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Bos DPA, Keesman M, Roggeveen A, Vase L, Evers AWM, Peerdeman KJ. Mindfulness Effects on Anxiety: Disentangling the Role of Decentering and Treatment Expectations. Behav Ther 2024; 55:1059-1070. [PMID: 39174265 DOI: 10.1016/j.beth.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 03/04/2024] [Accepted: 03/14/2024] [Indexed: 08/24/2024]
Abstract
Mindfulness interventions have been found to lower anxiety. However, the current literature has not adequately considered the role of its individual components and of placebo effects. In an online experiment using a balanced placebo design, we aimed to disentangle effects of decentering, a key component of mindfulness, and expectations, a key component of placebo effects, on anxiety related to the COVID-19 pandemic. One hundred twenty-eight adults were randomly assigned to one of four groups: placebo/mindful decentering, placebo/sham decentering, sham/mindful decentering, and sham/sham decentering. Instructions were provided using standardized audio instructions. Current anxiety was assessed pre- and postintervention with the Short State version of the State-Trait Anxiety Inventory. Mindful decentering was found to reduce anxiety postintervention, as compared to sham decentering, regardless of induced expectations regarding its effectiveness. Participants in the mindful decentering group also mentioned more decentering-related words than those in the sham decentering group. These findings indicate that a short, standardized, and online mindful decentering intervention can effectively decrease pandemic-related anxiety independently of one's expectations. These findings provide insights into the efficacy of the individual elements of mindfulness, highlighting decentering as an effective active component for anxiety relief. Moreover, these findings suggest that, in a nonclinical sample, individuals can apply mindful decentering with minimal training.
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Riegner G, Dean J, Wager TD, Zeidan F. Mindfulness meditation and placebo modulate distinct multivariate neural signatures to reduce pain. Biol Psychiatry 2024:S0006-3223(24)01556-7. [PMID: 39216636 DOI: 10.1016/j.biopsych.2024.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 08/20/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Rather than a passive reflection of nociception, pain is shaped by the interplay between one's experiences, current cognitive-affective states, and expectations. The placebo-response, a paradoxical yet reliable phenomenon, is postulated to reduce pain by engaging mechanisms shared with "active" therapies. It has been assumed that mindfulness meditation, practiced by sustaining nonjudgmental awareness of arising sensory events, merely reflects mechanisms evoked by placebo. Recently, brain-based multivariate pattern analysis (MVPA) has been validated to successfully disentangle nociceptive-specific, negative-affective, and placebo-based dimensions of the subjective pain experience. METHODS To determine if mindfulness meditation engages distinct brain mechanisms from placebo and sham-mindfulness to reduce pain, MVPA pain signatures were applied across two randomized clinical trials that employed overlapping psychophysical pain testing procedures (49°C noxious heat; visual analogue pain scales) and distinct fMRI techniques (blood-oxygen-level dependent; perfusion-based). After baseline pain testing, 115 healthy participants were randomized into a four-session mindfulness meditation (n = 37), placebo-cream conditioning (n = 19), sham-mindfulness meditation (n = 20), or book-listening (n = 39) intervention. After each intervention, noxious heat was administered during fMRI and each manipulation. RESULTS A double dissociation in the MVPA signatures supporting pain regulation was revealed by mindfulness meditation as compared to placebo-cream. Mindfulness meditation produced significantly greater reductions in pain intensity and pain unpleasantness ratings, nociceptive-specific and negative-affective pain signatures when compared to placebo-cream, sham-mindfulness meditation and controls. Placebo-cream only reduced the placebo-based signature. CONCLUSIONS Mindfulness meditation and placebo engage distinct neural pain signatures to reduce pain to demonstrate mechanistic granularity between placebo and mindfulness.
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Affiliation(s)
- Gabriel Riegner
- Department of Anesthesiology, University of California San Diego
| | - Jon Dean
- Department of Anesthesiology, University of California San Diego
| | - Tor D Wager
- Department of Psychological and Brain Science, Dartmouth College
| | - Fadel Zeidan
- Department of Anesthesiology, University of California San Diego.
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Gray C, Jones F, Agostinis A, Morris J. Experience of compassion-based practice in mindfulness for health for individuals with persistent pain. Br J Pain 2024; 18:337-353. [PMID: 39092208 PMCID: PMC11289905 DOI: 10.1177/20494637241232555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
Purpose of the Study Research indicates that acquiring compassion is an integral part to positive outcomes to Mindfulness-based interventions (MBI), yet there is both theoretic and empirical literature suggesting that people with persistent pain are more likely to experience challenges and distress when engaging compassion-based practices. Mindfulness for Health is a standardised MBI for people with persistent pain and health conditions. This study sought to explore the positive, neutral and difficult experiences of compassion-based practice and meditation for participants in Mindfulness for Health to further understand implications and risks for participants of MBI's. Method and Design A qualitative design using Interpretative Phenomenological Analysis was applied to explore how participants understood of the experience of compassion-based practice and the meaning they gave to it. Eight participants who had completed the Mindfulness for Health from four separate groups were interviewed about their experience. Results Five master themes were identified 'turning away from self-with-pain', 'self-with-pain experienced as shameful', 'facilitating change', 'turning towards self-with-pain', and 'accepting self'. Participants identified both perceived positive changes and difficult emotional experiences during the meditation practice, which they related to the context of compassion in their past and present life. Conclusions Developing compassion is an important part of Mindfulness for Health, which is salient for participants as both a challenging and potentially valuable experience. Acquisition of mindfulness skills, supporting group dynamics and modelling compassion are understood as helpful in overcoming personal barriers and challenging experiences. Further research is needed to understand processes involved and explore the experience of non-completers.
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Affiliation(s)
- Callum Gray
- Pain Service, Health and Social Services, St Helier, Jersey
- Canterbury Christ Church University, Tunbridge Wells, UK
| | - Fergal Jones
- Canterbury Christ Church University, Tunbridge Wells, UK
| | | | - Julia Morris
- Pain Service, Health and Social Services, St Helier, Jersey
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Fan C, Wu M, Liu H, Chen X, Gao Z, Zhao X, Zhou J, Jiang Z. Effects of meditation on neural responses to pain: A systematic review and meta-analysis of fMRI studies. Neurosci Biobehav Rev 2024; 162:105735. [PMID: 38821153 DOI: 10.1016/j.neubiorev.2024.105735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/17/2024] [Accepted: 05/19/2024] [Indexed: 06/02/2024]
Abstract
This systematic review investigates the impact of meditation on neural responses to pain, as measured by functional magnetic resonance imaging (fMRI). Up to March 2024, we conducted searches across four databases for human studies implementing fMRI to assess the efficacy of meditation for pain relief. Eighteen studies met the inclusion criteria. Our systematic review indicates that activation of the insula, anterior cingulate cortex, and orbitofrontal cortex is positively associated with meditation for pain relief, while activity in regions like the amygdala and medial prefrontal cortex is negatively correlated with pain relief. Meta-analyses consistently reveal the involvement of various brain regions, including the insula, putamen, amygdala, anterior cingulate cortex, precentral gyrus, postcentral gyrus, inferior parietal lobule, superior temporal gyrus, inferior frontal gyrus, and caudate nucleus, in meditation-induced alleviation of pain. These findings suggest ccthat meditation acts on specific brain regions related to pain, mood, and cognition, providing insight into the potential mechanisms underlying the pain-alleviating effects of meditation on both pain sensations and emotional experiences.
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Affiliation(s)
- Cheng Fan
- The First Clinical Medical College, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China; Department of Rehabilitation Medicine, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710004, China; Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation, Fujian University of Traditional Chinese Medicine, Ministry of Education, Fuzhou 350122, China
| | - Mengjiao Wu
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation, Fujian University of Traditional Chinese Medicine, Ministry of Education, Fuzhou 350122, China; College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China; Department of Rehabilitation Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, China
| | - Hong Liu
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation, Fujian University of Traditional Chinese Medicine, Ministry of Education, Fuzhou 350122, China; College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China.
| | - Xiaolin Chen
- Department of Rehabilitation, Dongguan Songshan Lake Tungwah Hospital, DongGuan 523000, China
| | - Zhen Gao
- Department of Rehabilitation, Fuzhou Second Hospital, Fuzhou 350122, China
| | - Xin Zhao
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation, Fujian University of Traditional Chinese Medicine, Ministry of Education, Fuzhou 350122, China; College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Jianhao Zhou
- The First Clinical Medical College, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China; Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation, Fujian University of Traditional Chinese Medicine, Ministry of Education, Fuzhou 350122, China
| | - Zheng Jiang
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation, Fujian University of Traditional Chinese Medicine, Ministry of Education, Fuzhou 350122, China; College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China.
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Rajjoub R, Sammak SE, Rajjo T, Rajjoub NS, Hasan B, Saadi S, Kanaan A, Bydon M. Meditation for perioperative pain and anxiety: A systematic review. Brain Behav 2024; 14:e3640. [PMID: 39073307 DOI: 10.1002/brb3.3640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/20/2024] [Accepted: 07/09/2024] [Indexed: 07/30/2024] Open
Abstract
INTRODUCTION Effective pain and anxiety management during the perioperative phase remains a challenge for patients undergoing surgeries and other invasive procedures. The current standard of care involves prescribing analgesics to treat these conditions; however, there has been recent interest in applying multimodal strategies that limit the use of these medications. One such modality is meditation, which has been shown to be effective in alleviating various physical and psychological symptoms in other settings. This systematic review aims to assess how current meditative practices affect perioperative pain and anxiety. METHODS We conducted a systematic review of randomized controlled trials following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was conducted using PubMed MEDLINE, Embase, PsycINFO, APA PsycINFO, EBM Reviews, Scopus, and Web of Science for all available dates. Our primary outcomes of interest were patient-reported pain and anxiety scores using the Visual Analog Scale, the Brief Pain Inventory, the Depression Anxiety Stress Scale, the State-Trait Anxiety Inventory (STAI), and the Hospital Anxiety and Depression Scale (HADS). For the HADS and STAI scales, only the anxiety and anxiety-state subgroups were reported, respectively. RESULTS The literature search yielded 1746 articles. A total of 286 full-text articles were screened, and 16 studies were included in this systematic review. A total of eight studies assessed pain scores after invasive procedures; five reported improvements in pain scores, and three reported no change after meditative practices. Ten studies assessed anxiety outcomes after invasive procedures: nine reported a decrease in overall anxiety levels as a result of meditation practices while one study reported no change in anxiety scores. CONCLUSION Data from this limited literature suggests that different meditation practices could be effective in alleviating pain and anxiety within the perioperative phase for patients undergoing various types of invasive procedures. Future prospective studies are needed to determine whether routine meditation in the perioperative setting is effective in mitigating perioperative pain and anxiety.
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Affiliation(s)
- Rami Rajjoub
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Sally El Sammak
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Tamim Rajjo
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Noora S Rajjoub
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Bashar Hasan
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Samer Saadi
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Adel Kanaan
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
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Zarka D, Cevallos C, Ruiz P, Petieau M, Cebolla AM, Bengoetxea A, Cheron G. Electroencephalography microstates highlight specific mindfulness traits. Eur J Neurosci 2024; 59:1753-1769. [PMID: 38221503 DOI: 10.1111/ejn.16247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/29/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024]
Abstract
The present study aimed to investigate the spontaneous dynamics of large-scale brain networks underlying mindfulness as a dispositional trait, through resting-state electroencephalography (EEG) microstates analysis. Eighteen participants had attended a standardized mindfulness-based stress reduction training (MBSR), and 18 matched waitlist individuals (CTRL) were recorded at rest while they were passively exposed to auditory stimuli. Participants' mindfulness traits were assessed with the Five Facet Mindfulness Questionnaire (FFMQ). To further explore the relationship between microstate dynamics at rest and mindfulness traits, participants were also asked to rate their experience according to five phenomenal dimensions. After training, MBSR participants showed a highly significant increase in FFMQ score, as well as higher observing and non-reactivity FFMQ sub-scores than CTRL participants. Microstate analysis revealed four classes of microstates (A-D) in global clustering across all subjects. The MBSR group showed lower duration, occurrence and coverage of microstate C than the control group. Moreover, these microstate C parameters were negatively correlated to non-reactivity sub-scores of FFMQ across participants, whereas the microstate A occurrence was negatively correlated to FFMQ total score. Further analysis of participants' self-reports suggested that MBSR participants showed a better sensory-affective integration of auditory interferences. In line with previous studies, our results suggest that temporal dynamics of microstate C underlie specifically the non-reactivity trait of mindfulness. These findings encourage further research into microstates in the evaluation and monitoring of the impact of mindfulness-based interventions on the mental health and well-being of individuals.
