Quadratic Relationship Between Alexithymia and Interoceptive Accuracy, and Results From a Pilot Mindfulness Intervention

Abstract

Alexithymia, or a reduced ability to label and describe one's emotions, is a transdiagnostic construct associated with poor psychosocial outcomes. Currently, the mechanisms underlying affective deficits associated with alexithymia are unclear, hindering targeted treatment delivery. Recent research suggests deficient interoceptive awareness, or reduced awareness of one's internal bodily state, may be key in the etiology of alexithymia. It has long been demonstrated that mindfulness meditation can alter perceptions of one's own emotions and bodily cues. Therefore, it is possible that mindfulness meditation may reduce affective deficits associated with alexithymia by improving interoceptive awareness. In this study, we aimed to (1) elucidate the role of interoceptive accuracy and sensibility, two dimensions of interoceptive awareness, in alexithymia, and (2) test the efficacy of a brief mindfulness meditation for improving interoceptive accuracy, interoceptive sensibility, and emotional awareness. Seventy six young adults completed a baseline heartbeat detection task, to assess interoceptive accuracy and sensibility, and the Toronto Alexithymia Scale-20 item. They were randomly assigned to a brief mindfulness-based body scan meditation intervention or control condition. Afterwards, participants completed tasks assessing emotional awareness (i.e., affect labeling, emotional granularity) and follow-up heartbeat detection task. Relationships between alexithymia and interoceptive accuracy and sensibility were best described as quadratic (p = 0.002) and linear (p = 0.040), respectively. Participants in both conditions showed robust improvements in interoceptive accuracy from baseline to follow-up (p < 0.001; η 2 p = 0.15); however, there were no group (meditation or control) differences in degree of improvement. Similarly, there were no group differences in affect labeling or emotional granularity. These preliminary results suggest that heightened alexithymia may be associated with either relatively high or low interoceptive accuracy. The meditation condition did not result in improved interoceptive accuracy or sensibility above and beyond that of a control group. Improvements in interoceptive accuracy, interoceptive sensibility, and emotional awareness may require longer or more interactive intervention approaches. More research is needed to parse the potentially complex relationship between alexithymia and interoceptive awareness, and to develop targeted treatment approaches to ameliorating associated affective deficits.

Mindfulness Training led to Catharsis and Mindfulness-To-Meaning in a Patient with Social Anxiety Disorder Comorbid with Persistent Depressive Disorder (Dysthymia) - A Case Report with Patient's Personal Note -

“…Mrs. A's alexithymia seems to have been relieved by the long-term MT as reported by Bornemann & Singer [24]. On the contrary, a brief MT had no signi cant effect on alexithymia [25]. In the present case, alexithymia was almost completely released by long-term MT.…”

“…At the same time, she had a strange experience and a telepathic experience. The acquisition of interoceptive sense in MT is said to be closely related to the disappearance of alexithymia [25]. Her strange and telepathic experience could be a prelude to a mystical experience seen in meditation.…”

Interoceptive pathways to understand and treat mental health conditions

“…Other studies find no relationship between alexithymia and worse cardiac interoceptive accuracy [126] or better cardiac interoception in high alexithymia participants [127]. These inconsistent findings can be explained by a quadratic relationship between alexithymia and interoceptive accuracy; although many individuals with heightened alexithymia show low interoceptive accuracy, a subset of individuals with heightened alexithymia show abnormally high interoceptive accuracy in specific domains [128]. This may also speak to different subtypes of alexithymia, underscored by either attenuated or noisy augmented afferent signals.…”

Lower emotional awareness is associated with greater early adversity and faster life history strategy.

“…Females also tend to have slower LHS characteristics than males (e.g., greater parental investment), similar to the pattern of sex differences seen in EA (Barrett et al, 2000; Ciarrochi et al, 2005; Wright et al, 2017). In addition, previous work has also linked LHS to both bodily/interoceptive awareness (Proffitt Leyva & Hill, 2018) and emotional intelligence (van der Linden et al, 2015), each of which have been linked to EA or the related construct of alexithymia (Aaron et al, 2020; Brewer et al, 2016; Herbert et al, 2011; Onur et al, 2013; Pollatos et al, 2005; Simmons et al, 2013; Smith, Lane, et al, 2018; Terasawa et al, 2014; Trevisan et al, 2019; Zaki et al, 2012). For example, Proffitt Leyva and Hill (2018) have suggested that individuals may develop low interoceptive awareness because they selectively allocate energy resources toward monitoring the conditions in the external environment, and therefore fail to monitor and learn from internal bodily and emotional states.…”