Mindfulness Training Alters Neural Activity During Self-reflection: Treating Depression Symptomatology in Adults with Autism Broc Pagni , Melissa Walsh, Emily Foldes, Ann Sebren, Maria Dixon, Leslie Baxter, Cory Riecken, Caleb Haynes, B. Blair Braden (Arizona State University, Tempe, AZ ) C9
Adults with autism spectrum disorder (ASD) suffer from rates of depression and anxiety at about quadruple the rate of the general population. Emerging evidence suggests Mindfulness-Based Stress Reduction (MBSR) is effective in reducing depression and anxiety, however, the neural mechanisms and benefit beyond support groups are unknown. Functional MRI (fMRI) research shows adults with ASD do not activate the ventral medial prefrontal cortex (vmPFC) and middle cingulate cortex (MCC) during self-reflection as seen in neurotypicals. Mindfulness training regulates self-reflection neural activation in NT adults, making this a likely mediator of symptom-reducing effects in adults with ASD. We investigated whether MBSR would increase blood-oxygen-level dependent (BOLD) response in regions activated during self-reflection, compared to a support/education control group, and if the BOLD signal change correlated with changes in depression and anxiety. Twenty-eight adults (nine women; mean age=31.8 +/- 12.9, range=18-64; mean IQ=106 +/- 18.5, range=70-139) were randomly assigned to a MBSR group (n=15) or a support group (n=13). All participants met ASD criteria on the ADOS-2 and both groups met for two-hours once/week for eight weeks with homework. Pre- and post-intervention fMRI scans were collected for the self-reflection task where participants: (1) reflected on whether or not trait adjectives characterizing physical, mental, and emotional abilities described themselves (self-condition), and (2) made a judgement about the positive valence of the same trait words (word-condition). Self-reported symptoms were assessed via the Beck Depression Inventory-2 and the State-Trait Anxiety Inventory. Within group comparisons were performed with paired t-tests and correlations with Pearson product-moment. The MBSR group demonstrated significant depression reduction with a moderately large effect size (t(14)=3.31, p=0.005, d=0.66), while the control group approached significance (t(12)=1.82, p=0.09, d=0.40); neither intervention significantly reduced anxiety symptoms. We found increased activation in right MCC (p=0.018, small-volume family-wise error corrected [FWE]) in the Self>Word contrast after MBSR intervention that negatively correlated with depression alleviation (r(11)=-0.49, p=0.04). There were no changes in vmPFC for the MBSR group or either region for the control group. Seed-to-voxel connectivity analysis revealed that MBSR increased functional connectivity between right MCC and bilateral pre/postcentral gyrus (p=0.001, FWE). This study suggests that MBSR may be effective for reducing depression in adults with ASD over and above a support/education group, and the neural mechanism may be increased right MCC activation during self-reflection.