Neural Mechanisms of Mindful Disengagement from Worry

Abstract

Uncontrollable worry is a hallmark of generalized anxiety disorder and a transdiagnostic feature of psychopathology. Mindfulness-based strategies show promise for treating worry, but neural mechanisms of mindful disengagement remain incompletely characterized. We recruited 40 participants with clinically significant worry to undergo fMRI while engaging in real-time, idiographic worry and instructed disengagement using two mindfulness strategies (focused attention; acceptance) and one comparison strategy (suppression). Hypotheses were preregistered and partially supported. All disengagement strategies downregulated default mode and upregulated frontoparietal and salience networks. Focused attention was most effective for promoting disengagement and elicited decreased activity in cognitive control and sensorimotor regions. Successful disengagement was associated with increased activity in rostrolateral prefrontal cortex and functional connectivity between posterior cingulate and primary somatosensory cortex. Findings support the role of cognitive control and somatosensory networks in disengagement from worry and suggest common and distinct mechanisms of disengagement, with focused attention a particularly promising strategy.