What do alexithymia items measure? A discriminant content validity study of the Toronto-alexithymia-scale-20.

BACKGROUND: Questions have been raised about whether items of alexithymia scales assess the construct alexithymia and its key features, and no other related constructs. This study assessed the (discriminant) content validity of the most widely used alexithymia scale, i.e., the Toronto Alexithymia Scale (TAS-20). METHODS: Participants (n = 81) rated to what extent TAS-20 items and items of related constructs were relevant for assessing the constructs 'alexithymia', 'difficulty identifying feelings', 'difficulty describing feelings', 'externally-oriented thinking', 'limited imaginal capacity', 'anxiety', 'depression', and 'health anxiety'. RESULTS: Results revealed that, overall, the TAS-20 did only partly measure 'alexithymia'. Only the subscales 'difficulty identifying feelings' and 'difficulty describing feelings' represented 'alexithymia' and their intended construct, although some content overlap between these subscales was found. In addition, some items assessed (health) anxiety equally well or even better. CONCLUSIONS: Revision of the TAS-20 is recommended to adequately assess all key features of alexithymia. Findings with the TAS-20 need to be interpreted with caution in people suffering from medical conditions.

Let's talk about pain catastrophizing measures: an item content analysis.

BACKGROUND: Concerns have been raised about whether self-report measures of pain catastrophizing reflect the construct as defined in the cognitive-behavioral literature. We investigated the content of these self-report measures; that is, whether items assess the construct 'pain catastrophizing' and not other theoretical constructs (i.e., related constructs or pain outcomes) using the discriminant content validity method. METHOD: Items (n = 58) of six pain catastrophizing measures were complemented with items (n = 34) from questionnaires measuring pain-related worrying, vigilance, pain severity, distress, and disability. Via an online survey, 94 participants rated to what extent each item was relevant for assessing pain catastrophizing, defined as "to view or present pain or pain-related problems as considerably worse than they actually are" and other relevant constructs (pain-related worrying, vigilance, pain severity, distress, and disability). RESULTS: Data were analyzed using Bayesian hierarchical models. The results revealed that the items from pain-related worrying, vigilance, pain severity, distress, and disability questionnaires were distinctively related to their respective constructs. This was not observed for the items from the pain catastrophizing questionnaires. The content of the pain catastrophizing measures was equally well, or even better, captured by pain-related worrying or pain-related distress. CONCLUSION: Based upon current findings, a recommendation may be to develop a novel pain catastrophizing questionnaire. However, we argue that pain catastrophizing cannot be assessed by self-report questionnaires. Pain catastrophizing requires contextual information, and expert judgment, which cannot be provided by self-report questionnaires. We argue for a person-centered approach, and propose to rename 'pain catastrophizing' measures in line with what is better measured: 'pain-related worrying'.

Prefrontal and temporal cortical thickness in adolescents with traumatic brain injury.

AIM: To investigate the impact of traumatic injury on the developing prefrontal-temporal adolescent cortex, and correlated brain structural measures with neurocognitive functioning. METHOD: Nineteen adolescents (12 males, 7 females, age range: 11-17y, mean 15y 8mo, standard deviation 1y 7mo, median 15y 11mo) with traumatic brain injury (TBI) were included. Cortical thickness of frontal and temporal lobes was assessed using magnetic resonance imaging. We correlated cortical thickness of prefrontal-temporal regions with age, time since injury, and neurocognitive functioning, and compared these results with a matched control cohort without TBI. RESULTS: We found thinner prefrontal (p=0.039) and temporal cortices (p=0.002) in adolescents with TBI compared to typically developing children. Furthermore, significant age effect was observed on the prefrontal (r=-0.75, p=0.003) and temporal (r=-0.66, p=0.013) cortical thickness in typically developing adolescents, but not in adolescents with TBI. Executive function (measured using the Behaviour Rating Inventory of Executive Function questionnaire, with lower scores meaning higher functioning) was correlated with prefrontal cortical thickness in typically developing adolescents (r=0.72, p=0.009). Opposite trends were found for correlations between cortical thickness and executive function in the TBI and control cohort. INTERPRETATION: Structural maturation in typically developing adolescents correlates with functional development: the older the adolescent, the thinner the prefrontal cortex, the better executive function. In adolescents with TBI we observed an opposite trend, that appeared significantly different from the control group: the thinner the prefrontal and temporal cortex, the worse executive functioning. WHAT THIS PAPER ADDS: Cortical thickness is negatively correlated with age in typically developing adolescents. Prefrontal cortex thickness correlates negatively with executive function in typically developing adolescents. Correlations between cortical thickness and executive functioning rise for adolescents without traumatic brain injury (TBI). Correlations between cortical thickness and executive functioning fall for adolescents with TBI. Adolescents with TBI have a long-term impairment of adaptive functioning in daily living.

