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Impaired cognitive self-awareness mediates the association between alexithymia and excitation/inhibition balance in the pgACC

Published online by Cambridge University Press:  22 July 2019

A. Kühnel ,
A. Widmann ,
L. Colic ,
L. Herrmann ,
L. R. Demenescu ,
A. L. Leutritz ,
M. Li ,
S. Grimm ,
T. Nolte  and
P. Fonagy
...Show all authors
A. Kühnel
Affiliation:
Clinical Affective Neuroimaging Laboratory, Magdeburg, Germany Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry and International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
A. Widmann
Affiliation:
Clinical Affective Neuroimaging Laboratory, Magdeburg, Germany University Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany Experimental and Molecular Psychiatry, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
L. Colic
Affiliation:
Clinical Affective Neuroimaging Laboratory, Magdeburg, Germany Leibniz Institute for Neurobiology, Magdeburg, Germany Department of Psychiatry, Mood Disorders Research Program, Yale School of Medicine, New Haven, CT, USA
L. Herrmann
Affiliation:
University Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany
L. R. Demenescu
Affiliation:
Clinical Affective Neuroimaging Laboratory, Magdeburg, Germany
A. L. Leutritz
Affiliation:
Clinical Affective Neuroimaging Laboratory, Magdeburg, Germany
M. Li
Affiliation:
University Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany Department of Psychiatry and Psychotherapy, OVGU Magdeburg, Magdeburg, Germany
S. Grimm
Affiliation:
Department of Psychiatry, Charité, CBF, Berlin, Germany MSB Medical School Berlin, Calandrellistraße 1-9, 12247Berlin, Germany Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8032Zurich, Switzerland
T. Nolte
Affiliation:
The Anna Freud National Centre for Children and Families, London, UK Wellcome Trust Centre for Neuroimaging, University College London, London, UK
P. Fonagy
Affiliation:
The Anna Freud National Centre for Children and Families, London, UK Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
M. Walter*
Affiliation:
Clinical Affective Neuroimaging Laboratory, Magdeburg, Germany University Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany Leibniz Institute for Neurobiology, Magdeburg, Germany Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany Max Planck Institute for Biological Cybernetics, Tübingen, Germany
*
Author for correspondence: M. Walter, E-mail: [email protected]
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Abstract

Background

Previous research showed that automatic emotion regulation is associated with activation of subcortical areas and subsequent feedforward processes to cortical areas. In contrast, cognitive awareness of emotions is mediated by negative feedback from cortical to subcortical areas. Pregenual anterior cingulate cortex (pgACC) is essential in the modulation of both affect and alexithymia. We considered the interplay between these two mechanisms in the pgACC and their relationship with alexithymia.

Method

In 68 healthy participants (30 women, age = 26.15 ± 4.22) we tested associations of emotion processing and alexithymia with excitation/inhibition (E/I) balance represented as glutamate (Glu)/GABA in the pgACC measured via magnetic resonance spectroscopy in 7 T.

Results

Alexithymia was positively correlated with the Glu/GABA ratio (N = 41, p = 0.0393). Further, cognitive self-awareness showed an association with Glu/GABA (N = 52, p = 0.003), which was driven by a correlation with GABA. In contrast, emotion regulation was only correlated with glutamate levels in the pgACC (N = 49, p = 0.008).

Conclusion

Our results corroborate the importance of the pgACC as a mediating region of alexithymia, reflected in an altered E/I balance. Furthermore, we could specify that this altered balance is linked to a GABA-related modulation of cognitive self-awareness of emotions.

Keywords

Alexithymiaanterior cingulate cortex (ACC)emotion regulationmagnetic resonance spectroscopy (MRS)
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 10 , July 2020 , pp. 1727 - 1735
Copyright
Copyright © Cambridge University Press 2019

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Footnotes

*

Shared first authorship.

