A pilot study investigating changes in neural processing after mindfulness training in elite athletes

Emotions in search of words: Does alexithymia predict treatment outcome in chronic musculoskeletal pain?

Chronic pain, with its complex and multidimensional nature, poses significant challenges in identifying effective long-term treatments. There is growing scientific interest in how psychopathological and personality dimensions may influence the maintenance and development of chronic pain. This longitudinal study aimed to investigate whether alexithymia can predict the improvement of pain severity following a treatment-as-usual programme for chronic musculoskeletal pain over and above psychological cofactors (emotional distress, catastrophizing, and self-efficacy). A consecutive sample of 129 patients with diagnosed chronic musculoskeletal pain referred to two tertiary care centres was recruited and treated for 16 weeks. Clinical pain, psychological distress, self-efficacy, catastrophizing, and alexithymia were assessed with validated self-report measures at the first medical visit (T0) and at 16-week follow-up (T1). Compared with non-responder patients (n = 72, 55.8%), those who responded (i.e., reduction of >30% in pain severity; n = 57, 44.2%) reported an overall improvement in psychological variables except alexithymia. Alexithymia showed relative stability between baseline and follow-up within the entire sample and remained a significant predictor of treatment outcome even when other predictive cofactors (i.e., pain interference, depressive symptoms, and catastrophizing) were considered simultaneously. Our results suggest that identifying patients with a co-occurrence between alexithymia, depressive symptoms, catastrophizing, and the stressful experience of chronic pain can be clinically relevant in pain prevention and intervention programs.

Neural correlates of mindfulness meditation and hypnosis on magnetic resonance imaging: similarities and differences. A scoping review

BACKGROUND

Mindfulness meditation (MM) and hypnosis practices are gaining interest in mental health, but their physiological mechanisms remain poorly understood. This study aimed to synthesize the functional, morphometric and metabolic changes associated with each practice using magnetic resonance imaging (MRI), and to identify their similarities and differences.

METHODS

MRI studies investigating MM and hypnosis in mental health, specifically stress, anxiety, and depression, were systematically screened following PRISMA guidelines from four research databases (PubMed, Web of Science, Embase, PsycINFO) between 2010 and 2022.

RESULTS

In total, 97 references met the inclusion criteria (84 for MM and 13 for hypnosis). This review showed common and divergent points regarding the regions involved and associated brain connectivity during MM practice and hypnosis. The primary commonality between mindfulness and hypnosis was decreased default mode network intrinsic activity and increased central executive network - salience network connectivity. Increased connectivity between the default mode network and the salience network was observed in meditative practice and mindfulness predisposition, but not in hypnosis.

CONCLUSIONS

While MRI studies provide a better understanding of the neural basis of hypnosis and meditation, this review underscores the need for more rigorous studies.

Physical Exercise to Redynamize Interoception in Substance use Disorders

Physical exercise is considered a promising medication-free and cost-effective adjunct treatment for substance use disorders (SUD). Nevertheless, evidence regarding the effectiveness of these interventions is currently limited, thereby signaling the need to better understand the mechanisms underlying their impact on SUD, in order to reframe and optimize them. Here we advance that physical exercise could be re-conceptualized as an "interoception booster", namely as a way to help people with SUD to better decode and interpret bodily-related signals associated with transient states of homeostatic imbalances that usually trigger consumption. We first discuss how mismatches between current and desired bodily states influence the formation of reward-seeking states in SUD, in light of the insular cortex brain networks. Next, we detail effort perception during physical exercise and discuss how it can be used as a relevant framework for re-dynamizing interoception in SUD. We conclude by providing perspectives and methodological considerations for applying the proposed approach to mixed-design neurocognitive research on SUD.

High performance coach cognition in the wild: using applied cognitive task analysis for practical insights-cognitive challenges and curriculum knowledge

Despite significant empirical work in the sport coaching domain, there remains a paucity of evidence to inform practice in high-performance sport coaching. As a result, there are gaps in our understanding regarding coaching expertise at different levels of athlete performance. A significantly underutilized approach in coaching research is Cognitive Task Analysis and it's knowledge elicitation tools. Addressing these concerns, here we utilize applied Cognitive Task Analysis and a semi-structured interview protocol to elicit the cognitive challenges and use of knowledge by a group of N = 7 high-performance endurance sport coaches from a single national governing body. Analysis suggested prominent and ongoing challenges in day-to-day practice which, in turn require significant adaptive skill. In addition, results show how coaches used knowledge flexibly and conditionally to meet the demands of their role. A novel finding being the identification of the use of curriculum knowledge to mentally project the needs of athletes. The findings suggest opportunities for utilizing Cognitive Task Analysis to investigate the cognitive challenges of sport coaching and enhance coach development practice.

