Mindfulness-based cognitive therapy is associated with distinct resting-state neural patterns in patients with generalized anxiety disorder

Effects of brief mindfulness training on smoking cue-reactivity in tobacco use disorder: Study protocol for a randomized controlled trial

BACKGROUND

The prevalence of Tobacco Use Disorder (TUD) represents a significant and pressing global public health concern, with far-reaching and deleterious consequences for individuals, communities, and healthcare systems. The craving caused by smoking cue is an important trigger for relapse, fundamentally hindering the cessation of cigarette smoking. Mindfulness interventions focusing on cue-reactivity was effective for the treatment of related dependence. Brief mindfulness training (BMT) meets the short-term needs for intervention but the effects still need to be examined. The objective of the present study is to investigate the impact of BMT intervention on smoking cue-reactivity among Chinese college students with TUD, to uncover the dynamic models of brain function involved in this process.

METHOD

A randomized control trial (RCT) based on electroencephalography (EEG) was designed. We aim to recruit 90 participants and randomly assign to the BMT and control group (CON) with 1:1 ratio. A brief mindfulness training will be administered to experimental group. After the intervention, data collection will be conducted in the follow-up stage with 5 timepoints of assessments. EEG data will be recorded during the smoking cue-reactivity task and 'STOP' brief mindfulness task. The primary outcomes include subjective reports of smoking craving, changes in EEG indicators, and mindfulness measures. The secondary outcomes will be daily smoking behaviours, affect and impulsivity, as well as indicators reflecting correlation between mindfulness and smoking cue-reactivity. To evaluate the impact of mindfulness training, a series of linear mixed-effects models will be employed. Specifically, within-group effects will be examined by analysing the longitudinal data. Additionally, the effect size for all statistical measurements will be reported, offering a comprehensive view of the observed effects.

DISCUSSION

The current study aims to assess the impact of brief mindfulness-based intervention on smoking cue-reactivity in TUD. It also expected to enhance our understanding of the underlying processes involved in brain function and explore potential EEG biomarkers at multiple time points.

TRIAL REGISTRATION

Trial registration number: ChiCTR2300069363, registered on 14 March 2023. Protocol Version 1.0., 10 April 2023.

Breaking the Fear Barrier: Aberrant Activity of Fear Networks as a Prognostic Biomarker in Patients with Panic Disorder Normalized by Pharmacotherapy

Panic disorder (PD) is a prevalent type of anxiety disorder. Previous studies have reported abnormal brain activity in the fear network of patients with PD. Nonetheless, it remains uncertain whether pharmacotherapy can effectively normalize these abnormalities. This longitudinal resting-state functional magnetic resonance imaging study aimed to investigate the spontaneous neural activity in patients with PD and its changes after pharmacotherapy, with a focus on determining whether it could predict treatment response. The study included 54 drug-naive patients with PD and 54 healthy controls (HCs). Spontaneous neural activity was measured using regional homogeneity (ReHo). Additionally, support vector regression (SVR) was employed to predict treatment response from ReHo. At baseline, PD patients had aberrant ReHo in the fear network compared to HCs. After 4 weeks of paroxetine treatment (20 mg/day), a significant increase in ReHo was observed in the left fusiform gyrus, which had shown reduced ReHo before treatment. The SVR analysis showed significantly positive correlations (p < 0.0001) between the predicted and actual reduction rates of the severity of anxiety and depressive symptoms. Here, we show patients with PD had abnormal spontaneous neural activities in the fear networks. Furthermore, these abnormal spontaneous neural activities can be partially normalized by pharmacotherapy and serve as candidate predictors of treatment response. Gaining insight into the trajectories of brain activity normalization following treatment holds the potential to provide vital insights for managing PD.

Psychological Outcomes and Mechanisms of Mindfulness-Based Training for Generalised Anxiety Disorder: A Systematic Review and Meta-Analysis

