Towards a computational phenomenology of mental action: modelling meta-awareness and attentional control with deep parametric active inference

Meta-awareness refers to the capacity to explicitly notice the current content of consciousness and has been identified as a key component for the successful control of cognitive states, such as the deliberate direction of attention. This paper proposes a formal model of meta-awareness and attentional control using hierarchical active inference. To do so, we cast mental action as policy selection over higher-level cognitive states and add a further hierarchical level to model meta-awareness states that modulate the expected confidence (precision) in the mapping between observations and hidden cognitive states. We simulate the example of mind-wandering and its regulation during a task involving sustained selective attention on a perceptual object. This provides a computational case study for an inferential architecture that is apt to enable the emergence of these central components of human phenomenology, namely, the ability to access and control cognitive states. We propose that this approach can be generalized to other cognitive states, and hence, this paper provides the first steps towards the development of a computational phenomenology of mental action and more broadly of our ability to monitor and control our own cognitive states. Future steps of this work will focus on fitting the model with qualitative, behavioural, and neural data.

Validation of a Set of Stimuli to Investigate the Effect of Attributional Processes on Social Motivation in Within-Subject Experiments

Attribution of responsibility for the causes of suffering is one of the main factors that influence responses to individuals in distress. While the role of attributional processes on prosocial motivation has been widely investigated in social psychology, only few attempts have been made to characterize their behavioural and neurophysiological underpinnings. This is partly due to the lack of stimuli that can facilitate within-subject experimental designs. To overcome this problem, we created a set of stimuli consisting of videos depicting people in different situations of distress. Each video is paired with short stories that aim to manipulate the perceived degree of responsibility of the main character.

To validate the stimuli, we investigated the effect of different context-video pairs on self-report measures of participants’ subjective experience. We found that different contexts preceding the same video can influence blame and responsibility judgments, affective responses and willingness to help.

In a complementary analysis, we replicated previous findings on the influence of empathy and responsibility on willingness to help, showing how the latter is mediated by moral judgments.

Finally, we observed a general increase in responses times when videos were paired with responsible contexts. We provide interpretations of this finding that can relate attribution accounts to prominent theories in moral psychology.

Overall, this study highlights the possibility of expanding existing theories on prosocial motivation by implementing a set of stimuli that includes multiple scenarios and allows for the collection of third person measures in within-subject designs.

Pain regulation during mindfulness meditation: Phenomenological fingerprints in novices and experts practitioners

BACKGROUND

The way people respond to pain is based on psychological mechanisms, beliefs and expectations. Mindfulness meditation (MM) has been shown to regulate pain and mental suffering through different mechanisms such as positive reappraisal, attentional and emotional regulation. Yet, subjective experience and meaning of pain in connection with MM are still largely unexplored.

METHODS

The present mixed-methods study combined an interpretative-phenomenological qualitative approach with an experimental thermal pain paradigm to explore and compare the meaning of experiencing pain in 32 novices who received short meditation training and 30 experts in meditation practice (more than 10, 000 hr in life). We collected the qualitative data during in-depth semi-structured interviews where we probed participants' response strategies. During the pain task, we collected self-reports of intensity and unpleasantness, while after the task we collected self-reports of avoidance, openness, vividness and blissfulness.

RESULTS

Five phenomenological clusters (PhC) emerged from the interviews, including three which described pain as an unpleasant sensation calling for: (1) experiential avoidance-suppression, (2) volitional agency-distanciation, or (3) a positive cognitive reappraisal and flexibility. Two additional clusters (4-5), containing mostly expert meditators, thematized pain sensation as an opportunity to gain metacognitive insights about mental processes, and to deconstruct one's suffering through these insights. PhC5 further integrates these insights with the recognition that suffering is part of the shared human experience and with the aspiration to relieve others from suffering. Each PhC was correlated to a unique profile of self-reports during the pain paradigm.

CONCLUSION

These findings need to be replicated in patients and practicing MM. They also warrant the integration of this mixed-method approach with brain imaging data to refine the experiential neuroscience of pain.

