception task. Participants also completed self-report measures of emotional awareness and regulation (Profile of Emotional Competence, intrapersonal emotion identification and emotion regulation sub-scales), and rated their use of different coping strategies (Brief COPE).

RESULTS

Noticing predicted emotion identification, emotion regulation, and the use of adaptive but not maladaptive coping strategies. Heartbeat perception accuracy did not significantly contribute to the prediction of any outcome variables.

DISCUSSION

Future work is needed to extend these findings to clinical populations. The results from this study support the use of interoceptive training interventions to promote emotional wellbeing.

Psychological Distress, Alexithymia and Alcohol Misuse in Patients with Psoriasis: A Cross-Sectional Study

This study investigates (a) the prevalence of psychological distress, alexithymia and alcohol misuse in psoriasis patients; and (b) the relationship between psoriasis severity, alexithymia, alcohol and psychological distress in patients with psoriasis. A cross-sectional study was conducted. Outpatients (n = 184) with moderate to severe psoriasis completed a psychological screening battery. Measures included the Hospital Anxiety and Depression Scale, the Penn State Worry Questionnaire, the twenty-item Toronto Alexithymia Scale, the Dermatology Life Quality Index, the Psoriasis Area and Severity Index, the Self-Administered Psoriasis Area and Severity Index, and the Alcohol Use Disorders Identification Test. Demographic, clinical details and information on knowledge of psychosocial issues, alcohol and confidence on coping with distress and talking to others about psoriasis was also gathered. Alexithymia was associated with anxiety, depression and worry; subjective psoriasis severity was associated with worry. Alcohol misuse was related to anxiety and worry, but not to depression. Appropriate identification and treatment of alcohol difficulties and psychological distress of patients with psoriasis is needed.

The Role of Impulsivity Facets on the Incidence and Development of Alcohol Use Disorders

Alcohol Use Disorder (AUD) is a chronic relapsing disorder defined according to the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5; American Psychiatric Association 2013), "by a cluster of behavioural and physical symptoms, which can include, withdrawal, tolerance and craving". Social, emotional, behavioural and cognitive factors are important contributors to AUD. Impulsivity, a multifaceted behavioural concept, defined as a predisposition for rapid and unplanned actions, without considering potential negative consequences of these actions, represents an important such factor. In this chapter, research on the role of distinct impulsivity dimensions in different severity stages of alcohol use is presented.Increased self-reported (trait) impulsivity and an inability to wait, as well as difficulty to adjust behaviour appropriately following a failure to withhold a response are observed across the spectrum of alcohol-use severities. Research on temporal impulsivity (inability to delay gratification) consistently shows deficits in more severe alcohol users. Data on temporal impulsivity in early stages of alcohol use are less consistent, with some studies showing no differences between high and moderate drinkers, while others indicating increased impulsivity in high alcohol users. Data on reflexion impulsivity are currently limited to draw conclusions. Recent research is also presented suggesting the importance of perception and interpretation of physiological and emotional signals on alcohol use behaviour highlighting the necessity of comprehensive integration of the field of the study of emotion and interoception with impulsivity research.

Understanding and Taking Stock of Positive Emotion Disturbance

The prevailing view on positive emotions is that they correlate with and confer psychological health benefits for the individual, including improved social, physical and cognitive functioning. Yet an emerging wave of scientific work suggests that positive emotions are also related to a range of suboptimal psychological health outcomes, especially when the intensity, duration, or context do not optimize the individual's goals or meet current environmental demands. This paper provides an overview of the 'other side' of positive emotion, by describing and reviewing evidence supporting the emerging field of Positive Emotion Disturbance (PED). We review relevant emotion processes and key themes of PED and apply this framework to example emotional disorders, and discuss implications for psychological change and future research agendas.

