The Relationship Between Alexithymia, Psychological Inflexibility and Self-Concealment Among a Sample of Male and Female Adolescents

The present study aimed to explore differences in alexithymia, psychological inflexibility, and self-concealment among a sample of male and female students in Irbid Governorate, Jordan. The study sample consisted of 192 students (80 males and 112 Females), selected randomly from two public high schools. The participants completed three scales: an alexithymia scale, a psychological inflexibility scale, and a self-concealment scale. Results indicated that the level of alexithymia and self-concealment among males was significantly higher than among females. Furthermore, results indicated that the level of psychological inflexibility among males was significantly higher than among females on the avoidance subscale, while the level of psychological inflexibility among females was significantly higher than among males on the acceptance subscale. Additionally, results indicated that there were significant positive correlations between alexithymia, psychological inflexibility, and self-concealment among male and female students. We proposed that early detection and intervention for alexithymia may help adolescents develop and consolidate themselves and reduce the risk of negative emotions.

Adolescence is a developmental period that is characterized by a variety of challenges, adjustments, and developments in the biological, psychological, and social domains, making them more likely to take risks that have long-term effects on their health and development (Toghyania and Akrami, 2011). The author observed while she was spending time working in schools that many teenagers find it difficult to express their feelings, and they often struggle to find the appropriate words to do so. She also observed that some teenagers may exhibit insensitivity towards friends or family members and engage in inappropriate emotional interactions. These feelings play a crucial role in maintaining mental wellness and influencing a person's behavior; therefore, she recognized the necessity to investigate the effects of alexithymia, psychological inflexibility, and self-concealment.

