How does brain activity during body awareness relate to alexithymia?
Healthy people with difficulty describing emotions show altered brain activity during body-awareness tasks, a pattern that is disrupted in individuals with major depression.
Source
Neural activity during interoceptive awareness and its associations with alexithymia-An fMRI study in major depressive disorder and non-psychiatric controls
Study at a glance
- Design
- Case-control — fMRI heartbeat-counting (interoceptive awareness) plus TAS-20 in MDD vs non-psychiatric controls split by alexithymia
- N
- N=46 · 30 non-psychiatric controls and 16 MDD patients who completed both TAS and scanning
- Population
- Patients with major depressive disorder and non-psychiatric controls
- Outcome
- Insula and related fMRI activity during heartbeat counting, associated with TAS alexithymia
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How does brain activity during body awareness relate to alexithymia?
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30 healthy control participants
Hence, 30 NC (mean age 33.73 ± 11.62 years, range 22–60 years; mean years of education: 16.05 ± 2.42; 15 female participants) and 16 MDD patients (mean age 41.19 ± 11.78 years, range 23–58 years; mean years of education: 15.72 ± 2.88; 11 female participants) completed both study parts and were included in further analysis.
9 to 13 seconds
Each condition was presented 48 times in total in a pseudo-randomized order for 9–13 s each.
What they did
The researchers scanned 30 healthy control participants and 16 patients with major depressive disorder using functional magnetic resonance imaging. During the scans, participants completed a task where they silently counted their own heartbeat for trials lasting 9 to 13 seconds, which was repeated 48 times per condition. Participants also filled out the 20-item Toronto Alexithymia Scale to measure their difficulty identifying and describing emotions.
What they found
Healthy controls with higher scores for difficulty describing feelings showed decreased activity in the supragenual anterior cingulate cortex during the body awareness task. When healthy participants were split into a high-alexithymia group of 14 and a low-alexithymia group of 16, the high-alexithymia group showed increased activity in the insula. However, the 16 depressed patients did not show this increased insula activity despite having similarly high difficulty describing feelings.
The limits
What it doesn't show
Because this is a correlational study using functional neuroimaging, it cannot establish whether changes in brain activity directly cause alexithymia or depressive symptoms. Additionally, all depressed patients were taking medication, which could confound the observed neural differences. Finally, the division of healthy controls into high and low categories was based on a small sample, which may not capture the true continuous nature of personality traits.
Key terms
- Alexithymia
- A personality trait characterized by difficulties identifying, describing, and processing emotions.
- Interoceptive awareness (IA)
- The conscious perception and processing of internal bodily signals, such as heartbeats.
- Insula
- A brain structure crucial for integrating bodily sensations with emotional and cognitive processing.
- Supragenual anterior cingulate cortex (sACC)
- A brain region involved in emotional regulation, conflict monitoring, and autonomic processing.
- Median-split
- A statistical method where a continuous variable is divided into two categories based on the middle value of the dataset.
- Salience network
- A large-scale brain network involved in detecting and filtering personally relevant internal and external stimuli.
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What does the term "alexithymia" literally translate to, and how is it defined as a personality construct?
Common questions
Why did the researchers use a heartbeat-counting task to study an emotional trait?
Body awareness and emotion processing share overlapping neural pathways, and people with alexithymia often experience confusion regarding both physical sensations and emotional states.
Did the participants actually have to count their heartbeats accurately?
No, the study focused on the cognitive act of directing attention inward rather than the objective accuracy of physical perception.
Why did depressed patients and healthy participants with high alexithymia differ in their insula activity?
The researchers suggest that healthy individuals with high alexithymia use increased insula activity as a compensatory mechanism to process emotions, which fails or is disrupted in people with depression.
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