Mindfulness Training Alters Emotional Memory Recall Compared to Active Controls: Support for an Emotional Information Processing Model of Mindfulness

While mindfulness-based interventions have received widespread application in both clinical and non-clinical populations, the mechanism by which mindfulness meditation improves well-being remains elusive. One possibility is that mindfulness training alters the processing of emotional information, similar to prevailing cognitive models of depression and anxiety. The aim of this study was to investigate the effects of mindfulness training on emotional information processing (i.e., memory) biases in relation to both clinical symptomatology and well-being in comparison to active control conditions.  Fifty-eight university students (28 female, age = 20.1 ± 2.7 years) participated in either a 12-week course containing a “meditation laboratory” or an active control course with similar content or experiential practice laboratory format (music). Participants completed an emotional word recall task and self-report questionnaires of well-being and clinical symptoms before and after the 12-week course.  Meditators showed greater increases in positive word recall compared to controls [F(1, 56) = 6.6, p = 0.02]. The meditation group increased significantly more on measures of well-being [F(1, 56) = 6.6, p = 0.01], with a marginal decrease in depression and anxiety [F(1, 56) = 3.0, p = 0.09] compared to controls. Increased positive word recall was associated with increased psychological well-being (r = 0.31, p = 0.02) and decreased clinical symptoms (r = −0.29, p = 0.03).  Mindfulness training was associated with greater improvements in processing efficiency for positively valenced stimuli than active control conditions. This change in emotional information processing was associated with improvements in psychological well-being and less depression and anxiety. These data suggest that mindfulness training may improve well-being via changes in emotional information processing. Future research with a fully randomized design will be needed to clarify the possible influence of self-selection.

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title: Mindfulness Training as a Clinical Intervention: A Conceptual and Empirical Review
abstract: Interventions based on training in mindfulness skills are becoming increasingly popular. Mindfulness involves intentionally bringing one's attention to the internal and external experiences occurring in the present moment, and is often taught through a variety of meditation exercises. This review summarizes conceptual approaches to mind-fulness and empirical research on the utility of mindfulness-based interventions. Meta-analytic techniques were incorporated to facilitate quantification of findings and comparison across studies. Although the current empirical literature includes many methodological flaws, findings suggest that mindfulness-based interventions may be helpful in the treatment of several disorders. Methodologically sound investigations are recommended in order to clarify the utility of these interventions.

title: Meditation practices for health: state of the research.
abstract: To review and synthesize the state of research on a variety of meditation practices, including: the specific meditation practices examined; the research designs employed and the conditions and outcomes examined; the efficacy and effectiveness of different meditation practices for the three most studied conditions; the role of effect modifiers on outcomes; and the effects of meditation on physiological and neuropsychological outcomes.



Comprehensive searches were conducted in 17 electronic databases of medical and psychological literature up to September 2005. Other sources of potentially relevant studies included hand searches, reference tracking, contact with experts, and gray literature searches.



A Delphi method was used to develop a set of parameters to describe meditation practices. Included studies were comparative, on any meditation practice, had more than 10 adult participants, provided quantitative data on health-related outcomes, and published in English. Two independent reviewers assessed study relevance, extracted the data and assessed the methodological quality of the studies.



Five broad categories of meditation practices were identified (Mantra meditation, Mindfulness meditation, Yoga, Tai Chi, and Qi Gong). Characterization of the universal or supplemental components of meditation practices was precluded by the theoretical and terminological heterogeneity among practices. Evidence on the state of research in meditation practices was provided in 813 predominantly poor-quality studies. The three most studied conditions were hypertension, other cardiovascular diseases, and substance abuse. Sixty-five intervention studies examined the therapeutic effect of meditation practices for these conditions. Meta-analyses based on low-quality studies and small numbers of hypertensive participants showed that TM(R), Qi Gong and Zen Buddhist meditation significantly reduced blood pressure. Yoga helped reduce stress. Yoga was no better than Mindfulness-based Stress Reduction at reducing anxiety in patients with cardiovascular diseases. No results from substance abuse studies could be combined. The role of effect modifiers in meditation practices has been neglected in the scientific literature. The physiological and neuropsychological effects of meditation practices have been evaluated in 312 poor-quality studies. Meta-analyses of results from 55 studies indicated that some meditation practices produced significant changes in healthy participants.



Many uncertainties surround the practice of meditation. Scientific research on meditation practices does not appear to have a common theoretical perspective and is characterized by poor methodological quality. Firm conclusions on the effects of meditation practices in healthcare cannot be drawn based on the available evidence. Future research on meditation practices must be more rigorous in the design and execution of studies and in the analysis and reporting of results.

title: An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results.
abstract: The practice of mindfulness meditation was used in a 10-week Stress Reduction and Relaxation Program to train chronic pain patients in self-regulation. The meditation facilitates an attentional stance towards proprioception known as detached observation. This appears to cause an "uncoupling " of the sensory dimension of the pain experience from the affective/evaluative alarm reaction and reduce the experience of suffering via cognitive reappraisal. Data are presented on 51 chronic pain patients who had not improved with traditional medical care. The dominant pain categories were low back, neck and shoulder, and headache. Facial pain, angina pectoris, noncoronary chest pain, and GI pain were also represented. At 10 weeks, 65% of the patients showed a reduction of greater than or equal to 33% in the mean total Pain Rating Index (Melzack) and 50% showed a reduction of greater than or equal to 50%. Similar decreases were recorded on other pain indices and in the number of medical symptoms reported. Large and significant reductions in mood disturbance and psychiatric symptomatology accompanied these changes and were relatively stable on follow-up. These improvements were independent of the pain category. We conclude that this form of meditation can be used as the basis for an effective behavioral program in self-regulation for chronic pain patients. Key features of the program structure, and the limitations of the present uncontrolled study are discussed.

title: Promoting Mindfulness in Psychotherapists in Training Influences the Treatment Results of Their Patients: A Randomized, Double-Blind, Controlled Study
abstract: All therapists direct their attention in some manner during psychotherapy. A special form of directing attention, ‘mindfulness’, is recommended. This study aimed to examine whether, and to what extent, promoting mindfulness in psychotherapists in training (PiT) influences the treatment results of their patients.  The therapeutic course and treatment results of 124 inpatients, who were treated for 9 weeks by 18 PiTs, were compared. The PiTs were randomly assigned to 1 of 2 groups: (i) those practicing Zen meditation (MED; n = 9 or (ii) control group, which did not perform meditation (noMED; n = 9). The results of treatment (according to the intent-to-treat principle) were examined using the Session Questionnaire for General and Differen-tial Individual Psychotherapy (STEP), the Questionnaire of Changes in Experience and Behavior (VEV) and the Symptom Checklist (SCL-90-R).  Compared to the noMED group (n = 61), the patients of PiTs from the MED group (n = 63) had significantly higher evaluations (according to the intent-to-treat principle) for individual therapy on 2 STEP scales, clarification and problem-solving perspectives. Their evaluations were also significantly higher for the entire therapeutic result on the VEV. Furthermore, the MED group showed greater symptom reduction than the noMED group on the Global Severity Index and 8 SCL-90-R scales, including Somatization, Insecurity in Social Contact, Obsessiveness, Anxiety, Anger/Hostility, Phobic Anxiety, Paranoid Thinking and Psychoticism.  This study indicates that promoting mindfulness in PiTs could positively influence the therapeutic course and treatment results in their patients.

title: Defining an Agenda for Future Research on the Clinical Application of Mindfulness Practice
abstract: Interest in the clinical use of mindfulness practices has expanded rapidly in recent years. To provide a direction for future research in this area, this article identifies the primary scientific and clinical questions regarding the clinical application of mindfulness practice. In particular, the following questions are addressed: What is mindful-ness? What are the consequences of separating mindful-ness from its spiritual and cultural origins? Is mindfulness training an efficacious treatment intervention? What are the active or essential ingredients of mindfulness training? Can mindfulness enhance clinical practice apart from its role as a clinical intervention? How does mindfulness work? How should therapists be trained in order to deliver mindfulness interventions competently? Is mindfulness training amenable to widespread dissemination?

title: Attention Bias Modification Treatment: A Meta-Analysis Toward the Establishment of Novel Treatment for Anxiety
abstract: Attention Bias Modification Treatment (ABMT) is a newly emerging, promising treatment for anxiety disorders. Although recent randomized control trials (RCTs) suggest that ABMT reduces anxiety, therapeutic effects have not been summarized quantitatively.



Standard meta-analytic procedures were used to summarize the effect of ABMT on anxiety. With MEDLINE, January 1995 to February 2010, we identified RCTs comparing the effects on anxiety of ABMT and quantified effect sizes with Hedge's d.



Twelve studies met inclusion criteria, including 467 participants from 10 publications. Attention Bias Modification Treatment produced significantly greater reductions in anxiety than control training, with a medium effect (d = .51 [corrected] (p < .001). Age and gender did not moderate the effect of ABMT on anxiety, whereas several characteristics of the ABMT training did.



Attention Bias Modification Treatment shows promise as a novel treatment for anxiety. Additional RCTs are needed to fully evaluate the degree to which these findings replicate and apply to patients. Future work should consider the precise role for ABMT in the broader anxiety-disorder therapeutic armamentarium.

title: Depression and memory impairment: a meta-analysis of the association, its pattern, and specificity.
abstract: The existing evidence paints an unclear picture of whether an association exists between depression and memory impairment. The purpose of this investigation was to determine whether depression is associated with memory impairment, whether moderator variables determine the extent of this association, and whether any obtained association is unique to depression. Meta-analytic techniques were used to synthesize data from 99 studies on recall and 48 studies on recognition in clinically depressed and nondepressed samples. Associations between memory impairment and other psychiatric disorders (e.g., schizophrenia, dementia) were also examined. A significant, stable association between depression and memory impairment was revealed. Further analyses indicated, however, that it is likely that depression is linked to particular aspects of memory, the linkage is found in particular subsets of depressed individuals, and memory impairment is not unique to depression.

title: Cognitive vulnerability to emotional disorders.
abstract: A review of recent research on cognitive processing indicates that biases in attention, memory, and interpretation, as well as repetitive negative thoughts, are common across emotional disorders, although they vary in form according to type of disorder. Current cognitive models emphasize specific forms of biased processing, such as variations in the focus of attention or habitual interpretative styles that contribute to the risk of developing particular disorders. As well as predicting risk of emotional disorders, new studies have provided evidence of a causal relationship between processing bias and vulnerability. Beyond merely demonstrating the existence of biased processing, research is thus beginning to explore the cognitive causes of emotional vulnerability, and their modification.

title: Time course of selective attention in clinically depressed young adults: an eye tracking study.
abstract: Depressed individuals display biased attention for emotional information when stimuli are presented for relatively "long" (e.g., 1s) durations. The current study examined whether attentional biases are sustained over a much longer period. Specifically, clinically depressed and never depressed young adults simultaneously viewed images from four emotion categories (sad, threat, positive, neutral) for 30s while line of visual gaze was assessed. Depressed individuals spent significantly more time viewing dysphoric images and less time viewing positive images than their never depressed counterparts. Time course analyses indicated that these biases were maintained over the course of the trial. Results suggest that depressed participants' attentional biases for dysphoric information are sustained for relatively long periods even when other emotional stimuli are present. Mood congruent information-processing biases appear to be a robust feature of depression and may have an important role in the maintenance of the disorder.

title: Neural mechanisms of the cognitive model of depression
abstract: In the 40 years since Aaron Beck first proposed his cognitive model of depression, the elements of this model — biased attention, biased processing, biased thoughts and rumination, biased memory, and dysfunctional attitudes and schemas — have been consistently linked with the onset and maintenance of depression. Although numerous studies have examined the neural mechanisms that underlie the cognitive aspects of depression, their findings have not been integrated with Beck's cognitive model. In this Review, we identify the functional and structural neurobiological architecture of Beck's cognitive model of depression. Although the mechanisms underlying each element of the model differ, in general the negative cognitive biases in depression are facilitated by increased influence from subcortical emotion processing regions combined with attenuated top-down cognitive control.

title: Attentional biases for negative interpersonal stimuli in clinical depression.
abstract: An information-processing paradigm was used to examine attentional biases in clinically depressed participants, participants with generalized anxiety disorder (GAD), and nonpsychiatric control participants for faces expressing sadness, anger, and happiness. Faces were presented for 1000 ms, at which point depressed participants had directed their attention selectively to depression-relevant (i.e., sad) faces. This attentional bias was specific to the emotion of sadness; the depressed participants did not exhibit attentional biases to the angry or happy faces. This bias was also specific to depression; at 1000 ms, participants with GAD were not attending selectively to sad, happy, or anxiety-relevant (i.e., angry) faces. Implications of these findings for both the cognitive and the interpersonal functioning of depressed individuals are discussed and directions for future research are advanced.

title: Trait anxiety, trait depression, worry, and memory.
abstract: A study is reported which investigated the proposal that high trait anxiety is associated with a memory bias for worry themes. Forty-five participants were categorised as being high or low trait anxious on the basis of scores on the (Spielberger et al., 1983) (Manual for the State-Trait Anxiety Inventory (Form Y) (1983)). The participants were requested to rate a number of worry and non-worry statements for how much they generally thought about the issues represented by them. Analysis of the ratings given by the participants showed that low trait anxiety individuals thought about the non-worry items significantly more than worry items. The high trait anxiety participants, however, showed little or no difference in the amount of time spent thinking about worry and non-worry themes. In a subsequent free recall task of the statements it was observed that the low trait anxiety group recalled significantly more non-worry than worry items, whereas there was no such difference for the high trait group. It was also found that the degree of memory bias was related to both positive affectivity and trait anxiety. The implications of such findings are discussed.

title: Illusion and well-being: a social psychological perspective on mental health.
abstract: Many prominent theorists have argued that accurate perceptions of the self, the world, and the future are essential for mental health. Yet considerable research evidence suggests that overly positive selfevaluations, exaggerated perceptions of control or mastery, and unrealistic optimism are characteristic of normal human thought. Moreover, these illusions appear to promote other criteria of mental health, including the ability to care about others, the ability to be happy or contented, and the ability to engage in productive and creative work. These strategies may succeed, in large part, because both the social world and cognitive-processing mechanisms impose niters on incoming information that distort it in a positive direction; negative information may be isolated and represented in as unthreatening a manner as possible. These positive illusions may be especially useful when an individual receives negative feedback or is otherwise threatened and may be especially adaptive under these circumstances. Decades of psychological wisdom have established contact with reality as a hallmark of mental health. In this view, the well-adjusted person is thought to engage in accurate reality testing, whereas the individual whose vision is clouded by illusion is regarded as vulnerable to, if not already a victim of, mental illness. Despite its plausibility, this viewpoint is increasingly difficult to maintain (cf. Lazarus, 1983). A substantial amount of research testifies to the prevalence of illusion in normal human cognition (see Fiske& Taylor, 1984;Greenwald, 1980; Nisbett & Ross, 1980; Sackeim, 1983; Taylor, 1983). Moreover, these illusions often involve central aspects of the self and the environment and, therefore, cannot be dismissed as inconsequential. In this article, we review research suggesting that certain illusions may be adaptive for mental health and well-being. In particular, we examine evidence that a set of interrelated positive illusions—namely, unrealistically positive self-evaluations, exaggerated perceptions of control or mastery, and unrealistic optimism—can serve a wide variety of cognitive, affective, and social functions. We also attempt to resolve the following para

title: Optimism, pessimism, and psychological well-being.
abstract: Presents an overview of research on the effects of an optimistic orientation to life on psychological well-being. The chapter begins by commenting on a distinction between two ways of assessing optimism and pessimism. Then the authors review some of the empirical evidence linking positive thinking to well-being, focusing on prospective studies in both health- and nonhealth-related contexts. They then consider why optimism might confer benefits, arguing that the benefits are due, in part, to the way in which optimists and pessimists cope with problems. The conclusion addresses whether or not the effects of optimism are always good and the effects of pessimism are always bad.

title: Responsiveness of measures of attentional bias to clinical change in social phobia
abstract: This study examined responsiveness of the dot probe measure of attentional bias to standard cognitive-behaviour group therapy (CBGT) for social phobia. People who met criteria for social phobia were randomly allocated to either an immediate treatment condition or a waiting list control (WLC). All participants completed self-report measures of social anxiety, depression, and anxiety sensitivity, a verbal dot probe and a facial dot-probe task before and after eight weeks of standard CBGT was undertaken by the treatment group. On the first measurement occasion the two groups had similar scores on all measures. On the second measurement occasion the self-report scores for the CBGT group were lower than those of the WLC group. Performance on the dot-probe tasks for the CBGT group had also changed. The treatment group appeared to direct their attention away from social threat words and threatening faces after CBGT.

title: Effect of short-term SSRI treatment on cognitive bias in generalised anxiety disorder
abstract: RationaleThere is considerable evidence showing that individuals with generalised anxiety disorder (GAD) selectively process threat-related information, e.g. they have a bias to interpret ambiguous information in a threat-related manner. Cognitive theories of anxiety, which provide the basis of cognitive-behaviour therapy, propose that such processing biases play an important role in causing and maintaining anxiety.ObjectivesGiven that treatment with selective serotonin re-uptake inhibitors (SSRIs) appears to be effective for GAD, we examined whether it is successful in removing cognitive bias.MethodsThe clinical group included 19 patients with a diagnosis of GAD, and the control group consisted of a non-clinical sample of volunteers, matched for age, gender and years in education. The patients were assessed on measures of interpretative bias (homophone task), anxiety and depression before being prescribed an SSRI (paroxetine or citalopram). After 4 weeks, the cognitive task and mood measures were repeated in the patient group.ResultsPrior to treatment, the GAD group showed a significantly greater level of threat-related interpretive bias than controls. Following SSRI treatment, there were significant reductions in both interpretive bias and in anxiety levels in the GAD group. Furthermore, individuals who showed greater clinical improvement (e.g. reflected by reduced anxiety scores) showed a correspondingly greater reduction in their cognitive bias.ConclusionThe results suggest that SSRIs are effective in modifying both subjective anxiety levels and threat-related interpretive bias.

