Mindfulness practice leads to increases in regional brain gray matter density Britta K. Hölzel a,b, ⁎, James Carmody c , Mark Vangel a , Christina Congleton a , Sita M. Yerramsetti a , Tim Gard a,b , Sara W. Lazar a a Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA b Bender Institute of Neuroimaging, Justus Liebig Universität Giessen, Germany c University of Massachusetts Medical School, Worcester, MA, USA abstract article info Article history: Received 26 March 2010 Received in revised form 9 August 2010 Accepted 11 August 2010 Keywords: Meditation Mindfulness Voxel-based morphometry Gray matter Magnetic resonance imaging Hippocampus Posterior cingulate Therapeutic interventions that incorporate training in mindfulness meditation have become increasingly popular, but to date little is known about neural mechanisms associated with these interventions. Mindfulness-Based Stress Reduction (MBSR), one of the most widely used mindfulness training programs, has been reported to produce positive effects on psychological well-being and to ameliorate symptoms of a number of disorders. Here, we report a controlled longitudinal study to investigate pre–post changes in brain gray matter concentration attributable to participation in an MBSR program. Anatomical magnetic resonance (MR) images from 16 healthy, meditation-naïve participants were obtained before and after they underwent the 8-week program. Changes in gray matter concentration were investigated using voxel-based morphometry, and compared with a waiting list control group of 17 individuals. Analyses in a priori regions of interest confirmed increases in gray matter concentration within the left hippocampus. Whole brain analyses identified increases in the posterior cingulate cortex, the temporo-parietal junction, and the cerebellum in the MBSR group compared with the controls. The results suggest that participation in MBSR is associated with changes in gray matter concentration in brain regions involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking. © 2010 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Mindfulness meditation has been reported to produce positive effects on psychological well-being that extend beyond the time the individual is formally meditating. Over the last three decades mindfulness meditation practices have been increasingly incorporat- ed into psychotherapeutic programs, to take advantage of these benefits (cf. Baer, 2003; Grossman et al., 2004). A large body of research has established the efficacy of these mindfulness-based interventions in reducing symptoms of a number of disorders, including anxiety (Roemer et al., 2008), depression (Teasdale et al., 2000), substance abuse (Bowen et al., 2006), eating disorders (Tapper et al., 2009), and chronic pain (Grossman et al., 2007), as well as improving well-being and quality of life (e.g., Carmody and Baer, 2008). Mindfulness meditation involves the development of aware- ness of present-moment experience with a compassionate, non- judgmental stance (Kabat-Zinn, 1990). It has been suggested that this process is associated with a perceptual shift (Carmody, 2009), in which one's thoughts and feelings are recognized as events occurring in the broader field of awareness. Neuroimaging studies have begun to explore the neural mechan- isms underlying mindfulness meditation practice with techniques such as electroencephalography (EEG) (Davidson et al., 2003; Slagter et al., 2007) and functional magnetic resonance imaging (MRI) (Farb et al., 2007; Lutz et al., 2008; Farb et al., 2010; Goldin and Gross, 2010). Recently, several cross-sectional anatomical MRI studies have demon- strated that experienced meditators exhibit a different gray matter morphometry in multiple brain regions when compared with non- meditating individuals (Lazar et al., 2005; Pagnoni and Cekic, 2007; Hölzel et al., 2008; Luders et al., 2009; Vestergaard-Poulsen et al., 2009; Grant et al., 2010). While most of the brain regions identified have been reported in only one of these studies, the divergent results are likely due to differences in participant characteristics, type of meditation, and data analysis methods (see Table 1). Group differences in the hippocampus and the right anterior insula, however, have each been identified in at least two of the studies. Furthermore, activation in both regions has been reported during meditative states (hippocampus (Lazar et al., 2000; Hölzel et al., 2007); insula (Farb et al., 2007; Lutz et al., 2008)). The hippocampus is known to be critically involved in learning and memory processes (Squire, 1992), and in the modulation of emotional control (Corcoran et al., 2005; Milad et al., 2007), while the insula has been postulated to play a key role in the process of awareness (Craig, 2009) — functions which have been shown to be important in the process and outcomes of mindfulness training (Bishop et al., 2004; Shapiro et al., 2006; Ortner et al., 2007). Psychiatry Research: Neuroimaging 191 (2011) 36–43 ⁎ Corresponding author. Massachusetts General Hospital, 120 2nd Avenue, Charles- town, MA 02129, USA. Tel.: +1 617 724 2256; fax: +1 617 643 7340. E-mail address: britta@nmr.mgh.harvard.edu (B.K. Hölzel). 0925-4927/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.pscychresns.2010.08.006 Contents lists available at ScienceDirect Psychiatry Research: Neuroimaging journal homepage: www.elsevier.com/locate/psychresns