SIGNIFICANCE

We compared the meaning of experiencing and regulating pain in novices and expert meditators using qualitative interviews. We identified five phenomenological clusters describing relevant features implicated in pain response strategies and meditation. These clusters were organized along a pseudo-gradient, which captured meditation expertise and predicted self-reports related to a pain paradigm and psychometric scales associated with pain and its regulation. These findings advance our understanding of the metacognitive mechanisms and beliefs underlying mindfulness meditation and can inform pain treatment strategies.

Association of Sleep-Disordered Breathing With Alzheimer Disease Biomarkers in Community-Dwelling Older Adults: A Secondary Analysis of a Randomized Clinical Trial

Importance

Increasing evidence suggests that sleep-disordered breathing (SDB) increases the risk of developing Alzheimer clinical syndrome. However, the brain mechanisms underlying the link between SDB and Alzheimer disease are still unclear.

Objective

To determine which brain changes are associated with the presence of SDB in older individuals who are cognitively unimpaired, including changes in amyloid deposition, gray matter volume, perfusion, and glucose metabolism.

Design, Setting, and Participants

This cross-sectional study was conducted using data from the Age-Well randomized clinical trial of the Medit-Ageing European project, acquired between 2016 and 2018 at Cyceron Center in Caen, France. Community-dwelling older adults were assessed for eligibility and were enrolled in the Age-Well clinical trial if they did not meet medical or cognitive exclusion criteria and were willing to participate. Participants who completed a detailed neuropsychological assessment, polysomnography, a magnetic resonance imaging, and florbetapir and fluorodeoxyglucose positron emission tomography scans were included in the analyses.

Main Outcomes and Measures

Based on an apnea-hypopnea index cutoff of 15 events per hour, participants were classified as having SDB or not. Voxelwise between-group comparisons were performed for each neuroimaging modality, and secondary analyses aimed at identifying which SDB parameter (sleep fragmentation, hypoxia severity, or frequency of respiratory disturbances) best explained the observed brain changes and assessing whether SDB severity and/or SDB-associated brain changes are associated with cognitive and behavioral changes.

Results

Of 157 participants initially assessed, 137 were enrolled in the Age-Well clinical trial, and 127 were analyzed in this study. The mean (SD) age of the 127 participants was 69.1 (3.9) years, and 80 (63.0%) were women. Participants with SDB showed greater amyloid burden (t114 = 4.51; familywise error-corrected P = .04; Cohen d, 0.83), gray matter volume (t119 = 4.12; familywise error-corrected P = .04; Cohen d, 0.75), perfusion (t116 = 4.62; familywise error-corrected P = .001; Cohen d, 0.86), and metabolism (t79 = 4.63; familywise error-corrected P = .001; Cohen d, 1.04), overlapping mainly over the posterior cingulate cortex and precuneus. No association was found with cognition, self-reported cognitive and sleep difficulties, or excessive daytime sleepiness symptoms.

Conclusions and Relevance

The SDB-associated brain changes in older adults who are cognitively unimpaired include greater amyloid deposition and neuronal activity in Alzheimer disease-sensitive brain regions, notably the posterior cingulate cortex and precuneus. These results support the need to screen and treat for SDB, especially in asymptomatic older populations, to reduce Alzheimer disease risk.

Trial Registration

ClinicalTrials.gov Identifier: NCT02977819.

Toward a theory-based specification of non-pharmacological treatments in aging and dementia: Focused reviews and methodological recommendations

INTRODUCTION

Non-pharmacological treatments (NPTs) have the potential to improve meaningful outcomes for older people at risk of, or living with dementia, but research often lacks methodological rigor and continues to produce mixed results.

METHODS

In the current position paper, experts in NPT research have specified treatment targets, aims, and ingredients using an umbrella framework, the Rehabilitation Treatment Specification System.

RESULTS

Experts provided a snapshot and an authoritative summary of the evidence for different NPTs based on the best synthesis efforts, identified main gaps in knowledge and relevant barriers, and provided directions for future research. Experts in trial methodology provide best practice principles and recommendations for those working in this area, underscoring the importance of prespecified protocols.

