https://orcid.org/0000-0001-7557-9078
Figures
Abstract
Evidence suggests that incidental modulation of affective states affects the ability to keep track of time. Alexithymia represents an ideal condition to further address the emotion-time processing link, as it refers to a trait characterized by a deficit of affective processing. 31 healthy participants completed an online version of the TAS-20 scale, which measures alexithymia, and a time reproduction task of visual stimuli related to positive (i.e., happiness) and negative (i.e., anger) facial expressions. Results documented a positive correlation between TAS-20 score and the variability in reproducing sub-second durations of the anger expression stimuli We also found an overestimation of sub-second durations of non-affective expressions in borderline/alexithymic participants. Finally, in line with the literature, we confirmed the overall tendency to overestimate the duration of anger expression stimuli. These findings, which can be interpreted in terms of abnormal scalar timing property in alexithymia, expand previous investigations linking this personality trait with abnormal processing of negative emotions. The evidence that alexithymia predicts the reproduction variability of sub-second durations of negative affective stimuli corroborates previous neuroimaging studies documenting cerebellar deficits in these individuals.
Citation: Vicario CM, Scavone V, Lucifora C, Falzone A, Pioggia G, Gangemi S, et al. (2023) Evidence of abnormal scalar timing property in alexithymia. PLoS ONE 18(1): e0278881. https://doi.org/10.1371/journal.pone.0278881
Editor: Ruth Sarah Ogden, Liverpool John Moores University, UNITED KINGDOM
Received: June 26, 2022; Accepted: November 26, 2022; Published: January 23, 2023
Copyright: © 2023 Vicario et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The data underlying the results presented in the study are available following formal request. Attached to this submission is now a minimal anonymized data set. Data are also available at https://www.researchgate.net/publication/365616116_Data_Output_PlosOne.
Funding: The authors received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Research exploring the cognitive and neural correlates of time processing offers a wide amount of evidence supporting the influence of emotions and affective states to the experience of time in both healthy adults and children [1–3]. example, Droit-Volet et al. [4] found that angry faces were judged to last longer than neutral faces. Moreover, watching a scary movie that increases the emotion of fear leads to an overestimation of the duration of neutral stimuli, compared to the exposure to a control condition [5].
A link between emotion processing and time perception is also provided by results from clinical populations affected by affective disorders such as depression, anxiety, and other related clinical conditions. For instance, a meta-analysis documented that depressed patients perceive time to pass less quickly than healthy controls [6]. Mioni et al. [7] found an under-reproduction of supra-second durations in anxiety via time reproduction task, which could indicate an overestimation in duration. Interestingly, this overestimation timing pattern has been reported also in patients affected by post-traumatic stress disorder–PTSD [8, 9].
In summary, this literature suggests that both the incidental modulation of affective states, as well as affective deficits can modulate the way in which the duration of visual stimuli is perceived. A missing knowledge, which would be useful for providing a complete picture of the interaction between time and affective processing, could refers to the role of the emotion processing style as personality trait on the perception of time.
The study of the perception of time in Alexithymia can serve this purpose as it refers to a stable personality feature or trait [10, 11] characterized by an affective-emotional processing disorder that causes difficulties in identifying, describing feelings and emotions [e.g., 12–17]. The study of time estimation in alexithymia would allow to clarify whether a possible influence of emotion on time processing can take place even when we refer to a stable trait of the personality relevant for the processing of emotions, as well as in response to incidental modulation of affective states [4].
A recent study of our group [18] has explored the temporal perspective in Alexithymia using the Zimbardo Time Perspective Inventory [19]. This scale is composed of 56 items, to detect individual differences in time-orientation regarding different aspects of the past, present, and future. The results documented greater attention to past negative aspects in participants with borderline or manifest alexithymia scores, as compared to non-alexithymic individuals. Moreover, the higher the Toronto Alexithymia Scale-20 (TAS-20) score, the greater the tendency to focus on negative aspects of the past and interpret the present in a fatalistic way.
