The Impact of Inhibitory Control Training on the Emotional Regulation of Individuals with Alexithymic Symptoms

The Impac o Inhibi o y Con ol T aining on he Emo ional Regula ion o Indi iduals wi h Alexi hymic Symp oms Jade Zina Mande s uc2[email p o ec ed] In e -Uni e si y Mas e in Clinical and Expe imen al Neu opsychology Uni e sidade de Coimb a, Uni e sidade de Lisboa, Uni e sidade do Minho Mas e Thesis P o esso Ósca F. Gonçal es P o esso Se gi Be múdez I Badia EMOTION REGULATION IN ALEXITHYMIA 2 Abs ac Emo ions in luence human beha io and a e an impo an componen in e e yday-li e o ien a ion. Alexi hymic pe sons a e no able o in e p e hei eelings co ec ly and he e o e ha e a disad an age in social si ua ions. This s udy es ed he e ec o inhib o y con ol o p ime ei he he de ensi e o appe i i e sys em in a g oup o alexi hymic indi iduals and non-alexi hymic con ols wi h he in en ion o mi iga e alexi hymic symp oms. Fo p iming ia inhibi o y con ol an emo ional Go/No-Go pa adigm was chosen. The goal was o achie e ele a ed emo ional epo s a e he aining compa ed o he beginning o he aining. In o de o es his, pa icipan s illed ou he TAS and we e alloca ed o he condi ional o con ol g oup, espec i ely. On h ee execu i e days p obands would pa icipa e in an emo ional Go/No-Go aining wi h bo h a p eceden and ollowing PANAS. Las ly, he pa icipan s wa ched and a ed ideos o he EMDB in e ms o hei alence and a ousal. A la ge e ec size was ound o an inc ease in posi i e a ec a e ha ing p imed he appe i i e sys em wi h Go(pleasan )/No- Go(Unpleasan ) in alexi hymic pe sons. Howe e , hose esul s did no u n ou signi ican H2 (1,2) = 1,9 , p= .179, ηp2= .158. Fu he mo e, he small sample size o N = 12 does no allow o an accu a e in e p e a ion o he esul s. Keywo ds: alexi hymia, emo ion egula ion, a ec i e p iming, de ensi e sys em, appe i i e sys em, inhibi o y con ol Resumo As emoções in luenciam o compo amen o humano e são um componen e impo an e na o ien ação da ida quo idiana. Pessoas alexi ímicas não são capazes de in e p e a os seus sen imen os co e amen e e, po an o, êm uma des an agem em si uações sociais. Es e es udo es ou o e ei o do con olo inibi ó io pa a p epa a o sis ema de ensi o ou ape i i o num g upo de indi íduos alexi ímicos e num g upo de con olo de não alexi ímicos com o obje i o de mi iga os sin omas alexi ímicos. Pa a o p iming ia con ole inibi ó io, oi escolhido um pa adigma Go / No-Go emocional. O obje i o e a alcança ele ados ela os emocionais após o eino em elação ao início. Pa a al os pa icipan es p eenche am a TAS e o am alocados no g upo condicional ou con ole. Em ês dias execu i os, eles pa icipa iam num eino Go / No-Go emocional com PANAS p eceden e e pos e io men e. Po úl imo, os pa icipan es assis i am e a alia am ídeos do EMDB em e mos das suas alência e exci ação. Foi encon ado um amanho de e ei o ele ado pa a um aumen o no a e o posi i o após p iming do sis ema ape i i o com EMOTION REGULATION IN ALEXITHYMIA 3 Go (ag adá el) / No-Go (desag adá el) em pessoas alexi ímicas. No en an o, esses esul ados não se mos a am signi ica i os H2 (1,2) = 1,9, p = 0,179, ηp2 = 0,158. Além disso, o pequeno amanho da amos a de N = 12 não pe mi e uma in e p e ação p ecisa dos esul ados. Pala as-cha e: alexi imia, egulação da emoção, p iming a e i o, sis ema de ensi o, sis ema ape i i o, con ole inibi ó io EMOTION REGULATION IN ALEXITHYMIA 4 In oduc ion Many psychological sys ems wo k oge he o ensu e su i ing o i s bes possibili ies. Howe e , he e a e wo main supe ising sys ems wo king opposi ely oge he , namely he de ensi e and he appe i i e sys em. The i s one, he de ense sys em in e enes in si ua ions o h ea by esponding wi h igh , ligh o eeze (Lang e al., 1990). Unpleasan emo ions a e expe ienced and he e o e elici a oidance beha io . The appe i i e sys em, con a y o ha , is igge ed in ci cums ances ha p omo e su i al, comp ising sus enance, p oc ea ion, and nu u ance and in u n e lec beha io s such as ood consump ion, copula ion and nu sing (B adley, 2009; G ay, 1976, 1982). App oaching beha io is p imed by he ac i a ion o he appe i i e sys em h ough sa is ac o y, ewa ding emo ions (Lang, 1995). Neu al ci cles in ol ed in his a e amongs o he s he amygdala, hypo halamus, and b ains em (e.g. Choi e al., 2010; LeDoux e al., 1988). The amygdala is known o i s pa icipa