Neural regulation of pain anticipation is associated with mindful behavior change in patients with anxiety or depression: A pilot study

Michael Datko; Jacqueline Lutz; Richa Gawande; Alexandra Comeau; Jenny Gan; My Ngoc To; Gaelle Desbordes; Todd Griswold; Jean King; Eric Loucks; Vitaly Napadow; Zev Schuman-Olivier

doi:10.1016/j.pscychresns.2024.111941

Neural regulation of pain anticipation is associated with mindful behavior change in patients with anxiety or depression: A pilot study

Psychiatry Res Neuroimaging. 2024 Dec 11:347:111941. doi: 10.1016/j.pscychresns.2024.111941. Online ahead of print.

Authors

Affiliations

¹ Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge, MA, USA; Harvard Medical School, Boston, USA; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA, USA. Electronic address: mdatko@cha.harvard.edu.
² Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge, MA, USA.
³ Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge, MA, USA; Harvard Medical School, Boston, USA.
⁴ Mind and Life Institute, Charlottesville, VA, USA.
⁵ University of Massachusetts Medical School, Worcester, MA, USA; Department of Biology and Biotechnology, Worcester Polytechnic Institute, Worcester, MA, USA.
⁶ Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Mindfulness Center, Brown University, Providence, RI, USA.
⁷ Harvard Medical School, Boston, USA; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA, USA.

PMID: 39752812
DOI: 10.1016/j.pscychresns.2024.111941

Abstract

Behavior change often requires overcoming discomfort or difficult emotions. Emotional dysregulation associated with anxiety or depression may prevent behavior change initiation among people managing chronic illness. Mindfulness training may catalyze chronic disease self-management by reducing experiential avoidance of aversive experiences that act as barriers to change initiation. Using a fMRI evoked pain task, we examined the effects of 8 weeks of Mindfulness Training for Primary Care (MTPC) on brain response to the anticipation of a noxious event (i.e., pain) among patients with anxiety and/or depression. We modeled the association between post-MTPC changes in brain response to pain anticipation and post-MTPC Action Plan Initiation (API), a measure of successful initiation of health behavior change. Greater post-MTPC increase in response to pain anticipation in the dorsal medial prefrontal cortex (dmPFC) was associated with higher levels of API (r=0.77, p<0.001). This increase in dmPFC response correlated with post-MTPC self-reported increase in emotion regulation skills related to goal-directed behaviors (r=-0.52, p=0.002). This suggests that mindfulness training increases the capacity to maintain goal-directed behavior in the face of aversive experiences by strengthening neural mechanisms of emotion- and self-regulation supporting successful health behavior change initiation in patients struggling with anxiety and/or depression.

Keywords: Anxiety; Behavior change; Depression; Intervention; Meditation; Mindfulness; Mood disorders; Pain; Pain anticipation; fMRI.