Re: 마음챙김 명상의 최신 뇌과학!! 2015 Nature

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• Review Article
• Published: 18 March 2015

The neuroscience of mindfulness meditation

• Yi-Yuan Tang, 
• Britta K. Hölzel & 
• Michael I. Posner 

Nature Reviews Neuroscience volume 16, pages213–225 (2015)Cite this article

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An Erratum to this article was published on 10 April 2015

Key Points

• It is proposed that the mechanism through which mindfulness meditation exerts its effects is a process of enhanced self-regulation, including attention control, emotion regulation and self-awareness.
• Research on mindfulness meditation faces a number of important challenges in study design that limit the interpretation of existing studies.
• A number of changes in brain structure have been related to mindfulness meditation.
• Mindfulness practice enhances attention. The anterior cingulate cortex is the region associated with attention in which changes in activity and/or structure in response to mindfulness meditation are most consistently reported.
• Mindfulness practice improves emotion regulation and reduces stress. Fronto-limbic networks involved in these processes show various patterns of engagement by mindfulness meditation.
• Meditation practice has the potential to affect self-referential processing and improve present-moment awareness. The default mode networks — including the midline prefrontal cortex and posterior cingulate cortex, which support self-awareness — could be altered following mindfulness training.
• Mindfulness meditation has potential for the treatment of clinical disorders and might facilitate the cultivation of a healthy mind and increased well-being.
• Future research into mindfulness meditation should use randomized and actively controlled longitudinal studies with large sample sizes to validate previous findings.
• The effects of mindfulness practice on neural structure and function need to be linked to behavioural performance, such as cognitive, affective and social functioning, in future research.
• The complex mental state of mindfulness is likely to be supported by the large-scale brain networks; future work should take this into account rather than being restricted to activations in single brain areas.

질문 양극성 장애를 가진 개인은 건강한 대조군과 비교했을 때 전두-한계 네트워크의 특정 뇌 영역에서 이상적인 뇌 활동을 보일까요? 결과 49개의 기능적 자기공명영상(fMRI) 연구(양극성 장애 환자 999명과 건강한 대조군 1,027명)를 포함한 이 체계적 문헌고찰 및 메타분석은 감정 처리, 보상 처리, 작업 기억 등 3개 영역에서의 뇌 활동을 분석한 결과, 주로 전두-한계망 내 뇌 영역에서 강력한 활동 장애를 발견했습니다. 의미 전두-한계 네트워크의 이상은 양극성 장애를 가진 개인의 인지 및 정서적 기능 장애의 기반이 될 수 있습니다.

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Abstract

Research over the past two decades broadly supports the claim that mindfulness meditation — practiced widely for the reduction of stress and promotion of health — exerts beneficial effects on physical and mental health, and cognitive performance. Recent neuroimaging studies have begun to uncover the brain areas and networks that mediate these positive effects. However, the underlying neural mechanisms remain unclear, and it is apparent that more methodologically rigorous studies are required if we are to gain a full understanding of the neuronal and molecular bases of the changes in the brain that accompany mindfulness meditation.

