The effects of mindfulness on emotional clarity

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Mindfulness practice may help to develop skills that increase emotional clarity.

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A systematic review yielded 17 pre–post intervention studies, totalling 894 participants.

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Overall, the interventions resulted in small to moderate increases in emotional clarity.

An inability to identify or describe internal emotional experience has been linked to a range of affective disorders. Despite burgeoning research on mindfulness-based interventions and their possible effects on emotion regulation, the effects of such interventions on emotional clarity is unclear. This review examines the evidence for the effect of mindfulness-based interventions on self-reported emotional clarity.

There is preliminary evidence to suggest that mindfulness-based interventions may increase emotional clarity.

1. Introduction

Clarity about one’s own emotions is a key component of emotional regulation (Gratz and Roemer, 2004). On the other hand, a lack of emotional clarity, known in its most severe form as alexithymia, hinders emotion regulation (Vine and Aldao, 2014) and is associated with affective disorders including depression (Honkalampi et al., 2004, van Randenborgh et al., 2012); post-traumatic stress disorder (PTSD; Boden et al., 2012), obsessive-compulsive disorder (OCD; Kang et al., 2012), and anxiety disorders (De Berardis et al., 2008, Karukivi et al., 2010). Alexithymia is a dimensional personality characteristic that involves skill deficits in monitoring, identifying and describing emotions (Taylor, 2000). Because mindfulness practice hones many of the skills that promote emotional clarity by training the self to attend to present experiences (Kabat-Zinn, 1994), mindfulness training may be an effective method of addressing these skills deficits in people who persistently lack clarity about their feelings.

A lack of emotional clarity is often conceptualised according to the three components that comprise alexithymia: (1) difficulty identifying feelings, (2) difficulty describing feelings, and (3) externally-oriented thinking (Bagby et al., 1994). Difficulty in identifying feelings refers to problems in differentiating between somatic symptoms of emotional arousal and emotional feelings themselves. For example, a person may not be able to discern a racing heart as a physiological manifestation of anxiety. Difficulty in describing feelings refers to the inability to articulate and differentiate between the qualitative characteristics of emotions (Boden and Berenbaum, 2011, Boden et al., 2013). Externally-oriented thinking reflects a lack of emotional monitoring, as attention tends to be focused on concrete, tangible, reality-based concepts and stimuli (Coffey et al., 2003, Koven and Thomas, 2010).

A lack of emotional clarity is associated with poorer physical and mental health, particularly in its more severe form. Prevalence estimates of alexithymia in the community range from 9 to 18% (Darrow and Follette, 2014) and from 30 to 60% in clinical samples (Parker et al., 2008). In a recent Australian study, McGillivray et al. (2017) found that among 151 psychiatric outpatients, 48% scored high in self-reported alexithymia, compared to 12% among a community sample of healthy individuals. Not surprisingly, alexithymia is not only associated with depression and anxiety, but also in a wide range of psychological and physical disorders, including somatoform and functional gastrointestinal disorders (De Gucht and Heiser, 2003, Waller and Scheidt, 2004), hypertension (Grabe et al., 2010), hypochondriasis (Huber et al., 2009), pathological gambling (Lumley and Roby, 1995, Toneatto et al., 2009), compulsive buying (Rose and Segrist, 2012), eating disorders (Bydlowski et al., 2005, Westwood et al., 2017), and problem alcohol use (Coriale et al., 2012, Shishido et al., 2013, Stasiewicz et al., 2012).

These links can be explained by the role that emotional clarity has in regulating emotions. In a cross-sectional study of non-clinical undergraduate students, Vine and Aldao (2014) found that emotional clarity affected a range of disorders through its moderating effect on emotional regulation. The ability to regulate emotions was, in part, dependent on the ability to be clear about them. The authors also found that a lack of emotional clarity affects various disorders differently. For example, a lack of emotional clarity can increase impulsivity in people with alcohol use disorder. On the other hand, it can encourage rumination over distressing thoughts in people with anhedonia. These results are consistent with existing interventions for emotional dysregulation that emphasise the necessity of emotional clarity (Barlow et al., 2010, Linehan, 1993a).

Given its transdiagnostic nature, research into interventions that improve emotional clarity could yield insights that assist in treating a range of disorders. In a review of 26 interventions designed to reduce alexithymia, Cameron et al. (2014) found that alexithymia, as a trait, was somewhat open to influence, particularly through interventions that specifically targeted emotional clarity. However, the review did not examine studies that employed mindfulness-based interventions. Because there is an overlap between mindfulness skills and emotional clarity, it is important to address this gap. The present review aims, therefore, to investigate the effect of mindfulness on emotional clarity.

1.1. Mindfulness

Mindfulness is aptly described as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” (Kabat-Zinn, 1994, p. 4). It is an attentive, present-focused acceptance of all physical, emotional and mental stimuli that enter conscious awareness (Segal et al., 2002, Shapiro, 2000). Whereas people process much of their day in “autopilot”, or think primarily about past or future events, a mindful approach involves consciously paying attention to, and accepting, present experience (Baer, 2003, Bishop et al., 2004).

Mindfulness is thematically similar to, but distinct from, other psychological constructs. It is more general than insight or self-awareness, although the concepts are related. Bishop et al. (2004) explain that insight and self-awareness involve developing knowledge about the relationships between thoughts, behaviours and emotional experience. In contrast, mindfulness is simply a process of acknowledging subjective experience. Mindfulness is also broader than attentional control. Although attention is a key component of its practice, mindfulness equally incorporates an openness to experience, which reflects a non-judgemental acceptance widely linked to greater health (Keng et al., 2011).

Higher levels of trait mindfulness are associated with greater optimism, satisfaction with life, self-esteem, and sense of efficacy. On the other hand, the authors found that low levels of trait mindfulness are associated with higher scores on measures of depression, anxiety, rumination, dissociation, maladaptive emotional regulation and, pertinently, alexithymia. 

Results:

The results from three studies suggest that participants who reported low emotional clarity scores at baseline reported the greatest changes following the intervention (Bornemann and Singer, 2017, Byrne et al., 2016, Santarnecchi et al., 2014). For example, Bornemann and Singer (2017) performed separate analyses on participants with scores that reflected alexithymia (15% of the sample, using the TAS-20 cut-off criteria) and people who reported non-alexithymic scores. The authors found that the decrease in TAS-20 scores among alexithymic participants was 5.62 greater than the decrease among non-alexithymic participants.

Mindfulness training in becoming more aware, consciously observant, and non-judgementally open to the nuances of present experience can increase emotional clarity.

Additionally, an emphasis on non-judgemental acceptance might discourage the tendency to either ruminate or seek a distraction from internal experience, which might then free the attention to continue observing the evolving experience (Kabat-Zinn, 1994).

Conclusion

In conclusion, the findings of this systematic review and meta-analysis suggest that mindfulness-based interventions may be helpful in increasing emotional clarity. Because the lack of emotional clarity can occur in all affective disorders, there is clinical utility of integrating mindfulness into current treatments for affective disorders. It should however be noted that despite their complementary characteristics, this review identified less than twenty studies reporting the effect of mindfulness-based interventions on emotional clarity. Further, except for only one study, emotional clarity was not the primary outcome of the intervention. More high-quality randomised control trials, specifically targeting and measuring emotional clarity, are required to evidence its clinical utility. Additionally, researchers investigating the effectiveness of mindfulness-based interventions would do well to examine the extent to which interventions influence behaviours related to emotional clarity and the psychological well-being of people with affective disorders.