ion in ea condi ioning (Fanselow & Kim, 1994; LeDoux e al., 1990; Ma en & Qui k, 2004) and i s link o ewa d associa ions (Bax e & Mu ay, 2002; Cado e al., 1989; Ca dinal e al., 2002) by ecei ing senso y in o ma ion. Subsequen ly, neu onal signals a e sen o he soma omo o sys ems including he skele al muscle, and isce omo o sys ems, di ec ing he app oach o a oidance beha io (Lang e al., 1990). To abs ac his, bo h he appe i i e and de ensi e sys em o igina e in a senso y inpu , causing ce eb al neu al ci cui s including he amygdalae o induce soma ic and au onomic physiological sys ems o a en ion and ac ion o espond (Da is, 2000; Fanselow & Kim, 1994; LeDoux, 1990). Howe e , he e a e addi ional dimensions in luencing he emo ional esponse. The wo mos consis en dimensions ound h oughou di e en s udies a e alence and a ousal (e.g. Mauss & Robinson, 2009; Smi h & Ellswo h, 1985). Valence co ela es wi h he ac i a ion o mo i a ion and can be pleasan , which co esponds wi h a posi i e hedonic impac and appe i i e mo i a ion; o i can be unpleasan , which hen co esponds wi h a nega i e hedonic impac and de ensi e mo i a ion (Bind a, 1978; Schnei la, 1959). This is also he a ec i e essences o ewa d and punishmen , and an essen ial cons i uen o nume ous o he emo ions (F ijda & Pa o , 2011; Russell & Ba e , 1999; Zajonc, 1980). A ousal, on he o he hand, is he le el o deg ee o mo i a ional ac i a ion and can be a ed as high o low. To ou line, unpleasan emo ions a e co ela ed wi h an ac i a ion o he de ensi e sys em, and pleasan emo ions a e co ela ed wi h he ac i a ion o he appe i i e sys em. I is he e o e possible o measu e which sys em is ac i a ed by in e p e ing he alence o gi en emo ional s imuli. Fu he mo e, he in ensi y o mo i a ional ac i a ion can be indica ed by judgemen s o a ousal (B adley, 2000; EMOTION REGULATION IN ALEXITHYMIA 5 Cu hbe , Schupp, B adley, McManis, & Lang, 1998; G eenwald, Cook, & Lang, 1989; Lang, G eenwald, B adley, & Hamm, 1993). As can be seen, a ec and emo ion ha e a i al impac on human beha io , which makes i e en mo e di icul o people o beha e acco ding o he no m when hey canno in e p e hem co ec ly. Abou 10.2% in he nonclinical Ge man popula ion (F anz e al., 2008) ha e a de icien a ec egula ion and disabili y o cogni i ely p ocess a ec i e in o ma ion (Lumine e al., 2006). This phenomenon is called alexi hymia. The wo d „Alexi hymia“, in oduced by Si neos (1973), o igina es om he G eek e ms “A” – inabili y, “lexis” – wo d, and “ hymos” – eeling, as he inabili y o ind wo ds o speak abou eelings and emo ions. Alexi hymic pe sons a e he e o e desc ibed o ha e di icul ness o communica e, exp ess and desc ibe eelings, also ha e ha dship iden i ying one’s eelings (see also Zhang e al., 2012), especially nega i e ones, and o di e en ia e eelings om physical pe cep ions. They addi ionally lack an asy and imagina ion, including dayd eaming, and ha e an ex e nal o ien ed way o hinking (Lausbe g e al., 2016; Si neos, 1973, 1996; Taylo e al., 1991). Because o his “s i ness” ha hose symp oms lead o, alexi hymia was also called “Pinocchio-Synd om” by Sellschopp-Rüppel & onRad (1977). Howe e , i is no a classical psychological diso de as de ined in he In e na ional Classi ica ion o Diseases (ICD) o Diagnos ic and S a is ical Manual o Men al Diso de s (DSM) as pe oday, bu a he a pe sonali y ai o synd ome. Fu he mo e, many diagnoses wi hin he clinical popula ion sha e a como bidi y wi h alexi hymia, such as as hma, hype ension, ch onic pain, and especially unc ional gas oin es inal diso de s (Lumley e al., 2007; Po celli e al., 2004; Taylo , 2000; Taylo & Michael Bagby, 2004). The symp oms o alexi hymia a e suppo ed by neu oimaging g oundwo k, as alexi hymic pe sons do no show he same b ain ac i a ion in a eas known o be o i al impo ance o emo ion e alua ion and p ocessing as heal hy subjec s, namely limbic and pa alimbic a eas (Hube e al., 2002). Naming emo ions suppo s down egula ing he emo ional limbic esponse (Fak a e al., 2008; Foland-Ross e al., 2010; Ha i i e al., 2000), which would make i ha de o people who expe ience di icul y naming hei emo ions, such as alexi hymic, o adjus hei emo ions (Neumann e al., 2017). Subsequen ly, alexi hymic indi iduals a e incapable o e icien ly ecognizing and egula ing hei esponse owa ds emo ional s imuli (S a i a e al., 