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Affiliation(s)
- D Zarka
- Laboratory of Neurophysiology and Movement Biomechanics, Research Unit in Sciences of Osteopathy, Faculty of Human Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
- Research Unit in Sciences of Osteopathy, Faculty of Human Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - C Cevallos
- Laboratory of Neurophysiology and Movement Biomechanics, Research Unit in Sciences of Osteopathy, Faculty of Human Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
- Departamento de Ingeniería Mecánica, Facultad de Ingeniería Mecánica, Escuela Politécnica Nacional, Quito, Ecuador
| | - P Ruiz
- Departamento de Ingeniería Mecánica, Facultad de Ingeniería Mecánica, Escuela Politécnica Nacional, Quito, Ecuador
| | - M Petieau
- Laboratory of Neurophysiology and Movement Biomechanics, Research Unit in Sciences of Osteopathy, Faculty of Human Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - A M Cebolla
- Laboratory of Neurophysiology and Movement Biomechanics, Research Unit in Sciences of Osteopathy, Faculty of Human Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - A Bengoetxea
- Research Unit in Sciences of Osteopathy, Faculty of Human Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
- Athenea Neuroclinics, San Sebastian, Spain
| | - G Cheron
- Laboratory of Neurophysiology and Movement Biomechanics, Research Unit in Sciences of Osteopathy, Faculty of Human Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Electrophysiology, Université de Mons, Mons, Belgium
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7
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Voss S, Boachie DA, Nieves N, Gothe NP. Mind-body practices, interoception and pain: a scoping review of behavioral and neural correlates. Ann Med 2023; 55:2275661. [PMID: 37939212 PMCID: PMC10768869 DOI: 10.1080/07853890.2023.2275661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVE Chronic pain is a significant source of suffering in the United States, and many individuals increasingly turn towards yoga for pain relief. However, little is known regarding how yoga improves pain. Herein we seek to examine the scope of the literature linking mind-body practices, pain and interoception; an emerging mechanism by which yoga may improve chronic pain. METHODS This scoping review followed the five-stage methodological framework proposed by Arksey and O'Malley to examine behavioral and neural correlates of interoception in mind-body practices and pain. A broad search of the Pubmed, CINAHL, SportDiscus, Scopus, PsychInfo, and SocIndex databases was conducted, utilizing three clusters of search terms: (1) interoceptive terms, (2) mind-body terms, and (3) pain terms. RESULTS A combined total of 690 articles were screened, and 24 findings included for analysis. Sixteen studies examined interoceptive outcomes in response to mind-body practices for chronic pain, and 8 studies examined interoceptive outcomes in response to evoked-pain tasks in experienced mind-body practitioners. Only three studies linked yoga, interoception and pain. CONCLUSION This review relied on the broader mind-body literature to inform our analyses as the literature examining yoga, pain and interoception remains limited. Interoceptive techniques including attending to and acceptance of bodily sensations, appear to be key therapeutic mechanisms in mind-body practices for chronic pain. Future yoga-based interventions would benefit examining interoceptive outcomes and integrating interoceptive strategies to facilitate the pain-modulating benefits of yoga.
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Affiliation(s)
- Stephanie Voss
- Department of Kinesiology and Community Health, University of IL Urbana-Champaign, Champaign, IL, USA
- Occupational Therapy, Shirley Ryan Ability Lab, Chicago, IL, USA
| | - Daniel A. Boachie
- Department of Kinesiology and Community Health, University of IL Urbana-Champaign, Champaign, IL, USA
| | - Norberto Nieves
- Department of Kinesiology and Community Health, University of IL Urbana-Champaign, Champaign, IL, USA
| | - Neha P. Gothe
- Department of Kinesiology and Community Health, University of IL Urbana-Champaign, Champaign, IL, USA
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana Champaign, Champaign, IL, USA
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
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Chaudhary IS, Shyi GCW, Huang STT. A systematic review and activation likelihood estimation meta-analysis of fMRI studies on arousing or wake-promoting effects in Buddhist meditation. Front Psychol 2023; 14:1136983. [PMID: 38022985 PMCID: PMC10646186 DOI: 10.3389/fpsyg.2023.1136983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 09/22/2023] [Indexed: 12/01/2023] Open
Abstract
Conventional Buddhist texts illustrate meditation as a condition of relaxed alertness that must fend against extreme hypoarousal (sleep, drowsiness) and extreme hyperarousal (restlessness). Theoretical, neurophysiological, and neuroimaging investigations of meditation have highlighted the relaxing effects and hypoarousing without emphasizing the alertness-promoting effects. Here we performed a systematic review supported by an activation-likelihood estimate (ALE) meta-analysis in an effort to counterbalance the surfeit of scholarship emphasizing the hypoarousing and relaxing effects of different forms of Buddhist meditation. Specifically, the current systematic review-cum-meta-analytical review seeks to highlight more support for meditation's wake-promoting effects by drawing from neuroimaging research during wakefulness and meditation. In this systematic review and meta-analysis of 22 fMRI studies, we aim to highlight support for Buddhist meditation's wake-promoting or arousing effects by identifying brain regions associated with alertness during meditation. The most significant peaks were localized medial frontal gyrus (MFG) and precuneus. We failed to determine areas ostensibly common to alertness-related meditation such as the medial prefrontal cortex (mPFC), superior parietal lobule, basal ganglia, thalamus, most likely due to the relatively fewer fMRI investigations that used wakefulness-promoting meditation techniques. Also, we argue that forthcoming research on meditation, related to alertness or wakefulness, continues to adopt a multi-modal method to investigate the correlation between actual behaviors and neural networks connected to Buddhist meditation. Moreover, we recommend the implementation of fMRI paradigms on Buddhist meditation with clinically diagnosed participants to complement recent trends in psychotherapy such as mindfulness-based cognitive therapy (MBCT).
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Affiliation(s)
- Inder S. Chaudhary
- PhD Program in Cognitive Sciences, National Chung Cheng University, Chiayi City, Taiwan
- Center for Research in Cognitive Sciences, National Chung Cheng University, Chiayi City, Taiwan
- Department of Psychology, National Chung Cheng University, Chiayi City, Taiwan
| | - Gary Chon-Wen Shyi
- PhD Program in Cognitive Sciences, National Chung Cheng University, Chiayi City, Taiwan
- Center for Research in Cognitive Sciences, National Chung Cheng University, Chiayi City, Taiwan
- Department of Psychology, National Chung Cheng University, Chiayi City, Taiwan
| | - Shih-Tseng Tina Huang
- PhD Program in Cognitive Sciences, National Chung Cheng University, Chiayi City, Taiwan
- Center for Research in Cognitive Sciences, National Chung Cheng University, Chiayi City, Taiwan
- Department of Psychology, National Chung Cheng University, Chiayi City, Taiwan
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Riganello F, Tonin P, Soddu A. I Feel! Therefore, I Am from Pain to Consciousness in DOC Patients. Int J Mol Sci 2023; 24:11825. [PMID: 37511583 PMCID: PMC10380260 DOI: 10.3390/ijms241411825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/13/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Pain assessment and management in patients with disorders of consciousness (DOC) is a challenging and important aspect of care, with implications for detecting consciousness and promoting recovery. This narrative review explores the role of pain in consciousness, the challenges of pain assessment, pharmacological treatment in DOC, and the implications of pain assessment when detecting changes in consciousness. The review discusses the Nociception Coma Scale and its revised version, which are behavioral scales used to assess pain in DOC patients, and the challenges and controversies surrounding the appropriate pharmacological treatment of pain in these patients. Moreover, we highlight recent evidence suggesting that an accurate pain assessment may predict changes in the level of consciousness in unresponsive wakefulness syndrome/vegetative state patients, underscoring the importance of ongoing pain management in these patients.
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Affiliation(s)
- Francesco Riganello
- Research in Advanced Neurorehabilitation, S. Anna Institute, 88900 Crotone, Italy
| | - Paolo Tonin
- Research in Advanced Neurorehabilitation, S. Anna Institute, 88900 Crotone, Italy
| | - Andrea Soddu
- Physics, and Astronomy Department, Western Institute for Neuroscience, University of Western Ontario, London, ON N6A 3K7, Canada
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Sugiura M, Katayori Y, Muratsubaki T, Shiratori M, Hanawa S, Nejad KK, Tamura D, Kawashima R, Fukudo S. Automatic adaptive emotion regulation is associated with lower emotion-related activation in the frontoparietal cortex and other cortical regions with multi-componential organization. Front Behav Neurosci 2023; 17:1059158. [PMID: 36950064 PMCID: PMC10025472 DOI: 10.3389/fnbeh.2023.1059158] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/07/2023] [Indexed: 03/08/2023] Open
Abstract
Although some researchers consider automatic adaptive emotion regulation to be an automatized strategy whereas others consider it to be implicit disengagement of deliberative process, to date, its neural correlates have been poorly investigated. In addition, the valence specificity of automatic adaptive emotion regulation and levels of activation relative to the neutral condition are controversial; the former is relevant to the attribution of resilient emotion regulation to positivity bias or emotional stability, and the latter to determining whether regulation is based on emotion-specific or emotion-non-specific processes. In this functional magnetic resonance imaging (fMRI) study, we presented positive and negative emotional pictures to healthy young participants and investigated the neural correlates of automatic adaptive emotion regulation in spontaneous emotional response. A significant negative trait effect (i.e., regression coefficient) on activation was identified both for positive and negative emotional responses in various cortical regions. A cluster analysis identified three clusters among these regions based on the valence specificity of the trait effect and level of activation relative to neutral stimuli. Cluster 1 included regions in the sensorimotor cortex characterized by negative emotion-specific decreases in activation relative to neutral stimuli in adaptive individuals. Cluster 2 included several cortical regions including the bilateral dorsal executive network, anterior cingulate, and inferior frontal gyrus, which were characterized by valence-independent decreases in activation in adaptive individuals. Cluster 3 included the bilateral ventrolateral and dorsomedial prefrontal cortices, right insula, and other posterior regions, which were characterized by increased activation for negative stimuli in non-adaptive individuals. These findings support the assumption that automatic adaptive emotion regulation involves the implicit disengagement of deliberative process and suggest the relevance of different cortical networks to the potential emotion- and valence-specificity of adaptive regulation.
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Affiliation(s)
- Motoaki Sugiura
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
- International Research Institute of Disaster Science, Tohoku University, Sendai, Japan
| | - Yoko Katayori
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiko Muratsubaki
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Miyuki Shiratori
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Sugiko Hanawa
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | | | - Daisaku Tamura
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryuta Kawashima
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Shin Fukudo
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Riegner G, Posey G, Oliva V, Jung Y, Mobley W, Zeidan F. Disentangling self from pain: mindfulness meditation-induced pain relief is driven by thalamic-default mode network decoupling. Pain 2023; 164:280-291. [PMID: 36095039 PMCID: PMC9823141 DOI: 10.1097/j.pain.0000000000002731] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/14/2022] [Indexed: 02/06/2023]
Abstract
ABSTRACT For millenniums, mindfulness was believed to diminish pain by reducing the influence of self-appraisals of noxious sensations. Today, mindfulness meditation is a highly popular and effective pain therapy that is believed to engage multiple, nonplacebo-related mechanisms to attenuate pain. Recent evidence suggests that mindfulness meditation-induced pain relief is associated with the engagement of unique cortico-thalamo-cortical nociceptive filtering mechanisms. However, the functional neural connections supporting mindfulness meditation-based analgesia remain unknown. This mechanistically focused clinical trial combined functional magnetic resonance imaging with psychophysical pain testing (49°C stimulation and pain visual analogue scales) to identify the neural connectivity supporting the direct modulation of pain-related behavioral and neural responses by mindfulness meditation. We hypothesized that mindfulness meditation-based pain relief would be reflected by greater decoupling between brain mechanisms supporting appraisal (prefrontal) and nociceptive processing (thalamus). After baseline pain testing, 40 participants were randomized to a well-validated, 4-session mindfulness meditation or book-listening regimen. Functional magnetic resonance imaging and noxious heat (49°C; right calf) were combined during meditation to test study hypotheses. Mindfulness meditation significantly reduced behavioral and neural pain responses when compared to the controls. Preregistered (NCT03414138) whole-brain analyses revealed that mindfulness meditation-induced analgesia was moderated by greater thalamus-precuneus decoupling and ventromedial prefrontal deactivation, respectively, signifying a pain modulatory role across functionally distinct neural mechanisms supporting self-referential processing. Two separate preregistered seed-to-seed analyses found that mindfulness meditation-based pain relief was also associated with weaker contralateral thalamic connectivity with the prefrontal and primary somatosensory cortex, respectively. Thus, we propose that mindfulness meditation is associated with a novel self-referential nociceptive gating mechanism to reduce pain.
