THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 16, Number 5, 2010, pp.

597599 Mary Ann Liebert, Inc. DOI: 10.1089=acm.2009.0309

Case Study

Brain Activation During Compassion Meditation: A Case Study

1,2 Maria Engstro m, Ph.D., and Birgitta So derfeldt, Ph.D., M.D.3

Abstract

Objectives: B.L. is a Tibetan Buddhist with many years of compassion meditation practice. During meditation B.L. uses a technique to generate a feeling of love and compassion while reciting a mantra. The aim of the present study was to investigate the neural correlates of compassion meditation in 1 experienced meditator. Methods: B.L. was examined by functional magnetic resonance imaging during compassion meditation, applying a paradigm with meditation and word repetition blocks. Results: The most signicant nding was the activation in the left medial prefrontal cortex extending to the anterior cingulate gyrus. Other signicant loci of activation were observed in the right caudate body extending to the right insula and in the left midbrain close to the hypothalamus. Conclusions: The results in this study are in concordance with the hypothesis that compassion meditation is accompanied by activation in brain areas involved with empathy as well as with happy and pleasant feelings (i.e., the left medial prefrontal cortex and the anterior cingulate gyrus).

Introduction editation is a conscious mental process that inuences attention and emotional regulation.1 It has also been shown that meditation involves health-promoting benets such as stress reduction,2 decreased blood pressure,3 and higher pain threshold.4 However, the biological mechanisms behind the bodys response to meditation are poorly understood. Neuroimaging is regarded as one of the most promising tools for investigations of the coupling between the mind and the body during meditation.1,5,6 A few single-photon emission computed tomography,7 positron emission tomography,8 and functional magnetic resonance imaging (fMRI),913 studies on the regional neural response to meditation have been published in the last decade. Previous neuroimaging studies have, however, reported mismatching results. Discrepancies among results have been interpreted to be caused by the lack of standardized designs and the varied experience among the participants.1 In addition, participants were recruited from different schools applying different meditational techniques (e.g., relaxation meditation [yoga nidra],8 mantra meditation [kundalini yoga],9 mindfulness meditation,10 concentration meditation [Tibetan Buddhist],11 and mindfulness of breathing [vipassana]).12 Despite this, some converging results have been reported in that several studies have

shown activation in areas involved with attention regulation (i.e., frontal and prefrontal regions, and in hippocampal= parahippocampal formations).6 Meditational practice is commonly classied into two groups: (1) focused attention and (2) mindfulness meditation.1,6,14 Many meditational modes have features from both groups. Compassion meditation, on the other hand, is a common meditational practice among Buddhists, and it cannot be classied into either of the two groups. In this type of meditation, the meditator uses different techniques to generate a feeling of love and compassion. In a recent study by Lutz et al.,13 the emotional response to auditory stimuli was studied in subjects who were practicing compassion meditation. The authors found increased emotional-mediated activation in the insulae and the cingulate cortex during meditation. Since activation differences between novice and expert meditators were observed, the authors suggest that practice in compassion meditation could alter the neural circuitry of emotion. Diversities and similarities in previous neuroimaging studies of meditation techniques evoked the question of how different meditation modes affect brain activity. To our knowledge, no studies on the compassion meditation state have been reported in the literature. The aim of the present study was to investigate the neural correlates of compassion meditation in 1 expert meditator. A case study on the neural correlates to this kind of

1 2 3

ping University, Linko ping, Sweden. Center for Medical Image Science and Visualization (CMIV), Linko ping University Hospital, Linko ping, Sweden. Department of Radiological Sciences, Linko Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.

