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Anxiety is the cognitive state related to the inability to control emotional responses to perceived threats. Anxiety is inversely related to brain activity
associated with the cognitive regulation of emotions. Mindfulness meditation has been found to regulate anxiety. However, the brain mechanisms
involved in meditation-related anxiety relief are largely unknown. We employed pulsed arterial spin labeling MRI to compare the effects of distraction in
the form of attending to the breath (ATB; before meditation training) to mindfulness meditation (after meditation training) on state anxiety across the
same subjects. Fifteen healthy subjects, with no prior meditation experience, participated in 4 d of mindfulness meditation training. ATB did not reduce
The Author (2013). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com
752 SCAN (2014) F. Zeidan et al.
cognitive control and emotion regulation. Therefore, we also postu- before MRI session 1 and after MRI session 2. The FMI is a psycho-
lated that mindfulness meditation-related anxiety relief would be asso- metrically validated instrument with high internal consistency
ciated with brain mechanisms associated with the cognitive regulation (Cronbachs alpha 0.86)(Walach et al., 2006). Higher scores indicate
of emotions (e.g. ACC, vmPFC) when compared to ATB. higher levels of mindfulness.
Fig. 1 The SAI was administered before and after each MRI session. In first half of MRI session one, 1 heat (498C) and 1 neutral (358) series was randomly presented in each fMRI block. Furthermore, subjects
were instructed to close their eyes and reduce movement (rest), which served as the no-distraction condition. In the second half of MRI session one, 1 heat (498C) and neutral (358) series was randomly
presented in each fMRI block. Before anatomical acquisition, subjects were instructed to meditate by focusing on the changing sensations of the breath (ATB). ATB served as the self-distraction condition when
compared to rest and mindfulness meditation after training. Subjects then participated in 4 days of mindfulness meditation training (see Mindfulness-Based Mental Training for more detail). After successful
completion of meditation training, subjects returned for MRI session 2. In first half of MRI session 2, two heat (498C) and two neutral (358) series was randomly presented in each fMRI block. Similar to MRI
session 1, in the first half of MRI session 2, subjects were instructed to close their eyes (rest). Afterwards, subjects were instructed to begin meditating by focusing on the changing sensations of the breath
(mindfulness-based attention to breathmeditation). In the second half of MRI session 2, 2 heat (498C) and 2 neutral (358) series was randomly presented in each fMRI block. The presentation of noxious vs
neutral scans was counterbalanced across subjects to minimize potential order effects.
Mindfulness meditation-related anxiety relief SCAN (2014) 753
session and not after each individual scan, it is important to determine F(5,70) 5.96, P < 0.001, 2 0.30 was driven by a significant de-
if meditation-related changes in anxiety are distinct from meditation- crease in state anxiety after each session in which subjects meditated
related changes in pain. Therefore, separate bivariate regression ana- (Figure 2) as compared to MRI 1 where subjects simply attended to
lyses were conducted to compare ATB and meditation-related changes their breath. Meditation significantly reduced (P < 0.05) state anxiety
in SAI with ATB and meditation-related changes in pain ratings for in each meditation training session with decreases ranging from 15%
each MRI session. The degree of change in each of these variables was to 22% (Figures 2 and 3). Meditating in MRI session 2 reduced state
calculated as a percent change [MRI session 1 (post ATBpre ATB / anxiety scores by 12%. In contrast, ATB in MRI session 1 did not alter
pre-ATB) and MRI session 2 (post-meditationpre-meditation/pre- state anxiety when compared to rest (P > 0.05; Figure 2).
meditation)].
Four days of meditation training significantly increased
RESULTS mindfulness levels
Mindfulness meditation reduces state anxiety A RM ANOVA found that 4 days of mindfulness-based mental training
Twenty minutes of mindfulness meditation significantly reduced state significantly increased mindfulness levels after training,
anxiety in each session that meditation was practiced (Figures 2 and 3). F(1,14) 11.62, P 0.004, 2 0.46. Average mindfulness ratings
increased by 14% after training (M 51.80, S.E.M. 2.00) when com-
MRI session 2
Meditation reduces anxiety by activating higher-order brain
mechanisms. A regression analysis examining inter-individual dif-
ferences was conducted between regional brain signals during medita-
tion as compared to rest and demeaned percent decreases in state
anxiety scores. Meditation-related anxiety relief was associated with
greater activation in the vmPFC, ACC, perigenual ACC (pgACC), bi-
lateral anterior insula and SII (Figure 4). Morever, individuals who
reported increases in state anxiety after meditating exhibited increased
brain activity in the PCC.
Fig. 2 State anxiety was significantly reduced in every session in which subjects meditated. ATB did Mindfulness meditation compared to ATB. Brain activity related to
not significantly reduce state anxiety. * P < 0.05. MRI MRI session, MT Meditation Training. mindfulness meditation-related anxiety alterations were found in the
Fig. 3 Figure 3 illustrates the individual percent state anxiety changes in MRI sessions 1 and 2. Subject numbers in MRI session 1 correspond with subject numbers in MRI session 2. Four subjects reported
decreases in state anxiety in MRI session 1. There were nine subjects that reported decreases in state anxiety in MRI session 2.
