Mindfulness, Interoception, and the Body: A Contemporary Perspective

Bridging the gap of brain and experience - Converging Neurophenomenology with Spatiotemporal Neuroscience

Neuroscience faces the challenge of connecting brain and mind, with the mind manifesting in first-person experience while the brain's neural activity can only be investigated in third-person perspective. To connect neural and mental states, Neurophenomenology provides a methodological toolkit for systematically linking first-person subjective experience with third-person objective observations of the brain's neural activity. However, beyond providing a systematic methodological strategy ('disciplined circularity'), it leaves open how neural activity and subjective experience are related among themselves, independent of our methodological strategy. The recently introduced Spatiotemporal Neuroscience suggests that neural activity and subjective experience share a commonly underlying feature as their "common currency", notably analogous spatiotemporal dynamics. Can Spatiotemporal Neuroscience inform Neurophenomenology to allow for a deeper and more substantiative connection of first-person experience and third-person neural activity? The goal of our paper is to show how Spatiotemporal Neuroscience and Neurophenomenology can be converged and integrated with each other to gain better understanding of the brain-mind connection. We describe their convergence on theoretical grounds which, subsequently, is illustrated by empirical examples like self, meditation, and depression. In conclusion, we propose that the integration of Neurophenomenology and Spatiotemporal Neuroscience can provide complementary insights, enrich both fields, allows for deeper understanding of brain-mind connection, and opens the door for developing novel methodological approaches in their empirical investigation.

A cross-sectional study on the influence of emotion regulation strategies on the association between trait mindfulness and suicidality

BACKGROUND

Several risk factors for suicidality, including dysfunctional emotion regulation strategies (ERS), have been identified. With regard to the high number of suicides worldwide, suicide prevention and identifying potentially protective factors is of high relevance. Mindfulness has been discussed to positively influence both suicidality and ERS (e.g., expressive suppression, thought suppression, and cognitive reappraisal). The aim of this study was to examine associations between mindfulness, ERS, and suicidal ideation as well as the mediating role of ERS on the association between mindfulness and suicidal ideation.

METHODS

In a cross-sectional online study, 376 participants (M = 27.35, SD = 9.98, range = 18-77; n = 282 (75%) female) filled out questionnaires on mindfulness (Freiburger Questionnaire on Mindfulness; FFA), suicidal ideation (Beck Scale for Suicidal Ideation; BSS), expressive suppression (Emotion Regulation Questionnaire; ERQ), thought suppression (White Bear Suppression Inventory; WBSI), and cognitive reappraisal (ERQ). Correlations and mediation models were calculated using SPSS.

RESULTS

Mindfulness was negatively correlated with the use of expressive suppression and thought suppression as well as positively correlated with cognitive reappraisal. Suicidal ideation was negatively correlated with mindfulness and cognitive reappraisal and positively with expressive suppression and thought suppression. The mediation models showed that all three ERS mediated the relationship between mindfulness and suicidal ideation.

CONCLUSIONS

The results meaningfully complement other findings in the field and show how promising it can be to integrate mindfulness-based interventions in suicide prevention. Additionally, ERS can be a starting point for therapeutic interventions.

TRIAL REGISTRATION

The study was preregistered on 05/06/2022 at aspredicted.org (#96242) prior to any data collection (see https://aspredicted.org/a4yq7.pdf ).

Neural Correlates of Alexithymia Based on Electroencephalogram (EEG)-A Mechanistic Review

Introduction: Alexithymia is a multidimensional construct characterized by difficulties in identifying and describing emotions, distinguishing emotional states from bodily sensations, and an externally oriented thinking style. Although the prevalence in the general population is around 10%, it is significantly higher in clinical groups, including those with autism spectrum disorders, depression, anxiety, and neurological conditions. Neuroimaging research, especially using magnetic resonance imaging, has documented structural and functional alterations in alexithymia; however, electroencephalography (EEG)-an older yet temporally precise method-remains less comprehensively explored. This mechanistic review aims to synthesize EEG-based evidence of the neural correlates of alexithymia and to propose potential neurophysiological mechanisms underpinning its affective and cognitive dimensions. Methods: A thorough literature search was conducted in December 2024 across PubMed/Medline, ResearchGate, Google Scholar, and Cochrane using combined keywords ("EEG", "QEEG", "electroencephalography", "alexithymia") to identify English-language clinical trials or case studies published from January 1980 to December 2024. Two reviewers independently screened the titles and abstracts, followed by a full-text review. Studies were included if they specifically examined EEG activity in participants with alexithymia. Of the 1021 initial records, eight studies fulfilled the inclusion criteria. Results: Across the reviewed studies, individuals with alexithymia consistently demonstrated right-hemisphere dominance in EEG power and connectivity, particularly in the theta and alpha bands, during both neutral and emotion-eliciting tasks. Many exhibited reduced interhemispheric coherence and disrupted connectivity in the frontal and parietal regions, potentially contributing to difficulties in cognitive processing and emotion labeling. Some studies have also reported diminished gamma band activity and phase synchrony in response to negative stimuli, suggesting impaired higher-order integration of emotional information. Crucially, subjective reports (e.g., valence ratings) often do not differ between alexithymic and non-alexithymic groups, highlighting that EEG measures may capture subtle emotional processing deficits not reflected in self-reports. Conclusions: EEG findings emphasize that alexithymia involves specific disruptions in cortical activation and network-level coordination, rather than merely the absence of emotional experiences. Right-hemisphere over-reliance, reduced interhemispheric transfer, and atypical oscillatory patterns in the alpha, theta, and gamma bands appear to be central to the condition's pathophysiology. Understanding these neural signatures offers avenues for future research-particularly intervention studies that test whether modulating these EEG patterns can improve emotional awareness and expression. These insights underscore the potential clinical utility of EEG as a sensitive tool for detecting and tracking alexithymic traits in both research and therapeutic contexts.

Heart Rate Variability Biofeedback Training Can Improve Menopausal Symptoms and Psychological Well-Being in Women with a Diagnosis of Primary Breast Cancer: A Longitudinal Randomized Controlled Trial

Breast cancer survivors experience numerous chronic symptoms linked to autonomic dysfunction including anxiety, stress, insomnia, menopausal symptoms, and cognitive impairment. Effective non-pharmacological solutions to address these are currently lacking.

METHODS

Our three-armed longitudinal randomized controlled trial assessed the effectiveness of a 4-week remote smartphone-based heart rate variability biofeedback intervention which involved daily paced breathing at 6 breaths p/min; active (12 breaths p/min) and waitlist controls were included. Heart rate variability and self-reported cancer-related symptoms were assessed at baseline, post-, and 6 months-post intervention. Participants were 60 UK-based women with primary breast cancer history (6 to 60 months post-active treatment).

RESULTS

The intervention group showed significant increases in low-frequency heart rate variability over time (F (4, 103.89) = 2.862, p = 0.027, d = 0.33), long-lasting improvement in sleep quality (F (4, 88.04) = 4.87, p = 0.001, d = 0.43) and cessations in night sweats (X2 (2, N = 59) = 6.44, p = 0.04, Cramer's V = 0.33), and reduced anxiety post-intervention compared to the active and waitlist controls (F (4, 82.51) = 2.99, p = 0.023, d = 0.44). Other findings indicated that the intervention and active control participants reported lasting improvements in cognitive function, fatigue, and stress-related symptoms (all ps < 0.05). The waitlist group reported no symptom changes across time.

CONCLUSION

Heart rate variability biofeedback is a feasible intervention for addressing diverse chronic symptoms commonly reported by breast cancer survivors.

Symptom perception in adults with chronic physical disease: A systematic review of insular impairments

BACKGROUND

To perform self-care, individuals with a chronic illness must be able to perceive bodily changes (ie., interoception) so they can respond to symptoms when they arise. Interoception is regulated by the insular cortex of the brain. Symptom perception is poor in various physical diseases, which may be associated with impairments in the insular cortex.

OBJECTIVE

The purpose of this study was to explore whether patterns of insular impairment exist among adults with chronic physical diseases and to analyze the relationship with disease-related symptoms.

METHODS

We identified studies that assessed the structure and/or activity of the insula through MRI and/or (f)MRI in adults with chronic physical diseases (vs. healthy controls) by searching five databases. Results are reported as a narrative synthesis.

RESULTS

Fifty studies were conducted to investigate the structure or activity of the insula among adults with diabetes, cancer, heart failure, or chronic pulmonary disease. In 19 studies investigators found that patients with a chronic disease had lower/damaged insular volume/density/thickness than healthy controls or reduced insular blood flow. When insular activity was explored in 22 studies, most investigators reported higher insular activity and lower neural connectivity. Five studies explored the association between insular volume/activity and symptom severity: four reported a positive trend.

CONCLUSION

People with chronic physical diseases have lower insular grey matter volume/density/thickness and abnormal insular activity when compared to healthy people. Insular activity may be related to symptom severity. These results suggest that insular structure and/or activity may explain poor symptom perception.

Effect of a mindfulness program on stress, anxiety, depression, sleep quality, social support, and life satisfaction: a quasi-experimental study in college students

Introduction

The university experience often brings various personal and academic challenges that can negatively impact students' mental health. This research aimed to evaluate the effect of a mindfulness program on stress, anxiety, depression, sleep quality, social support, and life satisfaction among university students.