DISCUSSION

We conclude that the evidence strongly supports various NPTs in relation to their primary targets, and discuss opportunities and challenges associated with a unifying theoretical framework to guide future efforts in this area.

No Detectable Electroencephalographic Activity After Clinical Declaration of Death Among Tibetan Buddhist Meditators in Apparent Tukdam, a Putative Postmortem Meditation State

Recent EEG studies on the early postmortem interval that suggest the persistence of electrophysiological coherence and connectivity in the brain of animals and humans reinforce the need for further investigation of the relationship between the brain's activity and the dying process. Neuroscience is now in a position to empirically evaluate the extended process of dying and, more specifically, to investigate the possibility of brain activity following the cessation of cardiac and respiratory function. Under the direction of the Center for Healthy Minds at the University of Wisconsin-Madison, research was conducted in India on a postmortem meditative state cultivated by some Tibetan Buddhist practitioners in which decomposition is putatively delayed. For all healthy baseline (HB) and postmortem (PM) subjects presented here, we collected resting state electroencephalographic data, mismatch negativity (MMN), and auditory brainstem response (ABR). In this study, we present HB data to demonstrate the feasibility of a sparse electrode EEG configuration to capture well-defined ERP waveforms from living subjects under very challenging field conditions. While living subjects displayed well-defined MMN and ABR responses, no recognizable EEG waveforms were discernable in any of the tukdam cases.

Health promotion in Swiss municipalities: towards proportionate universalism

Background

Health promotion goes beyond the health sector. Municipalities, the local public authorities in Switzerland, have a crucial role to promote population health in all their decisions.

Initially developed by Promotion Santé Valais, the label “Healthy municipality” exists in the canton of Vaud since 2015. The label takes stock of existing measures in health promotion and prevention in all sectors and incentivise new interventions. The labelling process respects different criteria and is validated by an external committee. It is voluntarist, free of charge for the municipality but requires time and intersectoral communication. This abstract explores equity in the uptake of the label.

Results

In Vaud, 17 municipalities have been labelled “healthy”. Two external evaluations by Swiss universities highlighted that small villages are less involved in the label than urban areas. To achieve health equity, we need to identify and approach municipalities with limited human and financial resources, that might be less active in health promotion and/or whose population is socioeconomically disadvantaged. Preliminary results indicate that municipalities below 1000 inhabitants, in rural areas, should be targeted first. We are currently investigating the barriers and facilitators for them to enrol in the label.

Lessons

As labels rewarding healthy cities are expanding worldwide, it is important to document and reflect on who benefits from them, and who does not. Our practice is now focusing more on villages in rural areas, with less resources than urban settings. We investigate their needs regarding the type of support that we, public health professionals, can provide. Proportionate universalism principles should also apply to advocacy for health promotion, at the municipality level.

Key messages

To achieve health in all policies, the role of municipalities is essential. More efforts in health promotion should target specifically small and rural municipalities, with limited resources.

Integrating sustainability in professionals’ training in the field of health promotion and prevention

Background

Climate change poses a number of threats and challenges to our societies and has direct impacts on human health. Raising awareness and training health professionals to sustainable development represents a major strategy in order to respond to climate challenges. This article describes a teaching experience conducted in the context of a Certificate of Advanced Studies (CAS) in public health at the University of Lausanne, where students have been trained to sustainable development, through theoretical lessons and practical exercises.

Objectives

The integration of the topic of sustainable development in the teaching of health promotion and prevention to the students of the CAS in public health aimed to foster students' knowledge and competences in relation to this emerging topic. The main objective was to transmit concepts, methods and practical resources allowing them to incorporate sustainability into everyday health promotion and prevention practices.

Results

Health promotion and sustainable development share common goals and methodologies. The experience of teaching sustainability to public health students shows that these two topics can be easily integrated within a public health training, if teachers provide students with a clear theoretical and methodological framework, allowing them to make the appropriate connections between the two fields. Social determinants of health, intersectorial action and multilevel governance represent key topics that teachers can address with students in order to show the connections between public health and sustainability.

