The purpose of this research proposal is to study the neuropsychological effects of mindfulness-based practices on stress and anxiety. Specifically I would like to study the long-term effects of mindfulness on stress and anxiety, neurological changes that are associated with the practice of mindfulness long-term, and the longevity of positive effects associated with mindfulness after the practice has been discontinued.

            The implications of this research include a better understanding of how the practice of mindfulness effects anxiety and mental health, greater insight into the neurological mechanisms that are associated with practicing mindfulness, the long-term effects of practicing mindfulness, as well as the effects of discontinuing the practice. This research may also provide more information into mindfulness-based interventions as a potentially superior treatment options for individuals living with anxiety and stress, and how the practice alters the way the brain functions. In addition to this, I would like to further understand how neurological structural changes relate to self-reported changes in well-being.

            Current Mindfulness-Based intervention research lacks longitudinal research on the observed positive effects of the practice. I intend to address this barrier by conducting a longitudinal study of these effects over the course of 12 weeks. I postulate that this research will show that continuation of the practice long-term will result in more positive effects on mental health, stress and anxiety specifically. The continuation of the practice will result in greater mental benefits, as well as greater emotional regulation. I also postulate that in the discontinuation group, there will be an observable decline in positive effects associated with mindfulness.

Background:

            Generalized Anxiety Disorder is one of seven different types of pathological anxiety. The additional types of anxiety include: social anxiety disorder, panic disorder, selective mutism, agoraphobia, specific phobias, and separation anxiety disorder. It is believed that anxiety disorders can be inherited and/or developed through trauma. Environmental circumstances can be experiences that promote the onset of symptoms related to underlying anxiety disorders, or an environmental circumstance itself can be the experience that influences the development of an anxiety disorder (Rachman, 2004).

Neurological abnormalities have been recognized in individuals with anxiety disorders. Generalized Anxiety Disorder may stem from abnormalities found among the  neurotransmitters gamma-aminobutyric acid (GABA) and dopamine. Panic Disorders have been marked by abnormalities in the right parahippocampal region of the brain (Hartmann, 2019). Prior to engaging in the treatment of an anxiety disorder, etiology should be determined to ensure proper action and precautions are taken.

            Mindfulness is the practice of being present. It’s a control-based coping strategy that includes assessing one’s current situation, circumstances, emotions, feelings, and mental state. Mindfulness is observing these aspects of self and being, without judgement or anger. The practice of mindfulness encompasses teaching oneself to observe the present moment from a perspective that is open-minded and accepting of current realities (Strauss, Cavanagh, Oliver, & Pettman, 2014). Mindfulness is rooted in Hinduism, although varying aspects of the practice can be found within the writings of many cultures and religions.

Mindfulness has been more concisely defined by Kudesia (2019) as a metacognitive practice that involves monitoring information processing in relation to current circumstances, allowing for more agency is adjusting types of information processed and how it is processed, adjusting currently held beliefs about information processing to promote or restrict agency in making these information processing adjustments, and flexibility in responding increases when adjustments to information processing are made. (Kudesia, 2019).

Although the research relating these two topics is in its infancy, there are promising correlations between the practice of mindfulness meditation and the positive mental health benefits that have been observed in relation to stress and anxiety disorders. Over the last two decades, most research into meditation and the neurological effects associated with it have been cross-sectional studies. These studies have compared long-time meditators to non-meditators, and much has been found through these studies, but there lacks a presence of longitudinal studies in this area. (Tang, Hölzel, & Posner, 2015).

Through the current studies, researchers have investigated the effects of mindfulness practice with self-report anxiety measures, neurological change imagining, and comparative analysis between mindfulness practices and other known interventions that have also proven to be beneficial in reducing anxiety. Results from these studies have shown that after implementing Mindfulness Based Interventions, individuals reported lower levels of social anxiety, rumination, and state anxiety, as well as increases in self-esteem (Hatchard et al., 2017). Mindfulness based practices has also been associated with decreases in depression, stress, and anxiety, as well as assist in lowering emotional reactivity to negative beliefs about oneself (Goldin, Ziv, Jazaieri, Hahn, and Gross, 2013). In addition to these findings, mindfulness based interventions has been shown to improve sleep quality, lower blood pressure and stress levels, as well as assist with gastrointestinal health and pain management (Hocevar, 2018).

            In a study conducted by Coiro, Bettis, and Compas (2017), the effects of varying coping strategies on depression and anxiety within a group of undergraduate students was examined. The self-report questionnaires showed that the students who used coping strategies that facilitate the adaptation to life’s stressors (engagement coping strategies) experienced less symptoms of depression and anxiety. Disengagement coping strategies included behaviors such as rumination, avoidance, and suppression. Primary control engagement coping and secondary control engagement coping methods facilitate the adaptation to current circumstances, and include practicing acceptance, cognitive reappraisal, and problem solving. Mindfulness-based interventions teach engagement oriented coping strategies, and these types of coping strategies assist in facilitating the acceptance and adjustment to life’s stressors.