2020). In addi ion, people wi h alexi hymia show a dys unc ion in ejec ing dis ac ing in o ma ion (Zhang e al., 2011), no only when i comes o emo ional s imuli bu also when i comes o neu al s imuli in emo ional Go-/No-Go ials, sugges ing a gene alized de iciency in inhibi o y con ol (Co e o, 2020). An emo ional p iming s udy o alexi hymic indi iduals by Ve meulen, Lumine & Co neille (2006) composing o h ee sub-s udies, collec i ely e ealed a dec eased p iming e ec and inhibi ion e ec o EMOTION REGULATION IN ALEXITHYMIA 6 high alexi hymic sco es o cong uen p iming and a ge depending on he alence. The au ho s imply a bu den in alexi hymic pe sons when p ocessing and employing high a ousal emo ional inpu in o de o espond o accompanying beha io al demands. They asc ibe his o a mal unc ioning an e io cingula e co ex (ACC) in high alexi hymic sco ing indi iduals, building up on Damasio’s soma ic ma ke s hypo hesis (1999). This ag ees wi h he esul s o u he esea ch, which has poin ed ou co ela ions be ween he ACC while p ocessing nega i e emo ional s imuli (S adle e al., 2007) and he e o e abno mal ac i i y in he ACC du ing emo ional s imuli p ocessing in alexi hymics in gene al (Be hoz e al., 2002), and a dec eased ce eb al ac i a ion in he do sal ACC (dACC) du ing emo ional mo ie clips (Ka lsson e al., 2008) and pain ul isual s imuli (Mo iguchi e al., 2007). Those esul s a e consis en wi h a c oss-modal ERP s udy on a ec i e p iming o alexi hymia h ough a ec i e music and speech p osody by Goe lich, Wi eman, Aleman & Ma ens (2011). He e, high alexi hymics showed lowe a ec i e p iming e ec s o p osody a ge s, bu no o music and wo d a ge s. The au ho s p opose a minimized sensi i i y o he a ec i e cha ac e is ics o speech and music du ing emo ional ca ego iza ion in alexi hymic pe sons. ACC ac i a ion is also posi i ely co ela ed o acial exp essions o ange (Adolphs, 2002). Fu he esea ch shows ha limbic a eas, which a e di ec ly connec ed o he ACC, show less ac i a ion in alexi hymics ying o sense ano he ones eeling o e en hei own s a e. I is sugges ed ha especially he dACC plays a pi o al unc ion in conscious awa eness o emo ion (Lane e al., 1998; McRae e al., 2008). Addi ionally, i is i al in execu i e unc ions, no ably including inhibi o y p ocesses (Fallga e e al., 2002; Fellows & Fa ah, 2005; Swick & Jo ano ic, 2002), and hence also esponse inhibi ion in alexi hymia. To cla i y, esponse inhibi ion encompasses he supp ession o ac ions ha in e ene wi h goal- o ien ed beha io and ha a e inapp op ia e in a ce ain si ua ion (Mos o sky & Simmonds, 2008). The ela ion be ween emo ion and esponse inhibi ion and i s neu al co ela es ha e been s udied comp ehensi ely (Zhang e al., 2012). Neu ocogni i e esea ch has ag eed on especially s ong associa ions be ween inhibi o y con ol and he p e on al co ex, which is also s ongly in e connec ed and modula es mo o p ocessing (A on, 2007; Duncan, 2001; Hampshi e & Sha p, 2015). In non- alexi hymic indi iduals, unc ioning in mo o inhibi o y con ol and in a ec egula ion a e posi i ely co ela ed (Tabibnia e al., 2011). Howe e , up o his day, he mechanisms behind alexi hymia awai u he esea ch, as hey a e poo ly unde s ood (S a i a e al., 2020). Deduced by he abo e men ioned, he objec i e o his s udy is o es he e ec s o he a ec i e inhibi o y con ol pa adigm designed o p ime ei he he p ima y sys ems o de ense o app oach in EMOTION REGULATION IN ALEXITHYMIA 7 pa icipan s wi h alexi hymia symp oms and heal hy con ols. To es his, a g oup o pa icipan s wi h alexi hymia and heal hy con ols unde wen an in asubjec emo ional Go/No-Go pa adigm in h ee condi ions – pleasan , unpleasan and neu al. Concludingly, he ollowing hypo hesis will be es ed: H1.1: The Accu acy in he Go/No-Go ainings inc eases ac oss ials. H1.2: The eac ion ime in he Go/No-Go ainings dec eases ac oss ials. H2.1: A e p iming he appe i i e sys em wi h he Go(pleasan )/No-Go(Unpleasan ) aining ask he posi i e a ec will be inc eased. H2.2. A e p iming he de ensi e sys em wi h he Go(unpleasan )/No-Go(pleasan ) aining ask he nega i e a ec will be inc eased. H3. A e p iming he appe i i e sys em wi h Go(pleasan )/No-Go(unpleasan ), he a ing “pleasan alence” will be inc eased. H.4: A e p iming he a e si e sys em wi h Go(unpleasan )/No-Go(pleasan ), he a ing “unpleasan alence” will be inc eased. Me