Advertisement

Mindfulness training changes brain dynamics during depressive rumination: A randomized controlled trial.

      Abstract

      BACKGROUND

      Depression is the leading cause of disability worldwide and prevalence is on the rise. One of the most debilitating aspects of depression is the dominance and persistence of depressive rumination,- a state of mind that is linked to onset, and recurrence of depression. Mindfulness meditation trains adaptive attention regulation and present moment embodied awareness: skills that may be particularly useful during depressive mind states characterized by negative ruminative thoughts.

      METHODS

      In a randomized controlled fMRI study (N=80), we looked at the neurocognitive mechanisms behind Mindfulness-Based Cognitive Therapy (MBCT, N=50) treatment of recurrent depression compared to treatment as usual (TAU, N=30) across experimentally induced states of rest, mindfulness practice and rumination, and the relationship with dispositional psychological processes.

      RESULTS

      MBCT compared to TAU led to decreased salience network connectivity to the lingual gyrus during a ruminative state, and this change in salience network connectivity mediated improvements in the ability to sustain and control attention to body sensations.

      CONCLUSIONS

      These findings demonstrate that a clinically effective mindfulness intervention modulates neurocognitive functioning during depressive rumination and the ability to sustain attention to the body.

      KEYWORDS

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Biological Psychiatry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Organization WH (2020): Depression fact sheet.

        • Hoare E.
        • Callaly E.
        • Berk M.
        Can Depression Be Prevented? If So, How?.
        JAMA Psychiatry. 2020;
        • Richards D.
        Prevalence and clinical course of depression: a review.
        Clin Psychol Rev. 2011; 31: 1117-1125
        • Kupfer D.J.
        • Frank E.
        • Perel J.M.
        • Cornes C.
        • Mallinger A.G.
        • Thase M.E.
        • et al.
        Five-year outcome for maintenance therapies in recurrent depression.
        Arch Gen Psychiatry. 1992; 49: 769-773
        • Buckman J.E.J.
        • Underwood A.
        • Clarke K.
        • Saunders R.
        • Hollon S.D.
        • Fearon P.
        • et al.
        Risk factors for relapse and recurrence of depression in adults and how they operate: A four-phase systematic review and meta-synthesis.
        Clin Psychol Rev. 2018; 64: 13-38
      2. Segal, Williams, Teasdale (2013): Mindfulness-Based Cognitive Therapy for Depression. 2nd ed. New York: Guildford Press.

        • Figueroa C.A.
        • Ruhe H.G.
        • Koeter M.W.
        • Spinhoven P.
        • Van der Does W.
        • Bockting C.L.
        • et al.
        Cognitive reactivity versus dysfunctional cognitions and the prediction of relapse in recurrent major depressive disorder.
        J Clin Psychiatry. 2015; 76: e1306-1312
        • Segal Z.V.
        • Kennedy S.
        • Gemar M.
        • Hood K.
        • Pedersen R.
        • Buis T.
        Cognitive reactivity to sad mood provocation and the prediction of depressive relapse.
        Arch Gen Psychiatry. 2006; 63: 749-755
        • Kuyken W.
        • Warren F.C.
        • Taylor R.S.
        • Whalley B.
        • Crane C.
        • Bondolfi G.
        • et al.
        Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse: An Individual Patient Data Meta-analysis From Randomized Trials.
        JAMA Psychiatry. 2016; 73: 565-574
      3. National Institute for Health and Care Excellence (October 2009, updated April 2018): Depression in adults: recognition and management.

      4. Segal, Williams M, Teasdale JD (2013): Mindfulness-Based Cognitive Therapy for Depression. 2nd ed. New York: The Guilford Press.

