Evaluation of Cognitive Behavioral Therapy vs Mindfulness Meditation in Brain Changes During Reappraisal and Acceptance Among Patients With Social Anxiety Disorder: A Randomized Clinical Trial

Assessing barriers to meditation in patients with substance use disorder

BACKGROUND AND PURPOSE

Individuals living with substance use disorder (SUD) often face unique challenges that can hinder their engagement in beneficial practices like meditation, which has been shown to support recovery and well-being. This study aimed to explore the perceived barriers to meditation with SUD, identify key obstacles, and inform future interventions that promote the adoption of a personal practice.

MATERIALS AND METHODS

We conducted a cross-sectional analytic study with a convenience sample of participants attending a treatment center for SUD. Data collected included demographics, SUD history, health challenges, meditation knowledge, and previous meditation practice. Barriers to meditation were evaluated using the Determinants of Meditation Practice Inventory (DMPI) and its revised version, DMPI-R. Overall frequencies, proportions, and measures of central tendency were calculated. Participants currently practicing meditation were compared to those not meditating by using Fisher's exact test, Student's t-test, and Wilcoxon rank-sum test.

RESULTS

One hundred sixteen individuals completed the survey. Survey respondents were an average of 45 years (standard deviation, SD, 11.46), majority female (67.0 %), and White (90.3 %). Only 28.7 % of respondents were informed of meditation by their healthcare provider, yet 81.7 % were interested in learning about meditation. Among survey respondents, "prayer is my form of meditation," followed by "I can't stop my thoughts," were most agreed upon.

CONCLUSION

Individuals living with SUD are interested in education on meditation techniques; however, additional research is needed to understand the determinants of meditation practice and discern the barriers that could help facilitate the adoption and long-term practice of this method.

Clinical and psychological factors associated with fear of relapse in people with multiple sclerosis: A cross-sectional study

BACKGROUND

Fear of relapse (FoR) is one of the main psychological concerns in people with relapsing-remitting multiple sclerosis (PwRRMS). It has disastrous consequences on treatment adherence, quality of life (QoL), and clinical course. Although the issue is closely linked to psychosocial aspects, it is not widely explored despite its overall impact on managing the condition. The determinants of FoR are vital for the optimization of therapeutic intervention toward ensuring patient welfare.

METHODS

This cross-sectional study, carried out in Isfahan, Iran, from December 2023 to September 2024, investigated demographic, clinical, and psychological characteristics in PwRRMS. The level of FoR was measured by the Fear of Relapse Scale, and for anxiety, depression, and obsessive-compulsive symptoms, the Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) were used, respectively. Correlation between these factors were analyzed using linear regression.

RESULTS

A total of 189 PwRRMS were included. Multivariable linear regression analysis identified significant correlation between the higher annualized relapse rate (ARR) (B = 10.18, standardized 0.14, p-value < 0.05), anxiety (B = 0.32, standardized β = 0.19, p-value < 0.05), depression (B = 0.63, standardized β = 0.42, p-value < 0.001) and Expanded Disability Status Scale (EDSS) (B = 2.19, standardized β = 0.11, p-value < 0.05) with the FoR among PwRRMS. On the other hand, other demographic, clinical, and psychological variables, including disease duration, disability, and obsessive behavior, were found to lack a significant correlation with FoR (p-value < 0.05).

CONCLUSION

This study points out that ARR, anxiety, and depression are among the leading independent risk factors of FoR in PwRRMS. Given the great potential for attenuation with focused treatments and psychological consultation, becoming major contributors to the decrease of FoR and, importantly, to improved overall patient well-being, their proper management and clinical follow-up should be considered an important issue in dealing with such patients.

Effects of a 12-week dance intervention on left-behind children with co-occurring social anxiety and low self-concept

Objective

This study aimed to investigate the effects of a 12-week dance intervention on left-behind children (LBC) suffering from social anxiety and low self-concept, and to explore the relationship between social anxiety and self-concept.

Methods

Sixty LBC who met the criteria were selected from a school in Shaoyang City, Hunan Province, and were randomly divided into an Interventional group (n = 30) and a Control group (n = 30). The Interventional group received a 45-min dance intervention five times a week for 12 weeks, while the Control group maintained their original lifestyle. Social anxiety and self-concept were measured three times using the Social Anxiety Scale for Children and the Piers-Harris Child Self-concept Scale: at baseline (T0), post-intervention (12 weeks, T1), and follow-up (14 weeks after baseline, T2).

Results

(i) After the dance intervention, social anxiety and self-concept were significantly improved (p < 0.05). (ii) There was a significant negative correlation between the change scores (T1 minus T0) of social anxiety and self-concept (p < 0.05).