hod E en hough he majo i y o people show he same eac ion o unambiguous appe i i e and a e si e s imuli, e.g. appe i i e – esh ood – leading o an app oach; a e si e – moldy ood – leading o a oidance, he e a e also di e ences in e alua ing he s imuli. Judging he s imuli may be a ec ed by, o ins ance, pe sonali y ac o s, especially neu o icism and ex a e sion, by a simul aneously occu ing a e si e s a e (e.g., hunge o dep i a ion; see Rolls, 2000), o by he con ex o s imuli (Fowles, 2006). A con ex ual example he e would be he di e en eac ion o he noise o an explosi e on a a he no mal day compa ed o on New Yea ’s e ening. Howe e , as a o esaid, he e a e ambiguous s imuli ha cause app oach o one indi idual bu mo e o an a oidance beha io o ano he , such as o ins ance a ce ain ype o ood, like lico ice. Fu he mo e, when using a e si e and appe i i e s imuli in expe imen al se ings, he mo i a ional ac i a ion needs o be consis en . To a oid hese ypes o in e en ial haza d in his s udy, only dis inc s imuli ha we e ma ched acco ding o hei ac i a ion o mo i a ional sys ems a e used. Dis inc s imuli a e sexual s imuli o he opposi e gende and opposi e-sex e o ica. Those ype o pic o al s imuli educed he mos appa en physiological eac ions, such as he la ges skin conduc ance EMOTION REGULATION IN ALEXITHYMIA 8 esponses, inhibi ed s a le e lex, and addi ionally disposed he g ea es a ousal a ings (B adley e al., 2001). The p esen s udy employs a quan i a i e design o assess he e ec o emo ionally p iming he appe i i e and a e si e sys ems in alexi hymic pe sons in compa ison wi h non-alexi hymic pe sons. Pa icipan s Pa icipan s sel -selec ed in o he online s udy h ough he blackboa d o an alexi hymia o um (alexi hymia.com) and an aspe ge o um (aspe ge - o um.de), as aspe ge and alexi hymic symp oms o en co-occu (Fi zge ald & Bellg o e, 2006). Fu he mo e, a pa o he sample had been in o med abou he s udy h ough ad-hoc ec ui men . The o al sample ini ially included 16 pe sons, o which 4 showed missing da a and we e he e o e no conside ed o analysis. The emaining 12 pa icipan s‘ age anged om 23 o 58 yea s wi h a mean o M = 32.67 (S = 11,56). This esea ch was conduc ed in Ge man language, wi h one excep ion coming om Swi ze land, o which 4 (33.3%) we e emale and 8 (66.7%) male. The pa icipan s we e alloca ed o he condi ional g oup (alexi hymia) o con ol g oup (non-alexi hymic) acco ding o hei To on o-Alexi hymia-Scale (TAS) sco e, which was designed o iden i y indi iduals wi h alexi hymia. Female indi iduals we e iden i ied as alexi hymic wi h a sco e ≥ 52, male pa icipan s we e alloca ed o he alexi hymic g oup when sco ing 53 o abo e. Pa icipan s signed an in o med consen including he gene a ion o a pa icipan code o anonymiza ion pu poses. They did no ecei e a eimbu semen , o he han he ou come o hei TAS sco e, i eques ed. The e we e no o he exclusion c i e ia besides no app o ing he consen o m and i was manda o y o pa icipa e using a lap op o he s imuli esolu ion. The pu pose o his s udy was anspa en o he pa icipan s. This s udy was app o ed by he e hics commi ee o he Uni e si y o Coimb a. Go/No-Go Pa adigm To eliably measu e esponse inhibi ion, an emo ional Go/No Go Task was chosen. In he classical Go/No-Go Task (Falkens ein e al., 1999), he p oband is shown a se ies o s imuli, o which mos (>70%) a e so-called “go-s imuli” and emaining a e called “no-go-s imuli”. Those s imuli o cues can o example be squa es (go-cue) and ci cles (no-go-cue). To pa icipan has o eac as as as possible o EMOTION REGULATION IN ALEXITHYMIA 9 he go-s imuli/squa e bu e ain o espond o he no-go-s imuli/ci cle. Because o he much highe equency o go-s imuli, he p oband is p oned o eac o his kind o s imuli, so whene e a no-go-s imuli is shown, he p epo end esponse mus be inhibi ed. In he case o he emo ional Go/No-Go aining, he s imuli used a e emo ional, ins ead o neu al, and he e o e se e as a eliable measu e o he emo ional adjus men o beha io al inhibi ion. To bias he appe i i e and a e si e sys em, pa icula emo ional s imuli (pleasan /unpleasan ) had been pai ed wi h he go and no-go cues o squa es and ci cles. This pa o he expe imen was p og ammed in Open Sesame 3.3.8 and p esen ed ia Ja os on he pa icipan s’ compu e s/lap ops. A . The emo ional s imuli The In e na ional A ec i e Pic u e Sys em (IAPS) is based on he