The Effects of Respiratory Muscle Training on Resting-State Brain Activity and Thoracic Mobility in Healthy Subjects: A Randomized Controlled Trial

BACKGROUND

Although inspiratory muscle training (IMT) is an effective intervention for improving breath perception, brain mechanisms have not been studied yet.

PURPOSE

To examine the effects of IMT on insula and default mode network (DMN) using resting-state functional MRI (RS-fMRI).

STUDY TYPE

Prospective.

POPULATION

A total of 26 healthy participants were randomly assigned to two groups as IMT group (n = 14) and sham IMT groups (n = 12).

FIELD STRENGTH/SEQUENCE

A 3-T, three-dimensional T2* gradient-echo echo planar imaging sequence for RS-fMRI was obtained.

ASSESSMENT

The intervention group received IMT at 60% and sham group received at 15% of maximal inspiratory pressure (MIP) for 8 weeks. Pulmonary and respiratory muscle function, and breathing patterns were measured. Groups underwent RS-fMRI before and after the treatment.

STATISTICAL TESTS

Statistical tests were two-tailed P < 0.05 was considered statistically significant. Student's t test was used to compare the groups. One-sample t-test for each group was used to reveal pattern of functional connectivity. A statistical threshold of P < 0.001 uncorrected value was set at voxel level. We used False discovery rate (FDR)-corrected P < 0.05 cluster level.

RESULTS

The IMT group showed more prominent alterations in insula and DMN connectivity than sham group. The MIP was significantly different after IMT. Respiratory rate (P = 0.344), inspiratory time (P = 0.222), expiratory time (P = 1.000), and inspiratory time/total breath time (P = 0.572) of respiratory patterns showed no significant change after IMT. All DMN components showed decreased, while insula showed increased activation significantly.

DATA CONCLUSION

Differences in brain activity and connectivity may reflect improved ventilatory perception with IMT with a possible role in regulating breathing pattern by processing interoceptive signals.

EVIDENCE LEVEL

2 TECHNICAL EFFICACY: Stage 4.

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.

Knowing what you feel: Inferior frontal gyrus-based structural and functional neural patterns underpinning adaptive body awareness

BACKGROUND

Heightened body awareness (BA) is conducive for increasing understanding of bodily state and improves individuals' health and well-being. Although there has been cumulative research concentrating on the self-perceived tendency to focus on negatively valenced interoceptive sensations, the specific structural and functional neural patterns underlying BA and their role in the relationship between BA and individual well-being remain unclear.

METHODS

Voxel-based morphometry and whole brain functional connectivity analyses were conducted to examine the structural and functional neural patterns, respectively, in 686 healthy subjects. BA and subjective well-being were assessed using questionnaires.

RESULTS

BA was inversely related to gray matter volume of the right inferior frontal gyrus, opercular part (IFGoperc). Higher BA was correlated with enhanced IFGoperc-precuneus and IFGoperc-anterior supramarginal gyrus connectivities, and with decreased IFGoperc-lateral occipital cortex and IFGoperc-medial frontal cortex connectivities. The inferior frontal gyrus, triangular part (in the fronto-parietal task control network) acted as the hub that linked the sensory/somatomotor network, the default mode network, and the dorsal and ventral attention network. The IFGoperc-precuneus connectivity moderated the association between BA and subjective well-being.

LIMITATIONS

We were unable to rank all the networks by their relative importance, because the absolute weighted value in each module was not calculated.

CONCLUSION

Our findings demonstrated that BA was reflected by specific neural patterns mainly involved in cognitive-affective control, attentional and self-referential processing, as well as multisensory integration, which could offer some references for current therapies (e.g., mindfulness, yoga training) that are dedicated to solving health problems and improving individual well-being.

Neurofeedback-Augmented Mindfulness Training Elicits Distinct Responses in the Subregions of the Insular Cortex in Healthy Adolescents

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.

Effectiveness of virtual mindfulness-based interventions on perceived anxiety and depression of physicians during the COVID-19 pandemic: A pre-post experimental study

BACKGROUND

The outbreak of coronavirus disease 2019 (COVID-19) created unprecedented stress on physicians. Mindfulness is a type of meditation that focuses on being fully present, aware of senses, and emotions in the present moment without analyzing or judging them, and it may help reduce psychological distress in physicians. This study aimed to examine the effectiveness of virtual mindfulness-based intervention (MBI) on physicians' perceived anxiety and depression and different facets of mindfulness.

METHODS

During the COVID-19 pandemic, an online survey was administered to physicians to assess depression, anxiety, and awareness using the 9-item Patient Health Questionnaire (PHQ-9), 7-item General Anxiety Disorder (GAD-7), and Five-Facets Mindfulness Questionnaire (FFMQ), respectively. Physicians that received the virtual MBI sessions also completed post-questionnaires at a 3-week follow-up time point.