References

Abler, B, Hofer, C, Walter, H, Erk, S, Hoffmann, H, Traue, HC and Kessler, H (2010) Habitual emotion regulation strategies and depressive symptoms in healthy subjects predict fMRI brain activation patterns related to major depression. Psychiatry Research: Neuroimaging 183, 105–113.CrossRefGoogle ScholarPubMed
Ackenheil, M, Stotz-Ingenlath, G, Dietz-Bauer, R and Vossen, A (1999) MINI Mini International Neuropsychiatric Interview, German version 5.0. 0 DSM IV. Psychiatrische Universitätsklinik München, Germany.Google Scholar
Aleman, A and Kahn, R (2005) Strange feelings: do amygdala abnormalities dysregulate the emotional brain in schizophrenia? Progress in Neurobiology 77, 283–298.Google Scholar
Angst, J (2008) Bipolar disorder-methodological problems and future perspectives. Dialogues in Clinical Neuroscience 10, 129.Google ScholarPubMed
Antonsen, BT, Klungsøyr, O, Kamps, A, Hummelen, B, Johansen, MS, Pedersen, G, Urnes, Ø, Kvarstein, EH, Karterud, S and Wilberg, T (2014) Step-down versus outpatient psychotherapeutic treatment for personality disorders: 6-year follow-up of the Ullevål personality project. BMC Psychiatry 14, 119.CrossRefGoogle ScholarPubMed
Bach, M, Bach, D, de Zwaan, M, Serim, M and Böhmer, F (1996) Validation of the German version of the 20-item Toronto Alexithymia Scale in normal persons and psychiatric patients. Psychotherapie, Psychosomatik, Medizinische Psychologie 46, 23–28.Google ScholarPubMed
Badoud, D, Luyten, P, Fonseca-Pedrero, E, Eliez, S, Fonagy, P and Debbané, M (2015) The French version of the Reflective Functioning Questionnaire: validity data for adolescents and adults and Its association with non-suicidal self-injury. PLoS ONE 10, e0145892.CrossRefGoogle ScholarPubMed
Bagby, RM, Parker, JDA and Taylor, GJ (1994 a) The twenty-item Toronto Alexithymia scale – I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research 38, 23–32.CrossRefGoogle ScholarPubMed
Bagby, RM, Taylor, GJ and Parker, JDA (1994 b) The twenty-item Toronto Alexithymia scale – II. Convergent, discriminant, and concurrent validity. Journal of Psychosomatic Research 38, 33–40.CrossRefGoogle ScholarPubMed
Behr, M and Becker, M (2004) SEE: Skalen zum Erleben von Emotionen. Göttingen: Hogrefe, Verlag für Psychologie.Google Scholar
Berthoz, S, Artiges, E, Van de Moortele, P-F, Poline, J-B, Rouquette, S, Consoli, SM and Martinot, J-L (2002) Effect of impaired recognition and expression of emotions on frontocingulate cortices: an fMRI study of men with alexithymia. American Journal of Psychiatry 159, 961–967.CrossRefGoogle ScholarPubMed
Bird, G and Cook, R (2013) Mixed emotions: the contribution of alexithymia to the emotional symptoms of autism. Translational Psychiatry 3, e285.CrossRefGoogle ScholarPubMed
Bird, G, Silani, G, Brindley, R, White, S, Frith, U and Singer, T (2010) Empathic brain responses in insula are modulated by levels of alexithymia but not autism. Brain 133, 1515–1525.CrossRefGoogle Scholar
Braunstein, LM, Gross, JJ and Ochsner, KN (2017) Explicit and implicit emotion regulation: a multi-level framework. Social Cognitive and Affective Neuroscience 12, 1545–1557.CrossRefGoogle ScholarPubMed
Brooks, JCW, Roberts, N, Kemp, GJ, Gosney, MA, Lye, M and Whitehouse, GH (2001) A proton magnetic resonance spectroscopy study of age-related changes in frontal lobe metabolite concentrations. Cerebral Cortex 11, 598–605.CrossRefGoogle ScholarPubMed
