Neural mechanisms of mindfulness-based stress reduction in asthma.

Mindfulness-based stress reduction (MBSR) can improve symptoms of chronic inflammation; in asthma, improving asthma control and reducing airway inflammation. Understanding the neural mechanisms underlying these salubrious outcomes could help identify neuroimmune phenotypes and personalize interventions. Adults with asthma were randomized to 8 weeks of MBSR (n = 38) or a wait-list group (n = 34). Clinically relevant asthma-related and psychological outcomes were measured, and task-based fMRI data were acquired during exposure to emotional cues at baseline, post-intervention, and 6mo follow-up. Whole-brain group x time interactions and voxelwise regressions were used to evaluate changes in neural responses to emotion cues from baseline and their relationship to psychological and biological outcomes. Post-intervention, MBSR participants showed decreased lateral prefrontal/orbitofrontal cortex responses to aversive cues relative to controls, which was associated with increased mindfulness. Across participants, decreased salience network reactivity at post-intervention was associated with reduced psychological distress and airway inflammation. At 6 months, some relationships persisted while others did not. Results suggest that mindfulness training reduced effortful regulation of cognitive and affective responses to emotional cues, instead promoting more efficient processing strategies and reduced affective reactivity. Our findings clarify neural mechanisms underlying MBSR's clinical benefits for asthma, underscoring mind-brain-immune relationships as a critical target for asthma treatment.