핵심 포인트

• 마음챙김 명상이 그 효과를 발휘하는 메커니즘은 주의력 조절, 감정 조절 및 자기 인식 등을 포함한 강화된 자기 조절 과정이라는 것이 제안되었습니다.
• 마음챙김 명상에 대한 연구는 연구 설계 측면에서 기존 연구의 해석을 제한하는 여러 중요한 도전 과제에 직면해 있습니다.
• 마음챙김 명상과 관련된 뇌 구조의 변화가 여러 가지 보고되었습니다.
• 마음챙김 실천은 주의력을 향상시킵니다. 주의력과 관련된 뇌 영역인 전대상피질 anterior cingulate cortex 은 마음챙김 명상에 대한 반응으로 활동 및/또는 구조의 변화가 가장 일관되게 보고된 지역입니다.
• 마음챙김 실천은 감정 조절을 개선하고 스트레스를 감소시킵니다. 이러한 과정에 관여하는 전두-limbic 네트워크( Fronto-limbic networks )는 마음챙김 명상에 따라 다양한 활성화 패턴을 보입니다.
• 명상 실천은 자기 참조적 처리와 현재 순간 인식 개선에 영향을 미칠 수 있습니다. 자기 인식 지원을 담당하는 중간 전전두엽 피질과 후부 cingulate 피질을 포함하는 기본 모드 네트워크는 마음챙김 훈련 후 변화될 수 있습니다.
• 마음챙김 명상은 임상적 장애 치료에 잠재력을 가지고 있으며 건강한 마음과 증가된 웰빙을 촉진할 수 있습니다.
• 미래의 마음챙김 명상 연구는 이전 연구 결과를 검증하기 위해 무작위 배정 및 적극적으로 통제된 장기 추적 연구를 대규모 표본을 대상으로 수행해야 합니다.
• 마음챙김 실천이 신경 구조 및 기능에 미치는 영향은 인지, 정서적, 사회적 기능과 같은 행동적 성과와 연결되어야 합니다.
• 마음챙김의 복잡한 정신 상태는 대규모 뇌 네트워크에 의해 지원될 가능성이 높으며, 미래 연구는 단일 뇌 영역의 활성화에 국한되지 않고 이를 고려해야 합니다.

초록

지난 20년간의 연구는 스트레스 감소와 건강 증진을 위해 널리 실천되는 마음챙김 명상이 신체적 및 정신적 건강, 인지 성능에 유익한 영향을 미친다는 주장을 광범위하게 지지합니다.

최근 신경영상 연구는

이러한 긍정적 효과를 매개하는 뇌 영역과 네트워크를 밝혀내기 시작했습니다.

그러나

근본적인 신경 메커니즘은 여전히 불분명하며,

마음챙김 명상과 동반되는 뇌 변화의 신경학적 및 분자적 기반을 완전히 이해하려면

방법론적으로 엄격한 연구가 추가로 필요합니다.

Meditation can be defined as a form of mental training that aims to improve an individual’s core psychological capacities, such as attentional and emotional self-regulation. Meditation encompasses a family of complex practices that include mindfulness meditation, mantra meditation, yoga, tai chi and chi gong1 . Of these practices, mindfulness meditation — often described as nonjudgemental attention to present-moment experiences (BOX 1) — has received most attention in neuroscience research over the past two decades2–8. Although meditation research is in its infancy, a number of studies have investigated changes in brain activation (at rest and during specific tasks) that are associated with the practice of, or that follow, training in mindfulness meditation. These studies have reported changes in multiple aspects of mental function in beginner and advanced meditators, healthy individuals and patient populations9–14. In this Review, we consider the current state of research on mindfulness meditation. We discuss the methodological challenges that the field faces and point to several shortcomings in existing studies. Taking into account some important theoretical considerations, we then discuss behavioural and neuroscientific findings in light of what we think are the core components of meditation practice: attention control, emotion regulation and self-awareness (BOX 1). Within this framework, we describe research that has revealed changes in behaviour, brain activity and brain structure following mindfulness meditation training. We discuss what has been learned so far from this research and suggest new research strategies for the field. We focus here on mindfulness meditation practices and have excluded studies on other types of meditation. However, it is important to note that other styles of meditation may operate via distinct neural mechanisms15,16

명상은 개인의 핵심 심리적 능력, 

예를 들어 주의력 조절과 감정 조절을 향상시키는 것을 목표로 하는 정신적 훈련의 한 형태로 

정의될 수 있습니다. 

improve an individual’s core psychological capacities,

such as attentional and emotional self-regulation

명상은 마음챙김 명상, 만트라 명상, 요가, 태극권, 기공1 등 복잡한 실천 방법들을 포함하는 광범위한 범주입니다. 이 중 마음챙김 명상 — 현재 순간의 경험에 대한 판단 없는 주의력(BOX 1)으로 자주 설명되는 —은 지난 20년간 신경과학 연구에서 가장 많은 주목을 받았습니다2–8. 

