The neural correlates of mindfulness‐induced depression reduction in adults with autism spectrum disorder: A pilot study
Abstract
Adults with autism spectrum disorder (ASD) experience high rates of depression and anxiety, and some evidence suggests mindfulness‐based stress reduction (MBSR) is effective in reducing these symptoms. However, the neural mechanisms of symptom alleviation, and benefit of MBSR beyond education/support groups are unknown. Maladaptive forms of self‐reflection are linked to ASD, depression, and anxiety. In this pilot study, we hypothesized (a) MBSR would reduce depression and anxiety in adults with ASD and (b) a mechanism of symptom alleviation would be increased blood oxygen level‐dependent signal in neural self‐reflection hubs. Twenty‐eight adults were randomly assigned to an 8‐week MBSR group ( n = 15) or a support group ( n = 13) that met for the same amount of time with relaxation education materials. Based on previous self‐reflection literature in ASD, regions of interest (ROIs) were middle cingulate cortex (MCC) and ventromedial prefrontal cortex (vmPFC). Only the MBSR group demonstrated significant reductions in depression, and neither group significantly changed in anxiety. Only the MBSR group increased activity of right MCC during self‐reflection, and the increase correlated with depression alleviation. There were no changes in vmPFC for the MBSR group or either ROI for the support/education group. Seed‐to‐voxel connectivity analysis revealed that only the MBSR group increased functional connectivity between right MCC and pre/postcentral gyrus, suggesting MBSR may increase primary sensorimotor input to higher order cognitive brain regions. Taken together, MBSR may be effective for reducing depression in adults with ASD, and the neural mechanism may be increasing frontal circuit involvement during self‐directed thought.
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Antidepressant and anxiolytic effects of MBSR have been replicated in randomized controlled trials using cognitive behavioural therapy (CBT) and social support/relaxation education (SE) comparison groups.
“Antidepressant and anxiolytic effects of MBSR have since been replicated in randomized controlled trials (RCTs) using cognitive behavioural therapy (CBT)14 and social support/relaxation education (SE)15 comparison groups.”
From Distinct and shared therapeutic neural mechanisms of mindfulness-based and social support stress reduction groups in adults with autism spectrum disorder (2023) · cites this paper as [15]
Little is known about the therapeutic neural mechanisms of MBSR in adults with ASD, with the exception of a single pilot study implicating the middle cingulate cortex in MBSR-elicited alleviation of depression symptomatology.
“Little is known about the therapeutic neural mechanisms of MBSR in adults with ASD, with the exception of a single pilot study implicating the middle cingulate cortex (or dorsal anterior cingulate cortex [dACC]) in MBSR-elicited alleviation of depression symptomatology.15”
From Distinct and shared therapeutic neural mechanisms of mindfulness-based and social support stress reduction groups in adults with autism spectrum disorder (2023) · cites this paper as [15]
Pre-/postcentral gyrus connectivity changes have been reported in adults with ASD following MBSR.
“pre-/postcentral gyrus connectivity changes have also been reported in adults with ASD following MBSR.15”
From Distinct and shared therapeutic neural mechanisms of mindfulness-based and social support stress reduction groups in adults with autism spectrum disorder (2023) · cites this paper as [15]
Improved self-reflection and emotion regulation have been suggested as candidate mechanisms for mindfulness interventions for autistic adults.
“Improved self-reflection and emotion regulation have been suggested as candidate mechanisms for mindfulness interventions for autistic adults (Pagni et al., 2020)”
From Mindfulness-based stress reduction for autistic adults: A feasibility study in an outpatient context. (2024) · cites this paper as Pagni et al., 2020
Autistic individuals are more exposed to stressors and tend to run a higher risk of developing avoidant behaviors and maladaptive coping strategies.
“autistic individuals are more exposed to stressors, such as aversive sensory experiences and stressful social situations. Therefore, they tend to run a higher risk of developing avoidant behaviors and maladaptive coping strategies, which might cause long-term mental health problems (Conner et al., 2020; Pagni et al., 2020; Pfaff & Barbas, 2019).”
From Acceptance and commitment therapy for autistic adults: A randomized controlled pilot study in a psychiatric outpatient setting. (2023) · cites this paper as Pagni et al., 2020
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Forbes, Z. N. M., & Miller, K. (2023) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-023-00398-y · Cited by 5 · see citing works
“…only study assessing anxiety which did not use symptoms of anxiety/depression as a participation inclusion criterion, possibly leading to a lower baseline anxiety in the population studied and explaining why this study was the only study not to find a significant difference (Pagni et al., 2020).”
InfluentialPsychotherapeutic Approaches for Autistic Adolescents and Adults
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Mindfulness and Mindfulness-Based Interventions
Hwang, Y., & Singh, N. N. (2025) · Oxford University Press eBooks · doi:10.1093/oso/9780197635841.003.0022 · Cited by 2 · see citing works
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- Authors
- Pagni, B. A., Walsh, M. J. M., Foldes, E., Sebren, A., Dixon, M. V., Guerithault, N., & Braden, B. B.
- Affiliations
- Arizona State University (US)
- Corresponding author
- Braden, B. Blair
- Venue
- Journal of Neuroscience Research
- Publisher
- Wiley
- Published
- 2020-02-23
- Volume
- 98
- Issue
- 6
- Pages
- 1150-1161
- ISSN
- 0360-4012 (ISSN-L)
- 1097-4547
- OpenAlex
- W3006697539
- Cited by
- 25
- References
- 71
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 4 · 2023: 6 · 2022: 3 · 2021: 3
- FWCI
- 1.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Neuroscience Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Arizona State University (Start‐up Funding)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- autism spectrum disorder, mindfulness-based stress reduction, depression, anxiety, self-reflection, middle cingulate cortex, ventromedial prefrontal cortex, functional connectivity, autistic adults
- MeSH terms
- Autism Spectrum Disorder, Adolescent, Adult, Brain, Depressive Disorder, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Pilot Projects, Treatment Outcome, Young Adult, Mindfulness
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