The concept of alexithymia was introduced by psychotherapists John Case Nemiah and Peter Sifneos in 1972; it is an Ancient Greek word that means "no words for feelings", He used this concept to describe the people who strived to define and describe their feelings (Taylor and Taylor, 1997). Several non-medical terms, like "emotionless" and "impassive," have been used to describe similar situations (Nicholls et al., 1999). Alexithymia is defined by a diminished ability to be conscious of, recognize, and describe one's sensations; alexithymiacs may believe that these weak feelings will shield them from unpleasant emotions such as anxiety, sadness, melancholy, and depression (Hogeveen and Grafman, 2021). It is also defined as the relative limitation of emotional functioning, the relatively poor quality of fantasy life, and the inability to adequately express one's feelings; furthermore, it is seen as a dimensional personality feature that differs from person to person (Panaite and Bylsma, 2012). Cognitive styles suggest that alexithymia consists of three elements: having a greater propensity to ignore deeper emotions and concentrate on surface information; having less emotional sensitivity and difficulty identifying feelings; and having difficulty finding the appropriate words to express their feelings (Hogeveen and Grafman, 2021). Psychoanalytic models suggest that alexithymia consists of four elements: having difficulty identifying feelings; having trouble communicating feelings to others; having an externally focused way of thinking; and having limited imagination functions (Preece et al., 2017). It is suggested that this element be removed from the definition and that alexithymia be conceptually composed only of three elements. The concept of "psychological inflexibility" describes a person's inability to make decisions that are consistent with their stated values and goals as a result of their inability to completely connect with the current moment, follow rigid rules, or try to avoid challenging internal experiences (Duarte and Pinto-Gouveia, 2017). Psychological inflexibility usually focuses on how individuals respond to unpleasant physiological sensations, ideas, and feelings; however, individuals may also avoid pleasurable experiences, such as when individuals conceal their feelings to avoid disappointment in the future or when they don't feel empathy for others for fear of being exploited (Bond et al., 2011). This was confirmed by Miron et al. (2015), who indicated that resistance to empathy was correlated with PTSD symptom severity and psychological inflexibility. There are six main processes that are dysfunctional control attempts that can be an indicator of psychological inflexibility: "experiential avoidance, inflexible attention, disrupted values, inaction or impulsivity, conceptualized self, and cognitive fusion" (Uğuret al. 2021). People with psychological inflexibility are considerably more likely to experience psychological problems as a result of unwanted experiences that cause acute pain through one or more of these six main we might lead ourselves to develop cognitive errors like believing that we are "bad" or "worthless," but these thoughts frequently provide some type of temporary or short-term relief from anxiety or suffering, or we might become overly focused on how we see ourselves and tell our stories, and it's possible that we don't make the effort to figure out what our values are and then adjust our behavior to reflect them, or we might stay stuck in patterns of behavior that pull us away from the present moment, such as withdrawing socially, avoiding previously enjoyable activities, excessively using drugs or alcohol, or even attempting suicide, it is also possible to get "stuck" in the past when you dwell too much on regrettable or upsetting memories (Duarte and Pinto-Gouveia, 2017). processes over a period of time (Tanhan, 2019). Psychological inflexibility usually begins with experiential avoidance, which is an individual's attempt to avoid making space for their inner pleasant or unpleasant experiences, and that brings about additional suffering (Uğuret al. 2021). Research has shown that many behavioral or psychological problems have a favorable correlation with self-concealment; furthermore, people who conceal themselves from others and do not self-disclose face a lot of difficulties, which might later lead to health and psychological problems. Most people avoid disclosing to others uncomfortable feelings, thoughts, and knowledge about themselves; however, people vary in how much information they conceal from others; sometimes this information has been revealed to just one or two people, and other times it hasn't; It is defined as the propensity to keep uncomfortable information about oneself private and not disclose it to others (Algazou, 2023). Self-concealment is an enduring personality trait in which a person hides from others details about themselves, unpleasant experiences, and suffering that they have in real life that make them feel unhappy or uncomfortable; it also involves three signs: a tendency to keep things to oneself, a reluctance to discuss uncomfortable or private details, and worry about the disclosure of private personal information (Zhou et al., 2021). Psychoanalytic theory emphasizes their patients' most private experiences and their difficulty in expressing them; the therapist's job is to help patients reveal their most private thoughts, feelings, and behaviors (Larson & Chastain, 2015). According to the discouragement theory, even when levels of social support are maintained, concealing one's thoughts and feelings concerning traumatic occurrences has a negative impact on one's health; the therapist's job is to help patients write about their traumatic experiences (Finkenaur et al., 2009). Self-monitoring theory emphasizes that people conceal information from others in an effort to create a respectable, favorable impression of themselves (Algazou, 2023). However, self-presentational theory emphasizes that the person who maintains secrets believes that this can assist him in presenting a positive self-image to others (Baumann and Hill, 2016). In comparison to previous studies relating alexithymia, psychological inflexibility, and self-concealment, there has been a scarcity of studies exploring such relations between these variables together; some research has found a relationship between alexithymia and psychological inflexibility. For example, Duarte and Pinto-Gouveia (2017) emphasize that psychological inflexibility may be an important target for therapeutic interventions with individuals with increased alexithymia, and they found that a person with low psychological flexibility is more likely to avoid, divert from, or disregard their emotions, which might limit opportunities for appropriate emotion identification and expression. Panayiotou et al. (2015) also discovered that psychological inflexibility was an important mediator of the relationship between alexithymia and psychosomatic and depressive symptoms. Additionally, Venta et al. (2013) found that psychological inflexibility may play a mediating role in the relationship between alexithymia and emotion regulation; they also emphasize that the inability to properly utilize language to recognize and explain emotional states is closely tied to problems controlling one's emotions; this relation is mediated by the inability to withstand unpleasant private experiences. Some studies indicated that resistance to empathy was correlated with psychological inflexibility; Gilbert et al. (2014) found a positive correlation between alexithymia and resistance to empathy. Additionally, many studies indicate that people who have trouble knowing themselves and their feelings may also have a propensity for self-concealment, which makes it necessary to teach those people the ability to express themselves and be conscious of their sentiments (Çalık and Çelik, 2019). Harfush et al. (2023) also indicate that people who find it difficult to recognize and express their feelings may decide to keep feelings, thoughts, or intimate information to themselves. Kaya et al. 's (2019) study indicates a high positive correlation between self-concealment and alexithymia; self-concealers could feel more negatively about their relationships than others do because they might feel abandoned, forgotten, unacknowledged, and unappreciated. Self-concealment was also found to be negatively associated with psychological flexibility (Masuda et al., 2011). Masuda et al. (2017) found that psychological inflexibility was positively and uniquely associated with self-concealment; they emphasized that self-concealment was reflective of psychological inflexibility; and they expressed that the concept of self-concealment is a reflection of rigorous attempts to downregulate and avoid unpleasant internal feelings as well as reduced awareness of the present moment. The main goal of the current study was to explore differences in alexithymia, psychological inflexibility, and self-concealment among a sample of male and female students in Jordan. Two main hypotheses are addressed in this study:

Hypothesis 1:  Are alexithymia, psychological inflexibility, and self-concealment at a significance level (P<0>

Hypothesis 2: Is there a relationship at a significance level (p<.05) between alexithymia, psychological inflexibility, and self-concealment among male and female adolescents?

Participants: The study participants consisted of 192 female and male students (80 male and 112 female) who are registered to learn in the 10th grade at two high schools in Jordan in the 2022–2023 academic year. Their mean age was 15.02 years; they were chosen for the study by the simple random method. The survey was conducted during the counseling sessions in each school. The students needed about 30 minutes to fill out the questionnaires, which were returned to the author as soon as the students finished filling them out. It should be noted that the students who did not wish to participate were not given copies of the questionnaires. Participants were given symbolic reinforcement. Sample according to the genders in Table 1.

Table 1: Sample according to the genders

G= Gender; N= The number; M= Male; F=Female; T=Total; P=Percentage; Instruments: The study tools included three scales: an alexithymia scale, a psychological inflexibility scale, and a self-concealment scale.

Alexithymia Scale

In the current study, the Arabic version of the "Alexithymia Toronto" scale was used to measure alexithymia, translated by Dawoud (2016). This scale consists of 20 items and consists of three subscales: difficulty identifying feelings is represented by items of 1, 3, 6, 7, 9, 13, and 14; difficulty finding the appropriate words to express their feelings is represented by items of 2, 4, 11, 12, and 17; and the propensity to ignore deeper emotions and concentrate on surface information is represented by items of 5, 8, 10, 15, 16, 18, 19, and 20. Responses are rated on a five-point scale. The higher the participants’ scores, the higher their alexithymia levels. Total scores on the scale ranged from 20 to 100. Example items from this scale are "I have difficulty finding the appropriate words to express my feelings" and "I am often confused about what emotion I am feeling. (4, 5, 10, 18, and 19 items are reversely scored). In this study, Cronbach’s alpha for the scale was (0.82), and for the subscales, it was (0.72–0.71–0.72). Corrected item total correlations ranged from 0.75 to 0.92, and between the subscales, they were 0.36 to 0.72.

Psychological Inflexibility Scale

Psychological inflexibility was measured using a translated version of the psychological inflexibility scale. Developed by Bond et al. (2011). This scale consists of 10 items and has two subscales: acceptance and avoidance. The acceptance subscale is represented by items of 2, 3, 4, 5, 7, 8, and 9, while the avoidance subscale is represented by items of 1, 6, and 10, and they are reversely scored. Responses are rated on a seven-point scale from 1 (never true) to 7 (always true), with higher scores representing greater levels of psychological inflexibility. Total scores on the scale ranged from 10 to 70. Example items from this scale are "I dwell too much on regrettable or upsetting memories from the past", and "Emotion’s cause problems in my life." The scale was presented to a group of referees consisting of fifteen professors and specialists from the departments of counseling, educational psychology, and English at Jordanian University. In this study, test-retest reliability was assessed in a high school of female students (n=40) with a 1-month interval between testing and revelation. Cronbach’s alpha for the scale was 0.80. Corrected item total correlations were 0.82.