Conclusions

As stated in the 2019 Lancet Countdown on health and climate change, climate change is both a threat and an opportunity for our societies. While it puts health systems and professionals under considerable pressure, it also represents an opportunity to innovate and transform professional training and practices, and generate new knowledge and know-how.

Key messages

Training health professionals to sustainable development represents a major strategy to respond to climate change and its health impacts. In order to integrate sustainable development in public health training, teachers should provide students with a clear theoretical and methodological framework.

Mindfulness meditation is related to sensory-affective uncoupling of pain in trained novice and expert practitioners

BACKGROUND

Mindfulness meditation can alleviate acute and chronic pain. It has been proposed that mindfulness meditation reduces pain by uncoupling sensory and affective pain dimensions. However, studies to date have reported mixed results, possibly due to a diversity of styles of and expertise in mindfulness meditation. Furthermore, the interrelations between mindfulness meditation and pain catastrophizing during acute pain remain little known.

METHODS

This cross-sectional study investigated the effect of a style of mindfulness meditation called Open Monitoring (OM) on sensory and affective pain experience by comparing novice (2-day formal training; average ~20 hr practice) to expert practitioners (>10.000 hr practice). We implemented a paradigm that was designed to amplify the cognitive-affective aspects of pain experience by the manipulation of pain anticipation and uncertainty of stimulus length (8 or 16 s thermal pain stimuli). We collected pain intensity and unpleasantness ratings and assessed trait pain catastrophizing with the Pain Catastrophizing Scale (PCS).

RESULTS

Across groups, mindfulness meditation reduced unpleasantness, but not intensity ratings compared to attentional distraction. Experts reported a lower score on PCS, reduced amplification of unpleasantness by long painful stimuli, and larger sensory-affective uncoupling than novices particularly during long painful stimuli. In experts, meditation-induced uncoupling spilled over the control condition. Across groups and task conditions, a higher score on PCS predicted lower sensory-affective uncoupling during long painful stimuli and higher ratings of pain intensity during short painful stimuli.

CONCLUSION

These findings suggest that mindfulness meditation specifically down-regulates pain affect as opposed to pain intensity, and that pain catastrophizing undermines sensory-affective uncoupling of pain.

SIGNIFICANCE

In this study, we found that a style of mindfulness meditation referred to as OM reduced unpleasantness but not intensity ratings compared to attentional distraction in trained novice (state effect) and expert meditators (state and trait effects). We also observed that trait pain catastrophizing scores predicted this sensory-affective uncoupling. These findings advance our understanding of the cognitive mechanisms underlying mindfulness meditation and can inform treatment strategies for chronic pain.

Differential DNA methylation in experienced meditators after an intensive day of mindfulness-based practice: Implications for immune-related pathways

The human methylome is dynamically influenced by psychological stress. However, its responsiveness to stress management remains underexplored. Meditation practice has been shown to significantly reduce stress level, among other beneficial neurophysiological outcomes. Here, we evaluated the impact of a day of intensive meditation practice (t2-t1 = 8 h) on the methylome of peripheral blood mononuclear cells in experienced meditators (n = 17). In parallel, we assessed the influence of a day of leisure activities in the same environment on the methylome of matched control subjects with no meditation experience (n = 17). DNA methylation profiles were analyzed using the Illumina 450 K beadchip array. We fitted for each methylation site a linear model for multi-level experiments which adjusts the variation between t1 and t2 for baseline differences. No significant baseline differences in methylation profiles was detected between groups. In the meditation group, we identified 61 differentially methylated sites (DMS) after the intervention. These DMS were enriched in genes mostly associated with immune cell metabolism and ageing and in binding sites for several transcription factors involved in immune response and inflammation, among other functions. In the control group, no significant change in methylation level was observed after the day of leisure activities. These results suggest that a short meditation intervention in trained subjects may rapidly influence the epigenome at sites of potential relevance for immune function and provide a better understanding of the dynamics of the human methylome over short time windows.

