Abstract
This study explored the brain structural correlates of psychological flexibility (PF) as measured with the Psychological Inflexibility in Pain Scale (PIPS) in patients with fibromyalgia (FM). Structural magnetic resonance imaging data from 47 FM patients were used to identify Gray Matter Volume (GMV) alterations related to PIPS scores. Brain GMV clusters related to PIPS were then correlated with clinical and cognitive variables to further explore how emerged brain clusters were intertwined with FM symptomatology. Longitudinal changes in PIPS-related brain clusters values were assessed by studying pre–post data from 30 patients (15 allocated to a mindfulness-based stress reduction (MBSR) program and 15 to treatment-as-usual). Changes in PIPS-related brain clusters were also explored in participants showing greater/lower longitudinal changes in PIPS scores. PIPS scores were positively associated with GMV in a bilateral cluster in the ventral part of the bed nucleus of the stria terminalis (BNST). Significant associations between BNST cluster with functional impairment, depressive symptomatology, perceived stress and the nonjudging mindfulness facet were observed. Participants reporting greater pre–post increases in PIPS scores showed greater increases in BNST cluster values. These findings contribute to the understanding on the neurobiological bases of PF in FM and encourage further explorations of the role of the BNST in chronic pain.
Highlights
The neural underpinnings of third-wave cognitive behavioral therapies, such as mindfulness and acceptance-based interventions, have become a topic of burgeoning interest in recent years [1,2,3,4]
Multiple regression analysis revealed that Psychological Inflexibility in Pain Scale (PIPS) scores were significantly and positively associated with Gray Matter Volume (GMV) in two bilateral brain clusters that corresponded to the ventral part of the bed nucleus of the stria terminalis (BNST) (peak Montreal Neurological Institute (MNI) coordinates and KE: x = 11, y = –2, z = –12; T = 4.3748; 131 voxels and x = –8, y = 0, z = –11; T = 4.3687; 164 voxels) (Figure 2)
This part of the BNST is not included in some of the available BNST magnetic resonance imaging (MRI) masks [46], it is included in others [47]
Summary
The neural underpinnings of third-wave cognitive behavioral therapies, such as mindfulness and acceptance-based interventions, have become a topic of burgeoning interest in recent years [1,2,3,4]. Many studies have reported significant relationships between mindfulness and brain structures involved in attention regulation, body awareness, emotion regulation, and perspective taking Such associations have been found when studying mindfulness as a trait [5,6,7,8,9,10,11] or as a practice, in studies comparing meditators and non-meditators or in studies looking for brain changes following mindfulness-based interventions [12,13]. PF is defined as the ability to act effectively and in accordance with personal values even in the presence of difficult experiences such as negative thoughts and emotions or unpleasant body sensations (e.g. pain) This construct comprises six core processes, including mindfulness, acceptance, decentering, self as a context, accordance with personal values and committed action [15,17,18]
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