Complex harmonic manifolds in mindfulness-based cognitive therapy for major depressive disorder

In people with major depressive disorder, mindfulness-based cognitive therapy (MBCT) plus treatment as usual, compared to treatment as usual alone, alters whole-brain dynamics in ways that may reduce rumination. Using a novel method called complex harmonics decomposition on fMRI data from 80 patients, the study identified low-dimensional spatiotemporal manifolds that capture both local and long-range brain interactions. After MBCT, during rumination, brain regions involved in bodily and interoceptive processing became more consistently integrated across these manifolds. The latent configurations shifted with clinical and behavioral improvements, and the brain showed greater flexibility within the reduced space. These changes may reflect reduced 'stickiness' of ruminative thinking patterns following mindfulness training.

Study at a glance

Abstract

Major depressive disorder (MDD) is a heterogeneous mental disorder characterised by rumination. Mindfulness-based cognitive therapy (MBCT) is an evidence-based treatment developed to target rumination and recurrence risk. Ongoing studies have begun to identify neural changes associated with treatment effects. However, the low-dimensional organisation underlying whole-brain dynamics remains largely unexplored and may provide a more complete characterisation of the neural processes through which MBCT exerts its therapeutic effects in MDD. Here, we investigated functional magnetic resonance imaging (fMRI) of a randomised controlled trial of MBCT with treatment as usual (TAU), or TAU alone, in a group of MDD patients (N=80). We applied a novel framework, complex harmonics decomposition (CHARM), to uncover low-dimensional manifolds in the spacetime domain, capturing local as well as non-local interactions made possible by brain criticality and amplified by the anatomical long-range connectivity. We successfully identified distinct distributed spatiotemporal manifolds across brain states and outperformed traditional dimensionality reduction techniques. During rumination after MBCT we found consistent recruitment of regions involved in bodily and interoceptive processing integrated within the whole-brain across manifolds, changes in latent configurations associated with clinical and behavioural improvements, and greater flexibility within the reduced space. Integration of bodily and interoceptive processing regions within distributed whole-brain manifolds and greater brain flexibility may be associated with reduced 'stickiness' of ruminative thinking patterns following mindfulness training in depression. Our findings highlight the promise of low-dimensional manifolds and long-range interactions arising from critical brain dynamics in understanding how mindfulness targets depressive ruminative processing.