This systematic review aimed to identify 1) the effect of mindfulness training on pre-post measures of anxiety and attention among adults experiencing high levels of generalised anxiety; and 2) the impact of predictors, mediators and moderators on post-intervention changes in anxiety or attention. Trait mindfulness and distress measures were included as secondary outcomes. A systematic search was conducted in November 2021 in electronic databases using relevant search terms. Eight articles comprising four independent studies were included (N = 334). All studies included participants diagnosed with generalised anxiety disorder (GAD) who participated in an 8-week manualised program. The meta-analysis indicated that mindfulness training had a large effect on anxiety symptoms (g = -1.92, 95%CI[-3.44, -0.40]) when compared to inactive (i.e., care as usual, waitlist) or non-specified (i.e., condition not defined) controls. However, a significant effect was not found when compared to active controls. Effects for depression, worry and trait mindfulness did not reach statistical significance, despite small-large effect sizes favouring mindfulness compared to inactive/non-specified controls. Our narrative review found evidence that changes in aspects of trait mindfulness mediate anxiety reduction following mindfulness training. However, a small number of studies were available for inclusion in the review, with high risk of bias and low certainty of evidence present. Overall, the findings support the use of mindfulness training programs for GAD and indicate mechanisms that may differ from those involved in other cognitive therapy approaches. Further RCTs with evidence-based controls are needed to clarify techniques most beneficial for generalised anxiety to support individually tailored treatment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-023-04695-x.

Common and exclusive spontaneous neural activity patterns underlying pure generalized anxiety disorder and comorbid generalized anxiety disorder and depression

BACKGROUND

This study aimed to identify common and exclusive neural substrates underlying pure generalized anxiety disorder (GAD, G0) and comorbid GAD and depression (G1), assess whether they could assist in diagnosis and prediction of treatment response, and determine whether comorbid depression in GAD patients would change their neural plasticity.

METHODS

A longitudinal study was conducted, involving 98 patients (40 in the G0 group and 58 in the G1 group) and 54 healthy controls (HCs). The fractional amplitude of low-frequency fluctuations (fALFF), support vector machine, and support vector regression were employed.

RESULTS

The shared neural underpinnings across the two subtypes of GAD were hyperactivity in the right cerebellar Crus II and inferior temporal gyrus and hypoactivity in the right postcentral gyrus. The G1 group showed hypoactivity in the frontal gyrus, compared with HCs, and hyperactivity in the middle temporal gyrus, compared with the G0 group or HCs. These alterations could aid in diagnosis and the prediction of treatment response with high accuracy. After treatment, both the G1 and G0 groups showed higher fALFF than those before treatment but were located in different brain regions.

LIMITATIONS

The study was performed in a single center and subjects showed a fairly homogeneous ethnicity.

CONCLUSIONS

Common and exclusive neural substrates underlying the two subtypes of GAD were identified, which could assist in diagnosis and the prediction of treatment response. Pharmacotherapy for the two subtypes of GAD recruited different pathways, suggesting that comorbid depression in GAD patients would change their neural plasticity.

The effects of mindfulness-based interventions on anxiety, depression, stress, and mindfulness in menopausal women: A systematic review and meta-analysis

Background

Mindfulness-based interventions (MBIs) are psychological interventions widely used in menopausal women. Currently, there is no evidence summary on the effectiveness of MBIs on anxiety, depression, stress, and mindfulness in menopausal women. This meta-analysis examines the effectiveness of MBIs in improving anxiety, depression, stress, and mindfulness scores in menopausal women.

Methods

A systematic search was conducted in PubMed, Embase, Web of Science, the Cochrane Library, CNKI (China National Knowledge Infrastructure), and Wanfang, using relevant terms such as MBIs as keywords and covering all studies published before March 13, 2022. The outcomes were anxiety, depression, stress, and mindfulness. The screening and extraction of data were conducted by two independent reviewers.

Results

A total of 1,138 menopausal women participated in 13 studies. Meta-analysis results showed that MBIs significantly reduced stress in menopausal women (SMD = -0.84, 95% CI: -1.64 to -0.05, p = 0.04), but no statistical differences were found in reducing anxiety (SMD = -0.40, 95% CI: -0.81 to 0.01, p = 0.06) and depression (SMD = -0.19, 95% CI: -0.45 to 0.07, p = 0.16) and in raising the scores of mindfulness (SMD = 0.37, 95% CI: -0.06 to 0.81, p = 0.09) in menopausal women.

Conclusion

MBIs may reduce stress in menopausal women, but their effect on improving anxiety, depression, and mindfulness needs further validation.

Systematic review registration

https://www.crd.york.ac.uk/prospero/#recordDetails.