title: Combined cognitive bias modification treatment for social anxiety disorder: a pilot trial
abstract: Cognitive Bias Modification (CBM) is a promising treatment for Social Anxiety Disorder (SAD). However, previous randomized trials have not systematically examined the combination of CBM for attention (CBM‐A) and interpretation (CBM‐I) or the credibility and acceptability of these protocols.  We conducted a randomized, double‐blind placebo‐controlled trial (N = 32) to examine the efficacy of a CBM treatment called Attention and Interpretation Modification (AIM) for SAD. AIM comprised eight, twice weekly computer sessions with no therapist contact. During AIM, participants (1) completed a dot probe task in which probes always followed neutral faces when paired with a disgust face, thereby directing attention away from threat and (2) completed a word–sentence association task in which they received positive feedback for making benign interpretations of word–sentence pairs and negative feedback for making negative interpretations. We also assessed participants' perceived credibility of and satisfaction with AIM.  Participants receiving AIM reported significantly reduced self‐reported (Liebowitz Social Anxiety Scale) symptoms of social anxiety relative to the placebo. These gains were also evident on a behavioral measure (performance on an impromptu speech). AIM met our benchmarks for credibility and acceptability in this community sample, although credibility ratings were modest. Participants reported that CBM‐I was more helpful than CBM‐A.  A combined CBM treatment produced medium‐to‐large effects on social anxiety. Participants rated AIM as moderately credibly and acceptable. Should these findings be replicated in larger samples, AIM has the potential to be a widely accessible and efficacious treatment for SAD. Depression and Anxiety, 2011.

title: The modification of attentional bias to emotional information: A review of the techniques, mechanisms, and relevance to emotional disorders
abstract: A negative bias in the deployment of attention to emotional stimuli is commonly found in both anxiety and depression. Recent work has highlighted that such biases are causally related to emotional vulnerability, suggesting that interventions that ameliorate them may be therapeutic. Here, we review the evidence that attentional bias can be modified using both pharmacological and psychological interventions. We highlight the behavioral and neuroimaging studies that suggest that these interventions impact upon attention via alteration of distinct neural mechanisms. Specifically, pharmacological interventions appear to influence the initial deployment of attention via an effect on the amygdala-based stimulus appraisal system, whereas psychological interventions influence attention at later time points and may alter activity in the lateral prefrontal cortex. Finally, we suggest a conceptual framework that embraces both pharmacological and psychological approaches and consider the possible implications of this work for future research and treatment development.

title: The Emotional Brain, Fear, and the Amygdala
abstract: Considerable progress has been made over the past 20 years in relating specific circuits of the brain to emotional functions. Much of this work has involved studies of Pavlovian or classical fear conditioning, a behavioral procedure that is used to couple meaningless environmental stimuli to emotional (defense) response networks.2. The major conclusion from studies of fear conditioning is that the amygdala plays critical role in linking external stimuli to defense responses.3. Before describing research on the role of the amygdala in fear conditioning, though, it will be helpful to briefly examine the historical events that preceded modern research on conditioned fear.

title: An integrative theory of prefrontal cortex function.
abstract: The prefrontal cortex has long been suspected to play an important role in cognitive control, in the ability to orchestrate thought and action in accordance with internal goals. Its neural basis, however, has remained a mystery. Here, we propose that cognitive control stems from the active maintenance of patterns of activity in the prefrontal cortex that represent goals and the means to achieve them. They provide bias signals to other brain structures whose net effect is to guide the flow of activity along neural pathways that establish the proper mappings between inputs, internal states, and outputs needed to perform a given task. We review neurophysiological, neurobiological, neuroimaging, and computational studies that support this theory and discuss its implications as well as further issues to be addressed

title: Anterior cingulate cortex, error detection, and the online monitoring of performance.
abstract: An unresolved question in neuroscience and psychology is how the brain monitors performance to regulate behavior. It has been proposed that the anterior cingulate cortex (ACC), on the medial surface of the frontal lobe, contributes to performance monitoring by detecting errors. In this study, event-related functional magnetic resonance imaging was used to examine ACC function. Results confirm that this region shows activity during erroneous responses. However, activity was also observed in the same region during correct responses under conditions of increased response competition. This suggests that the ACC detects conditions under which errors are likely to occur rather than errors themselves.

title: Dorsal anterior cingulate cortex resolves conflict from distracting stimuli by boosting attention toward relevant events.
abstract: In everyday life, we often focus greater attention on behaviorally relevant stimuli to limit the processing of distracting events. For example, when distracting voices intrude upon a conversation at a noisy social gathering, we concentrate more attention on the speaker of interest to better comprehend his or her speech. In the present study, we investigated whether dorsal/caudal regions of the anterior cingulate cortex (dACC), thought to make a major contribution to cognitive control, boost attentional resources toward behaviorally relevant stimuli as a means for limiting the processing of distracting events. Sixteen healthy participants performed a cued global/local selective attention task while brain activity was recorded with event-related functional magnetic resonance imaging. Consistent with our hypotheses, greater dACC activity during distracting events predicted reduced behavioral measures of interference from those same events. dACC activity also differed for cues to attend to global versus local features of upcoming visual objects, further indicating a role in directing attention toward task-relevant stimuli. Our findings indicate a role for dACC in focusing attention on behaviorally relevant stimuli, especially when the achievement of our behavioral goals is threatened by distracting events.

title: Rethinking Feelings: An fMRI Study of the Cognitive Regulation of Emotion
abstract: The ability to cognitively regulate emotional responses to aversive events is important for mental and physical health. Little is known, however, about neural bases of the cognitive control of emotion. The present study employed functional magnetic resonance imaging to examine the neural systems used to reappraise highly negative scenes in unemotional terms. Reappraisal of highly negative scenes reduced subjective experience of negative affect. Neural correlates of reappraisal were increased activation of the lateral and medial prefrontal regions and decreased activation of the amygdala and medial orbito-frontal cortex. These findings support the hypothesis that prefrontal cortex is involved in constructing reappraisal strategies that can modulate activity in multiple emotion-processing systems.

title: Reflecting upon Feelings: An fMRI Study of Neural Systems Supporting the Attribution of Emotion to Self and Other
abstract: Understanding one's own and other individual's emotional states is essential for maintaining emotional equilibrium and strong social bonds. Although the neural substrates supporting reflection upon one's own feelings have been investigated, no studies have directly examined attributions about the internal emotional states of others to determine whether common or distinct neural systems support these abilities. The present study sought to directly compare brain regions involved in judging one's own, as compared to another individual's, emotional state. Thirteen participants viewed mixed valence blocks of photos drawn from the International Affective Picture System while whole-brain fMRI data were collected. Preblock cues instructed participants to evaluate either their emotional response to each photo, the emotional state of the central figure in each photo, or (in a baseline condition) whether the photo was taken indoors or outdoors. Contrasts indicated (1) that both self and other judgments activated the medial prefrontal cortex (MPFC), the superior temporal gyrus, and the posterior cingulate/precuneus, (2) that self judgments selectively activated subregions of the MPFC and the left temporal cortex, whereas (3) other judgments selectively activated the left lateral prefrontal cortex (including Broca's area) and the medial occipital cortex. These results suggest (1) that self and other evaluation of emotion rely on a network of common mechanisms centered on the MPFC, which has been hypothesized to support mental state attributions in general, and (2) that medial and lateral PFC regions selectively recruited by self or other judgments may be involved in attention to, and elaboration of, internally as opposed to externally generated information.

title: The cognitive control of emotion
abstract: The capacity to control emotion is important for human adaptation. Questions about the neural bases of emotion regulation have recently taken on new importance, as functional imaging studies in humans have permitted direct investigation of control strategies that draw upon higher cognitive processes difficult to study in nonhumans. Such studies have examined (1) controlling attention to, and (2) cognitively changing the meaning of, emotionally evocative stimuli. These two forms of emotion regulation depend upon interactions between prefrontal and cingulate control systems and cortical and subcortical emotion-generative systems. Taken together, the results suggest a functional architecture for the cognitive control of emotion that dovetails with findings from other human and nonhuman research on emotion.

title: Amygdala and Ventromedial Prefrontal Cortex Are Inversely Coupled during Regulation of Negative Affect and Predict the Diurnal Pattern of Cortisol Secretion among Older Adults
abstract: Among younger adults, the ability to willfully regulate negative affect, enabling effective responses to stressful experiences, engages regions of prefrontal cortex (PFC) and the amygdala. Because regions of PFC and the amygdala are known to influence the hypothalamic-pituitary-adrenal axis, here we test whether PFC and amygdala responses during emotion regulation predict the diurnal pattern of salivary cortisol secretion. We also test whether PFC and amygdala regions are engaged during emotion regulation in older (62- to 64-year-old) rather than younger individuals. We measured brain activity using functional magnetic resonance imaging as participants regulated (increased or decreased) their affective responses or attended to negative picture stimuli. We also collected saliva samples for 1 week at home for cortisol assay. Consistent with previous work in younger samples, increasing negative affect resulted in ventral lateral, dorsolateral, and dorsomedial regions of PFC and amygdala activation. In contrast to previous work, decreasing negative affect did not produce the predicted robust pattern of higher PFC and lower amygdala activation. Individuals demonstrating the predicted effect (decrease < attend in the amygdala), however, exhibited higher signal in ventromedial prefrontal cortex (VMPFC) for the same contrast. Furthermore, participants displaying higher VMPFC and lower amygdala signal when decreasing compared with the attention control condition evidenced steeper, more normative declines in cortisol over the course of the day. Individual differences yielded the predicted link between brain function while reducing negative affect in the laboratory and diurnal regulation of endocrine activity in the home environment.

title: Increased Amygdala and Decreased Dorsolateral Prefrontal BOLD Responses in Unipolar Depression: Related and Independent Features
abstract: Major depressive disorder is characterized by increased and sustained emotional reactivity, which has been linked to sustained amygdala activity. It is also characterized by disruptions in executive control, linked to abnormal dorsolateral prefrontal cortex (DLPFC) function. These mechanisms have been hypothesized to interact in depression. This study explored relationships between amygdala and DLPFC activity during emotional and cognitive information processing in unipolar depression.



Twenty-seven unmedicated patients with DSM-IV unipolar major depressive disorder and 25 never-depressed healthy control subjects completed tasks requiring executive control (digit sorting) and emotional information processing (personal relevance rating of words) during event-related functional magnetic resonance imaging (fMRI) assessment.



Relative to control subjects, depressed subjects displayed sustained amygdala reactivity on the emotional tasks and decreased DLPFC activity on the digit-sorting task. Decreased relationships between the time-series of amygdala and DLPFC activity were observed within tasks in depression, but different depressed individuals showed each type of bias.



Depression is associated with increased limbic activity in response to emotional information processing and decreased DLPFC activity in response to cognitive tasks though these may reflect separate mechanisms. Depressed individuals also display decreased relationships between amygdala and DLPFC activity, potentially signifying decreased functional relationships among these structures.

title: Reduction of prefrontal cortex glucose metabolism common to three types of depression.
abstract: Using positron emission tomography, we studied cerebral glucose metabolism in drug-free, age- and sex-matched, right-handed patients with unipolar depression (n = 10), bipolar depression (n = 10), obsessive-compulsive disorder (OCD) with secondary depression (n = 10), OCD without major depression (n = 14), and normal controls (n = 12). Depressed patients were matched for depression on the Hamilton Depression Rating Scale, and subjects with OCD without depression and OCD with depression had similar levels of OCD without depression and OCD with depression had similar levels of OCD pathology. We also studied six non-sex-matched patients with mania. Mean (+/- SD) glucose metabolic rates for the left dorsal anterolateral prefrontal cortex, divided by the rate for the ipsilateral hemisphere as a whole (ALPFC/hem), were similar in the primary depressions (unipolar depression = 1.05 +/- 0.05; bipolar depression = 1.04 +/- 0.05), and were significantly lower than those in normal controls (1.12 +/- 0.06) or OCD without depression (1.15 +/- 0.05). Results for the right hemisphere were similar. Values in subjects with OCD with depression (1.10 +/- 0.05) were also significantly lower than in subjects with OCD without depression, and values in subjects with bipolar depression were lower than those in manic subjects (1.12 +/- 0.03) on this measure in the left hemisphere, although results were not significant in the right hemisphere. There was a significant correlation between the HAM-D score and the left ALPFC/hem. With medication for depression (n = 12), the left ALPFC/hem increased significantly and the percentage change in the Hamilton scale score correlated with the percentage change in the left ALPFC/hem.(ABSTRACT TRUNCATED AT 250 WORDS)

title: Regional cerebral blood flow in depression measured by positron emission tomography: the relationship with clinical dimensions.
abstract: We have previously reported focal abnormalities of regional cerebral blood flow (rCBF) in a group of 33 patients with major depression. This report, on an extended sample of 40 patients who demonstrated identical regional deficits to those previously described, examines the relationships between depressive symptoms and patterns of rCBF. Patients' symptom ratings were subjected to factor analysis, producing a three-factor solution. The scores for these three factors, which corresponded to recognizable dimensions of depressive illness, were then correlated with rCBF. The first factor had high loadings for anxiety and correlated positively with rCBF in the posterior cingulate cortex and inferior parietal lobule bilaterally. The second factor had high loadings for psychomotor retardation and depressed mood and correlated negatively with rCBF in the left dorsolateral prefrontal cortex and left angular gyrus. The third factor had a high loading for cognitive performance and correlated positively with rCBF in the left medial prefrontal cortex. These data indicate that symptomatic specificity may be ascribed to regional functional deficits in major depressive illness.

title: Sustained attention deficit in bipolar disorder.
abstract: Recovery in bipolar disorder is central to its definition but is rarely complete. Previous work has suggested that neuropsychological impairment persists during the euthymic state but has been confounded partly by mild affective symptoms in remitted patients.



To characterise neuropsychological functioning in the euthymic phase of bipolar disorder with an emphasis on tasks of executive functioning.



Thirty euthymic patients with bipolar disorder were compared with thirty healthy controls on neuropsychological tasks differentially sensitive to damage within prefrontal cortex.



Bipolar I patients were impaired on tasks of attentional set shifting, verbal memory and sustained attention. Only sustained attention deficit survived controlling for mild affective symptoms. This deficit was related to progression of illness, but was none the less present in a subgroup of patients near illness onset.



Sustained attention deficit may represent a neuropsychological vulnerability marker for bipolar disorder, providing a focus for further understanding of the phenotype and analysis of the neuronal networks involved.

title: Using connectionist models to guide assessment of psychological disorder.
abstract: Connectionist models are introduced as promising tools for understanding the nature of psychological disorders and guiding their assessment. Specifically, ways in which connectionist models can guide the following aspects of the assessment process are described: understanding what constructs are relevant to assess, designing approaches to assessing these constructs, and understanding individual differences in data from assessments. Two extended examples are given based on the authors' research on cognitive aspects of depression and Alzheimer's disease.

title: Significance of Adolescent Neurodevelopment for the Neural Circuitry of Bipolar Disorder
abstract: The deficits of executive control of emotions and impulses of adult BD implicate involvement of a ventral prefrontal cortex (VPFC) neural system that subserves these functions that include the VPFC, as well as its subcortical connection sites of amygdala, striatum, and thalamus. Differences in the timing of major developmental changes in the structures within this neural system suggest that abnormalities in particular components of this neural system may emerge during critical developmental epochs during the course of the illness. Our recent neuroimaging data suggest that abnormalities in the subcortical components of VPFC neural systems may be evident by early adolescence in BD, whereas VPFC deficits progress over the course of adolescence and may be difficult to detect prior to late adolescence or early adulthood. This potential neurodevelopmental model for BD could have important implications for the recognition of early signs of the disorder and for age‐specific treatment strategies.

title: A prospective study of the association among impaired executive functioning, childhood attentional problems, and the development of bipolar disorder
abstract: Studies of adults who have been diagnosed with, and treated for, bipolar disorder have shown that these patients exhibit impairment on measures of executive functioning. However, it is unclear whether executive dysfunction precedes the diagnosis of bipolar illness, or develops subsequent to its onset. Moreover, investigators have failed to control for the effects of premorbid attentional problems on cognitive performance in these patients. The present authors explored these questions using data from a longitudinal prospective study of individuals at risk for major mood disorder. Results revealed that 67% of participants who met criteria for bipolar disorder in young adulthood showed impairment on the Wisconsin Card Sorting Test (WCST) when they were assessed during adolescence, as compared with 17% of individuals with no major mood diagnosis, and 19% with unipolar depression. This association between performance on the WCST and bipolar illness was not accounted for by high rates of premorbid attentional disturbance. In fact, among participants with early attentional problems, only those who ultimately developed bipolar disorder exhibited impairment on the WCST. Early attentional problems that preceded unipolar depression or no mood disorder were not associated with executive dysfunction.The findings presented in this paper come from the doctoral dissertation of the first author, which was funded by an NIMH Intramural Research Training Award. The authors are enormously grateful to Roger E. Meyer for his comments on earlier drafts of this paper and to Anne Mayfield, without whom this project would not have been possible. We are deeply indebted to Ann S. Masten, W. Andrew Collins, L. Alan Sroufe, Monica Luciana, and Carrie Borchardt, who provided invaluable guidance throughout all stages of this project, as well as Robert Asarnow, who was an important mentor during the review process. In addition, we acknowledge the contributions of Gail Inoff–Germain, who administered diagnostic interviews and neuropsychological measures at adolescent follow-up; Rula B. Garside, who undertook the painstaking job of establishing interrater reliability; Erika Sundstrom, who devoted many hours to data organization and quality assurance; and Sara Avery Torvik and Patricia Kasdan, whose combined gifts of organization and warmth created a comfortable atmosphere for study participants. Finally, we thank the extraordinary research participants of the NIMH Childrearing Study, who have shown enormous bravery and dedication by sharing with us 23 years of their lives.

title: Altered Emotional Interference Processing in Affective and Cognitive-Control Brain Circuitry in Major Depression
abstract: Major depression is characterized by a negativity bias: an enhanced responsiveness to, and memory for, affectively negative stimuli. However, it is not yet clear whether this bias represents 1) impaired top-down cognitive control over affective responses, potentially linked to deficits in dorsolateral prefrontal cortex function; or 2) enhanced bottom-up responses to affectively laden stimuli that dysregulate cognitive control mechanisms, potentially linked to deficits in amygdala and anterior cingulate function.



