Functional neural correlates of mindfulness meditations in comparison with psychotherapy, pharmacotherapy and placebo effect. Is there a link?

Global trends and hotspots in pain associated with bipolar disorder in the last 20 years: a bibliometric analysis

Purpose

The prevalence of comorbid pain and Bipolar Disorder in clinical practice continues to be high, with an increasing number of related publications. However, no study has used bibliometric methods to analyze the research progress and knowledge structure in this field. Our research is dedicated to systematically exploring the global trends and focal points in scientific research on pain comorbidity with bipolar disorder from 2003 to 2023, with the goal of contributing to the field.

Methods

Relevant publications in this field were retrieved from the Web of Science core collection database (WOSSCC). And we used VOSviewer, CiteSpace, and the R package "Bibliometrix" for bibliometric analysis.

Results

A total of 485 publications (including 360 articles and 125 reviews) from 66 countries, 1019 institutions, were included in this study. Univ Toront and Kings Coll London are the leading research institutions in this field. J Affect Disorders contributed the largest number of articles, and is the most co-cited journal. Of the 2,537 scholars who participated in the study, Stubbs B, Vancampfort D, and Abdin E had the largest number of articles. Stubbs B is the most co-cited author. "chronic pain," "neuropathic pain," "psychological pain" are the keywords in the research.

Conclusion

This is the first bibliometric analysis of pain-related bipolar disorder. There is growing interest in the area of pain and comorbid bipolar disorder. Focusing on different types of pain in bipolar disorder and emphasizing pain management in bipolar disorder are research hotspots and future trends. The study of pain related bipolar disorder still has significant potential for development, and we look forward to more high-quality research in the future.

Psycho-Neuroendocrinology in the Rehabilitation Field: Focus on the Complex Interplay between Stress and Pain

Chronic stress and chronic pain share neuro-anatomical, endocrinological, and biological features. However, stress prepares the body for challenging situations or mitigates tissue damage, while pain is an unpleasant sensation due to nociceptive receptor stimulation. When pain is chronic, it might lead to an allostatic overload in the body and brain due to the chronic dysregulation of the physiological systems that are normally involved in adapting to environmental challenges. Managing stress and chronic pain (CP) in neurorehabilitation presents a significant challenge for healthcare professionals and researchers, as there is no definitive and effective solution for these issues. Patients suffering from neurological disorders often complain of CP, which significantly reduces their quality of life. The aim of this narrative review is to examine the correlation between stress and pain and their potential negative impact on the rehabilitation process. Moreover, we described the most relevant interventions used to manage stress and pain in the neurological population. In conclusion, this review sheds light on the connection between chronic stress and chronic pain and their impact on the neurorehabilitation pathway. Our results emphasize the need for tailored rehabilitation protocols to effectively manage pain, improve treatment adherence, and ensure comprehensive patient care.

Effects of web-based mindfulness training on psychological outcomes, attention, and neuroplasticity

Mindfulness meditation training (MMT) reliably reduces stress and anxiety while also improving attention. The primary aim of this study was to investigate the relationship between MMT, stress and anxiety reduction, and its impact upon improvements in attention on the behavioral and neuronal levels. As a second aim, we sought to explore any relationship between MMT, attention, and modified states of mind such as flow. 118 healthy, meditation-naïve, participants were either assigned to a 31-day, web-based, MMT or an active control, health training (HT). Participants underwent functional magnetic resonance imaging while performing the attention network test (ANT) to assess functional and behavioural attentional changes, diffusion tensor imaging (DTI) to assess microstructural neuronal changes and completed relevant questionnaires to explore changes in psychological outcomes. Results confirmed a reduction in perceived stress and anxiety levels in the MMT group and significant improvements in the overall reaction time during the ANT, albeit no specific effects on the attentional components were observed. No statistically significant changes were found in the HT group. Interestingly, a significant group-by-time interaction was seen in flow experience. Functional data exhibited an increased activity in the superior frontal gyrus, posterior cingulate cortex, and right hippocampus during the alerting condition of the ANT after the MMT; decreased stress and trait anxiety were significantly correlated with the activation in the right hippocampus, and increased flow was also significantly correlated with all the aforementioned areas. DTI data showed increased fractional anisotropy values in the right uncinate fasciculus indicating white matter microarchitecture improvement between the right hippocampus and frontal areas of the brain. This study, therefore, demonstrates the effectiveness of web-based MMT on overall well-being and attentional performance, while also providing insight into the relationship between psychological outcomes, attention, and neuroplastic changes.

