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Modifying Resilience Mechanisms in At-Risk Individuals: A Controlled Study of Mindfulness Training in Marines Preparing for Deployment
Douglas C. Johnson, Ph.D.; Nathaniel J. Thom, Ph.D.; Elizabeth A. Stanley, Ph.D.; Lori Haase, Ph.D.; Alan N. Simmons, Ph.D.; Pei-an B. Shih, Ph.D.; Wesley K. Thompson, Ph.D.; Eric G. Potterat, Ph.D.; Thomas R. Minor, Ph.D.; Martin P. Paulus, M.D.
Am J Psychiatry 2014;171:844-853. doi:10.1176/appi.ajp.2014.13040502
View Author and Article Information

Dr. Stanley is the creator of the Mindfulness-Based Mind Fitness Training intervention and founder of the Mind Fitness Training Institute, a nonprofit organization established to support the delivery of the intervention; she serves as a volunteer member of the board of directors and receives consulting income from teaching the intervention. The other authors report no financial relationships with commercial interests.

Supported in part by funding from the Office of Naval Research Code 30 and the Navy Bureau of Medicine and Surgery. This study is the result of work supported with resources and the use of facilities at the 1st Marine Expeditionary Force, Camp Pendleton, Calif., and the University of California, San Diego, La Jolla.

The views expressed in this article are those of the authors and do not reflect the official policy or position of the Navy, the Department of Defense, or the U.S. Government.

From the Warfighter Performance Department, Naval Health Research Center, San Diego; the Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla; Department of Applied Health Science, Wheaton College, Wheaton, Ill.; the Edmund A. Walsh School of Foreign Service, Georgetown University, Washington, D.C.; the Mind Fitness Training Institute, Alexandria, Va.; the Department of Psychology, University of California, Los Angeles; and Naval Special Warfare Command, San Diego.

Address correspondence to Dr. Johnson (douglas.c.johnson@med.navy.mil).

Copyright © 2014 by the American Psychiatric Association

Received April 15, 2013; Revised September 13, 2013; March 04, 2014; Accepted March 13, 2014.

Abstract

Objective  Military deployment can have profound effects on physical and mental health. Few studies have examined whether interventions prior to deployment can improve mechanisms underlying resilience. Mindfulness-based techniques have been shown to aid recovery from stress and may affect brain-behavior relationships prior to deployment. The authors examined the effect of mindfulness training on resilience mechanisms in active-duty Marines preparing for deployment.

Method  Eight Marine infantry platoons (N=281) were randomly selected. Four platoons were assigned to receive mindfulness training (N=147) and four were assigned to a training-as-usual control condition (N=134). Platoons were assessed at baseline, 8 weeks after baseline, and during and after a stressful combat training session approximately 9 weeks after baseline. The mindfulness training condition was delivered in the form of 8 weeks of Mindfulness-Based Mind Fitness Training (MMFT), a program comprising 20 hours of classroom instruction plus daily homework exercises. MMFT emphasizes interoceptive awareness, attentional control, and tolerance of present-moment experiences. The main outcome measures were heart rate, breathing rate, plasma neuropeptide Y concentration, score on the Response to Stressful Experiences Scale, and brain activation as measured by functional MRI.

Results  Marines who received MMFT showed greater reactivity (heart rate [d=0.43]) and enhanced recovery (heart rate [d=0.67], breathing rate [d=0.93]) after stressful training; lower plasma neuropeptide Y concentration after stressful training (d=0.38); and attenuated blood-oxygen-level-dependent signal in the right insula and anterior cingulate.

Conclusions  The results show that mechanisms related to stress recovery can be modified in healthy individuals prior to stress exposure, with important implications for evidence-based mental health research and treatment.

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FIGURE 1. Heart and Breathing Rates Before, During, and After a Stressful Immersive Training Session in Marines Receiving Mindfulness Training (MT) or Training as Usual (Control)a

a The stressful immersive training session took place at the Infantry Immersion Trainer facility approximately 9 weeks after baseline. In panel A, heart rate during the 10-minute anticipatory period prior to immersive training was higher for the MT group. Although peak heart rate did not differ between groups during the training, the MT group also showed quicker heart rate recovery during the 10-minute period immediately following stressful training. In panel B, there were no differences between groups in breathing rate during the anticipatory or stress periods. During the 10-minute recovery period, the mean breathing rate for the control group did not significantly differ from peak response; however, the mean breathing rate for the MT group decreased significantly from peak during the stress period and was significantly lower than the rate for the control group during both the 10-minute recovery and the 45-minute rest period.