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Affiliation(s)
- Gabriel Riegner
- Department of Anesthesiology; University of California San Diego; La Jolla, CA, 92037; United States
| | - Grace Posey
- Department of Medicine; Tulane University School of Medicine; New Orleans, LA, 70112; United States
| | - Valeria Oliva
- Department of Anesthesiology; University of California San Diego; La Jolla, CA, 92037; United States
| | - Youngkyoo Jung
- Department of Radiology; University of California Davis; Sacramento, CA, 95817; United States
| | - William Mobley
- Department of Neurosciences; University of California San Diego; La Jolla, CA, 92093; United States
| | - Fadel Zeidan
- Department of Anesthesiology; University of California San Diego; La Jolla, CA, 92037; United States
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12
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A neurophenomenological approach to non-ordinary states of consciousness: hypnosis, meditation, and psychedelics. Trends Cogn Sci 2023; 27:139-159. [PMID: 36566091 DOI: 10.1016/j.tics.2022.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/01/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2022]
Abstract
No contemporary unifying framework has been provided for the study of non-ordinary states of consciousness (NSCs) despite increased interest in hypnosis, meditation, and psychedelics. NSCs induce shifts in experiential contents (what appears to the experiencer) and/or structure (how it appears). This can allow the investigation of the plastic and dynamic nature of experience from a multiscale perspective that includes mind, brain, body, and context. We propose a neurophenomenological (NP) approach to the study of NSCs which highlights their role as catalysts of transformation in clinical practice by refining our understanding of the relationships between experiential (subjective) and neural dynamics. We outline the ethical implications of the NP approach for standard conceptions of health and pathology as well as the crucial role of experience-based know-how in NSC-related research and application.
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13
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Bonin EAC, Lejeune N, Szymkowicz E, Bonhomme V, Martial C, Gosseries O, Laureys S, Thibaut A. Assessment and management of pain/nociception in patients with disorders of consciousness or locked-in syndrome: A narrative review. Front Syst Neurosci 2023; 17:1112206. [PMID: 37021037 PMCID: PMC10067681 DOI: 10.3389/fnsys.2023.1112206] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/06/2023] [Indexed: 04/07/2023] Open
Abstract
The assessment and management of pain and nociception is very challenging in patients unable to communicate functionally such as patients with disorders of consciousness (DoC) or in locked-in syndrome (LIS). In a clinical setting, the detection of signs of pain and nociception by the medical staff is therefore essential for the wellbeing and management of these patients. However, there is still a lot unknown and a lack of clear guidelines regarding the assessment, management and treatment of pain and nociception in these populations. The purpose of this narrative review is to examine the current knowledge regarding this issue by covering different topics such as: the neurophysiology of pain and nociception (in healthy subjects and patients), the source and impact of nociception and pain in DoC and LIS and, finally, the assessment and treatment of pain and nociception in these populations. In this review we will also give possible research directions that could help to improve the management of this specific population of severely brain damaged patients.
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Affiliation(s)
- Estelle A. C. Bonin
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre Hospitalier Neurologique (CHN) William Lennox, Saint-Luc Hospital Group, Ottignies-Louvain-la-Neuve, Belgium
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Emilie Szymkowicz
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Vincent Bonhomme
- Department of Anesthesia and Intensive Care Medicine, Liège University Hospital, Liège, Belgium
- Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
- Joint International Research Unit on Consciousness, CERVO Brain Research Centre, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSS), University Laval, Québec City, QC, Canada
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
- *Correspondence: Aurore Thibaut,
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14
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Hunt CA, Letzen JE, Krimmel SR, Burrowes SAB, Haythornthwaite JA, Finan PH, Vetter M, Seminowicz DA. Is Mindfulness Associated With Lower Pain Reactivity and Connectivity of the Default Mode Network? A Replication and Extension Study in Healthy and Episodic Migraine Participants. THE JOURNAL OF PAIN 2022; 23:2110-2120. [PMID: 35934277 PMCID: PMC9729370 DOI: 10.1016/j.jpain.2022.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/11/2022] [Accepted: 07/27/2022] [Indexed: 01/04/2023]
Abstract
Formal training in mindfulness-based practices promotes reduced experimental and clinical pain, which may be driven by reduced emotional pain reactivity and undergirded by alterations in the default mode network, implicated in mind-wandering and self-referential processing. Recent results published in this journal suggest that mindfulness, defined here as the day-to-day tendency to maintain a non-reactive mental state in the absence of training, associates with lower pain reactivity, greater heat-pain thresholds, and resting-state default mode network functional connectivity in healthy adults in a similar manner to trained mindfulness. The extent to which these findings extend to chronic pain samples and replicate in healthy samples is unknown. Using data from healthy adults (n = 36) and episodic migraine patients (n = 98) and replicating previously published methods, we observed no significant association between mindfulness and heat-pain threshold, pain intensity or unpleasantness, or pain catastrophizing in healthy controls, or between mindfulness and headache frequency, severity, impactor pain catastrophizing in patients. There was no association between default mode network connectivity and mindfulness in either sample when probed via seed-based functional connectivity analyses. In post-hoc whole brain exploratory analyses, a meta-analytically derived default mode network node (ie, posterior cingulate cortex) showed connectivity with regions unassociated with pain processing as a function of mindfulness, such that healthy adults higher in mindfulness showed greater functional connectivity between the posterior cingulate cortex-and cerebellum. Collectively, these findings suggest that the relationship between mindfulness and default mode network functional connectivity may be nuanced or non-robust, and encourage further investigation of how mindfulness relates to pain. PERSPECTIVE: This study found few significant associations between dispositional mindfulness and pain, pain reactivity and default mode connectivity in healthy adults and migraine patients. The relationship between mindfulness and default mode network connectivity may be nuanced or non-robust.
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Affiliation(s)
- Carly A Hunt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Janelle E Letzen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Samuel R Krimmel
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Shana A B Burrowes
- Department of Medicine, Boston University School of Medicine, Section of Infectious Diseases, Boston, Maryland; Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, Maryland
| | - Jennifer A Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Maria Vetter
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, Maryland
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15
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An Overview of Mindfulness-Oriented Addiction and Pain Recovery. J Nerv Ment Dis 2022; 210:808-810. [PMID: 36179375 DOI: 10.1097/nmd.0000000000001497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is evidence that mindfulness-based interventions are effective as stress-reduction techniques in people with various stressor-related disorders. Research also shows overall improvement in mental health well-being in practitioners of mindfulness. However, there is limited literature probing the potential negative impacts of mindfulness practice. Relapse is a major challenge in substance use disorders (SUDs), particularly for people with chronic pain. There is an overlap between SUDs and chronic pain, which share common pathophysiological pathways that could contribute to poor pain control and mental instability. In this report, we discuss the possible effects of mindfulness on specified aspects of substance craving and chronic pain perception. We propose future directions for research in mindfulness practices to maximize the potential for relapse prevention and pain control.
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16
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Kirlic N, Cohen ZP, Tsuchiyagaito A, Misaki M, McDermott TJ, Aupperle RL, Stewart JL, Singh MK, Paulus MP, Bodurka J. Self-regulation of the posterior cingulate cortex with real-time fMRI neurofeedback augmented mindfulness training in healthy adolescents: A nonrandomized feasibility study. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2022; 22:849-867. [PMID: 35292905 PMCID: PMC9293874 DOI: 10.3758/s13415-022-00991-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 02/06/2023]
Abstract
Mindfulness training (MT) promotes the development of one's ability to observe and attend to internal and external experiences with objectivity and nonjudgment with evidence to improve psychological well-being. Real-time functional MRI neurofeedback (rtfMRI-nf) is a noninvasive method of modulating activity of a brain region or circuit. The posterior cingulate cortex (PCC) has been hypothesized to be an important hub instantiating a mindful state. This nonrandomized, single-arm study examined the feasibility and tolerability of training typically developing adolescents to self-regulate the posterior cingulate cortex (PCC) using rtfMRI-nf during MT. Thirty-four adolescents (mean age: 15 years; 14 females) completed the neurofeedback augmented mindfulness training task, including Focus-on-Breath (MT), Describe (self-referential thinking), and Rest conditions, across three neurofeedback and two non-neurofeedback runs (Observe, Transfer). Self-report assessments demonstrated the feasibility and tolerability of the task. Neurofeedback runs differed significantly from non-neurofeedback runs for the Focus-on-Breath versus Describe contrast, characterized by decreased activity in the PCC during the Focus-on-Breath condition (z = -2.38 to -6.27). MT neurofeedback neural representation further involved the medial prefrontal cortex, anterior cingulate cortex, dorsolateral prefrontal cortex, posterior insula, hippocampus, and amygdala. State awareness of physical sensations increased following rtfMRI-nf and was maintained at 1-week follow-up (Cohens' d = 0.69). Findings demonstrate feasibility and tolerability of rtfMRI-nf in healthy adolescents, replicates the role of PCC in MT, and demonstrate a potential neuromodulatory mechanism to leverage and streamline the learning of mindfulness practice. ( ClinicalTrials.gov identifier #NCT04053582; August 12, 2019).
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Affiliation(s)
- Namik Kirlic
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA.
| | - Zsofia P Cohen
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
| | - Aki Tsuchiyagaito
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
| | - Masaya Misaki
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
| | - Timothy J McDermott
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
- Department of Psychology, University of Tulsa, Tulsa, OK, USA
| | - Robin L Aupperle
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
- School of Community Medicine, University of Tulsa, Tulsa, OK, USA
| | - Jennifer L Stewart
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
- School of Community Medicine, University of Tulsa, Tulsa, OK, USA
| | - Manpreet K Singh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Martin P Paulus
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
- School of Community Medicine, University of Tulsa, Tulsa, OK, USA
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK, 74136, USA
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, USA
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17
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Brandel MG, Lin C, Hennel D, Khazen O, Pilitsis JG, Ben-Haim S. Mindfulness Meditation in the Treatment of Chronic Pain. Neurosurg Clin N Am 2022; 33:275-279. [PMID: 35718396 DOI: 10.1016/j.nec.2022.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Chronic pain is a leading cause of disability in the United States. Limited efficacy associated with pharmacologic management and surgical interventions in refractory patients has led to further exploration of cognitive and behavioral interventions as both an adjunctive and primary therapeutic modality. Mindfulness-based meditation has shown to be effective in reducing pain in randomized studies of chronic pain patients as well as models of experimentally induced pain in healthy participants. These studies have revealed specific neural mechanisms which may explain both short-term and sustained pain relief associated with mindfulness-based interventions.
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Affiliation(s)
- Michael G Brandel
- Department of Neurosurgery, University of California, 200 W. Arbor Drive #8893, USA
| | - Christine Lin
- Department of Neurosurgery, University of California, 200 W. Arbor Drive #8893, USA
| | - Devon Hennel
- Department of Neurscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Olga Khazen
- Department of Neurscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Julie G Pilitsis
- Department of Biomedical Research, Florida Atlantic University, Boca Raton, Florida, USA
| | - Sharona Ben-Haim
- Department of Neurosurgery, University of California, 200 W. Arbor Drive #8893, USA.
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18
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da Silva GV, Magri LV, de Oliveira Melchior M, Andrade Leite-Panissi CR, da Silva Gherardi-Donato EC. Mindfulness and pain catastrophization: how are they associated in women with chronic painful temporomandibular disorder (TMD)? Cranio 2022:1-7. [PMID: 35723557 DOI: 10.1080/08869634.2022.2086208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Pain catastrophizing has dimensions of magnification, rumination, and helplessness, being an important evaluator of chronic pain. Studies with mindfulness intervention point to a possible modulation of chronic pain catastrophizing behavior. However, how these facets of mindfulness are associated with the catastrophizing subscales is uncertain. The scope of this study is to verify how the association of mindfulness facets and catastrophizing subdimensions occurs. METHODS Women with chronic TMD answered the Pain Catastrophizing Scale (PCS) and Five Facets of Mindfulness Questionnaire (FFMQ). RESULTS Magnification was inversely correlated with "not reacting," "not judging," and the total FFMQ score. Total PCS was also inversely correlated with "not reacting." CONCLUSION It is necessary to consider such possible correlations between mindfulness facets and the catastrophizing subdimensions in mindfulness-based interventions for this population.