Peng, Wenna, Chengjing, and Zhou (2018) studied the effect of Mindfulness based cognitive therapy on coping styles and attention. Similarly, their results showed that MBCT assisted in creating better, more positive and effective coping strategies. This training also assisted in increasing attention and executive functioning. Zeidan, Martucci, Kraft, McHaffie, and Coghill (2014) compared the effects of attending to the breath (a distraction or disengagement coping strategy) and mindfulness meditation across subjects without mood disorders. Their research revealed that state anxiety was reduced with each training on meditation, but not with attending to the breath. The practice of mindfulness meditation was also suggested to assist in emotional regulation through the stabilization of attention processes, help increase attention regarding digressive situations, and assist in the discontinuation of corresponding mood assessment. The findings of these studies suggest that control-based coping strategies, such as Mindfulness Based Stress Reduction, are more effective in coping with stress and anxiety than avoidance-based strategies

In order to assess the neuroanatomical and psychological changes associated with Mindfulness Based Stress Reduction, Santarnecchi, D’Arista, Egiziano, Gardi, Petrosino, Vatti, Reda, and Rossi employed the use of multiple scales and inventories, as well as a voxel-based cortical thickness (VBCT)  and a voxel-based morphometry (VBM) comparison. Their findings indicated that Mindfulness Based Stress Reduction can substantially lower depression, worry, and state anxiety. Right insula and somatosensory cortex cortical thickness showed greater increases within the Mindfulness Based Stress Reduction group as well (Sanraenecchi et al., 2014). Hatchard, Mioduszewski, Zambrana, O’Farrell, Caluyong, Poulin, and Smith (2017) examined multiple clinical and nonclinical articles on the neurological changes that are associated with mindfulness-based interventions. The nonclinical studies reported that neurological effects can be observed in as little as 2 months. Neurological changes were recognized in the clinical studies as well. The overall “findings of the review suggest that mindfulness meditation causes increased activation of the prefrontal cortex (PFC) and the anterior cingulate cortex (ACC)” (Hatchard et al., 2017).

In addition to this, Holzel, Carmody, Evans, Hage, Dusek, Morgan, and Lazar (2010) investigated the relationship between alterations in stress, and alterations is amygdaloid gray matter density after a Mindfulness based Stress Reduction program. Following an 8-week program, MRI scanning was used to measure amygdala gray matter density. Their findings revealed that psychological state improvement is associated with neurological changes. These changes were noted in the right amygdala, and were not seen in the left amygdala.

 In an article about emotional regulation and the practice of mindfulness, Guendelman, medeiros, and Rampes (2017), found that mindfulness can be highly beneficial to this process. Mindfulness-meditation produced structural changes within the hippocampus, right anterior insula, orbitofrontal cortex, anterior cingulate cortex, left temporal pole, left frontal gyrus, right frontal sulcus, corpus callosum, and brainstem regions. Goldin, Ziv, Jazaieri, Hahn, and Gross (2013) observed neurological increases in activity among a MBSR group in the right posterior inferior parietal lobe, the right anterior inferior parietal lobe, and the right SPL, which are brain regions related to attentional engagement. These neurological findings reiterate the association between MBSR and neurological structure alterations.

As we have seen, there is quite a bit of data suggesting that emotional regulation improves greatly through the practice of mindfulness based interventions. Grecucci, De Pisapia, Kusalagnana Thero, Paladino, Venuti, & Job, (2015) conducted a study to further understand the relationship between mindfulness and emotional regulation. Their research presented data that supports this relationship. The findings revealed that following the introduction of mindfulness, participants were able to nonjudgmentally assess current emotional experiences, allowing for “healthier mindful emotion regulation” (Grecucci et al., 2015) These results suggest that an individual’s ability to emotionally regulate, and their immediate reaction to a situation or stressor may be largely affected with the implementation of MBSR.

            The culmination of this research and the presented results has prompted my proposed research to further assess and study the question “does mindfulness practice alter anxiety?”. My aim is to increase the understanding of the long-term effects of mindfulness on anxiety, the neurological changes that are associated with the practice of mindfulness long-term (12 weeks), and the longevity of positive effects associated with mindfulness after the practice has been discontinued. It is my hypothesis that the practice of mindfulness will beneficially alter anxiety. Along with this, a secondary hypothesis is proposed, and that is that cessation of mindfulness practice may alter anxiety reversely. 

