However, outcomes related to mindfulness are an area of increasing interest because it is considered an intervention that trains control of attention and other EFs. A large body of evidence has demonstrated that mindfulness-based stress reduction MBSR is an effective intervention for a range of psychological disorders, including anxiety and depression Hofmann et al. It has been hypothesized that the improvement in emotional symptoms associated with mindfulness is due to the fact that it utilizes cognitive strategies that involve strengthening EFs, including sustaining attention, flexibly switching the focus of attention, and inhibiting elaborative processing Bishop et al.
Mindfulness interventions have been associated with significant improvements in performance on working memory and sustained attention tasks, as well as concomitant decreases in rumination, depressive symptoms, and negative affect relative to a control group Chambers et al. Mindfulness also appears to decrease rates of relapse in individuals who have experienced several depressive episodes Teasdale et al. Similar to CBM, the mindfulness literature has not directly assessed alterations in motivation-related processes and behaviors, though it is likely that the improvements in cognitive and emotional function enhance motivational processing.
The cognitive improvements and symptom reductions gained through mindfulness training are accompanied by mindfulness-induced neuroplasticity for a review, see Holzel et al. Healthy adults who completed an 8-week MBSR training course and expert meditators exhibited reduced activation in brain areas associated with a visceral sense of self, including anterior insula, ventral ACC, and mPFC during the act of meditation Ives-Deliperi et al. These effects suggest that experience with MBSR and other types of meditation results in reduced reactivity to both physical and emotional stimuli. In addition, there is evidence of increases in activity in brain regions associated with attention and executive control.
A study utilizing ERPs during a Stroop task found that individuals with MBSR experience displayed increased early-latency responses recorded over right posterior cortex to all stimuli, suggesting increased deployment of early attentional resources, and reduced later centro-parietal potentials to all stimuli but especially incongruent stimuli, indicating more efficient processing and control of these conflict stimuli Moore et al. Other noteworthy neuroimaging effects observed in individuals with MBSR experience comes from research employing techniques that examine structural changes in the brain.
These increases in gray matter density were found to positively correlate with meditation experience Lazar et al. Individuals with MBSR experience have been shown to exhibit increased connectivity among major fiber tracts in the brain, including whole brain fiber tracts, major tracts in both hemispheres, and the two largest interhemispheric fiber tracts than did healthy controls Luders et al. Finally, increased gyrification, or an increase in cortical gray matter and synaptogenesis, has been observed in precentral gyrus, fusiform gyrus, cuneus, and dorsal insula in individuals with MBSR experience Luders et al.
Among these areas showing increased gyrification, only dorsal anterior insula was correlated with meditation experience. This area is involved in integrating aspects of autonomic, affective, and cognitive processes and may contribute to decreased mind wandering, daydreaming, and ruminating, which are all key aspects of successful meditation. Although the study by Goldin and Gross appears to be the only one to directly examine the neural effects of MSBR in individuals diagnosed with an anxiety or depressive disorder thus far, the growing body of research on brain changes associated with MBSR in healthy populations has implications for how it may mitigate or prevent anxiety or depression.
Some of the neuroplastic effects observed in healthy individuals with MBSR experience occur in areas exhibiting dysfunction in anxiety and depression, as reviewed above. Thus, it is likely that MBSR practice in individuals with anxiety and depression normalizes activity in these regions, in addition to reducing symptoms and increasing control over rumination and worry.
In terms of neuroplasticity, many of the structural changes have been examined in relation to medication. Much less work has been done to understand the structural changes associated with psychological interventions. In fact, a pervasive premise, and not only among the general public, is that biological abnormalities should be treated with biological interventions. Yet there is now abundant evidence that psychological treatments alter biology, just as biological treatments alter psychology Miller, , Further, despite a large body of research examining the functional changes associated with various types of psychological and biological interventions, there is much we do not yet know because of the limited contexts in which these changes have been assessed.
These functional changes have been assessed almost entirely using tasks tapping basic emotional processing e. Understanding of the neural changes associated with such interventions would be greatly enhanced by examining changes across a variety of tasks and contexts recruiting a range of cognitive, emotional, and motivational processes. This would permit testing whether interventions lead to greater flexibility and dynamic range of neural activity, such that the degree of activation depends on the context and task demands rather than being habitually high or low, or whether interventions lead to consistently moderate responses.
In addition to research that examines a broader range of contexts, interventions would greatly benefit from future work that is informed by the psychological and biological research reviewed in the present paper. Although these strategies may not be sufficient alone, they could potentially address specific deficits that in turn allow individuals to more fully engage in challenging treatment techniques.
Further, research on shared brain mechanisms that contribute to various forms of psychopathology e. Several other methodological and theoretical limitations that are pervasive in the field also need to be addressed. The vast majority of the treatment studies reviewed reported results at the level of individual areas. However, the field is moving towards a network approach in order to better understand interactions among cognitive, emotional, and motivational processes, which involve a complex array of operations that engage distributed networks of brain regions.
There is some, albeit minimal evidence starting to accrue that treatment normalizes functional communication between regions in individuals with anxiety and depression. Further, measures of pre-treatment connectivity, rather than just the activity of a single region, may also be useful for predicting who will respond to treatment. Thus, the field would greatly benefit from future studies that utilize a network perspective in order to better understand the mechanisms through which various treatments exert their effects.