In the current study, we explored the perception of time in alexithymia using a computer-based time reproduction task that involved the temporal estimation of affective stimuli (i.e., facial expressions). We explored the ability to reproduce temporal intervals in the sub-second and supra-second ranges, as any difference between these two scales can be also informative for the neurocognitive correlate associated with the respective timing pattern of this trait. In line with the recent evidence of a rightward bias in alexithymia [20], we predict an overall time overestimation in alexithymia, according with the evidence that a rightward spatial attention bias causes and/or predicts a temporal overestimation [21, 22].
We also expect to detect any influence of negative facial expressions on temporal performance of these individuals according to previous works documenting a perception deficit for negative facial expressions in alexithymia [12, 23]. In this regard, we have chosen the expression of anger for the specific relevance of this emotion in alexithymia. For example, Rosenberg et al. [24] found that alexithymic features are related, in particular, to a lower sensitivity to covert facial expressions of anger.
Finally, we predict greater variability in temporal reproduction in line with the evidence of functional and structural cerebellar abnormalities in alexithymia [24–26], as this neural region is considered important in time processing variability [27].
Materials and methods
Participants
31 healthy participants took part in this study (16 females and 15 males, age mean 27.28, Standard Deviation 5.42 age range between 20 and 40 years). Participants were recruited at the department of Cognitive, Psychological, Educational and Cultural Studies, which includes students from different degree courses in social and humanities fields. 16 participants were non-alexithymic; 6 participants were classified as borderline; The remaining 10 participants were classified as alexithymic. Details on how participants were classified in these three groups are provided in the next paragraph. A one-way ANOVA showed no significant difference in gender [F(2, 29) = 0, p = 0.881, ηp 2 = 0.008] and age [F(2, 29) = 0,195, p = 0.823, ηp 2 = 0.013] across the three groups. Most participants were students recruited from the Department of Cognitive, Psychological, Pedagogical, and Cultural Studies (COSPECS) at the University of Messina. Participants were recruited via social network (e.g., Facebook) or email. Exclusion criteria were age over 40 years. All participants gave their written informed consent prior to inclusion in the study and were naïve to its purpose. The data were anonymously collected. The study was approved by the local ethics board (COSPECS Department, University of Messina, Italy) and was conducted in agreement with the principles of the Declaration of Helsinki.
General procedure
First, the participants were asked to sit down and complete the consent form and the TAS-20. Subsequently, they were asked to perform a trial session of the time reproduction task, to familiarize themselves with the procedure and to have the opportunity to ask the researcher for explanations. After completing the task, participants were allowed to ask questions (if any) about the study goal.
TAS-20 (20 Item-Toronto Alexithymia Scale)
The TAS-20 is a self-reported scale used to measure alexithymia. It is composed of three subscales: (a) Difficulty in identifying feelings (DIF); (b) Difficulty in describing feelings (DDF); and (c) External oriented thought (EOT). Bagby et al. [28] have proposed three cut-off scores for the classification of individuals: alexithymic subjects (≥61), borderline (score range between 51 to 60), and non-alexithymic subjects (≤50). In this study, the Italian version of the Toronto Alexithymia Scale (20 items, TAS-20) was used, which was validated by Bressi et al. [29] (Cronbach’s alpha 0.75).
Time reproduction task
We used a version of the time reproduction task previously used in previous studies of our group [29–32]. The test was programmed by using E-prime 2 software. Subjects sat at a distance of 60 cm opposite to the monitor of a pc and were asked to fixate a black cross of 0.2° in diameter, centrally located on the screen. After 500 ms, the stimulus (a photo of a facial expression, size: height, 12 cm, length, 10 cm) appeared in the same location of the fixating cross; after a specified period, it disappeared. Immediately after the stimulus disappeared, subjects had to start reproducing the interval they had just perceived by pressing the space bar on the computer keyboard using the index finger of their dominant hand. When they judged that the same amount of time had elapsed, they had to release the space bar. Facial stimuli included three conditions: i) A neutral expression; ii) A happy expression; iii) A angry expression. These stimuli were selected from the FACES database [33].
