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Aim and Background: Fundamental dysfunctions  in  affective  regulation have particular  importance  in development of psychological symptoms in mood disorders. The study investigated the role of alexithymic personality features to predict psychopathological symptoms in patients with major depression. Method and Materials: This was a longitudinal descriptive study. The sample consisted of 323 patients with major depression (225 women, 98 men; 32-45 years old, mean age = 38, SD = 3). They had referred to psychiatric clinics of Ardebil province and were enrolled in the study through convenient sampling after completing and  signing  informed consent  forms. The  instruments used  for data collection were Toronto Alexithymia  Scale-20  and  Symptom  Checklist-90-R.  Data  were  analyzed  using  multiple  regression analyses. Findings: Results demonstrated that only the first alexithymia facet (difficulties with identifying feelings) was  a  significant  predictor  for  all  psychopathological  symptoms  in  patients  with  major  depression   (P = 0.001). The contributions of other facets of alexithymia appeared to be almost negligible.    Conclusions: In general many psychopathological symptoms in major depression are associated with the patients’ inability to identify emotions.

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Aim and Background: Alexithymia or emotional inhibition is an important risk factor for psychosomatic disorders such as gastrointestinal disorders. The aim of this study was to evaluate the correlation between the dimensions of alexithymia with depression and anxiety in patients with functional gastrointestinal disorders (FGID). Methods and Materials: In a descriptive-correlation study, 129 patients were selected from patients with FGID referred to digestive clinic of the Noor hospital in Isfahan (during 5 months in 2008). They were investigated using Toronto Alexithymia scale , hospital anxiety and depression scale and gastrointestinal symptom rating scale. Data were analyzed using descriptive statistics, correlation coefficient and regression analysis. Findings: Only the dimension of “difficulty in identifying feelings” has a significant positive correlation with depression, anxiety and severity of gastrointestinal symptoms in FGID patients. This dimension is predictor variance of depression, anxiety and severity of gastrointestinal symptoms. Conclusions: The study emphasizes on the role of alexithymia especially the dimension of “ difficulty in identifying feelings” to understand the psychopathology of FGID. So, it seems that assessment and considering it as an effective factor in the treatment of these patients is essential.

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Aim and Background: The purpose of this study was to compare patients with functional gastrointestinal disorders (FGID) and normal persons in terms of alexithymia, severity of gastrointestinal symptoms, and demographic variables. Methods and Materials: This causal-comparative research included 129 FGID patients who were referred to a psychosomatic disorders clinic in Isfahan, Iran. A matched group of 108 healthy individuals (without digestive diagnoses) was also considered as the control group. Toronto alexithymia scale (TAS-20) and gastrointestinal symptoms rating scale (GSRS) were used to evaluate the participants. Data was analyzed using multivariate analysis of variance, correlation coefficient and Fisher's Z test. Findings: There was a significant difference between patients with FGIDs and healthy controls in terms of number of alexithymia symptoms and severity of gastrointestinal symptoms. The results also indicated a relationship between education level and alexithymia as well as its dimensions (difficulty identifying feelings and difficulty describing feelings) in both groups. However, no significant differences were found between the two groups in this regard. Conclusions: The findings of this study indicated that patients with FGIDs had higher scores of alexithymia and more severe somatic symptoms compared to the healthy control group. Furthermore, higher education levels were associated with lower risks of alexithymia. Such a finding might have been due to the higher ability of more educated patients in describing and identifying emotions.

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Aim and Background: Alexithymia is a psychological construct that is prevalent in a wide range of psychiatric and medical disorders. Because of its importance in mental and physical health, many surveys today assess the different aspects of alexithymia in clinical and nonclinical populations. The aim of the present study was to investigate the prevalence of alexithymia and compare male and female students of Shahid Chamran University in alexithymia and its subscales. Methods and Materials: The study sample consisted of 841 undergraduate students of Shahid Chamran University. This sample was selected by multistage random sampling method from the 8000 undergraduates in the year 2008. The data collection tool was the 20-item version of Toronto Alexithymia Scale (TAS-20). To analyze data descriptive statistics, chi-square test, Student&rsquo;s independent t-test, and multivariate analysis of variance were used. Findings: The results showed that the rate of alexithymia was 19.5% in the whole sample, 18.8% in females, and 20.2% in males. There was no significant difference in prevalence of alexithymia between male and female. Comparison of the two genders in the total score and three subscales showed that there were significant differences in total score and the external oriented thinking subscale in which the averages were higher in male students (P < 0.01). Conclusions: There was no difference in prevalence and intensity of difficulty in identifying and describing feelings between males and females. However, the high prevalence of alexithymia in Iranian undergraduate students is an indicator of the necessity for emotional education in schools and universities.

