Does alexithymia, independent of depressive and anxiety disorders, correlate with the severity of somatic manifestations among patients with medically unexplained physical symptoms?

Background: Medically unexplained physical symptoms (MUPS) are highly prevalent, frequently co-occurring with psychiatric symptoms such as depression, alexithymia, and anxiety. Objective: To evaluate the relation between depression, anxiety, and alexithymia and severity of somatic symptoms in patients with MUPS. Method: This is a cross-sectional study conducted on 196 patients suffering from MUPS. The patients were recruited from tertiary care internal medicine and neuropsychiatry clinics during the first quarter of 2019. The Patient Health Questionnaire (PHQ-15), (PHQ-9), Generalized Anxiety Disorder (GAD-7), Structured Clinical Interview for DSM-IV Axis I Disorders Clinician Version (SCID-I-CV), and Toronto Alexithymia Scale (TAS-20) were employed to assess somatic severity, depression, anxiety, major mental disorders, and alexithymia in the sample of patients. Results: The results of the study indicate that GAD-7 and PHQ-9 scores had a positive correlation with PHQ-15 ( p < 0.05) in multivariate regression. In contrast, TAS-20 was not independently correlated with PHQ-15. Adding TAS-20 to GAD-7 and PHQ-9 in the equation of the regression model enhances the predictive capacity of the model ( p < 001). Conclusion: The results of the study indicate that only anxiety and depressive symptoms, but not alexithymia, were associated independently with MUPS severity.

The interplay among paranoia, social relationships and negative affectivity in a heterogeneous clinical sample: A network analysis

Previous evidence suggests paranoia affects people’s functioning in interpersonal relationships. However, less is known about the interconnections among specific aspects of paranoia and domains of social relationships. The goal of the current study was to explore the interplay among different aspects of paranoia, social relationships and negative affectivity (depression, anxiety and social anxiety) in a diverse clinical sample using network analysis. A sample of 366 participants (84.4% female) with a history of mental illness was recruited online. The mean age was 35.31 years. Data were modelled using the Gaussian Graphical Model with regularization. The network included the following scales: R-GPTS, SAD-D, National Institute of Health Toolbox Adult Social Relationship scales, PHQ-9 and GAD-7. The results revealed substantial connections between aspects of paranoia (ideas of reference and ideas of persecution) and both perceived hostility and perceived rejection. Furthermore, significant associations of ideas of reference with social anxiety and loneliness with depression were observed. Perceived rejection and loneliness were the most central nodes in the estimated network. The current study provides robust evidence for the interconnections of paranoia, social relationships and negative affectivity, present across different diagnoses. This further supports the transdiagnostic approach to paranoia research and the related important role of social relationships.

Assessing distress tolerance using a modified version of the Emotional Image Tolerance task

The Emotional Image Tolerance (EIT) task assesses tolerance of negative emotion induced by negatively valenced images. We made several minor modifications to the task (Study 1) and adapted the task to include positive and neutral images in order to assess whether individuals respond to the valence or the intensity of the image content (Study 2). In both studies, we assessed subjective distress, gender differences in task responses, and associations between behavioral and self-reported distress tolerance, and related constructs. Across both studies, the EIT successfully induced distress and gender differences were observed, with females generally indicating more distress than males. In Study 2, responses on the adapted EIT task were correlated with self-reported distress tolerance, rumination, and emotion reactivity. The EIT successfully induces distress and the correlations in Study 2 provide promising evidence of validity.