Chen, J, Xu, T, Jing, J and Chan, RC (2011) Alexithymia and emotional regulation: a cluster analytical approach. BMC Psychiatry 11, 33.CrossRefGoogle ScholarPubMed
Colic, L, Demenescu, LR, Li, M, Kaufmann, J, Krause, AL, Metzger, C and Walter, M (2016) Metabolic mapping reveals sex-dependent involvement of default mode and salience network in alexithymia. Social Cognitive and Affective Neuroscience 11, 289–298.CrossRefGoogle ScholarPubMed
Colic, L, von Düring, F, Denzel, D, Demenescu, LR, Lord, A, Martens, L, Lison, S, Frommer, J, Vogel, M, Kaufmann, J, Speck, O, Li, M and Walter, M (2019) Rostral anterior cingulate Gln/Glu disbalance in major depressive disorder depends on symptom severity. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, in press.Google ScholarPubMed
Conrad, R, Wegener, I, Imbierowicz, K, Liedtke, R and Geiser, F (2009) Alexithymia, temperament and character as predictors of psychopathology in patients with major depression. Psychiatry Research 165, 137–144.CrossRefGoogle ScholarPubMed
Cook, R, Brewer, R, Shah, P and Bird, G (2013) Alexithymia, not autism, predicts poor recognition of emotional facial expressions. Psychological Science 24, 723–732.CrossRefGoogle Scholar
D'Argembeau, A, Jedidi, H, Balteau, E, Bahri, M, Phillips, C and Salmon, E (2012) Valuing one's self: medial prefrontal involvement in epistemic and emotive investments in self-views. Cerebral Cortex 22, 659–667.CrossRefGoogle ScholarPubMed
Deborde, A-S, Miljkovitch, R, Roy, C, Dugré-Le Bigre, C, Pham-Scottez, A, Speranza, M and Corcos, M (2012) Alexithymia as a mediator between attachment and the development of borderline personality disorder in adolescence. Journal of Personality Disorders 26, 676–688.CrossRefGoogle ScholarPubMed
Denny, BT, Kober, H, Wager, TD and Ochsner, KN (2012) A meta-analysis of functional neuroimaging studies of self- and other judgments reveals a spatial gradient for mentalizing in medial prefrontal cortex. Journal of Cognitive Neuroscience 24, 1742–1752.CrossRefGoogle ScholarPubMed
Donges, U-S and Suslow, T (2017) Alexithymia and automatic processing of emotional stimuli: a systematic review. Reviews in the Neurosciences 28, 247–264.CrossRefGoogle ScholarPubMed
Dou, W, Palomero-Gallagher, N, van Tol, M-J, Kaufmann, J, Zhong, K, Bernstein, H-G, Heinze, H-J, Speck, O and Walter, M (2013) Systematic regional variations of GABA, glutamine, and glutamate concentrations follow receptor fingerprints of human cingulate cortex. Journal of Neuroscience 33, 12698–12704.CrossRefGoogle ScholarPubMed
Duncan, NW, Enzi, B, Wiebking, C and Northoff, G (2011) Involvement of glutamate in rest-stimulus interaction between perigenual and supragenual anterior cingulate cortex: a combined fMRI-MRS study. Human Brain Mapping 32, 2172–2182.CrossRefGoogle ScholarPubMed
Duncan, NW, Wiebking, C, Tiret, B, Marjańska, M, Hayes, DJ, Lyttleton, O, Doyon, J and Northoff, G (2013) Glutamate concentration in the medial prefrontal cortex predicts resting-state cortical-subcortical functional connectivity in humans. PLoS ONE 8, e60312.CrossRefGoogle ScholarPubMed
