Panel A and B report a surface-based representation of average cortical thickness values for MBSR-trainees before and after the course.
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By computing the pre-post MBSR difference in cortical thickness level for both MBSR trainees and wait-list subjects, and by calculating this value for each of the 90 regions composing the AAL anatomical atlas, a support vector machine algorithm has been trained into discriminate the two groups.
Results indicates an average identification accuracy equal to The last decade has revealed growing evidence of anatomical and functional brain modifications associated with meditation practices, with results referring to a large variety of different methods of meditation.
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Noteworthy, evidence is often derived from cross-sectional studies based on subjects with a long-history of meditation practice. Finally, a significant negative correlation between alexithymia level and pre-post MBSR changes in insular thickness was also observed. Both brain imaging and electrophysiological studies have suggested that right insula is a key node for interoception, awareness of body movements and emotional awareness  , due to its extensive viscera-sensory inputs from the periphery and reciprocal connections with limbic, somatosensory, prefrontal and temporal cortices  , .
The insula has been specifically linked to the monitoring of visceral parts of the body, and its possible role into the re-representation of interoception offers a possible basis for its involvement in all subjective feelings . As for MBSR, using a fine anatomical parcellation analysis of insula activity, Farb and colleagues  showed higher activation of the anterior dysgranular insular regions in MBSR trainees with respect to controls during an interoceptive attention task, while in another study they demonstrated a reduced insula deactivation in MBSR practitioners during a sadness provocation task, which may be interpreted as increased interoceptive awareness and thus a lesser propensity to process highly-emotional incoming stimuli .
Accordingly, the increase of insula thickness observed in our participants may be the result of their increased awareness through paying attention moment to moment in a non-judgmental way of bodily sensations from the most subtle to the most evident. Interestingly, the insular lobe seems to be also involved in the cognitive processing of nociceptive stimuli, with an increase in its activity measured using arterial spin labeling after just 4 days of mindfulness training associated with a significantly diminished pain perception in healthy subjects .
In conclusion, our results confirm insula high responsiveness to MBSR and put forward the feasibility of a plasticity-related response even after a brief mindfulness training exposure. We also observed an MBSR-induced thickness change in right somatosensory cortex, a region associated with sensory-discriminative processing of nociceptive information .
As with the insula, this region is often associated with meditation practice, with findings of increased activation during experiential focusing  and observation of neutral and sad clips  in MBSR trainees. Accordingly, as suggested by evidence of increased alpha-band modulation after mindfulness training observed in this region using magneto-electroencephalography MEG  , repeated increases of average activation in the somatosensory cortex during the program could be responsible for the observed effect.
Multivariate pattern analysis revealed a large number of regions which seem to be highly informative for the identification of MBSR trainees. Interestingly, this pool of regions, encompassing frontal lobe, anterior cingulate cortex, insula, temporal pole, somatosensory cortex, angular and parahippocampal gyri, have been separately reported in previous anatomical or functional studies on different types of meditation  , . In light of the sensory and cognitive functions they are associated with, these regions may compose an unspecific network of areas that are highly sensitive to meditation practicing in general.
Besides morphometric changes, a significant after-training reduction of several psychological indexes related to worry, state anxiety, depression and alexithymia were observed, while no significant changes or correlation with the MAAS were detected.
More interestingly, the correlation between alexithymia levels and anatomical changes after mindfulness exposure gives reason of previous evidences correlating the insula and alexithymia levels in several morphometric studies not specifically involving meditation. For instance, in a positron emission tomography PET study, Kano and colleagues highlighted how individuals scoring higher than the clinical cut-off on the TAS showed hyperactivity of the right insula  , interpreting this hyperactivation as the tendency of these individuals to exacerbate physical illness, possibly caused by an unpleasant internal signal amplification.
Moreover, in a study using film clips to elicit emotional responses  , the authors documented increased activity in the bilateral insula in TAS high-scorers compared to low-scorers, along with increased sensory and motor cortices activity. Indeed, the functions associated with the insula seems to resemble the mental state promoted through mindfulness, while they are basically opposite to the theoretical description of alexithymia, which is intended as a reduction or incapacity to experience or verbalize emotions . A similar finding regarding the insula has been documented by Farb and colleagues  , by looking at differences in brain activation in response to different types of self-reference monitoring tasks in both novices and MBSR-trained subjects.
While a strong coupling between the right insula and self-referential cortical midline regions medial prefrontal cortex - mPFC has been observed in novices during experiential focus task, an increase in the activity of a right lateralized network comprising the lateral prefrontal cortex PFC and viscerosomatic areas such as the insula, secondary somatosensory cortex and inferior parietal lobule seems to characterize the response of MBSR-trained participants, also leading to the uncoupling of the aforementioned insula-mPFC connectivity.
The MBSR program, by training interoception, may improve the understanding and processing of own emotional reactions to internal and external stimuli, with a positive cascade effect on individual ability to exert cognitive control over emotions. Therefore, the insula-alexithymia interaction observed in the participants to the MBSR program could simply indicate an increase in their emotional awareness driven by the mindfulness experience  , a phenomena that seems to be neuro-biologically supported by an increase in the activity of the insula  , which could in turn plausibly lead, if expressed over time, to local neurogenesis.
However, regarding the cellular underpinnings of the observed structural changes, there is no evidence of neuronal proliferation in the human cortex during most of post-natal development, thus making unlikely that cortical thickness changes observed after MBSR training are due to changes in the number of cortical neurons .
Langerian mindfulness, quality of life and psychological symptoms in a sample of Italian students
Plausibly such alterations rely on changes in the amount of glial and capillary support, as well as in dendritic arborization and cortical capillary density  , . Consistently, gliogenesis as a consequence of learning and experience has been already demonstrated  and candidate as a possible mechanism for experience-related changes in gray matter morphology . Previous literature about MBSR training has included different solutions to address this issue, with the vast majority of the studies adopting a wait-control list approach [see 10,56—57].
Interestingly, recent evidences suggest how an active control condition might be more adequate to identify the active ingredients responsible for MBSR training efficacy into modulating, for instance, pain perception  and stress response . Moreover, the link with alexithymia levels also posits the existence of a specific neuroanatomical substrate linking mindfulness training and an increase in subjective awareness of their own emotions and feelings.
Analyzed the data: ES. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Several cross-sectional studies have documented neuroanatomical changes in individuals with a long history of meditation, while a few evidences are available about the interaction between neuroanatomical and psychological changes even during brief exposure to meditation. Funding: The authors have no support or funding to report.
Experimental Procedures 2.
Download: PPT. Table 1. Groups demographics and psychological changes after MBSR. Figure 2. Figure 3. Cortical thickness based multivariate pattern classification. Discussion The last decade has revealed growing evidence of anatomical and functional brain modifications associated with meditation practices, with results referring to a large variety of different methods of meditation.
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Brain Res Brain Res Rev — Twelve schools were involved in the study and participants, aged between 11 and 18, were enrolled in two studies. The two factors solution is identified both with Exploratory Factor Analysis- performed on participants recruited during the study 1 - and through the Confirmatory Factor Analysis - performed on participants recruited during the study 2 — showing good indices of goodness of fit. I-CAMM is a valid and reliable measure that can be easily used both in research and in clinical practice.