Brain systems

Spirituality Activates the Brain Networks Underlying Other-Than-Self Attention

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Spirituality Activates the Brain Networks Underlying Other-Than-Self Attention

 

By John M. de Castro, Ph.D.

 

“Understanding the neural bases of spiritual experiences may help us better understand their roles in resilience and recovery from mental health and addictive disorders.” – Ephrat Livni

 

Spirituality is defined as “one’s personal affirmation of and relationship to a higher power or to the sacred.” It has been shown to have a myriad of benefits including recovery from addiction.  In addition, spirituality alters the nervous system. It has been demonstrated that spirituality is associated with changes in the size, activity, and connectivity of the frontal and parietal lobes of the brain. So, spirituality and changes in neural systems co-occur. We may be better able to control addiction if we develop a more nuanced understanding of the changes in the brain that occur with spirituality.

 

In today’s Research News article “Spiritual experiences are related to engagement of a ventral frontotemporal functional brain network: Implications for prevention and treatment of behavioral and substance addictions.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044576/ ) McClintock and colleagues recruited healthy adult, age 18 to 27 years, participants and scanned their brains with functional Magnetic Resonance Imaging (fMRI) while they were being guided toward images of either neutral, stressful, or spiritual imagery. Before and after testing they completed a measure of spirituality.

 

They found that during spiritual but not neutral or stressful imagery there was a significant increase in the activity of brain structures that constitute a ventral frontotemporal network, including middle and inferior frontal cortices, superior, middle and inferior temporal cortices, insula and frontal opercula, striatum, thalamus, brainstem, and cerebellum. The greater the increase in spirituality reported over the testing, the greater the increase in the activity of the ventral frontotemporal network. Hence, the more the imagery increased their spiritual feelings, the greater the response of the brain. They also found that there was a significant decrease in activity in areas of the brain that are components of the default mode network, including the middle and posterior cingulate and parietal cortex.

 

These findings suggest that the ventral frontotemporal network is activated during spiritual imagery while components of the default mode network are deactivated. The ventral frontotemporal network has been associated with attentional processing while the default mode network has been associated with self-referential thinking and mind wandering. It can be speculated that during spiritual imagery attention is focused away from the self. Regardless, the findings suggest that specific parts of the brain are involved in processing spiritual imagery.

 

So, spirituality activates the brain networks underlying other-than-self attention.

 

“it’s essential to examine how people experience spirituality in order to fully understand how their brains work.” – Lynne Blumberg

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

McClintock, C. H., Worhunsky, P. D., Xu, J., Balodis, I. M., Sinha, R., Miller, L., & Potenza, M. N. (2019). Spiritual experiences are related to engagement of a ventral frontotemporal functional brain network: Implications for prevention and treatment of behavioral and substance addictions. Journal of behavioral addictions, 8(4), 678–691. https://doi.org/10.1556/2006.8.2019.71

 

Abstract

Background and aims

Spirituality is an important component of 12-step programs for behavioral and substance addictions and has been linked to recovery processes. Understanding the neural correlates of spiritual experiences may help to promote efforts to enhance recovery processes in behavioral addictions. We recently used general linear model (GLM) analyses of functional magnetic resonance imaging data to examine neural correlates of spiritual experiences, with findings implicating cortical and subcortical brain regions. Although informative, the GLM-based approach does not provide insight into brain circuits that may underlie spiritual experiences.

Methods

Spatial independent component analysis (sICA) was used to identify functional brain networks specifically linked to spiritual (vs. stressful or neutral-relaxing) conditions using a previously validated guided imagery task in 27 young adults.

Results

Using sICA, engagement of a ventral frontotemporal network was identified that was engaged at the onset and conclusion of the spiritual condition in a manner distinct from engagement during the stress or neutral-relaxing conditions. Degree of engagement correlated with subjective reports of spirituality in the scanner (r = .71, p < .001) and an out-of-the-magnet measure of spirituality (r = .48, p < .018).

Discussion and conclusion

The current findings suggest a distributed functional neural network associated with spiritual experiences and provide a foundation for investigating brain mechanisms underlying the role of spirituality in recovery from behavioral addictions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044576/

 

Improve the Brain for Better Emotions with Mindfulness

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Improve the Brain for Better Emotions with Mindfulness

 

By John M. de Castro, Ph.D.

 

“meditation affects the brain. . .  four regions of meditators’ brains associated with healthy brain function become more substantial, while one of the areas associated with undesirable behavior actually shrinks.” – Mindworks

 

Mindfulness training has been shown to improve health and well-being. It has also been found to be effective for a large array of medical and psychiatric conditions, either stand-alone or in combination with more traditional therapies. There are a number of ways that mindfulness practices produce these benefits, including changes to the brain and physiology.

 

The nervous system is a dynamic entity, constantly changing and adapting to the environment. It will change size, activity, and connectivity in response to experience. These changes in the brain are called neuroplasticity. Over the last decade neuroscience has been studying the effects of contemplative practices on the brain and has identified neuroplastic changes in widespread areas. In other words, mindfulness practice appears to mold and change the brain, producing psychological, physical, and spiritual benefits. It is not clear, however, what effects brief mindfulness training might have on temperament and the brain.

 

In today’s Research News article “Brief Mindfulness Meditation Induces Gray Matter Changes in a Brain Hub.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704181/ ) Tang and colleagues recruited healthy meditation-naïve college students and randomly assigned them to receive 30 minutes for 20 consecutive days of either Integrative Body-Mind Training or relaxation training. Before and after training they were measured for temperament, including effortful control, negative affect, extraversion/surgency, and orienting sensitivity, and underwent brain scanning with Magnetic Resonance Imaging (MRI).