Conclusion

Dance intervention is an acceptable, practical and effective intervention that we can incorporate into a health programme to improve social anxiety and low self-concept in LBC.

Effect of Qi-based mindfulness therapy for mild-to-moderate depression

BACKGROUND

Depression is a disorder characterized by significant and persistent depressed mood, cognitive impairment, impaired voluntary activity, working memory, and somatic symptoms.

AIM

To determine the efficacy of Qi-based mindfulness therapy (QMT) in treating anxiety, depression, and sleep disturbances in individuals with mild-to-moderate depression.

METHODS

A self-controlled before-after trial was conducted. The study invited online participants for recruitment between May and July 2023. Participants (n = 18) aged 18-65 years with mild-to-moderate depression, who were receiving QMT training for 4 weeks, were included. The primary efficacy indicators were the 17 Hamilton Depression Rating Scale and Hamilton Anxiety Scale scores. The secondary outcome indicators included the Zung Self-rating Depression Scale, the self-rating Anxiety Scale, and the Insomnia Severity Index. Pre- and post-intervention assessments were conducted. The patients' symptoms related to depression, anxiety, and insomnia were reassessed 4 weeks after the post-intervention evaluation.

RESULTS

Patients who underwent the QMT intervention for 4 weeks exhibited a statistically significant reduction in scores on the 17 Hamilton Depression Rating Scale, Hamilton Anxiety Scale, the Zung Self-Rating Depression Scale, the Self-Rating Anxiety Scale, and the Insomnia Severity Index relative to their pre-intervention scores (all P < 0.05).

CONCLUSION

QMT training for 4 weeks is an effective nonpharmacological treatment for symptoms of depression, anxiety, and insomnia among patients with mild-to-moderate depression.

ENIGMA-Meditation: Worldwide Consortium for Neuroscientific Investigations of Meditation Practices

Meditation is a family of ancient and contemporary contemplative mind-body practices that can modulate psychological processes, awareness, and mental states. Over the last 40 years, clinical science has manualized meditation practices and designed various meditation interventions that have shown therapeutic efficacy for disorders including depression, pain, addiction, and anxiety. Over the past decade, neuroimaging has been used to examine the neuroscientific basis of meditation practices, effects, states, and outcomes for clinical and nonclinical populations. However, the generalizability and replicability of current neuroscientific models of meditation have not yet been established, because they are largely based on small datasets entrenched with heterogeneity along several domains of meditation (e.g., practice types, meditation experience, clinical disorder targeted), experimental design, and neuroimaging methods (e.g., preprocessing, analysis, task-based, resting-state, structural magnetic resonance imaging). These limitations have precluded a nuanced and rigorous neuroscientific phenotyping of meditation practices and their potential benefits. Here, we present ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis)-Meditation, the first worldwide collaborative consortium for neuroscientific investigations of meditation practices. ENIGMA-Meditation will enable systematic meta- and mega-analyses of globally distributed neuroimaging datasets of meditation using shared, standardized neuroimaging methods and tools to improve statistical power and generalizability. Through this powerful collaborative framework, existing neuroscientific accounts of meditation practices can be extended to generate novel and rigorous neuroscientific insights that account for multidomain heterogeneity. ENIGMA-Meditation will inform neuroscientific mechanisms that underlie therapeutic action of meditation practices on psychological and cognitive attributes, thereby advancing the field of meditation and contemplative neuroscience.

The effect of stress mindset on psychological pain: the chain mediating roles of cognitive reappraisal and self-identity

Background

Psychological pain is the most important factor affecting suicide rates. However, the factors contributing to psychological pain in medical students remain poorly understood.

Objective

This study aimed to investigate the effects of a stress mindset on psychological pain and the mediating roles of cognitive reappraisal and self-identity among Chinese medical students.

Methods

Medical students (N = 2056; 1,369, 66.60% female; 683, 33.40% male) from China completed multiple measures of stress mindset, self-identity, cognitive reappraisal, and psychological pain. Correlation and mediation analyses were conducted using SPSS 29.0 and Mplus 8.3.

Results

(1) The stress mindset was significantly negatively correlated with psychological pain among medical students. (2) Cognitive reappraisal mediated the relationship between the stress mindset and psychological pain. (3) Self-identity mediated the relationship between the stress mindset and psychological pain. (4) Cognitive reappraisal and self-identity jointly mediated the relationship between the stress mindset and psychological pain.

Conclusion

The results of this study deepen the understanding of the psychological processes linking stress mindset and psychological pain and provide a valuable reference for reducing psychological pain and improving the well-being of medical students.