RESULTS

A total of 125 physicians responded to the online survey, with 56 completing the MBI. The prevalence of moderate to severe anxiety and depression was 45.0 and 46.7%, respectively. Mindfulness scores were negatively associated with depression (r = -0.38, P < 0.001) and anxiety (r = -0.36, p < 0.001). Mindfulness scores for the 56 physicians who received virtual MBI sessions were significantly improved (mean difference ± SD, 17.7 ± 16.1, p = 0.001). Significant reductions were also evidenced in anxiety (4.4 ± 4.2) and depression (4.5 ± 5.1) scores (p's < 0.001). There was also an improvement in mindfulness facets of observing (5.1 ± 4.7), describing (2.3 ± 4.3), acting with awareness (2.7 ± 5.3), non-judging of inner experience (3.6 ± 6.1), and non-reactivity to inner experience (3.9 ± 4.0) (p's < 0.001). A facet of mindfulness, acting with awareness was most efficiently associated with improved anxiety (B = -0.3, p = 0.02) and depression (B = -0.4, p = 0.01).

CONCLUSION

This study has demonstrated that virtual MBI improved physicians' psychological wellbeing and mindfulness during the crisis. Regular mindfulness practice may help physicians to tolerate and handle unpleasant circumstances, such as future epidemics or pandemics.

Alexithymia and metabolic syndrome: the mediating role of binge eating

PURPOSE

Alexithymia, a personality trait characterized by difficulties in emotional processing, has been associated with unhealthy behaviors and chronic medical conditions. This study aimed to further develop our understanding of this complex relationship by investigating whether alexithymia increases the risk of metabolic syndrome (MetS) in participants with obesity or overweight through the mediating role of binge eating (BE).

METHODS

A consecutive sample of 238 treatment-seeking patients with obesity or overweight were recruited. Alexithymia (TAS-20), binge eating symptoms (BES), body mass index (BMI), and depression and anxiety symptoms (HADS) were concurrently assessed.

RESULTS

Almost half of the participants met the criteria for MetS (44.12%). Compared to patients without MetS, those with MetS were older, had a longer duration of overweight, and had a higher BMI (p < 0.01). Individual with MetS also had higher HADS, BES, and TAS-20 scores, particularly difficulty identifying and describing feelings. The structural equation modeling (SEM) analysis revealed that BES levels exerted a significant direct effect on MetS (p < 0.01), and that TAS-20 levels exerted a significant direct effect on BES (p < 0.01), anxiety (p < 0.001) and depression (p < 0.001). Moreover, psychological distress (anxiety, p = 0.01, and depression, p = .05) indirectly affected MetS through the mediating effect of BES, and TAS-20 (p = 0.01) indirectly affected MetS through the mediating effect of HADS and BES. Finally, age had a significant direct effect on MetS (p < 0.001).

CONCLUSION

Our findings indicate that alexithymia is a concurrent causative factor to the development of MetS through the mediating role of BE and psychological distress.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Somatic interventions to improve self-regulation in children and adolescents

TOPIC

Children and adolescents who are exposed to stress and trauma often experience, as a result, an inability to regulate their emotions. Self-regulation is necessary to accurately respond to situations and ensure success in the academic setting. Self-regulation skills have been identified as improving resiliency and mitigating the effects of trauma on children and adolescents.

PURPOSE

The purpose of this review of the literature is to synthesize the available research on somatic interventions to improve self-regulation in the child and adolescent population.

SOURCES USED

A scoping review of literature utilizing the Arksey and O'Malley framework was conducted by a university health science librarian from 2006 to 2018 using PubMed, Scopus, CINAHL, ERIC, and Web of Science to identify studies that examined somatic self-regulation skills in children and adolescents. Search terms included were mindfulness, yoga, deep breathing exercises, and self-regulation. The PRISMA methodology was utilized to synthesize the available research on somatic interventions to improve self-regulation in the child and adolescent population.

CONCLUSION

Somatic interventions have been shown to improve self-regulation in the child and adolescent population. Future research is needed to identify dose-specific interventions and opportunities to improve self-regulation for children and adolescents.

Affective Neural Mechanisms of a Parenting-Focused Mindfulness Intervention

OBJECTIVES

Behavioral evidence suggests that parenting-focused mindfulness interventions can improve parenting practices and enhance family wellbeing, potentially operating through altered emotional processing in parents. However, the mechanisms through which parent mindfulness interventions achieve their positive benefits have not yet been empirically tested, knowledge which is key to refine and maximize intervention effects. Thus, as part of a randomized controlled trial, the present study examined the affective mechanisms of an 8-week parenting-focused mindfulness intervention, the Parenting Mindfully (PM) intervention, versus a minimal-intervention parent education control.