 

They found that in comparison to the relaxation group and the baseline after training the mindfulness group had a significant increase in the volume of the ventral posterior cingulate cortex in the brain. They also found that the greater the increase in the volume of the ventral posterior cingulate cortex the greater the decrease in negative emotions in the participant. So, 20 days of mindfulness training increased ventral posterior cingulate cortex volume which was, in turn, associated with lower levels of negative emotions.

 

The ventral posterior cingulate cortex is a component of the default mode network in the brain that is associated with emotion processing, self-referential thinking, and mind wandering. Mindfulness training has been shown previously to produce improvements in emotions including more positive and less negative emotions. This suggests that 20 days of mindfulness training reduces negative emotions by producing neuroplastic changes in the default mode network of the brain.

 

So, change the brain for better emotions with mindfulness.

 

“the brains of subjects thickened after an eight-week meditation course.” – Harvard Gazette

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Tang, R., Friston, K. J., & Tang, Y. Y. (2020). Brief Mindfulness Meditation Induces Gray Matter Changes in a Brain Hub. Neural plasticity, 2020, 8830005. https://doi.org/10.1155/2020/8830005

 

Abstract

Previous studies suggest that the practice of long-term (months to years) mindfulness meditation induces structural plasticity in gray matter. However, it remains unknown whether short-term (<30 days) mindfulness meditation in novices could induce similar structural changes. Our previous randomized controlled trials (RCTs) identified white matter changes surrounding the anterior cingulate cortex (ACC) and the posterior cingulate cortex (PCC) within 2 to 4 weeks, following 5-10 h of mindfulness training. Furthermore, these changes were correlated with emotional states in healthy adults. The PCC is a key hub in the functional anatomy implicated in meditation and other perspectival processes. In this longitudinal study using a randomized design, we therefore examined the effect of a 10 h of mindfulness training, the Integrative Body-Mind Training (IBMT) on gray matter volume of the PCC compared to an active control—relaxation training (RT). We found that brief IBMT increased ventral PCC volume and that baseline temperamental trait—an index of individual differences was associated with a reduction in training-induced gray matter increases. Our findings indicate that brief mindfulness meditation induces gray matter plasticity, suggesting that structural changes in ventral PCC—a key hub associated with self-awareness, emotion, cognition, and aging—may have important implications for protecting against mood-related disorders and aging-related cognitive declines.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704181/

 

Tai Chi Practice Changes the Brain Differently than Walking

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Tai Chi Practice Changes the Brain Differently than Walking

 

By John M. de Castro, Ph.D.

 

“tai chi appears to improve executive function—the ability to multitask, manage time, and make decisions—in people without any cognitive decline.” – Harvard Health

 

The aging process involves a systematic progressive decline in every system in the body, the brain included. The elderly frequently have problems with attention, thinking, and memory abilities, known as mild cognitive impairment. An encouraging new development is that mindfulness practices such as meditation training and mindful movement practices can significantly reduce these declines in cognitive ability. In addition, it has been found that mindfulness practices reduce the deterioration of the brain that occurs with aging restraining the loss of neural tissue. Indeed, the brains of practitioners of meditation,  yoga, and Tai Chi have been found to degenerate less with aging than non-practitioners.

 

Tai Chi has been practiced for thousands of years with benefits for health and longevity. Tai Chi training is designed to enhance function and regulate the activities of the body through regulated breathing, mindful concentration, and gentle movements. Tai Chi practice has been found to be effective for an array of physical and psychological issues. Tai Chi has been shown to help the elderly improve attention, balance, reducing falls, arthritis, cognitive function, memory, and reduce age related deterioration of the brain. So, it makes sense to further study the effects of Tai Chi training on the brains of older adults.

 

In today’s Research News article “Differential Effects of Tai Chi Chuan (Motor-Cognitive Training) and Walking on Brain Networks: A Resting-State fMRI Study in Chinese Women Aged 60.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151113/ ) Yue and colleagues recruited older women (over 60 years of age) who were long-term practitioners of Tai Chi or walking and scanned their brains with functional Magnetic Imaging (fMRI).

 

They examined 3 brain networks, the Default Mode Network, the Sensory Motor Network, and the Visual Network and found significant differences in the functional connectivity within these networks between the Tai Chi and walking groups. This suggests that the two exercises change the brains information processing in these women. They suggest that the brains of the older women went through neuroplastic changes as a result of their practices with different changes in different systems depending on the exercise.

 

There is evidence that physical fitness reduces the likelihood of dementia and Tai Chi practice has been shown to reduce the likelihood or severity of age-related cognitive decline. The observed changes, particularly in the Default Mode Network, which is known to be associated with memory and thinking, may underlie the effectiveness of these exercises in reducing the incidence of age-related cognitive decline and dementia. It remains for future research to determine which of the observed changes in the brains are responsible for retaining mental ability with aging.

 

Tai Chi practice is not strenuous, involves slow gentle movements, and is safe, having no appreciable side effects, it is appropriate for all ages including the elderly and for individuals with illnesses that limit their activities or range of motion. It can also be practiced without professional supervision and in groups making it inexpensive to deliver and fun to engage in. This makes Tai Chi practice an excellent means to maintain fitness with aging and help maintain a fit mind and body.

 

So, Tai Chi practice changes the brain differently than walking.