Methods

A quasi-experimental study was conducted with 128 participants, divided into experimental and waiting list control groups. The experimental group participated in a mindfulness meditation program consisting of 12 weekly sessions. Pre-test and post-test measurements were performed using the Perceived Stress Scale (PSS-10), the Zung Self-Rating Anxiety Scale (SAS), the Zung Self-Rating Depression Scale (SDS), the Pittsburgh Sleep Quality Index (PSQI), the Medical Outcomes Study Social Support Survey (MOS-SS), and the Satisfaction with Life Scale (SWLS) to assess the variables.

Results

The experimental group showed statistically significant differences between the study phases and the groups after the intervention for all the variables examined (p < 0.05). The effect sizes calculated using the HC3 model were stress (η 2 = 0.376), anxiety (η 2 = 0.538), depression (η 2 = 0.091), sleep quality (η 2 = 0.306), social support (η 2 = 0.704), and life satisfaction (η 2 = 0.510). The mindfulness program was shown to be effective in reducing levels of stress, anxiety, and depression while also improving sleep quality, social support, and life satisfaction in college students.

Conclusion

These findings indicate that mindfulness meditation may be valuable for enhancing psychological well-being in educational settings.

Mindfulness-based interventions for binge eating: an updated systematic review and meta-analysis

Mindfulness-based interventions (MBIs) have gained popularity in recent years in treating binge eating. Previous reviews and meta-analyses have found that MBIs demonstrated medium-large to large effects in reducing binge eating. However, as the literature on this topic has been growing rapidly, an updated review on MBIs' effectiveness is much needed. This study is a 10-year update of the Godfrey, Gallo, & Afari (2015) systematic review and meta-analysis of MBIs for binge eating. PubMED, PsycINFO, and Web of Science were searched using keywords including binge eating, overeating, objective bulimic episodes, acceptance and commitment therapy, dialectical behavior therapy, mindfulness, meditation, and mindful eating. Results indicate there has been a large increase in the number of studies testing MBIs for binge eating in the past 10 years with 54 studies meeting inclusion criteria, compared to 19 ten years ago. The majority of the studies yielded large and medium effect sizes. The random effects meta-analysis of between-group effect sizes yielded medium-large effects for MBIs versus non-psychological intervention controls at post-treatment (mean Hedge's g = - 0.65) and follow-up (mean Hedge's g = - 0.71), and negligible effects for MBIs versus active psychological controls at post-treatment (mean Hedge's g = - 0.05) and follow-up (mean Hedge's g = 0.13). Of all MBIs, DBT had the most studies with large effects. More studies examined MBIs that directly targeted binge eating had larger effects than studies with MBIs targeting other health outcomes (with binge eating as a secondary outcome). New studies included in the current review were internationally-conducted, focused more on participants with overweight or obesity, involved more self-help and technology-based components, and had more novel and innovative interventions components. Future MBIs research should conduct more RCTs comparing MBIs with other psychological interventions, conduct meta-analyses to examine the effectiveness of different types of MBIs and intervention targets, and extend follow-up periods.

States of consciousness and interoceptive hypersensibility: A study in patients with insomnia disorder

This exploratory study aimed to investigate the relationship between interoceptive sensibility and quality of consciousness in individuals with insomnia disorder, in order to understand how the modulation of internal states may contribute to modifying the experience of consciousness during sleep difficulties. A total of 37 patients with insomnia disorder (mean age = 46.05 ± 18.16) and 41 healthy good sleepers (mean age = 50.2 ± 12.99) underwent a psychometric sleep and interoceptive sensibility assessment, using Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Multidimensional Assessment of Interoceptive Awareness (MAIA). Moreover, patients with insomnia disorder also completed a quality of consciousness evaluation, using the Phenomenology of Consciousness Inventory (PCI). Patients with insomnia disorder exhibited heightened interoceptive sensibility, particularly in noticing body sensations (p < 0.0001) and emotional awareness (p = 0.032), along with diminished abilities in attention regulation (p = 0.040), not-worrying (p = 0.001), and trusting (p = 0.002). Furthermore, correlations between interoceptive sensibility and multiple aspects of the consciousness state during the insomnia night were identified. Specifically, higher emotional awareness was linked to a 2.49-fold increase in the likelihood of subjectively experiencing altered consciousness states during insomnia. The study sheds light on the relationship between interoceptive sensibility and the subjective state of consciousness during insomnia, emphasising the importance of exploring and considering interoception as part of the therapeutic process for insomnia disorder. Given the exploratory nature of the study and the increased risk of type-I error from numerous correlations, the results should be interpreted with caution. Further research is needed to validate and confirm their robustness.

Validation of the Multidimensional Assessment of Interoceptive Awareness Scale in a Sample of Transgender and Gender-Diverse Adults

The Multidimensional Assessment of Interoceptive Awareness (MAIA-2) is a leading assessment of interoception. We examined the factor structure and psychometric characteristics of the MAIA-2 and its associations with psychopathology in a sample of transgender and gender-diverse (TGD) adults. Participants (N = 301) were recruited via Prolific Academic. Regression analyses were conducted to examine the association between the MAIA-2 subscales, disordered eating, and self-injurious thoughts and behaviors. The eight-factor MAIA-2 demonstrated good model fit after removing Item 2. The MAIA-2 subscales were significantly positively associated with body appreciation and body satisfaction and negatively associated with depression, anxiety, and stress. The MAIA-2 subscales also demonstrated several significant associations with disordered eating. Only Body Trust was significantly negatively associated with participants' perceived likelihood of making a future suicide attempt. This study provided preliminary evidence that the MAIA-2 is an adequate measure of interception in TGD samples.

Effects of a Body-Based Mindfulness Program on Alexithymia, Dispositional Mindfulness, and Distress Symptoms: A Pilot Clinical Trial

Mind-body practices have shown to be effective in reducing psychological distress and improving well-being and quality of life in clinical samples and healthy populations. We tested the effects of a body-based mindfulness intervention based on alexithymia, distress symptoms, and dispositional mindfulness among healthy adults. A total of seventy-three participants (mean age 40.1) were assigned to a body-based mindfulness program (i.e., experimental group) and the control group (i.e., waiting list). Distress symptoms were assessed with the Symptoms Questionnaire; alexithymia was measured using the Toronto Alexithymia Scale; and dispositional mindfulness was assessed with the Five Facets Mindfulness Questionnaire. Measures were completed at baseline and at one-week post-test. Even when controlling for baseline score, the body-based mindfulness program has shown to be effective in reducing distress symptoms (i.e., anxiety, depression, and somatic symptoms) and alexithymia, as well as improving dispositional mindfulness (i.e., observing, acting with awareness, and non-reacting). The findings from this study provide evidence that the body-based mindfulness program may help individuals to integrate bodily expressions, thoughts, and emotions, keeping an integrated sense of self.

Edges of perception: balancing sensory loss and potential in assistive technology

Being deafblind means my perception differs profoundly from those who are conventionally sighted and have non-impaired hearing. A lot of hidden knowledge is to be found in the disparity between these differing experiences that could be of great value in developing assistive technologies that have a broad scope to engage with both disabled and non-disabled users. This article explores the balancing act between sensory loss and the potential inherent in all of us and how this should be part of the design process of haptic assistive technology.Facing the true impact of my sensory loss, I realised it held the unexpected gift of a-literally-different perspective. I am losing sights and sounds, but the world still reveals itself to me in many ways. Exploring my sensory potential, I combine daily life experiences and theoretical knowledge to better understand how to get the most out of my sensory processing systems. The goal is not to compensate what is lost, but stay connected in a way that enables me to live my life to the fullest.I undertake sensory life hacks based on the brain's unmatched capacity to adjust to circumstances and work with any kind of input. Both predicting processing and neuroplasticity offer an operating system of highly evolved flexibility that allows and even encourages creative solutions. I adjust my coping strategies to align them with these processes shaping my perceptual experience, balancing sensory loss and sensory gain.I believe there is great potential to enrich daily life experiences with haptic assistive technology, building on the natural sensory abilities we have as human beings, co-creating life. However, this comes with challenges: researchers who are not sensorily impaired should consider through experience that we all have limited perception in a way. At the edges of the familiar, you have to face your perceptual limits, pushing you out of your comfort zone and in doing so space is being created for growth; researchers used to the dominance of sight and hearing are less used to consciously experiencing the power of sensory proximity, such as touch and proprioception. These bodily tactile senses, however, are grounding senses in all of us and display a broad scope of sensations to be experienced.The hereditary disease that causes deafblindness forced me to explore the edges of my perception, and instead of devastating loss I discovered a richness of sensory abilities. This article is a plea to dive into this, using my lived experience and critical knowledge. Realising this potential can mean that inclusive research on assistive technologies might really do what it promises, co-creating technologies to enhance life experiences.

Promoting workplace psychological wellbeing through Yoga and Tai Chi classes in female university employees

Introduction

Academic environments are known for their high demands, often resulting in significant distress among employees. Thus, identifying effective intervention strategies to mitigate workplace stress is essential. The present study aims to evaluate the potential benefits of mind-body interventions (i.e., Yoga and Tai Chi) on the psychological wellbeing and perceived mental and physical health of female university employees.