Each session consisted in three (one for each expression) separate and consecutive blocks, which were administered in a counterbalanced order. One block consisted of 80 trials in which subjects estimated five sub-second intervals (500, 600, 700, 800, 900 ms) and five supra-second (1500, 1600, 1700, 1800, 1900 ms) intervals presented in randomised order. In all blocks, the inter-trial interval was 2000 ms. No feedback concerning the results of their performance was given to the subjects during the inter-trial interval.
Data analysis
A preliminary analysis for normality documented a normal distribution for all data (K-Sd = 0.221, p>0.20).
The reproduction performance (reproduction means) was analysed using two separated ANOVA for repeated measures (i.e., one per temporal scale): with GROUP (non-alexithymic vs. borderline/alexithymic subjects), as the between-subject factor, STIMULUS (neutral expression, happy expression, anger expression), and INTERVAL (500–900 ms or 1500–1900 ms) as within-subject factors. The same analysis was applied to reproduction performance variability. As a measure of variability in estimating the presented stimuli, we calculated the coefficient of variation with scores expressed as percentages [CV (Standard Deviation/mean reproduction performance) * 100]. Post hoc comparisons were performed using Scheffe test. We also performed a Pearson correlation analysis to explore any relationship between timing performance (i.e., mean and CV) and respective TAS-20 scores. For all statistical analyses, a p value of < 0.05 was considered to be significant.
Finally, as further measure of accuracy, we investigated the time reproduction performance of our participants via one sample t-test for single means for both groups and respective stimuli and intervals. Therefore, the reproduction mean provided for each interval was compared with the respective duration to be reproduced. p-level was corrected for corrected for multiple comparisons (i.e., t-test Bonferroni corrected). In this case it was considered significant if ≤ 0.016 (i.e., 0.05/3 types of expressions).
Borderline (score range between 51 to 60) and alexithymic (score > 60) individuals were grouped in a single category, to be compared with no alexithymic individuals, in keeping with previous evidence documenting a similar performance of these two groups in several cognitive and affective tasks [e.g., 12, 18, 20]. Data analysis was performed using Statistica software, version 8.0, StatSoft, Inc., Tulsa, USA.
Results
Reproduction means
Sub-second.
We detected a significant main effect of INTERVAL [F 4,112 = 100.4 p < 0.001, ηp2 = 0.782], showing that the reproduction mean increases with the size of the duration of respective stimuli. No further significant results were found (See supplemental results, S1 Table in S1 File).
Supra-second.
We detected a significant main effect of INTERVAL [F 4,112 = 64.89 p < 0.001, ηp2 = 0.698], showing that the reproduction mean increases with the size of the duration of respective stimuli. We also found a main effect of the STIMULUS [F 2,56 = 3.516, p = 0.036, ηp2 = 0.111]. Post-hoc comparison documents temporal overestimation for anger facial expression (M = 1342.6 ± 64.05) compared to neutral facial expression (M = 1259.9 ± 59.29, p = 0.008), and happy facial expression (M = 1254.2 ± 57.87, p = 0.031). No difference in time reproduction between neutral and happiness expressions was found (p = 0.885). No further significant results were found (See supplemental materials, S2 Table in S1 File).
Reproduction variability
Sub-second.
We detected a significant main effect of INTERVAL [F 4,112 = 2.968 p = 0.022, ηp2 = 0.095], showing that the coefficient of variation decreases with the size of the duration of respective stimuli. However, post hoc comparisons did not show significant difference (p>0.117). No further significant results were found (See supplemental results, S3 Table in S1 File).
Supra-second.
We detected a significant main effect of INTERVAL [F 4,112 = 3.031 p = 0.020, ηp2 = 0.097]. post hoc comparisons show significant difference only when comparing CV score in the reproduction of 1600 msec (M = 23.64 ± 1.681) compared with the reproduction of 1800 msec (M = 20.27 ± 1.665, p = 0.033). No further significant results were found (See supplemental results, S4 Table in S1 File).
