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One component of mindfulness training (MT) is the development of interoceptive attention (IA) to visceral bodily sensations, facilitated through daily practices such as breath monitoring. Using functional magnetic resonance imaging (fMRI), we examined experience-dependent functional plasticity in accessing interoceptive representations by comparing graduates of a Mindfulness-Based Stress Reduction course to a waitlisted control group. IA to respiratory sensations was contrasted against two visual tasks, controlling for attentional requirements non-specific to IA such as maintaining sensation and suppressing distraction. In anatomically partitioned analyses of insula activity, MT predicted greater IA-related activity in anterior dysgranular insula regions, consistent with greater integration of interoceptive sensation with external context. MT also predicted decreased recruitment of the dorsomedial prefrontal cortex (DMPFC) during IA, and altered functional connectivity between the DMPFC and the posterior insula, putative primary interoceptive cortex. Furthermore, meditation practice compliance predicted greater posterior insula and reduced visual pathway recruitment during IA. These findings suggest that interoceptive training modulates task-specific cortical recruitment, analogous to training-related plasticity observed in the external senses. Further, DMPFC modulation of IA networks may be an important mechanism by which MT alters information processing in the brain, increasing the contribution of interoception to perceptual experience.

Background: Due to the clinical challenges of treatment-resistant depression (TRD), we evaluated the efficacy of mindfulness-based cognitive therapy (MBCT) relative to a structurally equivalent active comparison condition as adjuncts to treatment-as-usual (TAU) pharmacotherapy in TRD. Methods: This single-site, randomized controlled trial compared 8-week courses of MBCT and the Health Enhancement Program (HEP), comprising physical fitness, music therapy and nutritional education, as adjuncts to TAU pharmacotherapy for outpatient adults with TRD. The primary outcome was change in depression severity, measured by percent reduction in the total score on the 17-item Hamilton Depression Rating Scale (HAM-D 17 ), with secondary depression indicators of treatment response and remission. Results: We enrolled 173 adults; mean length of a current depressive episode was 6.8 years (SD = 8.9). At the end of 8 weeks of treatment, a multivariate analysis showed that relative to the HEP condition, the MBCT condition was associated with a significantly greater mean percent reduction in the HAM-D 17 (36.6 vs. 25.3%; p = 0.01) and a significantly higher rate of treatment responders (30.3 vs. 15.3%; p = 0.03). Although numerically superior for MBCT than for HEP, the rates of remission did not significantly differ between treatments (22.4 vs. 13.9%; p = 0.15). In these models, state anxiety, perceived stress and the presence of personality disorder had adverse effects on outcomes. Conclusions: MBCT significantly decreased depression severity and improved treatment response rates at 8 weeks but not remission rates. MBCT appears to be a viable adjunct in the management of TRD.

Although the psychological benefits of mindfulness training on emotion regulation are well-documented, the precise mechanisms underlying these effects remain unclear. In the present account, we propose a new linkage between mindfulness and improved emotion regulation—one that highlights the role played by executive control. Specifically, we suggest that the present-moment awareness and nonjudgmental acceptance that is cultivated by mindfulness training is crucial in promoting executive control because it increases sensitivity to affective cues in the experiential field. This refined attunement and openness to subtle changes in affective states fosters executive control because it improves response to incipient affective cues that help signal the need for control. This, in turn, enhances emotion regulation. In presenting our model, we discuss how new findings in executive control can improve our understanding of how mindfulness increases the capacity for effective emotion regulation.

Mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) are particularly effective treatment approaches in terms of alleviating depressive symptoms and preventing relapse once remission has been achieved. Although engaging in mindfulness practice is an essential element of both treatments; it is unclear whether informal or formal practices differentially impact on symptom alleviation. The current study utilizes a correlational design to examine data provided by thirty-two previously depressed, remitted outpatients who received either MBCT or MBSR treatment. Outpatients in the MBCT group received treatment as part of a previously published randomized efficacy trial (Segal et al. in Arch Gen Psychiatry 67:1256–1264, 2010 ), while those in the MBSR group received treatment as part of a separate, unpublished randomized clinical trial. Throughout treatment, clients reported on their use of formal and informal mindfulness practices. Results indicate that engaging in formal (but not informal) mindfulness practice was associated with decreased rumination, which was associated with symptom alleviation.

