Alexithymia and Emotion Table 1. Mean scores (S.D.) on questionnaires for the alexithymic and non-alexithymic groups. Bermond-Vorst Alexithymia Questionnaire Verbalizing Analyzing Identifying Emotionalizing Fantasizing Reappraisal Suppression Total Positive Expressivity Total Negative Expressivity Empathy scale Control items positive affect negative affect Emotion Regulation Questionnaire (ERQ) Berkeley Expressivity Questionnaire (BEQ) Total Impulse strength 21.31 (5.51) Emotion Quotient (EQ) Positive and Negative Affective Scale (PANAS) Alexithymic 32.44 (4.46) 20.88 (5.80) 18.75 (4.88) 21.94 (6.39) 23.13 (5.40) 25.63 (5.12) 17.06 (3.00) 17.69 (2.41) 18.69 (3.28) 34.19 (14.47) 11.31 (2.52) 29.63 (5.21) 13.30 (3.79) Non- Alexithymic F P 13.83 (3.75) 13.78 (4.54) 14.44 (4.00) 19.67 (5.74) 20.50 (7.96) 30.22 (5.11) 10.39 (3.65) 174.89 0.001** 15.97 0.001** 7.98 0.008* 1.19 0.28 1.23 0.28 6.85 0.01* 33.42 0.001** 22.83 (3.49) 24.42 0.001** 25.33 (6.27) 14.43 0.001** 27.56 (7.45) 7.56 0.01* 45.67 (10.13) 7.31 0.01* 12.39 (3.99) 0.86 0.36 30.44 (6.22) 11.78 (2.34) 0.17 0.68 2.60 0.12 participants’ understanding of the false belief of actor B on the thoughts of actor A as well as the by actor B perceived associated emotional state of actor A. Two control questions were included to test recall of the story and the making of inferences. Two blind raters scored the task independently and assigned 0 for a wrong response, 1 for a partially correct response and 2 for a correct response. Statistical Analyses Statistical analyses were performed using Statistical Packages for the Social Sciences 14.0 [37]. All analyses were performed two sided. The alexithymic and non-alexithymic groups were com- pared on their verbalizing score with an independent t-test. Data from the BVAQ, ERQ, BEQ and EQ were analyzed with a multivariate analysis of variance (MANOVA) with the subscales of the questionnaires as dependent variables and Group as independent variable. The effect of alexithymia on the positive and negative affect scales were analyzed with an analysis of variance (ANOVA). Correlations between subscales of all questionnaires were analyzed by Spearman’s rank correlation coefficients. Differences between groups on reaction times (only correct trials) and accuracy scores of the associative learning task (identity and emotional learning) were both analyzed with analysis of variance (ANOVA). Task performance on the semantic subtask and prosody subtask of the affective prosody task were analyzed with two MANOVAs with reaction times per emotion as dependent variables. Accuracy scores of this task were analyzed in the same way. Accuracy scores on the METT task were compared with ANOVA. The Conflicting Beliefs and Emotions vignettes were tested with a Kruskal-Wallis test with the separate mean scores on the vignettes as dependent variables. Results Questionnaires MANOVA revealed a significant group effect on BVAQ, ERQ, BEQ and EQ scores (F(12,21) = 13.24, p,0.001). See Table 1 for descriptive statistics and group effects. Alexithymia Questionnaire (BVAQ). The alexithymic group not only scored higher on verbalizing (F(1,32) = 174.89, p,0.001), but also on identifying (F(1,32) = 7.98, p = 0.008) and analyzing (F(1,32) = 15.97, p,0.001). However, there were no group differences on the emotionalizing (p = 0.28) and fantasizing (p = 0.28) scales. We have to mention that the alexithymic group scored high on the cognitive component of the questionnaire but not on the emotionalizing component. Notably, the cognitive component of the BVAQ correlates highly with the TAS-20. This implies comparability between our sample and samples selected using the TAS-20 questionnaire. The verbalizing subscale of the BVAQ was positively correlated with the ERQ subscales reappraisal (r = 0.46, p = 0.006) and suppression (r = 0.82, p,0.001), and negatively correlated with the BEQ positive expressivity (r = 20.73, p,0.001), BEQ negative expressivity (r = 20.67, p,0.001), BEQ impulse strength (r = 20.46, p = 0.007) and EQ empathy scale (p = 0.04). Emotion Regulation Questionnaire. The high alexithymic group scored lower on the reappraisal (F(1,32) = 6.85 p = 0.013) and higher on the suppression scale of the ERQ (F(1,32) = 33.42, p,0.001). Berkeley Expressivity Questionnaire. The high alexithymic group had lower ratings on the positive *significant at p,0.01 level (two-sided). **significant at p,0.001 level (two-sided). doi:10.1371/journal.pone.0005751.t001 (F(1,32) = 24.42, p,0.001) and negative (F(1,32) = 14.43, p = 0.001) expressivity and impulse strength (F(1,32) = 7.56, p = 0.01) dimensions of the BEQ. Empathy Quotient. The high alexithymia group scored (significantly) lower on the empathy scale (F(1,32) = 7.31, p = 0.01) but did not differ on the control items (F(1,32) = 0.86, p = 0.36). Positive and Negative Affect Schedule. Groups did not differ on the positive (F(1,32) = 0.17, p = 0.68) and negative affect schedule (F(1,32) = 2.60, p = 0.12). Tasks Micro Expression Training Tool. Alexithymic participants scored significantly lower on recognizing brief emotional expressions (see Table 2) (F(1,31) = 9.60, p = 0.004). Associative Learning Task. The groups did not differ on their performance on the associative learning task. This was the case for both emotional learning (F(1,32) = 0.90, p = 0.35), and identity learning (F(1,32) = 0.99, p = 0.33) (see Table 2). Affective Prosody Task. The affective prosody task revealed no differences between groups, not on accuracy in the prosody task (F(4,29) = 1.77, p = 0.16) and not on accuracy in the semantics task (F(4,29 = 0.32, p = 0.86). Groups also showed no differences in reaction times, neither in the prosody task (F(4,25) = 0.59, p = 0.68) nor in the semantics task, although there was a trend for alexithymic individuals to react slower in the latter (see Table 2) (F(4,29) = 2.44, p = 0.07). Conflicting Beliefs and Emotions task. The high alexithymic group performed significantly worse on the first order emotion question of the conflicting beliefs and emotions PLoS ONE | www.plosone.org 4 June 2009 | Volume 4 | Issue 6 | e5751