Emotional awareness is correlated with ambulatory heart rate variability: A replication and extension.

OBJECTIVE: A positive association has previously been observed in healthy volunteers between emotional awareness (EA), the ability to identify and describe emotional experiences in oneself and others, and resting heart rate variability (HRV), which is dominated by vagus nerve activity. The current study aimed to investigate the EA-HRV association across multiple assessments in a "real-world" ambulatory context in patients with long QT syndrome (LQTS) who are at genetic risk for sudden cardiac death. METHOD: Participants (157 LQTS patients; MeanAge = 35.1, SDAge = 10.4; 115 women) completed the levels of emotional awareness scale (LEAS) on one occasion, which served as our measure of EA. In an ecological momentary assessment study involving 10 assessments per day over three days, multiple 5-minute ECG assessments (Mean = 24.6, SD = 5.1) were obtained in each patient using a Holter monitor, from which high-frequency HRV (HF-HRV) was computed on each occasion. RESULTS: There was a significant positive association between LEAS scores and HF-HRV controlling for biobehavioral covariates. We also detected a similar inverse relation between EA and mean heart rate. CONCLUSION: These findings suggest that, in patients with a well-defined genetic risk for ventricular arrhythmia and sudden death, the ability to experience emotions in a complex and differentiated way covaries with greater parasympathetic influences on the heart. These findings are consistent with the overlapping neural substrates of EA and HRV and their common contribution to adaptive emotional responding, consistent with the Neurovisceral Integration Model.

Emotional awareness for self and others and empathic abilities in clinical depression during acute illness and recovery.

BACKGROUND: The present longitudinal investigation had two major goals. First, we intended to clarify whether depressed patients are characterized by impairments of emotional awareness for the self and the other during acute illness and whether these impairments diminish in the course of an inpatient psychiatric treatment program. Previous research based on the performance measure Levels of Emotional Awareness Scale (LEAS) provided inconsistent findings concerning emotional self-awareness in clinical depression. Second, we investigated whether cognitive and affective empathic abilities change from acute illness to recovery in depressed patients. METHODS: Fifty-eight depressed patients were tested on admission and after 6-8 weeks of inpatient psychiatric treatment. A sample of fifty-three healthy individuals were also examined twice at an interval of 6-8 weeks. The LEAS and the Interpersonal Reactivity Index (IRI) were administered to assess emotional awareness and empathic abilities. Written texts were digitalized and then analyzed using the electronic scoring program geLEAS, the German electronic Levels of Emotional Awareness Scale. RESULTS: Depressed patients reported more depressive symptoms than healthy controls and less severe depressive symptomatology at time 2 compared to time 1. Independent of time, depressed individuals tended to show lower geLEAS self scores and had lower geLEAS other scores than healthy individuals. Depressed patients showed higher personal distress scores than healthy individuals at both measurement times. No group differences were observed for the cognitive empathy scales of the IRI (perspective taking and fantasy) and empathic concern, but empathic concern decreased significantly in depressed patients from time 1 to time 2. Empathic abilities as assessed by the IRI were not significantly correlated with emotional awareness for others, neither in the whole sample, nor in the patient and control subsample. CONCLUSIONS: Depressed patients seem to be characterized by impairments in emotional awareness of others during acute illness and recovery, but they also tend to show deficits in emotional self-awareness compared to healthy individuals. Self-reported cognitive empathic abilities seem to be at normal levels in depressed patients, but their heightened self-focused affective empathy may represent a vulnerability factor for depressive disorders.

Unconscious activation of negative emotional memories increases pain unpleasantness.

OBJECTIVE: The influence of unconscious emotional processes on pain remains poorly understood. The present study tested whether cues to forgotten unpleasant images might amplify pain (i.e., in the absence of conscious recall). METHODS: 72 healthy female adults (19 to 34 years) performed an adapted Think/No-think paradigm (T/NT) using 72 combinations of neutral face images (cues) paired with 36 neutral & 36 unpleasant images. After completion of the T/NT task, cues associated with forgotten neutral or unpleasant images were identified. Cues to either neutral or unpleasant images from the NT condition were then presented in randomized order while participants received intermediate-level thermal pain stimulation on the left hand. Ratings of both pain intensity and unpleasantness were acquired after each trial. RESULTS: Mean pain unpleasantness ratings were greater during presentation of cues to forgotten negative vs. neutral images (5.52 [SD = 2.06] vs. 5.23 [SD = 2.10]; p = 0.02). This pattern was also present when comparing cues to remembered negative vs. neutral images (5.62 [SD = 1.94] vs. 5.04 [SD = 1.90]; p < .001). Mean pain intensity ratings were higher for cues to negative vs. neutral images when remembered (5.48 [SD = 1.79] vs. 5.00 [SD = 1.69]; p < .001), but not when forgotten (5.27 [SD = 1.96] vs. 5.16 [SD = 1.93]; p = 0.30). CONCLUSIONS: Using an adapted T/NT-Pain paradigm, this study demonstrated that cues to non-recallable (but potentially unconsciously activated) negative emotional memories amplify pain unpleasantness, similar to known effects of conscious negative emotions.