Correlation analyses
Correlation analyses between reproduction mean and TAS-20 scores did not detect significant results (see Table 1, “mean scores” section for details). On the other hand, we found a positive correlation between TAS-20 and CV scores associated with anger expression stimuli (see Table 1, “CV scores” section and Fig 1 for details).
One sample t-test for single means
Sub-second intervals.
Non alexithymic individuals under-reproduced the duration of the neutral expression for all five (500–900 ms) intervals. Moreover, a significant under-reproduction was found for the expression of happiness for the 800 ms interval (Table 2 for details and respective t and p values for all stimuli and intervals).
Borderline/alexithymic individuals under-reproduced the duration of the happiness expression only for the 800 ms interval, as well as the control group. The Table 2 shows mean standard deviation (Std.DV) and respective t and p values for all stimuli and temporal intervals. More details are also provided in the Fig 2.
* Indicates significant difference for one sample t-test for single means. Vertical bars denote ± standard error of means.
Supra-second intervals
Both non alexithymic and borderline/alexithymic individuals under-reproduced the duration of the presented stimuli for all intervals and expressions. See the S5A and S5B Tables in S1 File, supplemental materials, for details.
Discussion
In the present study we explored time reproduction in healthy individuals with borderline/alexithymic traits and compared the respective performance with non alexithymic individuals. We focused on this personality trait as we aimed to investigate whether (and how) alterations of emotion processing style could affect the subjective ability to keep track of time. Participants were asked to reproduce the durations of emotion related (or control) visual stimuli, such as different types of facial expressions, to investigate any specific interaction between the type (i.e., positive, negative) of emotion and the level of difficulty in processing/recognizing affective stimuli as indicated by the respective TAS-20 score [12].
Overall, the results document a positive correlation between TAS-20 scores and the variability in time reproduction of anger facial expressions. This result, which reflects how repeated responses are scattered from their target [34–36] suggests an altered scalar property of time in borderline/alexithymic individuals for negative emotional stimuli. The concept of scalar property refers to the way in which the standard deviation and mean of the participants’ response distribution covary [36]. In this regard, CV is considered the golden measure to explore this property of the timing ability [37]. Our results suggest that variability in temporal reproduction of sub-second durations increases with the severity of the alexithymia personality trait. The evidence of a selective bias for anger expression is in line with previous works suggesting a specific relevance of anger expression in Alexithymia [24, 38–40]. For example, results from a visual ERP study [39] suggest that the perception of anger facial expression is disrupted in alexithymia. Given the relevance of decision-making processes for the execution of the proposed timing task, our results provide further evidence to the hypothesis of impaired integration of social anger signals into judgemental processes in alexithymia [24].
The evidence that the variability in the reproduction sub-second durations of anger facial expressions increases with the severity of alexithymia suggests a possible involvement of the cerebellum. CV is a measure particularly sensitive to alteration in cerebellar activity [41–44]. For example, Gibbon et al. [36] reported increased scalar variability of time in cerebellar patients. Neuroimaging evidence [25–27] have also reported a direct relationship between alexithymia and cerebellar volume. The evidence of a selective involvement of the sub-second range of durations further supports the cerebellar hypothesis, in line with the suggestion that the cerebellum is specialized in the representation of sub-second durations [43, 44], contrary to the timing of supra-second durations, which mainly relates with the cortical activity [45–47] Finally, the potential role of the cerebellum in explaining the current result is corroborated by the emerging literature documenting its involvement in social cognition and emotion processing [57]. Importantly, the study by Ferrucci et al. [48] showed a selective involvement of the cerebellum in the emotional recognition of anger, which is the facial expression for which we found the correlation pattern between TAS-20 and time reproduction.
Another noteworthy finding is the tendency of borderline/alexithymic participants to overestimate sub-second durations, compared to non-alexithymic participants. Non-alexithymic individuals underestimate sub-second durations (i.e., the 700–900 ms range) of neutral stimuli, and this difference is statistically significant, as shown via one sample t-test analysis. On the other hand, the difference between the reproduced means and respective durations was found to be not statistically significant in borderline/alexithymic participants. This latter result can be interpreted in terms of temporal overestimation, in line with our initial prediction, linking this timing pattern with the rightward bias in alexithymia [18]. An alternative interpretation for this result is that borderline/alexithymic participants can be more accurate in reproducing sub-second durations, as their temporal performance resulted closer to the respective temporal landmark. However, we think this interpretation is unlikely, in keeping with the evidence of impaired cognitive control in alexithymia [49] which seems to be necessary for accurate timing performance [50].