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Affiliation(s)
- Graziela Valle da Silva
- Department of Psychiatry Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, Brazil
| | - Laís Valencise Magri
- School of Dentistry of Ribeirão Preto, São Paulo, University of São Paulo, São Paulo, Brazil; Dentist at School of Dentistry of Ribeirão Preto, São Paulo, University of São Paulo, São Paulo, Brazil
| | - Melissa de Oliveira Melchior
- Department of Psychiatry Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, Brazil; Speech Therapist at School of Dentistry of Ribeirão Preto, São Paulo, University of São Paulo, São Paulo, Brazil
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19
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Wang S, Lu S. Brain Functional Connectivity in the Resting State and the Exercise State in Elite Tai Chi Chuan Athletes: An fNIRS Study. Front Hum Neurosci 2022; 16:913108. [PMID: 35782040 PMCID: PMC9243259 DOI: 10.3389/fnhum.2022.913108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
This study aimed to reveal the characteristics of multi-circuit brain synergy between elite tai chi chuan athletes in resting and exercise states and to provide neuroimaging evidence of improvements in brain function by motor skill training. Functional near-infrared spectroscopy (fNIRS) was used to compare the brain activity of professional tai chi chuan athletes (expert group) and beginners (novice group) in resting and exercise states, and to assess functional connectivity (FC) between the prefrontal lobe and the sensorimotor zone. In the resting state, the FC between the left prefrontal lobe and the right sensorimotor area in the expert group was significantly lower than that in the novice group (P < 0.05). In the exercise state, the patterns of FC between the left prefrontal lobe and right sensorimotor area, the right prefrontal lobe and left sensorimotor area, and the left and right sensorimotor areas in the expert group were significantly lower than that in the novice group (P < 0.05). From the resting state to the locomotor state, the expert group experienced a greater absolute value of functional connection increment between the left prefrontal cortex and right sensorimotor area, and between the left sensorimotor area and right sensorimotor area (P < 0.05). This was positively correlated with the self-evaluation results of motor performance behavior. Under sports conditions, professional athletes’ multi-circuit brain FC strength is significantly reduced, and their elite motor skill performance supports the neural efficiency hypothesis. This may be related to the high adaptation of the brain to specific tasks and the improvement of the integration of somatic perception processing and motor function.
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Affiliation(s)
- Shilong Wang
- Wushu School of China, Beijing Sports University, Beijing, China
| | - Shengnan Lu
- College of Dance and Martial Arts, Capital University of Physical Education and Sport, Beijing, China
- *Correspondence: Shengnan Lu
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20
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Kmiecik MJ, Tu FF, Silton RL, Dillane KE, Roth GE, Harte SE, Hellman KM. Cortical mechanisms of visual hypersensitivity in women at risk for chronic pelvic pain. Pain 2022; 163:1035-1048. [PMID: 34510138 PMCID: PMC8882209 DOI: 10.1097/j.pain.0000000000002469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Increased sensory sensitivity across non-nociceptive modalities is a common symptom of chronic pain conditions and is associated with chronic pain development. Providing a better understanding of the brain-behavior relationships that underlie multimodal hypersensitivity (MMH) may clarify the role of MMH in the development of chronic pain. We studied sensory hypersensitivity in a cohort of women (n = 147) who had diary confirmation of menstrual status and were enriched with risk factors for chronic pelvic pain, such as dysmenorrhea and increased bladder sensitivity. We administered 2 experimental tasks to evaluate the cross-modal relationship between visual and visceral sensitivity. Visual sensitivity was probed by presenting participants with a periodic pattern-reversal checkerboard stimulus presented across 5 brightness intensities during electroencephalography recording. Self-reported visual unpleasantness ratings for each brightness intensity were simultaneously assessed. Visceral sensitivity was evaluated with an experimental bladder-filling task associated with early clinical symptoms of chronic pelvic pain. Visually evoked cortical activity increased with brightness intensity across the entire scalp, especially at occipital electrode sites. Visual stimulation-induced unpleasantness was associated with provoked bladder pain and evoked primary visual cortex activity. However, the relationship between unpleasantness and cortical activity was moderated by provoked bladder pain. These results demonstrate that activity in the primary visual cortex is not greater in individuals with greater visceral sensitivity. We hypothesize that downstream interpretation or integration of this signal is amplified in individuals with visceral hypersensitivity. Future studies aimed at reducing MMH in chronic pain conditions should prioritize targeting of cortical mechanisms responsible for aberrant downstream sensory integration.
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Affiliation(s)
- Matthew J. Kmiecik
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Frank F. Tu
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Rebecca L. Silton
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Katlyn E. Dillane
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Genevieve E. Roth
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Steven E. Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Kevin M. Hellman
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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21
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Jones P. Mindfulness and Nondual Well-Being – What is the Evidence that We Can Stay Happy? REVIEW OF GENERAL PSYCHOLOGY 2022. [DOI: 10.1177/10892680221093013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research into subjective well-being (SWB) focuses on conducive life conditions, healthy cognitive-affective processes and adaptive behaviours, however, in this model, well-being fluctuates based on changing mental and physical phenomena. This inquiry explores the possibility that we can have a nondual experience of well-being that is unaffected by such movements and investigates if the literature supports this. The assertion in traditional mindfulness that the sense of self is constructed and responsible for such fluctuations is explored, along with what evidence there is that mindfulness practices deliver relevant cognitive and behavioural correlates associated with such a way of being. Proposed preconditions include (a) nondual awareness or the perception of no-self; (b) increased positive affect, decreased negative affect, and increased self-lessness; (c) increased capacity to maintain (or protect) well-being including heightened emotional self-regulation and resilience to aversive stimuli. Research findings provide some evidence that the sense of self can be both constructed and deconstructed, and that mindfulness training may target psychological dimensions that could contribute to an experience of well-being that transcends the impact of life conditions. Recommendations are made for a collaborative relationship between SWB research and mindfulness to expand the inquiry into possible causes and conditions of ‘nondual well-being’.
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Affiliation(s)
- Patrick Jones
- College of Science, Health, Engineering and Education (SHEE), Murdoch University, Perth, WA, Australia
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22
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Khatib L, Riegner G, Dean JG, Oliva V, Cruanes G, Mulligan BA, Zeidan F. The Effects of Mindfulness-Based Stress Reduction on Trauma in Victims of Gun Violence: a Pilot Study. Mindfulness (N Y) 2022; 13:1032-1041. [PMID: 35341090 PMCID: PMC8938160 DOI: 10.1007/s12671-022-01858-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/24/2022]
Abstract
Objectives Gun violence is a significant problem in the United States of America. Gun violence produces lifelong psychological adversity, trauma, and grief. In the face of this epidemic, efficacious therapies that assuage gun violence-based trauma and negative health are lacking. Methods The proposed, longitudinal pilot experiment examined the effects of an 8-week mindfulness-based stress reduction (MBSR) program on traumatized individuals as a direct consequence of gun violence. Twenty-four victims of gun violence (median age = 53 years; 21 female) completed measures of the primary outcome: trauma. Secondary outcomes were characterized as grief, depression, sleep quality, life satisfaction, and mindfulness. All assessments were administered before, after 5, and 8 weeks of MBSR training. It was hypothesized that trauma and other comorbidities would improve following MBSR. It was also predicted that outcomes would be significantly stronger from baseline to 5 weeks of MBSR training than from 5 to 8 weeks of training. Results Before MBSR, volunteers exhibited high levels of trauma, depression, sleep difficulty, and grief. Participation in MBSR was associated with improved trauma, depression, sleep difficulty, and life satisfaction. The most pronounced improvements in psychological disposition were exhibited within the first 5 weeks of MBSR. However, these benefits were largely preserved after completion of the course. Importantly, increases in dispositional mindfulness predicted lower trauma, complicated grief, and sleep difficulties. Conclusions The present findings should be interpreted with caution because they were derived from an uncontrolled, non-randomized trial. However, said findings suggest that MBSR may reduce trauma and improve overall well-being in gun violence victims.
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Affiliation(s)
- Lora Khatib
- Department of Anesthesiology, University of California San Diego, 9500 Gilman Drive, MC 0719, La Jolla, CA 92093 USA
| | - Gabriel Riegner
- Department of Anesthesiology, University of California San Diego, 9500 Gilman Drive, MC 0719, La Jolla, CA 92093 USA
| | - Jon G. Dean
- Department of Anesthesiology, University of California San Diego, 9500 Gilman Drive, MC 0719, La Jolla, CA 92093 USA
| | - Valeria Oliva
- Department of Anesthesiology, University of California San Diego, 9500 Gilman Drive, MC 0719, La Jolla, CA 92093 USA
| | - Gael Cruanes
- Department of Anesthesiology, University of California San Diego, 9500 Gilman Drive, MC 0719, La Jolla, CA 92093 USA
| | | | - Fadel Zeidan
- Department of Anesthesiology, University of California San Diego, 9500 Gilman Drive, MC 0719, La Jolla, CA 92093 USA
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23
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French Survey on Pain Perception and Management in Patients with Locked-In Syndrome. Diagnostics (Basel) 2022; 12:diagnostics12030769. [PMID: 35328322 PMCID: PMC8947195 DOI: 10.3390/diagnostics12030769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/08/2022] [Accepted: 03/15/2022] [Indexed: 11/17/2022] Open
Abstract
Patients with locked-in syndrome (LIS) may suffer from pain, which can significantly affect their daily life and well-being. In this study, we aim to investigate the presence and the management of pain in LIS patients. Fifty-one participants completed a survey collecting socio-demographic information and detailed reports regarding pain perception and management (type and frequency of pain, daily impact of pain, treatments). Almost half of the LIS patients reported experiencing pain (49%) that affected their quality of life, sleep and cognition. The majority of these patients reported that they did not communicate their pain to clinical staff. Out of the 25 patients reporting pain, 18 (72%) received treatment (60% pharmacological, 12% non-pharmacological) and described the treatment efficacy as 'moderate'. In addition, 14 (56%) patients were willing to try other non-pharmacological treatments, such as hypnosis or meditation. This study provides a comprehensive characterization of pain perception in LIS patients and highlights the lack of guidelines for pain detection and its management. This is especially pertinent given that pain affects diagnoses, by either inducing fatigue or by using pharmacological treatments that modulate the levels of wakefulness and concentration of such patients.
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Gill LN, Tabry V, Taylor V, Lussier M, Martinu K, Bherer L, Roy M, Rainville P. Effects of Brief Mindfulness Interventions on the Interference Induced by Experimental Heat Pain on Cognition in Healthy Individuals. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 2:673027. [PMID: 35295494 PMCID: PMC8915756 DOI: 10.3389/fpain.2021.673027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/06/2021] [Indexed: 12/25/2022]
Abstract
Background: Pain captures attention and interferes with competing tasks demanding cognitive effort. Brief mindfulness interventions involving both conceptual learning and meditation exercises have been shown to improve attention and reduce pain sensitivity, and could potentially reduce pain interference. This study assesses the effect of a 5-day mindfulness intervention (20 min/day) on the interference produced by thermal pain on working memory performance using a 2-back task. Methods: Healthy participants were randomized into three groups exposed to mindfulness meditation training (n = 15), an active educational control intervention comprising only conceptual information on mindfulness (n = 15), or no intervention (n = 15). The two active interventions were administered in a dual-blind fashion and outcomes were assessed by research personnel blind to this allocation. Evaluation sessions were conducted before and after the interventions to assess the effect of pain on 2-back performance (pain interference). Importantly, both pain stimuli and the 2-back task were calibrated individually and in each session before assessing pain interference, thereby controlling for possible changes in baseline pain sensitivity and cognitive performance. Secondary outcomes included heat pain sensitivity, cold pain tolerance, cognitive inhibition, cognitive flexibility, and divided attention. Results: Manipulation checks confirmed that heat pain interferes with the performance of the working-memory task. Compared to the no-intervention control group, pain interference was significantly reduced following the conceptual intervention but not the meditation intervention, although a corollary analysis suggests the effect might be due to regression toward the mean caused by baseline imbalance in pain interference. Secondary outcomes also suggested an increase in pain tolerance in the conceptual learning group only. Discussion: A short mindfulness meditation intervention was insufficient to reduce pain interference but conceptual learning about mindfulness produced some unexpected benefits. Although the generalization of experimental findings to clinical pain conditions may be premature, these results highlight the importance of distinguishing the contribution of mindfulness education and meditation training in future studies. Understanding the effects of mindfulness training on pain regulation and management must take into consideration the multiple factors underlying this complex intervention.
