No Words for Feelings: The Emotional Word Fluency Test

J. Morris, J. Gitten Aloia, J. Riordan, A. Masi, K. Voeller

Western Institute for Neurodevelopmental Studies and Interventions
2501 Walnut St. Suite #102
Boulder, CO 80302

Introduction Methods cont. Clinical Relevance of Emotion Word Fluency

Learning to regulate one’s behavior requires the ability to express one’s thoughts and
desires in language and requires a lexicon of emotion to identify, discriminate, and label
one’s internal emotional states. Individuals who have difficulty describing their internal
emotional states are described as alexithymic “without words for feelings” (Sifneos 1973).
Alexithymic patients often have difficulty discriminating between physical sensations and
emotion, and tend to have constricted fantasies and concrete thinking. They are felt to be at
risk for a variety of psychiatric disorders (Taylor et al., 1997; Luminet et al., 1999).
Although there are a number of rating scales for alexithymia, the current exploratory study
examines a subject’s ability to spontaneously generate lists of emotion words under a time-
pressure. This is a somewhat different task than asking a patient to describe or assess his
or her internal emotional state in the course of an interview or when filling out a
questionnaire. It assesses the subject’s ability to rapidly and fluently access words within a
specific lexical category. We have compared these word lists to those generated in standard
letter and category-fluency tasks.
Objectives
To examine emotional word fluency. This exploratory study is designed to:
1) Define “true/correct” emotion words versus “set-loss errors.”
2) Examine the distribution of emotion words with regard to word frequency as
well as the categorization of emotion.
3) Compare performance on the emotional word fluency task to standard Letter
and Category Fluency tasks.
4) Identify participants whose performance is atypical and evaluate how this may
relate to various psychiatric disorders.
H1: Ps with low emotion-word scores may present with difficulty
explaining their emotional states.
H2: Ps with mood disorders will have an atypical and mood-specific
distribution of affect words.
Methods
2) Equalizing Word Lists. The Emotion word lists were collected over a 60 second period, Our study population consisted of children and adolescents and some young adults. We do
which was one-third of the time allotted to Letter Fluency (3 minutes total) and one-half of the not have adequate normative data at this time, but we can provide some examples,
total time allotted for the Category Fluency response (2 minutes). Thus, in order to equalize comparing the performance of various individuals in terms of the ease with which they can
the amount of time for each of the word list types, the raw Letter Fluency scores from each generate emotion words. The youngest participant was a girl with severe dyslexia, 6.75
subject was divided by three and the raw Category Fluency scores was divided by two. A years of age. She was able to generate 8 emotion words, many of which were of positive
paired t-test compared the number of “correct” emotion words to the raw D-KEFS scores for valence. Despite her learning disability, she had good social relationships.
Letter and Category Fluency (Table 1).
Another patient, a 21-year-old female with a severe developmental language disorder,
ADHD, and severe mood regulation problems generated only 10 words (no set loss or
repetition errors). However, all of these words were or the dysphoric/negative type (5 angry,
3 sad, 2 frightened). This corresponded to her chronically dysphoric state.
Results A 22-year-old male who also had a severe developmental language disorder, ADHD,
oppositionality and impulsivity, generated 18 words, but made 3 repetition errors and 3 set
Is an individual participant’s performance on the Emotion Word Fluency Task loss errors [succumbed, stumped, opinitive (a neologism)]. Thus, he was able to generate 12
significantly different than performance on the D-KEFS Adjusted Raw Letter or correct words (4 positive, 4 sad, 3 angry, 2 frightened). Despite his earlier disruptive
Adjusted Raw Category Fluency Tasks? behaviors, he was able to work well with his therapist, in part because he could describe his
feelings accurately and ultimately evolved into a functional adult.
TABLE 1. COMPARISON OF FLUENCY TESTS
Mean N Sig (2-tailed)
Raw Emotion Word Fluency 8.42+ 2.06 19
vs. p =.118
Adjusted Raw Letter Fluency 7.42 + 2.66 19 Conclusion
Raw Emotion Word Fluency 8.42 + 2.06 19
This preliminary study suggests that asking patients to generate emotion word lists may
vs. p = .000 be a useful clinical tool. Although the issue of a patient’s ability to correctly describe his
Adjusted Raw Category Fluency 16.08 + 4.37 19 or her internal emotional state remains an issue, it nonetheless provides a way of
assessing the individual’s ability to access emotion words. Difficulty with describing
There was no difference between the raw Emotion Word fluency and the adjusted raw emotions may be due to several different factors. Impaired verbal fluency can result from
Letter Fluency scores. difficulty initiating verbal responses, impaired retrieval of lexical items, and inability to
simultaneous process and monitor verbal output. It is possible that some individuals will
The number of raw Emotion Words generated by an individual is significantly less than have a category-specific anomia for emotion words.
the adjusted raw Category Fluency scores.
It is also of interest that emotion word fluency more closely resembles Letter Fluency
than Category Fluency. Category Fluency requires the examinee to retrieve words from
Are there differences between individuals in the number of positive and negative
a high-frequency semantic category. It is a familiar, overlearned task and participants
emotions that are generated?
are typically able to generate more Category words than Letter words. This suggests
that emotional word fluency is not as well practiced.
Emotional Valence Participants Mean Range Std. Deviation
Further work will involve developing normative data and identifying patterns associated
Positive 18 2.33 0-4 1.33 with clinical psychiatric disorders.

Participants Sad 18 2.44 1-6 1.34

19 children and adults referred for neuropsychological assessment for learning disabilities
and behavior problems (mean age=12.5 years; range=6.75 to 22.5 years; 10 males; 9
females).
Procedures
The D-KEFS Verbal Fluency test (Delis, Kaplan, & Kramer, 2001) was administered and
scored in the standard fashion. Participants were then asked to “list as many words as you
can that are words for inside feelings . . . emotions. You will have 60 seconds before I tell you
to stop.”
The D-KEFS Letter (FAS) and Category (animals and boy’s name) Fluency responses were
scored in the standard fashion.
The following analyses were conducted:
1)“Correct” Emotion Words vs. Set-Loss Errors. The 98 emotion-word responses that
were collected were then compiled into a Likert-scale questionnaire which was presented to a
panel of 10 judges. They were asked evaluate the degree to which each word represented a
true emotion. The scale ranged from 1=Not An Emotion to 5=True Emotion.
Each of the 98 words was thus identified as to how closely the word represented a “true
emotion” by the judges. Mean scores for the words ranged from a low (“Not an Emotion
Word”) rating of 1 to 4.8 (“True Emotion Word”). Twenty-three words, rated with a score 1.9 or
below, were felt to be words that were questionable labels for internal emotional states (e.g.,
wet, bam, cheering, invisible). These words were designated as set-loss errors and when
encountered, subtracted from the total number of words that a participant generated. The
remaining words were labeled “True Emotion” words.
Angry 18 2.22 0-5 1.40 References
Frightened 18 .79 0-4 3.11
Delis, D. C., Kaplan, E., Kramer, J. (2001). Delis Kaplan Executive Function
System. San Antonio, TX: The Psychological Corporation.
For any given emotional valence category (positive, sad, angry, frightened), there is
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Note that negative emotions (sad, angry, frightened) are more heavily represented than
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Taylor, G.J., Bagby, R.M., Luminet, O. (2000) Assessment of alexithymia: Self
report and observer-rated measures. J.D.A. Parker R. Bar-On (Eds.), The
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Correspondence regarding this research should be addressed to: kvoeller@winsi.net