Multimodal non-invasive non-pharmacological therapies for chronic pain: mechanisms and progress

BACKGROUND

Chronic pain conditions impose significant burdens worldwide. Pharmacological treatments like opioids have limitations. Non-invasive non-pharmacological therapies (NINPT) encompass diverse interventions including physical, psychological, complementary and alternative approaches, and other innovative techniques that provide analgesic options for chronic pain without medications.

MAIN BODY

This review elucidates the mechanisms of major NINPT modalities and synthesizes evidence for their clinical potential across chronic pain populations. NINPT leverages peripheral, spinal, and supraspinal mechanisms to restore normal pain processing and limit central sensitization. However, heterogeneity in treatment protocols and individual responses warrants optimization through precision medicine approaches.

CONCLUSION

Future adoption of NINPT requires addressing limitations in standardization and accessibility as well as synergistic combination with emerging therapies. Overall, this review highlights the promise of NINPT as a valuable complementary option ready for integration into contemporary pain medicine paradigms to improve patient care and outcomes.

The Effect of Mindfulness-Based Cognitive-Behavioral Sex Therapy on Improving Sexual Desire Disorder, Sexual Distress, Sexual Self-Disclosure and Sexual Function in Women: A Randomized Controlled Clinical Trial

Sexual desire disorder is the most common form of sexual dysfunction among women and is associated with problems like sexual distress and reduced sexual self-disclosure. As a result, this RCT study was conducted with 70 reproductive-age women in the form of 4 weekly group educational sessions. Compared to the control group, the mindfulness-based cognitive-behavioral sex therapy (MBCST) intervention significantly improved sexual -desire, -distress, self-disclosure and -function immediately, 4 and 12 weeks after the educational sessions were completed in the intervention group (p < 0.001). Overall, our findings underscore the significance of the MBCST intervention on improving sexual dysfunction among women.Trial registration number: Iranian registry of clinical trials. IRCT Id: IRCT20160808029255N4.Trial registration date: 17th September 2018.Date of first patient's enrollment: 19th September 2018.Supplemental data for this article is available online at https://doi.org/10.1080/0092623X.2021.2008075.

Effect of Mindfulness on the Stress–Recovery Balance in Professional Soccer Players during the Competitive Season

Professional athletes are subjected to constant stress that often leads them to exceed their capacities and lose their homeostasis, which without a proper recovery program can lead to injury, chronic fatigue, and overtraining. This work examines the effect of six weeks of a psychological intervention called Mindful Sports Performance Enhancement (MSPE), on the stress–recovery balance in professional soccer players during a competitive season. Methods: The RESTQ-76 Sport psychometric questionnaire and heart rate variability (HRV) were used as psychometric and physiological evaluation methods. Under a longitudinal case–control study and having complied with bioethical procedures, 42 professional soccer players (22 control without treatment and 20 experimental), age 17 ± 1 year, weight 63 ± 11 kg, and height 172 ± 7 cm, were analyzed. Results: RESTQ-76 Sport increased the stress–recovery balance and global recovery (p < 0.5), but decreased global stress. The stress–recovery balance values measured by the nonlinear indicators of the HRV: SD1, SD2, SS, and S:PS, were not modified. Conclusions: Six weeks of MSPE improves the stress–recovery balance in third-division professional soccer players during the competitive season, reduces stress, and increases recovery. These positive effects were not observed in the nonlinear indicators of the HRV: SD1, SD2, SS, and S:PS.