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Affiliation(s)
- Louis-Nascan Gill
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Vanessa Tabry
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Véronique Taylor
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Maxime Lussier
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
| | - Kristina Martinu
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
| | - Louis Bherer
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada.,Department of Medicine, Université de Montréal, Montreal, QC, Canada.,Center for Research, Montreal Heart Institute, Montreal, QC, Canada
| | - Mathieu Roy
- Department of Psychology, McGill University, Montreal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
| | - Pierre Rainville
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada.,Department of Stomatology, Université de Montréal, Montreal, QC, Canada
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Yu X, Cohen ZP, Tsuchiyagaito A, Cochran G, Aupperle RL, Stewart JL, Singh MK, Misaki M, Bodurka J, Paulus MP, Kirlic N. Neurofeedback-Augmented Mindfulness Training Elicits Distinct Responses in the Subregions of the Insular Cortex in Healthy Adolescents. Brain Sci 2022; 12:brainsci12030363. [PMID: 35326319 PMCID: PMC8946655 DOI: 10.3390/brainsci12030363] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/25/2022] [Accepted: 03/03/2022] [Indexed: 02/05/2023] Open
Abstract
Mindfulness training (MT) reduces self-referential processing and promotes interoception, the perception of sensations from inside the body, by increasing one’s awareness of and regulating responses to them. The posterior cingulate cortex (PCC) and the insular cortex (INS) are considered hubs for self-referential processing and interoception, respectively. Although MT has been consistently found to decrease PCC, little is known about how MT relates to INS activity. Understanding links between mindfulness and interoception may be particularly important for informing mental health in adolescence, when neuroplasticity and emergence of psychopathology are heightened. We examined INS activity during real-time functional magnetic resonance imaging neurofeedback-augmented mindfulness training (NAMT) targeting the PCC. Healthy adolescents (N = 37; 16 female) completed the NAMT task, including Focus-on-Breath (MT), Describe (self-referential processing), and Rest conditions, across three neurofeedback runs and two non-neurofeedback runs (Observe, Transfer). Regression coefficients estimated from the generalized linear model were extracted from three INS subregions: anterior (aINS), mid (mINS), and posterior (pINS). Mixed model analyses revealed the main effect of run for Focus-on-Breath vs. Describe contrast in aINS [R2 = 0.39] and pINS [R2 = 0.33], but not mINS [R2 = 0.34]. Post hoc analyses revealed greater aINS activity and reduced pINS activity during neurofeedback runs, and such activities were related to lower self-reported life satisfaction and less pain behavior, respectively. These findings revealed the specific involvement of insula subregions in rtfMRI-nf MT.
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Affiliation(s)
- Xiaoqian Yu
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (X.Y.); (Z.P.C.); (A.T.); (G.C.); (R.L.A.); (J.L.S.); (M.M.); (M.P.P.)
| | - Zsofia P. Cohen
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (X.Y.); (Z.P.C.); (A.T.); (G.C.); (R.L.A.); (J.L.S.); (M.M.); (M.P.P.)
| | - Aki Tsuchiyagaito
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (X.Y.); (Z.P.C.); (A.T.); (G.C.); (R.L.A.); (J.L.S.); (M.M.); (M.P.P.)
| | - Gabriella Cochran
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (X.Y.); (Z.P.C.); (A.T.); (G.C.); (R.L.A.); (J.L.S.); (M.M.); (M.P.P.)
| | - Robin L. Aupperle
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (X.Y.); (Z.P.C.); (A.T.); (G.C.); (R.L.A.); (J.L.S.); (M.M.); (M.P.P.)
- Department of Community Medicine, University of Tulsa, Tulsa, OK 74104, USA
| | - Jennifer L. Stewart
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (X.Y.); (Z.P.C.); (A.T.); (G.C.); (R.L.A.); (J.L.S.); (M.M.); (M.P.P.)
- Department of Community Medicine, University of Tulsa, Tulsa, OK 74104, USA
| | - Manpreet K. Singh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA;
| | - Masaya Misaki
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (X.Y.); (Z.P.C.); (A.T.); (G.C.); (R.L.A.); (J.L.S.); (M.M.); (M.P.P.)
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (X.Y.); (Z.P.C.); (A.T.); (G.C.); (R.L.A.); (J.L.S.); (M.M.); (M.P.P.)
| | - Martin P. Paulus
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (X.Y.); (Z.P.C.); (A.T.); (G.C.); (R.L.A.); (J.L.S.); (M.M.); (M.P.P.)
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA;
| | - Namik Kirlic
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA; (X.Y.); (Z.P.C.); (A.T.); (G.C.); (R.L.A.); (J.L.S.); (M.M.); (M.P.P.)
- Correspondence: ; Tel.: +1-918-502-5747
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Tatta J, Willgens AM, Palombaro KM. Mindfulness and Acceptance-Based Interventions in Physical Therapist Practice: The Time Is Now. Phys Ther 2022; 102:6481182. [PMID: 35079796 DOI: 10.1093/ptj/pzab293] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/03/2021] [Accepted: 11/04/2021] [Indexed: 12/20/2022]
Abstract
UNLABELLED One in 5 adults in the United States lives with a mental illness, and many more struggle with stress-related chronic illnesses. Physical therapists often see the physical effects that stress has on the body, but there is an underutilization of evidence-based stress management strategies with patients and clients. Mindfulness and acceptance-based interventions (MABIs) constitute a family of methods that emphasize present-moment awareness, nonjudgment, and values-based living. They operate by teaching patients to cope with stressful thoughts, emotions, and physical sensations. MABIs are associated with improved health outcomes in areas commonly seen in physical therapist practice, including health promotion, physical function, injury prevention, pain management, immune function, and noncommunicable diseases. The purpose of this Perspective article is to (1) describe MABIs; (2) discuss the relevance of MABIs to physical therapist practice; (3) discuss the positive impact of MABIs for pain, sports, immune function, physical and mental health promotion, and wellness; and (4) identify MABI outcome measures related to health behavior change. It is time. IMPACT Contemporary practice requires that physical therapists manage patient care by addressing both the mind and body. Given the existing research on MABIs, it is time to translate the evidence into minimum accreditable standards for health promotion and prevention of chronic, noncommunicable disease. This approach would have far-reaching benefits for individuals, family units, communities, and society as a whole. LAY SUMMARY Mindfulness instruction delivered by a physical therapist can help improve physical and mental well-being.
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Affiliation(s)
- Joe Tatta
- Integrative Pain Science Institute, New York, New York, USA
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27
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How do placebo effects contribute to mindfulness-based analgesia? Probing acute pain effects and interactions using a randomized balanced placebo design. Pain 2022; 163:1967-1977. [PMID: 35082252 DOI: 10.1097/j.pain.0000000000002593] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Recent sham-controlled studies suggest placebo effects contribute to acute pain relief following mindfulness interventions. However, the specific effects of mindfulness processes and their interaction with placebo effects remain unclear. This study aimed to characterize the role of mindfulness and placebo processes underlying mindfulness-based pain attenuation. Both treatment (focused-attention mindfulness vs sham) and instruction ("told mindfulness" vs "told sham") were manipulated in a balanced placebo design. Changes in acute heat pain were evaluated in 153 healthy adults randomized to receive 6 x 20 minutes of one of the four treatment by instruction interventions or no treatment. Participants receiving any intervention demonstrated improved pain outcomes (unpleasantness, intensity and tolerance) relative to no treatment. The instruction manipulation increased expectation for pain relief in those told mindfulness relative to told sham, but there were no main effects or interactions of treatment or instruction on pain outcomes. However, irrespective of actual intervention received, the belief of receiving mindfulness predicted increased pain threshold and tolerance, with expectancy fully mediating the effect on pain tolerance. These findings suggest a lack of specific effects of mindfulness and instruction on acute pain. Nonetheless, participants' expectancies and beliefs about the treatment they received did predict pain relief. Together with the overall improvement following any intervention, these findings suggest that expectancy and belief may play a stronger role in attenuating acute pain in novices following brief mindfulness interventions than the actual mindfulness-specific processes or instructions delivered.
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28
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Faraj MM, Lipanski NM, Morales A, Goldberg E, Bluth MH, Marusak HA, Greenwald MK. A Virtual Reality Meditative Intervention Modulates Pain and the Pain Neuromatrix in Patients with Opioid Use Disorder. PAIN MEDICINE (MALDEN, MASS.) 2021; 22:2739-2753. [PMID: 33956146 DOI: 10.1093/pm/pnab162] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Standard of care for opioid use disorder (OUD) includes medication and counseling. However, there is an unmet need for complementary approaches to treat OUD patients coping with pain; furthermore, few studies have probed neurobiological features of pain or its management during OUD treatment. This preliminary study examines neurobiological and behavioral effects of a virtual reality-based meditative intervention in patients undergoing methadone maintenance treatment (MMT). DESIGN Prospective, non-blinded, single-arm, 12-week intervention with standardized assessments. SETTING Academic research laboratory affiliated with an on-site MMT clinic. METHODS Fifteen (11 female) MMT patients completed a virtual reality, therapist-guided meditative intervention that included breathing and relaxation exercisessessions were scheduled twice weekly. Assessments included functional magnetic resonance imaging (fMRI) of pain neuromatrix activation and connectivity (pre- and post-intervention), saliva cortisol and C-reactive protein (CRP) at baseline and weeks 4, 8 and 12; and self-reported pain and affective symptoms before and after each intervention session. RESULTS After each intervention session (relative to pre-session), ratings of pain, opioid craving, anxiety and depression (but not anger) decreased. Saliva cortisol (but not CRP) levels decreased from pre- to post-session. From pre- to post-intervention fMRI assessments, pain task-related left postcentral gyrus (PCG) activation decreased. At baseline, PCG showed positive connectivity with other regions of the pain neuromatrix, but this pattern changed post-intervention. CONCLUSIONS These preliminary findings demonstrate feasibility, therapeutic promise, and brain basis of a meditative intervention for OUD patients undergoing MMT.
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Affiliation(s)
| | - Nina M Lipanski
- Department of Biological Sciences, University of California, San Diego
| | - Austin Morales
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University
| | - Elimelech Goldberg
- School of Medicine, Wayne State University, Detroit, Michigan
- Kids Kicking Cancer
| | - Martin H Bluth
- School of Medicine, Wayne State University, Detroit, Michigan
- Kids Kicking Cancer
- Maimonides Medical Center, Brooklyn, New York, USA
| | - Hilary A Marusak
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University
- Merrill Palmer Skillman Institute for Child and Family Development, Wayne State University
| | - Mark K Greenwald
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University
- Department of Pharmacy Practice, Wayne State University
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29
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Colgan DD, Eddy A, Green K, Oken B. Adaptive body awareness predicts fewer central sensitization-related symptoms and explains relationship between central sensitization-related symptoms and pain intensity: A cross-sectional study among individuals with chronic pain. Pain Pract 2021; 22:222-232. [PMID: 34651401 DOI: 10.1111/papr.13083] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Central sensitization (CS), defined as the amplification of neural signaling within the CNS that elicits pain hypersensitivity, is thought be a characteristic of several chronic pain conditions. Maladaptive body awareness is thought to contribute and maintain CS. Less is known about the relationship between CS and adaptive body awareness. PURPOSE This cross-sectional study investigated relationships among self-reported adaptive body awareness (Multidimensional Interoceptive Awareness Scale-2; MAIA-2), CS-related symptoms (Central Sensitization Inventory; CSI), and pain intensity and further delineate potential direct and indirect links among these constructs. METHODS Online surveys were administered to 280 individuals with chronic pain reporting elevated CSI scores. Strategic sampling targeted respondents to reflect the 2010 census. Pearson's correlations characterized overall relationship between variables. Multiple regression analyses investigated potential direct links. A path analysis assessed mediational effects of CS-related symptoms on the relationship between adaptive body awareness and pain intensity. RESULTS CSI demonstrated strong, inverse correlations with some MAIA-2 subscales, but positive correlations with others. Higher CSI scores predicted greater pain intensity (b = 0.049, p ≤ 0.001). Two MAIA-2 subscales, Not-Distracting (b = -0.56, p ≤ 0.001) and Not-Worrying (b = -1.17, p ≤ 0.001) were unique predictors of lower CSI. Not-Distracting (b = -0.05, p = 0.003) and Not-Worrying (b = -0.06, p = 0.007) uniquely predicted lower pain intensity. CSI completely mediated the relationship between adaptive body awareness and pain intensity [point estimate = -0.04; 95% bootstrap confident intervals (CI) = -0.05 to -0.02]. CONCLUSIONS Findings also support future research to explore causal relationships of variables. Findings suggest that frequency of attention to bodily sensations is distinct from cognitive-affective appraisal of bodily sensation, and the two distinct higher order processes may have divergent influences on perceived pain and CS-related symptoms. Results also support future research to explore causal relationships of variables.
