Attentional processing of unpleasant stimuli in alexithymia: Early avoidance followed by attention maintenance bias

Abstract Alexithymia is a multifaceted personality trait linked to increased risk for psychological, psychosomatic, and physical health problems. One hypothesized mechanism through which alexithymia predisposes individuals to such problems is the interference of alexithymic characteristics in processing affective, particularly unpleasant content. This study aimed to investigate the relationship between alexithymia and biases in attentional processing of threatening vs. neutral pictorial stimuli, disentangling early (vigilance) from late (maintenance) attentional biases. One hundred participants (77 female; 18–35 years old) completed the Toronto Alexithymia Scale and underwent a free viewing task with picture pairs presenting illness, fear and neutral content, during which dwell time on each picture was recorded at time intervals of 0–500 ms, 501–1000 ms and 1001–6500 ms of exposure. Results from multilevel modeling showed that alexithymia interacted with time interval and picture type. Higher alexithymia scores were related to less dwell time towards fear pictures at 501 ms-1000 ms, but more dwell time at 1001 ms-6500 ms after stimulus onset. This effect was particularly observed for the externally oriented thinking and the difficulty in describing feelings facets of alexithymia, but not the difficulty in identifying feelings. There was no effect of alexithymia on early vigilance at 0–500 ms. This study provides evidence on the association between alexithymic traits and early avoidance, along with late maintenance bias to fear, which appears consistent with the view that alexithymia is associated with avoidant emotion regulation processes, but also greater requirements of cognitive resources for processing affective information.