Methods

A total of 166 female university employees and faculty members participated in 10 sessions of Tai Chi or Yoga. They completed self-report questionnaires assessing ruminative thoughts, somatic anxiety, general distress, perceived physical and mental health, and assertive and cooperative behaviors before and after the 10 Tai Chi/Yoga sessions. Additionally, participants completed a state anxiety questionnaire before and after Tai Chi/Yoga second and second-to-last lessons.

Results

Results showed significant differences between scores pre and post Tai Chi and Yoga programs, with lower ruminative thoughts (p = 0.007), lower somatic anxiety (p < 0.001), and higher perceived mental health (p = 0.038) at the end of the programs (i.e., after 10 sessions) compared to the beginning. Moreover, significant differences were found in state anxiety scores, with a reduction in state anxiety at the end of the second (p < 0.001) and second-to-last (p < 0.001) lessons compared to the start.

Conclusion

Our findings highlight the potential positive impact of Tai Chi and Yoga programs on the psychological wellbeing and perceived mental health of female university employees. Immediate reductions in state anxiety following single sessions further underscore the potential of these practices for short-term stress relief. Overall, the results support the implementation of mind-body practices in workplace settings to promote a healthier work environment.

Classification of mindfulness experiences from gamma-band effective connectivity: Application of machine-learning algorithms on resting, breathing, and body scan

BACKGROUND AND OBJECTIVE

Practicing mindfulness is a mental process toward interoceptive awareness, achieving stress reduction and emotion regulation through brain-function alteration. Literature has shown that electroencephalography (EEG)-derived connectivity possesses the potential to differentiate brain functions between mindfulness naïve and mindfulness experienced, where such quantitative differentiation could benefit telediagnosis for mental health. However, there is no prior guidance in model selection targeting on the mindfulness-experience prediction. Here we hypothesized that the EEG effective connectivity could reach a good prediction performance in mindfulness experiences with brain interpretability.

METHODS

We aimed at probing direct Directed Transfer Function (dDTF) to classify the participants' history of mindfulness-based stress reduction (MBSR), and aimed at optimizing the prediction accuracy by comparing multiple machine learning (ML) algorithms. Targeting the gamma-band effective connectivity, we evaluated the EEG-based prediction of the mindfulness experiences across 7 machine learning (ML) algorithms and 3 sessions (i.e., resting, focus-breathing, and body-scan).

RESULTS

The support vector machine and naïve Bayes classifiers exhibited significant accuracies above the chance level across all three sessions, and the decision tree algorithm reached the highest prediction accuracy of 91.7 % with the resting state, compared to the classification accuracies with the other two mindful states. We further conducted the analysis on essential EEG channels to preserve the classification accuracy, revealing that preserving just four channels (F7, F8, T7, and P7) out of 19 yielded the accuracy of 83.3 %. Delving into the contribution of connectivity features, specific connectivity features predominantly located in the frontal lobe contributed more to classifier construction, which aligned well with the existing mindfulness literature.

CONCLUSION

In the present study, we initiated a milestone of developing an EEG-based classifier to detect a person's mindfulness experience objectively. The prediction accuracy of the decision tree was optimal to differentiate the mindfulness experiences using the local resting-state EEG data. The suggested algorithm and key channels on the mindfulness-experience prediction may provide guidance for predicting mindfulness experiences using the EEG-based classification embedded in future wearable neurofeedback systems or plausible digital therapeutics.

Mind-Body Medicine in the Treatment of Depression: A Narrative Review of Efficacy, Safety and Mechanisms

PURPOSE OF THE REVIEW

This narrative review examines the efficacy, mechanisms and safety of mind-body medicine (MBM) in the treatment of depression. We reviewed the potential effects of various MBM interventions such as yoga, tai chi, qigong, mindfulness-based interventions and nutrition on clinical and subthreshold depressive symptoms.

RECENT FINDINGS

Current studies indicate a growing interest in the use of MBM for psychiatric disorders, including depression. MBM interventions demonstrate efficacy in reducing depressive symptoms with fewer adverse effects and costs compared to pharmacological treatments. MBM has significant potential to improve mental health outcomes for depression. These interventions encourage self-care and stress management through behavioural, exercise, relaxation and nutritional approaches. While existing data are promising, further, more rigorous studies are required to confirm long-term effectiveness and to determine the role of MBM in comprehensive depression treatment strategies.

From Surviving to Thriving: A Trauma-Informed Yoga Intervention for Adolescents and Educators in Rural Montana

Background

(1)Due to the mental health crisis that has spiraled since the onset of COVID-19, particularly among the nation's youth, the purpose of this study was to examine the efficacy of a novel, school-based mental health intervention for high school students (ages 15-17 years). This project's main aim was to determine which intervention modality was more effective with students across two school districts with varying degrees of rurality (in-person delivery vs. remote delivery). A secondary aim of this study was to determine the efficacy of a remotely delivered, concurrent intervention for educators across both school districts. This study took place in rural southwestern Montana.

Methods

(2)Utilizing a 6-week, trauma-informed yoga intervention, comparisons of mental and physical health outcomes were performed using cohort data drawn from participants' physiological data and validated mental health survey measures.

Results

(3)While physiological results were mixed across experimental groups, mental health outcomes were overwhelmingly positive for all groups. Additionally, educators reported improvements in career satisfaction and burnout levels.

Conclusions

(4)Findings indicate a great deal of promise with this intervention in improving mental health outcomes for both students and educators. Moreover, a face-to-face intervention for students showed dramatic improvement in physiological stress indicators.

Interoceptive Ability and Emotion Regulation in Mind-Body Interventions: An Integrative Review

It is increasingly recognized that interoceptive ability, the capacity to detect, interpret, and consciously integrate signals related to the physiological condition of the body, is central to emotion experience and regulation. Interoceptive ability can be trained and improved through mind-body interventions. This article attempts to provide an integrative review of the link between interoceptive ability and emotion regulation in mind-body interventions. To this aim, (1) we address the constructs of interoceptive ability and mind-body interventions in relation to the double pathway of emotion regulation, and (2) we include a review of selected empirical and qualitative studies. These show that mindfulness meditation affects the brain-body axis through top-down processing, improving both interoceptive ability and emotion regulation. Interventions based on bottom-up processing through body movement and emotional expression are illustrated, but it is argued that they are still under-investigated. In light of the literature reviewed, we contend that interoceptive ability is a crucial aspect associated with the effects of mind-body interventions on emotion regulation. Additionally, we suggest that if studied through both quantitative and qualitative methods, interoceptive ability may serve as a general construct that allows a more integrated view of the polarities related to the spectrum of embodied experience: top-down and bottom-up emotion processing, observational and non-observational body awareness, conscious and unconscious level of interoception.

Optimal modalities and doses of mind-body exercise for depressive symptoms in adults: A systematic review of paired analyses, network analyses and dose-response meta-analyses

The relative efficacy of various mind-body exercises in the treatment of depressive symptoms remains uncertain. We examined the optimal modalities (Tai Chi, qigong, yoga) and dose of mind-body exercise to improve depressive symptoms in adults. A systematic search of six electronic databases for randomized controlled trials on the relationship between exercise and depression was carried out, encompassing data from their inception up to November 2023. Pairwise analyses, network analyses and dose-response meta-analyses using random-effects models were performed to analyse the effect of exercise on depression. Forty studies were included. Results showed that Yoga [standardised mean difference (SMD) = -0.55; 95% confidence interval (CI): (-0.76, -0.35)] was the most effective form of exercise for improving depressive symptoms, followed by Qigong (SMD = -0.52; 95%CI: -0.92, -0.11) and Tai Chi exercise (SMD = -0.42; 95%CI: -0.71, -0.13). In addition, a non-linear dose-response relationship was found between overall mind-body exercise dose and depression levels and a significant response was observed after 260 METs-min. Our study examined the effectiveness of different types of mind-body exercise in improving depression and found that yoga may be the most effective adjunctive intervention. There was a non-linear dose-response relationship between total exercise and depression levels. However, caution should be exercised in interpreting and applying these results.

Meditation and interoception: a conceptual framework for the narrative and experiential self

The concept of the self is complex and there is no consensus on what the self is. However, there are emerging patterns in the literature that point to two different selves, the narrative and experiential self. The narrative self refers to a conceptual or representational knowledge of the self that extends across time and manifests in self-reflection and personality assessments. The experiential self refers to first-person perception, moment-to-moment awareness, embodiment, and a sense of agency. These two selves are reliably linked to two distinct neural circuits, the default mode network (DMN) and the insula and salience network (SN). One of the consistent themes in the meditative and mindfulness literature is a change in the perspective of the self. In this paper, I will review how meditation alters those neural circuits providing a plausible mechanism that can explain the changes in the self. I also propose a rudimentary conceptual framework to account for some of the mixed results found throughout meditation literature.

Rasch validation of the revised body awareness rating questionnaire (BARQ-R) in adults with and without musculoskeletal pain

BACKGROUND

The Revised Body Awareness Rating Questionnaire (BARQ-R) is a self-report measure of body awareness. First aim: evaluate the structural validity of BARQ-R with Rasch analysis in community-dwelling Americans with and without musculoskeletal pain. Subaim: validate a Rasch analysis of BARQ-R done in Norwegian adults with musculoskeletal pain, through a secondary analysis in our sample of Americans with musculoskeletal pain.