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Affiliation(s)
| | - Ashley Eddy
- School of Graduate Psychology, Pacific University, Forest Grove, Oregon, USA
| | - Kaylie Green
- School of Graduate Psychology, Pacific University, Forest Grove, Oregon, USA
| | - Barry Oken
- Neurology Department, Oregon Health and Science University, Portland, Oregon, USA
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30
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Hu XS, Beard K, Sherbel MC, Nascimento TD, Petty S, Pantzlaff E, Schwitzer D, Kaciroti N, Maslowski E, Ashman LM, Feinberg SE, DaSilva AF. Brain Mechanisms of Virtual Reality Breathing Versus Traditional Mindful Breathing in Pain Modulation: Observational Functional Near-infrared Spectroscopy Study. J Med Internet Res 2021; 23:e27298. [PMID: 34636731 PMCID: PMC8548979 DOI: 10.2196/27298] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Pain is a complex experience that involves sensory-discriminative and cognitive-emotional neuronal processes. It has long been known across cultures that pain can be relieved by mindful breathing (MB). There is a common assumption that MB exerts its analgesic effect through interoception. Interoception refers to consciously refocusing the mind's attention to the physical sensation of internal organ function. OBJECTIVE In this study, we dissect the cortical analgesic processes by imaging the brains of healthy subjects exposed to traditional MB (TMB) and compare them with another group for which we augmented MB to an outside sensory experience via virtual reality breathing (VRB). METHODS The VRB protocol involved in-house-developed virtual reality 3D lungs that synchronized with the participants' breathing cycles in real time, providing them with an immersive visual-auditory exteroception of their breathing. RESULTS We found that both breathing interventions led to a significant increase in pain thresholds after week-long practices, as measured by a thermal quantitative sensory test. However, the underlying analgesic brain mechanisms were opposite, as revealed by functional near-infrared spectroscopy data. In the TMB practice, the anterior prefrontal cortex uniquely modulated the premotor cortex. This increased its functional connection with the primary somatosensory cortex (S1), thereby facilitating the S1-based sensory-interoceptive processing of breathing but inhibiting its other role in sensory-discriminative pain processing. In contrast, virtual reality induced an immersive 3D exteroception with augmented visual-auditory cortical activations, which diminished the functional connection with the S1 and consequently weakened the pain processing function of the S1. CONCLUSIONS In summary, our study suggested two analgesic neuromechanisms of VRB and TMB practices-exteroception and interoception-that distinctively modulated the S1 processing of the ascending noxious inputs. This is in line with the concept of dualism (Yin and Yang).
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Affiliation(s)
- Xiao-Su Hu
- Headache & Orofacial Pain Effort Lab, Biologic and Materials Sciences & Prosthodontics Department, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Katherine Beard
- Headache & Orofacial Pain Effort Lab, Biologic and Materials Sciences & Prosthodontics Department, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Mary Catherine Sherbel
- Headache & Orofacial Pain Effort Lab, Biologic and Materials Sciences & Prosthodontics Department, University of Michigan School of Dentistry, Ann Arbor, MI, United States
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Thiago D Nascimento
- Headache & Orofacial Pain Effort Lab, Biologic and Materials Sciences & Prosthodontics Department, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Sean Petty
- 3D Lab, Digital Media Commons, University of Michigan, Ann Arbor, MI, United States
| | - Eddie Pantzlaff
- Headache & Orofacial Pain Effort Lab, Biologic and Materials Sciences & Prosthodontics Department, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - David Schwitzer
- Headache & Orofacial Pain Effort Lab, Biologic and Materials Sciences & Prosthodontics Department, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Niko Kaciroti
- Headache & Orofacial Pain Effort Lab, Biologic and Materials Sciences & Prosthodontics Department, University of Michigan School of Dentistry, Ann Arbor, MI, United States
- Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States
| | | | - Lawrence M Ashman
- Headache & Orofacial Pain Effort Lab, Biologic and Materials Sciences & Prosthodontics Department, University of Michigan School of Dentistry, Ann Arbor, MI, United States
- Department of Oral & Maxillofacial Surgery, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Stephen E Feinberg
- Headache & Orofacial Pain Effort Lab, Biologic and Materials Sciences & Prosthodontics Department, University of Michigan School of Dentistry, Ann Arbor, MI, United States
- Department of Oral & Maxillofacial Surgery, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Alexandre F DaSilva
- Headache & Orofacial Pain Effort Lab, Biologic and Materials Sciences & Prosthodontics Department, University of Michigan School of Dentistry, Ann Arbor, MI, United States
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31
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Neurocircuitry of Mindfulness-Based Interventions for Substance Use Prevention and Recovery. CURRENT ADDICTION REPORTS 2021. [DOI: 10.1007/s40429-021-00396-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Cognitive Defusion Is a Core Cognitive Mechanism for the Sensory-Affective Uncoupling of Pain During Mindfulness Meditation. Psychosom Med 2021; 83:566-578. [PMID: 33790200 DOI: 10.1097/psy.0000000000000938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Mindfulness meditation can downregulate the experience of pain. However, its specific underlying regulatory mechanisms are still largely unknown. Here, we aimed to investigate the role of cognitive defusion-a form of psychological distancing from internal experiences-in mindfulness-based pain regulation. METHODS We implemented a thermal heat paradigm that was designed to amplify the cognitive-affective aspects of pain in 43 novice meditators (2-day formal training; 51.2% women; 53.2 ± 7.0 years old) and 27 expert meditators (>10,000-hour practice; 44.4% women; 51.9 ± 8.4 years old). We collected pain intensity and unpleasantness reports and trait measures of pain catastrophizing assessed by the Pain Catastrophizing Scale (PCS), cognitive defusion assessed by the Drexel Defusion Scale (DDS), and cognitive fusion assessed by the Cognitive Fusion Questionnaire, as well as of several other constructs commonly reported in the literature. RESULTS Experts reported lower PCS (6.9 ± 5.2 versus 17.2 ± 8.5, p < .001) but higher DDS (39.4 ± 6.4 versus 28.9 ± 6.6, p < .001) than novices. Across participants, the PCS and DDS were negatively correlated and shared unique variance that survived adjusting for other mindfulness-related and cognitive-emotional constructs (β = -0.64, p < .001). Conversely, the relationships between PCS and other commonly reported constructs did not seem specific, as none of the relationships survived adjusting for DDS (adjusted β < 0.25, p > .05). Further supporting the relevance of DDS to pain, both the DDS and PCS specifically predicted pain unpleasantness as opposed to pain intensity. However, DDS seemed to be a more specific predictor of unpleasantness than PCS, as the relationship between DDS and unpleasantness survived adjusting for PCS (adjusted β = -0.33, p = .016), but not vice versa (adjusted β = 0.20, p = .162). We also found that the Cognitive Fusion Questionnaire showed a similar pattern of associations with PCS and pain self-reports to what was found for the DDS, although these associations were less consistent. CONCLUSIONS Collectively, these findings highlight the central role of cognitive defusion in mindfulness-based pain regulation.
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33
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De Benedittis G. Neural Mechanisms of Hypnosis and Meditation-Induced Analgesia: A Narrative Review. Int J Clin Exp Hypn 2021; 69:363-382. [PMID: 33960912 DOI: 10.1080/00207144.2021.1917294] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Meditation and hypnosis have both been found to attenuate pain; however, little is known about similarities and differences in the cognitive modulation of pain. Hypnotic and meditative states (e.g., mindfulness) reduce pain by sharing and overlapping multiple neuro-cognitive mechanisms, but they differ in many respects. While there are overlapping brain networks involved, the nature of these effects seems different. Both phenomena involve frontal modulation of pain-related areas. The role of the dorsolateral prefrontal cortex appears to depend, in hypnosis, on the type of suggestion given and, in meditation, on the level of practice. Whereas the anterior cingulate cortex seems to be a key node in both hypnosis and meditation, the dorsolateral prefrontal cortex appears to engage in hypnosis as a function of suggestion and, in meditation, as a function of proficiency.
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Liu Z, Li L, Liu S, Sun Y, Li S, Yi M, Zheng L, Guo X. Reduced feelings of regret and enhanced fronto-striatal connectivity in elders with long-term Tai Chi experience. Soc Cogn Affect Neurosci 2021; 15:861-873. [PMID: 33007783 PMCID: PMC7543941 DOI: 10.1093/scan/nsaa111] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/15/2019] [Accepted: 07/30/2020] [Indexed: 12/28/2022] Open
Abstract
The current study investigates how long-term Tai Chi experience affects the neural and emotional response to regret in elders. Participants perform the sequential risk-taking task while undergoing functional magnetic resonance imaging (fMRI) scanning. In the task, participants opened a series of boxes consecutively and decided when to stop. Each box contained a reward, except for one which contained a devil. If the devil was revealed, then this served to zero the participant’s gain in that trial. Once stopped, participant’s gains and missed chances were revealed. Behaviorally, the Tai Chi group showed less regret, reduced risk taking, higher levels of nonjudgment of inner experience and less emotional sensitivity to outcome. fMRI results showed that the Tai Chi group demonstrated stronger fronto-striatal functional connectivity in trials with numerous missed chances. The nonjudgment of inner experience mediated the impact of fronto-striatal functional connectivity on Tai Chi practitioners’ emotional sensitivity to outcome. These results highlight that long-term Tai Chi exercise may be effective in alleviating feelings of regret in elders by promoting reduced judgment of inner experience and enhanced emotion regulation through the strengthening of fronto-striatal functional connectivity.
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Affiliation(s)
- Zhiyuan Liu
- School of Psychology, Shaanxi Normal University, Xi'an, China.,Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Materials Science, East China Normal University, Shanghai, China
| | - Lin Li
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, China.,National Demonstration Center for Experimental Psychology Education, East China Normal University, Shanghai, China
| | - Sijia Liu
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Yubin Sun
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Materials Science, East China Normal University, Shanghai, China
| | - Shuang Li
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Meng Yi
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Li Zheng
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, China.,National Demonstration Center for Experimental Psychology Education, East China Normal University, Shanghai, China.,Key Laboratory of Brain Functional Genomics, Ministry of Education, Shanghai Key Laboratory of Brain Functional Genomics, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Xiuyan Guo
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Materials Science, East China Normal University, Shanghai, China.,School of Psychology and Cognitive Science, East China Normal University, Shanghai, China.,National Demonstration Center for Experimental Psychology Education, East China Normal University, Shanghai, China.,Key Laboratory of Brain Functional Genomics, Ministry of Education, Shanghai Key Laboratory of Brain Functional Genomics, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
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35
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Vencatachellum S, van der Meulen M, Van Ryckeghem DML, Van Damme S, Vögele C. Brief mindfulness training can mitigate the influence of prior expectations on pain perception. Eur J Pain 2021; 25:2007-2019. [PMID: 34101937 DOI: 10.1002/ejp.1817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/29/2021] [Accepted: 06/04/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Recent neuroimaging evidence suggests that mindfulness practice may mitigate the biasing influence of prior cognitive and emotional expectations on pain perception. The current study tested this hypothesis using a pain-cueing paradigm, which has reliably been shown to elicit conditioned hypoalgesic and hyperalgesic effects. Specifically, we aimed to investigate whether the instructed use of a mindfulness compared to a suppression strategy differentially modulates the magnitudes of conditioned hypoalgesia and hyperalgesia. METHODS Sixty-two healthy non-meditators were assigned to listen to either brief mindfulness or suppression instructions, in between the conditioning and testing phases of a pain-cueing task. Participants provided ratings of anticipatory anxiety, pain intensity and pain unpleasantness throughout the task. They also completed trait and state self-report measures of mindfulness and pain catastrophizing. RESULTS Results indicated that the paradigm was successful in inducing conditioned hyperalgesic and hypoalgesic effects. Importantly, while we found evidence of cue-induced hyperalgesia in both groups, only the suppression group reported cue-induced hypoalgesia. No group differences in pain ratings were found for unconditioned (novel-cued) stimuli. CONCLUSIONS These findings provide partial support for recently proposed predictive processing models, which posit that mindfulness may lead to a prioritization of current sensory information over previous expectations. We explore potential explanations for the asymmetrical group differences in conditioned hypoalgesia versus conditioned hyperalgesia, and discuss our results in light of recent neuroimaging insights into the neuropsychological mechanisms of mindfulness and expectancy-driven pain modulation. SIGNIFICANCE The current study provides novel insights into the working mechanisms of mindfulness-driven pain modulation. Our data suggest that brief mindfulness training may reduce the influence of prior beliefs and expectations on pain perception. This finding adds to growing evidence suggesting that mindfulness may alleviate pain via neuropsychological mechanisms opposite to those typically observed in conditioning/placebo procedures and other cognitive manipulations. These unique mechanisms underline the potential of mindfulness as an alternative to traditional cognitive pain regulatory strategies.