Finally, it should be mentioned the overall overestimation of durations related to the anger expression, as suggested by the main effect of the stimulus. The block per stimulus interaction term shows that this effect is specific for sub-second intervals. This result confirms previous works [e.g., 4] documenting that the duration of angry faces is judged to last longer than neutral faces.
In conclusion, our study shows that alexithymia, an emotion processing style characterized by an affective-emotional processing disorder that causes difficulties in identifying, describing feelings and emotions, affects time perception. This expands the literature on emotion-time processing interplay by showing that even a stable trait of the personality relevant for the processing of emotions affects the experience of time as well as the incidental modulation of affective states [4]. Moreover, it adds supports to the suggestion on relevance of this cognitive function as a transdiagnostic index for mental disorders [47].
Some limitations of the present study should be mentioned. First, the overall number of participants was relatively low, and no sample size calculation was applied. This might explain why the ANOVA on means and CV scores did not document a significant between groups difference regarding the main research hypotheses. Moreover, we have not collected data on anxiety and interoceptive awareness, which are known to be relevant to the experience of time processing [47, 51].
Future studies involving a larger sample, other type of timing tasks, other negative emotional expressions such as disgust, as there is evidence of altered time perception in clinical disorders such as Anorexia Nervosa [52] and Hyperphagia [53] which are known to be affected by abnormal disgust sensitivity as trait of personality [54–56]. For a review on clinical models see also [57]; and other emotion processing style as personality traits [e.g., see 58–60], are needed to explore in more detail the interplay between affective processing emotional regulation, and the experience of time.
References
- 1. Droit-Volet S., & Meck W.H. How emotions colour our perception of time. Trends Cogn Sci 11(12), 504–13 (2007). pmid:18023604
- 2. Droit-Volet S., Mermillod M., Cocenas-Silva R., & Gil S. The effect of expectancy of a threatening event on time perception in human adults. Emotion. 10(6), 908 (2010). pmid:21171761
- 3. Droit-Volet S., Tourret S., & Wearden J. Perception of the duration of auditory and visual stimuli in children and adults. Q J Exp Psychol A. 57(5), 797–818 (2004). pmid:15204118
- 4. Gil S., & Droit-Volet S. "Time flies in the presence of angry faces"… depending on the temporal task used! Acta Psychol (Amst).136(3), 354–62 (2011).
- 5. Droit-Volet S., Fayolle S.L., & Gil S. Emotion and time perception: effects of film-induced mood. Front Integr Neurosci. 5, 33 (2011). pmid:21886610
- 6. Thönes S., & Oberfeld D. Time perception in depression: a meta-analysis. J Affect Disord. 175, 359–72 (2015). pmid:25665496
- 7. Mioni G., Stablum F., Prunetti E., & Grondin S. Time perception in anxious and depressed patients: A comparison between time reproduction and time production tasks. J Affect Disord. 196, 154–63 (2016). pmid:26922144
- 8. Vicario C.M., & Felmingham K.L. Slower Time estimation in Post-Traumatic Stress Disorder. Sci Rep. 8(1), 1–8 (2018).
- 9. Vicario C.M., Martino G., Lucifora C., & Felmingham K. Preliminary evidence on the neural correlates of timing deficit in post-traumatic stress disorder. Eur J Psychotraumatol. 13(1), 2008151 (2022). pmid:35096283
- 10.