The Effect of Mindfulness Meditation on Impulsivity and its Neurobiological Correlates in Healthy Adults

Interest has grown in using mindfulness meditation to treat conditions featuring excessive impulsivity. However, while prior studies find that mindfulness practice can improve attention, it remains unclear whether it improves other cognitive faculties whose deficiency can contribute to impulsivity. Here, an eight-week mindfulness intervention did not reduce impulsivity on the go/no-go task or Barratt Impulsiveness Scale (BIS-11), nor produce changes in neural correlates of impulsivity (i.e. frontostriatal gray matter, functional connectivity, and dopamine levels) compared to active or wait-list control groups. Separately, long-term meditators (LTMs) did not perform differently than meditation-naïve participants (MNPs) on the go/no-go task. However, LTMs self-reported lower attentional impulsivity, but higher motor and non-planning impulsivity on the BIS-11 than MNPs. LTMs had less striatal gray matter, greater cortico-striatal-thalamic functional connectivity, and lower spontaneous eye-blink rate (a physiological dopamine indicator) than MNPs. LTM total lifetime practice hours (TLPH) did not significantly relate to impulsivity or neurobiological metrics. Findings suggest that neither short- nor long-term mindfulness practice may be effective for redressing impulsive behavior derived from inhibitory motor control or planning capacity deficits in healthy adults. Given the absence of TLPH relationships to impulsivity or neurobiological metrics, differences between LTMs and MNPs may be attributable to pre-existing differences.

Prediction-based neural mechanisms for shielding the self from existential threat

The human mind has an automatic tendency to avoid awareness of its mortality. How this protective mechanism is implemented at the neuronal level is unknown. Here we test the hypothesis that prediction-based mechanisms mediate death-denial by shielding the self from existential threat. We provide evidence that self-specific predictive processes are downregulated during the perception of death-related linguistic stimuli and that this mechanism can predict fear-of-death. Using a magnetoencephalography visual mismatch paradigm, we show that the brain's automatic prediction response to deviancy is eliminated when death words and self-face representations are coupled, but remains present when coupled to other-face or to negative words. We further demonstrate a functional link between how death impacts self-image vs. Other-image, and show that it predicts fear-of-death. Finally, we confirm this effect in a behavioral active inference experiment showing that death-related words bias perceptual judgment on facial self and other morphed video clips. Together these results lay out, for the first time, a plausible neural-based mechanism of death-denial.

Auditory perceptual learning is not affected by anticipatory anxiety in the healthy population except for highly anxious individuals: EEG evidence

OBJECTIVE

A recent neurocomputational model proposed that anxious hypervigilance impedes perceptual learning. This view is supported by the observed modulation of the mismatch negativity (MMN), a biomarker of implicit perceptual learning processes, in anxiety disorders. However, other studies found that anxious states sensitize brain responses with no impact on perceptual learning. The present research aimed to elucidate the impact of anticipatory anxiety on early stimulus processing in the healthy population.

METHODS

We used electroencephalography to investigate the impact of unpredictable threat on the amplitude of the MMN and other components of the auditory evoked response in healthy participants during a passive auditory oddball task.

RESULTS

We found a general sensitization of early components of the auditory evoked response and changes in subjective and autonomic measures of anxiety during threat periods. The MMN amplitude did not differ during threat, compared to safe periods. However, this difference was modulated by the level of state or trait anxiety.

CONCLUSION

We propose that anxiety sensitizes early brain responses to unspecific environmental stimuli but affects implicit perceptual learning processes only when an individual is located at the higher end of the anxiety spectrum.

SIGNIFICANCE

This view might distinguish between an adaptive role of anxiety on processing efficiency and its detrimental impact on implicit perceptual learning observed in psychiatric conditions.

The impact of meditation on healthy ageing - the current state of knowledge and a roadmap to future directions

There is increasing evidence that meditation-based training promotes healthy ageing across many dimensions. This review summarizes the existing knowledge on the effects of meditation training on healthy ageing in the domains of emotions, cognition (with a special emphasis on attentional processes), and the preservation of related brain structures. Although evidence so far is promising, more rigorous randomized controlled studies with active control groups and long-term follow-up in older people are needed. We outline how these challenges can be addressed in future studies using the example of an ongoing project, Medit-Ageing (public name: Silver Santé Study), including two independent randomized controlled trials (RCT) as well as one cross-sectional study with meditation experts.