METHODS

BARQ-R has 12 items with scores ranging from 0 (completely disagree) to 3 (completely agree), with higher total scores reflecting lower degrees of body awareness. Through Rasch analysis, we evaluated unidimensionality, item hierarchy, and structural validity with item and person fit, targeting, person separation reliability (PSR), local item dependence (LID), differential item functioning (DIF), and principal components analysis of residuals (PCAR).

RESULTS

We recruited 623 adults with and without musculoskeletal pain (average age = 50.27 ± 17.25 years). After rescoring 1 item and deleting 3 items, the 9-item Rasch-based BARQ-R had no misfitting items, the hierarchical ordering of the items followed clinical expectations, 3 (0.48%) misfitting persons, person mean location: -0.62 ± 1.03 logits (max -0.53, min 0.72 logits), minimal floor effect (1.93%) and ceiling effect (0.48%), no DIF, and PSR = 0.72. LID was found in 5 item pairs. The PCAR's eigenvalue was 2.18. The secondary Rasch analysis in 152 adults with musculoskeletal pain (average age = 52.26 ± 16.13 years), demonstrated that, after rescoring 2 items, BARQ-R had no misfitting items and only 2 (1.32%) misfitting persons, good targeting (person mean location: -0.36 ± 0.88 logits), minimal floor effect (0.01%), no ceiling effect (0.00%), and PSR = 0.75. LID was found in 6 item pairs. The PCAR's eigenvalue was 2.47.

CONCLUSIONS

BARQ-R had good item and person fit. PSR with items covering a limited logit range suggests that differing levels of body awareness are measured with only modest precision. Adding and revising items to cover a wider range of body awareness and to better address concepts of internal body awareness and body movements would improve BARQ-R's utility. Further analyses are needed before BARQ-R's use for research or in the clinic. In addition, future BARQ-R Rasch validation is needed in other populations with body awareness deficits, such as stroke or spinal cord injury.

Identifying subgroups of urge suppression in Obsessive-Compulsive Disorder using machine learning

Obsessive-compulsive disorder (OCD) is phenomenologically heterogeneous. While predominant models suggest fear and harm prevention drive compulsions, many patients also experience uncomfortable sensory-based urges ("sensory phenomena") that may be associated with heightened interoceptive sensitivity. Using an urge-to-blink eyeblink suppression paradigm to model sensory-based urges, we previously found that OCD patients as a group had more eyeblink suppression failures and greater activation of sensorimotor-interoceptive regions than controls. However, conventional approaches assuming OCD homogeneity may obscure important within-group variability, impeding precision treatment development. This study investigated the heterogeneity of urge suppression failure in OCD and examined relationships with clinical characteristics and neural activation. Eighty-two patients with OCD and 38 controls underwent an fMRI task presenting 60-s blocks of eyeblink suppression alternating with free-blinking blocks. Latent profile analysis identified OCD subgroups based on number of erroneous blinks during suppression. Subgroups were compared on behavior, clinical characteristics, and brain activation during task. Three patient subgroups were identified. Despite similar overall OCD severity, the subgroup with the most erroneous eyeblinks had the highest sensory phenomena severity, interoceptive sensitivity, and subjective urge intensity. Compared to other subgroups, this subgroup exhibited more neural activity in somatosensory and interoceptive regions during the early phase (first 30 s) of blink suppression and reduced activity in the middle frontal gyrus during the late phase (second 30 s) as the suppression period elapsed. Heterogeneity of urge suppression in OCD was associated with clinical characteristics and brain function. Our results reveal potential treatment targets that could inform personalized medicine.

Interoceptive brain network mechanisms of mindfulness-based training in healthy adolescents

Introduction

This study evaluated changes in the white matter of the brain and psychological health variables, resulting from a neuroscience-based mindfulness intervention, the Training for Awareness, Resilience, and Action (TARA), in a population of healthy adolescents.

Methods

A total of 100 healthy adolescents (57 female, age ranges 14-18 years) were randomized into the 12-week TARA intervention or a waitlist-control group. All participants were imaged with diffusion MRI to quantify white matter connectivity between brain regions. Imaging occurred at baseline/randomization and after 12 weeks of baseline (pre- and post-intervention in the TARA group). We hypothesized that structural connectivity in the striatum and interoceptive networks would increase following the TARA intervention, and that, this increased connectivity would relate to psychological health metrics from the Strengths and Difficulties Questionnaire (SDQ) and the Insomnia Severity Index (ISI). The TARA intervention and all assessments, except for the MRIs, were fully remotely delivered using secure telehealth platforms and online electronic data capture systems.

Results

The TARA intervention showed high consistency, tolerability, safety, recruitment, fidelity, adherence, and retention. After 12 weeks, the TARA group, but not controls, also demonstrated significantly improved sleep quality (p = 0.02), and changes in the right putamen node strength were related to this improved sleep quality (r = -0.42, p = 0.006). Similarly, the TARA group, but not controls, had significantly increased right insula node strength related to improved emotional well-being (r = -0.31, p = 0.04). Finally, we used the network-based statistics to identify a white matter interoception network that strengthened following TARA (p = 0.009).

Discussion

These results suggest that the TARA mindfulness-based intervention in healthy adolescents is feasible and safe, and it may act to increase structural connectivity strength in interoceptive brain regions. Furthermore, these white matter changes are associated with improved adolescent sleep quality and emotional well-being. Our results suggest that TARA could be a promising fully remotely delivered intervention for improving psychological well-being in adolescents. As our findings suggest that TARA affects brain regions in healthy adolescents, which are also known to be altered during depression in adolescents, future studies will examine the effects of TARA on depressed adolescents.

Clinical trial registration

https://clinicaltrials.gov/study/NCT04254796.

Body listening in the link between symptoms and self-care management in cardiovascular disease: A cross-sectional correlational descriptive study

OBJECTIVE

The aim of this study was to quantify relationships among symptoms, interoceptive sensibility (i.e. the conscious level of sensing, interpreting and integrating signals from the body), and self-care management behaviors (i.e. the response to symptoms when they occur) among adults with cardiovascular disease. We hypothesized that better interoceptive sensibility would increase the positive behavior-driving effects of symptoms on self-care management.

METHODS

Adult patients with cardiovascular disease who experienced recent symptoms were recruited to participate in this cross-sectional correlational descriptive study. Patient-Reported Outcomes Measurement Information System measures were used to capture dyspnea, pain interference, fatigue, sleep disturbances, nausea and vomiting, anxiety and depressive symptoms. Interoceptive sensibility was measured using the Multidimensional Assessment of Interoceptive Awareness Version 2. The Self-Care of Chronic Illness Inventory was used to measure self-care management. Network analysis was used to identify domains of interoceptive sensibility that were most central. Linear regression with interaction terms was used to test the moderating effect of interoceptive sensibility on the relationship between symptoms and self-care management.

RESULTS

The age of participants in the sample (n = 387) ranged from 18 to 88 years, a slight majority (53.5 %) were female, and a majority were Caucasian (66.4 %) or African American (32.0 %). Hypertension was the most common disorder (n = 238 (61.5 %)), followed by rhythm disorders (n = 124 (32.0 %)), coronary artery disease (n = 94 (24.3 %)), heart failure (n = 89 (23.0 %)), valve disease (n = 69 (17.8 %)), stroke (n = 62 (16.0 %)) and peripheral vascular disease (n = 49 (12.7 %)). Based on network analysis, body listening (i.e. active listening to the body for insights) was the most central interoceptive domain, and distracting (i.e. tendency to ignore or distract oneself from sensations of discomfort) was the least central. Noticing (i.e. greater awareness of body sensations), distracting, and body listening were significant in moderating relationships between dyspnea, sleep disturbances and anxiety and the outcome of self-care management behaviors (all p < 0.001). Better noticing and body listening were associated with better self-care management across symptoms, whereas ignoring or distracting oneself from discomfort was associated with worse self-care management behaviors.

CONCLUSION

Among adults with cardiovascular disease, interventions designed to augment the identified interoceptive sensibility domains like body listening, and mitigate the tendency to ignore or distract oneself from discomfort may support adults with cardiovascular disease through the development of future interventions that optimize patient behaviors in response to symptoms when they occur.

The Role of Emotion Regulation and Awareness in Psychosocial Stress: An EEG-Psychometric Correlational Study

BACKGROUND

In stressful situations, to overcome unpleasant emotions, individuals try to manage stress through emotion regulation strategies such as cognitive reappraisal, interoception, and mindfulness.

METHOD

26 healthy adults underwent a modified version of the Trier Social Stress Test (named the Social Stress Test, SST) while their electrophysiological (EEG) activity was monitored. Participants also completed self-report questionnaires prior to this, including the Five-Facet Mindfulness Questionnaire (FFMQ), Multidimensional Assessment of Interoceptive Awareness (MAIA), Emotional Regulation of Others and Self (EROS), and the Interpersonal Reactivity Index (IRI). Three brain regions of interest (ROIs) were considered in the EEG data processing: frontal, temporo-central, and parieto-occipital. Correlational analyses were performed between psychometric scales and EEG band power spectral values for each ROI.

