Entropy Rules

Trauma Training:

Mindfulness Meditation Effects On Brain Function

    As discussed earlier, one crucial mechanism through which child maltreatment is thought to exert its deleterious effects is through parental behavior that creates a state of unresolvable fear in the child (Siegel & Hartzell, 2014), which when repeated can result in chronic, toxic stress and psychophysiological dysregulation (e.g., Porges, 2001; Hesse & Main, 2000; Palaszynski & Nemeroff, 2009). When memories of childhood trauma such as maltreatment are unresolved, adult survivors of child maltreatment are at increased risk of experiencing PTSD-like symptoms, such as dissociation or impulsive aggressive behavior (e.g., Cassidy & Mohr, 2006; Schore, 2003a; 2003b). Such behavior (e.g., frightened, frightening, or atypical parenting behavior) can frighten the child, recreating the same problematic fright without solution dynamic with their own children (Abrams, Rifkin & Hesse, 2006; Bailey et al., 2007; Burkett, 1991; Jacobvitz et al., 2006; Levendosky & Graham-Bermann, 2001; Lyons-Ruth, Bronfman, & Parsons, 1999; Lyons-Ruth, Yellin, Meinick, & Atwood, 2005; MacDonald et al., 2008; Shaver & Fraley, 2008).
    Mindfulness meditation has been found to activate connections between parts that are involved in secure, healthy attachment (Siegel, 2007; Surrey, 2005). Some key parts of the brain involved in mindfulness meditation are the same brain areas implicated in socioemotional skills including the anterior cingulate cortex, posterior cingulate cortex, insula, and thalamus (Manuello, Vercelli, Nani, Costa, & Cauda, 2016). Davidson et al. (2003) found that meditators showed enhanced anterior brain activation, associated with increased compassion and positive affect, as well as less anxiety and negative affect, compared to nonmeditators. These changes persisted to the 4-month follow-up point. Similarly, Lazar (2005) found that mindfulness meditation practice led to enhancement in areas of the brain associated with empathy and self-observation. The experiential focus involved in mindfulness and trained in meditation enhances activation in areas of the brain implicated in the problematic sequelae of child maltreatment (i.e., right-lateralized ventromedial and dorsolateral prefrontal cortices, and the insula) relative to the medial prefrontal cortex, which is related to the narrative self and self-referential rumination (see Chambers, Gullone, & Allen, 2009 for a review). For example, Lutz, Bruhl, Scheere, Jancke, and Herwig (2016) found that a mindful state was related to decreased activation in cortical midline structures associated with excessive cognitive self-reference, depressive rumination and negative mood. They also reported less activation in the amygdala, which detects emotional threat. These effects were more pronounced in long term meditators compared to novices, indicating a cumulative impact of mindfulness training. This suggests mindful states are associated, as theorized, with less self-focused rumination and lower levels of emotional arousal (Lutz et al., 2016).
    Recall that one of the documented outcomes of child maltreatment is a lack of functional neural integration (e.g., Teicher, 2002; Teicher et al., 2004; Schore, 2001; 2003b). Siegel (2007, 2012) has proposed that neurological integration (i.e., functional connectivity between various parts of the brain) is a hallmark of mental health, one that is promoted by both secure attachment and mindfulness meditation. Research suggests that the extent of functional connectivity between the areas of the PFC (e.g., orbitofrontal cortex) and key limbic areas (e.g., the amygdala) underlies the emotion regulation strategy of cognitive reappraisal (e.g., Quirk & Beer, 2006; see Chambers, Gullone, & Allen, 2009 for a more complete review). These connections appear to be lacking in individuals with symptoms of mental illness that often characterize individuals with a history of child maltreatment, particularly personality disorders including depressive, anxious, and aggressive symptomology (Philips, Drevets, Rauch, & Lane, 2003), with the orbitofrontal region being particularly affected by child maltreatment (e.g., Anderson et al., 1999). Exposure-based therapies, which involve present-moment attention (i.e., mindfulness) to distressing experiences, are thought to exert their curative effects by promoting integration (Van der Kolk, 2014; Siegel & Hartzell, 2014). Interestingly, enhanced functional connectivity has also been associated with certain beneficial physiological biomarkers, such as reduced inflammatory biomarker interleukin-6 (e.g., Brewer et al., 2011; Creswell et al., 2016; Hasenkamp & Barsalou, 2012).
    Multiple researchers have found that mindfulness training enhances beneficial neuroplastic changes in functional connectivity. Yang et al. (2016) studied the impact of an 8-week MBSR-inspired course for 13 depressed individuals. They found that self-reported depression and anxiety levels were significantly reduced post-intervention such that participants were no longer symptomatic at a clinical level. They found significant differences in functional connectivity in areas of the brain associated with depression, both pre-post intervention and in various states (resting vs. meditating; Yang et al., 2016). This indicates that even individuals reporting significant levels of depressive symptoms are capable of affecting desirable integrative brain changes through mindfulness meditation training.
    Taren et al. (2015) explored the neural correlates of mindfulness' well-established stress reductive effects by examining functional connectivity changes involving the amygdala. They found that higher reported perceived stress was associated with greater connectivity between the amygdala and subgenual anterior cingulate cortex in a sample of community adults. They then demonstrated that participation in a 3-day intensive mindfulness training reduced this functional connectivity involving the amygdala (relative to an active control relaxation training group) providing evidence that even brief intensive mindfulness training can affect beneficial neuroplastic changes. This study also illustrates that adaptive changes in functional connectivity can occur not only by enhancing functional connectivity in desirable ways, but also by reducing unhelpful connectivity.