wo k by Hamm & Vai l (1993) and was ini ially de eloped eal ing o SAM by Lang e al. (1998). Due o he coope a ion wi h a ellow s uden o he Uni e si y o Coimb a, he images sco ing he mos simila used o he pleasan und unpleasan g oups acco ding o hei means and s anda d de ia ions using he no ma i e alues o he Eu opean Po uguese adap ion (Soa es e al., 2015) we e ma ched. To achie e ac i a ion as high as possible in he mo i e sys ems wi h he use o s a ic images, only e o ic images we e used, as esea ch ound he highes a ousing alues o his ca ego y in acco dance wi h la ge p omp ed physiological esponses, namingly elec ode mal esponses and s a le modula ion (B adley e al., 2001). This accoun ed only o images o membe s o he opposi e sex in e o ic poses. The same was ound o unpleasan images o he ca ego y “ h ea ” (B adley e al., 2001). Addi ionaly, only women a e sensi i e o easonable nega i e s imuli, bu bo h women and men a e sensi i e o he in luence o in ensly nega i e images (Li e al., 2008). Because o ha only highly nega i e s imuli o he ca ego ies mu illa ion and iolence we e chosen. Neu al images o he Go-condi ion we e also ma ched o neu al s imuli o he No-Go- condi ion acco ding o hei mean alues and s anda d de ia ions o mo i e sys ems. The s imuli we e shown in hei o iginal IAPS o ma o 1024 x 768 pixels. B. The Go/No-Go Pa adigm All Go/No-Go ainings included 3x ou expe imen al blocks, wi h 24 Go and 6 No-Go s imuli, equaling 360 ials. The emo ional neu al Go/No-Go aining ask consis ed o 24 Go squa e amed emo ional EMOTION REGULATION IN ALEXITHYMIA 16 Table 3. Desc ip i e S a is ics o Reac ion Times O e Time o Alexi hymics and Con ols wi h Respec o he P iming Condi ion. P iming Condi ion Alexi hymia Non-Alexi hymia M (SD) M (SD) Neu al T1 504,1 (0,8) 498,2 (25,1) T3 459,5 (43,7) 524,2 (26,9) Pleasan T1 543,9 (0,0) 538,2 (51,8) T3 505,7 (0,0) 455,0 (75,4) Unpleasan T1 544.9 (24,1) 551,9 (8,5) T3 528,5 (69,7) 558,6 (41,5) Figu e 3 Reac ion Times O e Time o Alexi hymics and Con ols wi h Respec o he P iming Condi ion. H2.1: A e p iming he appe i i e sys em wi h he Go(pleasan )/No-Go(Unpleasan ) aining ask he posi i e a ec will be inc eased. Fo es ing his hypo hesis, he a ings o he p e- and pos - PANAS ac o “posi i e a ec ” o we e compa ed wi h each o he unde conside a ion o he condi ional and con ol g oup and he day o pe o mance o he Go(pleasan ) aining. The desc ip i e s a is ics exp ess ha his posi i e e ec was 0 100 200 300 400 500 600 700 Neu al Pleasan Unpleasan Neu al Pleasan Unpleasan Alexi hymia Non-Alexi hymia Reac ion Time in ms P e Pos EMOTION REGULATION IN ALEXITHYMIA 17 especially al e ed in he pleasan g oup o alexi hymics, wi h an inc ease om M = 1,2 (SD = 0,1) o M = 4,4 (SD = 5,0), as can be seen in he ba cha in Figu e 4. In he con ol g oup, he an icipa ed e ec could only be ob ained in he pleasan g oup and o a smalle ex end. To a lowe deg ee, his pa e n occu ed in he neu al g oup, oo, wi h an inc ease om M = 1,2 (SD = 0,2) o M = 2,0 (SD = 1,2). In he unpleasan g oup on he o he hand, a sligh opposi e e ec showed wi h M = 3,0 (SD = 0,9) dec easing o M = 2,6 (SD = 0,4) in he alexi hymic g oup. Again, an ANOVA conside ing he pa icula measu emen imepoin (MTP) o pe o ming he pleasan aining was execu ed wi h espec o he condi ion and PANAS “Posi i e A ec ” as dependen measu emen . The esul did no u n ou signi ican F(1,2) = 1,9 , p= .179, ηp2= .158. Ne e heless, he la ge e ec size and a pos -hoc es indica e ha his e ec accoun s o alexi hymics o he pleasan g oup. Figu e 4 Means and S anda d De ia ion o he Posi i e A ec Scale o PANAS a e P iming Go(pleasan )/No-Go(unpleasan ) o e he MTPs wi h Respec o he G oups in Alexi hymic Indi iduals. H2.2. A e p iming he de ensi e sys em wi h he Go(unpleasan )/No-Go(pleasan ) aining ask he nega i e a ec will be inc eased. This hypo hesis was es ed like he H2.1, bu wi h due ega d he a ings o he PANAS o he ac o “Nega i e A ec ” and Go(unpleasan ) aining. Again, he esul s o he p e- and pos -PANAS we e -2 0 2 4 6 8 10 Neu al Pleasan Unpleasan Neu al Pleasan Unpleasan Alexi hymia Non-Alexi hymia PANAS Sco e P e Pos EMOTION REGULATION IN ALEXITHYMIA 18 compa ed wi h each o he wi h espec o he day he aining was execu ed. When looking a he desc ip i e s a is ics in Figu e 5 i becomes e iden ha he PANAS mean sco es o “Nega i e A ec ” inc