How mindfulness shapes the situational use of emotion regulation strategies in daily life

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 (N_Study1  = 125, N_Study2  = 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.

Expectancy effects in the Autonomous Sensory Meridian Response

The Autonomous Sensory Meridian Response (ASMR) is a tingling, almost euphoric, sensation often elicited following certain visual or auditory stimulations (Barratt & Davis, 2015). Despite considerable media attention, little empirical work has investigated the underlying mechanisms. In the present study, ASMR enthusiasts and naïve observers listened to audio clips with and without ASMR-eliciting characteristics. We also manipulated participants’ expectations of ASMR, providing a measure of “placebo effects.” Although naïve participants were susceptible to suggestive instructions, experienced users were not, suggesting that initial exposure to ASMR media may evoke somatosensory responses consistent with one’s expectations. Implications for at-home stress management techniques are discussed.

A Proposed Molecular Mechanism for Physical Analgesia in Chronic Pain

Although pain is indispensable for survival, chronic pain places a heavy burden on humans. As the efficacy of opioid treatment is limited, the development of alternative methods of pain relief without medication is desirable. Recently, we have developed a novel method of physical analgesia using an adhesive “pyramidal thorn patch.” When we apply about 3 trials of these patches on the skin of a pain region, the pain region moves toward the spinal cord like a “cutaneous rabbit,” and finally, the pain vanishes. In the present review, we propose a molecular mechanism for this analgesic method or pain relief following application of the pyramidal thorn patch where firstly the mechanoreceptors and their related nerves under the skin are activated in response to touch. Transient receptor potential (TRP) channels serve as mechanosensitive channels within these mechanoreceptors. We further propose that activation of the nerves connected with the mechanoreceptors releases oxytocin, which has an antinociceptive function and activates TRP channels to hyperpolarize the pain signal nerves. We believe that our system will pave the way for alternative pain treatment.

Gray Matter and Functional Connectivity in Anterior Cingulate Cortex are Associated with the State of Mental Silence During Sahaja Yoga Meditation

Some meditation techniques teach the practitioner to achieve the state of mental silence. The aim of this study was to investigate brain regions that are associated with their volume and functional connectivity (FC) with the depth of mental silence in long-term practitioners of Sahaja Yoga Meditation. Twenty-three long-term practitioners of this meditation were scanned using Magnetic Resonance Imaging. In order to identify the neural correlates of the depth of mental silence, we tested which gray matter volumes (GMV) were correlated with the depth of mental silence and which regions these areas were functionally connected to under a meditation condition. GMV in medial prefrontal cortex including rostral anterior cingulate cortex were positively correlated with the subjective perception of the depth of mental silence inside the scanner. Furthermore, there was significantly increased FC between this area and bilateral anterior insula/putamen during a meditation-state specifically, while decreased connectivity with the right thalamus/parahippocampal gyrus was present during the meditation-state and the resting-state. The capacity of long-term meditators to establish a durable state of mental silence inside an MRI scanner was associated with larger gray matter volume in a medial frontal region that is crucial for top-down cognitive, emotion and attention control. This is furthermore corroborated by increased FC of this region during the meditation-state with bilateral anterior insula/putamen, which are important for interoception, emotion, and attention regulation. The findings hence suggest that the depth of mental silence is associated with medial fronto-insular-striatal networks that are crucial for top-down attention and emotional control.