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Affiliation(s)
- Shervin Vencatachellum
- Department of Behavioural and Cognitive Sciences, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Marian van der Meulen
- Department of Behavioural and Cognitive Sciences, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Dimitri M L Van Ryckeghem
- Department of Behavioural and Cognitive Sciences, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg.,Experimental Health Psychology and Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Stefaan Van Damme
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Claus Vögele
- Department of Behavioural and Cognitive Sciences, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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36
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Berry MP, Lutz J, Schuman-Olivier Z, Germer C, Pollak S, Edwards RR, Gardiner P, Desbordes G, Napadow V. Brief Self-Compassion Training Alters Neural Responses to Evoked Pain for Chronic Low Back Pain: A Pilot Study. PAIN MEDICINE 2021; 21:2172-2185. [PMID: 32783054 DOI: 10.1093/pm/pnaa178] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Self-compassion meditation, which involves compassion toward the self in moments of suffering, shows promise for improving pain-related functioning, but its underlying mechanisms are unknown. This longitudinal, exploratory pilot study investigated the effects of a brief (eight contact hours, two weeks of home practice) self-compassion training on pain-related brain processing in chronic low back pain (cLBP). METHODS We evaluated functional magnetic resonance imaging (fMRI) response to evoked pressure pain and its anticipation during a self-compassionate state and compared altered brain responses following training with changes on self-reported measures of self-compassion (Self-Compassion Scale [SCS]), interoceptive awareness (Multidimensional Assessment of Interoceptive Awareness [MAIA]), and clinical pain intensity. RESULTS In a sample of participants with cLBP (N = 20 total, N = 14 with complete longitudinal data) who underwent self-compassion training, we observed reduced clinical pain intensity and disability (P < 0.01) and increased trait self-compassion and interoceptive awareness (all P < 0.05) following training. Evoked pressure pain response in the right temporo-parietal junction (TPJ) was reduced following training, and decreases were associated with reduced clinical pain intensity. Further, increased fMRI responses to pain anticipation were observed in the right dorsolateral prefrontal cortex (dlPFC) and ventral posterior cingulate cortex (vPCC), and these increases were associated with mean post-training changes in SCS scores and scores from the body listening subscale of the MAIA. DISCUSSION These findings, though exploratory and lacking comparison with a control condition, suggest that self-compassion training supports regulation of pain through the involvement of self-referential (vPCC), salience-processing (TPJ), and emotion regulatory (dlPFC) brain areas. The results also suggest that self-compassion could be an important target in the psychotherapeutic treatment of cLBP, although further studies using controlled experimental designs are needed to determine the specificity of these effects.
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Affiliation(s)
- Michael P Berry
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Jacqueline Lutz
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts.,Center for Mindfulness and Compassion, Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
| | - Zev Schuman-Olivier
- Center for Mindfulness and Compassion, Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
| | - Christopher Germer
- Center for Mindfulness and Compassion, Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
| | - Susan Pollak
- Center for Mindfulness and Compassion, Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paula Gardiner
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Gaelle Desbordes
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Vitaly Napadow
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
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37
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Explanation of emotion regulation mechanism of mindfulness using a brain function model. Neural Netw 2021; 138:198-214. [PMID: 33684653 DOI: 10.1016/j.neunet.2021.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 01/10/2021] [Accepted: 01/29/2021] [Indexed: 11/21/2022]
Abstract
The emotion regulation mechanism of mindfulness plays an important role in the stress reduction effect. Many researchers in the fields of cognitive psychology and cognitive neuroscience have attempted to elucidate this mechanism by documenting the cognitive processes that occur and the neural activities that characterize each process. However, previous findings have not revealed the mechanism of information propagation in the brain that achieves emotion regulation during mindfulness. In this study, we constructed a functional brain model based on its anatomical network structure and a computational model representing the propagation of information between brain regions. We then examined the effects of mindfulness meditation on information propagation in the brain using simulations of changes in the activity of each region. These simulations of changes represent the degree of processing resource allocation to the neural activity via changes in the weights of each region's output. As a result of the simulations, we reveal how the neural activity characteristic of emotion regulation in mindfulness, which has been reported in previous studies, is realized in the brain. Mindfulness meditation increases the weight of the output from each region of the thalamus and sensory cortex, which processes sensory stimuli from the external world. This sensory information activates the insula and anterior cingulate cortex (ACC). The orbitofrontal cortex and dorsolateral prefrontal cortex inhibit amygdala activity (i.e., top-down emotion regulation). However, when mindfulness meditation dominates bottom-up processing via sensory stimuli from the external world, amygdala activity increases through the insula and ACC activation.
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Najafi P, Misery L, Carré JL, Ben Salem D, Dufor O. Itch Matrixes. Front Med (Lausanne) 2021; 8:636904. [PMID: 33718409 PMCID: PMC7943862 DOI: 10.3389/fmed.2021.636904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Peyman Najafi
- Univ Brest, LIEN, Brest, France.,Paris-Saclay Institute of Neuroscience, Centre National de la Recherche Scientifique/Université Paris-Saclay, Gif-sur-Yvette, France
| | - Laurent Misery
- Univ Brest, LIEN, Brest, France.,University Hospital of Brest, Department of Dermatology, Brest, France
| | | | - Douraied Ben Salem
- Univ Brest, LATIM, INSERM UMR, Brest, France.,University Hospital of Brest, Department of Radiology, Brest, France
| | - Olivier Dufor
- Univ Brest, LIEN, Brest, France.,L@bISEN Yncréa Ouest, ISEN, Brest, France
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39
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Kmiecik MJ, Tu FF, Silton RL, Dillane KE, Roth GE, Harte SE, Hellman KM. Cortical Mechanisms of Visual Hypersensitivity in Women at Risk for Chronic Pelvic Pain. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 33501463 PMCID: PMC7836135 DOI: 10.1101/2020.12.03.20242032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Multisensory hypersensitivity (MSH), which refers to persistent discomfort across sensory modalities, is a risk factor for chronic pain. Developing a better understanding of the neural contributions of disparate sensory systems to MSH may clarify its role in the development of chronic pain. We recruited a cohort of women (n=147) enriched with participants with menstrual pain at risk for developing chronic pain. Visual sensitivity was measured using a periodic pattern-reversal stimulus during EEG. Self-reported visual unpleasantness ratings were also recorded. Bladder pain sensitivity was evaluated with an experimental bladder-filling task associated with early clinical symptoms of chronic pelvic pain. Visual stimulation induced unpleasantness was associated with bladder pain and evoked primary visual cortex excitation; however, the relationship between unpleasantness and cortical excitation was moderated by bladder pain. Thus, future studies aimed at reversing the progression of MSH into chronic pain should prioritize targeting of cortical mechanisms responsible for maladaptive sensory input integration.
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Affiliation(s)
- Matthew J Kmiecik
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Frank F Tu
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Rebecca L Silton
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Katlyn E Dillane
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Genevieve E Roth
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Kevin M Hellman
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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Abstract
OBJECTIVE Dispositional mindfulness is associated with reduced pain in clinical and experimental settings. However, researchers have neglected the type of pain assessment, as dispositional mindfulness may have unique benefits for reduced pain sensitivity when relying on summary pain assessments, in contrast to assessing the pain of each noxious stimulus. Here, we test the association between dispositional mindfulness and pain using both trial-by-trial pain assessments and overall summary ratings after acute pain tasks. METHODS One hundred thirty-one healthy adult volunteers (mean age = 29.09 [8.00] years, 55.7% female) underwent two experimental thermal pain paradigms. We tested whether dispositional mindfulness measured with the Mindful Attention Awareness Scale was related to a) heat-evoked pain sensitivity, as measured by pain threshold, pain tolerance, average pain, trial-by-trial ratings, and heat-evoked skin conductance response, and b) summary judgments of sensory and affective pain assessed using the McGill Pain Questionnaire (MPQ). RESULTS Mindful Attention Awareness Scale ratings were associated with decreased pain on the MPQ sensory (B = -0.18, SE = 0.05, 95% confidence interval = -0.29 to -0.07, t = -3.28, p = .001) and affective (B = -0.11, SE = 0.03, 95% confidence interval = -0.18 to -0.05, t = -3.32, p = .001) dimensions but not with experimental thermal pain assessments, including threshold, tolerance, heat-evoked pain, or skin conductance response (p values ≥ .29). CONCLUSIONS In this study, dispositional mindfulness mitigated acute thermal pain only when pain was assessed using the MPQ. These findings may reflect differences in immediate versus retrospective judgments or the type of pain assessed by each measure. Future research should examine regulation processes that may explain these differential analgesic benefits, such as attention, rumination, or reappraisal.
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Collin G, Bauer CCC, Anteraper SA, Gabrieli JDE, Molokotos E, Mesholam-Gately R, Thermenos HW, Seidman LJ, Keshavan MS, Shenton ME, Whitfield-Gabrieli S. Hyperactivation of Posterior Default Mode Network During Self-Referential Processing in Children at Familial High-Risk for Psychosis. Front Psychiatry 2021; 12:613142. [PMID: 33633608 PMCID: PMC7900488 DOI: 10.3389/fpsyt.2021.613142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/04/2021] [Indexed: 11/28/2022] Open
Abstract
Patients with schizophrenia spectrum disorders show disturbances in self-referential processing and associated neural circuits including the default mode network (DMN). These disturbances may precede the onset of psychosis and may underlie early social and emotional problems. In this study, we examined self-referential processing in a group of children (7-12 years) at familial high risk (FHR) for psychosis (N = 17), compared to an age and sex-matched group of healthy control (HC) children (N = 20). The participants were presented with a list of adjectives and asked to indicate whether or not the adjectives described them (self-reference condition) and whether the adjectives described a good or bad trait (semantic condition). Three participants were excluded due to chance-level performance on the semantic task, leaving N = 15 FHR and N = 19 HC for final analysis. Functional MRI (fMRI) was used to measure brain activation during self-referential vs. semantic processing. Internalizing and externalizing problems were assessed with the Child Behavior Checklist (CBCL). Evaluating main effects of task (self > semantic) showed activation of medial prefrontal cortex in HC and precuneus/posterior cingulate cortex (PCC) in FHR. Group-comparison yielded significant results for the FHR > HC contrast, showing two clusters of hyperactivation in precuneus/ PCC (p = 0.004) and anterior cerebellum / temporo-occipital cortex (p = 0.009). Greater precuneus/PCC activation was found to correlate with greater CBCL internalizing (r = 0.60, p = 0.032) and total (r = 0.69, p = 0.009) problems. In all, this study shows hyperactivity of posterior DMN during self-referential processing in pre-adolescent FHR children. This finding posits DMN-related disturbances in self-processing as a developmental brain abnormality associated with familial risk factors that predates not just psychosis, but also the prodromal stage. Moreover, our results suggest that early disturbances in self-referential processing may be related to internalizing problems in at-risk children.
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Affiliation(s)
- Guusje Collin
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, Netherlands
| | - Clemens C C Bauer
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Psychology, Northeastern University, Boston, MA, United States
| | - Sheeba Arnold Anteraper
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Psychology, Northeastern University, Boston, MA, United States
| | - John D E Gabrieli
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Elena Molokotos
- Department of Psychology, Suffolk University, Boston, MA, United States
| | - Raquelle Mesholam-Gately
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Heidi W Thermenos
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Larry J Seidman
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Susan Whitfield-Gabrieli
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Psychology, Northeastern University, Boston, MA, United States
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Inter-individual predictors of pain inhibition during performance of a competing cognitive task. Sci Rep 2020; 10:21785. [PMID: 33311585 PMCID: PMC7732830 DOI: 10.1038/s41598-020-78653-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 11/24/2020] [Indexed: 11/08/2022] Open
Abstract
The main function of pain is to automatically draw attention towards sources of potential injury. However, pain sometimes needs to be inhibited in order to address or pursue more relevant tasks. Elucidating the factors that influence how people manage this relationship between pain and task performance is essential to understanding the disruptive nature of pain and its variability between individuals. Here, 41 healthy adults completed a challenging working memory task (2-back task) while receiving painful thermal stimulations. Examining the trial-by-trial relationship between pain perception and task performance revealed that pain's disruptive effects on performance were mediated by self-reported pain intensity, and that the analgesic effects of a competing task were influenced by task performance. We found that higher pain catastrophizing, higher trait anxiety, and lower trait mindfulness were associated with larger trade-offs between pain perception and task performance, suggesting that these psychological factors can predict increased fluctuations between disruption by pain and analgesia from a competing task. Altogether these findings provide an important and novel perspective on our understanding of individual differences in the interplay between pain and ongoing task performance.