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Aim and Background: A large number of studies show that alexithymia may be a risk factor for many physical and mental illnesses. This study was conducted to evaluate the predictive value of different dimensions of alexithymia for assessing vulnerability to psychosomatic diseases. Methods and Materials: This case-control survey was conducted on 146 individuals. The subjects were selected through census method from among patients referred to the Psychosomatic Clinic of Isfahan University of Medical Sciences, Iran. The participants completed the Toronto Alexithymia Scale. The obtained data were analyzed using logistic regression in SPSS software. Findings: The results showed that for every one unit increase in total score of alexithymia, the chance of psychosomatic disease incidence increased by 5% (P < 0.008). On the other hand, for every one unit increase in the subscale of difficulty in identifying feelings, the chance of psychosomatic disease incidence increases by 11%. Conclusions: This study demonstrated that alexithymia, and especially the subscale of difficulty in identifying feelings can significantly increase the risk of psychosomatic diseases. Therefore, alexithymia can be introduced as a predictive tool for psychosomatic diseases.

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Aim and Background: The present study was conducted to compare alexithymia, character and temperament, and aggression between addicts and healthy individuals. Methods and Materials: This causal-comparative research was conducted on 80 addicts and 80 healthy individuals. The subjects were selected through convenience sampling method and were matched. The research tools included the Toronto Alexithymia Scale, Temperament and Character Inventory (TCI) (Cloninger et al.), and Buss-Perry Aggression Questionnaire (AGQ). Data were analyzed using MANOVA and ANOVA. Findings: There was a significant difference between addicts and healthy individuals in terms of alexithymia components (difficulty identifying feelings, difficulty describing feelings, and externally-oriented thinking) and aggression components (physical aggression, verbal aggression, and anger and hostility). The scores of alexithymia and aggression components were higher in addicts compared to healthy individuals. Moreover, the scores of damage and novelty seeking components in the character and temperament variable were higher in addcits. The scores of the components of self-leadership, partnership, and persistence were lower in addicts in comparison with healthy individuals. No significant difference was found between the two groups in terms of the components of remuneration, dependency, and self-transcendence. Conclusions: This study, in line with researches focused on investigating the underlying personality aspects involved in addiction, can be helpful in understanding the factors involved in this phenomenon and proposing suitable solutions for the prevention and treatment of addiction.

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Aim and Background: Functional dyspepsia is a chronic disorder of the upper gastrointestinal tract that anatomical or biochemical abnormalities do not explain it. The purpose of this study was to assess the mediating role of stress, anxiety, and depression in the relationship between Alexithymia and functional dyspepsia. Methods and Materials: This research was a correlational study. 224 male and female patients with functional dyspepsia were selected by available sampling method according to the inclusion criteria. Stress, anxiety, and depression in patients were evaluated by Depression Anxiety Stress Scale (21-item) (DASS-21); Alexithymia was evaluated by Toronto Alexithymia Scale (TAS); and after primary diagnosis of gastroenterologist, severity of functional dyspepsia was evaluated by Gastrointestinal Symptom Rating Scale (GSRS). Finally, data analysis was performed using SmartPLS software. Findings:  Alexithymia directly affected the severity of functional dyspepsia (effect size: 0.44). Moreover, Alexithymia by mediation of depression (0.20) and anxiety (0.17) affected the severity of dyspepsia at the level of 95% confidence interval (CI). However, because of the insignificance of path coefficient between the variables of stress and functional dyspepsia (T-value < 1.96), the indirect effect of the Alexithymia on the severity of functional dyspepsia with the mediation of stress was not confirmed. Conclusions: The findings of this study indicate the important role of psychological factors (Alexithymia, anxiety, and depression) in functional dyspepsia.

