Chapter 2 58 predecessor or successor of the Beth Israel Hospital Psychosomatic Questionnaire (BIQ) developed by Sifneos in 1973. As of 2006, however, Bagby and Taylor presented the Toronto Structured Interview for Alexithymia (TSIA) [43] as a new, independently developed structured interview. The TSIA is considered to be one of the most valid and reliable tools for assessing alexithymia, although as stated above, the recommendation to use a multi-method, multi-measure approach still remains [97, 109-112]. The TSIA has been translated and researched by Ghent University for use in the Dutch-speaking population. 5.1.2 Alexithymia 3.0 The Levels of Emotional Awareness Scale (LEAS) has been designed to map the degree of emotional awareness according to the levels of emotional awareness theory as discussed above [113]. The LEAS consists of a series of twenty short descriptions of hypothetical social situations or events that the subject and a fictional second person undergo together. Each description is followed by two questions, asking how the person taking the test would feel in that situation and how he thinks the other person would feel. Higher scores on the test indicate a more developed awareness of emotions and feelings. The person’s written responses about his and the other person’s emotions are then rated. Responses can be rated as reflecting emotional awareness on one of the five levels of the LEA theory. A response on levels 4 and 5 demonstrates the individual’s capacity to deal with ambivalence and to integrate and simultaneously experience different emotions and perspectives. At these levels, emotional awareness also transcends the personal experience and enters the interpersonal domain (which some would call ‘empathy’), in which one can also accurately reflect on the experience of another person from his or her perspective, even if this experience deviates from one's own. An obvious strength of the LEAS is that its outcomes are not based on selfassessment. The test has sound psychometric qualities, including high inter-rater reliability and high internal consistency. Although the test is performance-based in the sense that scores are assigned to the answers given per described situation, no pressure is placed on the person to provide the ‘best answer’ possible or to complete the test as quickly as they can. A computer program for administration and automatic scoring is now available (the ‘eLEAS’) in various languages (English, German, and French). The most important ‘limitation’ of the LEAS is that, strictly speaking, the test does not measure alexithymia. Given the evolution of the concept of ‘alexithymia’, however, this limitation should not be a reason to refrain from using the test in
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