Implementation of Mindfulness-Based Emotion Regulation Strategies: A Systematic Review and Meta-analysis

Among the strategies people can use to regulate their emotions, there is increasing interest in mindfulness. Although prior reviews support that mindful acceptance (equanimity) is an effective strategy, other components of mindfulness (monitoring/ mindful awareness) have received less attention. Further, a recent theoretical framework-the Dual-mode Model of Mindful Emotion Regulation-proposed that mindfulness has two "modes" of action in emotion regulation: (1) implementation to regulate emotions as time-limited strategies and (2) acting as a moderator that facilitates effective emotion regulation. The present systematic review and meta-analysis aimed to evaluate the implementation of mindfulness-based strategies and facilitation effects of mindfulness on emotion reactivity and strategy implementation. A total of 2037 records were screened, from which 110 studies with 767 effects (N = 8,105) were analyzed. There was a significant effect of mindfulness-based strategies (g = .28, 95% CI [.18, .38], I 2 = 83.3%). Components of monitoring (g = .17, 95% CI [.02, .32]) and equanimity (g = .3, 95% CI [.19, .41]) were also effective, although monitoring alone was significantly less effective than other strategies. The effect size was greater for within-subjects designs, text-based emotional stimuli, personally relevant stimuli, and behavioral outcomes (e.g., pain tolerance). Despite small-study effects and publication bias, the estimate was robust to sensitivity analyses (between .15 and .3). Meta-regression of facilitation supported that greater study-level equanimity was associated with reduced reactivity. As hypothesized, mindfulness-based strategies can effectively regulate emotions. Methodological considerations and directions for future study are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-024-00281-x.

Stress in specific population: Cognitive decline in aging, occupational challenges, strategies for medical professionals

Understanding cognitive decline and its contributing causes, such as stress, which presents differently in different groups, is crucial given the aging population's rapid growth. This chapter looks at how stress affects older persons' cognitive decline, with a particular emphasis on the difficulties faced by medical professionals in their line of work and how to lessen the consequences. The severity and course of cognitive decline differ from person to person and are impacted by factors such as lifestyle, medical history, and stress at work. The COVID-19 pandemic has made medical practitioners' already high demands even more precarious. Stress in underprivileged areas and among veterans emphasizes the negative effects of work-related stress on mental health even more. Techniques that improve psychological well-being and lessen burnout include resilience training, digital tools, supportive leadership, and mindfulness-based stress reduction (MBSR). Enhancing work-life balance and promoting a healthier work environment can be achieved by combining these interventions with organizational changes. Aging-related cognitive impairment necessitates a multimodal strategy that includes targeted stress reduction methods and organizational adjustments. Setting mental health as a top priority in healthcare settings promotes the wellbeing of staff members, enhances patient care, and improves healthcare results.

Fears Worth Testing Out: A Systematic Review of the Neural Mechanisms of Treatment Outcome for Anxiety-Related Disorders

With the advent of human neuroimaging, researchers were drawn to the idea that by better understanding the human brain, more effective mental health interventions could be developed. It has been more than 20 years since the first functional magnetic resonance imaging (fMRI) studies were conducted to examine changes in brain activation with anxiety-related treatments and more than 60 studies have since been published in this vein. For the current review, we conduct a systematic review of this literature, focusing on adult studies using task-based fMRI to measure brain activation changes with pharmacologic or psychotherapy interventions for phobia, social anxiety disorder, panic disorder, generalized anxiety disorder, posttraumatic stress disorder, and obsessive-compulsive disorder. Neuroscientific theories of anxiety-related disorders and their treatment have focused on prefrontal-insula-amygdala networks. Treatment-related decreases in amygdala and/or anterior insula activation were identified as the most consistent finding across disorders, with the most consistent results reported for specific phobia. Directionality of change and specific regions implicated in the prefrontal cortex were inconsistent across studies. The potential importance for probing other networks and processes as mechanisms of anxiety treatment was recognized, such as striatal regions underlying inhibitory learning or reward responsivity. Future treatment-fMRI research related to anxiety disorders would benefit from larger sample sizes, use of more nuanced computational approaches, and increased focus on replication. There is continued promise that fMRI research will enhance our understanding of how treatments work and inform the evolution of more effective or personalized mental health treatment.

Research hotspots and trends of neuroimaging in social anxiety: a CiteSpace bibliometric analysis based on Web of Science and Scopus database

Background

This study focused on the research hotspots and development trends of the neuroimaging of social anxiety (SA) in the past 25 years.

Methods

We selected 1,305 studies on SA neuroimaging from the Web of Science and Scopus from January 1998 to December 2023. CiteSpace was used to analyze the number of published articles visually, cited references, cooperation among authors and institutions, co-occurrence of keywords, clustering of keywords, burst of keywords, and time zone of co-occurring keywords.

