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.