Changes in the neural correlates of self-blame following mindfulness-based cognitive therapy in remitted depressed participants

Kate Williams,Rebecca Elliott,Shane Mckie,Roland Zahn,Thorsten Barnhofer,Ian M Anderson

doi:10.1016/j.pscychresns.2020.111152

Abstract

Mindfulness-Based-Cognitive-Therapy (MBCT) reduces vulnerability for relapse into depression by helping individuals to counter tendencies to engage in maladaptive repetitive patterns of thinking and respond more compassionately to negative self-judgment. However, little is known about the neural correlates underlying these effects. To elucidate these correlates, we investigated fMRI brain activation during a task eliciting feelings of blaming oneself or others. Sixteen participants in remission from major depressive disorder (MDD) completed fMRI assessments before and after MBCT, alongside self-reported levels of self-compassion, mindfulness, and depression symptoms. Analyses of self-blame versus other-blame contrasts showed a reduction in activation in the bilateral dorsal anterior cingulate/medial superior frontal gyrus after MBCT compared to baseline. Further, exploratory analyses showed that increases in self-kindness after MBCT correlated with reduced activation in the posterior cingulate cortex (PCC)/precuneus in self-blame versus rest contrasts. These findings suggest that MBCT is associated with a reduction in activations in cortical midline regions to self-blame which may be mediated by increasing self-kindness. However, this is a small, uncontrolled study with 16 participants and therefore our results will need confirmation in a controlled study.

Highlights

Major depression is highly prevalent and, in many of those affected, takes a recurrent course with an increased probability of relapse with each episode: 50% after one, rising to 70 and almost 90% following two and three episodes respectively (Rush et al, 2006; Kupfer, 1991)
For the self-blame>other-blame contrast, we identified one large and five moderately sized clusters extending across regions including the precentral, medial, frontal and superior temporal gyri, superior parietal lobe (SPL) and angular gyrus, dorsal anterior cingulate cortex, and into the right anterior insula (AI) and orbital inferior frontal gyrus (IFG; e.g., Supplementary Figure S1)
Our findings suggest that MBCT in people with remitted major depressive disorder (MDD) reduces engagement of neural networks associated with salient emotions when feeling self-blame

Summary

Introduction

Major depression is highly prevalent and, in many of those affected, takes a recurrent course with an increased probability of relapse with each episode: 50% after one, rising to 70 and almost 90% following two and three episodes respectively (Rush et al, 2006; Kupfer, 1991). Evidence for the beneficial effects of mindfulness meditation on mental capacities comes from studies investigating neuropsychological, brain structural and functional (fMRI) change in long-term meditators and people taking part in structured mindfulness-based interventions (MBIs; for reviews see Young et al, 2018; Lao et al, 2016; Gotink et al, 2016, or Fox et al, 2016). Two systematic reviews of MBI fMRI studies have reported activation changes during functional tasks (including paradigms investigating mindful awareness or responses to emotion stimuli) in the insula (Young et al, 2018) and the prefrontal cortex (PFC), hippocampus, amygdala, and the cingulate cortex (Gotink et al, 2016), regions typically involved in attention, learning, interoception, and self-referential processing. To our knowledge, no study has yet investigated fMRI changes following MBCT in remitted depressed individuals

Methods

Results

Discussion

Conclusion