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Aim and Background: Somatic symptoms and physical complaints (palpitations, dizziness, etc.) make a significant part of admittances to health centers. Therefore, identifying the mechanisms and their etiology is of very high importance. Clinical observations over the past two centuries have linked these symptoms with emotions. The purpose of this study was to investigate the etiology of somatic symptoms based on negative emotional schemas by mediating alexithymia and emotional expressiveness Methods and Materials: The method used in this research was correlation. The research sample consisted of 440 female undergraduate and postgraduate students at Khomeini Shahr Azad University who were selected using the convenience sampling method. The members completed the Toronto Alexithymia Scale (TAS-20), Emotional Expressiveness Questionnaire (EEQ), Somatic Symptom Disorder-B Criteria Scale (SSD-12) and Leahy Emotional Schemas Scale (LESS). The data was analyzed using structural equation modeling with SPSS and LISREL softwers. Findings: Based on the results, the hypothesized model has an appropriate fit with the data. The path of negative emotional schemas,emotional expressiveness (total effect: -0.269.P<0.001) and the path of emotional expressiveness, somatic symptoms (total effect: -0.346.P<0.001) is negative and significant. Also, the path of negative emotional schemas ,alexithymia (total effect: 0.358.P<0.001) and the path of alexithymia , somatic symptoms (total effect: 0.356.P<0.001) is positive and significant. the path of negative emotional schemas ,somatic symptoms (direct effect: 0.266. P<0.001) is positive and significant. According to the results of structural equations, negative emotional schemas had a significant effect on somatic symptoms through alexithymia and emotional expressiveness. (Indirect effect: 0.221. P<0.001) Conclusions: Research shows that emotional schemas, in addition to the direct effect on somatic symptoms, can also be influenced by alexithymia and emotional expressiveness. Therefore, the results of this study can be used in preventing, understanding the underlying causes and mechanisms for pathology, and treatment of somatic symptoms.

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Aim and Background: An integrated therapeutic approach, which is a cognitive behavioral approach focused on emotion and whose main purpose is emotional processes, and is applicable to disorders that have strong emotional components. The aim of this study was to investigate the effectiveness of emotional regulation-based intervention on cognitive emotion regulation strategies and alexithymia in patients with Coronary Heart Disease (CHD).

Methods and Materials: The method of this study was a clinical trial. The statistical population of this study included all patients with CHD referred to the heart center of Tehran between June and August. Of these, 30 volunteers were randomly divided into two experimental and control groups. To collect data, the Toronto Alexithymia Scale (TAS-20) and the Cognitive Emotion Regulation Questionnaire (CERQ) were used. Data were analyzed using descriptive statistics and multivariate covariance analysis (MANCOVA) using SPSS software version 22.

Findings: Results shows that emotional regulation intervention was effective on positive cognitive emotional regulation (F=11.19, P<004), negative cognitive emotional regulation (F=7.83, P<0.02), and alexithymia (F=10.87, P<0.006) in patients with CHD.

Conclusions: This study showed that emotion regulation intervention based on integrated treatment method was effective on cognitive emotional regulation strategies and alexithymia in patients with CHD. The results of this study can be helpful researcher and therapists' alexithymia in the field of factors influencing it in patients with CHD.

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Aim and Background: Somatic symptoms make a significant part of admittances to health centers. Since clinical observations have linked these symptoms with emotions, the present study was conducted to investigate the effectiveness of emotional schema therapy on decreasing negative emotional schemas, Alexithymia And Signs of Patients with somatic Symptoms. Methods and Materials: The present study was a type of semi-experimental research with pre-test post-test design with control group. The population of this study was all female patients with somatic symptoms of Isfahan province and sample included 30 referents from counseling centers of Isfahan and Khomeini shahr with somatic symptoms that were selected based on Judgment sampling and with psychiatrist's and psychologist's discriminant and divided into two experimental (15) and control (15) groups. The experimental group received 12 sessions of emotional schema therapy approach. The Leahy Emotional Schematic Scale (LESS), Toronto Alexithymia Scale (TAS_20), and the B-Score Somatic Symptom Inventory (SSD-12) were used for participants. Data were analyzed using descriptive statistics and multivariate analysis of covariance in SPSS 24. Findings: After the implementation of emotional schema therapy, there was a significant difference in the negative emotional schemas (F: 8. 24, P<0. 008), alexithymia (F: 250. 89, P<0. 001) and somatic symptoms (F: 374. 59, P<0. 001) in the experimental group compared to the control group and the mean scores of the experimental group were significantly lower than the control group. Conclusions: The results of this study showed The Emotional Schema Therapy Model, based on the existence of a relationship between negative emotional schemas and alexithymia with somatic symptoms, by modifying the underlying emotional processes and improving the maladaptive strategies of individuals toward emotions, reduced the negative emotional schema and alexithymia and somatic Symptoms.

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Aim and Background: Inability in cognitive processing, emotional awareness, and emotion regulation is called Alexithymia. The alexithymia is a common problem among people. The purpose of this study was to determine the effect of emotional regulation instruction on alexithymia of high school students.