Background Longitudinal neuroimaging investigations of antidepressant treatment offer the opportunity to identify potential baseline biomarkers associated with poor outcome. Methods To explore the neural correlates of nonresponse to cognitive behavioural therapy (CBT) or venlafaxine (VEN), we compared pretreatment (18)F-fluoro-2-deoxy-D-glucose positron emission tomography scans of participants with major depressive disorder responding to either 16 weeks of CBT ( n = 7) or VEN treatment ( n = 9) with treatment nonresponders ( n = 8). Results Nonresponders to CBT or VEN, in contrast to responders, exhibited pretreatment hypermetabolism at the interface of the pregenual and subgenual cingulate cortices. Limitations Limitations of our study include the small sample sizes and the absence of both arterial sampling to determine absolute glucose metabolism and high-resolution structural magnetic resonance imaging coregistration for region-of-interest analyses. Conclusion Our current findings are consistent with those reported in previous studies of relative hyperactivity in the ventral anterior cingulate cortex in treatment-resistant populations.

Cognitive behavioral therapy (CBT) is a powerful and evidence-based treatment for several mental health disorders. However, there are no simple learning guides covering CBT: what it is, how it works, and how to implement it in session. In CBT Made Simple, two psychologists and experts in CBT offer mental health professionals the ultimate \"how-to\" guide. This fully revised and updated second edition includes the core components of CBT--core beliefs, intermediate beliefs, and behavioral experiments--to make this the most comprehensive and practical CBT manual available.

Mindfulness involves nonjudgmental attention to present-moment experience. In its therapeutic forms, mindfulness interventions promote increased tolerance of negative affect and improved well-being. However, the neural mechanisms underlying mindful mood regulation are poorly understood. Mindfulness training appears to enhance focused attention, supported by the anterior cingulate cortex and the lateral prefrontal cortex (PFC). In emotion regulation, these PFC changes promote the stable recruitment of a nonconceptual sensory pathway, an alternative to conventional attempts to cognitively reappraise negative emotion. In neural terms, the transition to nonconceptual awareness involves reducing evaluative processing, supported by midline structures of the PFC. Instead, attentional resources are directed toward a limbic pathway for present-moment sensory awareness, involving the thalamus, insula, and primary sensory regions. In patients with affective disorders, mindfulness training provides an alternative to cognitive efforts to control negative emotion, instead directing attention toward the transitory nature of momentary experience. Limiting cognitive elaboration in favour of momentary awareness appears to reduce automatic negative self-evaluation, increase tolerance for negative affect and pain, and help to engender self-compassion and empathy in people with chronic dysphoria.

It has long been theorised that there are two temporally distinct forms of self-reference: extended self-reference linking experiences across time, and momentary self-reference centred on the present. To characterise these two aspects of awareness, we used functional magnetic resonance imaging (fMRI) to examine monitoring of enduring traits (’narrative’ focus, NF) or momentary experience (’experiential’ focus, EF) in both novice participants and those having attended an 8 week course in mindfulness meditation, a program that trains individuals to develop focused attention on the present. In novices, EF yielded focal reductions in self-referential cortical midline regions (medial prefrontal cortex, mPFC) associated with NF. In trained participants, EF resulted in more marked and pervasive reductions in the mPFC, and increased engagement of a right lateralised network, comprising the lateral PFC and viscerosomatic areas such as the insula, secondary somatosensory cortex and inferior parietal lobule. Functional connectivity analyses further demonstrated a strong coupling between the right insula and the mPFC in novices that was uncoupled in the mindfulness group. These results suggest a fundamental neural dissociation between two distinct forms of self-awareness that are habitually integrated but can be dissociated through attentional training: the self across time and in the present moment.

BackgroundDuring cognitive-behavioral therapy (CBT) for Obsessive Compulsive Disorder (OCD), individuals learn to utilize cognitive and behavioral skills to manage their symptoms. However, it is unclear whether these CBT skills have similar effects on symptom alleviation throughout treatment.MethodThis study examined the impact of CBT skill comprehension and CBT skill frequency on OCD symptom change during CBT for OCD. Participants experiencing a primary diagnosis of OCD (N = 101) completed self-report measures of OCD symptoms, skill comprehension (e.g., using the Skills of Cognitive Therapy Questionnaire (SoCT)), and skill frequency (i.e., comparing the thought record (TR) with exposure and response prevention (ERP)) during treatment.ResultsStructural equation modelling analyses involving an integration of growth curve analysis and cross-lagged regression analysis demonstrated that skill comprehension and skill frequency trajectories are associated with OCD symptom trajectories. There was a significant cross-lagged relationship between skill comprehension and OCD symptom change, in which higher levels of skill comprehension were associated with OCD symptom alleviation. Comparable analyses of skill frequency demonstrated that higher levels of both TR frequency and ERP frequency were associated with improvements in OCD symptoms.ConclusionsThese results demonstrate that higher levels of skill comprehension as well as skill frequency are associated with OCD symptom alleviation.