Associations Between Alexithymia, Cognitive Emotion Regulation, and Physical Symptoms in Coronary Heart Disease

Objective Coronary heart disease (CHD) remains the leading cause of death worldwide, with psychological symptoms being highly prevalent among patients and influencing both disease onset and prognosis. Limited research has explored the role of emotional regulation. This study aims to evaluate alexithymia subscales and cognitive emotion regulation strategies (CERS) in patients with CHD and to examine their associations with physical symptoms (PS) and other clinical variables. Methods The sample consisted of 199 patients with CHD and 116 healthy controls. All participants completed the Toronto Alexithymia Scale (TAS-20), the Cognitive Emotion Regulation Questionnaire (CERQ), and the Physical Symptoms Inventory (PSI). Alexithymia was evaluated dimensionally across three core domains (difficulty identifying feelings, difficulty describing feelings, externally oriented thinking), with participants categorized by established TAS-20 cutoff scores. Results Compared with healthy controls, CHD patients exhibited significantly higher levels of alexithymia, including difficulties identifying feelings (DIF), difficulties describing feelings (DDF), and externally oriented thinking (EOT) ( p  < 0.05). CHD patients also reported greater reliance on maladaptive cognitive emotion regulation strategies (CERS), including self-blame, rumination, catastrophizing, and other-blame ( p  < 0.01). Within the CHD group, DIF, DDF, EOT and maladaptive CERS were positively correlated with physical symptom (PSI, r = 0.37–0.48, p  < 0.01), and regression analyses indicated that DIF, EOT, and maladaptive CERS independently predicted PSI severity, accounting for 35% of the variance after controlling for age and New York Heart Association (NYHA) functional class. Conclusions Patients with CHD show marked deficits in emotion recognition and regulation, with DIF, EOT, and maladaptive CERS emerging as key predictors of physical symptoms.