METHODS

Twenty highly stressed mothers of adolescents completed pre- and post-intervention behavioral and fMRI sessions, in which mothers completed a parent-adolescent conflict interaction, fMRI emotion task, and fMRI resting state scan. Mothers reported on their mindful parenting, and maternal emotional reactivity to the parent-adolescent conflict task was assessed via observed emotion expression, self-reported negative emotion, and salivary cortisol reactivity.

RESULTS

Results indicated that the PM intervention increased brain responsivity in left posterior insula in response to negative affective stimuli, and altered resting state functional connectivity in regions involved in self-reference, behavioral regulation, and social-emotional processing. Changes in mothers' brain function and connectivity were associated with increased mindful parenting and decreased emotional reactivity to the parent-adolescent conflict task.

CONCLUSIONS

Findings suggest that mindfulness-based changes in maternal emotional awareness at the neurobiological level are associated with decreased emotional reactivity in parenting interactions, illuminating potential neurobiological targets for future parent-focused intervention.

Positive and Negative Emotion Regulation in College Athletes: A Preliminary Exploration of Daily Savoring, Acceptance, and Cognitive Reappraisal

BACKGROUND

Despite increasing interest in positive psychological states, we know little about how regulatory responses to positive (savoring) compared to negative events (e.g. acceptance, cognitive reappraisal) influence emotional functioning. Savoring may be particularly helpful for athletes who are often trained to attend more to negative (e.g. rectifying weaknesses) compared to positive stimuli (e.g. enjoying progress).

METHODS

Sixty-seven college athletes completed a two-week daily diary study. Using multi-level modeling, we first explored whether various regulatory responses to daily negative events predicted unique variance in daily emotions (i.e. happy, content, grateful, sad, angry, annoyed). Next, we tested whether savoring positive events strengthened the association between event intensity and positive daily emotions. Finally, we tested whether regulatory responses to positive compared to negative events had stronger moderating (buffering) effects on the association between daily negative event intensity and daily emotions.

RESULTS

Based on 836 daily observations, reappraising and accepting negative events were the only strategies that predicted unique variance in daily emotions. Savoring enhanced positive emotions related to positive events. Reappraising negative events buffered associations between negative event intensity and decreased daily gratitude, while savoring positive events buffered associations between negative event intensity and increased anger, annoyance, and average negative emotions. Accepting negative events had similar effects.

CONCLUSIONS

Savoring positive events may be an underappreciated strategy for helping athletes regulate emotions related to negative events. Since our sample predominantly identified as white and female, further research is needed to understand savoring use and effectiveness among the full, diverse spectrum of college athletes.

The Role of Future Time Perspective, Body Awareness, and Social Connectedness in the Relationship Between Self-efficacy and Resilience

Defined as the successful adaptation to dynamic environments, resilience is considered a cornerstone of mental health. However, with the underpinnings of resilience not yet fully understood, this manuscript tests the potential contribution of self-efficacy and embeddedness on resilience (explored through validated measures of future time perspective, body awareness, and social connectedness). The convenience sample of 18-to-77-year-old adults included 297 individuals, of which 36 were men and 171 were female. Participants completed online surveys composed of fifty-two questions in total, measuring self-efficacy, resilience, social connectedness, FTP, and body awareness. Resilience was positively related to self-efficacy, future time perspective, and social connectedness—but not to body awareness—and self-efficacy was positively associated with indices of embeddedness. Considering these correlations, and that only self-efficacy significantly predicted resilience, an exploratory model was proposed to test whether embeddedness directly predicted self-efficacy, and whether self-efficacy directly predicted resilience. Structural Equation Modelling suggested a good fit of this model, elucidating the interplay of psychological mechanisms underlying resilience. Thus, we identify potential variables of interest for clinical interventions aimed at increasing resilience and self-efficacy. Theoretical implications and future research are suggested based on these findings.

The Impact of App-Delivered Mindfulness Meditation on Functional Connectivity and Self-Reported Mindfulness Among Health Profession Trainees

Objectives

Previous research indicates that mindfulness meditation reduces anxiety and depression and enhances well-being. We examined the impact of app-delivered mindfulness meditation on resting state functional MRI (fMRI) connectivity among physician assistant (PA) students and surgery residents.

Methods

PA students and residents were randomized to receive a popular meditation app or to wait-list control group. Before and after the 8-week meditation period, we acquired fMRI scans of participants’ resting state, and participants completed a self-report measure of mindfulness. We used a 2 × 2, within- and between-group factorial design and leveraged a whole-brain connectome approach to examine changes in within- and between-network connectivity across the entire brain, and to examine whether changes in connectivity were associated with app use or to changes in self-reported mindfulness.