Methods and Materials: The research method was a semi-experimental design with pre-test and post-test with control group. The statistical population of this study included all female secondary high school students of Neyshabur who studying in the academic year of 2017-18. Among 20 high school students, 30 subjects were selected clustered sampling method and assigned in two control group (n=15) and experimental group randomly (n=15). The intervention program was conducted in 8 sessions of 90 minutes, weekly for the experimental group and the control group received was in wait list. Data were analyzed using covariance analysis

Findings: The findings of the study showed that emotional regulation training reduced alexithymia (p<.001).

Conclusions: To explain the above results, it can be said that are affected by the emotional ordering of individuals, so that the training of emotional regulation skills reduces alexithymia.

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Aim and Background: Alexithymia is prevalent in several psychological disorders, including depression, post-traumatic stress disorder and substance use disorder. Due to the prevalence of alexithymia and interpersonal problems among people with substance use disorder, this study aimed to determine the effectiveness of Acceptance and Commitment Therapy on alexithymia and interpersonal problems in men with substance use disorders.
Methods and Materials: The method of the present study was quasi-experimental with pre-test, post-test design and two-month follow-up with control group. The statistical population was men with substance abuse who in 2019 had referred to private addiction treatment centers in Tehran for treatment. Two centers were chosen for convenience and among them 42 subjects who fill informed consent were selected and randomly assigned in experimental and control group. Data were collected by Bagby et al.'s Toronto Alexithymian Scale (1994) and Barkham et al.’s Inventory of Interpersonal Problems (1996) in three stages of evaluation. The research findings were finally analyzed using repeated measure analysis of variance test using SPSS software version 22.
Findings: The results of data analysis showed that acceptance and commitment therapy was effective on alexithymia and interpersonal problems (p<.05). In addition, the results of the follow-up phase also showed that the effectiveness of acceptance and commitment therapy on alexithymia and interpersonal problems in men with substance use disorder was consistent.
Conclusions: According to these results, addiction therapists can use acceptance and commitment therapy to reduce mood disorders and interpersonal problems in people with a history of addiction.

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Aim and Background: Rheumatoid arthritis is associated with an increased risk of various types of psychological afflictions. Indication of these disorders is added to the erosive factors of chronic disease and has many negative effects on the level of adaptation and mental and social health of these people. This study aimed to evaluate the effectiveness of intensive short-term dynamic psychotherapy (ISTDP) on reducing alexithymia in rheumatoid patients.
Methods and Materials: The present research was a quasi-experimental study with pre-test, post-test design as well as control group. In order to select the sample, first of all, based on the criteria of the American Rheumatology Association and the inclusion and exclusion criteria, 40 male and female patients were purposefully selected from specialized rheumatology clinics in Kerman. This selection was made by rheumatologists. The members of the sample group were randomly divided into two 20-memeber groups of experimental and control. For the experimental group, 15 one-and-a-half-hour sessions of intensive short-term dynamic psychotherapy were held. Data were collected through Toronto Alexithymia Scale (TAS). Research data were analyzed using Analysis of covariance.
Findings: The findings showed that intensive short-term dynamic psychotherapy is effective in reducing the rate of alexithymia in rheumatoid patients (p <0.05).
Conclusions: Patients first performed better in recognizing emotions and then improved their ability to describe emotions and physical symptoms. Intensive short-term dynamic psychotherapy by affecting on anxiety discharge pathway and exact control and moment-by-moment monitoring of anxiety, feelings and defenses helps to reduce clinical symptoms in rheumatoid patients.

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Aim and Background: Psychological well-being consists of autonomy, environmental mastery, personal growth, positive relations with others, and purpose in life, and self-acceptance. Numerous factors especially childhood trauma and psychological well-being. Besides this relationship does not seem direct and is influenced by other variables such as fear of happiness and alexithymia. The aim of this research was assessing the mediating role of fear of happiness and alexithymia in relation to trauma and psychological well-being.
Methods and Materials: In a descriptive—correlation study, a sample of 262 students from Alborz and Science and Culture Universities were selected by convenience sampling. Participants answered the battery of questionnaires including psychological well-being, fear of happiness scale (FHS), Toronto alexithymia scale (TAS), childhood traumatic Questionnaire (CTQ). Data were analyses using Structural Equation Modeling (SEM) by LISREL 8.85 software. For evaluating the descriptive statistics SPSS 24 was used as well.
Findings: The analyses revealed that hypothetical model fit the measurement model (RMSEA= 0.55, CFI= 0.92, X2/df= 2.588). The results of the analysis showed that childhood trauma by mediating roles of alexithymia and fear of happiness were able to predict the psychological well- being, so that fear of happiness and alexithymia predicted psychological well-being positively and indirectly.
Conclusion: Based on the study, it can be concluded that fear of happiness and alexithymia are mediating the relation of childhood trauma and psychological well-being. Consisting this effect can be useful for improving individual well-being and also can be effective for intervention of childhood traumas.

