Posted 02.27.2019 | by AMRA

The death of a loved one is a powerful stressor. Bereavement is not only painful and distressing, but can also trigger the onset of a variety of mental and medical disorders. Bereaved individuals may experience difficulty regulating their emotions and intrusive unpleasant thoughts and feelings that can disrupt cognitive functioning.

Huang et al. [Frontiers in Human Neuroscience] tested whether Mindfulness-Based Cognitive Therapy (MBCT) can improve emotional regulation and executive cognitive functioning in bereaved individuals.

The researchers recruited 23 participants reporting unresolved grief (91% female; average age = 48) who had lost at least one significant relative in the previous four years. All the participants attended an 8-week MBCT program. Self-report measures of grief, anxiety, depression, emotional regulation difficulty, and mindfulness (using the Five Facet Mindfulness Questionnaire) were obtained pre- and post-intervention.

Neurocognitive functioning was assessed before and after the intervention by having participants perform a Stroop task while monitoring their brain activity with functional magnetic resonance imaging. The Stroop task required participants to judge which of two visually presented digits was numerically larger. In each presentation, the relative physical sizes of the digits were either congruent or incongruent with their relative numerical size.

People usually take longer to correctly respond on incongruous Stroop trials. Their reaction time on those trials was used as a measure of executive cognitive function—the ability to make judgments in the presence of conflicting information.

After MBCT, participants reported significantly reduced grief (Cohen’s d = -0.89), anxiety (d = -0.65), depression (d = -1.17), and emotional regulation difficulty (d = -0.76), as well as increased mindfulness (d = 0.80). Post-MBCT mindfulness scores were significantly associated with lower post-MBCT grief (r = -.52), anxiety (r = -.70), depression (r = -.59) and emotional regulation difficulty (r = -.91).

The participants’ average reaction times to incongruous Stroop task presentations also significantly decreased from 624 milliseconds before MBCT to 608 milliseconds after MBCT.

There were significant reductions in posterior cingulate cortex (PCC) and precuneus activity during post-intervention incongruous Stroop trials, suggesting that the trials now required less cognitive effort. Higher levels of PCC activity were significantly associated with higher levels of grief (r = .34), as were higher levels of thalamic activity (r = .33). PCC activity was also significantly correlated with anxiety (r = .36). To summarize, the greater a participant’s negative emotions, the higher the level of dorsal attentional system neurological activation required to successfully perform the Stroop task.

The study demonstrates large within-group decreases in grief and emotional regulation difficulty, large increases in mindfulness, and significantly improved executive functioning in bereaved participants following MBCT. Improved executive functioning was accompanied by a decrease in the level of dorsal attentional network activation needed to perform accurately on incongruous Stroop trials.

The lack of a control group makes it hard to determine if treatment effects would be similar for any group-based type of intervention or if they were simply due to the passage of time. Nonetheless, it is important to note that prior research with the grief scale used in this study suggests that changes of this order of magnitude usually take place over a matter of years rather than a matter of weeks.

Reference:

Huang, F. -Y., Hsu, A. -L., Hsu, L. -M., Tsai, J. -S., Huang, C. -M., Chao, Y. -P., . . . Wu, C. W. (2018). Mindfulness improves emotion regulation and executive control on bereaved individuals: An fmri study. Frontiers in Human Neuroscience, 12, 541.

[Link to abstract]