A mixed methods study investigating alexithymia, experiential avoidance, and psychological distress: Insights into men with high externally oriented thinking

Previous research suggests that experiential avoidance mediates the relationship between alexithymia and psychological distress. However, concerns persist regarding the validity of:

1) mediation analyses in cross-sectional samples, 2) common measures of alexithymia and experiential avoidance, and 3) solely quantitative approaches to studying alexithymic individuals. This study addresses these gaps using a sequential explanatory methodology comprising of: 1) a quantitative phase employing improved psychometric questionnaires to examine relationships between alexithymia, experiential avoidance, and distress, and 2) a qualitative phase exploring the lived experiences of individuals with alexithymia. A sample of 211 UK adults replicated prior quantitative findings, showing strong positive correlations between experiential avoidance, alexithymia, and psychological distress. However, no link was found between the Externally Oriented Thinking (EOT) facet of alexithymia and psychological distress. This led to a qualitative investigation of men with EOT, analysed using template analysis, a codebook approach to Thematic Analysis. The combined results suggest that life experiences may drive avoidance of unwanted private experiences. Moreover, the qualitative findings indicate two mechanisms explaining EOT's lack of association with psychological distress. First, EOT may serve as a protective factor against positive and negative emotional affect. Second, patriarchal norms may encourage emotional suppression and avoidant coping, leading to underreporting distress in mood questionnaires. Important theoretical and clinical implications are discussed through a Counselling Psychology lens, leading to a critique of assumptions underlying modern therapeutic techniques that may contribute to social injustice.