The Great Disrupter: Relationship of Alexithymia to Emotion Regulation Processes and Smoking among Pregnant Women

Background: Many women continue to smoke during pregnancy, despite known risks, often in response to negative affect. Recent scholarship has begun to examine factors that decrease the success of behavioral treatments for smoking cessation in pregnancy, which are the preferred interventions. Alexithymia is one factor that may interfere with smoking cessation interventions. Alexithymia restricts access to emotional information and increases propensity toward maladaptive behaviors, including smoking. However, mechanisms underlying such effects are largely unknown. Objectives: Using data from a longitudinal treatment study, the present research examined difficulties with emotion regulation as a potential mechanism linking alexithymia and smoking. Pregnant smokers (n = 73; mean age = 24.78; SD = 4.50) completed measures related to alexithymia, smoking, emotion regulation, depression, anxiety, and anger at baseline and then again following eight sessions of Cognitive-Behavioral Smoking Cessation Treatment. Results: Nearly 40% of the sample met the criteria for alexithymia. The alexithymia group reported higher depression, anxiety, and anger. They also reported more difficulties with emotion regulation. In a path analysis, baseline alexithymia had a significant positive indirect effect on number of cigarettes smoked at the end of treatment through difficulties with emotion regulation. Conclusions/Importance: Similar to other studies, alexithymia limits the understanding of emotional information necessary for selection and implementation of adaptive coping responses. Our results extend the literature by suggesting that smoking may be an attempt to manage undifferentiated and unpleasant sensations created by alexithymia.

Testing the independence of self-reported interoceptive accuracy and attention

It has recently been proposed that measures of the perception of the state of one’s own body (“interoception”) can be categorised as one of several types depending on both how an assessment is obtained (objective measurement vs. self-report) and what is assessed (degree of interoceptive attention vs. accuracy of interoceptive perception). Under this model, a distinction is made between beliefs regarding the degree to which interoceptive signals are the object of attention and beliefs regarding one’s ability to perceive accurately interoceptive signals. This distinction is difficult to test, however, because of the paucity of measures designed to assess self-reported perception of one’s own interoceptive accuracy. This article therefore reports on the development of such a measure, the Interoceptive Accuracy Scale (IAS). Use of this measure enables assessment of the proposed distinction between beliefs regarding attention to, and accuracy in perceiving, interoceptive signals. Across six studies, we report on the development of the IAS and, importantly, its relationship with measures of trait self-reported interoceptive attention, objective interoceptive accuracy, confidence in the accuracy of specific interoceptive percepts, and metacognition with respect to interoceptive accuracy. Results support the distinction between individual differences in perceived attention towards interoceptive information and the accuracy of interoceptive perception.

Interoceptive accuracy and interoceptive sensibility in individuals with alcohol use disorder-Different phenomena with different clinical correlations?

BACKGROUND

Interoception may contribute to substance use disorder as it relates to the body's experience of substance use or withdrawal. However, only a few studies have directly investigated associations between interoception and alcohol use. The objective of this study was to compare individuals with alcohol use disorder (AUD) and healthy controls on interoceptive sensibility and accuracy.

METHODS

The sample was comprised of two groups: individuals meeting criteria for AUD (N = 114) and healthy controls (N = 110) not meeting criteria for AUD. Interoceptive sensibility was assessed with a self-report measure (the Private Body Consciousness subscale) and interoceptive accuracy - with a behavioral measure (the Schandry test). In addition, associations between interoception and other well-recognized correlates of AUD (sleep problems, depressive and anxiety symptoms, impulsivity) were tested. Barratt's Impulsiveness Scale, Brief Symptom Inventory, and Athens Insomnia Scale were utilized to assess psychopathological symptoms as covariates.

RESULTS

When controlling for level of anxiety, sleep problems, age, sex and education, individuals with AUD scored significantly higher on self-reported interoceptive sensibility and lower on interoceptive accuracy in comparison to healthy controls. Higher interoceptive sensibility was associated with more severe sleep problems and anxiety symptoms.

CONCLUSIONS

These results have to be treated as preliminary and need to be replicated; however, findings indicate that interoception may present a novel therapeutic target for treatment of AUD.