597

598 meditation might provide one further step toward the understanding of the biological mechanisms of different meditational modes and techniques. Methods One (1) active Buddhist (B.L., female, 59 years) participated in the study. B.L. meditates daily and is exceedingly well trained in the practice of meditation. She has, among other training, participated in two traditional Tibetan Buddhist retreats; each of them lasted for 3 years, 3 months, and 3 days. The subject gave informed consent to participate in the study according to the Declaration of Helsinki. fMRI images were acquired using an echo planar imaging sequence on a 1.5-T Philips Achieva body scanner. Scanning parameters were: repetition time 2.7 seconds, echo time 40 milliseconds, matrix 8080, eld of view 24 cm, number of slices 31, slice thickness 3 mm. The fMRI paradigm consisted of three alternating blocks of 30 seconds each with 5-second interstimulus interval. The subject was instructed to (1) repeat a sentence in Swedish, (2) repeat the same sentence translated into Sanskrit, and (3) perform compassion meditation while repeating the traditional Buddhist mantra, Ohm mani padme hum. B.L. used the mantra to visualize the deity Chenrezig, which is a technique to generate a feeling of love and compassion. The blocks were repeated 6 times, giving a total session time of 11 minutes 55 seconds. The functional images were preprocessed applying movement correction, normalization, and smoothing and analysed with SPM5 software (Wellcome Department of Imaging Neuroscience, University College, London, UK). A threshold of p < 0.05 corrected for false discovery rate, and an extent threshold of more than 10 voxels were used in the analysis. Results Mantra versus baseline Signicant loci of activation were found in the left medial prefrontal cortex extending to the anterior cingulate gyrus (Fig. 1), the right caudate body extending to the right insula, the left midbrain close to hypothalamus, and the left postcentral gyrus. Mantra versus Sanskrit Signicant activation was found in the same areas as in the baseline comparison with addition to activation in the right rectal gyrus, the right superior frontal gyrus, and the left parietalfrontal lobe junction. Mantra versus Swedish Similar activation as in the baseline comparison was observed. In addition, the left inferior frontal gyrus and the right insula were activated. Swedish versus Sanskrit Signicant activation in the orbital part of the left inferior frontal gyrus was found. Sanskrit versus Swedish A signicant locus of activation was noted in the right insula.

M AND SO DERFELDT ENGSTRO

FIG. 1. Activation in the left medial prefrontal cortex and anterior cingulate gyrus from the meditationbaseline condition.

Discussion In this study on the compassion meditation state, we found a large signicant activation cluster in the left medial prefrontal cortex extending to the anterior cingulate gyrus. Almost identical activation was reported in the meditation lzel et al.,12 where subjects who were trained at a study by Ho Vipassana center were practicing mindfulness of breathing during fMRI. The authors propose that activation in the dorsomedial prefrontal cortex reects a strong emotional engagement during meditation. Previous neuroimaging studies have also identied the medial prefrontal cortex, especially the left hemisphere, as important for empathy.1517 Other imaging studies have found anterior cingulate activation induced by happy and pleasant feelings.18,19 It has been proposed that right-sided prefrontal activation is involved in inducing and maintaining sustained attention and regulation of emotional response during meditation.1,5 The subject in this study, however, did not elicit much activation in this area except for a small activation cluster in the superior frontal gyrus. The explanation for this nonoccurring