eased om M = 1,3 (SD =1,5) o M = 2,9 (SD = 1,1) in he condi ional g oup and om M = 1,5 (SD = 0,7) o M = 2,4 (SD = 1,2) in he con ols, bu o he unpleasan g oup, only. Fo es ing he hypo hesis, he a ings o he pos -PANAS ac o “Nega i e A ec ” o he p e- and pos - PANAS sco es we e compa ed wi h each o he unde conside a ion o he condi ional and con ol g oup and he imepoin o when he Go(unpleasan ) aining was implemen ed. Again, an ANOVA conside ing he day o pe o ming he unpleasan aining was calcula ed. The esul did no u n ou signi ican F(1,2) = 0,81 , p= .461, ηp2= .075. Figu e 5 Means and S anda d De ia ion o he Nega i e A ec Scale o PANAS a e P iming Go(unpleasan )/No- Go(pleasan ) o e he MTPs wi h Respec o he G oups in Alexi hymic Indi iduals. H3. A e p iming he appe i i e sys em wi h Go(pleasan )/No-Go(unpleasan ), he a ing “pleasan alence” will be inc eased. In Figu e 6, he mean sco es and s anda d de ia ions o alence a ings can be seen as ba g aphs. They iden i y ha he mean sco es o alence gene ally mani es a a lowe le el in he alexi hymic g oup, wi h excep ion o he neu al g oup, compa ed o non-alexi hymic p obands. The mos ob ious di e ences can be ound in he pleasan g oup wi h a mean alence o M = 40,0 (SD = 0,0) o alexi hymia 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 Neu al Pleasan Unpleasan Neu al Pleasan Unpleasan Alexi hymia Non-Alexi hymia PANAS Sco e P e Pos EMOTION REGULATION IN ALEXITHYMIA 19 (included only one p oband) and M = 46,0 (SD = 4,2) o non-alexi hymia, and in he unpleasan g oup, wi h M = 32,5 (SD = 5,0) o alexi hymia and M = 39,0 (SD = 13,2) o non-alexi hymia. An ANOVA was calcula ed o es his hypo hesis. Va iables included we e he SAM-sco es o alence wi h espec o p iming he appe i i e sys em ia he pleasan Go/No-Go aining. Again, esul s did no u n ou signi ican F(1,2) = 0.97, p= .396 ηp2= .088. The pos -hoc ba cha s sugges he opposi e o wha was expec ed. A dec ease o a ing o pleasan alence o e all h ee MTP o bo h alexi hymic and non-alexi hymic seems o be he case wi h s onge mani es a ion in he alexi hymic condi ion. Conside ing he di e en ch onological o de s o he g oups (neu al, pleasan , unpleasan ) his pa e n is s ill shown, bu in e es ingly, only in alexi hymic pe sons he a ings dec eased con inuously o e all g oups. In he non-alexi hymic condi ion his pa e n did no appea . Figu e 6. Mean and S anda d De ia ions o Sam Sco es o "Valence" o Go(pleasan )/No- Go(unpleasan ) in Alexi hymia and Con ols wi h Respec o G oup (= day he Go(pleasan ) aining was execu ed) No e. Abb e ia ions Neu al – N; Pleasan – P; Unpleasan – U. H.4: A e p iming he a e si e sys em wi h Go(unpleasan )/No-Go(pleasan ), he a ing “unpleasan alence” will be inc eased. Looking a he desc ip i e s a is ics in Figu e 7, he mos s iking di e ence be ween alexi hymics and non-alexi hymics can be ound in he unpleasan g oups (alexi hymic: M = 21,0; SD = 8,5; con ols: M = 29,7; SD = 5,8), whe eas he a ings a e simila in he o he g oups. 0 10 20 30 40 50 60 Alexi hymia Non-Alexi hymia SAM 'Valence'-Sco es N P U EMOTION REGULATION IN ALEXITHYMIA 20 Fo es ing he a ing o unpleasan alence, an ANOVA wi h SAM-sco es o alence wi h espec o p iming he a e si e sys em ia he unpleasan Go/No-Go aining we e included as dependen a iables. Again, esul s did no u n ou signi ican F(1, 2) = 0.91, p= .420, ηp2= .083, bu he ba cha s o he pos hoc analysis imply ha he expec ed hypo hesis seems o be he case o bo h condi ions. Figu e 7. Sam Sco es o “Valence” o Go(unpleasan )/No-Go(pleasan ) in Alexi hymia and Con ols wi h Respec o G oup (=day he Go(unpleasan ) aining was execu ed). No e. Abb e ia ions Neu al – N; Pleasan – P; Unpleasan – U; P e-Measu e – 1; Pos -Measu e – 2. 