Enzi, B, Duncan, NW, Kaufmann, J, Tempelmann, C, Wiebking, C and Northoff, G (2012) Glutamate modulates resting state activity in the perigenual anterior cingulate cortex – a combined fMRI–MRS study. Neuroscience 227, 102–109.CrossRefGoogle ScholarPubMed
Ernst, J, Böker, H, Hättenschwiler, J, Schüpbach, D, Northoff, G, Seifritz, E and Grimm, S (2014) The association of interoceptive awareness and alexithymia with neurotransmitter concentrations in insula and anterior cingulate. Social Cognitive and Affective Neuroscience 9, 857–863.CrossRefGoogle ScholarPubMed
Etkin, A, Egner, T and Kalisch, R (2011) Emotional processing in anterior cingulate and medial prefrontal cortex. Trends in Cognitive Sciences 15, 85–93.CrossRefGoogle ScholarPubMed
Fonagy, P and Target, M (1997) Attachment and reflective function: their role in self-organization. Development and Psychopathology 9, 679–700.CrossRefGoogle ScholarPubMed
Fonagy, P, Luyten, P, Moulton-Perkins, A, Lee, Y-W, Warren, F, Howard, S, Ghinai, R, Fearon, P and Lowyck, B (2016) Development and validation of a self-report measure of mentalizing: the reflective functioning questionnaire. PLoS ONE 11, e0158678.CrossRefGoogle ScholarPubMed
Franz, M, Popp, K, Schaefer, R, Sitte, W, Schneider, C, Hardt, J, Decker, O and Braehler, E (2008) Alexithymia in the German general population. Social Psychiatry and Psychiatric Epidemiology 43, 54–62.CrossRefGoogle ScholarPubMed
Goerlich-Dobre, KS, Bruce, L, Martens, S, Aleman, A and Hooker, CI (2014) Distinct associations of insula and cingulate volume with the cognitive and affective dimensions of alexithymia. Neuropsychologia 53, 284–292.CrossRefGoogle ScholarPubMed
Grabe, HJ, Wittfeld, K, Hegenscheid, K, Hosten, N, Lotze, M, Janowitz, D, Völzke, H, John, U, Barnow, S and Freyberger, HJ (2014) Alexithymia and brain gray matter volumes in a general population sample. Human Brain Mapping 35, 5932–5945.CrossRefGoogle Scholar
Green, MJ, Cahill, CM and Malhi, GS (2007) The cognitive and neurophysiological basis of emotion dysregulation in bipolar disorder. Journal of Affective Disorders 103, 29–42.CrossRefGoogle ScholarPubMed
Gross, JJ (1998) The emerging field of emotion regulation: an integrative review. Review of General Psychology 2, 271–299.CrossRefGoogle Scholar
Guttman, H and Laporte, L (2002) Alexithymia, empathy, and psychological symptoms in a family context. Comprehensive Psychiatry 43, 448–455.CrossRefGoogle Scholar
Gyurak, A, Gross, JJ and Etkin, A (2011) Explicit and implicit emotion regulation: a dual-process framework. Cognition and Emotion 25, 400–412.CrossRefGoogle ScholarPubMed
Heinzel, A, Minnerop, M, Schäfer, R, Müller, H-W, Franz, M and Hautzel, H (2012) Alexithymia in healthy young men: a voxel-based morphometric study. Journal of Affective Disorders 136, 1252–1256.CrossRefGoogle ScholarPubMed
Horn, DI, Yu, C, Steiner, J, Buchmann, J, Kaufmann, J, Osoba, A, Eckert, U, Zierhut, K, Schiltz, K, He, H, Biswal, B, Bogerts, B and Walter, M (2010) Glutamatergic and resting-state functional connectivity correlates of severity in major depression – the role of pregenual anterior cingulate cortex and anterior insula. Frontiers in Systems Neuroscience 4, 33.Google ScholarPubMed
Joormann, J and Gotlib, IH (2010) Emotion regulation in depression: relation to cognitive inhibition. Cognition and Emotion 24, 281–298.CrossRefGoogle ScholarPubMed