Mindfulness meditation-related anxiety relief SCAN (2014) 755
ACC (BA 24, 32), vmPFC, left anterior insula, superior frontal gyrus, (r 0.71, P 0.003) ratings (Table 2). However, there was no sig-
pgACC and right SII when compared to brain regions involved in nificant relationship between post-scan SAI ratings and post-ATB
ATB-related anxiety changes (Figure 4). When compared to mindful- (MRI session 1), pre-meditation, or post-meditation (MRI session 2)
ness meditation, ATB-related anxiety changes were associated with pain ratings (Table 2).
greater brain activity in the right occipital cortex, middle frontal A simple bivariate regression analysis comparing the percent change
gyrus, hippocampus, right putamen and PCC/precuneus (Figure 4). in SAI and the percent change in pain ratings revealed no differences in
the relationship between the percent change in SAI scores and pain
No relationships between global CBF, respiration rate, heart rate ratings in MRI session 1 or MRI session 2 (Table 3).
and state anxiety. A simple bivariate regression analysis was em-
ployed to determine if percent changes in global CBF, respiration rate DISCUSSION
and heart changes are associated with changes in state anxiety. There Mindfulness meditation is postulated to regulate emotions by stabiliz-
was no relationship between global CBF and SAI in MRI session 1 ing attentional processes, enhancing awareness of discursive sensory
(r 0.11, P 0.71) or MRI session 2 (r 0.34, P 0.21; Table 1). events, and disengaging from corresponding affective appraisals
There was also no relationship found between respiration rate and (Kabat-Zinn et al., 1992; Gunaratana, 2002; Vago and Silbersweig,
state anxiety in MRI 1 (r 0.34, P 0.25) or MRI 2 (r 0.27, 2012). The present findings provide evidence for these principles by
P 0.35), and no correlation between changes in heart rate and SAI identifying the brain mechanisms involved in mindfulness meditation-
scores in MRI session 1 (r 0.12, P 0.72) or MRI session related anxiety relief. Meditation significantly reduced state anxiety in
2(r 0.39, P 0.19; Table 1). every session that subjects meditated (Figure 2). Anxiety is inversely
related to activity in a brain network involved in cognitive and affective
State anxiety and pain. A simple bivariate regression analysis com- control (Bishop et al., 2004; Bishop, 2009). Meditation-related activa-
paring raw pain ratings to raw SAI scores revealed that higher state tion of this network was clearly associated with anxiety reduction
anxiety ratings in pre-scan MRI session 1 were related to lower pre- (Figure 4). When compared to ATB, meditation reduced anxiety by
ATB pain intensity (r 0.60, P 0.02) and pain unpleasantness engaging brain mechanisms involved in sensory evaluation (SII) and
756 SCAN (2014) F. Zeidan et al.
Table 1 CBF, respiration rate and heart rate means (S.E.M.) across conditions and regions by mindfulness meditation regulates anxiety through multiple
sessions potential mechanisms.
Meditation-related anxiety relief was associated with greater activity
CBF Respiration rate H.R. in a distinct network of brain regions involved in cognitive reappraisal
processes (Ochsner and Gross, 2005; Eippert et al., 2007; Wager et al.,
Session 1
Rest 74.12(3.01) 19.97(1.29) 72.53(2.33)
2008; Figure 4). Greater reductions in anxiety during meditation were
ATB 70.69(3.56) 17.05(1.00)a 70.46(1.79) associated with increased vmPFC activity. Furthermore, the vmPFC is
crucially involved in successfully down regulating negative emotions
Session 2 and is associated with enhanced cognitive control, working memory
Rest 68.57(3.17) 16.72(.82)b 74.82(3.08) processing and modifying appraisals of sensory events (Teasdale et al.,
Meditation 65.09(3.59) 11.55(.74)c 73.62(2.77)
1999; Urry et al., 2006; Hermann et al., 2009; Kompus et al., 2009;
There were no differences in global CBF between rest and ATB in Session 1 or between rest and McRae et al., 2009). The relationship between the vmPFC and medi-
meditation in session 2.
a
Subjects exhibited lower respiration rate during ATB when compared to rest in session 1. tation-related anxiety relief is consistent with the act of monitoring
b
Overall respiration rate was lower in session 2 when compared to session 1. and reappraising cognitive and affective states. Creswell et al. (2007)
c
Respiration rate was lower during meditation when compared to rest in session 2 but was not
associated with anxiety changes. found that greater activity in the vmPFC was directly associated with
ATB does not modulate anxiety Supplementary Material). Further support for these findings is pro-
Similar to previous studies (Kalisch et al., 2006; Zeidan et al., 2010a), vided by conjunction analyses that revealed no significant overlap be-
we did not find that self-distraction (ATB) attenuated state anxiety. tween brain regions associated with meditation-related anxiety relief
Some may argue that focusing on the sensations of the breath is a form and meditation-related pain relief.
of concentrative meditation, associated with other meditative tech-
niques such as Transcendental, yogic, Zen and Shamatha (Cahn and
Considerations for mindfulness meditation-related anxiety relief
Polich, 2006). As such, subjects in MRI session 1 may have been
practicing a form of concentrative meditation. ATBs failure to Inclusion of a sham meditation group in the present study could have
reduce anxiety may be due to the lack of the actual mindfulness com- provided additional insight into possible demand characteristics and
ponent and/or the lack of training with this attentional task. However, social support effects related to meditation training. However, we have
consistent with previous findings, cognitive techniques using re- found that comparable meditation training regimens produced similar
appraisal are more effective at attenuating anxiety when compared to improvements in anxiety and mood even when compared to relaxation
those employing distraction (Kalisch et al., 2006; McRae et al., 2009). and sham meditation regimens (Zeidan et al., 2010a, b, c). Moreover,
Regression analyses revealed that the limited number of individuals in order to control for potential confounds from different experimen-
who reported anxiety relief by self-distraction (ATB; Figure 3) did so tal directives (McRae et al., 2009), we employed the same experimental
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