Self-Concealment Scale

In the current study, the Arabic version of the self-concealment scale was used to measure self-concealment, translated by Algazou (2023). This scale consists of 10 items. The scale uses a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The higher the participants’ scores, the higher their self-concealment levels. Total scores on the scale ranged from 10 to 50. Example items from this scale are "I have a secret that is so private that I would lie if anybody asked me about it". (No item is reversely scored.) In this study, Cronbach’s alpha for the scale was 0.80. Corrected item total correlations ranged from 0.50 to 0.88.

Producer

After receiving approval from the Jordanian ministry of education, the questionnaires were administered to students in the 10th grade at two Jordanian high schools (High schools for males and high schools for females). Students who did not wish to participate were not given copies of the questionnaires. whereas students who wished to participate were given copies of the questionnaires. It should be noted that participants and their parents provided written agreements with a full explanation of the object.

Study Methodology

The current study followed a descriptive approach, which showed differences in alexithymia, psychological inflexibility, and self-concealment among male and female students in the 10th grade.

Study variables

Independent variable

Gender: It is represented by males and females.

Dependent variables

An alexithymia, psychological inflexibility, and self-concealment, as measured by the study instruments.

The T- test was used to evaluate the differences between males and females’ means (M) in alexithymia, psychological inflexibility, and self-concealment. Pearson correlation coefficients were also calculated to reveal the nature of the relationships between alexithymia, a psychological inflexibility, and self-concealment.

The present study tested two hypotheses about alexithymia, a psychological inflexibility, and self-concealment among male and female students in the 10th grade. Means (M) and standard deviations (SD) for students’ scores on the alexithymia scale, a psychological inflexibility scale, and a self-concealment scale by gender. There were significant differences between students’ scores on the alexithymia scale, a psychological inflexibility scale, and a self-concealment scale due to the gender variable. To assess the differences between students’ scores on the alexithymia scale, a psychological inflexibility scale, and the self-concealment scale.  T-test was conducted for students’ scores on the basis of gender. Results are presented in Table 2.

Table 2: Means, Standard Deviations and T-test by Gender

Table 2 indicates that there were significant differences at a significance level (P<0>

Table 3: Pearson correlation coefficients between alexithymia, a psychological inflexibility, and self-concealment

plessthan0.05*, plessthan0.01**

Table 3 indicates that flow

• There were significant positive correlations between alexithymia and psychological inflexibility among male and female students in 10th grade.
• There were significant positive correlations between alexithymia and self-concealment among male and female students in 10th grade.
• There were significant positive correlations between psychological inflexibility and self-concealment among male and female students in 10th grade.

Results of the study indicated that alexithymia at a significance level (P<0>

In sum, changes in one of the three variables will lead to changes in the other variable. We proposed that early detection and intervention for alexithymia may help adolescents develop and consolidate themselves and reduce the risk of negative emotions. Additionally, in order for a person to be able to express their feelings and emotions, they must first be able to identify the particular emotion and have psychological flexibility. School counselors should also be trained to use therapeutic modalities that focus on students and their problems, such as psychological counseling programs based on expressive activities, to help students develop expressive abilities and reduce self-concealment. Furthermore, Duarte and Pinto-Gouveia (2017) recommended that individuals with high alexithymia may benefit from therapy approaches that focus on their psychological inflexibility; they argue that psychological inflexibility more accurately predicts changes in particular behaviors.

There were proportionally more female respondents and fewer male respondents. Furthermore, all of the participants were 10th graders, and the study was limited to two high schools, so it's probable that the results can't be generalized because the study wasn't tested on students of other ages or at other schools. The study tools also included three scales: the alexithymia scale, the psychological inflexibility scale, and the self-concealment scale. The study was performed in the second semester of the school year 2022-2023.