Increased insula response to interoceptive attention following mindfulness training is associated with increased body trusting among patients with depression

• Published in: Psychiatry research. Neuroimaging Vol. 327; p. 111559
• Main Authors: Datko, Michael, Lutz, Jacqueline, Gawande, Richa, Comeau, Alexandra, To, My Ngoc, Desel, Tenzin, Gan, Jenny, Desbordes, Gaelle, Napadow, Vitaly, Schuman-Olivier, Zev
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.12.2022
• Subjects: Adult; Anxiety; Awareness - physiology; Brain Mapping; Depression - diagnostic imaging; Depression - therapy; fMRI; Humans; Interoception; Interoception - physiology; Intervention; Meditation; Mindfulness; Mood disorders; Intervention; Mood disorders; fMRI; Anxiety; Interoception; Meditation
• ISSN: 0925-4927; 1872-7506; 1872-7506
• DOI: 10.1016/j.pscychresns.2022.111559

•Mindfulness intervention improved interoceptive awareness among depressed patients.•fMRI brain response to interoception increased in anterior insula after mindfulness.•Post-intervention insula response linked with more body trust in depressed patients.•Inverse insula-body-trust association after intervention in patients with anxiety. Interoceptive dysfunction is often present in anxiety and depression. We investigated the effects of an 8-week intervention, Mindfulness Training for Primary Care (MTPC), on brain mechanisms of interoceptive attention among patients with anxiety and/or depression. We hypothesized that fMRI brain response to interoception in the insula, a region known for interoceptive processing, would increase following the MTPC intervention, and that such increases would be associated with post-intervention changes in self-reported measures of interoceptive awareness. Adults (n = 28) with anxiety and/or depression completed baseline and post-intervention fMRI visits, including a task in which they alternated between focusing on their heartbeat (interoception (INT)) and a control visual attention task (exteroception (EXT)). Following MTPC, we observed increased evoked fMRI response (relative to baseline) in left anterior insula during the INT-EXT task contrast (z > 3.1, p < 0.001 corrected). In patients with moderate-to-severe depression as defined by the Patient Reported Outcomes Measurement Information System (PROMIS), increased post-intervention insula response was associated with increased Body Trusting, a subscale of the Multidimensional Assessment of Interoceptive Awareness (z > 3.1, p = 0.007 corrected). This study demonstrates that patients with mood disorders may respond differentially to mindfulness-based treatment depending on depression severity, and that among those who are more depressed, increased trusting in one's own body sensations and experiencing the body as a safe place to attend to may be necessary components of positive responses to mindfulness-based interventions.