Mindfulness‐based cognitive therapy is associated with distinct resting‐state neural patterns in patients with generalized anxiety disorder

Abstract

Introduction: Mindfulness-based cognitive therapy (MBCT) may be effective for generalized anxiety disorder (GAD); however, the neural mechanism is poorly understood. In this study, we examined the potential neural mechanisms through which MBCT may reduce anxiety in patients with mild-to-moderate GAD.Methods: Eight weekly group MBCT sessions (2 h each) were conducted with 32 GAD patients. Resting-state functional magnetic resonance imaging (fMRI) was used, along with clinical and mindfulness profiles. A regional homogeneity (ReHo) approach was applied, and resting-state functional connectivity in the default mode network (DMN) using the posterior cingulate cortex (PCC) seed was examined.Results: MBCT reduced the anxiety and increased the mindfulness abilities of patients. After MBCT, patients had reduced ReHo in broad regions of the limbic system, along with increased DMN functional connectivity in the anterior cingulate cortex (ACC) and bilateral insula. Overlapping regions of reduced ReHo and increased DMN functional connectivity were observed in the mid-cingulate cortex (MCC) and bilateral insula. The increased PCC-ACC and PCC-insula functional connectivity following MBCT were related to anxiety improvements, suggesting a potential therapeutic mechanism for mindfulness-based therapies. Discussion: Group MBCT treatment appears to have effectively reduced anxiety symptoms in patients with mild-to-moderate GAD. Activation and functional connectivity appeared significantly different across some limbic regions after MBCT treatment. The salience network showed reduced ReHo and increased connectivity to the PCC. The DMN functional connectivity of the MCC may indicate reduced anxiety and improved mindfulness in GAD patients. K E Y W O R D S functional MRI (fMRI), generalized anxiety disorder, mindfulness-based cognitive therapy (MBCT), waiting list

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“…Using the standard protocol of 8‐week MBSR training, Kral et al observed the enhanced PCC‐DLPFC connectivity with small effect size (Kral et al, 2019). The other two studies conducting 8‐week MBCT, however, reported the declined magnitude of intranetwork and internetwork PCC‐seeded connectivity without prominent changes of PCC‐DLPFC connectivity (Zhao et al, 2019; Zimmerman et al, 2019). Therefore, the program duration and consistent practices seemed to be crucial on the connectivity enhancement.…”

“…This findings could be counter-intuitive because a majority of previous findings reported the reduction in emotion-induced brain activity (Huang et al, 2019;Tomasino & Fabbro, 2016) or the altered RSFC DMN (such as reduced intra-DMN and enhanced PCC-DLPFC connectivity) following the mindfulness training (Creswell et al, 2016;King et al, 2016;Zimmerman et al, 2019 (Hensley & Clayton, 2008), sleep disturbance, and neuroendocrine activations (Buckley et al, 2012). In other words, the bereavement grief could have far Previous neuroimaging studies performing MBI have reported the enhanced connectivity strengths between PCC and DLPFC using the seed-correlation analysis (King et al, 2016;Kral et al, 2019;Scult et al, 2019); however, adopting the same strategy with different seed locations, the PCC-DLPFC connectivity strengths after MBCT were insignificantly increased in the bereaved population (- ity (Zhao et al, 2019;Zimmerman et al, 2019). Therefore, the program duration and consistent practices seemed to be crucial on the connectivity enhancement.…”

“…For example, King et al demonstrated the increased functional connectivity between PCC and dorsolateral prefrontal cortex (DLPFC) in patients with post‐traumatic stress disorder after a 16‐week mindfulness‐based exposure training (King et al, 2016); Scult et al also observed the enhanced PCC‐DLPFC connectivity strength in 21 patients with general anxiety disorder (GAD) following a 20‐week mindful emotion regulation therapy (Scult et al, 2019). In addition, another study revealed the decreased magnitude of PCC‐seeded internetwork connectivity (PCC‐insula and PCC‐dorsal anterior cingulate cortex), without prominent changes of PCC‐DLPFC connectivity, after an 8‐week MBCT in 32 GAD patients (Zhao et al, 2019). Accordingly, the mindfulness‐based interventions (MBI) may lead to multiple scenarios of internetwork neuroplasticity to stressful populations in the resting state.…”