Mindfulness-based intervention to decrease mood lability in at-risk youth: Preliminary evidence for changes in resting state functional connectivity

• Published in: Journal of affective disorders 2020-11, Vol.276, p.23-29
• Main Authors: Hafeman, Danella M., Ostroff, A. Noelle, Feldman, Jamie, Hickey, Mary Beth, Phillips, Mary L., Creswell, David, Birmaher, Boris, Goldstein, Tina R.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Bipolar disorder; Child; Emotion regulation; Gyrus Cinguli - diagnostic imaging; Humans; Magnetic Resonance Imaging; Mindfulness; Mood Disorders - diagnostic imaging; Mood Disorders - therapy; Mood lability; Neuroimaging; Pilot Projects; Prefrontal Cortex - diagnostic imaging; Resting-state functional connectivity
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2020.06.042

•Many youth at familial risk for bipolar disorder have mood lability, which is a risk factor for bipolar disorder onset.•We tested whether a mindfulness-based intervention could improve mood lability in at-risk youth, and the neural mechanisms.•Following the mindfulness intervention, at-risk youth showed increased PCC-DLPFC functional connectivity.•Higher levels of PCC-DLPFC connectivity predicted lower mood lability at the follow-up visit. Background: In youth at familial risk for bipolar disorder (BD), mood lability is an important precursor to BD onset. Previous work in adults indicates that mindfulness-based interventions (MBI) may improve emotion regulation, in part by increasing resting-state functional connectivity (rsFC) between posterior cingulate cortex (PCC) and executive control network (ECN). In this pilot study, we assessed effects of an MBI on PCC-ECN rsFC and mood lability in at-risk youth. Methods: We recruited 35 youth (10–14 years old) with a first-degree family history of BD and mood lability, and 21 age-matched healthy controls. Eligible at-risk youth were scanned pre/post an 8-week MBI and assessed three months later. Healthy controls were scanned at matched timepoints but did not participate in the MBI. The MBI used age-appropriate strategies to promote non-judgmental, present-moment awareness. We assessed pre/post changes in PCC-ECN rsFC and how rsFC changes were related to mood outcomes. Results: Twenty at-risk youth were scanned pre/post MBI; 16 had high-quality rsFC data. Following MBI, at-risk youth showed increased rsFC between PCC and left dorsolateral prefrontal cortex (DLPFC) (BA 9; k = 28; corrected p=.006); healthy controls did not show this increase. Following MBI, at-risk youth reported more mindfulness (F = 7.15, p=.003), less mood lability (F = 7.2, p=.002), and less suppression of negative emotions (F = 5.05, p=.01). PCC-DLPFC rsFC increases predicted less mood lability (t=−2.25, p=.04) and less emotion suppression (t=−2.75, p=.02) at follow-up. Limitations: Small sample and lack of a control intervention. Conclusions: PCC-DLPFC rsFC may be a clinically meaningful neural target of an MBI in at-risk youth, related to improvements in mood lability.