We used an attentional interference task using emotional distracters to test for top-down versus bottom-up dysfunction in the interaction of cognitive-control circuitry and emotion-processing circuitry. A total of 27 patients with major depression and 24 control participants was tested. Event-related functional magnetic resonance imaging was carried out as participants directly attended to, or attempted to ignore, fear-related stimuli.



Compared with control subjects, patients with depression showed an enhanced amygdala response to unattended fear-related stimuli (relative to unattended neutral). By contrast, control participants showed increased activity in right dorsolateral prefrontal cortex (Brodmann areas 46/9) when ignoring fear stimuli (relative to neutral), which the patients with depression did not show. In addition, the depressed participants failed to show evidence of error-related cognitive adjustments (increased activity in bilateral dorsolateral prefrontal cortex on posterror trials), but the control group did show them.



These results suggest multiple sources of dysregulation in emotional and cognitive control circuitry in depression, implicating both top-down and bottom-up dysfunction.

title: Depression symptoms and cognitive control of emotion cues: a functional magnetic resonance imaging study
abstract: Few studies have examined associations between depressive symptoms and alterations in neural systems that subserve cognitive control. Cognitive control was assessed with an exogenous cueing task using happy, sad, and neutral facial expressions as cues among women with mild to moderate symptoms of depression and a non-depressed control group while functional magnetic resonance imaging (fMRI) measured brain activity. Amygdala and medial/orbital prefrontal cortex (PFC) response to valid emotion cues did not differ as a function of depression symptoms. However, significant depression group differences were observed when task demands required cognitive control. Participants with elevated depression symptoms showed weaker activation in right and left lateral PFC and parietal regions when shifting attentional focus away from invalid emotion cues. No depression group differences were observed for invalid non-emotional cues. Findings suggest that mild to moderate depression symptoms are associated with altered function in brain regions that mediate cognitive control of emotional information.

title: Mood-congruent attention and memory bias in dysphoria: Exploring the coherence among information-processing biases.
abstract: Recent studies indicate that depression is characterized by mood-congruent attention bias at later stages of information-processing. Moreover, depression has been associated with enhanced recall of negative information. The present study tested the coherence between attention and memory bias in dysphoria. Stable dysphoric (n = 41) and non-dysphoric (n = 41) undergraduates first performed a spatial cueing task that included negative, positive, and neutral words. Words were presented for 250 ms under conditions that allowed or prevented elaborate processing. Memory for the words presented in the cueing task was tested using incidental free recall. Dysphoric individuals exhibited an attention bias for negative words in the condition that allowed elaborate processing, with the attention bias for negative words predicting free recall of negative words. Results demonstrate the coherence of attention and memory bias in dysphoric individuals and provide suggestions on the influence of attention bias on further processing of negative material.

title: Neurocognitive mechanisms in depression: implications for treatment.
abstract: Mood disorders collectively account for a substantial proportion of disease burden across the globe and have a devastating impact on quality of life and occupational function. Here we evaluate recent progress in understanding the neurocognitive mechanisms involved in the manifestation of mood disorders. We focus on four domains of cognitive function that are altered in patients with depression: executive control, memory, affective processing, and feedback sensitivity. These alterations implicate a distributed neural circuit composed of multiple sectors of the prefrontal cortex in interaction with subcortical regions (striatum, thalamus) and temporal lobe structures (amygdala, hippocampus). Affective processing and feedback sensitivity are highly sensitive to serotonergic manipulation and are targeted by antidepressant treatments. By drawing together cognitive, neuroanatomical, and pharmacological tiers of research, we identify treatment targets and directions for future investigation to identify people at risk, minimize relapse, and maximize long-term beneficial outcomes for those suffering from depression.

title: The effects of sleep and sleep deprivation on task‐switching performance
abstract: Neural systems of the prefrontal cortex (PFC) involved in executive functions are particularly vulnerable to sleep deprivation (SD). In this study, we investigated whether SD selectively affects specific components of the executive control processes involved in task‐switching performance. Two different tasks are performed in rapid and random succession in this procedure, so that the to‐be‐executed task may change from one trial to the next (switch trial), or may be repeated (repetition trial). Task‐switches are usually slower than task repetitions, giving way to the ‘switch cost’. One hundred and eight university students were assigned randomly to the sleep (S) or the SD group. Each of them was tested on a task‐switching paradigm before and after an experimental night (S or SD), and after one recovery night. SD impaired both task‐switching accuracy and speed. A higher proportion of errors and increased switch costs after SD have been observed, compared to normal sleep. Control analyses on switch and repetition trials showed that the SD group was significantly worse only on the switch trials. The effects of SD are reverted by one night of recovery sleep. It is concluded that the ability to adjust behaviour rapidly and flexibly to changing environmental demands, which relies on the functional integrity of the PFC, is impacted negatively by sleep loss.

title: The Role of Functional Neuroimaging in the Neuropsychology of Depression
abstract: Depressed individuals show impaired performance in tests of attention and concentration. They also exhibit PET resting state abnormalities in dorsal prefrontal cortex and anterior cingulate, regions known to be substrates of attentional processing in healthy individuals. This chapter outlines a strategy to study neuropsychological mechanisms in emotional disorders using functional imaging methods. It reviews evidence strongly implicating the dorsolateral prefrontal cortex, particularly in the right hemisphere, as a key brain structure in emotion/cognition interactions in negative mood states. It will be argued that this neocortical region is a crucial convergence zone, being the substrate of sustained attention to the external environment, and the main target of limbic-cortical influences during changes in mood state across health and disease.

title: Unmasking disease-specific cerebral blood flow abnormalities: mood challenge in patients with remitted unipolar depression.
abstract: Remitted major depressive disorder is a vulnerable clinical state, suggesting persistence of an underlying disease diathesis between episodes. To investigate neural correlates of such risk and to identify potential depression trait markers, euthymic unipolar patients in remission, acutely depressed patients, and never-depressed volunteers were studied before and after transient sad mood challenge.



Common and differential changes in regional blood flow among the groups relative to the baseline state were examined with [(15)O]H(2)O positron emission tomography after provocation of sadness with autobiographical memory scripts.



Mood provocation in both depressed groups resulted in regional cerebral blood flow (rCBF) decreases in medial orbitofrontal cortex Brodmann's area 10/11, which were absent in the healthy group. In the remitted group, mood provocation produced a unique rCBF decrease in pregenual anterior cingulate 24a. The main effects in healthy subjects, an rCBF increase in subgenual cingulate Brodmann's area 25 and a decrease in right prefrontal cortex Brodmann's area 9, were not present in the depressed groups.



Mood challenge in unipolar euthymic patients in full remission unmasks an apparent depression trait marker. The pattern of acute CBF changes is distinct from that seen in euthymic healthy volunteers and mirrors the untreated depressed state seen during a major depressive episode and the pattern of change seen in depressed patients. These findings suggest that disease-specific modifications of pathways mediating transient mood changes are present in unipolar depression independent of clinical illness status. These findings have implications for understanding the vulnerability of remitted patients for illness relapse.

title: The neural substrates of affective processing in depressed patients treated with venlafaxine.
abstract: The purpose of this study was to use functional magnetic resonance imaging (fMRI) to probe the neural circuitry associated with reactivity to negative and positive affective stimuli in patients with major depressive disorder before treatment and after 2 and 8 weeks of treatment with venlafaxine. Relations between baseline neural activation and response to treatment were also evaluated.



Patients with major depressive disorder (N=12) and healthy comparison subjects (N=5) were scanned on three occasions, during which trials of alternating blocks of affective and neutral pictorial visual stimuli were presented. Symptoms were evaluated at each testing occasion, and both groups completed self-report measures of mood. Statistical parametric mapping was used to examine the fMRI data with a focus on the group-by-time interactions.



Patients showed a significant reduction in depressive symptoms with treatment. Group-by-time interactions in response to the negative versus neutral stimuli were found in the left insular cortex and the left anterior cingulate. At baseline, both groups showed bilateral activation in the visual cortices, lateral prefrontal cortex, and amygdala in response to the negative versus neutral stimuli, with patients showing greater activation in the visual cortex and less activation in the left lateral prefrontal cortex. Patients with greater relative anterior cingulate activation at baseline in response to the negative versus neutral stimuli showed the most robust treatment response.



The findings underscore the importance of the neural circuitry activated by negative affect in depression and indicate that components of this circuitry can be changed within 2 weeks of treatment with antidepressant medication.

title: Increased Parietal and Frontal Activation after Remission from Recurrent Major Depression: A Repeated fMRI Study
abstract: Nine patients with unipolar major depression were scanned with MRI twice over a 2-year period, and compared with 12 healthy control subjects. All patients fulfilled criteria for major depressive disorder, recurrent type, at first scanning. Level of depressive psychopathology was assessed by the Hamilton Depression Rating Scale. The participants had to work on a mental arithmetics/working memory task while in the MR scanner. The task consisted of single digits (1 to 9) that were shown to the participant, who had to add the numbers in successive pairs and press a response button when the sum was 10. Neuronal activation was recorded based on the BOLD contrast phenomenon in a functional MRI protocol. The results showed significant increase in activation for the patients in the inferior frontal gyrus and the superior and inferior parietal lobule at the second compared with the first MR scanning session. There were also significant correlations between the HDRS scores and neuronal activation which showed a negative correlation particularly in the inferior frontal and parietal lobe areas, which overlapped with similar areas activated in the healthy control participants. This may indicate normalization of brain activation in depressed patients as a function of time from an illness phase to a remission/recovery state.

title: Emotional Disorders and Metacognition: Innovative Cognitive Therapy
abstract: List of Figures.  Metacognition and Cognitive Therapy. The Self-Regulatory Executive Function (S-REF) Model. Metacognition and Emotional Disorder: Evidence for the S-REF Model. Emotional Processing, the S-REF and Trauma Therapy. S-REF, Schema Theory and Interactive Cognitive Subsystems (ICS). PART II: CLINICAL APPLICATIONS.  Basic Constructs.  Modifying Beliefs. New Pathways for Cognitive  Attention Modifications (ATT and SAR). Treating Pathological Worry and Generalized Anxiety Disorder. Treating Obsessive-Compulsive Disorder. Concluding Remarks.  Metacognitions Questionnaire (MCQ).  Scoring Key for the MCQ.   Scoring Key for the AnTI.  Generalized Anxiety Disorder Scale (GADS).

title: Cognitive Remediation Therapy for outpatients with chronic schizophrenia: A controlled and randomized study
abstract: Cognitive Remediation Therapy (CRT) is a novel rehabilitation approach designed to improve neurocognitive abilities such as attention, memory and executive functioning. The aim of the present study is to evaluate the effect of CRT on neurocognition, and secondarily on symptomatology and psychosocial functioning. Cognitive Behavioural Therapy (CBT) was used as a control condition because it aims to improve emotional problems and positive symptoms, focusing on modification of maladaptive beliefs and schemas, but neurocognition is not targeted. A total of 40 chronic patients with DSM-IV schizophrenia disorder were randomly assigned for 4 months to one of two treatment groups: CRT or CBT. Repeated assessments were conducted before and after the treatments and at the end of a follow-up period of 6 months. Additionally, a method to establish reliable change was calculated from a separate sample of 20 schizophrenic patients who were under standard medication without any kind of psychological treatment. Results showed that CRT produced an overall improvement on neurocognition (Mean effect size=0.5), particularly in verbal and nonverbal memory, and executive function. CBT showed the expected treatment effect on general psychopathology (anxiety and depression) but produced only a slight non-specific improvement in neurocognition (Working Memory). Furthermore, patients receiving CRT showed improvement in social functioning, demonstrating that cognitive improvements are clinically meaningful. These gains were still present at the 6 month follow-up.

title: Neurobehavioral Therapies in the 21st Century: Summary of an Emerging Field and an Extended Example of Cognitive Control Training for Depression
abstract: The promise of a new generation of therapies targeted to address neurobiological mechanisms thought to underlie psychological disorders, particularly depression, using cognitive and behavioral techniques is discussed. Relationships between such neurobehaviorally focused therapies and other psychological and rehabilitative interventions are also discussed. Their potential utility as adjuncts to conventional treatment, and the importance of multi-method assessment in their evaluation are emphasized. Finally, initial data from a neurobehavioral “cognitive control training” (CCT) adjunctive intervention for severe unipolar depression is presented as an extended example. These data suggest that CCT aids in reducing both physiological mechanisms underlying depression as well as depressive symptomatology.

title: Introduction to the special section on cognitive bias modification in emotional disorders.
abstract: Cognitive models of anxiety disorders and unipolar depression have postulated that selective information processing plays an important role in the development and maintenance of emotional psychopathology. Cognitive bias modification (CBM) procedures have recently been developed to test this theoretical claim. The purpose of this special section is to introduce the central ideas underlying CBM and to bring together the research that exemplifies the theoretical and clinical potential of the CBM approach.

title: Inducing a benign interpretational bias reduces trait anxiety.
abstract: If negative interpretational bias causes emotional vulnerability, reduction of this bias should reduce proneness to anxiety. High trait-anxious volunteers were trained over four sessions to resolve descriptions of ambiguous events in an increasingly positive manner. This group subsequently made more positive interpretations of novel descriptions than did those in a test-retest control condition. Furthermore, trait anxiety scores reduced more in the trained group than in untrained controls. These results confirm earlier findings that modifying interpretation biases produces congruent changes in emotional vulnerability, and suggest a possible role for similar training methods in controlling pathological anxiety.

title: Trained interpretive bias and anxiety.
abstract: The relationship between anxiety and interpretive bias has been studied extensively, but the causal direction of this relationship remains largely unexplored. Do negative interpretations cause anxiety or is anxiety the cause of negative interpretations? Or are the two mutually reinforcing? The present study addressed this issue by experimentally inducing either a negative or a positive interpretive bias using Mathews and Mackintosh' [(2002). Induced emotional interpretation bias and anxiety. Journal of Abnormal Psychology, 109, 604-615] training paradigm and then examining its impact on state anxiety and anxiety vulnerability. In addition, it was investigated as to whether the interpretive bias was trained implicitly. Results indicated that style of interpreting could be manipulated. That is, when confronted with ambiguous information after the training, participants (n=118) interpreted this information congruent with their (positive or negative) training condition. Data on the issue of implicitness showed that participants tended to be explicitly aware of the valence of their training stimuli. Effects of trained interpretive bias on anxiety were only marginal and absent on anxiety vulnerability. It appears that interpretive bias can be trained reliably, but its effects on mood and vulnerability require further explanation.

title: A multi-session interpretation modification program: changes in interpretation and social anxiety symptoms.
abstract: Previous research suggests that socially anxious individuals interpret ambiguous social information in a more threatening manner compared to non-anxious individuals. Recently, studies have experimentally modified interpretation and shown that this subsequently affected anxiety in non-anxious individuals. If similar procedures can modify interpretation biases in socially anxious individuals, they may lead to a reduction in social anxiety symptoms. In the current study, we examined the effect of a computerized Interpretation Modification Program (IMP) on interpretation bias and social anxiety symptoms. Twenty-seven socially anxious individuals were randomly assigned to the IMP or a control condition. Participants completed eight computer sessions over four weeks. The IMP modified interpretation by providing positive feedback when participants made benign interpretations and negative feedback in response to threat interpretations. The IMP successfully decreased threat interpretations, increased benign interpretations, and decreased social anxiety symptoms compared to the control condition. Moreover, changes in benign interpretation mediated IMP's effect on social anxiety. This initial trial suggests that interpretation modification may have clinical utility when applied as a multi-session intervention.

title: Continual training of attentional bias in social anxiety.
abstract: Using the dot-probe paradigm, it has been shown that high social anxiety is associated with an attentional bias toward negative information. In the present study, individuals with high social anxiety were divided into two groups randomly. One group was the attentional bias training group (Group T), and the other was the control group (Group C). For Group T, 7 days' continuous training of attentional bias was conducted using the dot-probe paradigm to make socially anxious individuals focus more on positive face pictures. The results showed that the training was effective in changing attentional bias in Group T. Scores of the Social Interaction Anxiety Scale (SIAS) in Group T were reduced compared to Group C, while the scores of Social Phobia Scale (SPS) and scores of Negative Evaluation Scale (FNE) showed no difference between the two groups, which suggested a limited reduction of social anxiety.

title: Attention modification program in individuals with generalized anxiety disorder.
abstract: Research suggests that individuals with generalized anxiety disorder (GAD) show an attention bias for threat-relevant information. However, few studies have examined the causal role of attention bias in the maintenance of anxiety and whether modification of such biases may reduce pathological anxiety symptoms. In the present article, the authors tested the hypothesis that an 8-session attention modification program would (a) decrease attention bias to threat and (b) reduce symptoms of GAD. Participants completed a probe detection task by identifying letters (E or F) replacing one member of a pair of words. The authors trained attention by including a contingency between the location of the probe and the nonthreat word in one group (Attention Modification Program; AMP) and not in the other (attention control condition; ACC). Participants in the AMP showed change in attention bias and a decrease in anxiety, as indicated by both self-report and interviewer measures. These effects were not present in the ACC group. These results are consistent with the hypothesis that attention plays a causal role in the maintenance of GAD and suggest that altering attention mechanisms may effectively reduce anxiety.

title: Attentional retraining: a randomized clinical trial for pathological worry.
abstract: Research has consistently shown that highly anxious individuals tend to show an attentional bias in favor of threat cues (i.e., a threat bias). Further, recent evidence suggests that it is possible to modify patterns of attention allocation for such stimuli and the resulting changes in attention allocation alter affective responses to stress. However, to date such changes in patterns of attention have been shown only over brief time intervals and only in non-anxious individuals who lack a pre-existing attentional bias. In contrast, the present study tested the efficacy of such attentional training in a sample of severe worriers over an extended period of time using psychometrically validated measures of anxiety and depression.



Twenty-four adult participants reporting severe worry were randomly assigned to receive five sessions of either computer-delivered attentional retraining or sham training. The study was conducted from January to August 2001 and June to August 2002.