Results

A total of 1,305 articles were included, and the annual number of articles published over nearly 25 years showed the overall trend is on the rise. The analysis of author and institutional collaboration reveals that most authors collaborate closely. Among them, the team led by Pine, Daniel S published 59 articles, making it the most central team. Harvard University is identified as the most central institution in this network. The research hotspots can be categorized into four areas: research techniques, cognitive processing research areas, core brain regions and brain networks, and the neural predictors of treatment outcomes in SA. The most recent burst keywords are "cognitive behavioral therapy," "systematic review," "machine learning," "major clinical study," "transcranial direct current stimulation," "depression," and "outcome assessment," which provided clues on research frontiers. Based on the burst map and keyword time zone map, it appears that exploring the activity of brain regions involved in cognitive processing, such as face processing and attentional bias, as well as the comorbidity of SA and depression, through brain imaging technology, using brain signals as predictors of treatment outcomes in SA.

Conclusion

This study conducted a comprehensive, objective, and visual analysis of publications, and revealed hot topics and trends concerning the study of the brain mechanism of SA from 1998 to 2023. This work might assist researchers in identifying new insights on potential collaborators and institutions, hot topics, and research directions.

Cognitive behavioral group therapy for social anxiety disorder - A critical review of methodological designs

Social anxiety disorder (SAD) is highly prevalent with significant lifetime impacts, especially when left untreated. Cognitive behavioral therapy is the current gold standard treatment with successful patient outcomes. Cognitive behavioral group therapy (CBGT) is one form that provides unique benefits to participants including normalization of symptoms and social support, as well as providing increased access to treatment at a lower per-session cost. Research on this mode of treatment has been ongoing for over 20 years, but we still have much to learn about its overall efficacy. The goals of this critical review were to summarize and evaluate the most current research, including an analysis of the overall methodological design quality, and provide recommendations for the enhancement of future studies based on best practices. Recent studies included some best practice design elements used in measuring efficacy such as the use of comparison groups, masking procedures, fidelity assessments, and consideration of clinical significance in outcomes. However, many gaps exist such as a lack of consensus around measures and therapy manuals, as well as baseline competencies of facilitators. Future studies should consider incorporating additional best practice elements aligning with study goals to strengthen designs and provide the field with even more confidence in this mode of treatment.

Neural activation changes following attention bias modification treatment or a selective serotonin reuptake inhibitor for social anxiety disorder

BACKGROUND

Delineation of changes in neural function associated with novel and established treatments for social anxiety disorder (SAD) can advance treatment development. We examined such changes following selective serotonin reuptake inhibitor (SSRI) and attention bias modification (ABM) variant - gaze-contingent music reward therapy (GC-MRT), a first-line and an emerging treatments for SAD.

METHODS

Eighty-one patients with SAD were allocated to 12-week treatments of either SSRI or GC-MRT, or waitlist (ns = 22, 29, and 30, respectively). Baseline and post-treatment functional magnetic resonance imaging (fMRI) data were collected during a social-threat processing task, in which attention was directed toward and away from threat/neutral faces.

RESULTS

Patients who received GC-MRT or SSRI showed greater clinical improvement relative to patients in waitlist. Compared to waitlist patients, treated patients showed greater activation increase in the right inferior frontal gyrus and anterior cingulate cortex when instructed to attend toward social threats and away from neutral stimuli. An additional anterior cingulate cortex cluster differentiated between the two active groups. Activation in this region increased in ABM and decreased in SSRI. In the ABM group, symptom change was positively correlated with neural activation change in the dorsolateral prefrontal cortex.

CONCLUSIONS

Brain function measures show both shared and treatment-specific changes following ABM and SSRI treatments for SAD, highlighting the multiple pathways through which the two treatments might work. Treatment-specific neural responses suggest that patients with SAD who do not fully benefit from SSRI or ABM may potentially benefit from the alternative treatment, or from a combination of the two.

TRIAL REGISTRATION

ClinicalTrials.gov, Identifier: NCT03346239. https://clinicaltrials.gov/ct2/show/NCT03346239.

Latent profile analysis of benefit finding among family caregivers of Chinese older adults with disabilities and its influencing factors

OBJECTIVES

The increase in the number of older adults with disability creates new challenges for caregivers. Benefit finding is the positive experience that caregivers get from caregiving, helping to reduce the negative impact on the caregiver's quality of life. However, there is less research on the positive experiences of family caregivers of older adults with disabilities. This study aimed to identify different benefit finding profiles among family caregivers of older adults with disabilities in China and to explore the sociodemographic characteristics and psychosocial factors with different benefit finding profiles.

METHODS

A cross-sectional study of 218 family caregivers of Chinese older adults with disabilities using the sociodemographic questionnaire, the Family-APGAR, the Sense of Coherence-13, the Emotion Regulation Scale and Benefit Finding Scale from October 2022 to June 2023 in communities and hospitals of China, Shenyang, Liaoning Province. Latent profile analysis was used to analyze the latent profiles of benefit finding among family caregivers of Chinese older adults with disability. Multiple logistic regression was used to explore the predictors of different profiles.