RESULTS

The results showed positive correlations between interoceptive awareness, mindfulness, and high-frequency EEG bands (beta, alpha, gamma) over frontal ROI, indicating enhanced cognitive processing and emotional regulation. Conversely, emotion regulation and empathy measures correlated positively with low-frequency EEG bands (delta, theta), associated with improved social cognition and top-down regulatory processes.

CONCLUSIONS

These findings suggest that EEG correlations of the stress response are connected to emotion regulation mechanisms, emphasizing the importance of body state awareness in managing stress and emotions for overall well-being and quality of life.

Psychometric properties of the short form of the Freiburg Mindfulness Inventory in the Arabic language

Interests in including mindfulness techniques in medical and psychological fields have been increasing recently. Accordingly, it is important to validate the short form of the Freiburg Mindfulness Inventory (FMI-14) to help professionals living in Arabic speaking countries. Thus, we aimed to validate the FMI-14 in the Arabic language (FMI-Ar) in Arabic-speaking university students from Lebanon. We carried-out a cross-sectional study between July and September 2021; 363 university students (mean age 22.65 ± 3.48 years, 61.7% females) were enrolled. The McDonald's omega and Cronbach's alpha values for the total score were excellent (0.92 for both). Confirmatory factor analysis of the one-factor model of the FMI-Ar showed satisfactory fit indices: χ2/df = 218.33/77 = 2.83, RMSEA = 0.071 [0.060-0.082], CFI = 0.92, and TLI = 0.90. Additionally, the FMI score was negatively associated with depression (r = -0.51; p = 0.001) and anxiety (r = -0.48; p < 0.001). All hypotheses (factor, convergent, and divergent validity) related to the FMI-Ar were verified in our study. Therefore, professionals can now benefit from the FMI-Ar, a suitable scale to measure mindfulness among Lebanese University students.

Enhancing interoceptive sensibility through exteroceptive-interoceptive sensory substitution

Exploring a novel approach to mental health technology, this study illuminates the intricate interplay between exteroception (the perception of the external world), and interoception (the perception of the internal world). Drawing on principles of sensory substitution, we investigated how interoceptive signals, particularly respiration, could be conveyed through exteroceptive modalities, namely vision and hearing. To this end, we developed a unique, immersive multisensory environment that translates respiratory signals in real-time into dynamic visual and auditory stimuli. The system was evaluated by employing a battery of various psychological assessments, with the findings indicating a significant increase in participants' interoceptive sensibility and an enhancement of the state of flow, signifying immersive and positive engagement with the experience. Furthermore, a correlation between these two variables emerged, revealing a bidirectional enhancement between the state of flow and interoceptive sensibility. Our research is the first to present a sensory substitution approach for substituting between interoceptive and exteroceptive senses, and specifically as a transformative method for mental health interventions, paving the way for future research.

Islamic Mindfulness-Based Caring as an Intervention to Manage Fatigue

Purpose: This study aims to determine the effects of Islamic Mindfulness-based Caring (IMC) on fatigue among breast cancer patients. Design: A quasi-experimental study was undertaken in the chemotherapy unit of a hospital, in Bandung, Indonesia. Methods: A total of 112 females with stage III breast cancer undertaking chemotherapy treatment were recruited by purposive sampling technique. The experimental group (n = 53) was given both IMC and usual care, whereas the control group (n = 59) received only the usual care. Data were collected on days 1, 3, 23, and 44 using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) and demographic information tools. Data analyses were carried out with the Mixed-Effects Linear Regression. Findings: We found a significant difference in fatigue between the control and experimental groups on days 23 (mean: 29.34-34.92; p = .001) and 44 (mean: 28.68-37.89; p < .001) after IMC intervention. The increase of time was significantly associated with a lower fatigue score (p < .05). Mixed-Effect Linear Regression showed a significant interaction between time and intervention of IMC effect on fatigue score on time-4 (adjusted β coefficient: 6.62; 95% CI: 2.17-11.06). Conclusions: Nurse-administered IMC is capable of reducing fatigue among breast cancer patients who underwent chemotherapy.

Changes in mindfulness facets across yoga, CBT and stress education in individuals with generalized anxiety disorder

Improving mindfulness is an important treatment target for generalized anxiety disorder (GAD). However, less is known about how different treatments impact specific aspects of mindfulness. In a clinical trial (Simon et al., 2021), 226 individuals with GAD were randomized to 12 weeks of Kundalini Yoga (KY), cognitive behavioral therapy (CBT) or stress education (SE). To examine whether specific facets of mindfulness, as measured by the Five Facet Mindfulness Questionnaire (FFMQ) change more than others across treatment and between treatments, we ran a multi-variate multilevel growth curve model (MMLM). Results indicated that while the Non-judge, Act with Awareness, and Non-react facets increased significantly during treatment, the Observe and Describe facets did not. Improvement in the Acting with Awareness facet during treatment was significantly greater for KY than CBT. These findings reveal the need to better understand how behavioral treatments can influence specific components of mindfulness for those with anxiety.

Effectiveness of Interoceptive Programs to Improve Academic Self-Regulation and Reduce Behavioral Problems Among Children With Learning Disabilities

Background Learning disabilities occur in very young children, yet they are usually not noticed until the child reaches school age. These issues can affect the child's ability to perform activities of daily living and their ability to learn including academic activities. Occupational therapy can assist with improving their ability to learn which will also help their performance at school. Aims and objectives The present study was designed to investigate the impact of interoceptive programs on improving academic self-regulation and reducing behavioral problems among children with learning disabilities. The objectives of the study were to determine a learning disability through the use of the Learning Disability Checklist. The Academic Self-Regulation Questionnaire for Learning Disability (SRQ-A LD) was used to assess the degree of academic self-regulation, while the Behavior Rating Inventory for Executive Functioning-2 (BRIEF-2) was used to assess the degree of behavioral problems. The primary objective was to evaluate the efficacy of interoceptive programs to enhance academic self-regulation and lessen behavioral issues in the experimental group, as well as to find out the impact of conventional occupational therapy for children with learning disabilities in the control group. Methodology This was a quasi-experimental design with convenience sampling and selected samples (n=50), which were then split into two groups, an experimental group (n=25) and a control group (n=25), based on the inclusion and exclusion criteria. The experimental group received intervention based on interoception activities, while the control group received conventional occupational therapy. A pre-test and post-test were conducted to measure the changes. The study assessed 50 children in the range of 7 to 11 years, using an initial Madras Dyslexia Association Checklist. Academic self-regulation was assessed using SRQ-A LD. Behaviors were assessed using BRIEF-2. The duration of the study was six months, three sessions per week, lasting 45 minutes to an hour each. The statistical analysis was done with significance at a 1% alpha level using IBM SPSS version 29.0 (Armonk, NY: IBM Corp). Results The pre-test and post-test data were analyzed using the Wilcoxon signed-rank test and the Mann-Whitney test. The study found that the interoceptive program had an impact on academic self-regulation and behavioral problems among children with learning disabilities. The p-value of academic self-regulation was <0.001, and the p-value of the behavior rating inventory was <0.001, the alternate hypothesis was accepted. Thus, the results showed significant improvement in academic self-regulation and behavioral problems in the experimental group compared to the control group. Conclusion The results of the study showed that the Interoceptive program helped children with learning disabilities improve their academic self-regulation and have fewer behavioral issues. Interoception can positively regulate their behavior. For this reason, the primary therapeutic approach for children with learning disabilities can be the implementation of Interoceptive activities.

Effects of mindfulness-based interventions on symptoms and interoception in trauma-related disorders and exposure to traumatic events: Systematic review and meta-analysis

Interoception is defined as the sense of the internal state of the body. Dysfunctions in interoception are found in several mental disorders, including trauma-related conditions. Mindfulness-Based Interventions (MBIs) have been shown to influence interoceptive processes. Randomised controlled trials (RCTs) have investigated whether MBIs impact symptoms and interoception in patients with trauma-related disorders. We undertook a systematic review and meta-analysis to synthesize these data. We included RCTs with an MBI arm which enrolled adult patients with trauma related-disorders or exposure to a traumatic experience, and addressed changes in interoception and trauma-related symptoms. A random-effects multivariate meta-analytic model was performed to quantify group differences in score change from baseline to follow-up. Twelve studies were included in the systematic review, and eleven in the meta-analysis. Overall, MBIs showed small to moderate positive effects on both interoception and symptoms. Despite a high heterogeneity in results, sensitivity analyses confirmed the robustness of the findings. We conclude that the efficacy of MBIs on trauma-related symptoms and interoception is supported by randomised evidence. However, further research is needed to understand whether changes in interoception might underpin the effectiveness of MBIs in trauma-related disorders.

