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Impaired cognitive self-awareness mediates the association between alexithymia and excitation/inhibition balance in the pgACC.

  • Kühnel, A1, 2
  • Widmann, A1, 3, 4
  • Colic, L1, 5, 6
  • Herrmann, L3
  • Demenescu, L R1
  • Leutritz, A L1
  • Li, M3, 7
  • Grimm, S8, 9, 10
  • Nolte, T11, 12
  • Fonagy, P11, 13
  • Walter, M1, 3, 5, 14, 15
  • 1 Clinical Affective Neuroimaging Laboratory, Magdeburg, Germany. , (Germany)
  • 2 Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry and International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany. , (Germany)
  • 3 University Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany. , (Germany)
  • 4 Experimental and Molecular Psychiatry, LWL University Hospital, Ruhr University Bochum, Bochum, Germany. , (Germany)
  • 5 Leibniz Institute for Neurobiology, Magdeburg, Germany. , (Germany)
  • 6 Department of Psychiatry, Mood Disorders Research Program, Yale School of Medicine, New Haven, CT, USA.
  • 7 Department of Psychiatry and Psychotherapy, OVGU Magdeburg, Magdeburg, Germany. , (Germany)
  • 8 Department of Psychiatry, Charité, CBF, Berlin, Germany. , (Germany)
  • 9 MSB Medical School Berlin, Calandrellistraße 1-9, 12247Berlin, Germany. , (Germany)
  • 10 Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8032Zurich, Switzerland. , (Switzerland)
  • 11 The Anna Freud National Centre for Children and Families, London, UK.
  • 12 Wellcome Trust Centre for Neuroimaging, University College London, London, UK.
  • 13 Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
  • 14 Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany. , (Germany)
  • 15 Max Planck Institute for Biological Cybernetics, Tübingen, Germany. , (Germany)
Published Article
Psychological Medicine
Cambridge University Press
Publication Date
Jul 01, 2020
DOI: 10.1017/S0033291719001806
PMID: 31328716


Previous research showed that automatic emotion regulation is associated with activation of subcortical areas and subsequent feedforward processes to cortical areas. In contrast, cognitive awareness of emotions is mediated by negative feedback from cortical to subcortical areas. Pregenual anterior cingulate cortex (pgACC) is essential in the modulation of both affect and alexithymia. We considered the interplay between these two mechanisms in the pgACC and their relationship with alexithymia. In 68 healthy participants (30 women, age = 26.15 ± 4.22) we tested associations of emotion processing and alexithymia with excitation/inhibition (E/I) balance represented as glutamate (Glu)/GABA in the pgACC measured via magnetic resonance spectroscopy in 7 T. Alexithymia was positively correlated with the Glu/GABA ratio (N = 41, p = 0.0393). Further, cognitive self-awareness showed an association with Glu/GABA (N = 52, p = 0.003), which was driven by a correlation with GABA. In contrast, emotion regulation was only correlated with glutamate levels in the pgACC (N = 49, p = 0.008). Our results corroborate the importance of the pgACC as a mediating region of alexithymia, reflected in an altered E/I balance. Furthermore, we could specify that this altered balance is linked to a GABA-related modulation of cognitive self-awareness of emotions.

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