Interoceptive awareness: MBSR training alters information processing of salience network

Mindfulness refers to a mental state of awareness of internal experience without judgment. Studies have suggested that each mindfulness practice may involve a unique mental state, but the underlying neurophysiological mechanisms remain unknown. Here we examined how distinct mindfulness practices after mindfulness-based intervention alter brain functionality. Specifically, we investigated the functional alterations of the salience network (SN) using functional magnetic resonance imaging (fMRI) among the two interoceptive mindfulness practices-breathing and body scan-associated with interoceptive awareness in fixed attention and shifted attention, respectively. Long-distance functional connectivity (FC) and regional homogeneity (ReHo) approaches were applied to measure distant and local neural information processing across various mental states. We hypothesized that mindful breathing and body scan would yield a unique information processing pattern in terms of long-range and local functional connectivity (FC). A total of 18 meditation-naïve participants were enrolled in an 8-week mindfulness-based stress reduction (MBSR) program alongside a waitlist control group (n = 14), with both groups undergoing multiple fMRI sessions during breathing, body scan and resting state for comparison. We demonstrated that two mindfulness practices affect both the long-distance FC _SN and the local ReHo, only apparent after the MBSR program. Three functional distinctions between the mindfulness practices and the resting state are noted: (1) distant SN connectivity to occipital regions increased during the breathing practice (fixed attention), whereas the SN increased connection with the frontal/central gyri during the body scan (shifting attention); (2) local ReHo increased only in the parietal lobe during the body scan (shifting attention); (3) distant and local connections turned into a positive correlation only during the mindfulness practices after the MBSR training, indicating a global enhancement of the SN information processing during mindfulness practices. Though with limited sample size, the functional specificity of mindfulness practices offers a potential research direction on neuroimaging of mindfulness, awaiting further studies for verification.

Neural correlates of psychodynamic and non-psychodynamic therapies in different clinical populations through fMRI: A meta-analysis and systematic review

Background

The COVID-19 pandemic has exacerbated the ongoing crisis in psychiatric and psychological care, contributing to what we have identified as a new psychological and psychiatric pandemic. Psychotherapy is an effective method for easing the psychological suffering experienced also by the various impacts of COVID-19. This treatment can be examined from a neurological perspective, through the application of brain imaging techniques. Specifically, the meta-analysis of imaging studies can aid in expanding researchers' understanding of the many beneficial applications of psychotherapy.

Objectives

We examined the functional brain changes accompanying different mental disorders with functional Magnetic Resonance Imaging (fMRI), through a meta-analysis, and systematic review in order to better understand the general neural mechanism involved in psychotherapy and the potential neural difference between psychodynamic and non-psychodynamic approaches.

Data sources

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were employed for our systematic review and meta-analysis. We conducted a computer-based literature search, following the Population, Intervention, Comparison and Outcomes (PICO) approach, to retrieve all published articles in English regarding the above-described topics from PubMed (MEDLINE), Scopus, and Web of Science.

Study eligibility criteria participants and interventions

We combined terms related to psychotherapy and fMRI: ("psychotherapy" [All Fields] OR "psychotherapy" [MeSH Terms] OR "psychotherapy" [All Fields] OR "psychotherapies" [All Fields] OR "psychotherapy s" [All Fields]) AND ("magnetic resonance imaging" [MeSH Terms]) OR ("magnetic"[All Fields] AND "resonance"[All Fields] AND "imaging"[All Fields]) OR ("magnetic resonance imaging"[All Fields] OR "fmri"[All Fields]). We considered (1) whole brain fMRI studies; (2) studies in which participants have been involved in a clinical trial with psychotherapy sessions, with pre/post fMRI; (3) fMRI results presented in coordinate-based (x, y, and z) in MNI or Talairach space; (4) presence of neuropsychiatric patients. The exclusion criteria were: (1) systematic review or meta-analysis; (2) behavioral study; (3) single-case MRI or fMRI study; and (4) other imaging techniques (i.e., PET, SPECT) or EEG.

Results

After duplicates removal and assessment of the content of each published study, we included 38 sources. The map including all studies that assessed longitudinal differences in brain activity showed two homogeneous clusters in the left inferior frontal gyrus, and caudally involving the anterior insular cortex (p < 0.0001, corr.). Similarly, studies that assessed psychotherapy-related longitudinal changes using emotional or cognitive tasks (TASK map) showed a left-sided homogeneity in the anterior insula (p < 0.000) extending to Broca's area of the inferior frontal gyrus (p < 0.0001) and the superior frontal gyrus (p < 0.0001). Studies that applied psychodynamic psychotherapy showed Family-Wise Error (FWE) cluster-corrected (p < 0.05) homogeneity values in the right superior and inferior frontal gyri, with a small cluster in the putamen. No FWE-corrected homogeneity foci were observed for Mindful- based and cognitive behavioral therapy psychotherapy. In both pre- and post-therapy results, studies showed two bilateral clusters in the dorsal anterior insulae (p = 0.00001 and p = 0.00003, respectively) and involvement of the medial superior frontal gyrus (p = 0.0002).