Kjaer, TW, Bertelsen, C, Piccini, P, Brooks, D, Alving, J and Lou, HC (2002) Increased dopamine tone during meditation-induced change of consciousness. Cognitive Brain Research 13, 255–259.CrossRefGoogle Scholar
Koole, SL (2009) The psychology of emotion regulation: an integrative review. Cognition and Emotion 23, 4–41.CrossRefGoogle Scholar
Lane, R, Sechrest, L, Riedel, R, Shapiro, D and Kaszniak, A (2000) Pervasive emotion recognition deficit common to alexithymia and the repressive coping style. Psychosomatic Medicine 62, 492–501.CrossRefGoogle ScholarPubMed
Lee, H, Heller, AS, van Reekum, CM, Nelson, B and Davidson, RJ (2012) Amygdala–prefrontal coupling underlies individual differences in emotion regulation. NeuroImage 62, 1575–1581.CrossRefGoogle ScholarPubMed
Leweke, F, Stark, R, Milch, W, Kurth, R, Schienle, A, Kirsch, P, Stingl, M, Reimer, C and Vaitl, D (2004) Neuronale Aktivitätsmuster auf affektinduktive Reize bei Alexithymie. PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie 54, 437–444.CrossRefGoogle Scholar
Leweke, F, Leichsenring, F, Kruse, J and Hermes, S (2012) Is alexithymia associated with specific mental disorders? Psychopathology 45, 22–28.CrossRefGoogle ScholarPubMed
Li, M, Metzger, CD, Li, W, Safron, A, van Tol, M-J, Lord, A, Krause, AL, Borchardt, V, Dou, W, Genz, A, Heinze, H-J, He, H and Walter, M (2014) Dissociation of glutamate and cortical thickness is restricted to regions subserving trait but not state markers in major depressive disorder. Journal of Affective Disorders 169, 91–100.CrossRefGoogle Scholar
Li, M, Woelfer, M, Colic, L, Safron, A, Chang, C, Heinze, H-J, Speck, O, Mayberg, HS, Biswal, BB, Salvadore, G, Fejtova, A and Walter, M (2018) Default mode network connectivity change corresponds to ketamine's delayed glutamatergic effects. European Archives of Psychiatry and Clinical Neuroscience, in press.Google ScholarPubMed
Lin, F, Weng, S, Xie, B, Wu, G and Lei, H (2011) Abnormal frontal cortex white matter connections in bipolar disorder: a DTI tractography study. Journal of Affective Disorders 131, 299–306.CrossRefGoogle ScholarPubMed
Luminet, O (2010) Commentary on the paper ‘Is alexithymia a risk factor for major depression, personality disorder, or alcohol use disorders? A prospective population-based study’. Journal of Psychosomatic Research 68, 275–277.CrossRefGoogle ScholarPubMed
Mauss, IB, Bunge, SA and Gross, JJ (2007 a) Automatic emotion regulation. Social and Personality Psychology Compass 1, 146–167.CrossRefGoogle Scholar
Mauss, IB, Cook, CL and Gross, JJ (2007 b) Automatic emotion regulation during anger provocation. Journal of Experimental Social Psychology 43, 698–711.CrossRefGoogle Scholar
Mériau, K, Wartenburger, I, Kazzer, P, Prehn, K, Lammers, C-H, van der Meer, E, Villringer, A and Heekeren, HR (2006) A neural network reflecting individual differences in cognitive processing of emotions during perceptual decision making. NeuroImage 33, 1016–1027.CrossRefGoogle ScholarPubMed
Moriguchi, Y, Ohnishi, T, Lane, RD, Maeda, M, Mori, T, Nemoto, K, Matsuda, H and Komaki, G (2006) Impaired self-awareness and theory of mind: an fMRI study of mentalizing in alexithymia. NeuroImage 32, 1472–1482.CrossRefGoogle ScholarPubMed