        • Tang Y.Y.
        • Holzel B.K.
        • Posner M.I.
        The neuroscience of mindfulness meditation.
        Nat Rev Neurosci. 2015; 16: 213-225
        • Young K.S.
        • van der Velden A.M.
        • Craske M.G.
        • Pallesen K.J.
        • Fjorback L.
        • Roepstorff A.
        • et al.
        The impact of mindfulness-based interventions on brain activity: A systematic review of functional magnetic resonance imaging studies.
        Neurosci Biobehav Rev. 2018; 84: 424-433
        • Marwood L.
        • Wise T.
        • Perkins A.M.
        • Cleare A.J.
        Meta-analyses of the neural mechanisms and predictors of response to psychotherapy in depression and anxiety.
        Neurosci Biobehav Rev. 2018; 95: 61-72
        • Vignaud P.
        • Donde C.
        • Sadki T.
        • Poulet E.
        • Brunelin J.
        Neural effects of mindfulness-based interventions on patients with major depressive disorder: A systematic review.
        Neurosci Biobehav Rev. 2018; 88: 98-105
        • Gotink R.A.
        • Meijboom R.
        • Vernooij M.W.
        • Smits M.
        • Hunink M.G.
        8-week Mindfulness Based Stress Reduction induces brain changes similar to traditional long-term meditation practice - A systematic review.
        Brain and cognition. 2016; 108: 32-41
        • Williams K.
        • Elliott R.
        • McKie S.
        • Zahn R.
        • Barnhofer T.
        • Anderson I.M.
        Changes in the neural correlates of self-blame following mindfulness-based cognitive therapy in remitted depressed participants.
        Psychiatry Res Neuroimaging. 2020; 304111152
        • Hayes A.M.
        • Andrews L.A.
        A complex systems approach to the study of change in psychotherapy.
        BMC medicine. 2020; 18 (197): 197
        • Hayes A.M.
        • Yasinski C.
        • Ben Barnes J.
        • Bockting C.L.
        Network destabilization and transition in depression: New methods for studying the dynamics of therapeutic change.
        Clin Psychol Rev. 2015; 41: 27-39
        • Dichter G.S.
        • Gibbs D.
        • Smoski M.J.
        A systematic review of relations between resting-state functional-MRI and treatment response in major depressive disorder.
        J Affect Disord. 2015; 172: 8-17
        • Godlewska B.R.
        • Browning M.
        • Norbury R.
        • Igoumenou A.
        • Cowen P.J.
        • Harmer C.J.
        Predicting Treatment Response in Depression: The Role of Anterior Cingulate Cortex.
        Int J Neuropsychopharmacol. 2018; 21: 988-996
        • Hamilton J.P.
        • Farmer M.
        • Fogelman P.
        • Gotlib I.H.
        Depressive Rumination, the Default-Mode Network, and the Dark Matter of Clinical Neuroscience.
        Biol Psychiatry. 2015; 78: 224-230
        • Wang X.
        • Ongur D.
        • Auerbach R.P.
        • Yao S.
        Cognitive Vulnerability to Major Depression: View from the Intrinsic Network and Cross-network Interactions.
        Harv Rev Psychiatry. 2016; 24: 188-201
        • Marchetti I.
        • Koster E.H.
        • Sonuga-Barke E.J.
        • De Raedt R.
        The default mode network and recurrent depression: a neurobiological model of cognitive risk factors.
        Neuropsychol Rev. 2012; 22: 229-251
        • Fox K.C.
        • Nijeboer S.
        • Dixon M.L.
        • Floman J.L.
        • Ellamil M.
        • Rumak S.P.
        • et al.
        Is meditation associated with altered brain structure? A systematic review and meta-analysis of morphometric neuroimaging in meditation practitioners.
        Neurosci Biobehav Rev. 2014; 43: 48-73
        • Downar J.
        • Blumberger D.M.
        • Daskalakis Z.J.
        The Neural Crossroads of Psychiatric Illness: An Emerging Target for Brain Stimulation.
        Trends Cogn Sci. 2016; 20: 107-120
        • McGrath C.L.
        • Kelley M.E.
        • Holtzheimer P.E.
        • Dunlop B.W.
        • Craighead W.E.
        • Franco A.R.
        • et al.
        Toward a neuroimaging treatment selection biomarker for major depressive disorder.
        JAMA Psychiatry. 2013; 70: 821-829
        • Posner J.
        • Hellerstein D.J.
        • Gat I.
        • Mechling A.
        • Klahr K.
        • Wang Z.
        • et al.
        Antidepressants normalize the default mode network in patients with dysthymia.
        JAMA Psychiatry. 2013; 70: 373-382
        • Lythe K.E.
        • Moll J.
        • Gethin J.A.
        • Workman C.I.
        • Green S.
        • Lambon Ralph M.A.
        • et al.
        Self-blame-Selective Hyperconnectivity Between Anterior Temporal and Subgenual Cortices and Prediction of Recurrent Depressive Episodes.
        JAMA Psychiatry. 2015; 72: 1119-1126
        • Farb N.A.
        • Anderson A.K.
        • Mayberg H.
        • Bean J.
        • McKeon D.
        • Segal Z.V.
        Minding one's emotions: mindfulness training alters the neural expression of sadness.
        Emotion. 2010; 10: 25-33
        • Yang C.C.
        • Barros-Loscertales A.
        • Li M.
        • Pinazo D.
        • Borchardt V.
        • Avila C.
        • et al.
        Alterations in Brain Structure and Amplitude of Low-frequency after 8 weeks of Mindfulness Meditation Training in Meditation-Naive Subjects.
        Sci Rep. 2019; 910977
        • Doll A.
        • Holzel B.K.
        • Boucard C.C.
        • Wohlschlager A.M.
        • Sorg C.
        Mindfulness is associated with intrinsic functional connectivity between default mode and salience networks.
        Front Hum Neurosci. 2015; 9: 461
      5. Borders A (2020): Chapter 9 - Rumination, cognition, and the brain. In: Borders A, editor. Rumination and Related Constructs: Academic Press, pp 279-311.