Significant Treatment Group X Time interactions were found for both threat bias (p=001) and a composite measure of anxious and depressive symptoms (p=.002). Compared to sham-training, the active retraining program produced significant reductions in both threat bias and symptoms.



These data support the view that an attentional bias in favor of threat cues is an important causal factor in generalized anxiety and suggest that a computer-based attentional retraining procedure may be an effective component of treatment.

title: Examination of vigilance and disengagement of threat in social anxiety with a probe detection task
abstract: Selective attention for threat faces in social anxiety is commonly measured with a probe detection task. Various studies that have used this task show socially anxious individuals exhibit selective attention for threat faces (Mogg & Bradley, 2002; Mogg, Philippot, & Bradley, 2004b; Pishyar, Harris, & Menzies, 2004). Selective attention for threat when measured with a probe detection task is interpreted as an attentional shift toward threat (“vigilance”). Yet, there is data that show socially anxious individuals may have difficulty in shifting their attention away from threat (“disengagement”; Amir, Elias, Klumpp, & Przeworski, 2003). A step toward clarifying the extent to which selective attention for threat comprises vigilance or disengagement effects is described by Koster, Crombez, Verschuere, and de Houwer (2004). We adapted their modified probe detection task to examine vigilance and disengagement effects for threat and happy faces in individuals with and without social anxiety. The results indicate that socially anxious individuals exhibit vigilance for threat faces, but not for happy faces, compared to individuals without social anxiety. Our study is consistent with cognitive theories of anxiety that propose vigilance for threat may contribute to the maintenance of anxiety disorders.

title: Attention training for generalized social anxiety disorder.
abstract: Attentional bias toward negative social cues is thought to serve an etiological and/or maintaining role in social anxiety disorder (SAD). The current study tested whether training patients to disengage from negative social cues may ameliorate social anxiety in patients (N = 36) with a primary diagnosis of generalized SAD. Patients were randomly assigned to either an attention training condition (n = 18), in which patients completed a modified dot-probe task designed to facilitate attentional disengagement from disgusted faces, or a control dot-probe task condition (n = 18). As predicted, patients in the attention training condition exhibited significantly greater reductions in social anxiety and trait anxiety, compared with patients in the control condition. At termination, 72% of patients in the active treatment condition, relative to 11% of patients in the control condition, no longer met Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for SAD. At 4-month follow-up, patients in the attention training condition continued to maintain their clinical improvement, and diagnostic differences across conditions were also maintained. Results support attention-based models of anxiety and suggest that attention training is a promising alternative or complementary intervention.

title: The reduction of anxiety vulnerability through the modification of attentional bias: a real-world study using a home-based cognitive bias modification procedure.
abstract: Recent laboratory work suggests that biased attentional responding to negative information causally impacts anxiety reactivity to a contrived laboratory stressor. However, it remains unknown whether such attentional bias contributes to real-world anxiety vulnerability. In the present study, the authors addressed this issue by experimentally inducing biased attentional response to emotionally negative stimuli, using a home-based attentional training program and then examining the influence of this attentional manipulation on trait anxiety scores and on state anxiety responses to a subsequent stressful life event. The attentional bias modification procedure was effective in inducing attentional avoidance of negative information. Furthermore, this attentional manipulation served to reduce trait anxiety scores and to attenuate state anxiety responses to the subsequent naturalistic stressor. These findings support the hypotheses that biased attentional responding to emotionally negative information contributes causally to real-world anxiety vulnerability.

title: Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: a practice-friendly meta-analysis.
abstract: Do positive psychology interventions-that is, treatment methods or intentional activities aimed at cultivating positive feelings, positive behaviors, or positive cognitions-enhance well-being and ameliorate depressive symptoms? A meta-analysis of 51 such interventions with 4,266 individuals was conducted to address this question and to provide practical guidance to clinicians. The results revealed that positive psychology interventions do indeed significantly enhance well-being (mean r=.29) and decrease depressive symptoms (mean r=.31). In addition, several factors were found to impact the effectiveness of positive psychology interventions, including the depression status, self-selection, and age of participants, as well as the format and duration of the interventions. Accordingly, clinicians should be encouraged to incorporate positive psychology techniques into their clinical work, particularly for treating clients who are depressed, relatively older, or highly motivated to improve. Our findings also suggest that clinicians would do well to deliver positive psychology interventions as individual (versus group) therapy and for relatively longer periods of time.

title: Neural plasticity in response to attention training in anxiety
abstract: Behavioral studies show that attention training can alter threat bias, influence vulnerability to stress and reduce clinical anxiety symptoms. The aim of this study was to examine which cognitive functions of attention processing are modulated by attention training, and how a priori anxiety interacts with the attention training procedure. Specifically, we expected modulation in the P1/N1 event-related potential (ERP) complex if early spatial attention was to be affected by training and modulation in later ERP components (P2, N2, P3) had training affected top-down attentional processes.  Thirty anxious and 30 non-anxious adults performed a modified probe detection task. Electroencephalograms (EEGs) were recorded throughout for later ERP analyses. Half the participants in each anxiety group were randomly assigned to undergo a training procedure designed to divert their attention away from threat and the other half received placebo training.  Anxious participants who were trained to avoid threat showed a linear reduction in response time (RT) to targets replacing neutral faces with the progression of training. This change in RT was not observed among non-anxious participants or among anxious participants who were exposed to placebo training. Following training, the anxious participants who were trained to avoid threat showed a reduction in P2 and P3 mean amplitudes and an enhancement in N2 mean amplitude.  Attention training affects anxious participants whereas non-anxious participants seem not to respond to it. The ERP data suggest that attention training modulates top-down processes of attention control rather than processes of early attention orienting.

title: Attention regulation and monitoring in meditation
abstract: Meditation can be conceptualized as a family of complex emotional and attentional regulatory training regimes developed for various ends, including the cultivation of well-being and emotional balance. Among these various practices, there are two styles that are commonly studied. One style, focused attention meditation, entails the voluntary focusing of attention on a chosen object. The other style, open monitoring meditation, involves nonreactive monitoring of the content of experience from moment to moment. The potential regulatory functions of these practices on attention and emotion processes could have a long-term impact on the brain and behavior.

title: Responding to subliminal threat cues is related to trait anxiety and emotional vulnerability: a successful replication of Macleod and Hagan (1992)
abstract: Macleod and Hagan (1992) [Behaviour Research and Therapy, 30, 151-161] reported that threat-relevant interference on a masked Stroop task, where neutral and negative words cannot be consciously perceived, is positively correlated with trait anxiety and emotional vulnerability to stressful life events. Their findings were obtained from subjects who were currently stressed. The aim of the present study was to determine whether the Macleod and Hagan findings could be replicated in a sample that was not currently stressed. Using a sample of 32 volunteers, we found a significant correlation between trait anxiety and threat-relevant interference on a masked Stroop. Furthermore, it was found that the single best predictor of vulnerability to life stress was the interference on the masked Stroop. The findings of the present study correspond quite closely to those reported by Macleod and Hagan (1992).

title: Meditation can reduce habitual responding.
abstract: Although cognitive aspects of meditation underlie much of its clinical application, very little research has examined meditation's cognitive consequences. This investigation provides experimental support for the idea that meditation leads to a reduction in habitual responding using randomly selected subjects, a secular form of meditation, and a full experimental design.



To test the hypothesis that meditation leads to a reduction in habitual responding.



Studies 1 and 2 each incorporated pre-test and post-test designs with a 20-minute intervening attention task (meditation, rest, or a cognitive control).



Yale University in New Haven, Conn, and the University of California, Berkeley.



One hundred and twenty and 90 undergraduates participated in Studies 1 and 2, respectively.



Stroop and Word Production (category generation and stem-completion) tasks assessed habitual responding in Study 1. Galvanic Skin response measured arousal in Study 1. The category generation task assessed habitual responding in Study 2. Tellegen's Absorption Scale (TAS) measured attention ability.



In Study 1, meditation participants showed a reduction in habitual responding on the Stroop task as compared to controls. Study 1 revealed no statistically significant effects in the word production task. Stroop task performance was not mediated by arousal reduction. In Study 2, meditation participants showed a reduction in habitual responding on the category production task. Specifically, when participants generated either typical or atypical items, on average, meditation participants produced more atypical items than controls. Category production performance was not mediated by Tellegen's Absorption Scale (TAS) scores. Overall, high TAS scores were related to atypical responding.



Across cognitive tasks, when participants understood that the goal was to respond non-habitually, meditation reduced habitual responding.

title: Neural correlates of attentional expertise in long-term meditation practitioners
abstract: Meditation refers to a family of mental training practices that are designed to familiarize the practitioner with specific types of mental processes. One of the most basic forms of meditation is concentration meditation, in which sustained attention is focused on an object such as a small visual stimulus or the breath. In age-matched participants, using functional MRI, we found that activation in a network of brain regions typically involved in sustained attention showed an inverted u-shaped curve in which expert meditators (EMs) with an average of 19,000 h of practice had more activation than novices, but EMs with an average of 44,000 h had less activation. In response to distracter sounds used to probe the meditation, EMs vs. novices had less brain activation in regions related to discursive thoughts and emotions and more activation in regions related to response inhibition and attention. Correlation with hours of practice suggests possible plasticity in these mechanisms.

title: Effects of level of meditation experience on attentional focus: is the efficiency of executive or orientation networks improved?
abstract: The present investigation examined the contributions of specific attentional networks to long-term trait effects of meditation. It was hypothesized that meditation could improve the efficiency of executive processing (inhibits prepotent/incorrect responses) or orientational processing (orients to specific objects in the attentional field). Participants (50 meditators and 10 controls) were given the Stroop (measures executive attention) and Global-Local Letters (measures orientational attention) tasks. Results showed that meditation experience was associated with reduced interference on the Stroop task (p < 0.03), in contrast with a lack of effect on interference in the Global-Local Letters task. This suggests that meditation produces long-term increases in the efficiency of the executive attentional network (anterior cingulate/prefrontal cortex) but no effect on the orientation network (parietal systems). The amount of time participants spent meditating each day, rather than the total number of hours of meditative practice over their lifetime, was negatively correlated with interference on the Stroop task (r = -0.31, p < 0.005).

title: Mindfulness training modifies subsystems of attention
abstract: Mindfulness is defined as paying attention in the present moment. We investigate the hypothesis that mindfulness training may alter or enhance specific aspects of attention. We examined three functionally and neuroanatomically distinct but overlapping attentional subsystems: alerting, orienting, and conflict monitoring. Functioning of each subsystem was indexed by performance on the Attention Network Test (ANT; Fan, McCandliss, Sommer, Raz, & Posner, 2002). Two types of mindfulness training (MT) programs were examined, and behavioral testing was conducted on participants before (Time 1) and after (Time 2) training. One training group consisted of individuals naive to mindfulness techniques who participated in an 8-week mindfulness-based stress reduction (MBSR) course that emphasized the development of concentrative meditation skills. The other training group consisted of individuals experienced in concentrative meditation techniques who participated in a 1-month intensive mindfulness retreat. Performance of these groups was compared with that of control participants who were meditation naive and received no MT. At Time 1, the participants in the retreat group demonstrated improved conflict monitoring performance relative to those in the MBSR and control groups. At Time 2, the participants in the MBSR course demonstrated significantly improved orienting in comparison with the control and retreat participants. In contrast, the participants in the retreat group demonstrated altered performance on the alerting component, with improvements in exogenous stimulus detection in comparison with the control and MBSR participants. The groups did not differ in conflict monitoring performance at Time 2. These results suggest that mindfulness training may improve attention-related behavioral responses by enhancing functioning of specific subcomponents of attention. Whereas participation in the MBSR course improved the ability to endogenously orient attention, retreat participation appeared to allow for the development and emergence of receptive attentional skills, which improved exogenous alerting-related process.

title: Age effects on gray matter volume and attentional performance in Zen meditation
abstract: Zen meditation, a Buddhist practice centered on attentional and postural self-regulation, has been speculated to bring about beneficial long-term effects for the individual, ranging from stress reduction to improvement of cognitive function. In this study, we examined how the regular practice of meditation may affect the normal age-related decline of cerebral gray matter volume and attentional performance observed in healthy individuals. Voxel-based morphometry for MRI anatomical brain images and a computerized sustained attention task were employed in 13 regular practitioners of Zen meditation and 13 matched controls. While control subjects displayed the expected negative correlation of both gray matter volume and attentional performance with age, meditators did not show a significant correlation of either measure with age. The effect of meditation on gray matter volume was most prominent in the putamen, a structure strongly implicated in attentional processing. These findings suggest that the regular practice of meditation may have neuroprotective effects and reduce the cognitive decline associated with normal aging.

title: Mental Training Affects Distribution of Limited Brain Resources
abstract: The information processing capacity of the human mind is limited, as is evidenced by the so-called “attentional-blink” deficit: When two targets (T1 and T2) embedded in a rapid stream of events are presented in close temporal proximity, the second target is often not seen. This deficit is believed to result from competition between the two targets for limited attentional resources. Here we show, using performance in an attentional-blink task and scalp-recorded brain potentials, that meditation, or mental training, affects the distribution of limited brain resources. Three months of intensive mental training resulted in a smaller attentional blink and reduced brain-resource allocation to the first target, as reflected by a smaller T1-elicited P3b, a brain-potential index of resource allocation. Furthermore, those individuals that showed the largest decrease in brain-resource allocation to T1 generally showed the greatest reduction in attentional-blink size. These observations provide novel support for the view that the ability to accurately identify T2 depends upon the efficient deployment of resources to T1. The results also demonstrate that mental training can result in increased control over the distribution of limited brain resources. Our study supports the idea that plasticity in brain and mental function exists throughout life and illustrates the usefulness of systematic mental training in the study of the human mind.

title: Concentrative meditation enhances preattentive processing: a mismatch negativity study
abstract: The mismatch negativity (MMN) paradigm that is an indicator of preattentive processing was used to study the effects of concentrative meditation. Sudarshan Kriya Yoga meditation is a yogic exercise practiced in an ordered sequence beginning with breathing exercises, and ending with concentrative (Sahaj Samadhi) meditation. Auditory MMN waveforms were recorded at the beginning and after each of these practices for meditators, and equivalently after relaxation sessions for the nonmeditators. Overall meditators were found to have larger MMN amplitudes than nonmeditators. The meditators also exhibited significantly increased MMN amplitudes immediately after meditation suggesting transient state changes owing to meditation. The results indicate that concentrative meditation practice enhances preattentive perceptual processes, enabling better change detection in auditory sensory memory.

title: Short-term meditation training improves attention and self-regulation
abstract: Recent studies suggest that months to years of intensive and systematic meditation training can improve attention. However, the lengthy training required has made it difficult to use random assignment of participants to conditions to confirm these findings. This article shows that a group randomly assigned to 5 days of meditation practice with the integrative body–mind training method shows significantly better attention and control of stress than a similarly chosen control group given relaxation training. The training method comes from traditional Chinese medicine and incorporates aspects of other meditation and mindfulness training. Compared with the control group, the experimental group of 40 undergraduate Chinese students given 5 days of 20-min integrative training showed greater improvement in conflict scores on the Attention Network Test, lower anxiety, depression, anger, and fatigue, and higher vigor on the Profile of Mood States scale, a significant decrease in stress-related cortisol, and an increase in immunoreactivity. These results provide a convenient method for studying the influence of meditation training by using experimental and control methods similar to those used to test drugs or other interventions.

title: New Beginnings: Evidence That the Meditational Regimen Can Lead to Optimization of Perception, Attention, Cognition, and Other Functions
abstract: A “framework” is presented for understanding empirically confirmed and unconfirmed phenomena in the Indo‐Tibetan meditation system, from an integrative perspective, and providing evidence that certain meditative practices enable meditators to realize the innate human potential to perceive light “at the limits imposed by quantum mechanics,” on the level of individual photons. This is part of a larger Buddhist agenda to meditatitively develop perceptual/attentional capacities to achieve penetrating insight into the nature of phenomena. Such capacities may also allow advanced meditators to perceive changes in natural scenes that are “hidden” from persons with “normal” attentional capacities, according to research on “change blindness,” and to enhance their visual system functioning akin to high‐speed and time‐lapse photography, in toto allowing for the perception, as well as sophisticated understanding, of the “moment to moment change or impermanence” universally characteristic of the phenomenal world but normally outside untrained attention and perception according to Buddhist doctrine.

title: Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder.
abstract: Mindfulness-based stress reduction (MBSR) is an established program shown to reduce symptoms of stress, anxiety, and depression. MBSR is believed to alter emotional responding by modifying cognitive-affective processes. Given that social anxiety disorder (SAD) is characterized by emotional and attentional biases as well as distorted negative self-beliefs, we examined MBSR-related changes in the brain-behavior indices of emotional reactivity and regulation of negative self-beliefs in patients with SAD. Sixteen patients underwent functional MRI while reacting to negative self-beliefs and while regulating negative emotions using 2 types of attention deployment emotion regulation-breath-focused attention and distraction-focused attention. Post-MBSR, 14 patients completed neuroimaging assessments. Compared with baseline, MBSR completers showed improvement in anxiety and depression symptoms and self-esteem. During the breath-focused attention task (but not the distraction-focused attention task), they also showed (a) decreased negative emotion experience, (b) reduced amygdala activity, and (c) increased activity in brain regions implicated in attentional deployment. MBSR training in patients with SAD may reduce emotional reactivity while enhancing emotion regulation. These changes might facilitate reduction in SAD-related avoidance behaviors, clinical symptoms, and automatic emotional reactivity to negative self-beliefs in adults with SAD.

title: Changed pattern of regional glucose metabolism during yoga meditative relaxation.
abstract: Using positron emission tomography (PET), measurements of the regional cerebral metabolic rate of glucose (rCMRGlc) are able to delineate cerebral metabolic responses to external or mental stimulation. In order to examine possible changes of brain metabolism due to Yoga meditation PET scans were performed in 8 members of a Yoga meditation group during the normal control state (C) and Yoga meditative relaxation (YMR). Whereas there were intraindividual changes of the total CMRGlc, the alterations were not significant for intergroup comparison; specific focal changes or changes in the interhemispheric differences in metabolism were also not seen; however the ratios of frontal vs. occipital rCMRGlc were significantly elevated (p less than 0.05) during YMR. These altered ratios were caused by a slight increase of frontal rCMRGlc and a more pronounced reduction in primary and secondary visual centers. These data indicate a holistic behavior of the brain metabolism during the time of altered state of consciousness during YMR.

