1. Introduction
The ability to regulate emotion develops across the first two decades of
life, corresponding with maturational changes in brain networks
supporting emotion processing and self-regulation.1Emotion regulation is central to developmental
outcomes.2–4 Deficits in emotion regulation can
increase risk of mental disorders in adulthood (e.g.,
depression5). Therefore, strategies that are effective
for bolstering emotion regulation during childhood may have long term
benefits, such as ameliorating adverse outcomes during
adulthood.6 Emotion regulation strategies that involve
forms of mindfulness and meditation originate from ancient
practices.7 Meditation refers to an umbrella of mental
practices that involve the monitoring and regulation of attention and
emotion.8,9 Mindfulness is a form of meditation that
involves focusing attention to and accepting thoughts and emotions in
the present.10 There are also individual differences
in the tendency towards mindfulness (i.e., trait mindfulness) that can
change over time through deliberate meditation
practice.11 Meditation techniques are now integrated
into established treatments for psychological disorders involving
emotion dysregulation, including depression.12Meditation programs have been shown to be effective for reducing stress,
anxiety, depression, and pain among clinical13 and
non-clinical14 adult populations. They show promise
for reducing disease- and treatment-related distress among patients with
chronic conditions, such as cancer.15 Active
engagement in meditation has also been shown to lower self-reported pain
and negative emotion.16,17
Although most research has been conducted in adults, emerging evidence
suggests that mindfulness and meditation are beneficial for children. A
meta-analysis of 33 randomized controlled trials reported benefits of
meditation programs on attention, depression, and stress among clinical
and non-clinical pediatric samples.18 Mindfulness and
meditation-based programs are popular in school
settings,19 and increasingly used to help children
cope with stressful experiences, such as chronic conditions (e.g.,
cancer)20,21 or trauma.22 Meditation
as an emotion regulation strategy is promising for preventing mental
disorders, given that nearly half of all mental disorders begin during
childhood and adolescence.23 However, the neural
mechanisms supporting meditation as an emotion regulation strategy in
children remain unclear. Insight on these mechanisms could help validate
and improve interventions for at-risk pediatric populations exposed to
high stress and trauma.
Meditation strategies are distinct from other forms of emotion
regulation, such as distraction. Rather than controlling attention away
from emotional experiences, meditation strategies involve noticing and
accepting emotional reactions as they arise.8Meditation also appears to be neurobiologically distinct from other
forms of emotion regulation that rely on ‘top down’ modulation of
emotional responses. More ‘cognitive’ forms of emotion regulation, such
as distraction, commonly engage brain regions in the central executive
network (CEN), with core nodes in the dorsolateral prefrontal cortex and
the parietal cortex.24,25 Meditation emotion
regulation strategies do not appear to engage the CEN. Rather, these
techniques have been shown to reduce activation in regions of the
default mode network (DMN), including the medial frontal cortex (MFC),
posterior cingulate cortex, and precuneus, during deliberate meditation
and exposure to aversive stimuli.16,17,26 The DMN is
associated with self-referential thought and depressive
rumination.27,28 Prior research suggests that
depressed individuals fail to downregulate DMN activity when exposed to
negative emotional stimuli.29 Taken together, existing
research suggests that meditation can modulate DMN activity, and these
effects do not rely on ‘top-down’ control mechanisms. This is important
because children might not be able to employ complex regulatory
strategies due to underdevelopment of the CEN.30,31Further, simple meditation strategies, such as focused attention to the
breath, may be more accessible to children in stressful situations.
To our knowledge, only two functional magnetic resonance imaging (fMRI)
studies have examined the neural correlates of meditation training in
children. These studies report lower amygdala response to fearful faces
and lower resting-state functional connectivity between the DMN and CEN
in children (mean age = 11.75 years) following an 8-week
mindfulness-based school program relative to a control
program.32,33 These finding support the notion that
meditation can modulate brain activity (e.g., DMN) in children. These
patterns are consistent with our prior fMRI study showing that more
trait mindful youth spent less time in a dynamic functional connectivity
state characterized by higher DMN-CEN connectivity.34However, no studies to our knowledge have examined neural activity in
children actively engaged in meditation emotion regulation.
To address this gap, we examined the within-subjects effects of
meditation on brain activity in a sample of children with cancer, who
experience significant disease and treatment-related
distress.35 Participants received minimal meditation
training (4 hrs) through a well-established martial arts-based
meditation program21,36 prior to undergoing an adapted
version of an established fMRI emotion regulation task in the scanner.
We compared two meditation emotion regulation techniques (i.e., focused
attention and mindful acceptance) with a control condition (i.e.,
passive viewing) and with a non-meditation emotion technique (i.e.,
distraction). Participants were asked to engage in one of the four
conditions while they were exposed to aversive video clips (e.g., a
child receiving an injection), and rated their negative emotion after
each trial. This design allowed us to test (1) whether meditation
techniques can reduce brain activity in the DMN, and (2) whether
meditation emotion regulation techniques are more effective than a
non-meditation technique —distraction — at reducing DMN activity. We
also (3) compared brain activation during the two meditation techniques,
based on evidence that different meditation techniques have different
effects on brain activity.37