      6. Gorgens KA (2011): Structured Clinical Interview For DSM-IV (SCID-I/SCID-II). In: Kreutzer JS, DeLuca J, Caplan B, editors. Encyclopedia of Clinical Neuropsychology. New York, NY: Springer New York, pp 2410-2417.

        • Beck A.T.
        • Steer R.A.
        • Ball R.
        • Ranieri W.
        Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients.
        J Pers Assess. 1996; 67: 588-597
      7. Kuyken W, Crane, R., & Williams, M. (2012): Mindfulness-Based Cognitive Therapy (MBCT) Implementation Resources.

        • Rush A.J.
        • Trivedi M.H.
        • Ibrahim H.M.
        • Carmody T.J.
        • Arnow B.
        • Klein D.N.
        • et al.
        The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression.
        Biol Psychiatry. 2003; 54: 573-583
        • Cohen S.
        • Kamarck T.
        • Mermelstein R.
        A global measure of perceived stress.
        J Health Soc Behav. 1983; 24: 385-396
        • Mehling W.E.
        • Price C.
        • Daubenmier J.J.
        • Acree M.
        • Bartmess E.
        • Stewart A.
        The Multidimensional Assessment of Interoceptive Awareness (MAIA).
        PLoS One. 2012; 7e48230
        • Fresco D.M.
        • Moore M.T.
        • van Dulmen M.H.
        • Segal Z.V.
        • Ma S.H.
        • Teasdale J.D.
        • et al.
        Initial psychometric properties of the experiences questionnaire: validation of a self-report measure of decentering.
        Behav Ther. 2007; 38: 234-246
        • Baer R.A.
        • Smith G.T.
        • Lykins E.
        • Button D.
        • Krietemeyer J.
        • Sauer S.
        • et al.
        Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples.
        Assessment. 2008; 15: 329-342
        • Roelofs J.
        • Muris P.
        • Huibers M.
        • Peeters F.
        • Arntz A.
        On the measurement of rumination: a psychometric evaluation of the ruminative response scale and the rumination on sadness scale in undergraduates.
        J Behav Ther Exp Psychiatry. 2006; 37: 299-313
        • Poldrack R.A.
        • Baker C.I.
        • Durnez J.
        • Gorgolewski K.J.
        • Matthews P.M.
        • Munafo M.R.
        • et al.
        Scanning the horizon: towards transparent and reproducible neuroimaging research.
        Nat Rev Neurosci. 2017; 18: 115-126
        • Mumford J.A.
        A power calculation guide for fMRI studies.
        Soc Cogn Affect Neurosci. 2012; 7: 738-742
        • Smallwood J.
        • Karapanagiotidis T.
        • Ruby F.
        • Medea B.
        • de Caso I.
        • Konishi M.
        • et al.
        Representing Representation: Integration between the Temporal Lobe and the Posterior Cingulate Influences the Content and Form of Spontaneous Thought.
        PLoS One. 2016; 11e0152272
        • Karl A.
        • Williams M.J.
        • Cardy J.
        • Kuyken W.
        • Crane C.
        Dispositional self-compassion and responses to mood challenge in people at risk for depressive relapse/recurrence.
        Clin Psychol Psychother. 2018; 25: 621-633
        • Smith S.M.
        • Jenkinson M.
        • Woolrich M.W.
        • Beckmann C.F.
        • Behrens T.E.
        • Johansen-Berg H.
        • et al.
        Advances in functional and structural MR image analysis and implementation as FSL.
        Neuroimage. 2004; 23: S208-219
        • Yeo B.T.
        • Krienen F.M.
        • Sepulcre J.
        • Sabuncu M.R.
        • Lashkari D.
        • Hollinshead M.
        • et al.
        The organization of the human cerebral cortex estimated by intrinsic functional connectivity.
        J Neurophysiol. 2011; 106: 1125-1165
        • Winkler A.M.
        • Ridgway G.R.
        • Webster M.A.
        • Smith S.M.
        • Nichols T.E.
        Permutation inference for the general linear model.
        Neuroimage. 2014; 92: 381-397
      8. Haynes W (2013): Bonferroni Correction. In: Dubitzky W, Wolkenhauer O, Cho K-H, Yokota H, editors. Encyclopedia of Systems Biology. New York, NY: Springer New York, pp 154-154.