title: Effects on regional cerebral blood flow of transcendental meditation
abstract: Previous blood flow measurements in this laboratory have indicated increased nonrenal nonhepatic blood flow during behaviorally induced rest states, especially during the stylized mental technique of transcendental meditation (TM). We have hypothesized that increased cerebral blood flow (CBF) may account for most of the increased nonrenal nonhepatic blood flow during TM. In this report we describe increased frontal and occipital CBF in TM determined by the electrical impedance plethysmographic methodology known as rheoencephalography (REG), which allows noninvasive, nondisturbing, continuous CBF monitoring. We also report high correlation between increased CBF and decreased cerebrovascular resistance (CVR) during TM, suggesting that a contributing vascular mechanism to the increased CBF may be decreased CVR. Because only a small amount of stage 1 sleep was observed during TM and because stage 1 sleep has been reported to be accompanied by decreased CBF, we believe that sleep did not contribute to the CBF increase. The data of this study are consistent with the hypothesis that blood flow changes during TM comprise a patterned response subserving needs of increased cerebral activity.

title: Explicit and implicit memory biases in depression and panic disorder.
abstract: The purpose of the present study was to investigate the presence of a bias for emotional information (panic-related, depression-related, positive and neutral) in explicit memory and implicit memory (by means of free recall and word-stem completion tasks, respectively) among depressed (N=20) and panic (N=20) patients. Three different encoding conditions (graphemic, semantic and self-reference) were used. The results of this study failed to show the existence of a mood-congruent memory bias for both implicit and explicit memory in these emotional disorders. According to the correlational analyses performed, differences among categories of emotional words meant less than the difference among various types of encoding and memory bias in order to differentiate among groups.

title: Neural Correlates of Dispositional Mindfulness During Affect Labeling
abstract: Mindfulness is a process whereby one is aware and receptive to present moment experiences. Although mindfulness-enhancing interventions reduce pathological mental and physical health symptoms across a wide variety of conditions and diseases, the mechanisms underlying these effects remain unknown. Converging evidence from the mindfulness and neuroscience literature suggests that labeling affect may be one mechanism for these effects.  Participants (n = 27) indicated trait levels of mindfulness and then completed an affect labeling task while undergoing functional magnetic resonance imaging. The labeling task consisted of matching facial expressions to appropriate affect words (affect labeling) or to gender-appropriate names (gender labeling control task).  After controlling for multiple individual difference measures, dispositional mindfulness was associated with greater widespread prefrontal cortical activation, and reduced bilateral amygdala activity during affect labeling, compared with the gender labeling control task. Further, strong negative associations were found between areas of prefrontal cortex and right amygdala responses in participants high in mindfulness but not in participants low in mindfulness.  The present findings with a dispositional measure of mindfulness suggest one potential neurocognitive mechanism for understanding how mindfulness meditation interventions reduce negative affect and improve health outcomes, showing that mindfulness is associated with enhanced prefrontal cortical regulation of affect through labeling of negative affective stimuli. fMRI = functional magnetic resonance imaging; PFC = prefrontal cortex; VLPFC = ventrolateral prefrontal cortex; VMPFC = ventromedial prefrontal cortex; MPFC = medial prefrontal cortex; DLPFC = dorsolateral prefrontal cortex.

title: Minding one's emotions: mindfulness training alters the neural expression of sadness.
abstract: Recovery from emotional challenge and increased tolerance of negative affect are both hallmarks of mental health. Mindfulness training (MT) has been shown to facilitate these outcomes, yet little is known about its mechanisms of action. The present study employed functional MRI (fMRI) to compare neural reactivity to sadness provocation in participants completing 8 weeks of MT and waitlisted controls. Sadness resulted in widespread recruitment of regions associated with self-referential processes along the cortical midline. Despite equivalent self-reported sadness, MT participants demonstrated a distinct neural response, with greater right-lateralized recruitment, including visceral and somatosensory areas associated with body sensation. The greater somatic recruitment observed in the MT group during evoked sadness was associated with decreased depression scores. Restoring balance between affective and sensory neural networks-supporting conceptual and body based representations of emotion-could be one path through which mindfulness reduces vulnerability to dysphoric reactivity.

title: Differential engagement of anterior cingulate and adjacent medial frontal cortex in adept meditators and non-meditators
abstract: This study investigated differences in brain activation during meditation between meditators and non-meditators. Fifteen Vipassana meditators (mean practice: 7.9 years, 2h daily) and fifteen non-meditators, matched for sex, age, education, and handedness, participated in a block-design fMRI study that included mindfulness of breathing and mental arithmetic conditions. For the meditation condition (contrasted to arithmetic), meditators showed stronger activations in the rostral anterior cingulate cortex and the dorsal medial prefrontal cortex bilaterally, compared to controls. Greater rostral anterior cingulate cortex activation in meditators may reflect stronger processing of distracting events. The increased activation in the medial prefrontal cortex may reflect that meditators are stronger engaged in emotional processing.

title: Investigation of mindfulness meditation practitioners with voxel-based morphometry.
abstract: Mindfulness meditators practice the non-judgmental observation of the ongoing stream of internal experiences as they arise. Using voxel-based morphometry, this study investigated MRI brain images of 20 mindfulness (Vipassana) meditators (mean practice 8.6 years; 2 h daily) and compared the regional gray matter concentration to that of non-meditators matched for sex, age, education and handedness. Meditators were predicted to show greater gray matter concentration in regions that are typically activated during meditation. Results confirmed greater gray matter concentration for meditators in the right anterior insula, which is involved in interoceptive awareness. This group difference presumably reflects the training of bodily awareness during mindfulness meditation. Furthermore, meditators had greater gray matter concentration in the left inferior temporal gyrus and right hippocampus. Both regions have previously been found to be involved in meditation. The mean value of gray matter concentration in the left inferior temporal gyrus was predictable by the amount of meditation training, corroborating the assumption of a causal impact of meditation training on gray matter concentration in this region. Results suggest that meditation practice is associated with structural differences in regions that are typically activated during meditation and in regions that are relevant for the task of meditation.

title: The underlying anatomical correlates of long-term meditation: Larger hippocampal and frontal volumes of gray matter
abstract: Although the systematic study of meditation is still in its infancy, research has provided evidence for meditation-induced improvements in psychological and physiological well-being. Moreover, meditation practice has been shown not only to benefit higher-order cognitive functions but also to alter brain activity. Nevertheless, little is known about possible links to brain structure. Using high-resolution MRI data of 44 subjects, we set out to examine the underlying anatomical correlates of long-term meditation with different regional specificity (i.e., global, regional, and local). For this purpose, we applied voxel-based morphometry in association with a recently validated automated parcellation approach. We detected significantly larger gray matter volumes in meditators in the right orbito-frontal cortex (as well as in the right thalamus and left inferior temporal gyrus when co-varying for age and/or lowering applied statistical thresholds). In addition, meditators showed significantly larger volumes of the right hippocampus. Both orbito-frontal and hippocampal regions have been implicated in emotional regulation and response control. Thus, larger volumes in these regions might account for meditators' singular abilities and habits to cultivate positive emotions, retain emotional stability, and engage in mindful behavior. We further suggest that these regional alterations in brain structures constitute part of the underlying neurological correlate of long-term meditation independent of a specific style and practice. Future longitudinal analyses are necessary to establish the presence and direction of a causal link between meditation practice and brain anatomy.

title: Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders.
abstract: This study was designed to determine the effectiveness of a group stress reduction program based on mindfulness meditation for patients with anxiety disorders.



The 22 study participants were screened with a structured clinical interview and found to meet the DSM-III-R criteria for generalized anxiety disorder or panic disorder with or without agoraphobia. Assessments, including self-ratings and therapists' ratings, were obtained weekly before and during the meditation-based stress reduction and relaxation program and monthly during the 3-month follow-up period.



Repeated measures analyses of variance documented significant reductions in anxiety and depression scores after treatment for 20 of the subjects--changes that were maintained at follow-up. The number of subjects experiencing panic symptoms was also substantially reduced. A comparison of the study subjects with a group of nonstudy participants in the program who met the initial screening criteria for entry into the study showed that both groups achieved similar reductions in anxiety scores on the SCL-90-R and on the Medical Symptom Checklist, suggesting generalizability of the study findings.



A group mindfulness meditation training program can effectively reduce symptoms of anxiety and panic and can help maintain these reductions in patients with generalized anxiety disorder, panic disorder, or panic disorder with agoraphobia.

title: Effects of Mindfulness-Based Stress Reduction on Medical and Premedical Students
abstract: The inability to cope successfully with the enormous stress of medical education may lead to a cascade of consequences at both a personal and professional level. The present study examined the short-term effects of an 8-week meditation-based stress reduction intervention on premedical and medical students using a well-controlled statistical design. Findings indicate that participation in the intervention can effectively (1) reduce self-reported state and trait anxiety, (2) reduce reports of overall psychological distress including depression, (3) increase scores on overall empathy levels, and (4) increase scores on a measure of spiritual experiences assessed at termination of intervention. These results (5) replicated in the wait-list control group, (6) held across different experiments, and (7) were observed during the exam period. Future research should address potential long-term effects of mindfulness training for medical and premedical students.

title: A Randomized, Wait-List Controlled Clinical Trial: The Effect of a Mindfulness Meditation-Based Stress Reduction Program on Mood and Symptoms of Stress in Cancer Outpatients
abstract: The objective of this study was to assess the effects of participation in a mindfulness meditation–based stress reduction program on mood disturbance and symptoms of stress in cancer outpatients.  A randomized, wait-list controlled design was used. A convenience sample of eligible cancer patients enrolled after giving informed consent and were randomly assigned to either an immediate treatment condition or a wait-list control condition. Patients completed the Profile of Mood States and the Symptoms of Stress Inventory both before and after the intervention. The intervention consisted of a weekly meditation group lasting 1.5 hours for 7 weeks plus home meditation practice.  Ninety patients (mean age, 51 years) completed the study. The group was heterogeneous in type and stage of cancer. Patients’ mean preintervention scores on dependent measures were equivalent between groups. After the intervention, patients in the treatment group had significantly lower scores on Total Mood Disturbance and subscales of Depression, Anxiety, Anger, and Confusion and more Vigor than control subjects. The treatment group also had fewer overall Symptoms of Stress; fewer Cardiopulmonary and Gastrointestinal symptoms; less Emotional Irritability, Depression, and Cognitive Disorganization; and fewer Habitual Patterns of stress. Overall reduction in Total Mood Disturbance was 65%, with a 31% reduction in Symptoms of Stress.  This program was effective in decreasing mood disturbance and stress symptoms in both male and female patients with a wide variety of cancer diagnoses, stages of illness, and ages.

title: Mindfulness-based psychotherapies: a review of conceptual foundations, empirical evidence and practical considerations.
abstract: This paper, composed by an interest group of clinicians and researchers based in Melbourne, presents some background to the practice of mindfulness-based therapies as relevant to the general professional reader. We address the empirical evidence for these therapies, the principles through which they might operate, some practical questions facing those wishing to commence practice in this area or to refer patients into mindfulness-based therapies, and some considerations relevant to the conduct and interpretation of research into the therapeutic application of mindfulness.



Databases (e.g. PsycINFO, MEDLINE) were searched for literature on the impact of mindfulness interventions, and the psychological and biological mechanisms that underpin the effects of mindfulness practice. This paper also draws upon the clinical experience of the author group.



Mindfulness practice and principles have their origins in many contemplative and philosophical traditions but individuals can effectively adopt the training and practice of mindfulness in the absence of such traditions or vocabulary. A recent surge of interest regarding mindfulness in therapeutic techniques can be attributed to the publication of some well-designed empirical evaluations of mindfulness-based cognitive therapy. Arising from this as well as a broader history of clinical integration of mindfulness and Western psychotherapies, a growing number of clinicians have interest and enthusiasm to learn the techniques of mindfulness and to integrate them into their therapeutic work. This review highlights the importance of accurate professional awareness and understanding of mindfulness and its therapeutic applications.



The theoretical and empirical literatures on therapeutic applications of mindfulness are in states of significant growth and development. This group suggests, based on this review, that the combination of some well-developed conceptual models for the therapeutic action of mindfulness and a developing empirical base, justifies a degree of optimism that mindfulness-based approaches will become helpful strategies to offer in the care of patients with a wide range of mental and physical health problems.

title: A randomized controlled trial of mindfulness meditation versus relaxation training: Effects on distress, positive states of mind, rumination, and distraction
abstract: Although mindfulness meditation interventions have recently shown benefits for reducing stress in various populations, little is known about their relative efficacy compared with relaxation interventions. This randomized controlled trial examines the effects of a 1-month mindfulness meditation versus somatic relaxation training as compared to a control group in 83 students (M age=25; 16 men and 67 women) reporting distress. Psychological distress, positive states of mind, distractive and ruminative thoughts and behaviors, and spiritual experience were measured, while controlling for social desirability. Hierarchical linear modeling reveals that both meditation and relaxation groups experienced significant decreases in distress as well as increases in positive mood states over time, compared with the control group (p<.05 in all cases). There were no significant differences between meditation and relaxation on distress and positive mood states over time. Effect sizes for distress were large for both meditation and relaxation (Cohen’s d=1.36 and .91, respectively), whereas the meditation group showed a larger effect size for positive states of mind than relaxation (Cohen’s d=.71 and .25, respectively). The meditation group also demonstrated significant pre-post decreases in both distractive and ruminative thoughts/behaviors compared with the control group (p<.04 in all cases; Cohen’s d=.57 for rumination and .25 for distraction for the meditation group), with mediation models suggesting that mindfulness meditation’s effects on reducing distress were partially mediated by reducing rumination. No significant effects were found for spiritual experience. The data suggest that compared with a no-treatment control, brief training in mindfulness meditation or somatic relaxation reduces distress and improves positive mood states. However, mindfulness meditation may be specific in its ability to reduce distractive and ruminative thoughts and behaviors, and this ability may provide a unique mechanism by which mindfulness meditation reduces distress.

title: Treatment-resistant Depressed Patients Show a Good Response to Mindfulness-based Cognitive Therapy
abstract: Mindfulness-based Cognitive Therapy (MBCT) is a class-based programme designed for use in the prevention of relapse of major depression. Its aim is to teach participants to disengage from those cognitive processes that may render them vulnerable to future episodes. These same cognitive processes are also known to maintain depression once established, hence a clinical audit was conducted to explore the use of MBCT in patients who were currently actively depressed, and who had not responded fully to standard treatments. The study showed that it was acceptable to these patients and resulted in an improvement in depression scores (pre-post Effect Size=1.04), with a significant proportion of patients returning to normal or near-normal levels of mood. (Reprinted with permission from Behaviour Research and Therapy 2007; 45:617–625)

title: Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer
abstract: This investigation used a non-randomized controlled design to evaluate the effect and feasibility of a mindfulness based stress reduction (MBSR) program on immune function, quality of life (QOL), and coping in women recently diagnosed with breast cancer. Early stage breast cancer patients, who did not receive chemotherapy, self-selected into an 8-week MBSR program or into an assessment only, control group. Outcomes were evaluated over time. The first assessment was at least 10 days after surgery and prior to adjuvant therapy, as well as before the MBSR start-up. Further assessments were mid-MBSR, at completion of MBSR, and at 4-week post-MBSR completion. Women with breast cancer enrolled in the control group (Non-MBSR) were assessed at similar times. At the first assessment (i.e., before MBSR start), reductions in peripheral blood mononuclear cell NK cell activity (NKCA) and IFN-gamma production with increases in IL-4, IL-6, and IL-10 production and plasma cortisol levels were observed for both the MBSR and Non-MBSR groups of breast cancer patients. Over time women in the MBSR group re-established their NKCA and cytokine production levels. In contrast, breast cancer patients in the Non-MBSR group exhibited continued reductions in NKCA and IFN-gamma production with increased IL-4, IL-6, and IL-10 production. Moreover, women enrolled in the MBSR program had reduced cortisol levels, improved QOL, and increased coping effectiveness compared to the Non-MBSR group. In summary, MBSR is a program that is feasible for women recently diagnosed with early stage breast cancer and the results provide preliminary evidence for beneficial effects of MBSR; on immune function, QOL, and coping.

title: Neural correlates of processing valence and arousal in affective words.
abstract: Psychological frameworks conceptualize emotion along 2 dimensions, "valence" and "arousal." Arousal invokes a single axis of intensity increasing from neutral to maximally arousing. Valence can be described variously as a bipolar continuum, as independent positive and negative dimensions, or as hedonic value (distance from neutral). In this study, we used functional magnetic resonance imaging to characterize neural activity correlating with arousal and with distinct models of valence during presentation of affective word stimuli. Our results extend observations in the chemosensory domain suggesting a double dissociation in which subregions of orbitofrontal cortex process valence, whereas amygdala preferentially processes arousal. In addition, our data support the physiological validity of descriptions of valence along independent axes or as absolute distance from neutral but fail to support the validity of descriptions of valence along a bipolar continuum.

title: Stress reduction correlates with structural changes in the amygdala.
abstract: Stress has significant adverse effects on health and is a risk factor for many illnesses. Neurobiological studies have implicated the amygdala as a brain structure crucial in stress responses. Whereas hyperactive amygdala function is often observed during stress conditions, cross-sectional reports of differences in gray matter structure have been less consistent. We conducted a longitudinal MRI study to investigate the relationship between changes in perceived stress with changes in amygdala gray matter density following a stress-reduction intervention. Stressed but otherwise healthy individuals (N = 26) participated in an 8-week mindfulness-based stress reduction intervention. Perceived stress was rated on the perceived stress scale (PSS) and anatomical MR images were acquired pre- and post-intervention. PSS change was used as the predictive regressor for changes in gray matter density within the bilateral amygdalae. Following the intervention, participants reported significantly reduced perceived stress. Reductions in perceived stress correlated positively with decreases in right basolateral amygdala gray matter density. Whereas prior studies found gray matter modifications resulting from acquisition of abstract information, motor and language skills, this study demonstrates that neuroplastic changes are associated with improvements in a psychological state variable.