 

“Scientists . . . found increases in brain volume and improvements on tests of memory and thinking in Chinese seniors who practiced Tai Chi.” – ScienceDaily

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Yue, C., Zhang, Y., Jian, M., Herold, F., Yu, Q., Mueller, P., Lin, J., Wang, G., Tao, Y., Zhang, Z., & Zou, L. (2020). Differential Effects of Tai Chi Chuan (Motor-Cognitive Training) and Walking on Brain Networks: A Resting-State fMRI Study in Chinese Women Aged 60. Healthcare (Basel, Switzerland), 8(1), 67. https://doi.org/10.3390/healthcare8010067

 

Abstract

Background: This cross-sectional study aimed to investigate whether a long-term engagement in different types of physical exercise may influence resting-state brain networks differentially. In particular, we studied if there were differences in resting-state functional connectivity measures when comparing older women who are long-term practitioners of tai chi chuan or walking. Method: We recruited 20 older women who regularly practiced tai chi chuan (TCC group), and 22 older women who walked regularly (walking group). Both the TCC group and the walking group underwent a resting-state functional magnetic resonance imaging (rs-fMRI) scan. The acquired rs-fMRI data of all participants were analyzed using independent component analysis. Age and years of education were added as co-variables. Results: There were significant differences in default network, sensory-motor network, and visual network of rs-fMRI between the TCC group and walking group (p < 0.05). Conclusions: The findings of the current study suggested that long-term practice of different types of physical exercises (TCC vs. walking) influenced brain functional networks and brain functional plasticity of elderly women differentially. Our findings encourage further research to investigate whether those differences in resting-state functional connectivity as a function of the type of physical exercise have implications for the prevention of neurological diseases.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151113/

 

Poor Mental Health in Patients with Fibromyalgia is Associated with Brain Systems

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Poor Mental Health in Patients with Fibromyalgia is Associated with Brain Systems

 

By John M. de Castro, Ph.D.

 

“practicing mindfulness techniques may be a low-cost, side effect free option for people wishing to reduce the severity of their fibromyalgia.” – Kim Jones

 

Fibromyalgia is a mysterious disorder whose causes are unknown. It is very common affecting over 5 million people in the U.S., about 2% of the population with about 7 times more women affected than men. It is characterized by widespread pain, abnormal pain processing, sleep disturbance, and fatigue that lead to psychological distress. Fibromyalgia may also have morning stiffness, tingling or numbness in hands and feet, headaches, including migraines, irritable bowel syndrome, sleep disturbances, thinking and memory problems, and painful menstrual periods. The symptoms are so severe and debilitating that about half the patients are unable to perform routine daily functions and about a third have to stop work. Although it is not itself fatal, suicide rates are higher in fibromyalgia sufferers. Clearly, fibromyalgia greatly reduces the quality of life of its’ sufferers.

 

There are no completely effective treatments for fibromyalgia. Symptoms are generally treated with pain relievers, antidepressant drugs and exercise. But these only reduce the severity of the symptoms and do not treat the disease directly. Mindfulness practices have also been shown to be effective in reducing pain from fibromyalgia. Some of the effects of mindfulness practices are to alter thought processes, changing what is thought about. In terms of pain, mindfulness training, by focusing attention on the present moment has been shown to reduce worry and catastrophizing. Pain is increased by worry about the pain and the expectation of greater pain in the future. Brain systems are involved in pain processing. It is not known, however, what brain systems may be involved in the psychological effects of fibromyalgia.

 

In today’s Research News article “The Bed Nucleus of the Stria Terminalis as a Brain Correlate of Psychological Inflexibility in Fibromyalgia.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074535/ ) Feliu-Soler and colleagues recruited adult women who were diagnosed with fibromyalgia and assigned them to either treatment as usual or to receive and 8-week program of Mindfulness-Based Stress Reduction (MBSR). They were measured before and after the program for psychological inflexibility in pain, functional impairment, anxiety, depression, perceived stress, pain catastrophizing, mindfulness, and self-compassion. They also underwent measurements of the gray matter volume in the brain with Magnetic Resonance Imaging (MRI).

 

They found that the higher the levels of psychological inflexibility in pain, the higher the gray matter volume of the bed nucleus of the stria terminalis (BNST). Further they found that the higher the gray matter volume of the BNST the higher the levels of functional impairment, anxiety, depression, perceived stress, and pain catastrophizing and the lower the levels of mindfulness and self-compassion. The Mindfulness-Based Stress Reduction (MBSR) program did not significantly alter the BNST volume or psychological inflexibility in pain.

 

These results are correlative and as such caution must be exercised in causal inferences. It was disappointing that mindfulness training did not produce a change in either psychological inflexibility or BNST volume. But the results are clear that the gray matter volume of the bed nucleus of the stria terminalis (BNST) is associated with poor mental health in patients with fibromyalgia. This brain structure is associated with physiological and psychological responses to stress. Since, the constant pain associated with fibromyalgia is very stressful it is not surprising that enlargement of the BNST would be associated with poor mental health in these patients.

 

So, poor mental health in patients with fibromyalgia is associated with brain systems.

 

“being overly observant of symptoms or trying to avoid pain can actually contribute towards the development of fibromyalgia and worsen the existing symptoms. Mindfulness practice can actually change the way you relate to your pain, . . the mindfulness group showed less avoidant and hypervigilance behaviour, supporting the idea that mindfulness encourages a non-judgemental and accepting relationship with pain, rather than trying to push it away.” – Vidyamala Burch

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Feliu-Soler, A., Martínez-Zalacaín, I., Pérez-Aranda, A., Borràs, X., Andrés-Rodríguez, L., Sanabria-Mazo, J. P., Fayed, N., Stephan-Otto, C., Núñez, C., Soriano-Mas, C., & Luciano, J. V. (2020). The Bed Nucleus of the Stria Terminalis as a Brain Correlate of Psychological Inflexibility in Fibromyalgia. Journal of clinical medicine, 9(2), 374. https://doi.org/10.3390/jcm9020374

 

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.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074535/

 

Improve Stress-Related Neuropsychiatric Disorders with Yoga and Mindfulness

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Improve Stress-Related Neuropsychiatric Disorders with Yoga and Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness training holds promise for treating mood disorders partly because it may lead to changes in patients’ brains, improving connectivity among some brain areas and changing tissue density in key regions, research suggests.” – Stacy Lu

 

Over the last several decades, research and anecdotal experiences have accumulated an impressive evidential case that the development of mindfulness has positive benefits for the individual’s mental, physical, and spiritual life. Mindfulness appears to be beneficial both for healthy people and for people suffering from a myriad of mental and physical illnesses. It appears to be beneficial across ages, from children, to adolescents, to the elderly. And it appears to be beneficial across genders, personalities, race, and ethnicity. The breadth and depth of benefits is unprecedented. There is no other treatment or practice that has been shown to come anyway near the range of mindfulness’ positive benefits.