FIGURE 2. Mean Plasma Neuropeptide Y and Norepinephrine Concentrations in Marines Receiving Mindfulness Training (MT) or Training as Usual (Control)a

a Neuropeptide Y and norepinephrine levels are shown for baseline, after 8 weeks, and after a stressful immersive training session at the Infantry Immersion Trainer facility approximately 9 weeks after baseline. For neuropeptide Y, there were no group differences at baseline or at 8 weeks. There was a significant interaction in response to stressful training (F=4.67, df=2, 350, p<0.01; d=0.33), with the control group showing significantly higher levels of neuropeptide Y 45 minutes after stressful training, whereas the MT group had recovered to near baseline levels.

FIGURE 3. Activation of the Right Insula and Anterior Cingulate Cortex During Emotion Recognition in Marines Receiving Mindfulness Training (MT) or Training as Usual (Control)a

a From the original fMRI subsample of 20 Marines in each group, data from one Marine in the MT group and four in the control group were excluded from analyses because of excessive head-motion artifact at either the baseline or the follow-up assessment (at approximately 10 weeks). Analyses adjusted for baseline differences in sleep quality, combat exposure, and previous training at the Infantry Immersion Trainer facility. Compared with Marines in the control group, those in the MT group showed significantly decreased activation in the right insula and anterior cingulate cortex.

FIGURE 4. Relationship Between Change Score From Baseline to Follow-Up on the Response to Stressful Experiences Scale and Changes in Activation in the Right Anterior Insula (N=25)a

a fMRI scanning took place at baseline and again approximately 10 weeks later, within 2 weeks after a stressful immersive training session at the Infantry Immersion Trainer. As insula activation decreased from baseline to follow-up, resilience characteristics increased (r=−0.42). BOLD=blood-oxygen-level-dependent.

Anchor for Jump
TABLE 1.Baseline Characteristics of Marines Receiving Mindfulness Training (MT Group) or Training as Usual (Control Group)
Table Footer Note

a From the original fMRI subsample of 20 Marines in each group, data from one Marine in the MT group and four in the control group were excluded from analyses because of excessive head-motion artifact at either the baseline or the follow-up assessment (at approximately 10 weeks).

Table Footer Note

b Significant difference between MT and control groups (p=0.003).

Table Footer Note

c Significant difference between MT and control groups (p=0.007) and between fMRI subgroups (p=0.03).

Table Footer Note

d Significant difference between MT and control groups (p=0.002) and between fMRI subgroups (p=0.01).

Table Footer Note

e IIT=Infantry Immersion Trainer facility. Significant difference between MT and control groups (p=0.02).

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TABLE 2.Group-by-Time Interaction of Emotion Recognition on Brain Activation in 35 Marines Receiving Mindfulness Training (N=19) or Training as Usual (N=16)a
Table Footer Note

a Marines underwent functional MRI (fMRI) scanning at baseline and again approximately 10 weeks later. From the original fMRI subsample of 20 Marines in each group, data from one Marine in the MT group and four in the control group were excluded from analyses because of excessive head-motion artifact at either the baseline or the follow-up assessment. The table summarizes results of fMRI analysis of the linear mixed effects for group-by-time interaction of mindfulness training in Marines during an emotion recognition task. Coordinates are normalized to Talairach space. Analyses controlled for individual differences in baseline sleep quality (as assessed by the Pittsburgh Sleep Quality Index) and combat exposure.

Anchor for Jump
TABLE 3.Summary of Results of Mindfulness Training Compared With Training as Usual in Marines
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References

Hoge  CW;  Auchterlonie  JL;  Milliken  CS:  Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan.  JAMA 2006; 295:1023–1032
[CrossRef] | [PubMed]
 
Haglund  MEM;  Nestadt  PS;  Cooper  NS;  Southwick  SM;  Charney  DS:  Psychobiological mechanisms of resilience: relevance to prevention and treatment of stress-related psychopathology.  Dev Psychopathol 2007; 19:889–920
[CrossRef] | [PubMed]
 
Southwick  SM;  Vythilingam  M;  Charney  DS:  The psychobiology of depression and resilience to stress: implications for prevention and treatment.  Annu Rev Clin Psychol 2005; 1:255–291
[CrossRef] | [PubMed]
 
Southwick  SM;  Charney  DS:  The science of resilience: implications for the prevention and treatment of depression.  Science 2012; 338:79–82
[CrossRef] | [PubMed]
 
Sousa  N;  Almeida  OF:  Disconnection and reconnection: the morphological basis of (mal)adaptation to stress.  Trends Neurosci 2012; 35:742–751
[CrossRef] | [PubMed]
 
Khalsa  SS;  Rudrauf  D;  Feinstein  JS;  Tranel  D:  The pathways of interoceptive awareness.  Nat Neurosci 2009; 12:1494–1496
[CrossRef] | [PubMed]
 
Craig  AD:  How do you feel? Interoception: the sense of the physiological condition of the body.  Nat Rev Neurosci 2002; 3:655–666
[PubMed]
 