Mindfulness-Based Treatment for Bipolar Disorder: A Systematic Review of the Literature

Despite the increasing number of studies examining the effects of mindfulness interventions on symptoms associated with Bipolar Disorder (BD), the effectiveness of this type of interventions remains unclear. The aim of the present systematic review was to (i) critically review all available evidence on Mindfulness Based Cognitive Therapy (MBCT) as a form of intervention for BD; (ii) discuss clinical implications of MBCT in treating patients with BD; and (iii) provide a direction for future research. The review presents findings from 13 studies (N = 429) that fulfilled the following selection criteria: (i) included BD patients; (ii) presented results separately for BD patients and control groups (where a control group was available); (iii) implemented MBCT intervention; (iv) were published in English; (v) were published in a peer reviewed journal; and (vi) reported results for adult participants. Although derived from a relatively small number of studies, results from the present review suggest that MBCT is a promising treatment in BD in conjunction with pharmacotherapy. MBCT in BD is associated with improvements in cognitive functioning and emotional regulation, reduction in symptoms of anxiety depression and mania symptoms (when participants had residual manic symptoms prior to MBCT). These, treatment gains were maintained at 12 month follow up when mindfulness was practiced for at least 3 days per week or booster sessions were included. Additionally, the present review outlined some limitations of the current literature on MBCT interventions in BD, including small study sample sizes, lack of active control groups and idiosyncratic modifications to the MBCT intervention across studies. Suggestions for future research included focusing on factors underlying treatment adherence and understanding possible adverse effects of MBCT, which could be of crucial clinical importance.

Dancing Mindfulness: A Phenomenological Investigation of the Emerging Practice

An extensive review of both quantitative and qualitative literature reveals numerous connections between mindfulness practice and psychological well-being. Dancing Mindfulness, as a holistic wellness practice, is a creative approach to mindfulness meditation that draws on dance as the vehicle for engaging in the ancient practice characterized by non-judgment, loving kindness, and present-centered awareness. Of the first participants who learned the Dancing Mindfulness practice in a community-based setting, 10 shared their lived experience with the practice, and these experiences were analyzed using A.P. Giorgi׳s descriptive phenomenological psychological method. As a collective sample, the women described positive experiences with the Dancing Mindfulness practice. Specific themes indicated improvements in emotional and spiritual well-being, increased acceptance, positive changes to the self, and increased application of mindfulness techniques and strategies to real-world living. Another thematic area suggested that dancing and music are the two major components of action within Dancing Mindfulness leading to these benefits.

Group mindfulness-based therapy significantly improves sexual desire in women

At least a third of women across reproductive ages experience low sexual desire and impaired arousal. There is increasing evidence that mindfulness, defined as non-judgmental present moment awareness, may improve women's sexual functioning. The goal of this study was to test the effectiveness of mindfulness-based therapy, either immediately or after a 3-month waiting period, in women seeking treatment for low sexual desire and arousal. Women participated in four 90-min group sessions that included mindfulness meditation, cognitive therapy, and education. A total of 117 women were assigned to either the immediate treatment (n = 68, mean age 40.8 yrs) or delayed treatment (n = 49, mean age 42.2 yrs) group, in which women had two pre-treatment baseline assessments followed by treatment. A total of 95 women completed assessments through to the 6-month follow-up period. Compared to the delayed treatment control group, treatment significantly improved sexual desire, sexual arousal, lubrication, sexual satisfaction, and overall sexual functioning. Sex-related distress significantly decreased in both conditions, regardless of treatment, as did orgasmic difficulties and depressive symptoms. Increases in mindfulness and a reduction in depressive symptoms predicted improvements in sexual desire. Mindfulness-based group therapy significantly improved sexual desire and other indices of sexual response, and should be considered in the treatment of women's sexual dysfunction.

Effects of antidepressant medication on emotion regulation in depressed patients: an iSPOT-D report

BACKGROUND

Antidepressant medication (ADM) is thought to reduce depressive symptoms by altering emotion-generative brain systems. However, it is unknown whether successful ADM treatment is associated with changes in psychobehavioral strategies used to regulate emotions. We examined depressive symptoms and emotion regulation strategies before and after ADM in the international Study to Predict Optimized Treatment in Depression (iSPOT-D).