Improvements in mindfulness, interoceptive and emotional awareness, emotion regulation, and interpersonal emotion management following completion of an online emotional skills training program.

Socioemotional skills, such as the ability to recognize, understand, and regulate the emotions of self and others, are associated with both physical and emotional health. The present study tested the effectiveness of a recently validated online training program for increasing these emotional skills in adults. In this study, 448 participants (323 female) were randomly assigned to complete this training program or a placebo control program. Among those who completed the training program or placebo (N = 326), the training program led to improved scores post-training on measures of interoceptive and emotional awareness, mindfulness, emotion recognition, and emotion regulation strategies (e.g., reduced emotion suppression and greater impulse control) relative to placebo. In a smaller group of participants who also completed a 6-month follow-up visit (N = 94), sustained improvements were observed on several measures in those who completed the training program, while the placebo group instead showed decreased performance. This suggested a potentially protective effect against emotional challenges associated with the COVID-19 pandemic occurring during this time. These results suggest that this online training program shows promise in improving emotional skills relevant to adaptive social and emotional functioning, and that it might be useful as an intervention within at-risk populations and those with emotional disorders associated with reduced application of these skills. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Development and validation of an online emotional intelligence training program.

Introduction: Emotional intelligence (EI) is associated with a range of positive health, wellbeing, and behavioral outcomes. The present article describes the development and validation of an online training program for increasing EI abilities in adults. The training program was based on theoretical models of emotional functioning and empirical literature on successful approaches for training socioemotional skills and resilience. Methods: After an initial design, programming, and refinement process, the completed online program was tested for efficacy in a sample of 326 participants (72% female) from the general population. Participants were randomly assigned to complete either the EI training program (n = 168) or a matched placebo control training program (n = 158). Each program involved 10-12 hours of engaging online content and was completed during either a 1-week (n = 175) or 3-week (n = 151) period. Results: Participants who completed the EI training program showed increased scores from pre- to post-training on standard self-report (i.e., trait) measures of EI (relative to placebo), indicating self-perceived improvements in recognizing emotions, understanding emotions, and managing the emotions of others. Moreover, those in the EI training also showed increased scores in standard performance-based (i.e., ability) EI measures, demonstrating an increased ability to strategically use and manage emotions relative to placebo. Improvements to performance measures also remained significantly higher than baseline when measured six months after completing the training. The training was also well-received and described as helpful and engaging. Discussion: Following a rigorous iterative development process, we created a comprehensive and empirically based online training program that is well-received and engaging. The program reliably improves both trait and ability EI outcomes and gains are sustained up to six months post-training. This program could provide an easy and scalable method for building emotional intelligence in a variety of settings.

Development and validation of a computer program for measuring emotional awareness in German-The geLEAS (German electronic Levels of Emotional Awareness Scale).

Introduction: Emotional awareness is the ability to identify, interpret, and verbalize the emotional responses of oneself and those of others. The Levels of Emotional Awareness Scale (LEAS) is an objective performance inventory that accurately measures an individual's emotional awareness. LEAS assessments are typically scored manually and are therefore both time consuming and cognitively demanding. This study presents a German electronic scoring program for the LEAS (geLEAS), the first non-English computerized assessment approach of the LEAS. Methods: Data were collected from a healthy German community sample (N = 208). We developed a modern software for computerizing LEAS scoring, an open-source text-based emotion assessment tool called VETA (Verbal Emotion in Text Assessment). We investigated if the software would arrive at similar results as hand scoring in German and if emotional awareness would show similar associations to sociodemographic information and psychometric test results as in previous studies. Results: The most frequently used scoring method of the geLEAS shows excellent internal consistency (α = 0.94) and high correlations with hand scoring (r = 0.97, p < 0.001). Higher emotional awareness measured by the geLEAS is associated with female gender, older age, and higher academic achievement (all p < 0.001). Moreover, it is linked to the ability to identify emotions in facial expressions (p < 0.001) and more accurate theory of mind functioning (p < 0.001). Discussion: An automated method for evaluating emotional awareness greatly expands the ability to study emotional awareness in clinical care and research. This study aims to advance the use of emotional awareness as a clinical and scientific parameter.