Moriguchi, Y, Maeda, M, Igarashi, T, Ishikawa, T, Shoji, M, Kubo, C and Komaki, G (2007) Age and gender effect on alexithymia in large, Japanese community and clinical samples: a cross-validation study of the Toronto Alexithymia Scale (TAS-20). Biopsychosocial Medicine 1, 7.CrossRefGoogle Scholar
Moriguchi, S, Takamiya, A, Noda, Y, Horita, N, Wada, M, Tsugawa, S, Plitman, E, Sano, Y, Tarumi, R, ElSalhy, M, Katayama, N, Ogyu, K, Miyazaki, T, Kishimoto, T, Graff-Guerrero, A, Meyer, JH, Blumberger, DM, Daskalakis, ZJ, Mimura, M and Nakajima, S (2018) Glutamatergic neurometabolite levels in major depressive disorder: a systematic review and meta-analysis of proton magnetic resonance spectroscopy studies. Molecular Psychiatry 24, 952–964.CrossRefGoogle ScholarPubMed
New, AS, aan het Rot, M, Ripoll, LH, Perez-Rodriguez, MM, Lazarus, S, Zipursky, E, Weinstein, SR, Koenigsberg, HW, Hazlett, EA, Goodman, M and Siever, LJ (2012) Empathy and alexithymia in borderline personality disorder: clinical and laboratory measures. Journal of Personality Disorders 26, 660–675.CrossRefGoogle ScholarPubMed
Nolte, T, Bolling, DZ, Hudac, C, Fonagy, P, Mayes, LC and Pelphrey, KA (2013) Brain mechanisms underlying the impact of attachment-related stress on social cognition. Frontiers in Human Neuroscience 7, 816.CrossRefGoogle ScholarPubMed
Northoff, G, Walter, M, Schulte, RF, Beck, J, Dydak, U, Henning, A, Boeker, H, Grimm, S and Boesiger, P (2007) GABA concentrations in the human anterior cingulate cortex predict negative BOLD responses in fMRI. Nature Neuroscience 10, 1515–1517.CrossRefGoogle ScholarPubMed
Onoda, K, Okamoto, Y, Nakashima, K, Nittono, H, Ura, M and Yamawaki, S (2009) Decreased ventral anterior cingulate cortex activity is associated with reduced social pain during emotional support. Social Neuroscience 4, 443–454.CrossRefGoogle ScholarPubMed
Paradiso, A, Berardino, R, de Pinto, MC, Sanita di Toppi, L, Storelli, MM, Tommasi, F and De Gara, L (2008) Increase in ascorbate-glutathione metabolism as local and precocious systemic responses induced by cadmium in durum wheat plants. Plant and Cell Physiology 49, 362–374.CrossRefGoogle ScholarPubMed
Parker, JDA, Taylor, GJ and Bagby, RM (2003) The 20-item Toronto Alexithymia Scale. Journal of Psychosomatic Research 55, 269–275.CrossRefGoogle ScholarPubMed
Peng, D-H, Shen, T, Zhang, J, Huang, J, Liu, J, Liu, S-Y, Jiang, K, Xu, Y-F and Fang, Y-R (2012) Abnormal functional connectivity with mood regulating circuit in unmedicated individual with major depression: a resting-state functional magnetic resonance study. Chinese Medical Journal 125, 3701–3706.Google ScholarPubMed
Philippi, CL, Motzkin, JC, Pujara, MS and Koenigs, M (2015) Subclinical depression severity is associated with distinct patterns of functional connectivity for subregions of anterior cingulate cortex. Journal of Psychiatric Research 71, 103–111.CrossRefGoogle ScholarPubMed
Phillips, M, Ladouceur, C and Drevets, W (2008) A neural model of voluntary and automatic emotion regulation: implications for understanding the pathophysiology and neurodevelopment of bipolar disorder. Molecular Psychiatry 13, 829–857.CrossRefGoogle ScholarPubMed
Pollatos, O and Gramann, K (2012) Attenuated modulation of brain activity accompanies emotion regulation deficits in alexithymia. Psychophysiology 49, 651–658.CrossRefGoogle ScholarPubMed