    Doll et al. (2016) trained 26 healthy individuals in a type of mindfulness meditation involving attention to breath. After 2 weeks of training they examined brain activation during exposure to aversive photos while meditating and while not meditating. They found that attention to breath meditation downregulated amygdala activation and increased amygdala-prefrontal integration (Doll et al., 2016). King et al. (2016) investigated the impact of mindfulness-based exposure therapy (MBET) on PTSD symptom improvement and altered resting state functional connectivity in a small (N=14) group of combat veterans. They compared the effects of MBET to a group participating in Present Centered Group Therapy. Results indicated that both groups of veterans showed relatively equivalent improvements in PTSD symptoms. However, only veterans in the MBET program showed pre-post therapy alterations in default mode network resting state functional connectivity, specifically enhanced connection between dorsolateral prefrontal cortex and dorsal anterior cingulate cortex regions. These brain areas are associated with enhanced executive control, which enables intentional shifting from habitual self-referential narrative thought (associated with depression and anxiety symptoms) to experiential/intereoceptive experiencing in the present moment. These changes in resting functional connectivity were correlated with improvements in PTSD avoidance and hyperarousal symptoms (King et al., 2016). Considered together, these studies provide preliminary evidence that beneficial integrative brain changes underlying improved emotion regulation associated with mindfulness are also possible to achieve not only in healthy individuals, but also in traumatized populations. However, caution should still be exercised in generalizing these findings to adult survivors of child maltreatment who are exposed to trauma early in life during more sensitive developmental periods.
    Adult survivors of child maltreatment, like other trauma survivors, tend to experience intense emotional reactivity, especially to traumatic cues, which may contribute to their propensity towards aggressive or withdrawn interpersonal styles (Cassidy & Mohr, 2006). Hšlzel and colleagues (2016) demonstrated that MBSR may enhance white matter functioning in the UNC (a brain area associated with subthreshold PTSD hyperarousal symptoms; Costanzo et al., 2016) and emotional empathy (Oishi et al., 2015; Hšlzel et al., 2016). Participants in this study reported reduced subjective distress to a feared stimulus, despite remaining sensitive to the conditioned fear stimulus over time. The study was limited by the fact that the authors excluded all individuals with psychiatric diagnoses from the study, so it is not clear if these processes would work in similar ways in a clinical population, such as adult survivors of child maltreatment. Nevertheless, the prospect that mindfulness practice can help individuals remain regulated even in the context of an upsetting experience, may be crucial for this subpopulation of parents (Hšlzel et al., 2016).
    Another study used EEG methodology to examine associations among emotional exposure, extinction, and mindfulness in response to viewing emotional evocative images (Uusberg, Uusberg, Talpsep, & Paaver, 2016). Unlike participants in the control conditions (i.e., distraction and mundane monitoring), participants who practiced mindfulness while viewing negative images became less reactive over subsequent viewing, indicating the extinction of the fear response and integration of the image (Uusberg et al., 2016). This suggests that over time mindfulness could help an individual overcome emotional reactivity to trauma cues, which may be important for survivor parents who are likely to encounter a variety of child maltreatment trauma cues while parenting.
    Evidence suggests that mindfulness meditation not only enhances cognitive control (e.g., the ability to switch from self-referential narrative processing to experiential monitoring), but with sustained practice also appears to help reduce the neurobiological substrates of emotional reactivity. Allen et al. (2012) found that mindfulness training significantly improved performance on an affective Stroop task compared to an active control group. Enhanced performance on the affective Stroop task was associated with enhanced activation in the dorso-lateral prefrontal cortex, an area of the brain associated with top-down resolution of response conflict. Amount of home practice predicted individual differences in the use of anterior insula, anterior cingulate cortex, and midline regions (structures involved in bottom-up cognitive control, awareness, and stimuli salience) in processing negative affective stimuli. The authors interpreted the data to mean that early stages of mindfulness training increase cognitive control, whereas affective sensitivity and the ability to respond to negatively charged situations with intrinsic mindfulness can occur more automatically with accumulated practice over time (Allen et al., 2012). A strength of this study is that it controlled for covariates such as motivation, social support, and demand characteristics by comparing a 6-week mindfulness training program in a meditation-na•ve sample to an active control group.
    Finally, a recent study investigated the impact of an 8-week Mindful Families Stress Reduction (MFSR) program on the neural and family functioning of parents and their adolescent children (May, Reinka, Tipsord, Felver & Berkman, 2016). They found that participation in MFSR led to changes in neural activation in areas of the brain associated with self-awareness and evaluation, emotional awareness, interoception, and emotion regulation. Interestingly, adolescents' self-reports of improved family relationships were related to parental changes in activation in brain regions associated with empathy and emotional regulation and processing. Parental self-reported trait mindfulness and child-reported improvements in family trust, togetherness, and support were also correlated (May et al., 2016).
    Taken together, these studies suggest mindfulness training can affect desirable changes at the level of neural structure and function, in ways that may be particularly helpful to adult survivors of child maltreatment. These effects include enhanced functional connectivity, decreased subjective distress while maintaining emotional responsiveness, and enhanced the functions of brain areas associated with social-emotional functioning.

⇲ About The Author

Robin Hertz, MA is currently in the process of completing a PhD in Clinical Psychology at the University of Oregon.