When the body fosters empathy: The interconnectivity between bodily reactivity, meditation, and embodied abstract concepts

Empathy is a fundamental social ability that allows humans to infer others' emotions and intentions. Empathy is thought to be rooted in bodily sensations coming from the autonomic nervous system. In parallel, the functionality and perceptions coming from the autonomic nervous system could be improved by practicing activities that involve mind-body interactions, such as meditation. Furthermore, perceptions from the autonomic nervous system are thought to be important in the embodiment of abstract concepts. Consequently, in the current study, we collected data online from 581 participants and explored the associations between levels of empathy and (1) the practice of meditation, music, and sports; (2) the impact of self-report measures on bodily awareness and reactivity; and (3) the embodiment of abstract concepts in interoception. In line with previous studies, Meditators were found to have higher empathy scores than Non-Meditators. In addition, lower levels of autonomic reactivity in organs above the diaphragm were associated with higher empathy. Finally, we also observed that empathy was positively associated with interoceptive components of abstract concepts in those participants with high autonomic reactivity. Taken together, the results suggest that meditation practice and having low autonomic reactivity are associated with empathy, arguably through the downregulation of autonomic responses. Implications for mind-body interaction in meditation and its role in promoting empathy are discussed.

Effects of mindful breathing training combined with diary-based rehabilitation guidance in lung cancer patients undergoing surgery: A randomized controlled trial

BACKGROUND AND PURPOSE

Lung cancer surgery patients experience severe physical and mental symptoms, which seriously affect their quality of life and prognosis. Mindful breathing training is a promising strategy to improve their symptoms, but its effectiveness is affected by training compliance, and diary-based rehabilitation instruction has been shown to help improve training compliance. Therefore, the aim of this study was to evaluate the effects of mindful breathing training combined with diary-based rehabilitation guidance on improving perioperative outcomes in lung cancer surgery patients.

MATERIALS AND METHODS

This single-center, assessor-blinded, prospective, three-arm randomized controlled trial was conducted from November 1, 2021 to November 1, 2022. Patients diagnosed with primary non-small cell lung cancer and scheduled for thoracoscopic surgery were randomly allocated to the combined intervention group, the mindful breathing group or the control group, with 34 patients in each group. The control group received routine care, while the mindful breathing group received mindful breathing training and routine care. The combined intervention group received both mindful breathing training and diary-based rehabilitation guidance, along with routine care.

RESULTS

The per-protocol analysis revealed that patients in the mindful breathing group experienced statistically significant improvements in dyspnea, fatigue and anxiety. Patients in the combined intervention group had statistically significant improvements in dyspnea, fatigue, anxiety, depression, exercise self-efficacy and training compliance.

CONCLUSION

This study provides evidence that mindful breathing training combined with diary-based rehabilitation guidance can be effective in improving perioperative outcomes in lung cancer patients. It can be applied in clinical practice in the future.

Mindfulness Through Storytelling for Mental Health of Primary School Children: Impact on Acceptability and Its Associations with Personality

Purpose

Acceptability of mindfulness-based programs (MBPs) in primary school settings seems to represent a critical factor influencing the intervention effects on children's mental health. This study aims at assessing the acceptability of an MBP delivered through the technique of storytelling, as well as identifying which participants' personality characteristics can influence it.

Participants and Methods

Italian children in grades 3-to-5 (n = 147, 47.6% girls) participated in a 24-session MBP, which included 225 minutes of formal mindfulness practices and was delivered by the pupils' school teachers. Children's personality traits were assessed with the junior Temperament and Character Inventory (jTCI), while their subjective experiences and acceptability of the program were investigated using a survey containing open-ended and closed-ended questions.

Results

Program acceptability was 2.9 ± 0.7 on a 0-4 scale. Higher jTCI scores of persistence, cooperativeness, and self-transcendence were related to higher ratings in liking the program, finding it useful and engaging themselves in it. Moreover, 57.8% of the children generalized the mindfulness practices in daily life and 93.9% of them declared they would recommend the program to their friends/parents. Five main themes emerged from children's answers on what they learned: "help for difficulties (emotional, mental, and physical)", "calm, relax, tranquility", "resilience, positiveness, personal growth", "self-exploration, interoception", and "attention, concentration, and here-and-now".

Conclusion

Program acceptability was generally higher than in similar programs in the literature, and children reported personal gains in various areas related to psychological well-being. The study also suggests which children's personality traits should be considered when proposing an MBP in order to improve its acceptability and utility.

Chronic pain as an emergent property of a complex system and the potential roles of psychedelic therapies

Despite research advances and urgent calls by national and global health organizations, clinical outcomes for millions of people suffering with chronic pain remain poor. We suggest bringing the lens of complexity science to this problem, conceptualizing chronic pain as an emergent property of a complex biopsychosocial system. We frame pain-related physiology, neuroscience, developmental psychology, learning, and epigenetics as components and mini-systems that interact together and with changing socioenvironmental conditions, as an overarching complex system that gives rise to the emergent phenomenon of chronic pain. We postulate that the behavior of complex systems may help to explain persistence of chronic pain despite current treatments. From this perspective, chronic pain may benefit from therapies that can be both disruptive and adaptive at higher orders within the complex system. We explore psychedelic-assisted therapies and how these may overlap with and complement mindfulness-based approaches to this end. Both mindfulness and psychedelic therapies have been shown to have transdiagnostic value, due in part to disruptive effects on rigid cognitive, emotional, and behavioral patterns as well their ability to promote neuroplasticity. Psychedelic therapies may hold unique promise for the management of chronic pain.

Attention to cardiac sensations enhances the heartbeat-evoked potential during exhalation

Respiration and cardiac activity intricately interact through complex physiological mechanisms. The heartbeat-evoked potential (HEP) is an EEG fluctuation reflecting the cortical processing of cardiac signals. We recently found higher HEP amplitude during exhalation than inhalation during a task involving attention to cardiac sensations. This may have been due to reduced cardiac perception during inhalation and heightened perception during exhalation through attentional mechanisms. To investigate relationships between HEP, attention, and respiration, we introduced an experimental setup that included tasks related to cardiac and respiratory interoceptive and exteroceptive attention. Results revealed HEP amplitude increases during the interoceptive tasks over fronto-central electrodes. When respiratory phases were taken into account, HEP increases were primarily driven by heartbeats recorded during exhalation, specifically during the cardiac interoceptive task, while inhalation had minimal impact. These findings emphasize the role of respiration in cardiac interoceptive attention and could have implications for respiratory interventions to fine-tune cardiac interoception.

Mindfulness Affects the Boundaries of Bodily Self-Representation: The Effect of Focused-Attention Meditation in Fading the Boundary of Peripersonal Space

Peripersonal space (PPS) is a dynamic multisensory representation of the space around the body, influenced by internal and external sensory information. The malleability of PPS boundaries, as evidenced by their expansion after tool use or modulation through social interactions, positions PPS as a crucial element in understanding the subjective experiences of self and otherness. Building on the existing literature highlighting both the cognitive and bodily effects of mindfulness meditation, this study proposes a novel approach by employing focused-attention meditation (FAM) and a multisensory audio-tactile task to assess PPS in both the extension and sharpness of its boundaries. The research hypothesis posits that FAM, which emphasizes heightened attention to bodily sensations and interoception, may reduce the extension of PPS and make its boundaries less sharp. We enrolled 26 non-meditators who underwent a repeated measure design in which they completed the PPS task before and after a 15-min FAM induction. We found a significant reduction in the sharpness of PPS boundaries but no significant reduction in PPS extension. These results provide novel insights into the immediate effects of FAM on PPS, potentially shedding light on the modulation of self-other representations in both cognitive and bodily domains. Indeed, our findings could have implications for understanding the intricate relationship between mindfulness practices and the subjective experience of self within spatial contexts.

Tai Chi Chuan evidence related to impulsivity and impulse related disorders: A scoping review

BACKGROUND

The purpose of this study was to review the evidence for the potential of Tai Chi Chuan (TCC) as a model of meditative movement in benefiting people with impulsivity related disorders and provide guidance for future research.

METHODS

A scoping review of the literature was conducted in five databases. Eligibility criteria were original articles reporting TCC based interventions or included TCC techniques and provided any assessment on impulsivity or related measures, impulse control disorders, or other psychiatric disorders related to impulsivity (e.g., addictive disorders, ADHD, and other conduct disorders). Twenty-eight out of 304 studies initially retrieved were reviewed. The reports concentrated mostly on neurodegenerative conditions, cognitive decline, and substance use disorders (SUD).

RESULTS

TCC had several positive effects in cognitive domains resulting in improvements in memory, executive functions, inhibitory control, attention, and verbal fluency. These improvements in memory, executive function, including inhibitory control and attention, and verbal fluency were associated with changes in the brain plasticity, resting activity, and other neurobiological markers.

CONCLUSION

Albeit no study was found on the use of TCC in impulse control disorders or impulse related conditions, other than SUD, the findings suggest that considering the behavioral impact of TCC, especially the improvement of executive functions, it could be a valuable therapeutic tool for approaching impulse control related disorders.