Craig  AD:  How do you feel—now? The anterior insula and human awareness.  Nat Rev Neurosci 2009; 10:59–70
[CrossRef] | [PubMed]
 
Paulus  MP;  Stein  MB:  An insular view of anxiety.  Biol Psychiatry 2006; 60:383–387
[CrossRef] | [PubMed]
 
Stein  MB;  Simmons  AN;  Feinstein  JS;  Paulus  MP:  Increased amygdala and insula activation during emotion processing in anxiety-prone subjects.  Am J Psychiatry 2007; 164:318–327
[CrossRef] | [PubMed]
 
Domschke  K;  Stevens  S;  Pfleiderer  B;  Gerlach  AL:  Interoceptive sensitivity in anxiety and anxiety disorders: an overview and integration of neurobiological findings.  Clin Psychol Rev 2010; 30:1–11
[CrossRef] | [PubMed]
 
Paulus  MP;  Stein  MB:  Interoception in anxiety and depression.  Brain Struct Funct 2010; 214:451–463
[CrossRef] | [PubMed]
 
Norton  PJ;  Price  EC:  A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders.  J Nerv Ment Dis 2007; 195:521–531
[CrossRef] | [PubMed]
 
Lee  K;  Noda  Y;  Nakano  Y;  Ogawa  S;  Kinoshita  Y;  Funayama  T;  Furukawa  TA:  Interoceptive hypersensitivity and interoceptive exposure in patients with panic disorder: specificity and effectiveness.  BMC Psychiatry 2006; 6:32
[CrossRef] | [PubMed]
 
Craske  MG;  Rowe  M;  Lewin  M;  Noriega-Dimitri  R:  Interoceptive exposure versus breathing retraining within cognitive-behavioural therapy for panic disorder with agoraphobia.  Br J Clin Psychol 1997; 36(Pt 1):85–99
[CrossRef] | [PubMed]
 
Wald  J;  Taylor  S:  Responses to interoceptive exposure in people with posttraumatic stress disorder (PTSD): a preliminary analysis of induced anxiety reactions and trauma memories and their relationship to anxiety sensitivity and PTSD symptom severity.  Cogn Behav Ther 2008; 37:90–100
[CrossRef] | [PubMed]
 
Wald  J;  Taylor  S;  Chiri  LR;  Sica  C:  Posttraumatic stress disorder and chronic pain arising from motor vehicle accidents: efficacy of interoceptive exposure plus trauma-related exposure therapy.  Cogn Behav Ther 2010; 39:104–113
[CrossRef] | [PubMed]
 
Craske  MG;  Wolitzky-Taylor  KB;  Labus  J;  Wu  S;  Frese  M;  Mayer  EA;  Naliboff  BD:  A cognitive-behavioral treatment for irritable bowel syndrome using interoceptive exposure to visceral sensations.  Behav Res Ther 2011; 49:413–421
[CrossRef] | [PubMed]
 
Labus  JS;  Naliboff  BD;  Berman  SM;  Suyenobu  B;  Vianna  EP;  Tillisch  K;  Mayer  EA:  Brain networks underlying perceptual habituation to repeated aversive visceral stimuli in patients with irritable bowel syndrome.  Neuroimage 2009; 47:952–960
[CrossRef] | [PubMed]
 
Critchley  HD;  Melmed  RN;  Featherstone  E;  Mathias  CJ;  Dolan  RJ:  Volitional control of autonomic arousal: a functional magnetic resonance study.  Neuroimage 2002; 16:909–919
[CrossRef] | [PubMed]
 
Cameron  OG;  Minoshima  S:  Regional brain activation due to pharmacologically induced adrenergic interoceptive stimulation in humans.  Psychosom Med 2002; 64:851–861
[PubMed]
 
Paulus  MP;  Simmons  AN;  Fitzpatrick  SN;  Potterat  EG;  Van Orden  KF;  Bauman  J;  Swain  JL:  Differential brain activation to angry faces by elite warfighters: neural processing evidence for enhanced threat detection.  PLoS One 2010; 5:e10096
[CrossRef] | [PubMed]
 
Paulus  MP;  Flagan  T;  Simmons  AN;  Gillis  K;  Kotturi  S;  Thom  N;  Johnson  DC;  Van Orden  KF;  Davenport  PW;  Swain  JL:  Subjecting elite athletes to inspiratory breathing load reveals behavioral and neural signatures of optimal performers in extreme environments.  PLoS ONE 2012; 7:e29394
[CrossRef] | [PubMed]
 
Simmons  AN;  Fitzpatrick  S;  Strigo  IA;  Potterat  EG;  Johnson  DC;  Matthews  SC;  Orden  KF;  Swain  JL;  Paulus  MP:  Altered insula activation in anticipation of changing emotional states: neural mechanisms underlying cognitive flexibility in Special Operations Forces personnel.  Neuroreport 2012; 23:234–239
[CrossRef] | [PubMed]
 