Results

Meditation practitioners exhibited significantly stronger connectivity between the frontoparietal network and the left and right nucleus accumbens and between the default mode (DMN) and salience networks, among other regions. Mindfulness practice time was correlated with increased connectivity between the lateral parietal cortex and the supramarginal gyrus, which were also positively correlated with increased scores on the “Describing” subscale of the Five Facet Mindfulness Questionnaire between baseline and post-meditation. These findings are consistent with previous research indicating that mindfulness-based interventions alter functional connectivity within the DMN and between the DMN and other networks both during meditation and at rest, as well as increased connectivity in systems important for emotion and reward.

Conclusions

Recent commentaries call for healthcare provider and trainee wellness programs that are sustainable and preventive in nature rather than reactive; these data indicate that even brief sessions of app-delivered mindfulness practice are associated with functional connectivity changes in a dose-dependent manner.

Electronic supplementary material

The online version of this article (10.1007/s12671-020-01502-7) contains supplementary material, which is available to authorized users.

Mindfulness Training Enhances Endurance Performance and Executive Functions in Athletes: An Event-Related Potential Study

Mindfulness interventions have been linked to improved sport performance and executive functions; however, few studies have explored the effects of mindfulness on sport performance and executive functions simultaneously. This study sought to examine whether a mindfulness training program would affect both the endurance performance and executive functions of athletes. In addition, event-related potentials (ERPs) associated with the Stroop task were assessed to investigate the potential electrophysiological activation associated with the mindfulness training. Applying a quasiexperimental design, forty-six university athletes were recruited and assigned into a five-week mindfulness training program or a waiting list control group. For each participant, the mindfulness level, endurance performance assessed by a graded exercise test, executive functions assessed via Stroop task, and N2 component of ERPs were measured prior to and following the 5-week intervention. After adjusting for the preintervention scores as a covariate, it was found that the postintervention mindfulness level, exhaustion time, and Stroop task accuracy scores, regardless of task condition, of the mindfulness group were higher than those of the control group. The mindfulness group also exhibited a smaller N2 amplitude than the control group. These results suggest that the five-week mindfulness program can enhance the mindfulness level, endurance performance, and multiple cognitive functions, including executive functions, of university athletes. Mindfulness training may also reduce conflict monitoring in neural processes.

Building the bodily self-awareness: Evidence for the convergence between interoceptive and exteroceptive information in a multilevel kernel density analysis study

Exteroceptive and interoceptive signals shape and sustain the bodily self-awareness. The existence of a set of brain areas, supporting the integration of information coming from the inside and the outside of the body in building the sense of bodily self-awareness has been postulated, yet the evidence remains limited, a matter of discussion never assessed quantitatively. With the aim of unrevealing where in the brain interoceptive and exteroceptive signals may converge, we performed a meta-analysis on imaging studies of the sense of body ownership, modulated by external visuotactile stimulation, and studies on interoception, which involves the self-awareness for internal bodily sensations. Using a multilevel kernel density analysis, we found that processing of stimuli of the two domains converges primarily in the supramarginal gyrus bilaterally. Furthermore, we found a right-lateralized set of areas, including the precentral and postcentral, and superior temporal gyri. We discuss these results and propose this set of areas as ideal candidates to match multiple body-related signals contributing to the creation of a multidimensional representation of the bodily self.

Mindfulness and Suicide Risk in Undergraduates: Exploring the Mediating Effect of Alexithymia

The present study was designed to examine the relationship between dispositional mindfulness and suicide risk in undergraduates, and it further explored the potential mediating role of alexithymia in this relationship. A total of 2,633 undergraduates completed the Mindful Attention Awareness Scale (MAAS), the Suicidal Behaviors Questionnaire – Revised (SBQ-R), and the 20-item Toronto Alexithymia Scale (TAS-20). The results indicate that mindfulness and suicide risk were negatively correlated, and alexithymia partially mediated the relationship between mindfulness and suicide risk only in the female undergraduates. Moreover, only the difficulty in identifying feelings (DIF) factor of alexithymia mediated the relationship between mindfulness and suicide risk in the female undergraduates. These findings contribute to the potential mechanism that explains the relationship between mindfulness and suicide risk. Furthermore, it is possible to implement mindfulness in the suicide intervention of alexithymic individuals.

How to Train Your Health: Sports as a Resource to Improve Cognitive Abilities in Cancer Patients

From a cognitive-psychological perspective, physical exercise (PE) and sports are an interesting tool for improving people's cognitive abilities. One field of application for such a tool is decision making (DM) support in chronic patients, cancer patients, and survivors in particular. On the one hand, cancer patients and survivors have to continually take important decisions about their own care (e.g., treatment choice; changes in lifestyle), in collaboration with caregivers and health providers; on the other hand, side effects of treatment may be detrimental to cognitive abilities, such as attention, which make the health DM tasks even more demanding, complex, and emotionally disruptive for patients. Since cancer patients have to engage in healthy activities both for improving their own quality of life and for sustaining the effects of medications, clinical advice to engage in sport and PE is becoming more and more widespread within interventions. However, while sports are usually seen as healthy physical activities, their impact on cognitive abilities is mostly overlooked in the literature. The hypothesis of the present work is that sports could be fully exploited in their potential as focused exercises for cognitive ability training, in the field of cognitive training for chronic patients specifically. Indeed, literature shows that different sports (e.g., individual or team-based) influence and possibly augment cognitive abilities such as focused and divided attention, working memory, and DM under time constraints. Moreover, besides providing training for cognitive abilities, the experience of sports may represent an opportunity to explore, train and sharpen DM abilities directly: we identify five ways in which sport experiences may influence DM processes, and provide indications for future research on the topic.