Limitations

Subjective experiences, such as an individual's response to therapy, are intrinsically challenging to quantify as objective, factual realities. Brain changes observed both pre- and post-therapy could be related to other factors, not necessary to the specific treatment received. Therapeutic modalities and study designs are generally heterogeneous. Differences exist in sample characteristics, such as the specificity of the disorder and number and duration of sessions. Moreover, the sample size is relatively small, particularly due to the paucity of studies in this field and the little contribution of PDT.

Conclusions and implications of key findings

All psychological interventions seem to influence the brain from a functional point of view, showing their efficacy from a neurological perspective. Frontal, prefrontal regions, insular cortex, superior and inferior frontal gyrus, and putamen seem involved in these neural changes, with the psychodynamic more linked to the latter three regions.

Mindfulness meditation increases default mode, salience, and central executive network connectivity

Recent research has begun to identify the neural mechanisms underlying the beneficial impact of mindfulness meditation training (MMT) on health and cognition. However, little is known about the effects of MMT on the global interplay of large-scale networks (LSNs) in the brain. In the present study, healthy, meditation-naïve adults (N = 46) underwent resting state fMRI prior to and upon completing 31 days of MMT or an active control intervention. Independent component analysis, sliding time window, and seed-based correlation analyses were performed to assess training-related changes in functional connectivity (FC) within and between networks with relevance to mindfulness meditation. Across sliding time window analyses and seed-based correlation analyses, we found increased FC between nodes of the default mode network (DMN) and nodes of the salience network (SN) in participants of the MMT. Seed-based correlation analyses revealed further connectivity increases between the SN and key regions of the central executive network (CEN). These results indicate, that, among multiple LSNs, one month of mindfulness meditation effectively increases interconnectivity between networks of the triple network model (DMN, SN, CEN), hereby introducing a potential mechanistic concept underlying the beneficial impact of MMT.

Clinical trial registration: This study is listed as a clinical trial on the ISRCTN registry with trial ID ISRCTN95197731 (date of first registration: 15/02/2022).

Classification of Mindfulness Meditation and Its Impact on Neural Measures in the Clinical Population

Different forms of mindfulness meditation are increasingly integrated in the clinical practice in the last three decades. Previous studies have identified changes in the neurophysiology and neurochemistry of the brain resulting from different mindfulness meditation practices in the general population. However, research on neural correlates of different types of meditation, particularly on the clinical outcomes, is still very sparse. Therefore, the aim of this article is to review the neural impact of mindfulness meditation interventions on different mental disorders via the classification of main components of mindfulness meditation. The clearer classification of mindfulness meditation may inform future clinical practice and research directions.

Neurocircuitry of Treatment in Anxiety Disorders

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Alterations of regional spontaneous brain activities in anxiety disorders: A meta-analysis

BACKGROUND

Recent resting-state functional magnetic resonance imaging studies have provided strong evidence of abnormal regional spontaneous brain activities among anxiety-disordered patients. However, the evidence has been divergent and inconclusive. Therefore, it is necessary to perform a meta-analysis identifying a common pattern of altered regional spontaneous brain activity for anxiety disorders.

METHOD

Corresponding research of anxiety disorders, namely, whole-brain rs-fMRI studies that measured differences in regional homogeneity, amplitude of low-frequency fluctuations, or fractional amplitude of low-frequency fluctuations, were analyzed in this study. Overall, seven studies with 235 anxiety-disordered patients and 241 healthy controls were ultimately included in the meta-analysis. The meta-analysis was processed by seed-based d mapping.

RESULTS

Compared with healthy controls, patients with anxiety disorders showed significantly decreased regional spontaneous brain activities in the right putamen, the right orbital inferior frontal gyrus, and the right temporal pole. No increases in regional spontaneous brain activities were detected in patients relative to the controls.

LIMITATION

Limited number of available studies, only Asian samples, and insufficient information of sample characteristics.

CONCLUSION

The present study suggests that anxiety disorders are associated with aberrant regional brain activity in areas connected with emotion processing, which extends our understanding of anxiety disorders' pathophysiology.

Calcarine as a bridge between brain function and structure in irritable bowel syndrome: A multiplex network analysis

BACKGROUND AND AIM

Jointly analyzing structural and functional brain networks enables a better understanding of pathological underpinnings of irritable bowel syndrome (IBS). Multiplex network analysis provides a novel framework to study complex networks consisting of different types of connectivity patterns in multimodal data.