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Aim and Background: Chronic pain is one of the most common and expensive medical problems. The aim of this study was to compare the effectiveness of emotion focused therapy and cognitive analytic therapy on anxiety sensitivity, pain catastrophizing, experiential avoidance and cognitive emotion regulation in patients with chronic pain and alexithymia.
Methods and Materials: This research was experiential study with pre, post-test and follow-up with control group. Among patients suffering from chronic in Isfahan, using available and voluntary sampling method, 36 patients that had top point in alexithymia questionnaire were selected and then  were assigned in two groups randomly (each group n=12). Members of first experimental group, received online emotion-focused group therapy and members of second experimental group received online cognitive-analytic group therapy. In this period control group didn’t received any intervention. Instruments were Karnfeskesʼs Cognitive Emotion Regulation Questionnaire (2001), Solivanʼs Pain Catastrophizing Scale (1995), Taylor and Koksʼes Anxiety Sensitinty Inventort (1998), Acceptance and Action Questionaire (2011) that were completed in 3 stages of pre, post-rest and follow up. Data were analyzed using repeated measure analysis.
Findings: Reults showed that the emotion focused therapy has been more effective than the cognitive analytic therapy in improving pain catastrophizing, experiential avoidance and the negative aspect of cognitive emotion regulation (P<0.05).
Conclusions: With respect to the effectiveness of these two therapeutic methods on the research variables, these two therapeutic methods can be sought so as to improve the conditions of the patients with chronic pain and alexithymia.

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Aim and Background: Emotional freedom technique (EFT) is one of the new therapies that can have a positive effect on emotional mood and mood swings with its positive effects on the physiology of the brain. The main purpose of this study was to evaluate the effectiveness of emotional freedom technique (EFT) training on improving emotional malaise and negative mood in women with mood-trait anxiety.
Methods and Materials: The design of the present study was a single case study of an experimental design. The statistical population of the present study was all women with trait anxiety who referred to counseling centers in Isfahan in the summer and fall of 1399, of which 3 had the criteria of trait-trait anxiety and in terms of entry and exit criteria and other characteristics. In terms of education, age, and economic and social status, they were similar; were chosen. Subjects answered the Toronto Alexithymia Questionnaire, Anxiety, Depression and Stress (DASS-21) and the Mental Disorders Checklist (SCL90). Then, the experimental group received 10 sessions of 90 minutes of emotional freedom technique training, while the control group did not receive any training. Data were analyzed using intra-situational and inter-situational analysis to analyze the effectiveness of the independent variable (EFT intervention) on dependent variables (emotional malaise and negative mood).
Findings: The results showed that emotional freedom technique improved emotional malaise (alexithymia) and negative mood in women with trait anxietyHas been significantly effective (p<0.01).
Conclusions: Based on the results of the present study, it can be said that the emotional freedom technique can be used as an effective intervention option to help women with trait anxiety to reduce emotional malaise and their negative mood.

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Aim and Background: The aim of the current study was to investigate the effectiveness of Emotion Focused Therapy on Alexithymia and Internalized Self-Criticism in Neurotic Perfectionist girls.
Methods and Materials: The statistical population consisted of all Neurotic Perfectionist girls in Ahvaz. The research sample consisted of 5 girls that were selected according to the results of the neurotic perfectionism questionnaires (NPQ), using purposeful sampling method. In this research, a single-case experimental design, type of concurrent multiple baseline designs was used. Instruments were Toronto ʼs Alexithymia Scale (1994), Thompson and Zuroff ʼs The Levels of Self-Criticism Scale (LSCS) (2004). The data was collected in three phases of baseline, during intervention, and three month follow-up.
Findings: The findings indicate that the subjects in the treatment phase experienced improvement in Alexithymia (10.58) and Internalized Self-Criticism (21.32), and in the follow-up in regards to Alexithymia (19.41) and Internalized Self-Criticism (51.76). The change index was indicative of meaningful changes (z=1.96 α=0.05).
Conclusions: Therefore, the research findings illustrated that Emotion Focused Therapy reduces Alexithymia and Internalized Self-Criticism in Neurotic Perfectionist girls.

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