명상에는 거의 모든 문화와 종교에서 다양한 스타일과 형태가 존재합니다. 마음챙김 명상은 원래 불교 명상 전통에서 비롯되었습니다3. 1990년대 이후로 마음챙김 명상은 다양한 정신적 및 신체적 건강 상태에 적용되어 심리학 연구에서 많은 주목을 받았습니다2,4–7. 현재 임상 및 연구 맥락에서 마음챙김 명상은 일반적으로 현재 순간의 경험에 대한 판단 없는 주의력으로 설명됩니다3–8. 이 정의는 불교의 마음챙김과 평정심 개념을 포함하며, 주의력 조절(즉각적인 경험, 예를 들어 생각, 감정, 신체 자세, 감각 등에 집중을 유지하기 위해)과 자신의 경험에 개방적이고 수용적인 태도로 접근하는 능력을 요구하는 실천을 설명합니다2–10,53,158–161. 마음챙김 명상은 집중된 주의력을 요구하는 방법과 현재 순간의 경험을 열린 상태로 관찰하는 방법으로 구분될 수 있습니다9. 신경과학 연구의 대상이 된 마음챙김 실천은 불교 명상 전통(예: 비파사나 명상, 도겐, 선)과 마음챙김 기반 접근법(예: 통합적 신체-마음 훈련(IBMT), 마음챙김 기반 스트레스 감소(MBSR), MBSR 기반 임상 개입)을 포함한 다양한 방법과 기술을 포함합니다4–6. MBSR과 IBMT는 불교 전통에서 마음챙김 실천을 채택했으며, 다양한 기술을 통해 순간순간의 판단 없는 인식을 발전시키는 것을 목표로 합니다8-11,53,73. IBMT는 문헌에서 개방적 모니터링 마음챙김 명상으로 분류되었습니다9,10,161, 반면 MBSR은 집중적 주의와 개방적 모니터링 실천을 모두 포함합니다8. 마음챙김 명상은 강화된 자기 조절 과정을 구성하는 세 가지 상호작용하는 구성 요소를 포함한다고 제안되었습니다: 강화된 주의력 조절, 개선된 감정 조절, 그리고 변화된 자기 인식(자기 참조 처리 감소와 신체 인식 강화)10 (그림의 부분 a 참조). 마음챙김 명상은 연습의 세 가지 다른 단계 — 초기, 중간(중급), 고급 —로 대략 구분될 수 있으며, 각 단계는 다른 정도의 노력을 요구합니다11 (그림 참조, 부분 b).

명상 연구는 아직 초기 단계에 있지만, 마음챙김 명상 훈련 전후 또는 훈련 중 뇌 활성화 변화(휴식 상태와 특정 과제 수행 시)를 조사한 연구들이 다수 진행되었습니다. 이러한 연구들은 초보자 및 숙련된 명상자, 건강한 개인 및 환자 집단에서 정신 기능의 다양한 측면에서 변화를 보고했습니다9–14. 

이 리뷰에서는 마음챙김 명상에 대한 현재 연구의 현황을 검토합니다. 우리는 이 분야가 직면한 방법론적 도전 과제를 논의하고 기존 연구의 몇 가지 한계점을 지적합니다. 중요한 이론적 고려 사항을 반영하여, 우리는 명상 실천의 핵심 구성 요소라고 생각하는 주의력 조절, 감정 조절, 자기 인식(BOX 1)을 중심으로 행동적 및 신경과학적 발견을 논의합니다. 

이 틀 내에서, 

마음챙김 명상 훈련 후 행동, 뇌 활동, 뇌 구조의 변화를 드러낸 연구를 

설명합니다. 