RESULTS

The benefit finding among family caregivers of Chinese older adults with disability can be classified into three potential profiles: Profile 1 - high-level benefit finding group (12.84%), Profile 2 - medium-level benefit finding group (43.58%), Profile 3 - low-level benefit finding group (43.58%). Working status, family function, and cognitive reappraisal of caregiver were predictors of different profiles.

CONCLUSIONS

Nurses and community health care staffs should pay attention to the characteristics, family function, and emotion regulation strategies of family caregivers of older adults with different disability. Help family caregivers enhance family cohesion and cognitive reappraisal to improve positive experiences for caregivers in different profiles.

Effects of an online mindfulness-based intervention on brain haemodynamics: a pilot randomized controlled trial using functional near-infrared spectroscopy

Although many neuroimaging studies have evaluated changes in the prefrontal cortex during mindfulness-based interventions, most of these studies were cross-sectional studies of skilled participants or involved pre-post comparisons before and after a single session. While functional near-infrared spectroscopy is a useful tool to capture changes in the hemodynamic response of the prefrontal cortex during continuous mindfulness-based intervention, its ability to detect the accumulated effects of continuous mindfulness-based intervention is currently unclear. We investigated whether a 12-wk online mindfulness-based intervention changed the hemodynamic response of the prefrontal cortex during a verbal fluency task. Eighty-two healthy university students were randomly allocated to a 12-wk online mindfulness-based intervention group or a wait-list control group. The integral values of oxygenated hemoglobin measured using functional near-infrared spectroscopy before and after the intervention were compared to the values in the wait-list group. The intervention condition showed significantly greater functional near-infrared spectroscopy signal activation than the control condition; however, the effect sizes before and after the intervention were small. Thus, continuous mindfulness-based intervention could alter prefrontal cortex function, and functional near-infrared spectroscopy could be useful for measuring the accumulated effects of continuous mindfulness-based interventions. With a better understanding of the association between mindfulness and functional near-infrared spectroscopy signals, functional near-infrared spectroscopy can be used for biofeedback analyses.

Quality of life and its association with predictors in lung transplant recipients: a latent profile analysis

Backgrounds

Improving quality of life (QOL) is one of the main aims of lung transplantation (LTx). There is a need to identify those who have poor quality of life early. However, research addressing inter individual quality of life variability among them is lacking. This study aims to identify group patterns in quality of life among lung transplant recipients and examine the predictors associated with quality of life subgroups.

Methods

In total, 173 lung transplant recipients were recruited from one hospital in Guangdong Province between September 2022 and August 2023. They were assessed using the Lung Transplant Quality of Life scale (LT-QOL), Mindful Attention Awareness Scale (MAAS), Life Orientation Test-Revised scale (LOT-R), and Positive and Negative Affect Scale (PANAS). Latent profile analysis was used to identify QOL subtypes, and logistic regression analysis was used to examine the associations between latent profiles and sociodemographic and psychosocial characteristics.

Results

Two distinct QOL profiles were identified: "low HRQOL" profile [N = 53 (30.94%)] and "high HRQOL" profile [N = 120 (69.06%)]. Single lung transplant recipients, and patients who reported post-transplant infection, high levels of negative emotion or low levels of mindfulness and optimism were significantly correlated with the low QOL subgroup.

Conclusion

Using the domains of the LT-QOL scale, two profiles were identified among the lung transplant recipients. Our findings highlighted that targeted intervention should be developed based on the characteristics of each latent class, and timely attention must be paid to patients who have undergone single lung transplantation, have had a hospital readmission due to infection, exhibit low levels of optimism, low levels of mindfulness or high negative emotions.

Emotion Regulation as a Mechanism of Mindfulness in Individual Cognitive-Behavioral Therapy for Depression and Anxiety Disorders

Background

The global prevalence of depression and anxiety disorders underscores the need for a more profound comprehension of effective treatments. Mindfulness has shown promise in enhancing treatment outcomes and preventing relapse in these conditions, but the underlying mechanisms remain poorly understood.

Methods

This study examined the role of emotion regulation as a mediator in the relationship between changes in mindfulness and the reduction of depression and anxiety symptoms during individual cognitive-behavioral therapy (CBT). We tracked longitudinal changes in mindfulness, emotion regulation, depression, and anxiety at baseline (pre), early treatment (session 5), midtreatment (session 15), and posttreatment (session 25) in 162 patients with depression and anxiety disorders. Further, we examined whether the effects of mindfulness on emotion regulation could be enhanced by introducing a brief mindfulness intervention at the beginning of each CBT session, as compared to progressive muscle relaxation and individual psychotherapy without any standardized session-introducing interventions.