Conventional and Alternative Strategies to Cope With the Subtropical Climate of Tokyo 2020: Impacts on Psychological Factors of Performance

The thermal discomfort caused by a hot or hot-wet climate can have negative effects on human performance. The 2020 Summer Olympic and Paralympic Games will take place in Tokyo’s hot and humid summer period, possibly exposing athletes to severe environmental stressors. In addition to technical, tactical, physical and nutritional preparation, Olympians and Paralympians need an optimal psychological state to turn in their best performances, especially in terms of emotional control, concentration and motivation. Yet, the tropical climate can have many negative effects on these factors. Better understanding of the negative effects of this climate and the strategies to manage them might be crucial for competitors, coaches and their teams in Japan. At the psychological level, cooling interventions before, during and/or immediately after exercise were mainly studied on perceptual responses. However, the effects of these interventions on other psychological components such as cognitive abilities or psychological states and the use of psychological techniques have been little explored, especially in hot-wet climate. Thus, this article proposes to take stock of the knowledge on the conventional and alternative strategies that help athletes to psychologically cope with the subtropical climate of Tokyo.

Altered anticipation and processing of aversive interoceptive experience among women remitted from bulimia nervosa

Bulimia nervosa (BN) is characterized by dysregulated intake of food, which may indicate homeostatic imbalance. Critically important for homeostatic regulation is interoception, or the sensing and processing of body-relevant information. A well-documented link between avoidance of unpleasant body sensations and BN symptoms suggests that aversive interoceptive experiences may be particularly relevant to BN pathophysiology. This study examined whether individuals with a history of BN show aberrant neural processing of aversive interoceptive stimuli. Using a cued inspiratory breathing load paradigm, we compared women remitted from BN (RBN; n = 24; to reduce the confounding effects of active bulimic symptoms) and control women (CW; n = 25). During breathing load anticipation, the RBN group, relative to CW, showed increased activation in mid-insula, superior frontal gyrus, putamen, dorsal anterior cingulate, posterior cingulate, and amygdala. However, over the course of the aversive experience, neural activation in RBN relative to CW showed an aberrant decline in most of these regions. Exploratory analyses indicated that greater activation during breathing load anticipation was associated with past bulimic symptom severity and the duration of symptom remission. An exaggerated anticipatory response and an abnormally decreasing response during aversive homeostatic perturbations may promote hallmark bulimic behaviors-binge eating, dietary restriction, and purging. Our findings support a role for homeostatic instability in BN, and these altered patterns of brain activation may serve as novel targets for pharmacological, neuromodulatory, and behavioral interventions.

A neurobehavioral account for decentering as the salve for the distressed mind

Distress is commonly characterized by prolonged internal suffering that can range from self-focused processing of negative emotions and stressors, to highly intensely aversive and prolonged emotional states, thereby, worsening or complicating emotional and physical conditions. Decentering represents a metacognitive capacity thought to reflect three interrelated processes: meta-awareness, disidentification from internal experience, and reduced reactivity to thought content-which is reliably increased with mindfulness-based interventions. In this essay, we seek to link the clinical presentation of distress disorders to known or hypothesized disruptions in neural networks that underlie emotion, cognition, and goal directed behavior, and offer a neurobehavioral account for how and why treatments imbued with mindfulness meditation might ameliorate these conditions, in part through increases in decentering.

Effects of mindfulness-based interventions on alexithymia: a systematic review

QUESTION

Alexithymia has been found to be modifiable through treatment, with associated clinical benefits. Recent studies have begun to test the potential of mindfulness-based interventions to reduce alexithymia, using skills-based, group training to improve non-judgemental, present-moment awareness. The objective of this review therefore was to conduct a systematic synthesis to assess the current state of knowledge about the effect of mindfulness-based interventions on alexithymia to inform clinical practice.

STUDY SELECTION AND ANALYSIS

We carried out a systematic review of the literature and found four randomised controlled trials of the effect of mindfulness-based interventions on alexithymia, with a combined total of 460 participants.