Reker, M, Ohrmann, P, Rauch, AV, Kugel, H, Bauer, J, Dannlowski, U, Arolt, V, Heindel, W and Suslow, T (2010) Individual differences in alexithymia and brain response to masked emotion faces. Cortex 46, 658–667.CrossRefGoogle ScholarPubMed
Ristow, I, Li, M, Colic, L, Marr, V, Födisch, C, von Düring, F, Schiltz, K, Drumkova, K, Witzel, J, Walter, H, Beier, K, Kruger, THC, Ponseti, J, Schiffer, B and Walter, M (2018) Pedophilic sex offenders are characterised by reduced GABA concentration in dorsal anterior cingulate cortex. NeuroImage: Clinical 18, 335–341.CrossRefGoogle ScholarPubMed
Rothschild-Yakar, L, Peled, M, Enoch-Levy, A, Gur, E and Stein, D (2018) ‘Eating me up from inside’: a pilot study of mentalization of self and others and emotion regulation strategies among young women with eating disorders. The Israel Journal of Psychiatry and Related Sciences 55, 35–43.Google Scholar
Salminen, JK, Saarijärvi, S, Äärelä, E, Toikka, T and Kauhanen, J (1999) Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland. Journal of Psychosomatic Research 46, 75–82.CrossRefGoogle ScholarPubMed
Sankoh, AJ, Huque, MF and Dubey, SD (1997) Some comments on frequently used multiple endpoint adjustment methods in clinical trials. Statistics in Medicine 16, 2529–2542.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
Schurz, M, Kogler, C, Scherndl, T, Kronbichler, M and Kühberger, A (2015) Differentiating self-projection from simulation during mentalizing: evidence from fMRI. PLoS ONE 10, e0121405.CrossRefGoogle ScholarPubMed
Sharp, C, Pane, H, Ha, C, Venta, A, Patel, AB, Sturek, J and Fonagy, P (2011) Theory of mind and emotion regulation difficulties in adolescents with borderline traits. Journal of the American Academy of Child & Adolescent Psychiatry 50, 563–573, e1.CrossRefGoogle ScholarPubMed
Silani, G, Bird, G, Brindley, R, Singer, T, Frith, C and Frith, U (2008) Levels of emotional awareness and autism: an fMRI study. Social Neuroscience 3, 97–112.CrossRefGoogle Scholar
Sturm, VE and Levenson, RW (2011) Alexithymia in neurodegenerative disease. Neurocase 17, 242–250.CrossRefGoogle ScholarPubMed
Swart, M, Kortekaas, R and Aleman, A (2009) Dealing with feelings: characterization of trait alexithymia on emotion regulation strategies and cognitive-emotional processing. PLoS ONE 4, e5751.CrossRefGoogle ScholarPubMed
Taylor, GJ (2000) Recent developments in alexithymia theory and research. The Canadian Journal of Psychiatry 45, 134–142.CrossRefGoogle ScholarPubMed
Taylor, MJ (2014) Could glutamate spectroscopy differentiate bipolar depression from unipolar? Journal of Affective Disorders 167, 80–84.CrossRefGoogle ScholarPubMed
Taylor, GJ and Taylor, HL (1997) Alexithymia. In McCallum, M and Piper, W (eds), Psychological Mindedness: A Contemporary Understanding. Munich: Lawrence Erlbaum, pp. 77–104.Google Scholar
Taylor, GJ and Bagby, RM (2004) New trends in alexithymia research. Psychotherapy and Psychosomatics 73, 68–77.CrossRefGoogle ScholarPubMed
Taylor, GJ, Bagby, RM and Parker, JDA (2003) The 20-item Toronto Alexithymia Scale. Journal of Psychosomatic Research 55, 277–283.CrossRefGoogle ScholarPubMed
Toth, E, Gersner, R, Wilf-Yarkoni, A, Raizel, H, Dar, DE, Richter-Levin, G, Levit, O and Zangen, A (2008) Age-dependent effects of chronic stress on brain plasticity and depressive behavior: coping with chronic stress. Journal of Neurochemistry 107, 522–532.CrossRefGoogle Scholar