title: Effect of buddhist meditation on serum cortisol and total protein levels, blood pressure, pulse rate, lung volume and reaction time
abstract: Serum cortisol and total protein levels, blood pressure, heart rate, lung volume, and reaction time were studied in 52 males 20-25 years of age practicing Dhammakaya Buddhist meditation, and in 30 males of the same age group not practicing meditation. It was found that after meditation, serum cortisol levels were significantly reduced, serum total protein level significantly increased, and systolic pressure, diastolic pressure and pulse rate significantly reduced. Vital capacity, tidal volume and maximal voluntary ventilation were significantly lower after meditation than before. There were also significant decreases in reaction time after mediation practice. The percentage decrease in reaction time during meditation was 22%, while in subjects untrained in meditation, the percentage decrease was only 7%. Results from these studies indicate that practising Dhammakaya Buddhist meditation produces biochemical and physiological changes and reduces the reaction time.

title: Altered Responses of Cortisol, GH, TSH and Testosterone to Acute Stress after Four Months' Practice of Transcendental Meditation (TM) a
abstract: Evidence is growing for a role of chronic stress in the etiology of several psychiatric and somatic disorders. Thus, stress reduction techniques are beginning to receive attention as preventative or treatment alternatives. Previous studies suggesting that TM might produce benefits by strengthening adaptive mechanisms implied its effects would be opposite to those resulting from chronic stress.'" The present study investigates changes in neuroendocrine responses to acute laboratory stressors before and after four months of twice-daily practice of TM or of a cognitive approach to stress reduction. The effects of chronic stress on the hormones investigated in this study have been documented in previous studies on humans and/or nonhuman primates. In the wild baboon, chronic stress appears to elevate baseline cortisol and to reduce the cortisol response to acute stressors." This may be due in part to alterations in hippocampal neurons caused by frequent stress-induced elevations of cortisol. Since the above cortisol profile is associated with poorer health than its opposite, these and other results may support a stress-induced loss of hippocampal regulation of the hypothalamic-pituitary-adrenocortical axis as an important factor in disease and aging.5 In contrast to its tendency to elevate baseline cortisol, chronic stress appears to decrease testosterone titers, both in animals and in humans.Furthermore, a study of the relationship between social status and testosterone in the wild baboon reported an increase of testosterone in response to acute stress in successful males, while subordinate males (who appear chronically stressed) showed a decrease. In humans, thyroid stimulating hormone (TSH) has been reported to increase during strenuous exercise9 and in a stressful interview.I0 Short-term stressors may increase GH release,

title: One year pre–post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients
abstract: This study investigated the ongoing effects of participation in a mindfulness-based stress reduction (MBSR) program on quality of life (QL), symptoms of stress, mood and endocrine, immune and autonomic parameters in early stage breast and prostate cancer patients.



Forty-nine patients with breast cancer and 10 with prostate cancer enrolled in an eight-week MBSR program that incorporated relaxation, meditation, gentle yoga and daily home practice. Demographic and health behaviors, QL, mood, stress symptoms, salivary cortisol levels, immune cell counts, intracellular cytokine production, blood pressure (BP) and heart rate (HR) were assessed pre- and post-intervention, and at 6- and 12-month follow-up.



Fifty-nine, 51, 47 and 41 patients were assessed pre- and post-intervention and at 6- and 12-month follow-up, respectively, although not all participants provided data on all outcomes at each time point. Linear mixed modeling showed significant improvements in overall symptoms of stress which were maintained over the follow-up period. Cortisol levels decreased systematically over the course of the follow-up. Immune patterns over the year supported a continued reduction in Th1 (pro-inflammatory) cytokines. Systolic blood pressure (SBP) decreased from pre- to post-intervention and HR was positively associated with self-reported symptoms of stress.



MBSR program participation was associated with enhanced quality of life and decreased stress symptoms, altered cortisol and immune patterns consistent with less stress and mood disturbance, and decreased blood pressure. These pilot data represent a preliminary investigation of the longer-term relationships between MBSR program participation and a range of potentially important biomarkers.

title: Selective Attentional Bias Towards Pain-Related Threat in Fibromyalgia: Preliminary Evidence for Effects of Mindfulness Meditation Training
abstract: The current study investigated the effects of an 8-week mindfulness-based meditation training (MMT) intervention on attentional bias, engagement and disengagement of pain-related threat in fibromyalgia patients as compared to an age-matched control group. A well validated dot-probe task was used to explore early versus later stages of attentional processing through the use of two stimulus exposure durations (100, 500 ms) of pain-related threat words. The enduring effects of MMT were assessed 6-months after completion of MMT. Preliminary results suggest that MMT reduces avoidance of pain-related threat at early levels of processing, and facilitates disengagement from threat at later stages of processing. Furthermore, it appears that effects of MMT on early attentional threat processing do not remain stable after long-term follow-up.

title: The Effect of a Brief Mindfulness Intervention on Memory for Positively and Negatively Valenced Stimuli
abstract: A core component of mindfulness is non-judgmental observation of internal and external stimuli. The present study investigated the effect of mindfulness on memory for emotional stimuli. Participants were exposed to a brief mindfulness intervention and subsequently performed a verbal learning test consisting of positive, neutral, and negative words. Control participants received no intervention and directly performed the verbal learning test. After 20 min, participants recalled as many words as possible. Participants in the mindfulness condition remembered a significantly lower proportion of negative words compared to control participants. No differences between both groups were observed for the proportion of remembered positive words. These findings suggest that memory processes may be a potential mechanism underlying the link between mindfulness and subjective well-being.

title: Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program
abstract: Relationships were investigated between home practice of mindfulness meditation exercises and levels of mindfulness, medical and psychological symptoms, perceived stress, and psychological well-being in a sample of 174 adults in a clinical Mindfulness-Based Stress Reduction (MBSR) program. This is an 8- session group program for individuals dealing with stress-related problems, illness, anxiety, and chronic pain. Participants completed measures of mindfulness, perceived stress, symptoms, and well-being at pre- and post-MBSR, and monitored their home practice time throughout the intervention. Results showed increases in mindfulness and well-being, and decreases in stress and symptoms, from pre- to post-MBSR. Time spent engaging in home practice of formal meditation exercises (body scan, yoga, sitting meditation) was significantly related to extent of improvement in most facets of mindfulness and several measures of symptoms and well-being. Increases in mindfulness were found to mediate the relationships between formal mindfulness practice and improvements in psychological functioning, suggesting that the practice of mindfulness meditation leads to increases in mindfulness, which in turn leads to symptom reduction and improved well-being

title: Is learning mindfulness associated with improved affect after mindfulness-based cognitive therapy?
abstract: The increased popularity of mindfulness-based interventions and the growing body of empirical evidence confirming the positive effects of these interventions on well-being warrant more research to determine if the effects are indeed related to learning mindfulness. The present study extends previous studies, by examining whether and how changes in five core aspects of mindfulness are related to changes in the report of negative and positive affect during an 8-week course of mindfulness-based cognitive therapy. The study was performed in 64 individuals from the community with mild to moderate psychological problems. Data were collected by self-report questionnaires before and directly after the training. Results showed significant decreases in negative affect and increases in positive affect. We also found significant increases in four of the five aspects of mindfulness. Importantly, changes in mindfulness were significantly associated with improved affect, with a distinct pattern found for positive and negative affect. Hereby, our findings extend previous research by showing that learning distinct aspects of mindfulness is differently related to an improved positive affect and a decreased negative affect. Future randomized controlled trials with a larger sample and longer follow-up period are needed to replicate these findings.

title: Psychological Well-Being and Ill-Being: Do They Have Distinct or Mirrored Biological Correlates?
abstract: Increasingly, researchers attend to both positive and negative aspects of mental health. Such distinctions call for clarification of whether psychological well-being and ill-being comprise opposite ends of a bipolar continuum, or are best construed as separate, independent dimensions of mental health. Biology can help resolve this query – bipolarity predicts ‘mirrored’ biological correlates (i.e. well-being and ill-being correlate similarly with biomarkers, but show opposite directional signs), whereas independence predicts ‘distinct’ biological correlates (i.e. well-being and ill-being have different biological signatures).  Multiple aspects of psychological well-being (eudaimonic, hedonic) and ill-being (depression, anxiety, anger) were assessed in a sample of aging women (n = 135, mean age = 74) on whom diverse neuroendocrine (salivary cortisol, epinephrine, norepinephrine, DHEA-S) and cardiovascular factors (weight, waist-hip ratio, systolic and diastolic blood pressure, HDL cholesterol, total/HDL cholesterol, glycosylated hemoglobin) were also measured.  Measures of psychological well-being and ill-being were significantly linked with numerous biomarkers, with some associations being more strongly evident for respondents aged 75+. Outcomes for seven biomarkers supported the distinct hypothesis, while findings for only two biomarkers supported the mirrored hypothesis.  This research adds to the growing literature on how psychological well-being and mental maladjustment are instantiated in biology. Population-based inquiries and challenge studies constitute important future directions.

title: Psychology as the Science of Self-Reports and Finger Movements: Whatever Happened to Actual Behavior?
abstract: Psychology calls itself the science of behavior, and the American Psychological Association's current “Decade of Behavior” was intended to increase awareness and appreciation of this aspect of the science. Yet some psychological subdisciplines have never directly studied behavior, and studies on behavior are dwindling rapidly in other subdisciplines. We discuss the eclipse of behavior in personality and social psychology, in which direct observation of behavior has been increasingly supplanted by introspective self-reports, hypothetical scenarios, and questionnaire ratings. We advocate a renewed commitment to including direct observation of behavior whenever possible and in at least a healthy minority of research projects.

title: Treatment Choice and Placebo Expectation Effects
abstract: Placebo expectations can have a strong influence on physical and mental health outcomes. In prior research examining placebo expectation effects, participants have been assigned placebo treatments rather than being actively involved in selecting their treatment. In modern health care, however, individuals are often involved in health care decisions. We review relevant literature regarding choice and placebo expectation effects and conclude that exercising choice over a treatment should strengthen placebo effects. Data relevant to this hypothesis is reviewed. Next, we provide a framework for understanding the key variables involved in mediating and moderating the influence of treatment choice on placebo expectation effects. Finally, theoretical and practical issues revolving around treatment choice in the context of placebo effects are raised.

title: DMDX: A Windows display program with millisecond accuracy
abstract: DMDX is a Windows-based program designed primarily for language-processing experiments. It uses the features of Pentium class CPUs and the library routines provided in DirectX to provide accurate timing and synchronization of visual and audio output. A brief overview of the design of the program is provided, together with the results of tests of the accuracy of timing. The Web site for downloading the software is given, but the source code is not available.

title: Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications.
abstract: We review psychometric and other evidence relevant to mixed anxiety-depression. Properties of anxiety and depression measures, including the convergent and discriminant validity of self- and clinical ratings, and interrater reliability, are examined in patient and normal samples. Results suggest that anxiety and depression can be reliably and validly assessed; moreover, although these disorders share a substantial component of general affective distress, they can be differentiated on the basis of factors specific to each syndrome. We also review evidence for these specific factors, examining the influence of context and scale content on ratings, factor analytic studies, and the role of low positive affect in depression. With these data, we argue for a tripartite structure consisting of general distress, physiological hyperarousal (specific anxiety), and anhedonia (specific depression), and we propose a diagnosis of mixed anxiety-depression.

title: Happiness is everything, or is it? Explorations on the meaning of psychological well-being.
abstract: Reigning measures of psychological well-being have little theoretical grounding, despite an extensive literature on the contours of positive functioning. Aspects of well-being derived from this literature (i.e., self-acceptance, positive relations with others, autonomy, environmental mastery, purpose in life, and personal growth) were operationalized. Three hundred and twenty-one men and women, divided among young, middle-aged, and older adults, rated themselves on these measures along with six instruments prominent in earlier studies (i.e., affect balance, life satisfaction, self-esteem, morale, locus of control, depression). Results revealed that positive relations with others, autonomy, purpose in life, and personal growth were not strongly tied to prior assessment indexes, thereby supporting the claim that key aspects of positive functioning have not been represented in the empirical arena. Furthermore, age profiles revealed a more differentiated pattern of well-being than is evident in prior research.

title: Using SPSS for Windows and Macintosh : Analyzing and Understanding Data
abstract: For courses in Introductory Statistics and Research Methods courses using SPSS. Using SPSS guides students through the most basic of SPSS techniques usingstep-by-step descriptions, presents statistical techniques andinstruction on how to conduct statistical analyses, and explains in detail how to avoid all theobstacles common in the study of statistics. The development of easy-to-use statistical software like SPSS has changed the way statistics is being taught and learned. Students can make transformations of variables, creategraphs of distributions of variables,and select among statistical analyses all at the click of a button. However, even with these advancements,students sometimes still find statistics to be an arduous task. Theycontinue to befaced with many potential obstacles and they might feel overwhelmed and stressed rather than challenged and excited about the potential for mastering these important skills. Samuel Green and Neil Salkind have written a text to specifically address these issues.

title: Alterations in Brain and Immune Function Produced by Mindfulness Meditation
abstract: The underlying changes in biological processes that are associated with reported changes in mental and physical health in response to meditation have not been systematically explored. We performed a randomized, controlled study on the effects on brain and immune function of a well‐known and widely used 8‐week clinical training program in mindfulness meditation applied in a work environment with healthy employees.  We measured brain electrical activity before and immediately after, and then 4 months after an 8‐week training program in mindfulness meditation. Twenty‐five subjects were tested in the meditation group. A wait‐list control group (N = 16) was tested at the same points in time as the meditators. At the end of the 8‐week period, subjects in both groups were vaccinated with influenza vaccine.  We report for the first time significant increases in left‐sided anterior activation, a pattern previously associated with positive affect, in the meditators compared with the nonmeditators. We also found significant increases in antibody titers to influenza vaccine among subjects in the meditation compared with those in the wait‐list control group. Finally, the magnitude of increase in left‐sided activation predicted the magnitude of antibody titer rise to the vaccine.  These findings demonstrate that a short program in mindfulness meditation produces demonstrable effects on brain and immune function. These findings suggest that meditation may change brain and immune function in positive ways and underscore the need for additional research.

title: Well-being and affective style: neural substrates and biobehavioural correlates.
abstract: One of the most salient features of emotion is the pronounced variability among individuals in their reactions to emotional incentives and in their dispositional mood. Collectively, these individual differences have been described as affective style. Recent research has begun to dissect the constituents of affective style. The search for these components is guided by the neural systems that instantiate emotion and emotion regulation. In this article, this body of research and theory is applied specifically to positive affect and well-being. The central substrates and peripheral biological correlates of well-being are described. A resilient affective style is associated with high levels of left prefrontal activation, effective modulation of activation in the amygdala and fast recovery in response to negative and stressful events. In peripheral biology, these central patterns are associated with lower levels of basal cortisol and with higher levels of antibody titres to influenza vaccine. The article concludes with a consideration of whether these patterns of central and peripheral biology can be modified by training and shifted toward a more salubrious direction.

title: State Effects of Two Forms of Meditation on Prefrontal EEG Asymmetry in Previously Depressed Individuals
abstract: We investigated state effects of two forms of meditation on electroencephalography prefrontal α-asymmetry, a global indicator of approach versus withdrawal motivation and related affective state. A clinical series of previously depressed individuals were guided to practice either mindfulness breathing meditation (N = 8) or a form of meditation directly aimed at cultivating positive affect, loving kindness or metta meditation (N = 7). Prefrontal asymmetry was assessed directly before and after the 15-min meditation period. Results showed changes in asymmetry towards stronger relative left prefrontal activation, i.e., stronger approach tendencies, regardless of condition. Further explorations of these findings suggested that responses were moderated by participants’ tendencies to engage in ruminative brooding. Individuals high in brooding tended to respond to breathing meditation but not loving kindness meditation, while those low in brooding showed the opposite pattern. Comparisons with an additionally recruited “rest” group provided evidence suggesting that changes seen were not simply attributable to habituation. The results indicate that both forms of meditation practice can have beneficial state effects on prefrontal α-asymmetry and point towards differential indications for offering them in the treatment of previously depressed patients.

title: Frontal Electroencephalographic Asymmetry Associated With Positive Emotion Is Produced by Very Brief Meditation Training
abstract: Meditation training changes the brain. Recent reports suggest that 70 or more hours of standardized training in mindfulness meditation across 8 weeks shifts electroencephalographic (EEG) asymmetry toward a pattern associated with positive emotion (Davidson et al., 2003) and increases gray matter in the left hippocampus (Hölzel et al., 2010). Such training is dwarfed by the 10,000 or more hours accumulated by expert Buddhist practitioners (Lutz, Greischar, Rawlings, Ricard, & Davidson, 2004), but it likely represents a daunting commitment to many people. We examined whether frontal EEG asymmetry could be generated by a more accessible amount of meditation training.

title: Increased dopamine tone during meditation-induced change of consciousness.
abstract: This is the first in vivo demonstration of an association between endogenous neurotransmitter release and conscious experience. Using 11C-raclopride PET we demonstrated increased endogenous dopamine release in the ventral striatum during Yoga Nidra meditation. Yoga Nidra is characterized by a depressed level of desire for action, associated with decreased blood flow in prefrontal, cerebellar and subcortical regions, structures thought to be organized in open loops subserving executive control. In the striatum, dopamine modulates excitatory glutamatergic synapses of the projections from the frontal cortex to striatal neurons, which in turn project back to the frontal cortex via the pallidum and ventral thalamus. The present study was designed to investigate whether endogenous dopamine release increases during loss of executive control in meditation. Participants underwent two 11C-raclopride PET scans: one while attending to speech with eyes closed, and one during active meditation. The tracer competes with endogenous dopamine for access to dopamine D2 receptors predominantly found in the basal ganglia. During meditation, 11C-raclopride binding in ventral striatum decreased by 7.9%. This corresponds to a 65% increase in endogenous dopamine release. The reduced raclopride binding correlated significantly with a concomitant increase in EEG theta activity, a characteristic feature of meditation. All participants reported a decreased desire for action during meditation, along with heightened sensory imagery. The level of gratification and the depth of relaxation did not differ between the attention and meditation conditions. Here we show increased striatal dopamine release during meditation associated with the experience of reduced readiness for action. It is suggested that being in the conscious state of meditation causes a suppression of cortico-striatal glutamatergic transmission. To our knowledge this is the first time in vivo evidence has been provided for regulation of conscious states at a synaptic level.