FINDINGS

A random-effects meta-analysis, combining study endpoint data, showed a statistically significant effect of mindfulness-based treatment on alexithymia (Toronto Alexithymia Scale) compared with the control group (mean difference=-5.28, 95% CI -9.28 to -1.28, p=0.010). Subgroup analysis was conducted to investigate sources of heterogeneity (I2=52%). Heterogeneity was reduced when the meta-analysis was restricted to interventions of a similar duration (3 months or less).

CONCLUSIONS

Findings from our study should be replicated in further research with larger samples; however, the results indicate that mindfulness-based interventions may be an effective treatment in reducing alexithymia.

Functional brain anatomy of exercise regulation

Knowledge about possible brain mechanisms involved in the regulation of exercise intensity has vastly grown over the last decade. The current review attempts to condense this knowledge currently published with a focus on brain imaging studies. A number of psychological manipulations known to influence exercise intensity are discussed with respect to their possibly underlying brain structures. Although far from forming a complete picture, current knowledge allows to speculate on various possible influences and their corresponding neural bases. Especially, the roles of the insular cortex, anterior cingulate cortex, basal ganglia and prefrontal cortex structures are discussed. Interoceptive signals processed in the insular cortex can influence motor activity likely via anterior cingulate cortex with themselves being influenced by higher order prefrontal cortical regions (e.g., when mediating expectancy effects). Such higher order prefrontal regions can also modulate motivation and thus motor activity by influencing valuation processes in the midbrain and other structures.

Altered interoceptive activation before, during, and after aversive breathing load in women remitted from anorexia nervosa

BACKGROUND

The neural mechanisms of anorexia nervosa (AN), a severe and chronic psychiatric illness, are still poorly understood. Altered body state processing, or interoception, has been documented in AN, and disturbances in aversive interoception may contribute to distorted body perception, extreme dietary restriction, and anxiety. As prior data implicate a potential mismatch between interoceptive expectation and experience in AN, we examined whether AN is associated with altered brain activation before, during, and after an unpleasant interoceptive state change.

METHODS

Adult women remitted from AN (RAN; n = 17) and healthy control women (CW; n = 25) underwent functional magnetic resonance imaging during an inspiratory breathing load paradigm.

RESULTS

During stimulus anticipation, the RAN group, relative to CW, showed reduced activation in right mid-insula. In contrast, during the aversive breathing load, the RAN group showed increased activation compared with CW in striatum and cingulate and prefrontal cortices (PFC). The RAN group also showed increased activation in PFC, bilateral insula, striatum, and amygdala after stimulus offset. Time course analyses indicated that RAN responses in interoceptive processing regions during breathing load increased more steeply than those of CW. Exploratory analyses revealed that hyperactivation after breathing load was associated with markers of past AN severity.

CONCLUSIONS

Anticipatory deactivation with a subsequent exaggerated brain response during and after an aversive body state may contribute to difficulty predicting and adapting to internal state fluctuation. Because eating changes our interoceptive state, restriction may be one method of avoiding aversive, unpredictable internal change in AN.

The Trauma Resiliency Model: A "Bottom-Up" Intervention for Trauma Psychotherapy

BACKGROUND

The Trauma Resiliency Model (TRM) is an innovative therapeutic approach for trauma. This "bottom-up" somatic approach comprises nine skills that use sensory awareness for emotion regulation and integration. Body-based therapies may be more effective for trauma than currently used cognitive ('top-down") and exposure therapies.

OBJECTIVE

The purpose of this article is to present TRM and current literature on the neuroscience of trauma and resiliency, and the rationale for body-based therapy. Two case examples illustrate the practical use of TRM therapy.

DESIGN

The literature on the neuroscience of trauma, resiliency, and somatic approaches in therapy is reviewed.

RESULTS

TRM teaches the biology of trauma responses and the practice of emotion regulation through biologically based skills. Neuroscience theory supports somatic awareness models; however, research on somatic therapies is limited.

CONCLUSIONS

Chronic distress from trauma derails the ability to live life resiliently. TRM addresses trauma processing in a gentle and invitational manner and is a novel departure from existing therapies. Despite a paucity of research on body-based therapy, these therapies have strong neurophysiologic underpinnings.

Differentiating attention styles and regulatory aspects of self-reported interoceptive sensibility

