Neural Mechanisms of Mindfulness-Based Cognitive Therapy (MBCT) for Post-Traumatic Stress Disorder (PTSD)

Abstract. Our funded R61 is an RCT of Mindfulness-based Cognitive Therapy (MBCT) for posttraumatic stressdisorder (PTSD) vs a well-matched comparator and pre-post fMRI. We are testing the hypothesis that MBCTengages a novel therapeutic mechanism involving increased capacity for metacognitive emotion regulation("decentering"), and this is underlain by increased functional connectivity (FC) between the posterior cingulatecortex (PCC) and the dorsolateral prefrontal cortex (DLPFC). We hypothesized that MBCT-linked increases indecentering would reduce perservative negative thinking (PNT), a transdiagnostic process common to distressdisorders. However, at present our entire planet is caught in the grip of a global COVID-19 pandemic, which hasled to suspension of in-person research. Nearly half of US adults report negative mental health impact due toworry and stress over the virus, and disease and social burdens of the COVID-19 pandemic, as well as stressfrom the resulting economic downturn are profoundly impacting mental health. The state of Michigan (>52KCOVID-19 cases/>5K deaths) is among the most impacted "hot zones" in the US. Communities with highdensities of low-income African Americans are the hardest hit and disproportionately bear the brunt of thispandemic. African Americans account for 32% of all Michigan COVID cases and 44% of all COVID-relateddeaths, yet are only 14% of the Michigan population. Wayne County, which includes the city of Detroit, is thesingle hardest hit location in Michigan, with >19K cases and >2K deaths. African Americans are also oftenexposed to everyday racial discrimination, a prevalent and pernicious form of psychological stress, and havehigher rates of physical health disorders that amplify COVID risk. Childhood adversity, trauma exposures, andpoverty, disproportionately elevated in African Americans, as well as PNT, likely also substantially increase riskfor anxiety, depression, and SUD in the context of COVID-related stress. Mental health treatments are neededfor COVID-impacted individuals, especially low income African Americans who are disproportionately impacted;however, social distancing measures and increased financial insecurity create additional barriers. To adequatelyserve these communities we now face an urgent need to test the feasibility and efficacy of already validated,remotely-delivered stress management programs in health disparity populations. Such remotely deliveredinterventions, including MBCT, are feasible and recent data suggest are highly efficient and efficacious fordepression, anxiety, PTSD and SUD. Based on this evidence, we propose to conduct a RCT of remotelydelivered MBCT (N=30) & PMR (N=30) in underserved, trauma-exposed health disparity populationsdisproportionately impacted by COVID in South East Michigan. We will test hypotheses about the efficacy ofremotely-delivered stress management for COVID-related stress, anxiety and depression in this population, aswell as hypotheses about the specific psychological mechanism of MBCT, involving increased decentering /metacognitive emotional regulation, and how this relates to improvement in PNT and related distress.