Results

Multilevel structural equation modeling indicated that decreases in rumination and increases in reappraisal and acceptance mediated the relationship between mindfulness and reductions in depressive symptoms. In contrast, reductions in avoidance explained the association between mindfulness and changes in anxiety symptoms. These links remained unchanged when adding a mindfulness intervention into individual CBT.

Conclusion

Results support emotion regulatory properties of mindfulness and highlight distinct pathways of symptom reduction in depression and anxiety. These findings have important implications for understanding the mechanisms of mindfulness and tailoring treatment to individual patient needs. This trial is registered with NTC02270073.

Brain connectomics improve prediction of 1-year decreased quality of life in breast cancer: A multi-voxel pattern analysis

PURPOSE

Whether brain connectomics can predict 1-year decreased Quality of Life (QoL) in patients with breast cancer are unclear. A longitudinal study was utilized to explore their prediction abilities with a multi-center sample.

METHODS

232 breast cancer patients were consecutively enrolled and 214 completed the 1-year QoL assessment (92.2%). Resting state functional magnetic resonance imaging was collected before the treatment and a multivoxel pattern analysis (MVPA) was performed to differentiate whole-brain resting-state connectivity patterns. Net Reclassification Improvement (NRI) as well as Integrated Discrimination Improvement (IDI) were calculated to estimate the incremental value of brain connectomics over conventional risk factors.

RESULTS

Paracingulate Gyrus, Superior Frontal Gyrus and Frontal Pole were three significant brain areas. Brain connectomics yielded 7.8-17.2% of AUC improvement in predicting 1-year decreased QoL. The NRI and IDI ranged from 20.27 to 54.05%, 13.21-33.34% respectively.

CONCLUSION

Brain connectomics contribute to a more accurate prediction of 1-year decreased QoL in breast cancer. Significant brain areas in the prefrontal lobe could be used as potential intervention targets (i.e., Cognitive Behavioral Group Therapy) to improve long-term QoL outcomes in breast cancer.

Salivary testosterone and cortisol response in acute stress modulated by seven sessions of mindfulness meditation in young males

Stress is an established risk factor for negative health outcomes. Salivary cortisol and testosterone concentrations increase in response to acute psychosocial stress. It's crucial to reduce stress for health and well-being through evidence-based interventions. Body-mind interventions such as meditation and Tai Chi have shown reduced cortisol levels but mixed results in testosterone concentration after stress. To address this research gap, we conducted a pilot randomized controlled trial to examine the modulating effects of a short-term (seven 20-minute sessions) mindfulness meditation on testosterone and cortisol in response to acute stress. Using one form of mindfulness meditation - Integrative Body-Mind Training (IBMT) and an active control-relaxation training (RT), we assessed salivary cortisol and testosterone concentrations at three stages of stress intervention - rest, stress, and an additional 20-min IBMT or RT practice. We found increased cortisol and testosterone concentrations after acute stress in both groups, but testosterone rise was not associated with cortisol rise. Moreover, an additional practice immediately after stress produced higher testosterone concentrations in the IBMT group than the RT group, whereas cortisol concentration increased in the RT group than in the IBMT group at the same time point. These findings indicate that brief mindfulness intervention modulates a dual-hormone profile of testosterone and cortisol in response to acute stress presumably via the co-regulation of hypothalamus-pituitary-adrenal and hypothalamus-pituitary-testicular axes.

The Neural Separability of Emotion Reactivity and Regulation

One foundational distinction in affective science is between emotion reactivity and regulation. This conceptual distinction has long been assumed to be instantiated in spatially separable brain systems (a typical example: amygdala/insula for reactivity and frontoparietal areas for regulation). In this research, we begin by reviewing previous findings that support and contradict the neural separability hypothesis concerning emotional reactivity and regulation. Further, we conduct a direct test of this hypothesis with empirical data. In five studies involving healthy and clinical samples (total n = 336), we assessed neural responses using fMRI while participants were asked to either react naturally or regulate their emotions (using reappraisal) while viewing emotionally evocative stimuli. Across five studies, we failed to find support for the neural separability hypothesis. In univariate analyses, both presumptive "reactivity" and "regulation" brain regions demonstrated equal or greater activation for the reactivity contrast than for the regulation contrast. In multivariate pattern analyses (MVPA), classifiers decoded reactivity (vs. neutral) trials more accurately than regulation (vs. reactivity) trials using multivoxel data in both presumptive "reactivity" and "regulation" regions. These findings suggest that emotion reactivity and regulation-as measured via fMRI-may not be as spatially separable in the brain as previously assumed. Our secondary whole-brain analyses revealed largely consistent results. We discuss the two theoretical possibilities regarding the neural separability hypothesis and offer thoughts for future research.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-023-00227-9.

