8-week Mindfulness Based Stress Reduction induces brain changes similar to traditional long-term meditation practice – A systematic review
Introduction
Mindfulness has a millennia old history and is usually referred to as a mental state characterized by ‘full attention to internal and external experiences as they occur in the present moment’, and ‘an attitude characterized by non-judgment of, and openness to, this current experience’ (Bishop et al., 2004, Brown and Ryan, 2003, Kabat-Zinn et al., 1985). Stripped of all religious aspects, application of Mindfulness Based Stress Reduction (MBSR) (Kabat-Zinn et al., 1985) as a stress reduction method, and Mindfulness Based Cognitive Therapy to prevent relapse in depression (Teasdale et al., 2000), has increased over the past 35 years. In 8 weeks, MBSR and MBCT participants learn to cope with stress by means of cognitive exercises, concentration training and mental exposure, using a standardized evidence based protocol (Substance Abuse & Mental Health Services Administration, 2014). The MBSR- and MBCT protocol comprises both focused attention, open monitoring, and breathing meditation but without the transcending atmosphere of traditional meditative practice. The goal is not to reach Nirvana or Enlightenment. Instead, by learning to recognize automatic reactions, and letting go of dysfunctional ones in a non-judgmental manner, participants gain a new coping mechanism that studies have shown to improve perceived stress, anxiety, depression, and quality of life in all types of patients (Gotink et al., 2015, Vibe de, 2012).
Previous research on traditional meditation styles (i.e. Zen, Vipassana, Tibetan etc.) found that individuals who have regularly practiced meditation for several years exhibit significant altered brain structure, when compared to demographically matched controls (Holzel et al., 2008, Lazar et al., 2005, Luders et al., 2009, Pagnoni and Cekic, 2007, Tang et al., 2015, Vestergaard-Poulsen et al., 2009). Recent meta-analyses report eight regions to consistently show structural and functional differences in long-term meditators: the prefrontal cortex (related to enhanced meta-awareness and reappraisal), the sensory cortices and insula (related to body awareness), the hippocampus (related to memory processes), and the cingulate cortex (related to self and emotion regulation) (Boccia et al., 2015, Fox et al., 2014, Holzel et al., 2007, Manna et al., 2010, Tomasino et al., 2012).
Former neuroimaging literature focused on traditional meditation styles, or a combination of traditional and secular mindfulness. MBSR and MBCT are in some core aspects different from traditional meditation (i.e. duration and goal), and may therefore have different neuronal effects. In this article, we want to explore how the distilled mindfulness techniques in MBSR and MBCT, rather than spirituality of the traditional styles, are related to changes in brain structures and activity. We focus on regions described in studies on long-term meditators, but have not restricted ourselves to these areas. The current systematic review focusses on functional and structural magnetic resonance imaging (MRI) in order to understand the neuronal base of the psychological effects of MBSR and MBCT.
Section snippets
Inclusion and exclusion criteria
In this systematic review we give an overview of the published effects of the secular mindfulness program MBSR and MBCT, as designed by Kabat-Zinn et al. (1985) and Teasdale et al. (2000), on the function and structure of the brain. Studies reporting specific aspects of the program such as nonjudgmental awareness or focus on the breath, were also included to see whether these components have an impact on the brain and thus could explain more about the working mechanism of the 8-week program. To
Literature search
A total number of 1156 potentially relevant articles were identified, retrieved, and screened for potential inclusion (Fig. 1). 597 studies were excluded as being duplicates and 425 studies were discarded based on their titles. From the remaining 134 articles, 74 were excluded based on the abstract: 67 did not have MBSR, MBCT, or components as intervention, 26 did not use MRI or fMRI as imaging technique, and five were conference abstracts. Overall, 36 articles met our inclusion criteria and
Discussion
In this study we systematically reviewed the evidence of effect of secular mindfulness on function and structure of the brain, hence aiming to understand the neurobiological explanation of this increasingly popular stress reduction training. Long-term meditation has been associated with structural and functional differences in the prefrontal cortex, the sensory cortices and insula, the hippocampus, and the cingulate cortex (Fox et al., 2014, Holzel et al., 2007, Manna et al., 2010, Tomasino et
Acknowledgments
Gotink was supported by an internal grant of the Erasmus MC. All authors declare no conflict of interest in contributing to this paper.
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