        • Wager T.D.
        • Davidson M.L.
        • Hughes B.L.
        • Lindquist M.A.
        • Ochsner K.N.
        Prefrontal-subcortical pathways mediating successful emotion regulation.
        Neuron. 2008; 59: 1037-1050
        • Kukolja J.
        • Goreci D.Y.
        • Onur O.A.
        • Riedl V.
        • Fink G.R.
        Resting-state fMRI evidence for early episodic memory consolidation: effects of age.
        Neurobiol Aging. 2016; 45: 197-211
        • van der Werff S.J.
        • Pannekoek J.N.
        • Veer I.M.
        • van Tol M.J.
        • Aleman A.
        • Veltman D.J.
        • et al.
        Resilience to childhood maltreatment is associated with increased resting-state functional connectivity of the salience network with the lingual gyrus.
        Child abuse & neglect. 2013; 37: 1021-1029
        • Zhang L.
        • Qiao L.
        • Chen Q.
        • Yang W.
        • Xu M.
        • Yao X.
        • et al.
        Gray Matter Volume of the Lingual Gyrus Mediates the Relationship between Inhibition Function and Divergent Thinking.
        Frontiers in Psychology. 2016; 7
        • Liu X.
        • Chen W.
        • Hou H.
        • Chen X.
        • Zhang J.
        • Liu J.
        • et al.
        Decreased functional connectivity between the dorsal anterior cingulate cortex and lingual gyrus in Alzheimer's disease patients with depression.
        Behavioural Brain Research. 2017; 326: 132-138
        • Gong J.
        • Wang J.
        • Qiu S.
        • Chen P.
        • Luo Z.
        • Wang J.
        • et al.
        Common and distinct patterns of intrinsic brain activity alterations in major depression and bipolar disorder: voxel-based meta-analysis.
        Transl Psychiatry. 2020; 10: 353
        • Kim J.J.
        • Kent K.M.
        • Cunnington R.
        • Gilbert P.
        • Kirby J.N.
        Attachment styles modulate neural markers of threat and imagery when engaging in self-criticism.
        Sci Rep. 2020; 1013776
        • Teng C.
        • Zhou J.
        • Ma H.
        • Tan Y.
        • Wu X.
        • Guan C.
        • et al.
        Abnormal resting state activity of left middle occipital gyrus and its functional connectivity in female patients with major depressive disorder.
        BMC Psychiatry. 2018; 18: 370
        • van der Velden A.M.
        • Kuyken W.
        • Wattar U.
        • Crane C.
        • Pallesen K.J.
        • Dahlgaard J.
        • et al.
        A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder.
        Clin Psychol Rev. 2015; 37: 26-39
        • van Vugt M.K.
        • van der Velde M.
        • Investigators E.-M.
        How Does Rumination Impact Cognition? A First Mechanistic Model.
        Top Cogn Sci. 2018; 10: 175-191
        • Cladder-Micus M.B.
        • Speckens A.E.M.
        • Vrijsen J.N.
        • AR T.D.
        • Becker E.S.
        • Spijker J.
        Mindfulness-based cognitive therapy for patients with chronic, treatment-resistant depression: A pragmatic randomized controlled trial.
        Depress Anxiety. 2018; 35: 914-924
        • Kearns N.P.
        • Shawyer F.
        • Brooker J.E.
        • Graham A.L.
        • Enticott J.C.
        • Martin P.R.
        • et al.
        Does rumination mediate the relationship between mindfulness and depressive relapse?.
        Psychol Psychother. 2016; 89: 33-49
        • van Vugt M.K.
        • Hitchcock P.
        • Shahar B.
        • Britton W.
        The effects of mindfulness-based cognitive therapy on affective memory recall dynamics in depression: a mechanistic model of rumination.
        Front Hum Neurosci. 2012; 6: 257