METHODS

The study enrolled 1008 adult patients with MDD (18-65 years old) from 18 primary and psychiatric care sites worldwide. Patients were randomly assigned to an 8-week course of escitalopram, sertraline, or venlafaxine-extended-release. We examined whether ADM is associated with changes in suppression, usually associated with maladaptive outcomes, and reappraisal, usually associated with adaptive outcomes. We also tested whether changes in emotion regulation predict changes in depressive symptoms following ADM.

RESULTS

We observed more adaptive emotion regulation (decreased use of suppression and increased use of reappraisal) following ADM. Furthermore, the largest improvements in emotion regulation were associated with the best treatment outcomes.

LIMITATIONS

Because we assessed acute outcomes, it is not yet known if the effects of ADM on emotion regulation would persist over time.

CONCLUSIONS

ADMs are associated with acute, adaptive changes in the psychobehavioral strategies used to regulate emotions.

Mindful attention reduces neural and self-reported cue-induced craving in smokers

An emerging body of research suggests that mindfulness-based interventions may be beneficial for smoking cessation and the treatment of other addictive disorders. One way that mindfulness may facilitate smoking cessation is through the reduction of craving to smoking cues. The present work considers whether mindful attention can reduce self-reported and neural markers of cue-induced craving in treatment seeking smokers. Forty-seven (n = 47) meditation-naïve treatment-seeking smokers (12-h abstinent from smoking) viewed and made ratings of smoking and neutral images while undergoing functional magnetic resonance imaging (fMRI). Participants were trained and instructed to view these images passively or with mindful attention. Results indicated that mindful attention reduced self-reported craving to smoking images, and reduced neural activity in a craving-related region of subgenual anterior cingulate cortex (sgACC). Moreover, a psychophysiological interaction analysis revealed that mindful attention reduced functional connectivity between sgACC and other craving-related regions compared to passively viewing smoking images, suggesting that mindfulness may decouple craving neurocircuitry when viewing smoking cues. These results provide an initial indication that mindful attention may describe a 'bottom-up' attention to one's present moment experience in ways that can help reduce subjective and neural reactivity to smoking cues in smokers.

Mindfulness: top-down or bottom-up emotion regulation strategy?

The beneficial clinical effects of mindfulness practices are receiving increasing support from empirical studies. However, the functional neural mechanisms underlying these benefits have not been thoroughly investigated. Some authors suggest that mindfulness should be described as a 'top-down' emotion regulation strategy, while others suggest that mindfulness should be described as a 'bottom-up' emotion regulation strategy. Current discrepancies might derive from the many different descriptions and applications of mindfulness. The present review aims to discuss current descriptions of mindfulness and the relationship existing between mindfulness practice and most commonly investigated emotion regulation strategies. Recent results from functional neuro-imaging studies investigating mindfulness training within the context of emotion regulation are presented. We suggest that mindfulness training is associated with 'top-down' emotion regulation in short-term practitioners and with 'bottom-up' emotion regulation in long-term practitioners. Limitations of current evidence and suggestions for future research on this topic are discussed.

Mindfulness-based approaches: are they all the same?

Mindfulness-based approaches are increasingly employed as interventions for treating a variety of psychological, psychiatric and physical problems. Such approaches include ancient Buddhist mindfulness meditations such as Vipassana and Zen meditations, modern group-based standardized meditations, such as mindfulness-based stress reduction and mindfulness-based cognitive therapy, and further psychological interventions, such as dialectical behavioral therapy and acceptance and commitment therapy. We review commonalities and differences of these interventions regarding philosophical background, main techniques, aims, outcomes, neurobiology and psychological mechanisms. In sum, the currently applied mindfulness-based interventions show large differences in the way mindfulness is conceptualized and practiced. The decision to consider such practices as unitary or as distinct phenomena will probably influence the direction of future research.