Validation of an electronic version of the Self-Awareness Questionnaire in English and Italian healthy samples

OBJECTIVES

Interoception is a general sensitivity to bodily sensations that informs motivational processes and behaviours. Interoceptive abilities seem to be impaired in several clinical conditions, and the development of new pragmatic instruments to assess subjective components of interoception are crucially needed. An easy to use paper and pencil questionnaire measuring sensitivity to bodily sensations was validated in an Italian sample (Self-Awareness Questionnaire; SAQ).

METHODS

In the present study, we created and evaluated an electronic version of the SAQ in Italian and English language.

RESULTS

Psychometric properties of both electronic versions of the SAQ were validated in an Italian (n = 206) and an English (n = 275) sample, using factorial analyses. Differences in factorial structures observed between the two samples were discussed in terms of cultural impact on emotional regulation and bodily sensations processing.

CONCLUSIONS

The electronic version of SAQ in English and Italian provides a pragmatic and validated tool to evaluate bodily signal sensitivity in clinical settings, informing the development of a new therapy targeting interoceptive processes, in a wide range of psychopathological conditions.

Association Between Interoception and Emotion Regulation in Individuals With Alcohol Use Disorder

INTRODUCTION

Sensing body-related information includes interoceptive sensibility (the tendency to focus on internal body sensations) and accuracy (precision in perceiving real internal processes). Interoception and emotion regulation have both been linked to alcohol use disorder (AUD). However, the association between these factors have not been investigated within a clinical group of individuals with AUD.

OBJECTIVES

The current study examines associations between emotion regulation and interoceptive accuracy and sensibility among individuals with AUD and healthy controls (HCs).

METHODS

The sample comprised 165 individuals meeting criteria for AUD and 110 HCs. Interoceptive sensibility was assessed with a self-report measure (the Private Body Consciousness subscale) and interoceptive accuracy - with a behavioral measure (the Schandry test). Emotion regulation domains: non-acceptance of negative emotions, inability to engage in goal-directed behaviors when experiencing negative emotions, difficulties controlling impulsive behaviors when experiencing negative emotions, limited access to effective emotion regulation strategies, and lack of own emotional awareness and clarity were assessed with the Difficulties in Emotion Regulation Scale (DERS). Associations between interoception and emotion regulation were assessed while controlling for sleep problems, depressive symptoms, age, and sex.

RESULTS

Higher interoceptive accuracy was negatively associated with DERS subscale of non-acceptance of negative emotions in the AUD group (but not in the HC group). Higher interoceptive sensibility was significantly associated with problems in controlling impulsive behaviors when experiencing negative emotions. This association was moderated by symptoms of AUD. Higher interoceptive sensibility was associated with higher emotional awareness, but only in the HC group.

CONCLUSIONS

Individuals with AUD who are more interoceptively accurate may be more effective in regulating their emotions. On the other hand, individuals with AUD who are more interoceptively sensible, may have problems with controlling their behaviors while experiencing negative emotional states.

Interoceptive impairments do not lie at the heart of autism or alexithymia

Quattrocki and Friston (2014) argued that abnormalities in interoception—the process of representing one’s internal physiological states—could lie at the heart of autism, because of the critical role interoception plays in the ontogeny of social-affective processes. This proposal drew criticism from proponents of the alexithymia hypothesis, who argue that social-affective and underlying interoceptive impairments are not a feature of autism per se, but of alexithymia (a condition characterized by difficulties describing and identifying one’s own emotions), which commonly co-occurs with autism. Despite the importance of this debate for our understanding of autism spectrum disorder (ASD), and of the role of interoceptive impairments in psychopathology, more generally, direct empirical evidence is scarce and inconsistent. Experiment 1 examined in a sample of 137 neurotypical (NT) individuals the association among autistic traits, alexithymia, and interoceptive accuracy (IA) on a standard heartbeat-tracking measure of IA. In Experiment 2, IA was assessed in 46 adults with ASD (27 of whom had clinically significant alexithymia) and 48 NT adults. Experiment 1 confirmed strong associations between autistic traits and alexithymia, but yielded no evidence to suggest that either was associated with interoceptive difficulties. Similarly, Experiment 2 provided no evidence for interoceptive impairments in autistic adults, irrespective of any co-occurring alexithymia. Bayesian analyses consistently supported the null hypothesis. The observations pose a significant challenge to notions that interoceptive impairments constitute a core feature of either ASD or alexithymia, at least as far as the direct perception of interoceptive signals is concerned.