METHODS

In the present work, we integrated functional and structural networks to a multiplex network. Then, the multiplex metrics and the inner-layer/inter-layer hub nodes were investigated through 34 patients with IBS and 33 healthy controls.

RESULTS

Significantly differential multiplex degree in both left and right parts of calcarine was found, and meanwhile, IBS patients lost inner-layer hub properties in these regions. In addition, the left fusiform was no longer practicing as an inner-layer hub node, while the right median cingulate acted as a new inner-layer hub node in the IBS patients. Besides, the right calcarine, which lost its inner-layer hub identity, became a new inter-layer hub node, and the multiplex degree of the left hippocampus, which lost its inter-layer hub identity in IBS patients, was significantly positively correlated with the IBS Symptom Severity Score scores.

CONCLUSIONS

Inner-layer hub nodes of multiplex networks were preferentially vulnerable, and some inner-layer hub nodes would convert into inter-layer hub nodes in IBS patients. Besides, the inter-layer hub nodes might be influenced by IBS severity and therefore converted to general nodes.

The prevalence of depressive and anxiety symptoms and their associations with quality of life among clinically stable older patients with psychiatric disorders during the COVID-19 pandemic

The impact of the COVID-19 pandemic on clinically stable older patients with psychiatric disorders is unclear. This study examined the prevalence of depressive and anxiety symptoms, and their associations with quality of life (QOL) in clinically stable older patients with psychiatric disorders during the COVID-19 pandemic. This was a multicenter, cross-sectional study. Depressive and anxiety symptoms, insomnia, pain, and QOL were assessed with standardized instruments. A total of 1063 patients were included. The prevalence of depressive and anxiety symptoms, and combined depressive and anxiety symptoms were 62.3% (95%CI = 59.4-65.2%), 52.4% (95%CI = 49.3-55.4%), and 45.9% (95%CI = 42.9-48.9%), respectively. Patients with depressive and anxiety symptoms had significantly lower QOL than those without (P < 0.01). Binary logistic regression analyses revealed that having depressive symptoms was positively associated with more severe insomnia (OR = 1.29, P < 0.01) and pain (OR = 1.14, P < 0.01), and was negatively associated with other psychiatric diagnoses (except for major depressive disorder, schizophrenia, and organic mental disorder; OR = 0.50, P < 0.01), while having anxiety symptoms was positively associated with severe physical diseases (OR = 1.57, P = 0.02), poor adherence to treatment (OR = 1.50, P < 0.01), and more severe insomnia (OR = 1.15, P < 0.01) and pain (OR = 1.11, P < 0.01). Having combined depression and anxiety symptoms was positively associated with poor adherence to treatment (OR = 1.42, P = 0.02) and more severe insomnia (OR = 1.19, P < 0.01) and pain (OR = 1.15, P < 0.01), and was negatively associated with the diagnosis of schizophrenia (OR = 0.50, P = 0.04) and others (OR = 0.53, P < 0.01). Depressive and anxiety symptoms were common in clinically stable older patients with psychiatric disorders during the COVID-19 pandemic. Considering the negative impact of these symptoms on QOL, regular screening and appropriate treatment are recommended for this population.

Prevalence and socio-demographic correlates of major depressive disorder in older adults in Hebei province, China

BACKGROUND

Major depressive disorder (MDD) is common among older adults. The epidemiology of MDD is greatly influenced by sociocultural and economic factors. This study examined the 1-month and lifetime prevalence of MDD and its socio-demographic correlates in older adults living in Hebei province, an agricultural area of China.

METHODS

Multistage, stratified, random sampling was administered between April and August 2016. The diagnosis of MDD was established with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) Axis I Disorders.

RESULTS

A total of 3911 participants were enrolled. The 1-month and lifetime prevalence of MDD in older adults was 2.0% (95%CI: 1.6-2.4%) and 3.4% (95%CI: 2.8-4.0%), respectively. Multivariable logistic regression analyses revealed that female gender [P < 0.001, adjusted odds ratio (aOR) = 2.6, 95%CI: 1.53-4.53], presence of comorbid major medical conditions (P < 0.001, aOR = 4.8, 95%CI: 2.17-10.39) and family history of psychiatric disorders (P = 0.013, aOR = 3.4, 95%CI: 1.30-8.96) were independently and significantly associated with higher odds of MDD.

CONCLUSION

The prevalence of MDD in older adults in Hebei province, China, was lower than most findings in China and other countries. Nevertheless, continued surveillance of elderly depression in China along with the development of primary, secondary and tertiary preventative interventions for the elderly with MDD is indicated.