Training novice practitioners to reliably report their meditation experience using shared phenomenological dimensions

Empirical descriptions of the phenomenology of meditation states rely on practitioners' ability to provide accurate information on their experience. We present a meditation training protocol that was designed to equip naive participants with a theoretical background and experiential knowledge that would enable them to share their experience. Subsequently, novices carried on with daily practice during several weeks before participating in experiments. Using a neurophenomenological experiment designed to explore two different meditation states (focused attention and open monitoring), we found that self-reported phenomenological ratings (i) were sensitive to meditation states, (ii) reflected meditation dose and fatigue effects, and (iii) correlated with behavioral measures (variability of response time). Each of these effects was better predicted by features of participants' daily practice than by desirable responding. Our results provide evidence that novice practitioners can reliably report their experience along phenomenological dimensions and warrant the future investigation of this training protocol with a longitudinal design.

The Age-Well observational study on expert meditators in the Medit-Ageing European project

INTRODUCTION

The Age-Well observational, cross-sectional study investigates the affective and cognitive mechanisms of meditation expertise with behavioral, neuroimaging, sleep, and biological measures sensitive to aging and Alzheimer's disease (AD).

METHODS

Thirty cognitively unimpaired individuals aged 65 years or older with at least 10,000 hours of practice in mindfulness meditation (MM) and loving-kindness and compassion meditation (LKCM) are selected. The outcomes are the neuroimaging brain correlates of MM and LKCM and the assessments of long-term meditation practices on behavioral, neural, and biological measures as compared to nonmeditator older controls from the Age-Well randomized controlled trial.

RESULTS

Recruitment and data collection began in late 2016 and will be completed by late 2019.

DISCUSSION

Results are expected to foster the understanding of the effects of meditation expertise on aging and of the mechanisms of action underlying the meditation intervention in the Age-Well randomized controlled trial. These finding will contribute to the design of meditation-based prevention randomized controlled trials for the aged population and to the exploration of the possible long-time developmental trajectory of meditation training.

The SCD-Well randomized controlled trial: Effects of a mindfulness-based intervention versus health education on mental health in patients with subjective cognitive decline (SCD)

Introduction

Subjectively experienced cognitive decline in older adults is an indicator of increased risk for dementia and is also associated with increased levels of anxiety symptoms. As anxiety is itself emerging as a risk factor for cognitive decline and dementia, the primary question of the present study is whether an 8-week mindfulness-based intervention can significantly reduce anxiety symptoms in patients with subjective cognitive decline (SCD). The secondary questions pertain to whether such changes extend to other domains of psychological, social, and biological functioning (including cognition, self-regulation, lifestyle, well-being and quality of life, sleep, and selected blood-based biomarkers) associated with mental health, older age, and risk for dementia.

Methods

SCD-Well is a multicenter, observer-blinded, randomized, controlled, superiority trial, which is part of the Horizon 2020 European Union-funded “Medit-Ageing” project. SCD-Well compares an 8-week mindfulness- and compassion-based intervention specifically adapted for older adults with SCD with a validated 8-week health education program. Participants were recruited from memory clinics in four European sites (Cologne, Germany; London, United Kingdom; Barcelona, Spain; and Lyon, France) and randomized with a 1:1 allocation, stratified by site.

Results

The primary outcome, change in anxiety symptoms, and secondary outcomes reflecting psychological, cognitive, social, and biological functioning are assessed at baseline, postintervention, and 4 months after the end of the intervention.

Discussion

The study will provide evidence on whether a mindfulness-based intervention can effect changes in anxiety and other risk factors for cognitive decline and dementia in older adults with SCD and will inform the establishment of intervention strategies targeted at improving mental health in older adults.

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Mindfulness may benefit older adults with subjective cognitive decline (SCD).

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SCD-Well compares an 8-week mindfulness intervention to a health education course.

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Patients with SCD were recruited from memory clinics in four countries.

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Outcomes include anxiety symptoms, psychosocial, cognitive, and biological function.

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Results will inform future prevention studies and strategies in SCD.