Psychopathic tendencies are selectively associated with reduced emotional awareness in the context of early adversity.

It is unclear at present whether psychopathic tendencies are associated with lower or higher levels of emotional awareness (EA). Given that psychopathy includes a proficiency for manipulating others, one might expect an elevated ability to identify and use information about others' emotions. On the other hand, empathic deficits in psychopathy could arise from reduced emotional awareness. Further, heterogeneity in psychopathy may also play a role, wherein 'secondary' psychopathy is associated with early adversity and high negative affect, while 'primary' psychopathy is not. In this paper, we tested the relationship between EA and psychopathic tendencies in 177 undergraduate students (40 males) who completed the levels of emotional awareness scale (LEAS), the triarchic psychopathy measure (TPM), the affective (empathy-related) subscales of the interpersonal reactivity index (IRI), and two measures of early adversity: the childhood experiences of care and abuse questionnaire (CECA) and the childhood trauma questionnaire (CTQ). We found that lower LEAS scores were associated with higher TPM and lower IRI empathy scores, but these relationships were primarily present in those with early adversity and high negative affect. This suggests that lower EA may be selectively associated with higher levels of secondary psychopathy, while those with higher levels of primary psychopathy remain capable of higher EA.

Higher emotional awareness is associated with greater domain-general reflective tendencies.

The tendency to reflect on the emotions of self and others is a key aspect of emotional awareness (EA)-a trait widely recognized as relevant to mental health. However, the degree to which EA draws on general reflective cognition vs. specialized socio-emotional mechanisms remains unclear. Based on a synthesis of work in neuroscience and psychology, we recently proposed that EA is best understood as a learned application of domain-general cognitive processes to socio-emotional information. In this paper, we report a study in which we tested this hypothesis in 448 (125 male) individuals who completed measures of EA and both general reflective cognition and socio-emotional performance. As predicted, we observed a significant relationship between EA measures and both general reflectiveness and socio-emotional measures, with the strongest contribution from measures of the general tendency to engage in effortful, reflective cognition. This is consistent with the hypothesis that EA corresponds to the application of general reflective cognitive processes to socio-emotional signals.

Levels of Emotional Awareness: Theory and Measurement of a Socio-Emotional Skill.

Emotional awareness is the ability to conceptualize and describe one's own emotions and those of others. Over thirty years ago, a cognitive-developmental theory of emotional awareness patterned after Piaget's theory of cognitive development was created as well as a performance measure of this ability called the Levels of Emotional Awareness Scale (LEAS). Since then, a large number of studies have been completed in healthy volunteers and clinical populations including those with mental health or systemic medical disorders. Along the way, there have also been further refinements and adaptations of the LEAS such as the creation of a digital version in addition to further advances in the theory itself. This review aims to provide a comprehensive summary of the evolving theoretical background, measurement methods, and empirical findings with the LEAS. The LEAS is a reliable and valid measure of emotional awareness. Evidence suggests that emotional awareness facilitates better emotion self-regulation, better ability to navigate complex social situations and enjoy relationships, and better physical and mental health. This is a relatively new but promising area of research in the domain of socio-emotional skills. The paper concludes with some recommendations for future research.

Diseases, Disorders, and Comorbidities of Interoception.

Interoception, the sense of the body's internal physiological state, underpins homeostatic reflexes, motivational states, and sensations contributing to emotional experiences. The continuous nature of interoceptive processing, coupled to behavior, is implicated in the neurobiological construction of the sense of self. Aberrant integration and control of interoceptive signals, originating in the brain and/or the periphery, can perturb the whole system. Interoceptive abnormalities are implicated in the pathophysiology of psychiatric disorders and in the symptomatic expression of developmental, neurodegenerative, and neurological disorders. Moreover, interoceptive mechanisms appear central to somatic disorders of brain-body interactions, including functional digestive disorders, chronic pain, and comorbid conditions. The present article provides an overview of disorders of interoception and suggests future directions for better understanding, diagnosis, and management of these disorders.