title: The neurobiology of positive emotions
abstract: Compared to the study of negative emotions such as fear, the neurobiology of positive emotional processes and the associated positive affect (PA) states has only recently received scientific attention. Biological theories conceptualize PA as being related to (i) signals indicating that bodies are returning to equilibrium among those studying homeostasis, (ii) utility estimation among those favoring neuroeconomic views, and (iii) approach and other instinctual behaviors among those cultivating neuroethological perspectives. Indeed, there are probably several distinct forms of positive affect, but all are closely related to ancient sub-neocortical limbic brain regions we share with other mammals. There is now a convergence of evidence to suggest that various regions of the limbic system, including especially ventral striatal dopamine systems are implemented in an anticipatory (appetitive) positive affective state. Dopamine independent mechanisms utilizing opiate and GABA receptors in the ventral striatum, amygdala and orbital frontal cortex are important in elaborating consummatory PA (i.e. sensory pleasure) states, and various neuropeptides mediate homeostatic satisfactions.

title: Neural mechanisms mediating optimism bias
abstract: Humans expect positive events in the future even when there is no evidence to support such expectations. For example, people expect to live longer and be healthier than average, they underestimate their likelihood of getting a divorce, and overestimate their prospects for success on the job market. We examined how the brain generates this pervasive optimism bias. Here we report that this tendency was related specifically to enhanced activation in the amygdala and in the rostral anterior cingulate cortex when imagining positive future events relative to negative ones, suggesting a key role for areas involved in monitoring emotional salience in mediating the optimism bias. These are the same regions that show irregularities in depression, which has been related to pessimism. Across individuals, activity in the rostral anterior cingulate cortex was correlated with trait optimism. The current study highlights how the brain may generate the tendency to engage in the projection of positive future events, suggesting that the effective integration and regulation of emotional and autobiographical information supports the projection of positive future events in healthy individuals, and is related to optimism.

title: How unrealistic optimism is maintained in the face of reality
abstract: Unrealistic optimism is a pervasive human trait that influences domains ranging from personal relationships to politics and finance. How people maintain unrealistic optimism, despite frequently encountering information that challenges those biased beliefs, is unknown. We examined this question and found a marked asymmetry in belief updating. Participants updated their beliefs more in response to information that was better than expected than to information that was worse. This selectivity was mediated by a relative failure to code for errors that should reduce optimism. Distinct regions of the prefrontal cortex tracked estimation errors when those called for positive update, both in individuals who scored high and low on trait optimism. However, highly optimistic individuals exhibited reduced tracking of estimation errors that called for negative update in right inferior prefrontal gyrus. These findings indicate that optimism is tied to a selective update failure and diminished neural coding of undesirable information regarding the future.

title: The neural basis of mood-congruent processing biases in depression.
abstract: Mood-congruent processing biases are among the most robust research findings in neuropsychological studies of depression. Depressed patients show preferential processing of negatively toned stimuli across a range of cognitive tasks. The present study aimed to determine whether these behavioral abnormalities are associated with specific neural substrates.



Ten depressed patients and 11 healthy control subjects underwent scanning during performance of an emotional go/no-go task using functional magnetic resonance imaging. The task allowed comparison among neural response to happy, sad, and neutral words, in the context of these words as targets (ie, stimuli to which subjects were required to make a motor response) or distractors (ie, stimuli to which the motor response was withheld).



Depressed patients showed attenuated neural responses to emotional relative to neutral targets in ventral cingulate and posterior orbitofrontal cortices. However, patients showed elevated responses specific to sad targets in rostral anterior cingulate extending to anterior medial prefrontal cortex. Unlike controls, patients showed differential neural response to emotional, particularly sad, distractors in the lateral orbitofrontal cortex.



These findings suggest a distinct neural substrate for mood-congruent processing biases in performance. The medial and orbital prefrontal regions may play a key role in mediating the interaction between mood and cognition in affective disorder.

title: Neural basis of the emotional Stroop interference effect in major depression
abstract: A mood-congruent sensitivity towards negative stimuli has been associated with development and maintenance of major depressive disorder (MDD). The emotional Stroop task assesses interference effects arising from the conflict of emotional expressions consistent with disorder-specific self-schemata and cognitive colour-naming instructions. Functional neuroimaging studies of the emotional Stroop effect advocate a critical involvement of the anterior cingulate cortex (ACC) during these processes.  Subjects were 17 medication-free individuals with unipolar MDD in an acute depressive episode (mean age 39 years), and 17 age-, gender- and IQ-matched healthy volunteers. In an emotional Stroop task, sad and neutral words were presented in various colours, and subjects were required to name the colour of words whilst undergoing functional magnetic resonance imaging (fMRI). Overt verbal responses were acquired with a clustered fMRI acquisition sequence.  Individuals with depression showed greater increases in response time from neutral to sad words relative to controls. fMRI data showed a significant engagement of left rostral ACC (BA 32) and right precuneus during sad words in patients relative to controls. Additionally, rostral ACC activation was positively correlated with latencies of negative words in MDD patients. Healthy controls did not have any regions of increased activation compared to MDD patients.  These findings provide evidence for a behavioural and neural emotional Stroop effect in MDD and highlight the importance of the ACC during monitoring of conflicting cognitive processes and mood-congruent processing in depression.

title: Neural correlates of inhibitory deficits in depression
abstract: The present study used functional magnetic resonance imaging to examine neural correlates of inhibitory dysfunction in individuals diagnosed with major depressive disorder (MDD). Twelve MDD participants and 12 never-depressed controls completed the negative affective priming (NAP) task in the scanner. Results indicated that, in depressed participants, increased activation in the rostral anterior cingulate cortex (rACC) is associated with inhibition of negative, but not positive, words; in contrast, in nondepressed participants, inhibition of positive, but not negative, words is associated with increased activation in the rACC. These findings indicate that abnormalities in neural function, especially in the rACC, may underlie difficulties experienced by depressed individuals in inhibiting negative thoughts. These results underscore the importance of continuing to examine the relation between cognitive and neural functioning in depression in order to gain a broader and more integrative understanding of this disorder.

title: Mindfulness practice leads to increases in regional brain gray matter density
abstract: Therapeutic interventions that incorporate training in mindfulness meditation have become increasingly popular, but to date little is known about neural mechanisms associated with these interventions. Mindfulness-Based Stress Reduction (MBSR), one of the most widely used mindfulness training programs, has been reported to produce positive effects on psychological well-being and to ameliorate symptoms of a number of disorders. Here, we report a controlled longitudinal study to investigate pre-post changes in brain gray matter concentration attributable to participation in an MBSR program. Anatomical magnetic resonance (MR) images from 16 healthy, meditation-naïve participants were obtained before and after they underwent the 8-week program. Changes in gray matter concentration were investigated using voxel-based morphometry, and compared with a waiting list control group of 17 individuals. Analyses in a priori regions of interest confirmed increases in gray matter concentration within the left hippocampus. Whole brain analyses identified increases in the posterior cingulate cortex, the temporo-parietal junction, and the cerebellum in the MBSR group compared with the controls. The results suggest that participation in MBSR is associated with changes in gray matter concentration in brain regions involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking.

title: Cortical thickness and pain sensitivity in zen meditators.
abstract: Zen meditation has been associated with low sensitivity on both the affective and the sensory dimensions of pain. Given reports of gray matter differences in meditators as well as between chronic pain patients and controls, the present study investigated whether differences in brain morphometry are associated with the low pain sensitivity observed in Zen practitioners. Structural MRI scans were performed and the temperature required to produce moderate pain was assessed in 17 meditators and 18 controls. Meditators had significantly lower pain sensitivity than controls. Assessed across all subjects, lower pain sensitivity was associated with thicker cortex in affective, pain-related brain regions including the anterior cingulate cortex, bilateral parahippocampal gyrus and anterior insula. Comparing groups, meditators were found to have thicker cortex in the dorsal anterior cingulate and bilaterally in secondary somatosensory cortex. More years of meditation experience was associated with thicker gray matter in the anterior cingulate, and hours of experience predicted more gray matter bilaterally in the lower leg area of the primary somatosensory cortex as well as the hand area in the right hemisphere. Results generally suggest that pain sensitivity is related to cortical thickness in pain-related brain regions and that the lower sensitivity observed in meditators may be the product of alterations to brain morphometry from long-term practice.

title: Neural systems supporting interoceptive awareness
abstract: Influential theories of human emotion argue that subjective feeling states involve representation of bodily responses elicited by emotional events. Within this framework, individual differences in intensity of emotional experience reflect variation in sensitivity to internal bodily responses. We measured regional brain activity by functional magnetic resonance imaging (fMRI) during an interoceptive task wherein subjects judged the timing of their own heartbeats. We observed enhanced activity in insula, somatomotor and cingulate cortices. In right anterior insular/opercular cortex, neural activity predicted subjects' accuracy in the heartbeat detection task. Furthermore, local gray matter volume in the same region correlated with both interoceptive accuracy and subjective ratings of visceral awareness. Indices of negative emotional experience correlated with interoceptive accuracy across subjects. These findings indicate that right anterior insula supports a representation of visceral responses accessible to awareness, providing a substrate for subjective feeling states.

title: Do threatening stimuli draw or hold visual attention in subclinical anxiety?
abstract: Biases in information processing undoubtedly play an important role in the maintenance of emotion and emotional disorders. In an attentional cueing paradigm, threat words and angry faces had no advantage over positive or neutral words (or faces) in attracting attention to their own location, even for people who were highly state-anxious. In contrast, the presence of threatening cues (words and faces) had a strong impact on the disengagement of attention. When a threat cue was presented and a target subsequently presented in another location, high state-anxious individuals took longer to detect the target relative to when either a positive or a neutral cue was presented. It is concluded that threat-related stimuli affect attentional dwell time and the disengage component of attention, leaving the question of whether threat stimuli affect the shift component of attention open to debate.

title: Cognitive inhibition in depression
abstract: Cognitive inhibition is a key mechanism in the regulation of emotion. There is emerging evidence that depression is characterized by deficits in the inhibition of mood-congruent material. These deficits could result in prolonged processing of negative, goal-irrelevant aspects of presented information thereby hindering recovery from negative mood and leading to the sustained negative affect that characterizes depressive episodes. Indeed, it has been suggested that deficits in cognitive inhibition lie at the heart of memory and attention biases in depression, and set the stage for ruminative responses to negative events and negative mood states. A ruminative response style results in a heightened vulnerability to experience episodes of major depression. Recent research has demonstrated that deficient inhibition of negative material is associated with heightened rumination. In this article, we review the depression literature with a focus on studies that investigate cognitive inhibition in depressed participants and in participants who report a history of major depressive episodes. In addition, we summarize neurobiological findings that indicate a strong relation between depression and deficits in inhibition and we take a closer look at the relation of inhibition, rumination and mood regulation.

title: Cognition and depression: current status and future directions.
abstract: Cognitive theories of depression posit that people's thoughts, inferences, attitudes, and interpretations, and the way in which they attend to and recall information, can increase their risk for depression. Three mechanisms have been implicated in the relation between biased cognitive processing and the dysregulation of emotion in depression: inhibitory processes and deficits in working memory, ruminative responses to negative mood states and negative life events, and the inability to use positive and rewarding stimuli to regulate negative mood. In this review, we present a contemporary characterization of depressive cognition and discuss how different cognitive processes are related not only to each other, but also to emotion dysregulation, the hallmark feature of depression. We conclude that depression is characterized by increased elaboration of negative information, by difficulties disengaging from negative material, and by deficits in cognitive control when processing negative information. We discuss treatment implications of these conclusions and argue that the study of cognitive aspects of depression must be broadened by investigating neural and genetic factors that are related to cognitive dysfunction in this disorder. Such integrative investigations should help us gain a more comprehensive understanding of how cognitive and biological factors interact to affect the onset, maintenance, and course of depression.

title: Mood Regulation and Memory: Repairing Sad Moods with Happy Memories
abstract: A total of 106 undergraduates participated in a study examining how individuals retrieve memories to repair negative moods. Participants first completed a measure of depression. Two weeks later, participants were assigned to either a sad or neutral mood induction. After mood induction, they recalled two memories, rated their affective responses to the memories, and indicated why they chose the valence and order of the memories. Consistent with mood-congruent recall, participants in the sad condition reported sadder memories than those in the neutral condition. However, participants with prior low depression scores tended to recall more positive second memories, whereas participants with higher prior depression scores recalled consecutive negative memories. Sixty-eight per cent of sad participants who retrieved a negative first and positive second memory mentioned mood repair as motivating the recruitment of the more positive second memory.

title: Retrieving positive memories to regulate negative mood: consequences for mood-congruent memory.
abstract: Several researchers have suggested that mood-incongruency effects are due to a mood-regulatory process in which people retrieve positive memories to repair negative moods. The present studies tested this idea by manipulating mood-repair strategies and examining their impact on positive and negative memory retrieval. Mood-congruent retrieval occurred when participants stayed focused on events associated with their negative mood; mood-incongruent retrieval occurred when participants engaged in positive reappraisal (when they reinterpreted events as having positive outcomes). The effects of these strategies on memory retrieval also interacted with personality traits related to negative mood regulation. Individuals high in such traits showed stronger mood-incongruent memory than did individuals low in negative mood-regulation traits. Discussion focuses on integrating mood-regulatory variables and personality variables into existing mood-congruency theories (e.g., associative network models).

title: The role of mindfulness in positive reappraisal.
abstract: Mindfulness meditation is increasingly well known for therapeutic efficacy in a variety of illnesses and conditions, but its mechanism of action is still under debate in scientific circles. In this paper, we propose a hypothetical causal model that argues for the role of mindfulness in positive reappraisal coping. Positive reappraisal is a critical component of meaning-based coping that enables individuals to adapt successfully to stressful life events. Mindfulness, as a metacognitive form of awareness, involves the process of decentering, a shifting of cognitive sets that enables alternate appraisals of life events. We review the concept of positive reappraisal in transactional stress and coping theory, then describe research and traditional literature related to mindfulness and positive reappraisal, and detail the central role of mindfulness in the reappraisal process. With this understanding, we present a causal model explicating the proposed mechanism. The discussion has implications for clinical practice, suggesting how mindfulness-based integrative medicine interventions can be designed to support adaptive coping processes.

title: Mood-congruent recall of affectively toned stimuli: A meta-analytic review
abstract: A subset of the published research on mood-congruent memory in normal nondepressed, subclinically depressed, clinically depressed, induced depressed, and induced elated persons is examined with meta-analytic techniques. We estimated the magnitude of mood-congruent recall for these mood states, examined their robustness, and studied within each mood state the extent to which the strength of mood-congruent recall was related to self-referenced encoding and mood intensity. Asymmetric recall favoring positive stimuli appears to be part of the normative pattern of memory performance among individuals that have been labeled normal nondepressed (dh = .15; p .20). Clinically depressed, induced depressed, and induced elated subjects display mood congruent recall (dh, = − .19; p < .05; dh = − .12, p < .05; dh = .08; p < .10). With the exception of induced elated mood, effect estimates derived from different studies are robust in that sampling error accounts for the entire variability among effect estimates obtained from different studies. In studies on induced-elated mood, self-referent processing was associated with stronger mood-congruent recall as compared to other studies. Caveats and implications for future research on mood and memory are discussed.

title: Impaired positive inferential bias in social phobia.
abstract: People with social phobia report anticipatory and retrospective judgments about social situations that appear consistent with a negative interpretative bias. However, it is not at all clear that biased interpretative inferences are made "on-line;" that is, at the time that ambiguous information is first encountered. In a previous study, volunteers who were anxious about interviews were found to lack the positive on-line inferential bias that was characteristic of nonanxious controls but also failed to show a bias favoring threatening inferences (C. R. Hirsch & A. Mathews, 1997). This finding was confirmed in the present study, in which social phobic patients showed no evidence of making on-line emotional inferences, in contrast with socially nonanxious controls who were again clearly biased in favor of positive inferences. The authors concluded that nonanxious individuals are characterized by a benign on-line inferential bias, but that this is impaired in people with social phobia.

title: Comparison of cognitive behavioral and mindfulness meditation interventions on adaptation to rheumatoid arthritis for patients with and without history of recurrent depression.
abstract: This research examined whether cognitive behavioral therapy and mindfulness interventions that target responses to chronic stress, pain, and depression reduce pain and improve the quality of everyday life for adults with rheumatoid arthritis (RA). The 144 RA participants were clustered into groups of 6-10 participants and randomly assigned to 1 of 3 treatments: cognitive behavioral therapy for pain (P); mindfulness meditation and emotion regulation therapy (M); or education-only group (E), which served as an attention placebo control. The authors took a multimethod approach, employing daily diaries and laboratory assessment of pain and mitogen-stimulated levels of interleukin-6 (IL-6), a proinflammatory cytokine. Participants receiving P showed the greatest Pre to Post improvement in self-reported pain control and reductions in the IL-6; both P and M groups showed more improvement in coping efficacy than did the E group. The relative value of the treatments varied as a function of depression history. RA patients with recurrent depression benefited most from M across several measures, including negative and positive affect and physicians' ratings of joint tenderness, indicating that the emotion regulation aspects of that treatment were most beneficial to those with chronic depressive features.

title: Self-report Mindfulness as a Mediator of Psychological Well-being in a Stress Reduction Intervention for Cancer Patients—A Randomized Study
abstract: BackgroundThere is increasing recognition of mindfulness and mindfulness training as a way to decrease stress and increase psychological functioning.PurposeThe aims of this study were to examine the effects of mindfulness stress reduction training on perceived stress and psychological well-being and to examine if changes in mindfulness mediate intervention effects on these outcomes.MethodsSeventy women and one man with a previous cancer diagnosis (mean age 51.8 years, standard deviation = 9.86) were randomized into an intervention group or a wait-list control group. The intervention consisted of an 8-week mindfulness training course.ResultsCompared to participants in the control group, participants in the mindfulness training group had significantly decreased perceived stress and posttraumatic avoidance symptoms and increased positive states of mind. Those who participated in the intervention reported a significant increase in scores on the five-facet mindfulness questionnaire (FFMQ) when compared to controls. The increase in FFMQ score mediated the effects of the intervention on perceived stress, posttraumatic avoidance symptoms, and positive states of mind.ConclusionsThis study indicates that the improvements in psychological well-being resulting from mindfulness stress reduction training can potentially be explained by increased levels of mindfulness as measured with the FFMQ. The importance of these findings for future research in the field of mindfulness is discussed.

title: Mindfulness training increases momentary positive emotions and reward experience in adults vulnerable to depression: a randomized controlled trial.
abstract: To examine whether mindfulness-based cognitive therapy (MBCT) increases momentary positive emotions and the ability to make use of natural rewards in daily life.