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Efficacy and Feasibility of Behavioral Treatments for Migraine, Headache, and Pain in the Acute Care Setting. Curr Pain Headache Rep 2020; 24:66. [PMID: 32979092 DOI: 10.1007/s11916-020-00899-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW This narrative review examines the use of behavioral interventions for acute treatment of headache and pain in the emergency department (ED)/urgent care (UC) and inpatient settings. RECENT FINDINGS Behavioral interventions demonstrate reductions of pain and associated disability in headache, migraine, and other conditions in the outpatient setting. Behavioral treatments may be a useful addition for patients presenting with acute pain to hospitals and emergency departments. We review challenges and limitations and offer suggestions for implementation of behavioral interventions in the acute setting. Some evidence exists for relaxation-based treatments, mindfulness-based treatments, hypnosis/self-hypnosis, and immersive virtual reality for acute pain, migraine, and headache. There are few high-quality studies on behavioral treatments in the inpatient and emergency department settings. Further research is warranted to determine the efficacy and cost-effectiveness of these interventions. Given the general safety and cost-effectiveness of behavioral interventions, healthcare professionals may want to include these therapies in treatment plans.
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Tobe M, Saito S. Analogy between classical Yoga/Zen breathing and modern clinical respiratory therapy. J Anesth 2020; 34:944-949. [PMID: 32803435 PMCID: PMC7429199 DOI: 10.1007/s00540-020-02840-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/09/2020] [Indexed: 11/25/2022]
Abstract
Anesthesiologists and intensivists are modern-day professionals who provide appropriate respiratory care, vital for patient survival. Recently, anesthesiologists have increasingly focused their attention on the type of spontaneous breathing made by non-intubated patients with pulmonary disease cared for in an intensive care unit, and also patients with chronic pain receiving cognitive behavioral therapy. Prior to our modern understanding of respiratory physiology, Zen meditators recognized that breathing has a significant impact on a person’s mental state and general physical well-being. Examples of this knowledge regarding respiration include the beneficial effects of deep inhalation and slow exhalation on anxiety and general wellness. The classical literature has noted many suggestions for breathing and its psycho-physical effects. In the present review, we examine the effect of classical breathing methods and find an analogy between typical Yoga/Zen breathing and modern clinical respiratory therapy. Evidence is increasing about historical breathing and related meditation techniques that may be effective in modern clinical practice, especially in the field of anesthesiology, such as in improving respiratory function and reducing chronic pain. Clarification of the detailed mechanisms involved is anticipated.
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Affiliation(s)
- Masaru Tobe
- Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma, 371-8511, Japan.
| | - Shigeru Saito
- Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma, 371-8511, Japan
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Jinich-Diamant A, Garland E, Baumgartner J, Gonzalez N, Riegner G, Birenbaum J, Case L, Zeidan F. Neurophysiological Mechanisms Supporting Mindfulness Meditation–Based Pain Relief: an Updated Review. Curr Pain Headache Rep 2020; 24:56. [DOI: 10.1007/s11916-020-00890-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Seminowicz DA, Burrowes SAB, Kearson A, Zhang J, Krimmel SR, Samawi L, Furman AJ, Keaser ML, Gould NF, Magyari T, White L, Goloubeva O, Goyal M, Peterlin BL, Haythornthwaite JA. Enhanced mindfulness-based stress reduction in episodic migraine: a randomized clinical trial with magnetic resonance imaging outcomes. Pain 2020; 161:1837-1846. [PMID: 32701843 PMCID: PMC7487005 DOI: 10.1097/j.pain.0000000000001860] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We aimed to evaluate the efficacy of an enhanced mindfulness-based stress reduction (MBSR+) vs stress management for headache (SMH). We performed a randomized, assessor-blind, clinical trial of 98 adults with episodic migraine recruited at a single academic center comparing MBSR+ (n = 50) with SMH (n = 48). MBSR+ and SMH were delivered weekly by group for 8 weeks, then biweekly for another 8 weeks. The primary clinical outcome was reduction in headache days from baseline to 20 weeks. Magnetic resonance imaging (MRI) outcomes included activity of left dorsolateral prefrontal cortex (DLPFC) and cognitive task network during cognitive challenge, resting state connectivity of right dorsal anterior insula to DLPFC and cognitive task network, and gray matter volume of DLPFC, dorsal anterior insula, and anterior midcingulate. Secondary outcomes were headache-related disability, pain severity, response to treatment, migraine days, and MRI whole-brain analyses. Reduction in headache days from baseline to 20 weeks was greater for MBSR+ (7.8 [95% CI, 6.9-8.8] to 4.6 [95% CI, 3.7-5.6]) than for SMH (7.7 [95% CI 6.7-8.7] to 6.0 [95% CI, 4.9-7.0]) (P = 0.04). Fifty-two percent of the MBSR+ group showed a response to treatment (50% reduction in headache days) compared with 23% in the SMH group (P = 0.004). Reduction in headache-related disability was greater for MBSR+ (59.6 [95% CI, 57.9-61.3] to 54.6 [95% CI, 52.9-56.4]) than SMH (59.6 [95% CI, 57.7-61.5] to 57.5 [95% CI, 55.5-59.4]) (P = 0.02). There were no differences in clinical outcomes at 52 weeks or MRI outcomes at 20 weeks, although changes related to cognitive networks with MBSR+ were observed. Enhanced mindfulness-based stress reduction is an effective treatment option for episodic migraine.
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Affiliation(s)
- David A. Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Shana AB Burrowes
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Alexandra Kearson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21224
| | - Jing Zhang
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Samuel R Krimmel
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Program in Neuroscience, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Luma Samawi
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Andrew J Furman
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Program in Neuroscience, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Michael L Keaser
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Neda F. Gould
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21224
| | - Trish Magyari
- Private Mindfulness-based Psychotherapy Practice, 3511 N Calvert St, Baltimore, MD 21218
| | - Linda White
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21224
| | - Olga Goloubeva
- University of Maryland Greenebaum Comprehensive Cancer Center, University of Maryland Baltimore, Baltimore, MD, USA 21201
| | - Madhav Goyal
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287
| | - B. Lee Peterlin
- Neuroscience Institute, Penn Medicine Lancaster General Health, Lancaster, PA, USA 17601
| | - Jennifer A. Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21224
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Kober H, Buhle J, Weber J, Ochsner KN, Wager TD. Let it be: mindful acceptance down-regulates pain and negative emotion. Soc Cogn Affect Neurosci 2020; 14:1147-1158. [PMID: 31989171 PMCID: PMC7057281 DOI: 10.1093/scan/nsz104] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 09/23/2019] [Accepted: 10/22/2019] [Indexed: 11/12/2022] Open
Abstract
Mindfulness training ameliorates clinical and self-report measures of depression and chronic pain, but its use as an emotion regulation strategy—in individuals who do not meditate—remains understudied. As such, whether it (i) down-regulates early affective brain processes or (ii) depends on cognitive control systems remains unclear. We exposed meditation-naïve participants to two kinds of stimuli: negative vs. neutral images and painful vs. warm temperatures. On alternating blocks, we asked participants to either react naturally or exercise mindful acceptance. Emotion regulation using mindful acceptance was associated with reductions in reported pain and negative affect, reduced amygdala responses to negative images and reduced heat-evoked responses in medial and lateral pain systems. Critically, mindful acceptance significantly reduced activity in a distributed, a priori neurologic signature that is sensitive and specific to experimentally induced pain. In addition, these changes occurred in the absence of detectable increases in prefrontal control systems. The findings support the idea that momentary mindful acceptance regulates emotional intensity by changing initial appraisals of the affective significance of stimuli, which has consequences for clinical treatment of pain and emotion.
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Affiliation(s)
- Hedy Kober
- Departments of Psychiatry, Yale University, New Haven, CT
| | - Jason Buhle
- Department of Psychology, Columbia University, New York, NY
| | - Jochen Weber
- Department of Psychology, Columbia University, New York, NY
| | | | - Tor D Wager
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO.,Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH
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Novaes MM, Palhano-Fontes F, Onias H, Andrade KC, Lobão-Soares B, Arruda-Sanchez T, Kozasa EH, Santaella DF, de Araujo DB. Effects of Yoga Respiratory Practice ( Bhastrika pranayama) on Anxiety, Affect, and Brain Functional Connectivity and Activity: A Randomized Controlled Trial. Front Psychiatry 2020; 11:467. [PMID: 32528330 PMCID: PMC7253694 DOI: 10.3389/fpsyt.2020.00467] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 05/06/2020] [Indexed: 12/11/2022] Open
Abstract
Pranayama refers to a set of yoga breathing exercises. Recent evidence suggests that the practice of pranayama has positive effects on measures of clinical stress and anxiety. This study explored the impact of a Bhastrika pranayama training program on emotion processing, anxiety, and affect. We used a randomized controlled trial design with thirty healthy young adults assessed at baseline and after 4 weeks of pranayama practices. Two functional magnetic resonance imaging (MRI) protocols were used both at baseline and post-intervention: an emotion task as well as a resting-state acquisition. Our results suggest that pranayama significantly decreased states of anxiety and negative affect. The practice of pranayama also modulated the activity of brain regions involved in emotional processing, particularly the amygdala, anterior cingulate, anterior insula, and prefrontal cortex. Resting-state functional MRI (fMRI) showed significantly reduced functional connectivity involving the anterior insula and lateral portions of the prefrontal cortex. Correlation analysis revealed that changes in connectivity between the ventrolateral prefrontal cortex and the right anterior insula were associated with changes in anxiety. Although it should be noted that these analyses were preliminary and exploratory, it provides the first evidence that 4 weeks of B. pranayama significantly reduce the levels of anxiety and negative affect, and that these changes are associated with the modulation of activity and connectivity in brain areas involved in emotion processing, attention, and awareness. The study was registered at https://www.ensaiosclinicos.gov.br/rg/RBR-2gv5c2/(RBR-2gv5c2).
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Affiliation(s)
- Morgana M. Novaes
- Brain Institute, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
- Onofre Lopes University Hospital, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Fernanda Palhano-Fontes
- Brain Institute, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
- Onofre Lopes University Hospital, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Heloisa Onias
- Brain Institute, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
- Onofre Lopes University Hospital, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Katia C. Andrade
- Brain Institute, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
- Onofre Lopes University Hospital, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Bruno Lobão-Soares
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Tiago Arruda-Sanchez
- Department of Radiology, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Danilo F. Santaella
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Sports Center, University of São Paulo (CEPE-USP), São Paulo, Brazil
| | - Draulio Barros de Araujo
- Brain Institute, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
- Onofre Lopes University Hospital, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
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Wenzel M, Rowland Z, Kubiak T. How mindfulness shapes the situational use of emotion regulation strategies in daily life. Cogn Emot 2020; 34:1408-1422. [PMID: 32375595 DOI: 10.1080/02699931.2020.1758632] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Mindfulness is associated with a wide range of beneficial outcomes such as well-being. However, less is known about the mechanisms underlying these benefits. Some researchers suggest that the benefits could be driven by emotion regulation, either by improving the effectiveness of emotion regulation or by lessening the need for effortful emotion regulation. By using two longitudinal Ambulatory Assessment data sets (NStudy1 = 125, NStudy2 = 175), based on a six-week randomised controlled trial and a one-week study, we tested these competing notions in daily life and found support for the latter: Mindfulness, and especially its non-judgmental acceptance facet, was significantly associated with less use of emotion regulation strategies. However, mindfulness was not significantly associated with more effective emotion regulation strategy implementation. Moreover, the mindfulness training focusing on present-moment attention and awareness did not significantly influence emotion regulation. These findings demonstrate the importance of the non-judgmental acceptance component for emotion regulation and affective well-being.
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Affiliation(s)
- Mario Wenzel
- Institute of Psychology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Zarah Rowland
- Institute of Psychology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas Kubiak
- Institute of Psychology, Johannes Gutenberg University Mainz, Mainz, Germany
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Zorn J, Abdoun O, Bouet R, Lutz A. Mindfulness meditation is related to sensory-affective uncoupling of pain in trained novice and expert practitioners. Eur J Pain 2020; 24:1301-1313. [PMID: 32311185 DOI: 10.1002/ejp.1576] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/18/2020] [Accepted: 04/14/2020] [Indexed: 01/17/2023]
Abstract
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.
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Affiliation(s)
- Jelle Zorn
- Lyon Neuroscience Research Centre, INSERM U1028, CNRS, UMR5292, Lyon 1 University, Bron Cedex, Lyon, France
| | - Oussama Abdoun
- Lyon Neuroscience Research Centre, INSERM U1028, CNRS, UMR5292, Lyon 1 University, Bron Cedex, Lyon, France
| | - Romain Bouet
- Lyon Neuroscience Research Centre, INSERM U1028, CNRS, UMR5292, Lyon 1 University, Bron Cedex, Lyon, France
| | - Antoine Lutz
- Lyon Neuroscience Research Centre, INSERM U1028, CNRS, UMR5292, Lyon 1 University, Bron Cedex, Lyon, France
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