The Effects of Alexithymia and Age on Inhibitory Control

Alexithymia is a stable personality trait typified by externally oriented thinking and difficulties identifying and describing feelings. It is associated with cognitive-affective deficits such as poorer memory for emotional and neutral information as well as executive dysfunction. Relatedly, aging is accompanied by executive dysfunction and increasing alexithymia. Because executive functions comprise multiple cognitive skills, it is essential to demarcate which are impacted by aging and alexithymia. While age-related deficits in inhibitory control are well established, there is a dearth of literature examining inhibition in alexithymia. Thus, this study aimed to examine the effect of alexithymia on inhibition and to interrogate its potential additive impact to aging effects. Participants were 538 undergraduate students (age = 18–35) and 201 middle-aged to older adults (age = 48–92). All completed the 20-item Toronto Alexithymia Scale (TAS-20) and go, no-go, and stop-signal tasks. Following removal of participants with missing data or invalid task performance, the final sample included 384 younger and 81 older adults. Separate hierarchical regressions predicting accuracy and reaction time were examined. Post hoc models included TAS-20 subscores. Exploratory moderation and mediation models were also conducted to interrogate shared variance among covariates and predictor variables. Female sex and greater age predicted slower reaction times across all three tasks. Older age was also associated with less accurate responding to target and inhibition trials on no-go and slower and less accurate inhibition on stop. Alexithymia predicted poorer inhibition on no-go and stop via difficulty identifying feelings (DIF). Mood symptoms neither moderated nor mediated the relationship between DIF and inhibitory control. These results replicate the age-related tradeoff of speed for accuracy in reaction time and inhibition tasks. They also provide novel evidence for alexithymia deficits in non-emotive inhibitory control. The impact of DIF on both automatic (no-go) and conscious (stop) inhibitory control supports processing theories of alexithymia. In particular, DIF contributed to poorer extrinsically and intrinsically cued response suppression. Thus, top-down and bottom-up information processing may be disrupted in alexithymia. Critically, the alexithymia effects were additive to age effects extending support for alexithymia as a risk factor for cognitive aging

The effects of emotional arousal on false recognition in alexithymia

Alexithymia is a personality trait characterized by difficulties identifying feelings, difficulties describing feelings, and an externally oriented thinking style (EOT). Further, individuals with alexithymia experience chronic physiological arousal. Prior research has shown that non-clinical participants with alexithymic traits cannot subjectively recognize increased arousal in response to viewing an arousing video. Yet, these individuals will still experience physiological arousal and will still have arousal-induced memory modulation. No studies to date have examined arousal effects on false memory in alexithymia. The Deese-Roediger-McDermott (DRM) paradigm examines false memory by introducing words associated with a non-presented `theme' word (i.e., critical lure) as memoranda, which typically causes the lures to be remembered as frequently as studied words. Our prior work with non-alexithymic groups has shown enhanced veridical memory and reduced false memory when arousal is induced after learning (i.e., during memory consolidation). Thus, 130 subjects studied and recalled six DRM lists and then watched a 3-min arousing (n = 61) or neutral (n = 69) video. Recognition was tested 70 min later. A median split was utilized to separate participants into high and low alexithymia groups based on Toronto Alexithymia Scale – 20 (TAS-20) scores. Arousal was expected to interact with alexithymia in such a way to allow individuals with high alexithymia to overcome their EOT. Arousal enhanced conservative responding for studied words relative to all foils, including critical lures and `weak associates.' Alexithymia did not impact overall memory performance, but low alexithymia increased confident remembering and high alexithymia increased familiarity processes. Individuals with high alexithymia were more sensitive to both strong and weak false information (critical lures and weak associates, respectively). Arousal was expected to overcome these memory deficits in alexithymia. No direct evidence for an "overcoming" interaction between arousal and alexithymia was found. However, post hoc analyses of alexithymia clusters did support various mechanisms of arousal "overcoming" misinformation

Neuropsychological assessment with lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) individuals: Practice, education, and training survey

Objective: We sought to describe the LGBTQ + related education, training, and clinical practice of independently licensed neuropsychologists in the United States and to identify factors that predict affirmative neuropsychological practices. We hypothesized that LGBTQ + identity, female gender, more recent training, and extent of LGBTQ + education/training would predict use of LGBTQ + practice guidelines. Method: A workgroup of clinical psychologists with experience in LGBTQ + psychology and neuropsychology developed a survey to identify personal and professional factors that predict affirmative neuropsychological testing practices. The survey was distributed through professional organizations and listservs between August and September 2021 with 118 responses meeting inclusionary criteria. Results: The majority of participants identified as heterosexual (70.3%) and cisgender (97.5%), and most (48-63%) received LGBTQ + training post-licensure. Between 19% and 32% of participants reported never completing LGBTQ + specific education. Consistent with our hypotheses, factors predicting affirmative clinical practice behaviors were LGBTQ + education/training, and personal background (sexual minority status, female/feminine gender, and years since degree). Other significant factors included prior experience with LGBTQ + patients and primary patient population (child vs. adult). Qualitative responses indicated varying values, attitudes, and knowledge regarding collection of LGBTQ + information and modification of clinical practice. Conclusions: Neuropsychologists underutilize affirming practices as evidenced by low rates of querying pronouns, knowing whether LGBTQ + health information is available at their institutions, and adjusting evaluation and feedback approaches. We provide specific training and education recommendations to increase knowledge and skills and to address beliefs about LGBTQ + health that can serve to promote affirmative neuropsychological practice.</p