The relationship of insight with psychopathological dimensions in patients with schizophrenia

Impaired insight in patients with schizophrenia results in less satisfactory clinical outcomes. This study was conducted to investigate the relationship between insight and individual psychopathological dimensions in inpatients with schizophrenia using a self-report questionnaire. In this study, 90 patients with schizophrenia aged 18–75 years admitted in the acute psychiatric ward of a medical center in Taiwan were enrolled. Patient insight was measured using the Self-Appraisal of Illness Questionnaire (SAIQ), and psychopathological dimensions were measured using the Positive and Negative Syndrome Scale (PANSS) and its five-factor structure model. A higher SAIQ score indicates greater insight. In bivariate correlation analyses, statistically significant correlations were observed between age, single marital status, educational level, and positive, excited, and depressed symptom factor of the PANSS and SAIQ score. In regression analyses, age and excited and depressed symptom factors were significantly associated with SAIQ score. No significant association was observed between insight and neurocognitive functions. Considering demographic characteristics, psychopathology, and neurocognition, in the acute phase of schizophrenia, younger patients with less severe excited symptoms and more severe depressive symptoms had greater insight.

Rumination as a mechanism of the association between interpretation bias and depression symptoms: A longitudinal investigation

Depression is a common problem with debilitating effects. Both negative interpretation biases and rumination are related to depression, but how these factors interact to produce depression is unclear. Prior cross-sectional research indicates that negative interpretation biases have an indirect effect on depression symptoms through rumination, but to date, no longitudinal studies have examined this indirect effect, and prior studies have not differentiated between rumination subtypes. To examine these questions, data were collected online at three time points from undergraduates. Simple mediational models examined whether negative interpretation bias had an indirect effect on depression symptoms through rumination and rumination subtypes (brooding and reflection), and reverse models examined direction of effects. Cross-sectional analysis supported prior findings that interpretation bias had an indirect effect on depression symptoms through rumination, β = −.19, 95%CI [−.23, −.14], through both brooding, β = −.14, 95%CI [−.18, −.10], and reflection subtypes, β = −.09, 95%CI [−.12, −.05]. However, longitudinal analyses found no indirect effects of interpretation bias on depression symptoms through rumination, β = −.02, 95%CI [−.07, .02]; brooding: β = −.02, 95%CI [−.06, .01], reflection: β = .01, 95%CI [−.02, .04]. These longitudinal results contradict findings that cognitive biases lead to depression symptoms through rumination. The complex interplay between cognitive biases, rumination, and depression remains an important direction for future research.

The role of cognitive and affective flexibility in individual differences in the experience of experimentally induced heat pain

Adaptation to the context in which we experience pain requires cognitive flexibility (CF) and affective flexibility (AF). Deficits in both flexibility types may be precursors of more intense and prolonged pain. This study aimed to examine the relation between CF and AF, and the experience of experimentally induced pain. Furthermore, correlations between behavioral and self-report measures of flexibility were explored. CF and AF were assessed with task-switching paradigms, using neutral (numbers ranging from 1 to 9, excluding 5) or affective stimuli (positive and negative pictures), respectively. Pain sensitivity measures, such as pain threshold (°C), pain tolerance (°C), and retrospective pain experience ratings (Visual Analog Scale) were assessed for an experimentally induced heat pain stimulus. Self-reported CF was measured with a questionnaire. Results demonstrated no associations between the flexibility constructs and any of the pain outcome measures. Correlations between the behavioral and self-report measures of CF were absent or weak at best. Current results are discussed against the background of methodological considerations and prior empirical research findings, suggesting the contribution of AF in especially the recovery from pain.

A preliminary comparison of fundamental fears related to anxiety

In the quest to uncover lower order processes that underlie anxiety disorders, researchers have proposed a number of fundamental fears, which are thought to represent fears of inherently aversive stimuli that can explain a number of higher order constructs such as more specific fears. In a recent theoretical article, Carleton narrowed the list of potential fundamental fears down to three candidates: fear of death, fear of pain, and fear of the unknown. Carleton proposes that fear of the unknown represents the primary fundamental fear, suggesting that unlike the other two, fear of the unknown is inherently aversive and logically irreducible. The present study represents an initial empirical investigation of this hypothesis. In a cross-sectional study ( N = 373), fear of death, fear of pain, and fear of the unknown were assessed as simultaneous predictors of anxiety. Results showed that fear of the unknown was indeed the strongest unique predictor, while fear of pain also uniquely predicted anxiety, although to a lesser extent. While the results suggest that fear of the unknown may indeed be the most fundamental fear, the need for conceptual clarification and empirical work using diverse measures is discussed.