Electroencephalography microstates highlight specific mindfulness traits

The present study aimed to investigate the spontaneous dynamics of large-scale brain networks underlying mindfulness as a dispositional trait, through resting-state electroencephalography (EEG) microstates analysis. Eighteen participants had attended a standardized mindfulness-based stress reduction training (MBSR), and 18 matched waitlist individuals (CTRL) were recorded at rest while they were passively exposed to auditory stimuli. Participants' mindfulness traits were assessed with the Five Facet Mindfulness Questionnaire (FFMQ). To further explore the relationship between microstate dynamics at rest and mindfulness traits, participants were also asked to rate their experience according to five phenomenal dimensions. After training, MBSR participants showed a highly significant increase in FFMQ score, as well as higher observing and non-reactivity FFMQ sub-scores than CTRL participants. Microstate analysis revealed four classes of microstates (A-D) in global clustering across all subjects. The MBSR group showed lower duration, occurrence and coverage of microstate C than the control group. Moreover, these microstate C parameters were negatively correlated to non-reactivity sub-scores of FFMQ across participants, whereas the microstate A occurrence was negatively correlated to FFMQ total score. Further analysis of participants' self-reports suggested that MBSR participants showed a better sensory-affective integration of auditory interferences. In line with previous studies, our results suggest that temporal dynamics of microstate C underlie specifically the non-reactivity trait of mindfulness. These findings encourage further research into microstates in the evaluation and monitoring of the impact of mindfulness-based interventions on the mental health and well-being of individuals.

The relationship between mindfulness and athletes' mental skills may be explained by emotion regulation and self-regulation

BACKGROUND

Although numerous psychological determinants of sports success have been identified in the scientific literature, research on the contribution of mindfulness and interoceptive awareness to sports achievements remains limited. This study investigates the relationship between self-reported mental skills determining sports success (i.e., flow state, attention, technique, sensitivity to error, commitment, and achievement), state mindfulness for physical activity (of the mind and the body), and interoceptive awareness (including scales of noticing, not distracting, not worrying, attention regulation, emotional awareness, self-regulation, body listening, and trusting).

METHODS

A cross-sectional online survey was conducted on a sample of elite athletes in speed skating (n = 54) and university students of physical education (n = 102) representing various sports disciplines and competitive levels. The Sports Success Scale (SSS), the State Mindfulness Scale for Physical Activity (SMS-PA), and the Multidimensional Assessment of Interoceptive Awareness (MAIA-2) were used to assess psychological determinants of athletic achievements, state mindfulness, and interoceptive sensitivity, respectively.

RESULTS

Our findings indicate some small-to-moderate differences in particular dimensions of psychological traits related to sports success, mindfulness, and interoceptive awareness between athletes of different genders, groups, and competitive levels. A chain mediation model showed that the relationship between body mindfulness and psychological variables determining sports success is fully explained by two dimensions of interoception: self-regulation and attention regulation.

CONCLUSIONS

Cultivating the mindfulness state of the body can improve self-regulation and attention regulation, which in turn may increase the mental skills required for successful sports participation. Therefore, mental training should focus primarily on body mindfulness, attention regulation, and self-regulation to improve the mental skills responsible for athletes' sports achievements. In addition, individual differences in athletes' gender, sports discipline, and level of sports competition should be considered during mental training.

The Relationship Between Interoceptive Awareness, Emotion Regulation and Clinical Symptoms Severity of Depression, Anxiety and Somatization

OBJECTIVE

The primary objective of this study was to examine the associations among emotion regulation strategies, interoceptive awareness, and psychological distress measures-namely, depression, anxiety, and somatization. Additionally, we aimed to explore the predictive power of various facets of interoceptive awareness in determining the severity of symptoms for each mental disorder.

METHODS

A cohort of 130 outpatients diagnosed with depression/anxiety disorder were recruited, and 20 subjects exhibiting incomplete responses were excluded from the dataset, leading to a final sample size of 110 outpatients. The clinical symptoms were measured by Patient Health Questionnaire-9, State-Trait Anxiety Inventory Form Y, and Symptom Checklist-90-Revised, and the usage of emotion-regulation strategies and interoceptive awareness was assessed with Emotion Regulation Questionnaire and Multidimensional Assessment of Interoceptive Awareness (MAIA), respectively. A hierarchical regression analysis was performed to examine whether emotion-regulation strategies and interoceptive awareness explain the statistically significant variance in each of the symptoms.

RESULTS

In the depression model, cognitive reappraisal, accept, and attention regulation showed significant associations, while in the anxiety model, cognitive reappraisal, attention regulation, trust, and notice emerged as significant factors. Lastly, cognitive reappraisal and attention regulation were found to be significant contributors to the final model for somatization.

CONCLUSION

The inclusion of MAIA subscales improved the predictive ability of the regression model, highlighting the independent association between interoceptive awareness-particularly attention regulation-and clinical symptoms of anxiety and depression. Additionally, the study underscores the relevance of considering the specific pathological context when implementing interventions, as evidenced by the positive associations between the accept subscale and depression and between the notice subscale and anxiety, respectively.

Trauma, early life stress, and mindfulness in adulthood

This article is a review that was inspired by recent studies investigating the effects of childhood trauma or early life stress (ELS) and mindfulness in adulthood. One recent study found that some forms of abuse and neglect led to higher scores in several subscales of a self-report measure of mindfulness. The authors concluded that some forms of ELS can help cultivate certain aspects of mindfulness in adulthood. However, and in contrast to this recent finding, much of the extant literature investigating ELS and trauma are linked to emotional dysregulation, alexithymia, and a host of psychopathologies in adulthood which makes the results of this study surprising. Central to the mindfulness literature is cultivating an open, non-reactive, or non-judgment awareness of inner experiences which are important for emotional regulation. In this paper, I review some of the effects of trauma or ELS on critical neural circuits linked to mindfulness, interoception, attachment, and alexithymia which I hope may clarify some of the conflicting findings from this study and throughout the literature and provide additional context and a framework that may inform research investigating these two constructs going forward.

Differentiating mindfulness-integrated cognitive behavior therapy and mindfulness-based cognitive therapy clinically: the why, how, and what of evidence-based practice

It is important to be able to differentiate mindfulness-based programs in terms of their model, therapeutic elements, and supporting evidence. This article compares mindfulness-based cognitive therapy (MBCT), developed for relapse prevention in depression, and mindfulness-integrated cognitive behavior therapy (MiCBT), developed for transdiagnostic applications, on: (1) origins, context and theoretical rationale (why), (2) program structure, practice and, professional training (how), and (3) evidence (what). While both approaches incorporate behavior change methods, MBCT encourages behavioral activation, whereas MiCBT includes various exposure procedures to reduce avoidance, including a protocol to practice equanimity during problematic interpersonal interactions, and a compassion training to prevent relapse. MBCT has a substantial research base, including multiple systematic reviews and meta-analyses. It is an endorsed preventative treatment for depressive relapse in several clinical guidelines, but its single disorder approach might be regarded as a limitation in many health service settings. MiCBT has a promising evidence base and potential to make a valuable contribution to psychological treatment through its transdiagnostic applicability but has not yet been considered in clinical guidelines. While greater attention to later stage dissemination and implementation research is recommended for MBCT, more high quality RCTs and systematic reviews are needed to develop the evidence base for MiCBT.

Virtual Exercise in Medicine: A Proof of Concept in a Healthy Population

BACKGROUND

Science is beginning to establish the benefits of the use of virtual reality (VR) in health care. This therapeutic approach may be an appropriate complementary treatment for some mental illnesses. It could prevent high levels of morbidity and improve the physical health of patients. For many years, the literature has shown the health benefits of physical exercise. Physical exercise in a VR environment may improve the management of mild to moderate mental health conditions. In this context, we developed a virtual environment combined with an ergocycle (the augmented physical training for isolated and confined environments [APTICE] system).

OBJECTIVE

This study aims to investigate the impact of physical exercise in a VR environment.

METHODS

A total of 14 healthy participants (11 men and 3 women; mean age 43.28, SD 10.60 years) undertook 15 minutes of immersive physical exercise using the system. Measures included mindfulness and immersion disposition, subjective perceptions of sensory information, user experience, and VR experience (ie, psychological state, flow, and presence).

RESULTS

First, the APTICE system appears to be a useful tool because the user experience is positive (subscales in the AttrakDiff questionnaire: pragmatic quality=0.99; hedonic quality-stimulation=1.90; hedonic quality-identification=0.67; attractiveness=1.58). Second, the system can induce a positive psychological state (negative emotion, P=.06) and an experience of flow and presence (P values ranging from <.001 to .04). Third, individual immersive and mindful disposition plays a role in the VR experience (P values ranging from <.02 to .04). Finally, our findings suggest that there is a link between the subjective perception of sensory information and the VR experience (P values ranging from <.02 to .04).

CONCLUSIONS

These results indicate that the device is well accepted with positive psychological and exteroceptive outcomes. Overall, the APTICE system could be a proof of concept to explore the benefits of virtual physical exercise in clinical medicine.

Traditional Nostril Yoga Breathing Practices and Oxygen Consumption: A Randomized, Cross-over Study

Background

Traditional yoga texts describe "cross nostril breathing," with inhalation and exhalation through different nostrils. Previous research reported no clear differences in oxygen consumption during uninostril breathing (i.e., inhalation and exhalation through the same nostril), hence not supporting right and left uninostril breathing as activating or relaxing, respectively, with no research on oxygen consumed in "cross nostril breathing."

Methods

Oxygen consumed during "cross nostril breathing" was measured in healthy participants (n = 47, males, 26.3 ± 6.4 years). Five sessions (viz., right nostril inspiration yoga breathing [RNIYB], left nostril inspiration yoga breathing [LNIYB], alternate nostril yoga breathing [ANYB], breath awareness (BAW), and quiet rest (QR) were conducted on separate days in random order. Sessions were 33 min in duration with pre, during, and post states.