This article suggests that impairments in interoception—the process of representing one’s internal physiological states—do not lie at the heart of either autism or alexithymia.

Facets of impulsivity and alcohol use: What role do emotions play?

Alcohol misuse is a major public concern. Impulsivity has been recognised as a significant risk factor predisposing for the initiation of alcohol use, continuation and excessive alcohol use. Evidence suggests that impulsivity is also a result of both acute alcohol intoxication and long-term alcohol abuse. The multifaceted character of impulsivity and the various ways of assessing it in humans and animal models, hampers the full understanding of how impulsivity relates to alcohol use and misuse. Therefore, in this review we evaluate recent developments in the field, trying to disentangle the contribution of different impulsivity subtypes as causes and effects of alcohol use. Moreover, we review a growing body of evidence, including brain imaging, suggesting the importance of emotional states in engaging in alcohol consumption, particularly in highly impulsive individuals. We also present recent insights into how emotional processing is manifested in alcoholism and binge drinking and suggest novel approaches to treatment and prevention opportunities which target emotional-regulation as well as emotional perception and insight.

Alexithymia mediates the relationship between interoceptive sensibility and anxiety

A number of empirical and theoretical reports link altered interoceptive processing to anxiety. However, the mechanistic understanding of the relationship between the two remains poor. We propose that a heightened sensibility for interoceptive signals, combined with a difficulty in attributing these sensations to emotions, increases an individual’s vulnerability to anxiety. In order to investigate this, a large sample of general population adults were recruited and completed self-report measures of interoceptive sensibility, trait anxiety and alexithymia. Results confirmed that the positive association between interoceptive sensibility and trait anxiety was partially mediated by alexithymia, such that those most at risk for clinically significant levels of trait anxiety have both significantly higher levels of interoceptive sensibility and alexithymia. A subsequent factor analysis confirmed the independence of the three measures. Altered interoceptive processing in combination with alexithymia, increased the risk for anxiety above and beyond altered interoceptive processing alone. We suggest that a heightened sensibility for interoceptive signals, combined with a difficulty in attributing these sensations to emotions, leaves these sensations vulnerable to catastrophizing interpretation. Interventions that target the attribution of bodily sensations may prove valuable in reducing anxiety.

Impact of intranasal oxytocin on interoceptive accuracy in alcohol users: an attentional mechanism?

Interoception, i.e. the perception and appraisal of internal bodily signals, is related to the phenomenon of craving, and is reportedly disrupted in alcohol use disorders. The hormone oxytocin influences afferent transmission of bodily signals and, through its potential modulation of craving, is proposed as a possible treatment for alcohol use disorders. However, oxytocin's impact on interoception in alcohol users remains unknown. Healthy alcohol users (n = 32) attended two laboratory sessions to perform tests of interoceptive ability (heartbeat tracking: attending to internal signals and, heartbeat discrimination: integrating internal and external signals) after intranasal administration of oxytocin or placebo. Effects of interoceptive accuracy, oxytocin administration and alcohol intake, were tested using mixed-effects models. On the tracking task, oxytocin reduced interoceptive accuracy, but did not interact with alcohol consumption. On the discrimination task, we found an interaction between oxytocin administration and alcohol intake: Oxytocin, compared with placebo, increased interoceptive accuracy in heavy drinkers, but not in light social drinkers. Our study does not suggest a pure interoceptive impairment in alcohol users but instead potentially highlights reduced flexibility of internal and external attentional resource allocation. Importantly, this impairment seems to be mitigated by oxytocin. This attentional hypothesis needs to be explicitly tested in future research.