 

Meditation and yoga training have been shown to be effective for a large array of medical and psychiatric conditions, either stand-alone or in combination with more traditional therapies. Meditation and yoga appear to improve the individual’s ability to cope with stress and stress is the source of or aggravates many mental disorders. There are a number of ways that meditation and yoga practices produce these benefits, including changes to the brain and physiology. It is useful to review and summarize what has been discovered regarding how meditation and yoga practices improve mental disorders.

 

In today’s Research News article “Role of Yoga and Meditation as Complimentary Therapeutic Regime for Stress-Related Neuropsychiatric Disorders: Utilization of Brain Waves Activity as Novel Tool.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7545749/ ) Kaushik and colleagues review and summarize the published research on the effectiveness of meditation and yoga for the treatment of neuropsychiatric disorders.

 

They report that the published research finds that stress is highly related to anxiety and depression and that meditation and yoga practices, including breathing exercises and postures, significantly reduce perceived stress, anxiety, and depression. They further report that meditation and yoga may produce these improvements by increasing brain activity particularly in the frontal regions of the brain. They also report that meditation and yoga produce very few if any deleterious side effects.

 

Previous research has conclusively demonstrated that mindfulness practices in general are safe and effective in altering the electrical activity of the brain and reducing perceived stress, anxiety, and depression. It can be speculated that meditation and yoga reduce the responses to stress by altering brain activity and this, in turn, produces improvements in anxiety and depression. It remains for future research to investigate this model. Regardless, the employment of meditation and yoga practices for neuropsychiatric conditions has been shown to be safe and effective alternative treatments for the relief of the suffering of these patients.

 

So, improve stress-related neuropsychiatric disorders with yoga and mindfulness.

 

“mindfulness has become a household word, and the psychiatric and psychological literature abound with publications implementing mindfulness as a treatment or self-help tool for everything that ails you.” – John J. Miller

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Kaushik, M., Jain, A., Agarwal, P., Joshi, S. D., & Parvez, S. (2020). Role of Yoga and Meditation as Complimentary Therapeutic Regime for Stress-Related Neuropsychiatric Disorders: Utilization of Brain Waves Activity as Novel Tool. Journal of evidence-based integrative medicine, 25, 2515690X20949451. https://doi.org/10.1177/2515690X20949451

 

Abstract

During recent decades, stress-related neuropsychiatric disorders such as anxiety, depression, chronic tension headache, and migraine have established their stronghold in the lives of a vast number of people worldwide. In order to address this global phenomenon, intensive studies have been carried out leading to the advancement of drugs like anti-depressants, anxiolytics, and analgesics which although help in combating the symptoms of such disorders but also create long-term side effects. Thus, as an alternative to such clinical practices, various complementary therapies such as yoga and meditation have been proved to be effective in alleviating the causes and symptoms of different neuropsychiatric disorders. The role of altered brain waves in this context has been recognized and needs to be pursued at the highest level. Thus, the current study provides a review focused on describing the effects of yoga and meditation on anxiety and depression as well as exploring brain waves as a tool for assessing the potential of these complementary therapies for such disorders.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7545749/

 

Improve Brain Systems Underlying Sustained Attention in Sixth Graders with Mindfulness

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Improve Brain Systems Underlying Sustained Attention in Sixth Graders with Mindfulness

 

By John M. de Castro, Ph.D.

 

“research suggests that mindfulness meditation can increase awareness of our thoughts, or meta-cognitive awareness, as well as regulate emotion, enhance attention and reduce stress. These changes can also be detected in the brain.” – B. Grace Bullock

 

Childhood is a miraculous period during which the child is dynamically absorbing information from every aspect of its environment. This is particularly evident during the elementary school years. Mindfulness training in school has been shown to have very positive effects. These include improvements in the academic, cognitive, psychological, and social domains. Importantly, mindfulness training in school appears to improve attentional ability which is fundamental to success in all aspects of academic performance.

 

There is evidence that mindfulness training improves attention by altering the brain. It appears That mindfulness training increases the size, connectivity, and activity of areas of the brain that are involved in paying attention. Hence, it is important to further study the impact of mindfulness training on the development of attentional ability and associated brain mechanisms in elementary school children.

 

In today’s Research News article “Mindfulness training preserves sustained attention and resting state anticorrelation between default-mode network and dorsolateral prefrontal cortex: A randomized controlled trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670646/ ) Bauer and colleagues recruited 6th grade students and randomly assigned them to receive 45 minute 4 times per week for 8 weeks mindfulness or computer coding training. They were measured before and after training for sustained attention with a 15-minute go-no-go task and had their brains scanned with functional Magnetic Resonance Imaging (fMRI).

 

They found in comparison to baseline and the computer coding group that the mindfulness training produced a significant improvement in sustained attention (Go accuracy) while the computer coding group had a significant decrease in accuracy. The brain scans revealed an anticorrelation between the Default Mode Network (DMN) of the brain and the Central Executive Network (CEN), such that as one becomes active the other becomes less active.