The evolution and development of the uniquely human capacity for emotional awareness: A synthesis of comparative anatomical, cognitive, neurocomputational, and evolutionary psychological perspectives.

We offer an interdisciplinary framework for understanding the expanded capacity for emotional awareness (EA) in humans relative to other animals, synthesizing work within computational neuroscience, evolutionary psychology, and comparative anatomy. We argue that disproportionate cortical expansion during human evolution reflects additional hierarchical levels of computational processing, allowing representation of multimodal regularities over longer timescales - affording abstract concept learning, internal simulation of distal future outcomes, and expanded working memory capacity. This allows for the ability to simulate emotions, learn emotion concepts, and manipulate them in working memory when deciding how to act. We also draw on the construct of life history strategy within evolutionary psychology to argue that individual differences in EA within humans can be understood as the result of tuning particular computational parameters to the predictability of long timescale socioemotional regularities of the local environment. We conclude by discussing the implications and testable hypotheses offered by our proposed framework.

Thinking through others' emotions: Incorporating the role of emotional state inference in thinking through other minds.

The active inference framework offers an attractive starting point for understanding cultural cognition. Here, we argue that affective dynamics are essential to include when constructing this type of theory. We highlight ways in which interactions between emotional responses and the perception of those responses, both within and between individuals, can play central roles in both motivating and constraining sociocultural practices.

Higher Emotional Awareness Is Associated With Reduced Pain in Irritable Bowel Syndrome Patients: Preliminary Results.

OBJECTIVE: Recent evidence indicates that interventions designed to improve emotional awareness reduce pain in irritable bowel syndrome. This preliminary study sought to determine whether trait emotional awareness is associated with typical pain in patients with irritable bowel syndrome. METHODS: Healthy volunteers (n = 66) and irritable bowel syndrome patients (n = 50) were asked to self-report their typical levels of pain intensity and complete both the Levels of Emotional Awareness Scale and the Somatization Scale of the Brief Symptom Inventory. RESULTS: Levels of Emotional Awareness Scale scores in irritable bowel syndrome patients did not differ from scores in healthy participants; however, higher Levels of Emotional Awareness Scale scores in irritable bowel syndrome patients predicted lower levels of typical pain intensity (r(45) = -.36, p = .01, 95% CI [-.59, -.08]) and lower levels of somatization (r(45)= -.31, p = .03, 95% CI [-.55, -.02]). CONCLUSIONS: This inverse relationship between emotional awareness and both pain and somatization symptoms is consistent with evidence that irritable bowel syndrome patients experience reduced pain from therapies designed to improve emotional awareness. The Levels of Emotional Awareness Scale could potentially be used to identify patients who could benefit from such therapy and could potentially be a moderator of response to efficacious psychological therapies.

The role of anterior and midcingulate cortex in emotional awareness: A domain-general processing perspective.

The cingulate cortex has been implicated in a wide range of overlapping cognitive, affective, skeletomotor, and visceromotor functions. In this chapter, we focus on the role of the anterior and midcingulate cortex (ACC and MCC) in facilitating a person's ability to recognize and understand his or her own emotions. Here, we illustrate how this ability-often referred to as "emotional awareness" (EA)-may require integration across each of the aforementioned functions. To appropriately situate the role of the cingulate in EA, we first summarize a number of studies that have highlighted ACC/MCC engagement in the context of emotion. We then describe prominent domain-general views of the ACC (in interaction with MCC), which together suggest that it may serve as a hub within a high-level visceromotor control system. This high-level system functions to predict and mobilize the required metabolic resources in a given situation via the integration of multimodal information available from both sensory cortices and memory. Based on this work, we show that EA can be seen as an important consequence of this integrative process and how it can help to explain the adaptive nature of such advanced emotional capacities. We close by briefly considering the potential clinical relevance of understanding ACC/MCC function and its specific role in emotion and awareness.

Neurocomputational mechanisms underlying emotional awareness: Insights afforded by deep active inference and their potential clinical relevance.