Can you believe it? Examining the influence of safety behavior beliefs on speech task outcomes

Beliefs and expectations about treatment have been shown to significantly impact treatment outcomes in medical settings. However, researchers have seldom examined the role of beliefs within the context of cognitive behavioral therapy. Beliefs may be particularly salient for safety behavior (SB) use in exposure therapy, as clinicians often hold opinions about whether judicious SB use facilitates or inhibits treatment. These beliefs may consequently be relayed during psychoeducation, influencing client expectations of SB helpfulness and exposure efficacy. We investigated experimentally the influence of SB beliefs on working memory, speech predictions, speech duration, anxiety, performance, and speech acceptability. Speech anxious undergraduate participants ( N = 144) received psychoeducation on exposure and were told (using random assignment) either that SBs: increase anxiety (unhelpful), decrease anxiety (helpful), or were provided with no information on SBs (control). People in the helpful condition only believed the exposure would be more successful. Crucially, exposure expectancy mediated the relationship between the helpful (but not unhelpful) condition and willingness to engage in future exposures. There were no effects of condition on most cognitive, emotional, or behavioral outcomes, suggesting that SBs (and SB beliefs) may have less impact on exposure outcomes than is currently believed.

Cognitive, behavioural and familial maintenance mechanisms in childhood obsessive compulsive disorders: A systematic review

Cognitive Behavioural Therapy (CBT) for preadolescent children with obsessive compulsive disorder (OCD) is typically derived from adult cognitive behavioural models of OCD; however, it is unknown whether these adult models apply to preadolescent children. This systematic review examined whether 11 cognitive, behavioural and familial maintenance mechanisms identified from adult cognitive behavioural models of OCD and descriptions of how family factors may maintain OCD applied to preadolescent children with obsessive compulsive symptoms/disorder (OCS/OCD; Prospero:CRD42019153371). PsycINFO, MEDLINE and Web of Science Core Collection were searched in March 2019, with forward citation handsearching conducted in March/April 2020. Twenty-nine studies were synthesised. Studies were identified for only six of the 11 proposed maintenance factors. Of the cognitive and behavioural factors, only inflated responsibility and meta-cognitive beliefs showed evidence of independent and/or specific associations with childhood OCS. Of the family factors, only less frequent displays of parental confidence, positive problem solving and rewarding of children’s independence showed some evidence of specificity to childhood OCD. Notably, findings across studies were inconsistent and existing studies have considerable methodological limitations. Experimental and prospective longitudinal studies are needed to determine whether the proposed factors maintain childhood OCS/OCD, to improve the effectiveness and efficiency of CBT for preadolescent children with OCD.

Addicted to Self-esteem: Understanding the neurochemistry of narcissism by using cocaine as a pharmacological model

There are pronounced behavioural and neuroimaging parallels between cocaine abuse and narcissism. Although the observed commonalities are not specific to cocaine as opposed to other types of addiction, we argue that the relatively constrained molecular actions of cocaine and, more importantly, the covariance of narcissism-like behaviours with cocaine use build a strong case for taking the known effects of cocaine as a starting point for addressing the hitherto underinvestigated neurophysiology of narcissism. In this review, we discuss the potential relevance of cocaine abuse as a pharmacological model of narcissism. We outline previous research on the role of monoamines across several domains affected in narcissistic personality disorder and subclinical narcissism, namely, selected personality traits, social behaviour, emotional empathy and self-referential processing. We propose that dysregulation in dopamine signalling might underlie addiction-like features of narcissism and that altered serotonergic signalling may account for affective components of narcissism and, in particular, explain the differences between grandiose and vulnerable subtypes. In conclusion, we provide recommendations for future research.