Learning Not to Fear: Mindfulness-Based Stress Reduction Improves Fear Extinction

Gunes Sevinc, PhD

Gunes Sevinc, PhD, is a postdoctoral research fellow in the lab of Sara Lazar, PhD, in the Department of Psychiatry at Massachusetts General Hospital. Her poster recently won an award at Mass General’s Research Fellow Poster Celebration.

Continue reading to hear Dr. Sevinc explain her research:

Being able to regulate one’s emotions is a critical skill to reduce stress in everyday life. Mindfulness interventions have been widely utilized for this exact purpose. Numerous research studies over the past two decades have shown that mindfulness interventions successfully improve emotion regulation skills and reduce stress-related problems. However, the neural mechanisms that underlie these reported improvements are still largely unknown.

A key component of mindfulness meditation involves refraining from cognitive avoidance. Cognitive avoidance refers to keeping the mind occupied in order to evade stressful thoughts. During meditation, in contrast, one observes his/her thoughts in a nonjudgmental manner instead of avoiding them.

One proven method for reducing fear and anxiety is behavioral exposure therapy in which a person is gradually exposed to a feared situation or object, learning to become less sensitive over time.

We hypothesized that meditation would create a context similar to behavioral exposure, providing an opportunity to learn that stressful thoughts are not threatening, facilitating fear extinction and adaptive regulation of one’s emotional responses. Thus, in this study, we specifically examined whether mindfulness meditation would improve emotion regulation in the context of fear extinction and change neurobiological responses to aversive stimuli.

Healthy but highly stressed participants underwent a functional MRI scan while they were performing a fear conditioning and extinction task. This task is a well-established Pavlovian conditioning task, in which a neutral stimulus, in this case a red or blue light, is paired with a mild electric shock to the hand. After the association is learned, it is extinguished by viewing the light repeatedly while not being shocked. The next day the participants return and are scanned while viewing the lights again, in order to determine how well they remembered that the light was no longer associated with being shocked.

After these initial scans, participants were randomly assigned to either an eight-week mindfulness program or to an active control intervention of stress management education. This intervention was specifically designed to control for effects that are not specific to mindfulness, such as group and teacher support, active engagement, and informational materials given to participants on emotion regulation. Following completion of the programs, participants’ brains were again scanned while they were performing the same fear conditioning and extinction tasks, in order to test whether participants in the mindfulness training group were better able to successfully extinguish their conditioned fear responses.

For participants undergoing mindfulness training only, brain regions associated with memory became more active following the training. Considering that the ability to remember that a stimulus is no longer associated with a threat is critical for healthy emotional functioning, these results suggest that improving this recall ability may be one key mechanism to explain how meditation interventions reduce stress at the neurobiological level.

Our results provide the first evidence for meditation-specific mechanisms underlying enhanced emotion regulation in a randomized controlled investigation. The team is currently working on a study to determine how long the neural changes extend beyond the initial training period, and is also exploring the impact of training on other forms of cognition, including moral decision making.

Gunes Sevinc¹, Britta K. Hölzel^1,2, Tim Gard^1,3, Jonathan Greenberg¹, Muhammed Milad⁴, Sara W. Lazar^1
1Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
²Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
³ Institute for Complementary and Integrative Medicine, University Hospital Zurich, Switzerland
⁴ Department of Psychiatry, University of Illinois at Chicago, IL, USA