Emotional awareness (EA) is recognized as clinically relevant to the vulnerability to, and maintenance of, psychiatric disorders. However, the neurocomputational processes that underwrite individual variations remain unclear. In this paper, we describe a deep (active) inference model that reproduces the cognitive-emotional processes and self-report behaviors associated with EA. We then present simulations to illustrate (seven) distinct mechanisms that (either alone or in combination) can produce phenomena - such as somatic misattribution, coarse-grained emotion conceptualization, and constrained reflective capacity - characteristic of low EA. Our simulations suggest that the clinical phenotype of impoverished EA can be reproduced by dissociable computational processes. The possibility that different processes are at work in different individuals suggests that they may benefit from distinct clinical interventions. As active inference makes particular predictions about the underlying neurobiology of such aberrant inference, we also discuss how this type of modelling could be used to design neuroimaging tasks to test predictions and identify which processes operate in different individuals - and provide a principled basis for personalized precision medicine.

The importance of identifying underlying process abnormalities in alexithymia: Implications of the three-process model and a single case study illustration.

We present an in-depth case study of a rare individual (whom we will refer to as "Jane") who reported an inability to experience emotion. Jane completed a range of assessments measuring alexithymia, emotional awareness, and emotion recognition ability. She, along with 22 control participants, also underwent skin conductance (SC) measurement and facial electromyography (EMG) during exposure to affective images, and self reported the valence/arousal of their responses to those images. Jane scored high on alexithymia and low on emotional awareness; yet she performed well on emotion recognition measures and showed a typical pattern of valence ratings. Her SC responses and subjective arousal ratings were atypically low, and some of her EMG responses were also atypical. Jane's deficit profile highlights the dissociability of self-focused emotional awareness and other-focused emotion recognition ability, as well as the dissociability between the generation and representation of valence and arousal (with both subjective and objective measures).

Developmental Contributions to Emotional Awareness.

The Levels of Emotional Awareness Scale (LEAS) has received considerable support as a reliable and valid measure of individual differences in emotional awareness (EA) since the original report involving 40 participants (Lane, Quinlan, Schwartz, Walker, & Zeitlin, 1990 ). However, the hypothesized developmental nature of EA (conceptualized as a cognitive skill) has thus far only been examined in that 1 early study. Here we report multiple regression analyses on the entire sample of 94 participants who completed the LEAS as part of that original study, as well as the same developmental and affective measures used in the original report. We first observed that different developmental measures, including the Object Relations Inventory and the Sentence Completion Test of Ego Development, accounted for unique portions of the variance in LEAS scores. We also observed that higher LEAS scores were associated with greater within-category variance in the self-reported positive and guilt- and shame-related emotions people reported experiencing on a typical day. Based on these findings, we introduce a 3-dimensional cognitive-developmental framework that LEAS scores plausibly track, including (a) the transition from focusing on external/physical to internal/psychological characteristics, (b) greater conceptual complexity, and (c) self-other differentiation. We then discuss the implications of this framework for understanding the nature of EA and for future research.

Treating anxiety disorders by emotion-focused psychodynamic psychotherapy (EFPP)-An integrative, transdiagnostic approach.

Anxiety disorders are characterized by high levels of anxiety and avoidance of anxiety-inducing situations and of negative emotions such as anger. Emotion-focused therapy (EFT) and psychodynamic psychotherapy (PP) have underscored the therapeutic significance of processing and transforming repressed or disowned conflicted or painful emotions. Although PP provides sophisticated means of processing intrapsychic and interpersonal conflict, EFT has empirically tested a set of techniques to access, deepen, symbolize, and transform emotions consistent with current conceptualizations of emotions and memory. Based on our clinical experience, we propose that an integrative emotion-focused and psychodynamic approach opens new avenues for treating anxiety disorders effectively, and we present a transdiagnostic manual for emotion-focused psychodynamic psychotherapy. The therapeutic approach takes into account both the activation, processing, and modification of emotion and the underlying intrapsychic and interpersonal conflicts. The short-term treatment is based on the three phases of initiating treatment, therapeutic work with anxiety, and termination. Emotional poignancy (or liveliness) is an important marker for emotional processing throughout treatment. Instead of exposure to avoided situations, we endorse enacting the internal process of generating anxiety in the session providing a sense of agency and access to warded-off emotions. Interpretation serves to tie together emotional experience and insight into the patterns and the nature of underlying intrapersonal and interpersonal conflict. Treatment modules are illustrated by brief vignettes from pilot treatments.