Concepts of Self and Alexithymia

• Alexithymia is a personality trait marked by difficulties labeling one's emotions and those of others, as well as having ineffective social interactions.
• For people who notice changes in their bodies due to emotional changes, the conceptualized self — where one believes the content of their thoughts — governs the severity of alexithymia, according to research.
• Approaches that aim to help people detach themselves from believing the content of their thoughts may help those with alexithymia develop a more flexible way of thinking.

Who we are and what our self consists of can be difficult to define. However, we often find ourselves referring to "I" within the context of our experience. For instance, you may say to yourself or others, "I like ice cream," "I don’t like judgmental, egotistical, selfish people," "I like going to the cinema," "I don’t like going to the hospital," "I value loyalty, connection, and faithfulness in a relationship," and so on.

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Three Domains of the Self

So, who is this "I" that we keep referring to? Who am I? From an acceptance and commitment therapy (ACT) perspective, there are three domains of selves (or "I")^1,2; (1) self as content (also called the conceptualized self) – where you believe you are the literal content of your thoughts. So, in this case, if you have a thought that you are a failure, then you believe this to be the case about yourself, and this is likely to place boundaries on your life, and move you away from valued action as you perhaps wish to avoid the potential for further failing; (2) self as process (also called the observer self) – the self part of you which is concerned with the ongoing observing nature of your experiences; (3) self as context (also called the transcendent self) – this is the literal detachment of your self from thoughts and experience. You do not believe that the content of thoughts about yourself have any special role in who you are. Therefore, thoughts such as "I am a failure" do not determine the course of life or place any barriers towards your own life commitment to your values.

We often use "I" within our language when we are communicating to others the context of so many of our experiences, and which often consist of temporal, spatial, interpersonal components. For example, we may relate to "I" with some spatial and temporal dimension, such as in the sentence: "I want to go to my friend’s house tonight," or in relation to another person which may include both a temporal and interpersonal dimension, such as: "I like my friend Steven now, but not before."

We also often use language to discriminate and evaluate ourselves within the context of our experience. We may say to ourselves: "I’m rubbish at driving," if we fail a driving test, or "I’m not good enough to be at university," when we fail an exam. ACT suggests that if we buy into these thoughts, we can get stuck (called cognitive fusion), and this can create barriers to us fulfilling and working towards what is truly important to us, and ultimately lead to feeling detached from living a meaningful life.

Acceptance and commitment therapy (ACT)¹ is a psychotherapeutic approach that attempts to help the individual cognitively defuse from the content of their thoughts, through a variety of exercises such as using mindfulness present moment exercises, defusion, opens to pain, values identification and orientation, commitment to values orientation, and self-as-context through developing a perspective-taking and observer self. Through these exercises, psychological flexibility is promoted and behavioural avoidance patterns are diminished. Such avoidance patterns could include moving away from situations like a new job you value, further education, a relationship with someone you value, etc., due to believing and buying into the literal meaning of thoughts (such as "I am a failure," "I am unlovable").

What is interesting, is that processes relating to ACT, specifically the self, in the form of the conceptualized self (self-as-content) have been found to relate (through a statistical approach called mediation) to some complex forms of conditions relating to communication. One of these is in the area of alexithymia.

The Role of the Self in Alexithymia

Alexithymia is a personality trait³ and is characterized by an inability to identify and describe conscious experience. Individuals with alexithymia typically have problems labelling their emotions and those of others, have ineffective social interaction, and as a result, typically have low levels of positive emotion, wellbeing, and life satisfaction.

One study from my own lab⁴ has shown that a conceptualized self indirectly causes (through mediation analysis) the severity of alexithymia when an individual’s ability to notice and attend to changes in their body, as a result of emotional changes of any given moment, is high. These bodily interoceptive states can, for example, involve the individual reporting that they can feel it in their body and notice how their body changes when they are angry or when something is wrong in their life. For individuals where this is high, then conceptualized self (self as content) seems to be the process that governs the severity of alexithymia.

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Artificial intelligence was further used (a neural network) in this study to explore more deeply the relationship between measures (called predictors) of mental health, the conceptualized self, positive and negative affect, interoception (bodily awareness), and the outcome of the severity of alexithymia. This found that the condition of alexithymia was variable, and though the self is a very important component of the condition, each individual should be treated and diagnosed based on their specific set of circumstances.

This suggests that novel approaches in psychotherapy which involve ACT should target these processes through a process-based therapeutic (PBT) approach⁵. Specifically targeting the self to encourage a more psychologically flexible self-as-context approach in terms of how the client relates to themselves may be helpful, instead of allowing the client to believe in the content of their thoughts as they relate to the self, e.g., thoughts such as "I can’t do anything right, what’s the point of me even trying," or "I fail at everything, I am a loser and should avoid putting myself at risk of even trying."

Though someone suffering from alexithymia may have all kinds of thoughts that relate to themselves, these are likely to be rigidly held and not flexible in nature. Flexibility through perspective-taking exercises of self and other, and in the context of other ACT-based exercises such as mindfulness, openness, cognitive defusion, and values orientation, maybe the key to helping those who suffer from alexithymia adjust into a more flexible way of thinking and detach them from a conceptualized self.

These kinds of processed-based approaches (targeting mediating factors such as the conceptualized self) to therapy are novel and may ultimately prove to be a very effective approach in dealing with these types of conditions and other forms of mental health or cognitively related problems.