Interoception Underlies Therapeutic Effects of Mindfulness Meditation for Post-Traumatic Stress Disorder: A Randomized Clinical Trial

Published:October 21, 2021DOI:https://doi.org/10.1016/j.bpsc.2021.10.005

      ABSTRACT

      Background

      Mindfulness-based interventions have proven efficacy in treating post-traumatic 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; PCGT; n = 51). We assessed pre- and post-intervention PTSD symptoms and electroencephalography (EEG) measures of neural outcomes, including spontaneous brain activity, cognitive task-related brain responses, and interoceptive brain responses (heartbeat-evoked brain responses [HEBR]). We conducted statistical causal mediation analyses using treatment type as a predictor, and pre- and post-intervention measures of symptom severity as treatment response, and the neural outcomes as mediators.

      RESULTS

      Compared to controls, the MBSR group had greater improvements in PTSD symptoms and increases in spontaneous alpha (8-13 Hz) power, task-related frontal theta power (4-7 Hz in 140-220 ms post-stimulus), and frontal theta HEBR (3-5 Hz and 265-336 ms post-R-peak). The mediation analysis using latent difference score modeling revealed that only changes in frontal theta HEBR 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 appear to be a primary cerebral mechanism that improves symptoms of PTSD.

      Key Words

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