ESPESOR CORTICAL PREFRONTAL Y TEMPORAL EN ADOLESCENTES CON LESIÓN CEREBRAL TRAUMÁTICA: OBJETIVO: Investigar el impacto de la lesión traumática en el desarrollo de la corteza prefrontal-temporal en adolescentes y las medidas estructurales cerebrales correlacionadas con el funcionamiento neurocognitivo. MÉTODO: Diecinueve adolescentes (12 varones, siete mujeres, rango de edad: 11-17 años, media: 15 años 8 meses, desviación estándar: 1 años 7 meses, mediana: 15 años 11 meses) con lesión cerebral traumática (LCT). El grosor cortical de los lóbulos frontal y temporal se evaluó mediante imágenes de resonancia magnética. Se correlacionó el grosor cortical de las regiones prefrontal-temporales con la edad, el tiempo transcurrido desde la lesión y el funcionamiento neurocognitivo, y se compararon estos resultados con una cohorte de control emparejada sin TCE. RESULTADOS: Encontramos cortezas prefrontales (p = 0.039) y corticales temporales delgadas (p = 0.002) en adolescentes con LCT en comparación con niños con desarrollo típico. Además, se observó un efecto significativo de la edad en el grosor cortical prefrontal (r = -0.75, p = 0.003) y temporal (r = -0.66, p = 0.013) en adolescentes de desarrollo típico, pero no en adolescentes con LCT. La función ejecutiva (medida con el cuestionario Inventario de clasificación de la conducta de la función ejecutiva, con puntuaciones más bajas que significan un funcionamiento más alto) se correlacionó con el grosor cortical prefrontal en adolescentes con desarrollo típico (r = 0.72, p = 0.009). Se encontraron tendencias opuestas para las correlaciones entre el grosor cortical y la función ejecutiva en el LCT y la cohorte de control. INTERPRETACIÓN: La maduración estructural en adolescentes con desarrollo típico se correlaciona con el desarrollo funcional: cuanto mayor es el adolescente, más delgada es la corteza prefrontal, y mejor la función ejecutiva. En adolescentes con LCT observamos una tendencia opuesta, que parecía significativamente diferente del grupo de control: cuanto más delgada era la corteza prefrontal y temporal, peor el funcionamiento ejecutivo.

ESPESSURA PRÉ-FRONTAL E TEMPORAL EM ADOLESCENTES COM LESÃO CEREBRAL TRAUMÁTICA: OBJETIVO: Investigar o impacto da lesão cerebral traumática no córtex pré-frontal -temporal em desenvolvimento de adolescentes, e medidas cerebrais estruturais correlacionadas com o funcionamento cognitivo. MÉTODO: Dezenove adolescentes (12 do sexo masculino, sete do sexo feminino, variação de idade: 11-17a, média: 15a 8m, desvio padrão: 1a 7m, mediana: 15a 11m) com lesão cerebral traumática (LCT) foram incluídos. A espessura cortical dos lobos frontais e temporais foi avaliada usando ressonância magnética funcional. Correlacionamos a espessura cortical de regiões pré-frontais-temporais com a idade, tempo após a lesão, e funcionamento neurocognitivo, e comparamos estes resultados com uma coorte controle pareada, sem LCT. RESULTADOS: Encontramos córtex pré-frontal (p=0,039) e temporal (p=0,002) mais finos em adolescentes com LCT. Além disso, efeito significativo da idade foi observado na espessura pré-frontal (r=-0,75, p=0,003) e temporal (r=-0,66, p=0,013) em adolescentes com desenvolvimento típico, mas não nos com LCT. A função executiva (mensurada com o questionário Inventário de pontuação do comportamento da Função Executiva, com menor pontuação indicando maior funcionamento) foi correlacionada com a espessura cortical pré-frontal em adolescentes com desenvolvimento típico (r=0,72, p=0,009). Tendências opostas para as correlações entre espessura cortical e função executiva foram encontradas nas coortes com LCT e controle. INTERPRETAÇÃO: A maturação estrutural em adolescentes com desenvolvimento típico se correlaciona com o desenvolvimento functional: quanto mais velho o adolescente, mais fino o córtex e melhor a função executiva. Em adolescents com LCT observamos a tendência oposta, que foi significantemente diferente do grupo controle: quanto mais fino o córtex pré-frontal e temporal, pior a função cognitiva.

The relation between rumination and temporal features of emotion intensity.

Intensity profiles of emotional experience over time have been found to differ primarily in explosiveness (i.e. whether the profile has a steep vs. a gentle start) and accumulation (i.e. whether intensity increases over time vs. goes back to baseline). However, the determinants of these temporal features remain poorly understood. In two studies, we examined whether emotion regulation strategies are predictive of the degree of explosiveness and accumulation of negative emotional episodes. Participants were asked to draw profiles reflecting changes in the intensity of emotions elicited either by negative social feedback in the lab (Study 1) or by negative events in daily life (Study 2). In addition, trait (Study 1 & 2), and state (Study 2) usage of a set of emotion regulation strategies was assessed. Multilevel analyses revealed that trait rumination (especially the brooding component) was positively associated with emotion accumulation (Study 1 & 2). State rumination was also positively associated with emotion accumulation and, to a lesser extent, with emotion explosiveness (Study 2). These results provide support for emotion regulation theories, which hypothesise that rumination is a central mechanism underlying the maintenance of negative emotions.

Unraveling affective dysregulation in borderline personality disorder: a theoretical model and empirical evidence.

Although emotion dysregulation has consistently been conceptualized as a core problem of borderline personality disorder (BPD), a comprehensive, and empirically and ecologically validated model that captures the exact types of dysregulation remains absent. In the present article, we combine insights from basic affective science and the biosocial theory of BPD to present a theoretical model that captures the most fundamental affective dynamical processes that underlie BPD and stipulates that individuals with BPD are characterized by more negative affective homebases, higher levels of affective variability, and lower levels of attractor strength or return to baseline. Next, we empirically validate this proposal by statistically modeling data from three electronic diary studies on emotional responses to personally relevant stimuli in personally relevant environments that were collected both from patients with BPD (N = 50, 42, and 43) and from healthy subjects (N = 50, 24, and 28). The results regarding negative affective homebases and heightened affective variabilities consistently confirmed our hypotheses across all three datasets. The findings regarding attractor strengths (i.e., return to baseline) were less consistent and of smaller magnitude. The transdiagnostic nature of our approach may help to elucidate the common and distinctive mechanisms that underlie several different disorders that are characterized by affective dysregulation.