This anticorrelation was related to baseline sustained attention, with better sustained attention correlated with greater anticorrelation. They also found that after mindfulness training the anticorrelation was maintained while it decreased in the computer coding group. In addition, they found that the greater the increase in sustained attention after mindfulness training, the greater the increase in the anticorrelation while this was not true for the compute coding group.

 

The Default Mode Network (DMN) of the brain is a set of interconnected brain structures that is thought to be involved in mind wandering, thoughts not related to the task at hand, while the Central Executive Network (CEN) of the brain is a set of interconnected brain structures that is thought to be involved in high level thinking and attention to the task at hand. The anticorrelation between the two systems indicates that as the brain system underlying attention becomes stronger the brain system underlying mind wandering becomes weaker and vice versa. The strengthening of the anticorrelation indicates better neural processing ability by segregating mind wandering from attention, resulting in better sustained attention.

 

The results suggest that mindfulness training in 6th graders improves sustained attention by improving the brain systems underlying sustained attention with the greater the improvement in attention the greater the increase in the anticorrelation. These results indicate how mindfulness training may improve attention in these children. They suggest that mindfulness training improves neural processing which in turn improves the children’s attentional ability. Although not investigated, improvement in attention should result in better academic performance.

 

So, improve brain systems underlying sustained attention in sixth graders with mindfulness.

 

“a brief 10-min guided mindfulness meditation instruction period can improve executive attentional control even in naïve, inexperienced meditators.” – Catherine Norris

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Bauer, C., Rozenkrantz, L., Caballero, C., Nieto-Castanon, A., Scherer, E., West, M. R., Mrazek, M., Phillips, D. T., Gabrieli, J., & Whitfield-Gabrieli, S. (2020). Mindfulness training preserves sustained attention and resting state anticorrelation between default-mode network and dorsolateral prefrontal cortex: A randomized controlled trial. Human brain mapping, 41(18), 5356–5369. https://doi.org/10.1002/hbm.25197

 

Abstract

Mindfulness training can enhance cognitive control, but the neural mechanisms underlying such enhancement in children are unknown. Here, we conducted a randomized controlled trial (RCT) with sixth graders (mean age 11.76 years) to examine the impact of 8 weeks of school‐based mindfulness training, relative to coding training as an active control, on sustained attention and associated resting‐state functional brain connectivity. At baseline, better performance on a sustained‐attention task correlated with greater anticorrelation between the default mode network (DMN) and right dorsolateral prefrontal cortex (DLPFC), a key node of the central executive network. Following the interventions, children in the mindfulness group preserved their sustained‐attention performance (i.e., fewer lapses of attention) and preserved DMN–DLPFC anticorrelation compared to children in the active control group, who exhibited declines in both sustained attention and DMN–DLPFC anticorrelation. Further, change in sustained‐attention performance correlated with change in DMN–DLPFC anticorrelation only within the mindfulness group. These findings provide the first causal link between mindfulness training and both sustained attention and associated neural plasticity. Administered as a part of sixth graders’ school schedule, this RCT supports the beneficial effects of school‐based mindfulness training on cognitive control.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670646/

 

Improve Attention with Short-Term Loving Kindness Meditation

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Improve Attention with Short-Term Loving Kindness Meditation

 

By John M. de Castro, Ph.D.

 

“meditation practice is associated with enduring improvements in sustained attention,” – Anthony Zanesco

 

There has accumulated a large amount of research demonstrating that mindfulness has significant benefits for psychological, physiological, and spiritual wellbeing. It even improves high level thinking known as executive function and emotion regulation and compassion. One of the primary effects of mindfulness training is an improvement in the ability to pay attention to the task at hand and ignore interfering stimuli. This is an important consequence of mindfulness training and produces improvements in thinking, reasoning, and creativity. The importance of heightened attentional ability to the individual’s ability to navigate the demands of complex modern life cannot be overstated. It helps in school, at work, in relationships, or simply driving a car.

 

One understudied meditation technique is Loving Kindness Meditation. It is designed to develop kindness and compassion to oneself and others. The individual systematically pictures different individuals from self, to close friends, to enemies and wishes them happiness, well-being, safety, peace, and ease of well-being. Although Loving Kindness Meditation has been practiced for centuries, it has received very little scientific research attention. As important as attention is, it’s surprising that little is known about the short-term effects of Loving Kindness Meditation on attention.

 

In today’s Research News article “Short-Term Effects of Meditation on Sustained Attention as Measured by fNIRS.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564228/ ) Izzetoglu and colleagues recruited healthy non-meditating college students. During the one session study the participants had their blood pressure and heart rate monitored and functional near infrared spectroscopy (fNIRS) sensors placed on their foreheads. “fNIRS is an optics-based brain imaging modality which can measure relative changes in oxygenated (HbO2) and deoxygenated (Hb) hemoglobin using light in the near infrared range (650–950 nm)”. It is thought to measure blood flow from the prefrontal cortex which is involved in high level thinking.

 

The participants were then measured for sustained attention by performing in order the Stroop Color task, the Stroop word task, and then the Stroop Color Word task. These measurements were followed by a guided 22-minute Loving Kindness Meditation practice. After meditation the three sustained attention (Stroop) tasks were repeated. In the color Stroop test names of colors were presented in colors different from the word, e.g. the word RED appears in a blue color. The participants are asked to report the word (naming) or the color of the word ignoring the meaning of the word itself (inhibition) or switch back and forth (Executive function).

 

They found that in comparison to per-meditation, after Loving Kindness Meditation practice there was a significant increase in the speed of responding on the Stroop tasks and reduction in pulse pressure and systolic blood pressure. The fNIRS measure during the Stroop task suggested that after meditation there was a significant increase in blood flow to the dorsal lateral prefrontal cortex and area thought to be involved in attentional focus.

