What is it about?

Difficulty reflecting on one's own thoughts and feelings can make it difficult for persons with brain injury to benefit from psychological talk therapies. Both alexithymia (a deficit in how people process their own emotions) and impaired self-awareness (ISA), which can lead to persons underestimating their own difficulties, are known to impair the ability to self-reflect. In this study, we set out to investigate whether alexithymia after traumatic brain injury (TBI) was related to a more general construct of ISA, or whether it was an independent construct of its own. Furthermore, we were interested in how they both relate to emotional difficulties, aggression, impulse control, and executive functions. We present a novel finding that alexithymia is a construct of its own and does not equal a deficit in emotional awareness. We also show that emotional difficulties and aggression after TBI are worsened by the presence of alexithymia, and that changes in impulsivity and dysexecutive functioning further mediate these relationships.

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Why is it important?

This is the first sufficiently powered TBI study, demonstrating a conceptual finding that alexithymia is not merely a manifestation of ISA. Knowing that individuals with alexithymic tendencies are aware of, and often distressed by, their inability to make sense of (i.e., self- reflect) their feelings increases the importance of developing interventions that allow these individuals to better benefit from psychological interventions. Treatment of alexithymia could thus be a helpful primer intervention before commencing psychological talk therapy. Furthermore, our study provides an important practical implication that treatment of alexithymia is best provided together with neuropsychological rehabilitation of frontal system behavior changes. Future research is encouraged to invest in the development of TBI-specific alexithymia screening tools and large-scale intervention studies to build the evidence base for effective assessment and treatment.


Undertaking this research was a great pleasure and a longstanding interest of mine. In my clinical work, I frequently encounter patients with brain injuries who struggle to navigate their emotions, both introspectively and in interactions with others. I hope that this study will increase the understanding of how common alexithymia is post brain injury, and encourages clinicians to think creatively in how to integrate alexithymia screening and treatment into their practice.

Suvi Dockree
National Rehabilitation Hospital

Read the Original

This page is a summary of: Dissociating the impact of alexithymia and impaired self-awareness on emotional distress and aggression after traumatic brain injury., Neuropsychology, October 2023, American Psychological Association (APA),
DOI: 10.1037/neu0000926.
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