Mindfulness practice leads to increases in regional brain gray matter density
Introduction
Mindfulness meditation has been reported to produce positive effects on psychological well-being that extend beyond the time the individual is formally meditating. Over the last three decades mindfulness meditation practices have been increasingly incorporated into psychotherapeutic programs, to take advantage of these benefits (cf. Baer, 2003, Grossman et al., 2004). A large body of research has established the efficacy of these mindfulness-based interventions in reducing symptoms of a number of disorders, including anxiety (Roemer et al., 2008), depression (Teasdale et al., 2000), substance abuse (Bowen et al., 2006), eating disorders (Tapper et al., 2009), and chronic pain (Grossman et al., 2007), as well as improving well-being and quality of life (e.g., Carmody and Baer, 2008). Mindfulness meditation involves the development of awareness of present-moment experience with a compassionate, non-judgmental stance (Kabat-Zinn, 1990). It has been suggested that this process is associated with a perceptual shift (Carmody, 2009), in which one's thoughts and feelings are recognized as events occurring in the broader field of awareness.
Neuroimaging studies have begun to explore the neural mechanisms underlying mindfulness meditation practice with techniques such as electroencephalography (EEG) (Davidson et al., 2003, Slagter et al., 2007) and functional magnetic resonance imaging (MRI) (Farb et al., 2007, Lutz et al., 2008, Farb et al., 2010, Goldin and Gross, 2010). Recently, several cross-sectional anatomical MRI studies have demonstrated that experienced meditators exhibit a different gray matter morphometry in multiple brain regions when compared with non-meditating individuals (Lazar et al., 2005, Pagnoni and Cekic, 2007, Hölzel et al., 2008, Luders et al., 2009, Vestergaard-Poulsen et al., 2009, Grant et al., 2010). While most of the brain regions identified have been reported in only one of these studies, the divergent results are likely due to differences in participant characteristics, type of meditation, and data analysis methods (see Table 1). Group differences in the hippocampus and the right anterior insula, however, have each been identified in at least two of the studies. Furthermore, activation in both regions has been reported during meditative states (hippocampus (Lazar et al., 2000, Hölzel et al., 2007); insula (Farb et al., 2007, Lutz et al., 2008)). The hippocampus is known to be critically involved in learning and memory processes (Squire, 1992), and in the modulation of emotional control (Corcoran et al., 2005, Milad et al., 2007), while the insula has been postulated to play a key role in the process of awareness (Craig, 2009) — functions which have been shown to be important in the process and outcomes of mindfulness training (Bishop et al., 2004, Shapiro et al., 2006, Ortner et al., 2007).
A growing body of literature has demonstrated that neural systems are modifiable networks and changes in the neural structure can occur in adults as a result of training. For example, longitudinal studies have shown task-specific increases in brain gray matter as an effect of acquisition of abstract information (Draganski et al., 2006), motor skills (Draganski et al., 2004), aerobic training (Colcombe et al., 2006), and cognitive skills (Ilg et al., 2008). Cross-sectional studies have established that differences in regional gray matter are associated with performance abilities (Mechelli et al., 2004, Milad et al., 2005), suggesting that an increase in gray matter corresponds to improved functioning in the relevant area. Studies of experienced meditators have also suggested the possibility of structural plasticity, but their cross-sectional designs did not exclude the possibility of pre-existing group differences, precluding causal conclusions. Here we report a longitudinal study of gray matter changes associated with a mindfulness-based intervention. The focus of the study was to identify brain regions that changed in association with participation in an 8-week Mindfulness-Based Stress Reduction course (MBSR; Kabat-Zinn, 1990). This group program aims to improve participants' mindfulness and well-being, and reduce their levels of perceived stress. The study was an attempt to find objectively measurable neurological changes that could underlie the trait-changes associated with mindfulness practice. Changes in gray matter concentration were investigated using voxel-based morphometry. Focused analyses were conducted for the hippocampus and insula as our predefined regions of interest. Exploratory analyses were then performed on the entire brain and compared with a control group.
Section snippets
Participants
MBSR participants were recruited among individuals enrolled in four MBSR courses held at the Center for Mindfulness at the University of Massachusetts Medical School. The courses included physician- and self-referred individuals from across New England who were seeking stress reduction. Individuals were included in the study if they self-reported as physically and psychologically healthy and not taking any medications. Further inclusion criteria were as follows: no meditation classes in the
Amount of mindfulness practice
MBSR participants reported spending an average of 22.6 h (S.D.: 6.3 h) engaged in formal homework exercises over the 8-week course (average = 27 min per day). In detail, the amount of body scan practice ranged between 335 and 1002 min (mean: 699 min, S.D.: 217 min), yoga between 103 and 775 min (mean: 327 min, S.D.: 194 min), and sitting meditation between 0 and 755 min (mean: 332 min, S.D.: 211 min). The three measures were not significantly correlated with each other: body scan and yoga: r = − 0.042, P = 0.87;
Discussion
This study demonstrates longitudinal changes in brain gray matter concentration following an 8-week Mindfulness-Based Stress Reduction course compared with a control group. Hypothesized increases in gray matter concentration within the left hippocampus were confirmed. Exploratory whole brain analyses identified significant increases in gray matter concentration in the PCC, TPJ, and the cerebellum.
The hippocampus has been postulated to play a central role in mediating some of the benefits of
Acknowledgements
We thank our participants for their cooperation and the Center for Mindfulness for conducting the Mindfulness-Based Stress Reduction courses. We thank Daniel McCaffrey and Nik Olendzki for support in data collection, and Douglas Greve, Ulrich Ott, and Julie Bates for helpful discussions. This research was funded by the National Institutes of Health-NCCAM (R21-AT003425-01A2), the British Broadcasting Company, and the Mind and Life Institute (Varela research grant). B.K.H. was supported by a
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