Does acceptance lead to change? Training in radical acceptance improves implementation of cognitive reappraisal

Third-wave cognitive behavioral treatments such as dialectical behavioral therapy (DBT) theorize that emotional acceptance facilitates cognitive change. However, empirical evidence to support this notion is scarce. This study assessed how a two-week online training in using acceptance or cognitive change DBT skills influences the implementation of these strategies in an emotion regulation task. During six training sessions, 120 healthy individuals recorded personal negative events. In a Radical Acceptance group, participants implemented a DBT skill aimed to promote acceptance of the negative events they described. In a Check the Facts group, participants reappraised their interpretations of the described events. A Control group described negative events but did not use any DBT skill. Results supported our preregistered hypotheses showing that following the training, participants who practiced Radical Acceptance improved in their ability to implement both emotional acceptance and cognitive reappraisal (cognitive change) in an emotion regulation task. In contrast, the Check the Facts group improved only in the ability to use cognitive reappraisal, but not emotional acceptance. The control group did not improve in either strategy. The findings provide empirical evidence to support the notion that cultivating acceptance can subsequently improve the ability to reinterpret reality for coping adaptively with negative events.

Distinct and shared therapeutic neural mechanisms of mindfulness-based and social support stress reduction groups in adults with autism spectrum disorder

BACKGROUND

Mindfulness-based stress reduction (MBSR) alleviates depression and anxiety in adults with autism spectrum disorder (ASD); however, underlying therapeutic neural mechanisms and mindfulness-specific effects have yet to be elucidated.

METHODS

We randomly assigned adults with ASD to MBSR or social support/education (SE). They completed questionnaires that assessed depression, anxiety, mindfulness traits, autistic traits and executive functioning abilities as well as a self-reflection functional MRI task. We used repeated-measures analysis of covariance (ANCOVA) to evaluate behavioural changes. To identify task-specific connectivity changes, we performed a generalized psychophysiological interactions (gPPI) functional connectivity (FC) analysis on regions of interest (ROIs; insula, amygdala, cingulum and prefrontal cortex [PFC]). We used Pearson correlations to explore brain-behaviour relationships.

RESULTS

Our final sample included 78 adults with ASD - 39 who received MBSR and 39 who received SE. Mindfulness-based stress reduction uniquely improved executive functioning abilities and increased mindfulness traits, whereas both MBSR and SE groups showed reductions in depression, anxiety and autistic traits. Decreases specific to MBSR in insula-thalamus FC were associated with anxiety reduction and increased mindfulness traits, including the trait "nonjudgment;" MBSR-specific decreases in PFC-posterior cingulate connectivity correlated with improved working memory. Both groups showed decreased amygdala-sensorimotor and medial-lateral PFC connectivity, which corresponded with reduced depression.

LIMITATIONS

Larger sample sizes and neuropsychological evaluations are needed to replicate and extend these findings.

CONCLUSION

Together, our findings suggest that MBSR and SE are similarly efficacious for depression, anxiety and autistic traits, whereas MBSR produced additional salutary effects related to executive functioning and mindfulness traits. Findings from gPPI identified shared and distinct therapeutic neural mechanisms, implicating the default mode and salience networks. Our results mark an early step toward the development of personalized medicine for psychiatric symptoms in ASD and offer novel neural targets for future neurostimulation research.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT04017793.

Update on treatments for anxiety-related disorders

PURPOSE OF REVIEW

This review examines recent evidence that informs the treatment of anxiety-related disorders.

RECENT FINDINGS

In addition to selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines, agomelatine has demonstrated efficacy in treating generalized anxiety disorder (GAD). Other novel products, such as ketamine, psilocybin and cannabidiol, are in the process of gathering evidence in support of the treatment of anxiety disorders. In psychological therapy, various psychological treatments for anxiety disorders, such as mindfulness-based intervention, acceptance and commitment therapy, psychodynamic therapy, emotion-focused therapy and dialectical behavioural therapy, have been tried. Still, most therapies have not proven superior to cognitive behavioural therapy (CBT). In very preliminary findings: Repetitive transcranial magnetic stimulation (rTMS) was effective in GAD; transcranial direct current stimulation (tDCS) was effective for social anxiety disorder (SAD) and GAD and augmented exposure therapy for specific fears. Internet and mobile-based interventions have comparable efficacy to face-to-face therapy.

SUMMARY

Pharmacotherapy of anxiety disorders is expanding to novel products. Despite trying other psychological therapies for anxiety disorders, most therapies were comparable to but not superior to CBT. rTMS and tDCS were also used and show early promise for GAD, but further studies are needed. Most internet or mobile app based psychological therapies were based on CBT, and some can be considered as alternatives to in-person face-to-face therapy.

