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Neural Mechanisms of Improved Emotion Regulation Following Mindfulness Training: an fMRI Study

Final Report Summary - NMOIERFMT: FMRI (Neural Mechanisms of Improved Emotion Regulation Following Mindfulness Training: an fMRI Study)

Mindfulness meditation has been documented to produce beneficial effects on psychiatric, Project context and objectives

It has been documented that mindfulness meditation produces beneficial effects on psychiatric, functional somatic, and stress-related symptoms, and has been successfully applied in the treatment of a number of clinical disorders such as anxiety, mood disorders, and chronic pain. Not only has it been used successfully to improve health, but it has also been shown to produce positive effects on psychological well-being in healthy participants and to enhance cognitive functioning. Mindfulness meditation involves the development of awareness of present-moment experience with a compassionate non-judgmental stance. While its beneficial effects are widely documented, the underlying neurological mechanisms are still largely unknown. Understanding the mechanisms of mindfulness practice is critical in order to optimally apply it in the clinical domain, and to advance techniques that aim to cultivate a healthy mind and well-being.

Project work

In order to shed light on the neural mechanisms of mindfulness practice, a series of longitudinal studies were conducted to investigate the impact of mindfulness training on the structure and function of the brain in healthy participants and patients with Generalised Anxiety Disorder (GAD). Participants were assigned to either the manualised eight-week Mindfulness-Based Stress Reduction (MBSR) programme or to a control condition (a waiting list group or an active stress reduction intervention, Stress Management Education, SME). Participants underwent structural and functional magnetic resonance imaging (MRI) scanning before and after the MBSR course or control condition.

Structural MRI data of healthy participants were analysed to investigate the concentration of brain grey matter. The results demonstrated that participants who completed the MBSR course showed increases in grey matter concentration in the left hippocampus - a brain region crucially involved in learning and memory processes and known to be structurally impacted by high stress levels - while participants in the waiting list control group did not show any changes. Exploratory analysis identified further changes in the temporo-parietal junction, posterior cingulate cortex, and cerebellum - brain regions involved in the regulation of attention, self-related processes, and motor control. The findings were published in Psychiatry Research: Neuroimaging.

A second study investigated the structural changes in the brain that accompany the stress-reducing effects of the MBSR programme, measured with a self-reporting instrument, the perceived stress scale. Changes in perceived stress levels over the eight-week course were correlated with structural changes in the right amygdala, a region that is known to be involved in the processing of fear and stress responses, and that is often hyperactivated in pathological anxiety conditions. The findings were published in Social Cognitive and Affective Neuroscience.

3. In functional MRI studies, we investigated the influence of mindfulness training on a key underpinning of mental health, namely emotion regulation, and its associated brain activity. Pre- and post-intervention, participants’ brain activation in response to emotional stimuli (affective facial expressions) was assessed. In GAD patients, the change in brain activation in response to neutral and angry facial expressions was analyzed and compared between the MBSR and the active control intervention. We found a differential change in brain activation in ventrolateral prefrontal regions, where changes in the MBSR group were greater than in the control group, i.e. they were specific for the mindfulness intervention. Furthermore, functional connectivity between the amygdala and several regions of the prefrontal cortex increased significantly following the MBSR, but not the control training. Interestingly, increases in brain activation in the cluster in the left ventrolateral prefrontal cortex as well as increases in functional connectivity were correlated with improvements in clinical anxiety symptoms, demonstrating the clinical relevance of these changes. In conclusion, these findings demonstrate that in GAD patients mindfulness training is associated with enhanced activation in and connectivity between several brain regions that are known to be crucial in the successful regulation of emotional responses. The manuscript is currently under review. Additional analyses of data from these studies are ongoing, including structural MRI data from GAD patients, and various functional MRI data from both healthy and GAD subjects.

The number of publications in the field of mindfulness research has risen significantly over the last two decades. However, there is a paucity of theoretical reviews that integrate the existing literature into a comprehensive theoretical framework. A conceptual review paper was therefore written as part of the fellowship that suggests a theoretical model describing several components through which mindfulness meditation might exert its salutary effects. In this paper, we suggest that mindfulness meditation works through four mechanisms: attention regulation, body awareness, emotion regulation (including reappraisal and extinction processes), and change in self perspective. We suggest neuroscientific processes underlying each mechanism and provide empirical evidence supporting them, with a perspective on practitioners' subjective self-reports, behavioural data, and neuroscientific evidence. Finally, we discuss how these mechanisms might interact with one another and how they might relate to different disorders. Differentiating between these components seems useful to guide future basic research, and to specifically target areas of development in the treatment of psychological disorders. The review was published in Perspectives on Psychological Science.

Project outcomes

The fellowship has also enabled collaborations on projects that aim at further elucidating the neural mechanisms of mindfulness practice. One such with Ulrich Ott has investigated the neural mechanisms of pain attenuation through mindfulness in experienced meditation practitioners (study published in Cerebral Cortex; first author: Tim Gard). In collaboration with Thilo Deckersbach, a 12-week mindfulness-based intervention was developed for patients suffering from bipolar disorder. Publications from the project thus far include one paper published in CNS Neuroscience & Therapeutics (first author: Thilo Deckersbach), and one paper in the Journal of Psychiatric Practice (first author: Jonathan Stange). In collaboration with Mohammed Milad, a study is currently being conducted that investigates the effects of mindfulness practice on the extinction of conditioned fear, and the underlying neural mechanisms (structural and functional MRI, white matter plasticity), funded by the Templeton Foundation and the Mind and Life Institute.

These projects will further the understanding of the effects of mindfulness practice on brain plasticity and associated improvements in emotional self-regulation. Knowledge of the impact of mindfulness training on the brain is highly relevant for the targeted application of such programmes in the treatment of mental disorders and the cultivation of a healthy mind and enhanced well-being. The published findings have received worldwide attention. International media has widely reported on the findings (including reports in the New York Times, der Spiegel, Focus and Huffington Post). Beyond that, the scientific community has shown great interest in the research. One of the papers published within this fellowship was the #1 most downloaded article in the ‘Neuroscience’ section of Science Direct in Jan-March 2011.

Contact
For more information, see http://www.nmr.mgh.harvard.edu/~britta or contact britta@nmr.mgh.harvard.edu.

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