 

The study was very short term and there was no control comparison group. So, the results must be interpreted carefully. Nevertheless, they suggest that the immediate effects of Loving Kindness Meditation practice is to improve attentional focus reflected in behavioral performance, physiological relaxation, and brain activity. These short term effects of meditation are compatible with the observed long term effects of Loving Kindness Meditation. This suggests that the long-term effects of the meditation on the physiology and behavior occur due to an accumulation of short-term impacts.

 

So, improve attention with short-term Loving Kindness Meditation.

 

“meditation training helps people do better at focusing for a long time on a task that requires them to distinguish small differences between things they see.” – Science Daily

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

 

Study Summary

 

Izzetoglu, M., Shewokis, P. A., Tsai, K., Dantoin, P., Sparango, K., & Min, K. (2020). Short-Term Effects of Meditation on Sustained Attention as Measured by fNIRS. Brain sciences, 10(9), 608. https://doi.org/10.3390/brainsci10090608

 

Abstract

Cognitive abilities such as attention, memory, processing time, perception, and reasoning can be augmented using some type of intervention. Within the broad range of conventional and unconventional intervention methods used in cognitive enhancement, meditation is one of those that is safe, widely practiced by many since ancient times, and has been shown to reduce stress and improve psychological health and cognitive functioning. Various neuroimaging studies using functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) have shown functional and structural changes due to meditation in different types of meditation practices and on various groups of meditators. Recently, a few studies on meditation have used functional near infrared spectroscopy (fNIRS) to study the effects of meditation on cerebral hemodynamics. In this study, we examined the short-term effects of loving-kindness (LK) meditation on sustained attention using behavioral performance measures, physiological outcomes, and cognitive activity as measured by fNIRS in first-time meditators during Stroop color word task (SCWT) performance. Our results indicated that behavioral outcomes, assessed mainly on response time (RT) during SCWT performance, showed a significant decrease after meditation. As expected, physiological measures, primarily pulse pressure (PP) measured after meditation dropped significantly as compared to the before meditation measurement. For the hemodynamic measures of oxygenated-hemoglobin (HbO2), deoxygenated-hemoglobin (Hb), and total-hemoglobin (HbT), our findings show significant differences in SCWT performance before and after meditation. Our results suggest that LK meditation can result in improvements in cognitive, physiological, and behavioral outcomes of first-time meditators after a short-term session.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564228/

 

Change the Brain to Reduce Anxiety with Mindfulness

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Change the Brain to Reduce Anxiety with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness can enhance our ability to remember this new, less-fearful reaction, and break the anxiety habit.” It’s a tool that interrupts those old, fear-inducing memories, and creates new, less threatening associations in the mind.” – Nate Klemp

 

Meditation training has been shown to improve health and well-being. It has also been found to be effective for a large array of medical and psychiatric conditions, either stand-alone or in combination with more traditional therapies. There are a number of ways that meditation practices produce these benefits, including changes to the brain and physiology.  The nervous system is a dynamic entity, constantly changing and adapting to the environment. It will change size, activity, and connectivity in response to experience. These changes in the brain are called neuroplasticity. Over the last decade neuroscience has been studying the effects of contemplative practices on the brain and has identified neuroplastic changes in widespread areas. In other words, meditation practice appears to mold and change the brain, producing psychological, physical, and spiritual benefits.

 

In today’s Research News article “). Hippocampal circuits underlie improvements in self-reported anxiety following mindfulness training.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507558/ ) Sevinc and colleagues recruited healthy adults and randomly assigned them to receive weekly 2-hour sessions of either stress management education or Mindfulness-Based Stress Reduction (MBSR) along with 40-minutes of daily home practice. The stress management education consisted of discussion of sources of stress and light exercise. MBSR consisted of discussion, meditation, body scan, and yoga practices. They were measured before and after training for perceived stress, mindfulness, and anxiety.

 

All participants underwent classical fear conditioning with 2 different light colors presented just prior to an irritating shock to the finger and a third color light not followed by shock. The conditioning was then extinguished for one light color but not the other by repeated presentations of the light without shock. After training the participants underwent brain scanning focused on the subfields of the hippocampus with functional Magnetic Resonance Imaging (fMRI). The size of the hippocampal subfields was measured along with the connectivity between the hippocampus and other brain areas while the participants were shown the different colored lights used in the fear conditioning.

 

They found that after Mindfulness-Based Stress Reduction (MBSR) there was an increase in the volume of the hippocampal subfield of the subiculum. They also found a decrease in the connectivity of the hippocampus with the occipital cortex during presentation of the extinguished fear conditioning lights. In addition, they found that the greater the increase in volume of the subiculum, the greater the decrease in anxiety levels after MBSR.

 

The subiculum has been implicated in memory consolidation and retrieval. So, the increased volume detected after Mindfulness-Based Stress Reduction (MBSR) suggests that MBSR improves the memory process. Indeed, mindfulness training has previously been shown to improve memory processes.  The decrease in hippocampal connectivity during extinction recall after MBSR training suggests that the individual may be better able to ignore previously associated fear stimuli. This could well underlie a reduction in anxiety by not responding to fear stimuli that are no longer associated with frightening circumstances. This may be a mechanism that, at least in part, underlies the ability of mindfulness training to improve post-traumatic stress disorder (PTSD). Regardless, the results suggest that mindfulness training alters the brain in such a way to reduce anxiety.

 

So, change the brain to reduce anxiety with mindfulness.

