Interoception Underlies Therapeutic Effects of Mindfulness Meditation for Posttraumatic Stress Disorder: A Randomized Clinical Trial

Seung Suk Kang; Scott R Sponheim; Kelvin O Lim

doi:10.1016/j.bpsc.2021.10.005

Interoception Underlies Therapeutic Effects of Mindfulness Meditation for Posttraumatic Stress Disorder: A Randomized Clinical Trial

Biol Psychiatry Cogn Neurosci Neuroimaging. 2022 Aug;7(8):793-804. doi: 10.1016/j.bpsc.2021.10.005. Epub 2021 Oct 21.

Authors

Seung Suk Kang¹, Scott R Sponheim², Kelvin O Lim²

Affiliations

¹ Department of Biomedical Sciences, University of Missouri-Kansas City, Kansas City, Missouri. Electronic address: kangseung@umkc.edu.
² Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota; Veterans Affairs Health Care System, Minneapolis, Minnesota.

PMID: 34688923
DOI: 10.1016/j.bpsc.2021.10.005

Abstract

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

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

Trial registration: ClinicalTrials.gov NCT01548742.

Keywords: EEG; Interoception; Meditation; Mindfulness; Neurobiological mechanism; Posttraumatic stress disorder.

Publication types

Randomized Controlled Trial
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Humans
Interoception*
Meditation*
Mindfulness*
Stress Disorders, Post-Traumatic* / psychology
Stress Disorders, Post-Traumatic* / therapy
Veterans* / psychology

Associated data

ClinicalTrials.gov/NCT01548742

Grants and funding

I01 RX000622/RX/RRD VA/United States