From Arizona State University, College of Health Solutions, Phoenix, AZ.
From Arizona State University, College of Health Solutions, Phoenix, AZ
J Psychiatry Neurosci. 2023 Mar 29;48(2):E102-E114. doi: 10.1503/jpn.220159. Print 2023 Mar-Apr.
Mindfulness-based stress reduction (MBSR) alleviates depression and anxiety in adults with autism spectrum disorder (ASD); however, underlying therapeutic neural mechanisms and mindfulness-specific effects have yet to be elucidated.
We randomly assigned adults with ASD to MBSR or social support/education (SE). They completed questionnaires that assessed depression, anxiety, mindfulness traits, autistic traits and executive functioning abilities as well as a self-reflection functional MRI task. We used repeated-measures analysis of covariance (ANCOVA) to evaluate behavioural changes. To identify task-specific connectivity changes, we performed a generalized psychophysiological interactions (gPPI) functional connectivity (FC) analysis on regions of interest (ROIs; insula, amygdala, cingulum and prefrontal cortex [PFC]). We used Pearson correlations to explore brain-behaviour relationships.
Our final sample included 78 adults with ASD - 39 who received MBSR and 39 who received SE. Mindfulness-based stress reduction uniquely improved executive functioning abilities and increased mindfulness traits, whereas both MBSR and SE groups showed reductions in depression, anxiety and autistic traits. Decreases specific to MBSR in insula-thalamus FC were associated with anxiety reduction and increased mindfulness traits, including the trait "nonjudgment;" MBSR-specific decreases in PFC-posterior cingulate connectivity correlated with improved working memory. Both groups showed decreased amygdala-sensorimotor and medial-lateral PFC connectivity, which corresponded with reduced depression.
Larger sample sizes and neuropsychological evaluations are needed to replicate and extend these findings.
Together, our findings suggest that MBSR and SE are similarly efficacious for depression, anxiety and autistic traits, whereas MBSR produced additional salutary effects related to executive functioning and mindfulness traits. Findings from gPPI identified shared and distinct therapeutic neural mechanisms, implicating the default mode and salience networks. Our results mark an early step toward the development of personalized medicine for psychiatric symptoms in ASD and offer novel neural targets for future neurostimulation research.
ClinicalTrials.gov identifier NCT04017793.
正念减压（MBSR）可缓解自闭症谱系障碍（ASD）成人的抑郁和焦虑；然而，潜在的治疗神经机制和正念的特定影响仍有待阐明。
我们将 ASD 成人随机分配到 MBSR 或社会支持/教育（SE）组。他们完成了评估抑郁、焦虑、正念特质、自闭症特质和执行功能能力以及自我反思功能磁共振成像任务的问卷。我们使用重复测量方差分析（ANCOVA）来评估行为变化。为了确定任务特异性连接变化，我们对感兴趣区域（ROI；岛叶、杏仁核、扣带回和前额叶皮质 [PFC]）进行了广义心理生理相互作用（gPPI）功能连接（FC）分析。我们使用 Pearson 相关来探索大脑-行为关系。
我们的最终样本包括 78 名 ASD 成人-39 名接受 MBSR，39 名接受 SE。MBSR 可独特改善执行功能能力并提高正念特质，而 MBSR 和 SE 组均显示抑郁、焦虑和自闭症特质降低。与焦虑减轻和正念特质增加相关的 MBSR 特异性的岛叶-丘脑 FC 降低包括“非判断”特质；与工作记忆改善相关的 MBSR 特异性的 PFC-后扣带连接减少。两组均显示杏仁核-感觉运动和内侧-外侧 PFC 连接减少，与抑郁减轻相对应。
需要更大的样本量和神经心理学评估来复制和扩展这些发现。
总之，我们的研究结果表明，MBSR 和 SE 对抑郁、焦虑和自闭症特质同样有效，而 MBSR 则产生了与执行功能和正念特质相关的额外有益影响。gPPI 的发现确定了共享和独特的治疗神经机制，涉及默认模式和突显网络。我们的研究结果标志着个性化医疗在 ASD 精神症状方面的早期发展迈出了一步，并为未来的神经刺激研究提供了新的神经靶点。
ClinicalTrials.gov 标识符 NCT04017793。