Taylor G.J., & Bagby R.M. The alexithymia personality dimension. In The Oxford Handbook of Personality Disorders; Widiger T.A., Ed.; Oxford University Press: Oxford, UK, 2012; pp. 648–673
- 11. Martínez-Sánchez F. Ato-García M. & Ortiz-Soria B. Alexithymia—State or trait? Span. J. Psychol. 6, 51–59 (2003). pmid:12765051
- 12. Craparo G., Gori A., Dell’Aera S., Costanzo G., Fasciano S., Tomasello A., et al. Impaired emotion recognition is linked to alexithymia in heroin addicts. PeerJ. 4, e1864 (2016). pmid:27069803
- 13. Martino G., Caputo A., Schwarz P., Bellone F., Fries W., Quattropani M.C., et al. Alexithymia and Inflammatory Bowel Disease: A Systematic Review. Front Psychol. 11, 1763 (2020). pmid:32973596
- 14. Martino G., Caputo A., Vicario C.M., Catalano A., Schwarz P., & Quattropani M.C. The Relationship Between Alexithymia and Type 2 Diabetes: A Systematic Review. Front Psychol. 11, 2026 (2020). pmid:32982843
- 15. Orrù G., Gemignani A., Ciacchini R., Bazzichi L., & Conversano C. Machine Learning Increases Diagnosticity in Psychometric Evaluation of Alexithymia in Fibromyalgia. Front Med (Lausanne). 6, 319 (2020). pmid:31998737
- 16. Conversano C., Marchi L., Rebecca C., Carmassi C., Contena B., Bazzichi L.M., et al. Personality Traits in Fibromyalgia (FM): Does FM Personality Exists? A Systematic Review. Clin Pract Epidemiol Ment Health. 14, 223–232 (2018). pmid:30294356
- 17. La Rosa V.L., Gori A., Faraci P., Vicario C.M., & Craparo G. Traumatic Distress, Alexithymia, Dissociation, and Risk of Addiction During the First Wave of COVID-19 in Italy: Results from a Cross-sectional Online Survey on a Non-clinical Adult Sample. Int J Ment Health Addict. 1–17 (2021). pmid:34131416
- 18. Barchetta S., Martino G., Craparo G., Salehinejad M.A., Nitsche M.A., & Vicario C.M. Alexithymia Is Linked with a Negative Bias for Past and Current Events in Healthy Humans. Int J Environ Res Public Health. 18(13),6696 (2021). pmid:34206284
- 19. Zimbardo P.G., & Boyd J.N. Putting time in perspective: A valid, reliable individual-differences etric. J. Personal. Soc. Psychol. 77, 1271–1288 (1999).
- 20. Vicario C.M., Martino G., Marcuzzo A., & Craparo G. No Evidence of Perceptual Pseudoneglect in Alexithymia. Brain Sci. 11(3), 376 (2021). pmid:33804270
- 21. Vicario CM, Rappo G, Pepi AM, Oliveri M. Timing flickers across sensory modalities. Perception. 38(8):1144–51 (2009). pmid:19817148
- 22. Vicario CM, Pecoraro P, Turriziani P, Koch G, Caltagirone C, Oliveri M. Relativistic compression and expansion of experiential time in the left and right space. PLoS One. 3(3):e1716 (2008). pmid:18320037
- 23. Vicario C.M., Martino D., Pavone E.F., Fuggetta G. Lateral head turning affects temporal memory. Percept Mot Skills. 113(1), 3–10 (2011). pmid:21987905
- 24. Rosenberg N., Ihme K., Lichev V., Sacher J., Rufer M., Grabe H.J., et al. Alexithymia and automatic processing of facial emotions: behavioral and neural findings. BMC Neurosci. 21(1), 1–13 (2020).
- 25. Laricchiuta D., Petrosini L., Picerni E., Cutuli D., Iorio M., Chiapponi C., et al. The embodied emotion in cerebellum: a neuroimaging study of alexithymia. Brain Struct Funct. 220(4), 2275–87 (2015). pmid:24841618
- 26. Petrosini L., Cutuli D., Picerni E., & Laricchiuta D. Viewing the Personality Traits Through a Cerebellar Lens: a Focus on the Constructs of Novelty Seeking, Harm Avoidance, and Alexithymia. Cerebellum. 16(1), 178–190 (2017). pmid:26739351
- 27. Petrosini L., Cutuli D., Picerni E., & Laricchiuta D. Cerebellum and personality traits. Cerebellum. 14(1), 43–6 (2015). pmid:25504000
- 28. Bagby R.M., Taylor G.J. & Parker J.D.A. The twenty-item Toronto Alexithymia Scale. II. Convergent, discriminant, and concurrent validity. J. Psychiatr. Res. 38, 33–40 (1994).