0 5 10 15 20 25 30 35 Alexi hymia Con ols SAM 'Valence'-Sco es N P U EMOTION REGULATION IN ALEXITHYMIA 21 Discussion This s udy es ed he e ec o inhib o y con ol o p ime ei he he de ensi e o appe i i e sys em in a g oup o alexi hymic indi duals and non-alexi hymic con ols. Fo p iming ia inhibi o y con ol an emo ional Go/No-Go pa adigm was chosen. The goal was o achie e ele a ed emo ional epo s a e he aining compa ed o he beginning o he aining, and he e o e mi iga e alexi hymic symp oms in he condi ional g oup. Fo his pu pose, pa icipan s illed ou he TAS-20 and we e alloca ed ei he o he condi ional o con ol g oup, depending on hei sco e. On h ee execu i e days hey pa icipa ed in an emo ional Go/No-Go aining wi h bo h a p eceden and ollowing PANAS, each. Las ly, he pa icipan s wa ched ideos o he EMDB and he ea e a ed hem in e ms o hei alence and a ousal le el. The esul s o his s udy a e i s going o be discussed in he in e es o he hypo heses. Subsequen ly, he limi a ions o his s udy a e going o be deba ed. Finally, me hodological limi a ions o his s udy and implica ions o u he esea ch a e conside ed. Hypo hesis 1.1 pos ula es ha he accu acy in he Go/No-Go inc eases o e bo h condi ions o alexi ymic and non-alexi hymic indi iduals. E en hough he desc ip i e s a is ics show di e ences be ween he di e en MTP and g oups, no clea pa e n can be dedcuded he eo . In he condi ional g oup he accu acy ises in he pleasan g oup only, bu d ops in he unpleasan and neu al g oup. The con ol g oup opposi ely shows an inc ease in accu acy only in he unpleasan g oup and i d ops in he pleasan g oup. The in e p e a ion o his is highly isky, as he alexi hymic condi ion o he pleasan g oup, which showed he expec ed ou come, only included one pa icipan . All o he g oups included wo o h ee p obands. Howe e , Alexi hymic people also seem o ha e di icul ies especially wi h nega i e emo ions, which may explain why he expec ed e ec o imp o ed accu acy occu ed in he pleasan g oup only o his condi ion. Addi ionally, ha ing pe cei ed emo ional s imuli such as neu al, pleasan o unpleasan images, p io o execu ing inhibi o y con ol asks can signi ican ly comp omise he pa icipan ’s pe o mance (Ve b uggen & De Houwe , 2007; Yang e al., 2014). Pe de ini ion, alexi hymic people ha e di icul y o desc ibe one’s eelings and o communica e, exp ess eelings, and o iden i y ones eelings (see also Zhang e al., 2012). This may also ha e had a p e en ing e ec on he be o emen ioned pe o mance comp omise a e ha ing seen emo ional s imuli. This may be explained by he isen mo i a ion o alexi hymic people o keep up he a en ion h oughou all measu emen ime poin s whe eas non-alexi hymic may ha e shown mo e a igue e ec s. I is in e es ing o see ha in he non-alexi hymic g oup he e could be seen a dec ease in he he g oup s a ing wi h he pleasan Go/No-Go ask only whe eas he e ec was di ec ly he opposi e o he EMOTION REGULATION IN ALEXITHYMIA 22 alexi hymic g oup, which co esponds wi h he esul s o o he s udies pos ula ing ha esponse inhibi ion seems o be be e o nega i e in compa ison o posi i e s imuli (Chiu e al., 2008; Schulz e al., 2007). The alexi hymic g oup showed a sligh dec eases in bo h o he g oups, neu al and pleasan , bu an inc ease accu acy o he g oup beginning wi h he Go-pleasan aining. Fo he second pa o hypo hesis one, H1.2 he eac ion imes we e es ed using an ANOVA. They did dec ease, as expec ed, in bo h condi ions and e en mo e so in he alexi hymia condi ion, bu he di e ences we e no s a is ically signi ican . Likewise, o he s udies wi h non-alexi hymic p obands ha e epo ed ha he eac ion imes in emo ional Go/No-Go asks dec ease wi h epe i ion (e.g. Thigpen e al., 2018). Conce ning he alexi hymic popula ion, he esul s o his s udy a e no a om esul s by Zhang e al. (2012), who did no ind signi ican di e ences bu e ec s only o indi iduals wi h alexi hymic symp oms o Go/No-Go asks wi h espec o speed and accu acy. Fu he mo e, did he alexi hymic p obands sco e as e in he incong uen ial (M = 528,515, SD = 69,742) han cong uen ial (M = 544,865, SD = 24,134) in he unpleasan g oup, which is cong uen wi h o he s udies (Pan e al., 2016; Yao e al., 2019). The esul s a e cong uen o he esul s o o he s udies exposing a ec i e p iming e ec s o posi i e bu no o nega i e p imes in a lexical decision-p iming ask (Yao & Wang, 2013) o s onge o nega i e han posi i e p imes in acial exp ession p ocessing (Aguado e al., 2018). The second hypo hesis H.2.1 pos ula ed an inc ease in pleasan a ec when he appe i i e sys em was p imed p io ly. La ge e ec sizes o ηp2= .158 o he go-pleasan aining in liasion wi h pos hoc ba cha s indica e he expec ed especially in alexi hymics and o a lowe deg ee o non-alexi hymics, oo. On he con a y, no clea pa e n ele a es o he o he g oups, e en hough hey had ca ied ou he Go- pleasan aining o p ime he appe i i e sys em, me ely in a di e en ch onological o de . This indica es ha he Go/No-Go aining gene ally did no ha e a so ening in luence on he