 

“In mindfulness practice . . . you have an opportunity—the mental time and space, if you will—to see more elements of the story, a richer picture. “You may see more clearly as you anticipate a difficult encounter what the underlying emotion is that’s triggered and how it’s showing up in your body.” – Barry Boyce

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Sevinc, G., Greenberg, J., Hölzel, B. K., Gard, T., Calahan, T., Brunsch, V., Hashmi, J. A., Vangel, M., Orr, S. P., Milad, M. R., & Lazar, S. W. (2020). Hippocampal circuits underlie improvements in self-reported anxiety following mindfulness training. Brain and behavior, 10(9), e01766. Advance online publication. https://doi.org/10.1002/brb3.1766

 

Abstract

Introduction

Mindfulness meditation has successfully been applied to cultivate skills in self‐regulation of emotion, as it employs the unbiased present moment awareness of experience. This heightened attention to and awareness of sensory experience has been postulated to create an optimal therapeutic exposure condition and thereby improve extinction learning. We recently demonstrated increased connectivity in hippocampal circuits during the contextual retrieval of extinction memory following mindfulness training.

Methods

Here, we examine the role of structural changes in hippocampal subfields following mindfulness training in a randomized controlled longitudinal study using a two‐day fear‐conditioning and extinction protocol.

Results

We demonstrate an association between mindfulness training‐related increases in subiculum and decreased hippocampal connectivity to lateral occipital regions during contextual retrieval of extinguished fear. Further, we demonstrate an association between decreased connectivity and decreases in self‐reported anxiety following mindfulness training.

Conclusions

The results highlight the role of the subiculum in gating interactions with contextual stimuli during memory retrieval and, also, the mechanisms through which mindfulness training may foster resilience.

Abstract

Mindfulness meditation has successfully been applied to cultivate skills in self‐regulation of emotion, as it employs the unbiased present moment awareness of experience. This heightened attention to and awareness of sensory experience has been postulated to create an optimal therapeutic exposure condition and thereby improve extinction learning. Here, we examine the role of structural changes in hippocampal subfields and further demonstrate an association between mindfulness training‐related increases in subiculum and decreased hippocampal connectivity to lateral occipital regions during contextual retrieval of extinguished fear. Further, we demonstrate an association between decreased connectivity and decreases in self‐reported anxiety following mindfulness training. These results highlight the role of the subiculum in gating interactions with contextual stimuli during memory retrieval and, also, the mechanisms through which mindfulness training fosters resilience.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507558/

 

Change the Brain with Mindfulness Apps

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Change the Brain with Mindfulness Apps

 

By John M. de Castro, Ph.D.

 

“Rather than treating the usage of smartphones and mindfulness as oxymorons, we should consider ways to use our smartphones as a tool to aid our mindfulness practices.” – Courtney Ackerman

 

Mindfulness training has been shown through extensive research to be effective in improving physical and psychological health and particularly with reducing the physical and psychological reactions to stress and increasing resilience in the face of stress. There are a number of ways that meditation practices produce these benefits, including changes to the brain and physiology. The nervous system changes in response to how it is used and how it is stimulated in a process called neuroplasticity. Highly used areas grow in size, metabolism, and connectivity. Mindfulness practices in general are known to produce these kinds of changes in the structure and activity of the brain.

 

The vast majority of the mindfulness training techniques, however, require a trained teacher. The participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with busy employee schedules and at locations that may not be convenient. As an alternative, apps for smartphones have been developed. These have tremendous advantages in decreasing costs, making training schedules much more flexible, and eliminating the need to go repeatedly to specific locations. But the question arises as to the effectiveness of these apps and their ability to produce neuroplastic changes in the brain.

 

In today’s Research News article “The Impact of App-Delivered Mindfulness Meditation on Functional Connectivity and Self-Reported Mindfulness Among Health Profession Trainees.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543678/ ) Smith and colleagues recruited surgery residents and physicians assistant students and randomly assigned them to a wait-list control condition or to practice mindfulness meditation for 12 minutes per day for 8 weeks  guided by the “10% Happier” smartphone app. They were measured before and after training for mindfulness with the Five Facets of Mindfulness Questionnaire and had their brains scanned with a resting state functional Magnetic Resonance Imaging (fMRI).

 

They found in comparison to baseline and the wait-list control conditions that the mindfulness app group had a significantly higher Describe facet of mindfulness. They report that the greater the amount of app practice, the greater the increase in the Describe facet of mindfulness. The brain scans revealed that using the mindfulness app resulted in changes in the connectivity of a number of systems within the brain. They found that there was increased connectivity between the Central Executive Network and the Nucleus Accumbens and also between the Default Mode Network and the Salience Network. In addition, the greater the Describe mindfulness facet and the greater the amount of practice the greater the increase in these connectivities.

 

These networks are very important for the functioning of the brain. The Central Executive Network is involved in high level thinking, the Default Mode Network is involved in mind wandering and self-referential thinking, and the Salience Network is involved in attentional processing. The increased connectivity observed with the systems after using the mindfulness app suggests that the app was successful in increasing mindfulness which in turn improved the processing of important neural systems, effectively improving the brain.

 

So, change the brain with mindfulness Apps.

 

“meditation, which changes the brain for the better, is a very specific technique rooted in age old philosophies. How meditation apps work on the brain has been debated, but a recent study . . .  shows that mindfulness changes cells in the brain.” – Sophia Quaglia

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Smith, J. L., Allen, J. W., Haack, C., Wehrmeyer, K., Alden, K., Lund, M. B., & Mascaro, J. S. (2020). The Impact of App-Delivered Mindfulness Meditation on Functional Connectivity and Self-Reported Mindfulness Among Health Profession Trainees. Mindfulness, 1–15. Advance online publication. https://doi.org/10.1007/s12671-020-01502-7

 

Abstract

Objectives

Previous research indicates that mindfulness meditation reduces anxiety and depression and enhances well-being. We examined the impact of app-delivered mindfulness meditation on resting state functional MRI (fMRI) connectivity among physician assistant (PA) students and surgery residents.

