4. Discussion
This is the first study, to our knowledge, to investigate the neural correlates of active meditation as an emotion regulation technique in a pediatric sample. We examined neural activation in children with cancer while they viewed distress-inducing video clips and engaged in meditation (focused attention, mindful acceptance) or non-meditation (distraction) emotion regulation techniques. In the control condition, participants passively viewed the video clip. The following findings emerged: (1) compared to the control condition, mediation emotion regulation techniques were associated with lower activity in several regions of the DMN. (2) The non-meditation condition — distraction — was not associated with a similar reduction in neural activation as compared to the control condition, suggesting that meditation emotion regulation techniques may be more effective for downregulating DMN activity. (3) meditation emotion regulation strategies were associated with lower DMN activity than distraction. Distraction is often used to manage children’s pain in clinical settings, (e.g., needle-related procedures).48 Although there were no differences in distress ratings between conditions, evidence that meditation emotion regulation is more effective at quelling DMN activity may suggest longer-term benefits – a hypothesis that requires future study with larger sample sizes. These findings may have implications for understanding the neural mechanisms underlying meditation-based emotion regulation in children.
Both forms of meditation emotion regulation strategies examined in this study were associated with lower activity in DMN regions, including the parahippocampal gyrus, precuneus, and posterior cingulate cortex. Lower activity in the DMN during active meditation is consistent with prior fMRI studies in adults. For example, a meta-analysis of 78 fMRI studies in adults revealed consistent de-activations in DMN regions (e.g., posterior cingulate cortex) during focused attention meditation.37 Another fMRI study in meditation-naïve adults reported that mindful acceptance emotion regulation reduced pain-related activation in the DMN (e.g., posterior cingulate, precuneus).16 This suggests that children with minimal training may benefit from meditation. We did not detect activation in the CEN during meditation, consistent with studies showing that meditation does not engage CEN control systems 49. We also did not observe CEN activation for distraction, which may reflect underdevelopment of cognitive forms of emotion regulation and the CEN30,31.
Our whole-brain and ROI analyses revealed lower DMN activation for meditation emotion regulation techniques, but not for distraction. Prior studies on cognitive forms of emotion regulation (e.g., distraction) do not consistently report activation changes in the DMN49,50 and there is evidence that DMN engagement changes across development 30. Distraction is considered an attentional deployment strategy that re-directs attentionaway from emotion-eliciting stimuli 51 and engages the CEN in adults.49 Here, both meditation techniques (focused attention, mindful acceptance) were associated with lower DMN activity than distraction. Specifically, focused attention was associated with lower activation in the precuneus, a DMN region associated with maintaining self-consciousness during self-referential processes.52 Lower activity in the precuneus during focused attention is consistent with meta-analytic findings in adults.37 Therefore, focused attention meditation may suppress self-referential thoughts evoked by negative stimuli and protect against depressive rumination in children. Relative to distraction, mindful acceptance was associated with lower activity in the MFC, consistent with a prior emotion regulation study in adults.16 Other studies have reported reduced activation in the MFC during sustained meditation,53negative autobiographical memory recall, and acceptance of present emotional state.54 Taken together, lower MFC activation observed during mindful acceptance may reflect reduced elaboration and appraisal of emotional experiences. Although distraction and meditation techniques are effective for reducing children’s pain and distress, the present findings suggest that meditation techniques may be more effective for modulating DMN activity in children. Given that higher DMN activity is implicated in depressive rumination,28,54 these findings imply a potential long-term protective role of meditation for helping children cope with stressful experiences.
Although we observed differences in the brain between conditions, there were no differences in distress ratings. We may have been underpowered to detect changes in distress ratings. Prior studies support beneficial effects of meditation on self-reported pain and emotional distress in children over time (e.g., over 4- or 8-week programs)32 or following a single session.21 We also observed minimal differences in brain activity between conditions, which should be examined in future studies with larger sample sizes. However, we found preliminary evidence that focused attention may be more effective for downregulating DMN activity than mindful acceptance, which may reflect the fact that paying attention to the breath may be a simpler concept for children. This finding is interesting given results of a prior study in healthy adults showing that experienced meditators were better than beginners at downregulating MFC activity in response to emotional images.17 Therefore, more experience with meditation may improve attenuation of DMN activation.