- 29. Bressi C. Taylor G.J. Parker J.D.A. Bressi S. Brambilla V. Aguglia E., et al. Cross validation of the factor structure of the 20-item Toronto Alexithymia Scale: An Italian multicenter study. J. Psychosom. Res. 41, 551–559 (1996). pmid:9032718
- 30. Vicario C.M., Rappo G., Pepi A., Pavan A., & Martino D. Temporal abnormalities in children with developmental dyscalculia. Dev Neuropsychol. 37(7), 636–52 (2012). pmid:23066940
- 31. Vicario C.M., Bonní S., & Koch G. Left hand dominance affects supra-second time processing. Front Integr Neurosci. 5, 65 (2011). pmid:22028685
- 32. Vicario C.M., Gulisano M., Martino D., & Rizzo R. Timing recalibration in childhood Tourette syndrome associated with persistent pimozide treatment. J Neuropsychol. 10(2), 211–22 (2016). pmid:25705969
- 33. Ebner N.C., Riediger M., & Lindenberger U. FACES—a database of facial expressions in young, middle-aged, and older women and men: development and validation. Behav Res Methods. 42(1),351–62 (2010). pmid:20160315
- 34. Vicario C.M., & Martino D. Setting the scalar variance property to understand the time reproduction deficit in essential tremor. Mov Disord. 31(9), 1428 (2016). pmid:27431670
- 35. Jones C.R., Claassen D.O., Yu M., Spies J.R., Malone T., Dirnberger G., et al. Modeling accuracy and variability of motor timing in treated and untreated Parkinson’s disease and healthy controls. Front Integr Neurosci. 5, 81 (2011). pmid:22207839
- 36.
Gibbon J., Church R. M., & Meck W. H. (1984). Scalar timing in memory. In Gibbon J. & Allan L. (Eds.), Timing and time perception (pp. 52–77). New York: New York Academy of Sciences
- 37. Ren Y., Allenmark F., Müller H.J., & Shi Z. Variation in the "coefficient of variation": Rethinking the violation of the scalar property in time-duration judgments. Acta Psychol (Amst). 214,103263 (2021). pmid:33529789
- 38. Neumann S.A., Sollers JJ 3rd, Thayer J.F., & Waldstein S.R. Alexithymia predicts attenuated autonomic reactivity, but prolonged recovery to anger recall in young women. Int J Psychophysiol. 53(3), 183–95 (2004). pmid:15246672
- 39. Wang Z., Chen M., Goerlich K.S., Aleman A., Xu P., & Luo Y. Deficient auditory emotion processing but intact emotional multisensory integration in alexithymia. Psychophysiology. 58(6), e13806 (2021). pmid:33742708
- 40. Di Tella M., Enrici I., Castelli L., Colonna F., Fusaro E., Ghiggia A., et al. Alexithymia, not fibromyalgia, predicts the attribution of pain to anger-related facial expressions. J Affect Dis, 227, 272–279 (2018). pmid:29127814
- 41. Avanzino L., Bove M., Tacchino A., Ruggeri P., Giannini A., Trompetto C., et al. Cerebellar involvement in timing accuracy of rhythmic finger movements in essential tremor. Eur J Neurosci. 30(10), 1971–9 (2009). pmid:19912337
- 42. Gooch C.M., Wiener M., Wencil E.B., & Coslett H.B. Interval timing disruptions in subjects with cerebellar lesions. Neuropsychologia. 48(4), 1022–31 (2010). pmid:19962999
- 43. Avanzino L., Bove M., Pelosin E., Ogliastro C., Lagravinese G., & Martino D. The cerebellum predicts the temporal consequences of observed motor acts. PLoS One. 10(2), e0116607 (2015). pmid:25689858
- 44. Koch G., Oliveri M., Torriero S., Salerno S., Lo Gerfo E., & Caltagirone C. Repetitive TMS of cerebellum interferes with millisecond time processing. Exp Brain Res. 179(2), 291–9 (2007). pmid:17146647