Based on prior research, multiple discriminable dimensions of interoception have been defined: awareness, accuracy and sensibility. Some investigators defined interoceptive awareness as metacognitive awareness of interoceptive accuracy, assessed as correspondence between subjective confidence in and objective accuracy of one's heartbeat detection. However, metacognitive awareness has been understood quite differently: 'a cognitive set in which negative thoughts/feelings are experienced as mental events, rather than as the self' or as 'error awareness'. Interoceptive sensibility, defined as self-reported interoception, distinguishes self-reported interoception from objective interoceptive accuracy, but does not differentiate between anxiety-driven and mindful attention styles towards interoceptive cues, a distinction of key clinical importance: one attention style is associated with somatization and anxiety disorders; the other has been viewed as healthy, adaptive, resilience-enhancing. The self-report Multidimensional Assessment of Interoceptive Awareness was developed to differentiate these attention styles. It has been translated into 16 languages and applied in cross-sectional and longitudinal studies. Findings from these applications suggest that differentiating interoceptive sensibility according to attention style and regulatory aspects (i) provides insights into the psychology of interoceptive awareness, (ii) differentiates between clinically maladaptive and beneficial interoceptive attention, and (iii) helps elucidate therapeutic approaches that claim to provide health benefits by training mindful styles of bodily awareness.This article is part of the themed issue 'Interoception beyond homeostasis: affect, cognition and mental health'.

ALTERED DEFAULT MODE NETWORK (DMN) RESTING STATE FUNCTIONAL CONNECTIVITY FOLLOWING A MINDFULNESS-BASED EXPOSURE THERAPY FOR POSTTRAUMATIC STRESS DISORDER (PTSD) IN COMBAT VETERANS OF AFGHANISTAN AND IRAQ

BACKGROUND

Recent studies suggest that mindfulness may be an effective component for posttraumatic stress disorder (PTSD) treatment. Mindfulness involves practice in volitional shifting of attention from "mind wandering" to present-moment attention to sensations, and cultivating acceptance. We examined potential neural correlates of mindfulness training using a novel group therapy (mindfulness-based exposure therapy (MBET)) in combat veterans with PTSD deployed to Afghanistan (OEF) and/or Iraq (OIF).

METHODS

Twenty-three male OEF/OIF combat veterans with PTSD were treated with a mindfulness-based intervention (N = 14) or an active control group therapy (present-centered group therapy (PCGT), N = 9). Pre-post therapy functional magnetic resonance imaging (fMRI, 3 T) examined resting-state functional connectivity (rsFC) in default mode network (DMN) using posterior cingulate cortex (PCC) and ventral medial prefrontal cortex (vmPFC) seeds, and salience network (SN) with anatomical amygdala seeds. PTSD symptoms were assessed at pre- and posttherapy with Clinician Administered PTSD Scale (CAPS).

RESULTS

Patients treated with MBET had reduced PTSD symptoms (effect size d = 0.92) but effect was not significantly different from PCGT (d = 0.46). Increased DMN rsFC (PCC seed) with dorsolateral dorsolateral prefrontal cortex (DLPFC) regions and dorsal anterior cingulate cortex (ACC) regions associated with executive control was seen following MBET. A group × time interaction found MBET showed increased connectivity with DLPFC and dorsal ACC following therapy; PCC-DLPFC connectivity was correlated with improvement in PTSD avoidant and hyperarousal symptoms.

CONCLUSIONS

Increased connectivity between DMN and executive control regions following mindfulness training could underlie increased capacity for volitional shifting of attention. The increased PCC-DLPFC rsFC following MBET was related to PTSD symptom improvement, pointing to a potential therapeutic mechanism of mindfulness-based therapies.

A Pilot Study of Mindfulness-Based Exposure Therapy in OEF/OIF Combat Veterans with PTSD: Altered Medial Frontal Cortex and Amygdala Responses in Social-Emotional Processing

Combat-related posttraumatic stress disorder (PTSD) is common among returning veterans, and is a serious and debilitating disorder. While highly effective treatments involving trauma exposure exist, difficulties with engagement and early drop may lead to sub-optimal outcomes. Mindfulness training may provide a method for increasing emotional regulation skills that may improve engagement in trauma-focused therapy. Here, we examine potential neural correlates of mindfulness training and in vivo exposure (non-trauma focused) using a novel group therapy [mindfulness-based exposure therapy (MBET)] in Afghanistan (OEF) or Iraq (OIF) combat veterans with PTSD. OEF/OIF combat veterans with PTSD (N = 23) were treated with MBET (N = 14) or a comparison group therapy [Present-centered group therapy (PCGT), N = 9]. PTSD symptoms were assessed at pre- and post-therapy with Clinician Administered PTSD scale. Functional neuroimaging (3-T fMRI) before and after therapy examined responses to emotional faces (angry, fearful, and neutral faces). Patients treated with MBET had reduced PTSD symptoms (effect size d = 0.92) but effect was not significantly different from PCGT (d = 0.43). Improvement in PTSD symptoms from pre- to post-treatment in both treatment groups was correlated with increased activity in rostral anterior cingulate cortex, dorsal medial prefrontal cortex (mPFC), and left amygdala. The MBET group showed greater increases in amygdala and fusiform gyrus responses to Angry faces, as well as increased response in left mPFC to Fearful faces. These preliminary findings provide intriguing evidence that MBET group therapy for PTSD may lead to changes in neural processing of social-emotional threat related to symptom reduction.