Interoception Underlies Therapeutic Effects of Mindfulness Meditation for Posttraumatic Stress Disorder: A Randomized Clinical Trial

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Abstract

Background: Mindfulness-based interventions have proven efficacy in treating posttraumatic stress disorder (PTSD), but the neurobiological mechanism underlying the therapeutic effects is unknown. As mindfulness meditation cultivates attention to the present moment and bodily sensations, neural functions related to interoception (i.e., central processes of bodily signals) might be such a mechanism. Methods: We conducted a clinical trial in which veterans with PTSD were randomly assigned to receive an 8-week mindfulness-based stress reduction (MBSR) intervention (n = 47) or an active control intervention (present-centered group therapy; n = 51). We assessed pre- and postintervention PTSD symptoms and electroencephalography measures of neural outcomes, including spontaneous brain activity, cognitive task–related brain responses, and interoceptive brain responses (heartbeat-evoked brain responses). We conducted statistical causal mediation analyses using treatment type as a predictor, pre- and postintervention measures of symptom severity as treatment response, and the neural outcomes as mediators. Results: Compared with the control group, the MBSR group had greater improvements in PTSD symptoms and increases in spontaneous alpha power (8–13 Hz), task-related frontal theta power (4–7 Hz in 140–220 ms after stimulus), and frontal theta heartbeat-evoked brain responses (3–5 Hz and 265–336 ms after R peak). The mediation analysis using latent difference score modeling revealed that only changes in frontal theta heartbeat-evoked brain responses mediated the MBSR treatment effect. Conclusions: Mindfulness meditation improves brain functions of attentional control and resting brain states reflective of internally oriented relaxation. However, interoceptive neural functions enhanced by MBSR seem to be a primary cerebral mechanism that improves symptoms of PTSD.

Original languageEnglish (US)
JournalBiological Psychiatry: Cognitive Neuroscience and Neuroimaging
DOIs
StateAccepted/In press - 2022

Bibliographical note

Funding Information:
This work was supported with resources and the use of facilities at the Minneapolis Veterans Affairs (VA) Health Care System, Minneapolis, MN. This research was supported by a grant from the VA (Grant No. 5I01CX000683-01 [to KOL]).

Funding Information:
This work was supported with resources and the use of facilities at the Minneapolis Veterans Affairs (VA) Health Care System, Minneapolis, MN. This research was supported by a grant from the VA (Grant No. 5I01CX000683-01 [to KOL]). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. Minneapolis VA Health Care System staff clinical psychologists Melissa Polusny, Ph.D. Christopher Erbes, Ph.D. Greg Lamberty, Ph.D. and John Rodman, Ph.D. contributed to the design and supervision of the clinical trial as part of their research duties. Minneapolis VA Health Care System statistician Paul Thuras, Ph.D. staff clinical psychologist Rose C. Collins, and research staff Amy Moran, M.A. contributed to clinical data acquisition as part of their research and clinical duties. Minneapolis VA Health Care System electroencephalography technician Abraham C. Van Voorhis contributed to electroencephalography data collection and was provided compensation for his role in the study. Minneapolis VA Health Care System clinicians Torricia Yamada, Ph.D. Carolyn Anderson, Ph.D. Maureen Kennedy, Psy.D. Kelly Petska, Ph.D. Jacqueline Wright, LICSW, Nancy Koets, Psy.D. Margaret Gavian, Ph.D. and Ivy Miller, Ph.D. contributed to intervention delivery as part of their provision of clinical care. Mariann Johnson, B.A. University of Minnesota Center for Spirituality and Healing, contributed to intervention delivery and was provided compensation for her role in the study. Terry Pearson, R.Ph. M.B.A. University of Minnesota Center for Spirituality and Healing, provided consultation on mindfulness-based stress reduction and evaluation of treatment fidelity and was provided compensation for her role in the study. Melissa Wattenberg, Ph.D. VA Boston Healthcare System and Boston University School of Medicine, provided training and consultation on present-centered group therapy, for which she received no compensation. Leah Gause, M.A. and Cassandra Sartor, M.A. Minneapolis VA Health Care System, served as independent assessors and were provided compensation for their roles in the study. Doris Clancy, M.A. and Cory Voecks, M.A. provided administrative support and were provided compensation for their roles in the study. Elizabeth Gibson, B.A. Minneapolis VA Health Care System, provided editing assistance and received no compensation. A previous version of this article was published as a preprint on arXiv: https://arxiv.org/abs/2010.06078. The authors report no biomedical financial interests or potential conflicts of interest. ClinicalTrials.gov: Meditation Interventions for Treatment of PTSD in Veterans (VMP); https://clinicaltrials.gov/ct2/show/NCT01548742; NCT01548742.

Publisher Copyright:
© 2021 Society of Biological Psychiatry

Keywords

  • EEG
  • Interoception
  • Meditation
  • Mindfulness
  • Neurobiological mechanism
  • Posttraumatic stress disorder

PubMed: MeSH publication types

  • Journal Article

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