As reviewed above, various antidepressant and psychological treatments appear to target processes that rely heavily on top-down EF e. This is reflected in treatment-related enhancements of activity in regions involved more in top-down processing and decrements in activity in regions involved more in bottom-up, stimulus-driven processing.
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Future work explicitly examining functional connectivity should directly test this hypothesis. In addition, very few studies take into account the frequency at which anxiety and depression co-occur Sanderson et al. Comorbidity is present in at least one-half of those diagnosed with an anxiety or depressive disorder for reviews, see Gersh and Fowles, ; Breier et al. Comorbidity is associated with greater impairments in psychosocial function, greater severity of disorder, elevated rates of suicidality and morbidity, increased health service use, increased treatment resistance, and poorer short- and long-term outcomes Judd et al.
Without taking comormidity into account, it is unclear whether patterns of brain activity are specific to depression or anxiety or if instead they reflect their co-occurrence. Some evidence indicates that co-occurring anxiety and depression have additive and interactive effects on brain function e. Much work needs to be done to better understand how co-occurring levels of anxiety and depression alter brain network function during tasks involving a range of cognitive, emotional, and motivational processes as well as how treatment alters these patterns.
Another issue that warrants consideration in the hemodynamic neuroimaging treatment literature is the reliability of the blood-oxygen-dependant-level BOLD signal across time, given that various factors that can affect it e. Carrig and colleagues reviewed research investigating the test-retest reliability of fMRI and determined that studies examining intraclass correlation coefficients ICC have found good to excellent reliabilities. However, Plichta and colleagues found that the stability of within-subject amplitude varied depending on the specific task being examined emotional vs.
Little work has been done in examining the reliability of the BOLD signal specifically in patients, an issue that is particularly relevant for the treatment literature. Thus, future research would benefit from examining reliability of the BOLD signal in individuals with anxiety and depression prior to treatment. It has become clear just how interconnected the cognitive, emotional, and motivational deficits in anxiety and depression are, such that it is difficult to distinguish their influences. The present review has demonstrated how basic research on the relationships among cognition, emotion, and motivation in psychopathology and related neural mechanisms has been used to inform treatment-related research.
In fact, there continues to be rich potential for the synergy between these literatures. Despite numerous advances, we do not fully understand the mechanisms that lead to psychopathology, or how to harness these mechanisms most effectively for successful interventions.
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This review has highlighted numerous gaps in the literature. It is clear that motivation is related to the cognitive and emotional symptoms observed in psychopathology, but little work has been done to understand exactly how motivation interacts with and affects emotion and cognition. Additionally, much of the treatment-related research has focused on emotion-cognition interactions and neglected to examine how interventions may lead to alterations in motivational processes. This work could lead to the development and refinement of treatments that better target the motivational deficits observed in psychopathology.
Further, there is much excitement about the application of CBM procedures and EF training to better treat psychopathology, but much research remains to be done before these methods are used in common practice. For example, it is not clear how their effects translate to everyday performance or how long they last. If it is determined that they are as effective as current treatment methods or useful in improving the effectiveness of current methods, these training paradigms could likely be employed easily at home, via internet or computer software, for little cost.
There is much promise in capitalizing on the synergy between neuroscience and intervention research to better prevent and treat psychological disorders. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
National Center for Biotechnology Information , U. Journal List Front Hum Neurosci v. Published online Jun Warren , 2 Aminda J. O'Hare , 3 Zachary P. Infantolino , 4 and Gregory A. Miller 1, 4, 5.
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Warren 2 Department of Mental Health, St. Author information Article notes Copyright and License information Disclaimer. Received Feb 15; Accepted May This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in other forums, provided the original authors and source are credited and subject to any copyright notices concerning any third-party graphics etc.
This article has been cited by other articles in PMC. Abstract Emotion-cognition and motivation-cognition relationships and related brain mechanisms are receiving increasing attention in the clinical research literature as a means of understanding diverse types of psychopathology and improving biological and psychological treatments.
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Introduction Research on emotion and its relationship with cognition has garnered much attention in recent years e. Emotion-cognition interactions in anxiety and depression Emotion-cognition interactions gone awry can lead to clinically significant levels of anxiety and depression.
Executive function deficits in anxiety and depression Anxiety and depression have been associated with deficits in executive function EF; Levin et al. Motivation-cognition interactions in anxiety and depression Numerous behavioral and psychophysiological studies have provided evidence that depression is associated with motivation-related deficits. Relationships among EF, emotion, and motivation Evidence reviewed above establishes many interactions among cognition, emotion, and motivation and clearly indicates that these interactions contribute to psychopathology.
Intervention and neuroplasticity Numerous interventions, both psychological and biological, have been developed to target disruptions in cognition, emotion, and motivation interactions associated with anxiety and depression. Cognitive bias modification Another line of research has explored improving response rates with strategies other than treatment-matching.
Executive function training Evidence is accruing that EF can improve with training e. Mindfulness-based intervention Not much research has been conducted examining the outcomes of specific EF training procedures utilizing EF tasks in individuals with anxiety and depression beyond the preliminary study described above.
Limitations and future directions In terms of neuroplasticity, many of the structural changes have been examined in relation to medication. Conclusion It has become clear just how interconnected the cognitive, emotional, and motivational deficits in anxiety and depression are, such that it is difficult to distinguish their influences. Conflict of interest statement The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Neuropsychological functions in anxiety disorders in population-based samples: Executive dysfunction and long-term outcomes of geriatric depression.
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