- 45. Vicario C.M., & Martino D. The neurophysiology of magnitude: One example of extraction analogies. Cogn Neurosci. 1(2), 144–5 (2010). pmid:24168285
- 46. Wiener M., Turkeltaub P., & Coslett H.B. The image of time: a voxel-wise meta-analysis. Neuroimage. 49(2), 1728–40 (2010). pmid:19800975
- 47. Vicario C.M., Nitsche M.A., Salehinejad M.A., Avanzino L., & Martino G. Time Processing, Interoception, and Insula Activation: A Mini-Review on Clinical Disorders. Front Psychol. 11, 1893 (2020). pmid:32973605
- 48. Ferrucci R., Giannicola G., Rosa M., Fumagalli M., Boggio P.S., Hallett M., et al. Cerebellum and processing of negative facial emotions: cerebellar transcranial DC stimulation specifically enhances the emotional recognition of facial anger and sadness. Cogn Emot. 26(5), 786–99 (2012). pmid:22077643
- 49. Dressaire D., Stone C.B., Nielson K.A., Guerdoux E., Martin S., Brouillet D., et al. Alexithymia impairs the cognitive control of negative material while facilitating the recall of neutral material in both younger and older adults. Cogn Emot. 29(3), 442–59 (2015). pmid:24856581
- 50. Lewis P.A., & Miall R.C. Remembering the time: a continuous clock. Trends Cogn Sci. 10(9):401–6 (2006). pmid:16899395
- 51. Richter F., & Ibáñez A. Time is body: Multimodal evidence of crosstalk between interoception and time estimation. Biol Psychol. 159, 108017 (2021). pmid:33450326
- 52. Vicario C.M., & Felmingham K. The Perception of Time Is Underestimated in Adolescents With Anorexia Nervosa. Front Psychiatry. 9 121 (2018). pmid:29686631
- 53. Vicario C.M., Caruso V., Craparo G., & Felmingham K.J. Time is overestimated in obesity: A cohort study. Health Psychol. 26, 771–785 (2021). pmid:30990091
- 54. Vicario C.M. Altered insula response to sweet taste processing in recovered anorexia and bulimia nervosa: a matter of disgust sensitivity? Am J Psychiatry. 170, 1497 (2013). pmid:24306341
- 55. Houben K., Havermans R.C. A delicious fly in the soup. The relationship between disgust, obesity, and restraint. Appetite. 58, 827–30 (2012). pmid:22306298
- 56. Vicario C. M., and Rafal R. D. Relationship between body mass index and moral disapproval rating for ethical violations. Pers. Individ. Dif. 104, 8–11 (2017).
- 57. Vicario CM, Rafal RD, Martino D, Avenanti A. Core, social and moral disgust are bounded: A review on behavioral and neural bases of repugnance in clinical disorders. Neurosci Biobehav Rev. 80, 185–200. (2017). pmid:28506923
- 58. Tanzilli A., Di Giuseppe M., Giovanardi G., Boldrini T., Caviglia G., Conversano C., et al. Mentalization, attachment, and defense mechanisms: a Psychodynamic Diagnostic Manual-2-oriented empirical investigation. Res Psychother. 24, 531 (2021). pmid:33937117
- 59. Di Giuseppe M., Gennaro A., Lingiardi V., Perry J.C. The Role of Defense Mechanisms in Emerging Personality Disorders in Clinical Adolescents. Psychiatry. 82, 128–142 (2019). pmid:30925112
- 60. Di Giuseppe M., Perry J.C., Conversano C., Gelo O.C.G., Gennaro A. Defense Mechanisms, Gender, and Adaptiveness in Emerging Personality Disorders in Adolescent Outpatients. J Nerv Ment Dis. 208, 933–941 (2020). pmid:32947450