Thom  N;  Johnson  DC;  Flagan  T;  Simmons  AN;  Kotturi  SA;  Van Orden  KF;  Potterat  EG;  Swain  JL;  Paulus  MP:  Detecting emotion in others: increased insula and decreased medial prefrontal cortex activation during emotion processing in elite adventure racers.  Soc Cogn Affect Neurosci 2014; 9:225–231
[CrossRef] | [PubMed]
 
Kabat-Zinn  J:  Full Catastrophe Living: The Program of the Stress Reduction Clinic at the University of Massachusetts Medical Center .  New York,  Delta, 1990
 
Lutz  A;  Brefczynski-Lewis  J;  Johnstone  T;  Davidson  RJ:  Regulation of the neural circuitry of emotion by compassion meditation: effects of meditative expertise.  PLoS One 2008; 3:e1897
[CrossRef] | [PubMed]
 
Farb  NAS;  Segal  ZV;  Mayberg  H;  Bean  J;  McKeon  D;  Fatima  Z;  Anderson  AK:  Attending to the present: mindfulness meditation reveals distinct neural modes of self-reference.  Soc Cogn Affect Neurosci 2007; 2:313–322
[CrossRef] | [PubMed]
 
Farb  NAS;  Anderson  AK;  Mayberg  H;  Bean  J;  McKeon  D;  Segal  ZV:  Minding one’s emotions: mindfulness training alters the neural expression of sadness.  Emotion 2010; 10:25–33
[CrossRef] | [PubMed]
 
Brefczynski-Lewis  JA;  Lutz  A;  Schaefer  HS;  Levinson  DB;  Davidson  RJ:  Neural correlates of attentional expertise in long-term meditation practitioners.  Proc Natl Acad Sci USA 2007; 104:11483–11488
[CrossRef] | [PubMed]
 
Stanley  EA;  Schaldach  JM;  Kiyonaga  A;  Jha  AP:  Mindfulness-Based Mind Fitness Training: a case study of a high-stress predeployment military cohort.  Cogn Behav Pract 2011; 18:566–576
[CrossRef]
 
Russo  SJ;  Murrough  JW;  Han  M-H;  Charney  DS;  Nestler  EJ:  Neurobiology of resilience.  Nat Neurosci 2012; 15:1475–1484
[CrossRef] | [PubMed]
 
Hariri  AR;  Mattay  VS;  Tessitore  A;  Kolachana  B;  Fera  F;  Goldman  D;  Egan  MF;  Weinberger  DR:  Serotonin transporter genetic variation and the response of the human amygdala.  Science 2002; 297:400–403
[CrossRef] | [PubMed]
 
Johnson  DC;  Polusny  MA;  Erbes  CR;  King  D;  King  L;  Litz  BT;  Schnurr  PP;  Friedman  M;  Pietrzak  RH;  Southwick  SM:  Development and initial validation of the Response to Stressful Experiences Scale.  Mil Med 2011; 176:161–169
[CrossRef] | [PubMed]
 
Logothetis  NK:  The neural basis of the blood-oxygen-level-dependent functional magnetic resonance imaging signal.  Philos Trans R Soc Lond B Biol Sci 2002; 357:1003–1037
[CrossRef] | [PubMed]
 
Jackson  EM;  Dishman  RK:  Cardiorespiratory fitness and laboratory stress: a meta-regression analysis.  Psychophysiology 2006; 43:57–72
[CrossRef] | [PubMed]
 
Paulus  MP;  Potterat  EG;  Taylor  MK;  Van Orden  KF;  Bauman  J;  Momen  N;  Padilla  GA;  Swain  JL:  A neuroscience approach to optimizing brain resources for human performance in extreme environments.  Neurosci Biobehav Rev 2009; 33:1080–1088
[CrossRef] | [PubMed]
 
Lutz  J;  Herwig  U;  Opialla  S;  Hittmeyer  A;  Jäncke  L;  Rufer  M;  Grosse Holtforth  M;  Brühl  AB:  Mindfulness and emotion regulation: an fMRI study.  Soc Cogn Affect Neurosci  (Epub ahead of print, May 29, 2013)
 
Paulus  MP;  Feinstein  JS;  Castillo  G;  Simmons  AN;  Stein  MB:  Dose-dependent decrease of activation in bilateral amygdala and insula by lorazepam during emotion processing.  Arch Gen Psychiatry 2005; 62:282–288
[CrossRef] | [PubMed]
 
Chang  LJ;  Yarkoni  T;  Khaw  MW;  Sanfey  AG:  Decoding the role of the insula in human cognition: functional parcellation and large-scale reverse inference.  Cereb Cortex 2013; 23:739–749
[CrossRef] | [PubMed]
 
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