van der Velde, J, Servaas, MN, Goerlich, KS, Bruggeman, R, Horton, P, Costafreda, SG and Aleman, A (2013) Neural correlates of alexithymia: a meta-analysis of emotion processing studies. Neuroscience & Biobehavioral Reviews 37, 1774–1785.CrossRefGoogle ScholarPubMed
Venta, A, Hart, J and Sharp, C (2013) The relation between experiential avoidance, alexithymia and emotion regulation in inpatient adolescents. Clinical Child Psychology and Psychiatry 18, 398–410.CrossRefGoogle ScholarPubMed
Vermeulen, N, Luminet, O and Corneille, O (2006) Alexithymia and the automatic processing of affective information: evidence from the affective priming paradigm. Cognition & Emotion 20, 64–91.CrossRefGoogle Scholar
Versace, A, Almeida, JRC, Hassel, S, Walsh, ND, Novelli, M, Klein, CR, Kupfer, DJ and Phillips, ML (2008) Elevated left and reduced right orbitomedial prefrontal fractional anisotropy in adults with bipolar disorder revealed by tract-based spatial statistics. Archives of General Psychiatry 65, 1041–1052.CrossRefGoogle ScholarPubMed
Victor, TA, Furey, ML, Fromm, SJ, Bellgowan, PSF, Öhman, A and Drevets, WC (2012) The extended functional neuroanatomy of emotional processing biases for masked faces in major depressive disorder. PLoS ONE 7, e46439.CrossRefGoogle ScholarPubMed
Victor, TA, Furey, ML, Fromm, SJ, Öhman, A and Drevets, WC (2013) Changes in the neural correlates of implicit emotional face processing during antidepressant treatment in major depressive disorder. The International Journal of Neuropsychopharmacology 16, 2195–2208.CrossRefGoogle ScholarPubMed
Walker, S, O'Connor, DB and Schaefer, A (2011) Brain potentials to emotional pictures are modulated by alexithymia during emotion regulation. Cognitive, Affective, & Behavioral Neuroscience 11, 463–475.CrossRefGoogle ScholarPubMed
Walter, M, Henning, A, Grimm, S, Schulte, RF, Beck, J, Dydak, U, Schnepf, B, Boeker, H, Boesiger, P and Northoff, G (2009) The relationship between aberrant neuronal activation in the pregenual anterior cingulate, altered glutamatergic metabolism, and anhedonia in major depression. Archives of General Psychiatry 66, 478–486.CrossRefGoogle ScholarPubMed
Wiebking, C, Duncan, NW, Qin, P, Hayes, DJ, Lyttelton, O, Gravel, P, Verhaeghe, J, Kostikov, AP, Schirrmacher, R, Reader, AJ, Bajbouj, M and Northoff, G (2014) External awareness and GABA-A multimodal imaging study combining fMRI and [18F]flumazenil-PET: GABA and External Awareness. Human Brain Mapping 35, 173–184.CrossRefGoogle Scholar
Wozniak, J, Gönenç, A, Biederman, J, Moore, C, Joshi, G, Georgiopoulos, A, Hammerness, P, McKillop, H, Lukas, SE and Henin, A (2012) A magnetic resonance spectroscopy study of the anterior cingulate cortex in youth with emotional dysregulation. The Israel Journal of Psychiatry and Related Sciences 49, 62–69.Google ScholarPubMed
Xia, M, Wang, J and He, Y (2013) BrainNet viewer: a network visualization tool for human brain connectomics. PLOS ONE 8, e68910.CrossRefGoogle ScholarPubMed
Yüksel, C and Öngür, D (2010) Magnetic resonance spectroscopy studies of glutamate-related abnormalities in mood disorders. Biological Psychiatry 68, 785–794.CrossRefGoogle ScholarPubMed