Only vulnerable adults show change in chronic low-grade inflammation after contemplative mental training: evidence from a randomized clinical trial

Lara M C Puhlmann,Ioannis Papassotiriou,Filia Apostolakou,Veronika Engert,Pascal Vrtička,George P Chrousos,Tania Singer

doi:10.1038/s41598-019-55250-3

Abstract

Growing evidence suggests that chronic low-grade inflammation can be reduced through mindfulness-based mental training interventions. However, these results are inconsistent and based on patient populations with heterogeneous conditions. Similar research in healthy adults is lacking. Moreover, common intervention protocols involve varying combinations of different contemplative practices, such that it remains unclear which types of training most effectively influence biomarkers of inflammation. The present study investigated the effect of three distinct 3-month training modules cultivating a) interoception and present-moment focus (Presence), b) socio-affective skills (Affect), or c) socio-cognitive skills (Perspective) on the inflammatory biomarkers interleukin-6 (IL-6) and high sensitive C-reactive protein (hs-CRP) in 298 healthy adults. We observed no group-level effect of training on either biomarker, but trend-level interactions of training type and participant sex. In additionally exploring the influence of participants’ baseline inflammation, a selective training effect emerged: Following the Presence module, participants with relatively higher inflammatory load showed stronger reduction in IL-6 on average, and in hs-CRP if they were male. Mindfulness- and attention-based mental practice thus appears most effective when targeting chronic low-grade inflammation in healthy adults, particularly in men. Overall, our data point to a floor effect in the reduction of inflammatory markers through contemplative mental training, suggesting that mental training may be less effective in improving basal biological health outcomes in healthy, low-stressed adults than in vulnerable populations.

Highlights

Growing evidence suggests that chronic low-grade inflammation can be reduced through mindfulnessbased mental training interventions
The majority of intervention protocols are based on mindfulness[4], which has its roots in the contemplative traditions of Buddhism and has been described as “paying attention in a particular way; on purpose, in the present moment and non-judgmentally”[5]
Univariate analyses confirmed that IL-6 and high sensitive C-reactive protein (hs-CRP) levels as well as Trier Inventory for Chronic Stress (TICS) and Perceived Stress Scale (PSS) scores did not differ between cohorts at T0

Summary

Introduction

Growing evidence suggests that chronic low-grade inflammation can be reduced through mindfulnessbased mental training interventions These results are inconsistent and based on patient populations with heterogeneous conditions. Our data point to a floor effect in the reduction of inflammatory markers through contemplative mental training, suggesting that mental training may be less effective in improving basal biological health outcomes in healthy, low-stressed adults than in vulnerable populations. The most commonly assayed biomarkers of inflammation include the pro-inflammatory cytokine interleukin-6 (IL-6), and the surrogate marker of low-grade inflammation high sensitive C-reactive protein (hs-CRP) Both have been linked reliably to clinical conditions involving the immune system[10,13]. In order to reliably distinguish whether mental training interventions have either no effect or small effects on basal IL-6 and hs-CRP levels in low-risk adults, a sufficiently powered large-scale intervention study is necessary. To avoid conflation with exercise-related effects on inflammatory markers[28,29] these should not be equated with strictly mental training protocols

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