Results

Volume of oxygen consumed (VO2) and carbon dioxide eliminated (VCO2) increased during RNIYB (9.60% in VO2 and 23.52% in VCO2), LNIYB (9.42% in VO2 and 21.20% in VCO2) and ANYB (10.25% in VO2 and 22.72% in VCO2) with no significant change in BAW and QR. Diastolic blood pressure decreased during BAW and QR and after all five sessions (P < 0.05; in all cases). All comparisons were with the respective preceding state.

Conclusion

During the three yoga breathing practices, the volume of oxygen consumed increased irrespective of the nostril breathed through, possibly associated with (i) conscious regulation of the breath; (ii) attention directed to the breath, and (iii) "respiration-locked cortical activation." Restriction of the study to males reduces the generalizability of the findings.

The effect of a mindfulness-based body scan exercise on food intake during TV watching

In some studies mindfulness is associated with reduced food consumption, but the underlying mechanisms are less well researched. One potential mechanism is that mindfulness increases attention toward feelings of fullness. Additionally, experimental research on mindfulness and food intake has primarily been conducted in constrained laboratory settings, where it may be easier for participants to notice their internal bodily signals, as opposed to the real world where individuals are often engaged in other activities while eating. The effect of mindfulness on food intake while participants are distracted remains unexplored. This study therefore aimed to examine whether a mindfulness-based body scan exercise reduced food consumption within a distracted environment by increasing attention toward feelings of fullness. Participants (n = 137) listened to a 10-minute body scan meditation, or a 10-minute visualisation (control) meditation. They were then given a bowl of crisps to consume while watching a 10-minute TV show segment. Participants also completed measures assessing proposed mediators, including state mindfulness, attention to bodily sensations and eating automaticity. The body scan manipulation increased state mindfulness but had no direct effect on the other mediators or on food intake (intervention M = 34.79g, SD = 24.06; control M = 33.16g, SD = 23.88). State mindfulness was positively correlated with attention to bodily sensations while eating. Lower eating automaticity and greater reliance on decreased food appeal and physical satisfaction to stop eating were found to be associated with lower food intake. Contrary to previous studies, we found no evidence that a mindfulness body scan reduces food consumption when participants are distracted. Future research should examine the specific conditions under and mechanisms by which mindfulness may influence food consumption.

Insular dysfunction of interoception in major depressive disorder: from the perspective of neuroimaging

Interoception plays a crucial role in maintaining bodily homeostasis and promoting survival, and is considered the basis of human emotion, cognition, and self-formation. A malfunction of interoception is increasingly suggested to be a fundamental component of different mental health conditions, and depressive disorders have been especially closely associated. Interoceptive signaling and processing depends on a system called the "interoceptive pathway," with the insula, located in the deep part of the lateral fissure, being the most important brain structure in this pathway. Neuroimaging studies have revealed alterations in the structure and function of the insula in a large number of individuals with depression, yet the precise relationship between these alterations and interoceptive dysfunction remains unclear. The goal of this review is to examine the evidence that exists for dysfunction of interoception in people with Major Depressive Disorder (MDD), and to determine the associated specific alterations in the structure and function of the insula revealed by neuroimaging. Overall, three aspects of the potential relationship between interoceptive dysfunction and alterations in insular function in people with depression have been assessed, namely clinical symptoms, quantitative measures of interoceptive function and ability, and interoceptive modulation. To conclude, several specific limitations of the published studies and important lines of enquiry for future research are offered.

Interoception in functional motor symptoms and functional seizures: Preliminary evidence of intact accuracy alongside reduced insight and altered sensibility

Altered interoception may be a pathophysiological mechanism in functional neurological disorder (FND). However, findings have been inconsistent across interoceptive dimensions in FND including functional motor symptoms (FMS) and seizures (FS). Here, individuals with FMS/FS (n = 17) and healthy controls (HC, n = 17) completed measures of interoceptive accuracy and insight (adapted heartbeat tracking task [HTT] with confidence ratings), a time estimation control task (TET) and the Multidimensional Assessment of Interoceptive Awareness-2 (MAIA-2) to assess interoceptive sensibility. The groups did not differ in interoceptive accuracy (p = 1.00, g = 0.00) or confidence (p = .99, g = 0.004), although the FMS/FS group displayed lower scores on the "Not-Distracting" (p < .001, g = 1.42) and "Trusting" (p = .005, g = 1.17) MAIA-2 subscales, relative to HCs. The groups did not differ in TET performance (p = .82, g = 0.08). There was a positive relationship between HTT accuracy and confidence (insight) in HCs (r = .61, p = .016) but not in FMS/FS (r = 0.11, p = .69). HTT confidence was positively correlated with MAIA-2 "Self-Regulation" (r = 0.77, p = .002) and negatively correlated with FND symptom severity (r = -0.84, p < .001) and impact (r = -0.86, p < .001) in FMS/FS. Impaired interoceptive accuracy may not be a core feature in FMS/FS, but reduced insight and altered sensibility may be relevant. Reduced certainty in self-evaluations of bodily experiences may contribute to the pathogenesis of FND symptoms.

Patient Perceptions of Integrating Meditation-based Interventions in Office-based Opioid Treatment with Buprenorphine: A Mixed-methods Survey

INTRODUCTION

Recent findings support the provision of meditation-based interventions (MBIs) in primary care. However, the acceptability of MBI among patients prescribed medications for opioid use disorder (eg, buprenorphine) in primary care remains unclear. This study assessed experiences and preferences for adopting MBI among patients prescribed buprenorphine in office-based opioid treatment (OBOT).

METHODS

This 23-item, semistructured cross-sectional survey was administered by study staff to patients enrolled in OBOT (N = 72) and consisted of demographic and clinical characteristics, perceptions, experiences with MBI, and preferred strategies to access MBI to support their treatment on buprenorphine.

RESULTS

Most participants reported practicing at least 1 category of MBI (90.3%) on at least a daily (39.6%) or weekly (41.7%) basis including (1) spiritual meditation (eg, centering prayer; 67.7%); (2) nonmantra meditation (eg, comfortable posture; 61.3%); (3) mindfulness meditation (eg, mindfulness-based stress reduction; 54.8%); and (4) mantra meditation (eg, transcendental meditation; 29.0%). Interest in MBI was motivated by improving one's general health and well-being (73.4%), treatment outcomes with medications for OUD (eg, buprenorphine; 60.9%), and relationships with others (60.9%). Perceived clinical benefits of MBI included reduced anxiety or depression symptoms (70.3%), pain (62.5%), illicit substance or alcohol use (60.9%), cravings for illicit substances (57.8%), and opioid-related withdrawal symptoms (51.6%).

CONCLUSIONS

Findings from this study indicate high acceptability for adopting MBI among patients prescribed buprenorphine in OBOT. Further research is needed to assess the efficacy of MBI to improve clinical outcomes among patients initiating buprenorphine in OBOT.

Perspective on salutogenic approaches to persistent pain with a focus on mindfulness interventions

In this article, we provide a unique perspective on the use of mindfulness interventions in a whole health framework embedded within the theory of salutogenesis and the concept of painogenic environments. We argue that mindfulness is a valuable tool to bridge exploration of inner experiences of bodily pain with socio-ecological influences on thoughts and emotions. We outline research from neuroimaging studies that mindfulness techniques mediate neural processing and neuroplastic changes that alleviate pain and related symptoms. We also review evidence examining behavioural changes associated with mindfulness meditation providing evidence that it promotes self-regulatory activity, including the regulation and control of emotion and catalysation of health behaviour changes; both of which are important in chronic illness. Our viewpoint is that mindfulness could be a core element of salutogenic approaches to promote health and well-being for people living with pain because it rebuilds a fractured sense of cohesion. Mindfulness empowers people in pain to embrace their existence; shifting the focus away from pain and giving their lives meaning. We propose that integrating mindfulness into activities of daily living and individual or community-based activities will promote living well in the modern world, with or without pain; thus, promoting individual potential for fulfilment. Future research should consider the effects of mindfulness on people with pain in real-life settings, considering social, environmental, and economic factors using a broader set of outcomes, including self-efficacy, sense of coherence and quality of life.

Do mindfulness-based interventions change brain function in people with substance dependence? A systematic review of the fMRI evidence

BACKGROUND

Substance use disorders (SUDs) affect ~ 35 million people globally and are associated with strong cravings, stress, and brain alterations. Mindfulness-based interventions (MBIs) can mitigate the adverse psychosocial outcomes of SUDs, but the underlying neurobiology is unclear. Emerging findings were systematically synthesised from fMRI studies about MBI-associated changes in brain function in SUDs and their associations with mindfulness, drug quantity, and craving.

METHODS

PsycINFO, Medline, CINAHL, PubMed, Scopus, and Web of Science were searched. Seven studies met inclusion criteria.

RESULTS

Group by time effects indicated that MBIs in SUDs (6 tobacco and 1 opioid) were associated with changes in the function of brain pathways implicated in mindfulness and addiction (e.g., anterior cingulate cortex and striatum), which correlated with greater mindfulness, lower craving and drug quantity.

CONCLUSIONS

The evidence for fMRI-related changes with MBI in SUD is currently limited. More fMRI studies are required to identify how MBIs mitigate and facilitate recovery from aberrant brain functioning in SUDs.