symp oms o alexi hymia, bu when he Go-pleasan aining was ini ia ed as he e y i s aining, i did. Hypo hesis H2.2, simila ly as H2.1 pos ula ed an inc ease in nega i e a ec , when he de ensi e sys em was p imed p io ly. Alike he esul s abo e, he desc ip i e s a is ics expose an ele a ed e ec o he unpleasan g oup, in which he Go(unpleasan ) aining was un a he i s measu emen ime poin . Conside ing bo h hypo heses H2.1 and H2.2, i becomes appa en ha he expec ed e ec s a ise solely when he espec i e Go/No-Go aining ma ching he seeked p imed sys em is implemen ed on he i s day (p iming appe i i e sys em – Go(pleasan ) aining on i s day; p iming a e si e sys em – EMOTION REGULATION IN ALEXITHYMIA 23 Go(unpleasan ) aining on i s day). This hin s a he pa icipan s becoming mo e unin ol ed h oughou he days, which is comp ehensible, as he asks we e epe i ious and mono onous. Wi h ega ds o he hi d hypo hesis H3, pos ula ing an inc ease in pleasan alence a e ha ing p imed he appe i i e sys em, nei he did he esul s u n ou signi ican , no did hey show a la ge e ec size. The ba cha s o he desc ip i e s a is ics sugges he oppsi e o wha was expec ed. A dec ease o a ing o pleasan alence o e all h ee measu emen ime poin s o bo h alexi hymic and non- alexi hymic seems o be he case wi h s onge mani es a ion in he alexi hymic condi ion. Conside ing all g oups o ch onological o de (neu al, pleasan , unpleasan ) his pa e n is s ill shown, bu in e es ingly, only in alexi hymic pe sons he a ings dec eased con inusoly o e all g oups. In he non-alexi hymic condi ion his pa e n could no be shown. Howe e , o bo h condi ions, he a ings we e he s onges o hei i s measu emen ime poin s, which may be explained by he alence cong uency o p ime and s imulus (posi i e – posi i e) as has been ound in p e ious s udies (Zhang e al., 2012). Mo ing on o he ou h hypo hesis H4, which was s uc u ed as he a o emen ioned hypo hesis, bu o unplesan alence a ings once ha ing p imed he de ensi e sys em, a medium e ec size o ηp2=.083 was exposed. E en hough he e was less luc ua ion in he alexi hymic g oup compa ed o he non-alexi hymic g oup o e he h ee expe imen al days, hose esul s did no u n ou signi ican . The hypo hesis seems o apply o non-alexi hymics only, which, again, may be caused by alexi hymics s uggling wi h nega i e emo ions he mos . This means ha he aining did no ha e had he expec ed cause in alexi hymics. Gene ally said, s a is ical signi ican e ec s may had been ound in a la ge sample. The insu icien sample size o only 12 people did mos likely no e lec he esul s accu a ely and he e o e make i di icul o in e p e hose. Based on he esul s o his s udy, a sample size o a leas 66 people would be adequa e as calcula ed ia G*Powe (2007) o ein o ce and e i y he ound esul s. Fu he mo e did he s imuli no change h oughou he di e en days, bu eoccu and mos likely s engh ened he ina en ion o he pa icipan s on aining day wo and h ee. Pleasan pic u es and ideos, o ins ance, we e he same h oughou he di e en measu emen ime poin s. This e y p obably also had an habi ual e ec on he pa icipan s h oughou bo h condi ions o alexi hymic and non-alexi hymic p obands, as discussed in H1.1 and H1.2. EMOTION REGULATION IN ALEXITHYMIA 24 Ano he limi a ion is ha mos measu es aken in his s udy we e based on subjec i e a ings. Howe e , alexi hymic indi iduals ha e poo emo ional awa eness which could ha e in luenced he alidi y on all subjec i e emo ional measu es, jus as Kamme e (2016) had highligh ed speci ically wi h espec o he TAS-20. Be mond e al. (2006) sugges o include a cogni i e componen in o es ing o alexi hymia o a i m he g ading o alexi hymic cha ac e is ics. As inhibi o y phenomena demons ably a e no alloca ed o one common neu al subs a e, i is ha d o e e back o and d aw conclusion om speci ic neu al a eas ha may ha e impac ed he expe imen o his s udy in a way o he wise han expec ed. This makes u he neu ocogni i e esea ch on he subjec -ma e o inhibi on s ill a ele an opic, up un il oday, as al eady Munaka a e al. (2011) ha e hin ed owa ds. To conclude, hese mixed esul s in combina ion wi h he small sample size lea e oo much space o in e p e a ion, howe e i seems as hough he aining does no ha e he expec ed comp ehensi e posi i e ou come on indi iduals wi h alexi hymic symp oms. 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