Translating Big Data to Clinical Outcomes in Anxiety: Potential for Multimodal Integration

PURPOSE OF THE REVIEW

This review describes approaches to research on anxiety that attempt to link neural correlates to treatment response and novel therapies. The review emphasizes pediatric anxiety disorders since most anxiety disorders begin before adulthood.

RECENT FINDINGS

Recent literature illustrates how current treatments for anxiety manifest diverse relations with a range of neural markers. While some studies demonstrate post-treatment normalization of markers in anxious individuals, others find persistence of group differences. For other markers, which show no pretreatment association with anxiety, the markers nevertheless distinguish treatment-responders from non-responders. Heightened error related negativity represents the risk marker discussed in the most depth; however, limitations in measures related to error responding necessitate multimodal and big-data approaches. Single risk markers show limits as correlates of treatment response. Large-scale, multimodal data analyzed with predictive models may illuminate additional risk markers related to anxiety disorder treatment outcomes. Such work may identify novel targets and eventually guide improvements in treatment response/outcomes.

Mindfulness-Oriented Recovery Enhancement for Addictive Behavior, Psychiatric Distress, and Chronic Pain: A Multilevel Meta-Analysis of Randomized Controlled Trials

Objectives

Mindfulness-Oriented Recovery Enhancement (MORE) is an integrative intervention designed to ameliorate addiction, chronic pain, and psychiatric symptoms. Although multiple randomized controlled trials (RCTs) have examined the clinical efficacy of MORE, no study has quantitatively synthesized this body of research. Thus, we conducted a meta-analysis of RCTs examining the effects of MORE on addictive behaviors, craving, opioid dose, pain, and psychiatric symptoms.

Methods

Relevant manuscripts were identified through comprehensive searches of four bibliographic databases. Two- and three-level random-effects models were used to generate synthesized effect size estimates, and meta-regressions were performed to examine whether study and sample characteristics influenced the magnitude of aggregate effect sizes.

Results

Our search identified 16 manuscripts reporting data from eight RCTs (N = 816). Moderate to small effects in favor of MORE were observed for addictive behaviors (SMC =  - .54, p = .007), craving (SMC =  - .42, p = .010), opioid dose (MC =  - 17.95, p < .001), chronic pain (SMC =  - .60, p < .001), and psychiatric symptoms (SMC =  - .34, p < .001). MORE's effects on psychiatric symptoms and craving were not moderated by participant race, gender, age, or income.

Conclusions

Study findings provide empirical evidence of MORE's efficacy for a wide diversity of individuals, and as such, MORE should now be disseminated broadly throughout the healthcare system.

Meta-analysis Pre-registration PROSPERO #CRD42022319006

Supplementary Information

The online version contains supplementary material available at 10.1007/s12671-022-01964-x.

Mindfulness-oriented recovery enhancement improves negative emotion regulation among opioid-treated chronic pain patients by increasing interoceptive awareness

OBJECTIVE

Long-term opioid therapy presents health risks for people with chronic pain. Some chronic pain patients escalate their opioid dose to regulate negative emotions. Therefore, emotion regulatory strategies like reappraisal are key treatment targets for this population. Mindfulness has been shown to enhance reappraisal, but the mechanisms of action are unknown. This study was a secondary analysis of data from a randomized, controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE) to test a specific postulate of the Mindfulness-to-Meaning Theory: that mindfulness-based interventions promote reappraisal, via interoceptive self-regulation, as a means of decreasing emotional distress.

METHODS

Ninety-five patients with opioid-treated chronic pain (age = 56.8 ± 11.7, 66% female) were randomized to 8 weeks of MORE or Support Group (SG) psychotherapy. An interoceptive awareness latent variable was constructed from the Multidimensional Assessment of Interoceptive Awareness (MAIA). Next, interoceptive self-regulation was assessed as a mediator of the effect of MORE on post-treatment reappraisal, and then reappraisal was examined as a mediator of change in distress through 3-month follow-up.

RESULTS

MORE participants had greater improvements in interoceptive awareness than the SG as measured by the interoceptive awareness latent variable (β = 0.310, p = 0.008) and by the self-regulation MAIA subscale (β = 0.335, p = 0.001). The effect of MORE on treatment-induced increases in reappraisal was mediated by increased interoceptive self-regulation (indirect effect: β = 0.110, p = 0.030). In turn, decreases in distress through 3-month follow-up were mediated by increases in reappraisal (indirect: β = -0.136, p = 0.031).

CONCLUSION

MORE facilitated reappraisal of distress by enhancing interoceptive self-regulation, supporting a central mechanistic causal pathway specified by the Mindfulness-to-Meaning Theory.