Methods

PA students and residents were randomized to receive a popular meditation app or to wait-list control group. Before and after the 8-week meditation period, we acquired fMRI scans of participants’ resting state, and participants completed a self-report measure of mindfulness. We used a 2 × 2, within- and between-group factorial design and leveraged a whole-brain connectome approach to examine changes in within- and between-network connectivity across the entire brain, and to examine whether changes in connectivity were associated with app use or to changes in self-reported mindfulness.

Results

Meditation practitioners exhibited significantly stronger connectivity between the frontoparietal network and the left and right nucleus accumbens and between the default mode (DMN) and salience networks, among other regions. Mindfulness practice time was correlated with increased connectivity between the lateral parietal cortex and the supramarginal gyrus, which were also positively correlated with increased scores on the “Describing” subscale of the Five Facet Mindfulness Questionnaire between baseline and post-meditation. These findings are consistent with previous research indicating that mindfulness-based interventions alter functional connectivity within the DMN and between the DMN and other networks both during meditation and at rest, as well as increased connectivity in systems important for emotion and reward.

Conclusions

Recent commentaries call for healthcare provider and trainee wellness programs that are sustainable and preventive in nature rather than reactive; these data indicate that even brief sessions of app-delivered mindfulness practice are associated with functional connectivity changes in a dose-dependent manner.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543678/

 

Change the Brain for Greater Happiness with Meditation

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Change the Brain for Greater Happiness with Meditation

 

By John M. de Castro, Ph.D.

 

“meditation. . . appears to have an amazing variety of neurological benefits – from changes in grey matter volume to reduced activity in the “me” centers of the brain to enhanced connectivity between brain regions.” – Alice Walton

 

There has accumulated a large amount of research demonstrating that meditation practice has significant benefits for psychological, physical, and spiritual wellbeing. It has been shown to improve emotions and their regulation. It also increases happiness levels in practitioners. One way that meditation practices may produce these benefits is by altering the brain. The nervous system is a dynamic entity, constantly changing and adapting to the environment. It will change size, activity, and connectivity in response to experience. These changes in the brain are called neuroplasticity. Over the last decade neuroscience has been studying the effects of contemplative practices on the brain and has identified neuroplastic changes in widespread areas. In other words, meditation practice appears to mold and change the brain, producing greater happiness.

 

In today’s Research News article “Rajyoga meditation induces grey matter volume changes in regions that process reward and happiness.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528075/ ) Babu and colleagues recruited participants who practiced Rajyoga meditation and a group of non-meditators matched for age, gender, and handedness. Rajyoga meditation is an eyes-open focused meditation practice focusing on a point of light. They completed a measure of happiness and had their brains scanned with Magnetic Resonance Imaging (MRI).

 

They found that the Rajyoga meditators were significantly happier than the non-meditators and that the greater the number of hours of practice the greater the levels of happiness. The MRI scans revealed that the Rajyoga meditators had significantly great gray matter volume in the superior frontal gyrus, inferior orbitofrontal cortex, and precuneus. They also found that the greater the gray matter volume in the superior frontal gyrus, orbitofrontal cortex, insula, and anterior cingulate cortex the greater the levels of reported happiness.

 

The results of the present study need to be interpreted with caution as the groups were determined by whether they engaged in meditation or not. It is possible that people who choose to meditate are significantly different and have significantly different brains than those who do not. Nevertheless, the results suggest that Rajyoga meditators are happier and have greater amounts of brain matter in specific regions of the brain than non-meditators and that these changes are correlated with happiness. The brain areas with greater volume in the meditators are thought to process information regarding rewards and happiness. So, it is hypothesized that the meditation alters these brain regions that results in greater happiness.

 

So, change the brain for greater happiness with meditation.

 

“meditation physically impacts the extraordinarily complex organ between our ears. Recent scientific evidence confirms that meditation nurtures the parts of the brain that contribute to well-being. Furthermore, it seems that a regular practice deprives the stress and anxiety-related parts of the brain of their nourishment.“ – Mindworks

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Babu, M., Kadavigere, R., Koteshwara, P., Sathian, B., & Rai, K. S. (2020). Rajyoga meditation induces grey matter volume changes in regions that process reward and happiness. Scientific reports, 10(1), 16177. https://doi.org/10.1038/s41598-020-73221-x

 

Abstract

Studies provide evidence that practicing meditation enhances neural plasticity in reward processing areas of brain. No studies till date, provide evidence of such changes in Rajyoga meditation (RM) practitioners. The present study aimed to identify grey matter volume (GMV) changes in reward processing areas of brain and its association with happiness scores in RM practitioners compared to non-meditators. Structural MRI of selected participants matched for age, gender and handedness (n = 40/group) were analyzed using voxel-based morphometric method and Oxford Happiness Questionnaire (OHQ) scores were correlated. Significant increase in OHQ happiness scores were observed in RM practitioners compared to non-meditators. Whereas, a trend towards significance was observed in more experienced RM practitioners, on correlating OHQ scores with hours of meditation experience. Additionally, in RM practitioners, higher GMV were observed in reward processing centers—right superior frontal gyrus, left inferior orbitofrontal cortex (OFC) and bilateral precuneus. Multiple regression analysis showed significant association between OHQ scores of RM practitioners and reward processing regions right superior frontal gyrus, left middle OFC, right insula and left anterior cingulate cortex. Further, with increasing hours of RM practice, a significant positive association was observed in bilateral ventral pallidum. These findings indicate that RM practice enhances GMV in reward processing regions associated with happiness.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528075/