Adults with a life-time history of depression and current residual depressive symptoms (mean age = 43.9 years, SD = 9.6; 75% female; all Caucasian) were randomized to MBCT (n = 64) or waitlist control (CONTROL; n = 66) in a parallel, open-label, randomized controlled trial. The Experience Sampling Method was used to measure momentary positive emotions as well as appraisal of pleasant activities in daily life during 6 days before and after the intervention. Residual depressive symptoms were measured using the 17-item Hamilton Depression Rating Scale (Hamilton, 1960).



MBCT compared to CONTROL was associated with significant increases in appraisals of positive emotion (b* = .39) and activity pleasantness (b* = .22) as well as enhanced ability to boost momentary positive emotions by engaging in pleasant activities (b* = .08; all ps < .005). Associations remained significant when corrected for reductions in depressive symptoms or for reductions in negative emotion, rumination, and worry. In the MBCT condition, increases in positive emotion variables were associated with reduction of residual depressive symptoms (all ps < .05).



MBCT is associated with increased experience of momentary positive emotions as well as greater appreciation of, and enhanced responsiveness to, pleasant daily-life activities. These changes were unlikely to be pure epiphenomena of decreased depression and, given the role of positive emotions in resilience against depression, may contribute to the protective effects of MBCT against depressive relapse.

title: Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians.
abstract: Primary care physicians report high levels of distress, which is linked to burnout, attrition, and poorer quality of care. Programs to reduce burnout before it results in impairment are rare; data on these programs are scarce.



To determine whether an intensive educational program in mindfulness, communication, and self-awareness is associated with improvement in primary care physicians' well-being, psychological distress, burnout, and capacity for relating to patients.



Before-and-after study of 70 primary care physicians in Rochester, New York, in a continuing medical education (CME) course in 2007-2008. The course included mindfulness meditation, self-awareness exercises, narratives about meaningful clinical experiences, appreciative interviews, didactic material, and discussion. An 8-week intensive phase (2.5 h/wk, 7-hour retreat) was followed by a 10-month maintenance phase (2.5 h/mo).



Mindfulness (2 subscales), burnout (3 subscales), empathy (3 subscales), psychosocial orientation, personality (5 factors), and mood (6 subscales) measured at baseline and at 2, 12, and 15 months.



Over the course of the program and follow-up, participants demonstrated improvements in mindfulness (raw score, 45.2 to 54.1; raw score change [Delta], 8.9; 95% confidence interval [CI], 7.0 to 10.8); burnout (emotional exhaustion, 26.8 to 20.0; Delta = -6.8; 95% CI, -4.8 to -8.8; depersonalization, 8.4 to 5.9; Delta = -2.5; 95% CI, -1.4 to -3.6; and personal accomplishment, 40.2 to 42.6; Delta = 2.4; 95% CI, 1.2 to 3.6); empathy (116.6 to 121.2; Delta = 4.6; 95% CI, 2.2 to 7.0); physician belief scale (76.7 to 72.6; Delta = -4.1; 95% CI, -1.8 to -6.4); total mood disturbance (33.2 to 16.1; Delta = -17.1; 95% CI, -11 to -23.2), and personality (conscientiousness, 6.5 to 6.8; Delta = 0.3; 95% CI, 0.1 to 5 and emotional stability, 6.1 to 6.6; Delta = 0.5; 95% CI, 0.3 to 0.7). Improvements in mindfulness were correlated with improvements in total mood disturbance (r = -0.39, P < .001), perspective taking subscale of physician empathy (r = 0.31, P < .001), burnout (emotional exhaustion and personal accomplishment subscales, r = -0.32 and 0.33, respectively; P < .001), and personality factors (conscientiousness and emotional stability, r = 0.29 and 0.25, respectively; P < .001).



Participation in a mindful communication program was associated with short-term and sustained improvements in well-being and attitudes associated with patient-centered care. Because before-and-after designs limit inferences about intervention effects, these findings warrant randomized trials involving a variety of practicing physicians.

title: Intensive mindfulness training-related changes in cognitive and emotional experience
abstract: This study examined the role of intensive mindfulness training on changes in day-to-day experiential processing, psychological symptoms, resilience, and well-being in two groups of community adults (N = 69). Using both quasi-experimental and longitudinal methods, the study found that intensive training, operationalized as 10–12 hours of formal mindfulness practice per day for 1 month, was significantly related to increases in training-specific experiential processing capacities, namely trait mindfulness and decentering (reperceiving), in comparison to pre–post-training wait-list controls. In both training groups combined, mindfulness, decentering, and acceptance increased over the pre-training to 1-month follow-up period. Intensive mindfulness training was also related to declines in anxiety and enhanced both subjective well-being and self-compassion from pre-training to follow-up in the two training groups. Finally, increases in trait mindfulness and acceptance were related to improvements in psychological symptoms, well-being, and resilience. Future directions for this novel area of mindfulness research are discussed.

title: Enhanced psychosocial well-being following participation in a mindfulness-based stress reduction program is associated with increased natural killer cell activity.
abstract: Mindfulness-based stress reduction (MBSR) programs have consistently been shown to enhance the psychosocial well-being of participants. Given the well-established association between psychosocial factors and immunologic functioning, it has been hypothesized that enhanced psychosocial well-being among MBSR participants would be associated with corresponding changes in markers of immune activity.



The objectives of this study were to examine changes in psychosocial and immunologic measures in a heterogeneous patient sample following participation in a MBSR program.



A single-group, pretest/post-test design was utilized.



The intervention was conducted at an academic health center.



This pilot study involved 24 participants (aged 28-72 years). Inclusion criteria were as follows: > or =18 years of age, English-speaking, and no known autoimmune disorder.



The intervention was an 8-week MBSR program.



Distress and quality of life (QOL) measures included the Brief Symptom Inventory-18 and the Medical Outcomes Survey Short-Form Health Survey, respectively. Immunologic measures included natural killer (NK) cell cytolytic activity and C-reactive protein (CRP).



Patients completed psychosocial assessments and provided a blood sample at baseline (pre-MBSR) and within 2 weeks post-MBSR. Significant improvements in anxiety and overall distress as well as across multiple domains of QOL were observed from baseline to post-MBSR. Reductions in anxiety and overall distress were associated with reductions in CRP. Patients who reported improvement in overall mental well-being also showed increased NK cytolytic activity from pre- to post-MBSR, whereas patients who reported no improvement in mental well-being showed no change in NK cytolytic activity.



Positive improvement in psychologic well-being following MBSR was associated with increased NK cytolytic activity and decreased levels of CRP.

title: The benefits of being present: mindfulness and its role in psychological well-being.
abstract: Mindfulness is an attribute of consciousness long believed to promote well-being. This research provides a theoretical and empirical examination of the role of mindfulness in psychological well-being. The development and psychometric properties of the dispositional Mindful Attention Awareness Scale (MAAS) are described. Correlational, quasi-experimental, and laboratory studies then show that the MAAS measures a unique quality of consciousness that is related to a variety of well-being constructs, that differentiates mindfulness practitioners from others, and that is associated with enhanced self-awareness. An experience-sampling study shows that both dispositional and state mindfulness predict self-regulated behavior and positive emotional states. Finally, a clinical intervention study with cancer patients demonstrates that increases in mindfulness over time relate to declines in mood disturbance and stress.

title: A four-factor model of perceived control: Avoiding
abstract: This study provides evidence that people evaluate their control over events and over feelings separately with respect to both positive and negative experiences Confirmatory factor analyses revealed that subjects made separate self-evaluations of control regarding their ability to (a) avoid negative outcomes, (b) cope with negative outcomes, (c) obtain positive outcomes, and (d) savor positive outcomes In addition, beliefs about avoiding and obtaining were more highly correlated (r = 50) than were beliefs about coping and savoring (r= 27) It is argued that coping and savoring involve different sets of cognitive and behavioral skills Multiple regression analyses generally indicated that beliefs about avoiding and coping related more strongly to measures of subjective distress, whereas beliefs about obtaining and strongly related more strongly to measures of subjective well-being These four control beliefs are discussed in relation to other conceptual models of control, and ways in which savoring may promote perceived control are described

title: Regulation of Positive Emotions: Emotion Regulation Strategies that Promote Resilience
abstract: The regulation of emotions is essential in everyday life. In this paper, we discuss the regulation of positive emotional experiences. Our discussion focuses on strategies aimed at maintaining and increasing experiences of positive emotions. We discuss the importance of these strategies for well-being, and suggest that cultivating positive emotions may be particularly useful for building resilience to stressful events. Then, we explore possible mechanisms that link positive emotions to coping for resilient people, with a focus on the automatic activation of positive emotions while coping. We conclude by discussing alternative models and proposing future directions in the work on positive emotion regulation and resilience.

title: The relationship of social support to perceived control and subjective mental health in adolescents
abstract: This study investigated the link between social support and positive constructs, specifically, psychological well-being and the perceived ability to obtain and savor positive life events. Eighty-two high school students were surveyed. Social support was significantly related to positive dimensions of subjective mental health (happiness, gratification, and self-confidence), but not to its negative components (vulnerability, strain, and uncertainty), and was also significantly related to respondents' perceived ability to obtain and savor positive life events, but not to their perceived ability to avoid or cope with negative events. Future theory and research should examine the link between social support and positive constructs such as psychological well-being and positive life experience.

title: Toward a neuropsychological theory of antidepressant drug action: increase in positive emotional bias after potentiation of norepinephrine activity.
abstract: Antidepressants that increase serotonin or norepinephrine in the brain are effective in treating depression, but there is no neuropsychological account of how these changes relieve depressive states. Cognitive theories suggest that biases in information processing lead depressed patients to make unrealistically negative judgments about themselves and the world.



A single dose of the noradrenergic antidepressant reboxetine or placebo was administered to 24 healthy volunteers. Effects on emotional processing were assessed through facial expression recognition, emotional categorization, and emotional memory.



On the three measures, reboxetine biased perception toward positive, rather than negative, information in the absence of changes in nonemotional performance or mood.



These results suggest that a single dose of an antidepressant can increase the processing of positively valenced material in nondepressed volunteers. Antidepressants may therefore work in a manner similar to that of psychological treatments that aim to redress negative biases in information processing.

title: Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse
abstract: (2003). Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse.

title: How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help?
abstract: There is encouraging evidence that structured psychological treatments for depression, in particular cognitive therapy, can reduce subsequent relapse after the period of initial treatment has been completed. However, there is a continuing need for prophylactic psychological approaches that can be administered to recovered patients in euthymic mood. An information-processing analysis of depressive maintenance and relapse is used to define the requirements for effective prevention, and to propose mechanisms through which cognitive therapy achieves its prophylactic effects. This analysis suggests that similar effects can be achieved using techniques of stress-reduction based on the skills of attentional control taught in mindfulness meditation. An information-processing analysis is presented of mindfulness and mindlessness, and of their relevance to preventing depressive relapse. This analysis provides the basis for the development of Attentional Control Training, a new approach to preventing relapse that integrates features of cognitive therapy and mindfulness training and is applicable to recovered depressed patients.

title: Delineating mechanisms of change in child and adolescent therapy: methodological issues and research recommendations.
abstract: Mechanisms of therapeutic change are rarely studied in child and adolescent therapy. Our central thesis is that the study of mechanisms of treatment is an excellent investment for improving clinical practice and patient care. Indeed, extending treatment trials to clinical settings, without complementary research that studies why and how treatment works, could have great limitations.



In this article, we discuss the importance of studying mechanisms, the logical and methodological requirements, and why almost no studies to date provide evidence for why or how treatment works. Standard statistical practices (tests of mediation) and designs (randomized controlled clinical trials) contribute greatly to outcome research but have little to say about mechanisms given the way they are commonly used.



The article ends with recommendations to guide research on mechanisms of therapeutic change.

title: Individual differences in the selective processing of threatening information, and emotional responses to a stressful life event.
abstract: Previous research has established that high levels of trait anxiety commonly are associated with an automatic pattern of encoding selectivity, operating to favour the processing of emotionally threatening information. It has been suggested that this processing bias may play a functional role in mediating emotional vulnerability by moderating affective responses to stressful real life events. The current experiment employs a longitudinal design, capable of addressing the central predictions arising from this theoretical position. Thirty-one women awaiting colposcopy investigation were screened on both traditional questionnaire measures of emotional vulnerability, and on a modified emotional Stroop task that provided objective indices of their automatic and strategic patterns of processing selectivity. Subsequently, those 15 women who later received a diagnosis of cervical pathology reported the degree to which this diagnosis had impaired their level of emotional functioning. The results confirm that, at the initial test time, trait anxiety was indeed associated with an apparently automatic tendency to selectively process threat related distractor information. Furthermore, an index of this initial pattern of automatic processing selectivity was consistently the best predictor of the intensity of emotional distress elicited by the subsequent diagnosis of cervical pathology. None of our conventional questionnaire measures were capable of significantly predicting this later emotional response. We suggest that these findings offer empirical support for the hypotheses that patterns of automatic processing selectivity may moderate individuals' emotional responses to stressful life events.

title: Preconscious Processing Biases Predict Emotional Reactivity to Stress
abstract: Anxiety vulnerability is associated with biases in attention: a tendency to selectively process negative relative to neutral or positive information. It is not clear whether this bias is: 1) related to the physiological response to stressful events, and 2) causally related to the development of anxiety disorders.  We tested the predictive value of both preconscious and conscious attention biases in a prospective study of stress reactivity in a nonclinical sample. One hundred four male participants were assessed at baseline and then again 4 months (n = 82) and 8 months later (n = 70). Salivary cortisol and self-report measures were obtained at the baseline testing session in addition to measures of biased attention. Subsequent emotional reactivity was assessed by means of salivary cortisol and self-reported state-anxiety responses during a laboratory-based stressor (4 months later) as well as during a real-life stressor 8 months later (i.e., examination period).  Regression analyses indicated that a preconscious negative processing bias was the best predictor of the cortisol response to stressful events. Importantly, a measure of selective processing provided a better indicator of subsequent emotional reactivity than self-report measures of neuroticism, trait-anxiety, and extraversion.  These results suggest that preconscious biases toward negative material play a causal role in heightened anxiety vulnerability. Our results illustrate the potential utility of preconscious biases in attention in providing an early marker of anxiety vulnerability and a potential target for treatment intervention.

title: Cognitive bias modification for anxiety: current evidence and future directions
abstract: Cognitive bias modification (CBM) is an innovative approach to modifying cognitive biases that confer vulnerability to anxiety. CBM interventions are designed to directly modify attention and interpretation biases via repeated practice on cognitive tasks. Analogue studies have demonstrated that CBM affects cognitive biases and anxiety in a number of anxiety conditions. Multisession CBM treatments have shown preliminary efficacy for generalized social phobia and generalized anxiety disorder, with effect sizes comparable to existing treatments. However, with any newly developing field, there are a number of important limitations of the existing data that need to be addressed before making firm conclusions regarding CBM’s efficacy for anxiety disorders. This article focuses on the theoretical rationale for CBM and the current evidence from analogue and clinical samples.

title: Mediators and moderators of treatment effects in randomized clinical trials.
abstract: Randomized clinical trials (RCTs) not only are the gold standard for evaluating the efficacy and effectiveness of psychiatric treatments but also can be valuable in revealing moderators and mediators of therapeutic change. Conceptually, moderators identify on whom and under what circumstances treatments have different effects. Mediators identify why and how treatments have effects. We describe an analytic framework to identify and distinguish between moderators and mediators in RCTs when outcomes are measured dimensionally. Rapid progress in identifying the most effective treatments and understanding on whom treatments work and do not work and why treatments work or do not work depends on efforts to identify moderators and mediators of treatment outcome. We recommend that RCTs routinely include and report such analyses.

title: How and why criteria defining moderators and mediators differ between the Baron & Kenny and MacArthur approaches.
abstract: In recognition of the increasingly important role of moderators and mediators in clinical research, clear definitions are sought of the two terms to avoid inconsistent, ambiguous, and possibly misleading results across clinical research studies.



The criteria used to define moderators and mediators proposed by the Baron & Kenny approach, which have been long used in social/behavioral research, are directly compared to the criteria proposed by the recent MacArthur approach, which modified the Baron & Kenny criteria.



After clarifying the differences in criteria between approaches, the rationale for the modifications is clarified and the implications for the design and interpretation of future studies considered.



Researchers may find modifications introduced in the MacArthur approach more appropriate to their research objectives, particularly if their research might have a direct influence on decision making.

title: Mediators and mechanisms of change in psychotherapy research.
abstract: There has been enormous progress in psychotherapy research. This has culminated in recognition of several treatments that have strong evidence in their behalf. Even so, after decades of psychotherapy research, we cannot provide an evidence-based explanation for how or why even our most well studied interventions produce change, that is, the mechanism(s) through which treatments operate. This chapter presents central requirements for demonstrating mediators and mechanisms of change and reviews current data-analytic and designs approaches and why they fall short of meeting these requirements. The role of the therapeutic alliance in psychotherapy and cognitive changes in cognitive therapy for depression are highlighted to illustrate key issues. Promising lines of work to identify mediators and mechanisms, ways of bringing to bear multiple types of evidence, recommendations to make progress in understanding how therapy works, and conceptual and research challenges in evaluating mediators and mechanisms are also presented.