FMRI

AND COMPASSION MEDITATION

599
task of meditation: A preliminary SPECT study. Psychiatry Res Neuroimaging 2001;106:113122. Lou HC, Kjaer TW, Friberg L, et al. 15O-H2O PET study of meditation and the resting state of normal consciousness. Hum Brain Mapping 1999;7:98105. Lazar SW, Bush G, Gollub RL, et al. Functional brain mapping of the relaxation response to meditation. Neuroreport 2000;7:15811585. Farb NAS, Segal ZV, Mayberg H, et al. Attending to the present: Mindfulness meditation reveals distinct neural modes of self-reference. SCAN 2007;2:313322. Brefczynski-Lewis JA, Lutz A, Schaefer HS, et al. Neural correlates of attentional expertise in long-term meditation practitioners. PNAS 2007;104:1148211488. lzel BK, Ott U, Hempel H, et al. Differential engagement Ho of anterior cingulate and adjacent medial frontal cortex in adept meditators and non-meditators. Neurosci Lett 2007; 421:1621. 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; 3:110. Ivanovski B, Malhi GS. The psychological and neuropsychological concomitants of mindfulness forms of meditation. Acta Neuropsychiatr 2007;19:7691. Farrow TFD, Zheng Y, Wilkinson LD, et al. Investigating the functional anatomy of empathy and forgiveness. Neuroreport 2001;12:24332438. llm BA, Taylor ANW, Richardson P, et al. Neuronal Vo correlates of theory of mind and empathy: A functional magnetic resonance imaging study in a nonverbal task. Neuroimage 2006;29:9098. Seitz RJ, Nickel J, Azari NP. Functional modularity of the medial prefrontal cortex: Involvement in human empathy. Neuropsychology 2006;20:743751. Rolls ET, Grabenhorst F, Parris BA. Warm pleasant feelings in the brain. Neuroimage 2008;41:15041513. Habel U, Klein M, Kellerman T, et al. Same or different? Neural correlates of happy and sad mood in healthy males. Neuroimage 2005;26:206214. Azari NP, Nickel J, Wunderlich G, et al. Neural correlates of religious experience. Eur J Neurosci 2001;12:16491652. Beauregard M, Paquette V. Neural correlates of a mystical experience in Carmelite nuns. Neurosci Lett 2006;405: 186190.

activation could either be that the subject, being an expert meditator, did not need to make efforts in attention and=or emotional regulation or that the right-sided activation was masked by the strong left-sided activation. Similar activation patterns, but not identical to those found in this study, have been observed in studies on Christian religious experience. In a study by Azari et al.,20 a frontalparietal circuit was identied to be involved with religious experience. Beauregard and Paquette,21 on the other hand, concluded that mystical experiences are mediated by several brain regions including the right orbitofrontal cortex, the left medial prefrontal cortex, the anterior cingulate cortex, insula, caudate, the parietal lobe, and the left brainstem. The most dominating feature in the present study was, however, the prevailing activation in the left medial prefrontal cortex, which is probably explained by the strong feeling of love and compassion experienced by the subject. In conclusion, this study showed that compassion meditation in 1 experienced meditator is accompanied by activation in the left medial prefrontal cortex and the anterior cingulate gyrus. These areas are proposed to be involved with empathy as well as with happy and pleasant feelings. Acknowledgments Jacob Moell is acknowledged for subject recruitment. The stergo tland and the Strategic research County Council in O area of Medical Image Science and Visualization are acknowledged for nancial support. Disclosure Statement No competing nancial interests exist. References
1. Lutz A, Slagter HA, Dunne JD, Davidson RJ. Attention regulation and monitoring in meditation. Trends Cogn Neurosci 2008;12:163169. 2. Tang Y-Y, Ma Y, Wang J, et al. Short-term meditation training improves attention and self-regulation. PNAS 2007; 104:1715217156. 3. Rainforth MV, Schneider RH, Nidich SI, et al. Stress reduction programs in patients with elevated blood pressure: A systematic review and meta-analysis. Current Hypertens Rep 2007;9:520528. 4. Morone NE, Greco CM, Weiner DK. Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study. Pain 2008;134:310319. 5. Newberg AB, Iversen J. The neural basis of the complex mental task of meditation: Neurotransmitter and neurochemical considerations. Med Hypothesis 2003;61:282291. 6. Cahn BR, Polich J. Meditation states and traits: EEG, ERP, and neuroimaging studies. Psychol Bull 2006;132:180221. 7. Newberg A, Alavi A, Baime M, et al. The measurement of regional cerebral blood ow during the complex cognitive

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18. 19.

20. 21.

Address correspondence to: m, Ph.D. Maria Engstro Medical Image Science and Visualization (CMIV) ping University=US Linko ping SE-581 85 Linko Sweden E-mail: maria.engstrom@liu.se

Copyright of Journal of Alternative & Complementary Medicine is the property of Mary Ann Liebert, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.