Significance:

            Anxiety has been classified as one of the most common mental illnesses in the US. Individuals living with anxiety may experience a number of physical symptoms including short breathing, sweaty or cold hands, chills, muscle tension, dizziness, shaking, etc. In severe cases, individuals may develop more debilitating disorders, such as agoraphobia. Although clinicians have become quite adept at diagnosing and treating anxiety, the practice of mindfulness allows for a more natural approach to overcoming the symptoms of anxiety. In addition to this, mindfulness is a practice that can be taught and learned widely and remotely, allowing for a more widespread intervention for this mental illness.

            The results of this study will help contribute to the growing body of knowledge that exists regarding mindfulness practices and anxiety reduction. The findings will also allow for further direction in future studies regarding these topics. Results from this study may assist clinicians in creating more individual, and effective interventions for anxiety that rely more on the individual than the medications that can be prescribed.

            If the current hypothesis’ are proven correct, this would imply that mindfulness meditation is a longitudinally effective intervention for anxiety and its symptoms. Along with this, the findings will contribute to the growing body of research surrounding mindfulness interventions and reducing anxiety. These findings may promote the use of a different approach to anxiety than standard medicinal approach.

Proposed Study

Participants:

            I will be recruiting a total of 120 male and female participants, ages ranging from 18-80 years of age, to be included in this experiment. Approximately half of all participants will have normal rates of anxiety (NA), while the other portion of participants will have diagnosed anxiety (DA). A control group of 20 participants will be randomly selected consisting of approximately ten participants with NA and ten participants with DA. The remaining 100 participants will be subjected to the intervention in this experiment (50 NA: 50 DA). Following the study, the results from this experimental group will be separated between NA and DA. Results from the NA group, DA group, and the control group will then be analyzed and compared.

            Informed consent will be gathered from all participants prior to the onset of this experiment. In an article about the potential negative side effects of meditation, the author includes “fear, panic, hallucinations, mania, loss of motivation and memory, and depersonalization” as types of feelings that can be aroused through the practice (Downey, 2018). In order to account for this and avoid ethical concerns or any potential harm, participants will be given a choice for the depth and duration of the meditations that they listen to. In addition to this, participants will also have access to a clinician for help processing a resurgence of emotions, if it occurs. At the conclusion of this research all participants from experimental and control groups will be debriefed about the project. Participants will also receive a briefing discussing their individual results, and the overall results of the study.

Procedures:

            In this experiment I will be using a mixed-method design involving self-report measures and neuroimaging of the brain. Prior to the implementation of intervention, mindfulness and anxiety will be measured in each participant. Anxiety among all participants will be measured using the Penn State Worry Questionnaire (PSWQ), the Hamilton Anxiety Rating Scale (HAM-A), and the Beck Anxiety Inventory (BAI). Mindfulness will be measured using the Five Facet Mindfulness Questionnaire and Mindful Attention Awareness Scale. In addition to this, participants will undergo magnetoencephalography readings and fMRI scans.  Once all baseline measures have been produced, participants will then undergo either a control intervention, or the experimental mindfulness meditation intervention.

            In the experiment group, the participants will be instructed to follow the guided meditations that are provided through an app that simultaneously tracks participant usage to ensure that each participant is following the mindfulness intervention regime. In addition to this, the intervention group will also be provided a weekly group meditation setting in which they are able to experience the practice with others. Instead of mindfulness meditation, the control group will be subjected to a similar app that provides guided imagery recordings while tracking the participants usage. The control group will also be instructed to attend a group guided imagery session each week. This intervention will last approximately 12 weeks for each group. At the conclusion of the intervention portion of this experiment, participants will be subjected to each questionnaire a second time. They will also undergo neuroimaging for a second time. There will be a follow-up assessment, consisting of all measures, conducted 12 weeks after the succession of the intervention period.

Hypotheses & Analysis:

I hypothesize that the practice of mindfulness will positively alter anxiety. A secondary hypothesis is that the cessation of mindfulness practice will reversely alter anxiety. In addition to this I hope to find evidence of structural changes between the control and intervention groups. I expect to see a decrease in anxiety symptoms among both the NA and DA groups between the pre-intervention assessment and the post-intervention assessment. I expect an increase in self-reported mindfulness in both NA and DA groups as well.The control group may experience some alterations in anxiety and mindfulness scale ratings, as well as neurological imaging.

Budget Justification

            For this experiment, a $60,000 budget is proposed. This will cover personnel costs, equipment, supplies, participant compensation, and the indirect costs associated with this experiment. Personnel costs include that of the faculty adviser and the graduate research assistant. Equipment costs include the development of experimental applications and the neurological image scanning. This funding will cover the cost of the assessment measures that will be used throughout the experiment. The budget includes supplies needed for this study including printing, making photocopies, and other miscellaneous office items. Participants will be compensated with $50, through two disbursements. This experiment lands $2.00 under budget after the indirect costs are calculated, as can be seen in the Appendix.