우리는 이 연구에서 지금까지 얻은 교훈을 논의하고 

해당 분야를 위한 새로운 연구 전략을 제안합니다. 

여기서는 마음챙김 명상 실천에 초점을 맞추었으며, 

다른 유형의 명상에 대한 연구는 제외했습니다. 

그러나 

다른 명상 방식은 서로 다른 신경 메커니즘을 통해 작용할 수 있다는 점을 

중요하게 지적해야 합니다15,16.

Challenges in meditation research

Findings on the effects of meditation on the brain are often reported enthusiastically by the media and used by clinicians and educators to inform their work. However, most of the findings have not yet been replicated. Many researchers are enthusiastic meditators themselves. Although their insider perspective may be valuable for a deep understanding of meditation, these researchers must ensure that they take a critical view of study outcomes. In fact, for meditation studies there is a relatively strong bias towards the publication of positive or significant results, as was shown in a meta-analysis17. The methodological quality of many meditation research studies is still relatively low. Few are actively controlled longitudinal studies, and sample sizes are small. As is typical for a young research field, many experiments are not yet based on elaborated theories, and conclusions are often drawn from post-hoc interpretations. These conclusions therefore remain tentative, and studies must be carefully replicated. Meditation research also faces several specific methodological challenges.

명상 연구의 과제 

명상이 뇌에 미치는 영향에 대한 연구 결과는 언론에 열정적으로 보도되며, 임상가와 교육자들이 자신의 업무에 반영하기 위해 활용됩니다. 그러나 대부분의 연구 결과는 아직 재현되지 않았습니다. 많은 연구자들은 스스로 명상 실천자입니다. 그들의 내부적 관점은 명상에 대한 깊은 이해에 유용할 수 있지만, 이러한 연구자들은 연구 결과에 대해 비판적인 시각을 유지해야 합니다. 실제로 명상 연구에서는 긍정적 또는 유의미한 결과의 출판에 대한 상대적으로 강한 편향이 존재한다는 것이 메타분석17에서 보여졌습니다. 많은 명상 연구의 방법론적 품질은 여전히 상대적으로 낮습니다. 적극적으로 통제된 장기 추적 연구는 드물며, 표본 크기도 작습니다. 젊은 연구 분야답게 많은 실험은 아직 정교한 이론에 기반하지 않으며, 결론은 사후 해석에서 도출되는 경우가 많습니다. 따라서 이러한 결론은 여전히 잠정적이며, 연구는 신중하게 재현되어야 합니다. 명상 연구는 또한 몇 가지 특정 방법론적 도전 과제에 직면해 있습니다.

Cross-sectional versus longitudinal studies.

Early meditation studies were mostly cross-sectional studies: that is, they compared data from a group of meditators with data from a control group at one point in time. These studies investigated practitioners with hundreds or thousands of hours of meditation experience (such as Buddhist monks) and compared them with control groups of non-meditators matched on various dimensions9,18. The rationale was that any effects of meditation would be most easily detectable in highly experienced practitioners. A number of cross-sectional studies revealed differences in brain structure and function associated with meditation (see below). Although these differences may constitute training-induced effects, a cross-sectional study design precludes causal attribution: it is possible that there are pre-existing differences in the brains of meditators, which might be linked to their interest in meditation, personality or temperament2,19. Although correlational studies have attempted to discover whether more meditation experience is related to larger changes in brain structure or function, such correlations still cannot prove that meditation practice has caused the changes because it is possible that individuals with these particular brain characteristics may be drawn to longer meditation practice. More recent research has used longitudinal designs, which compare data from one or more groups at several time points and ideally include a (preferably active) control condition and random assignment to conditions11–14,20–25. In meditation research, longitudinal studies are still relatively rare. Among those studies, some have investigated the effects of mindfulness training over just a few days, whereas others have investigated programmes of 1 to 3 months. Some of these studies have revealed changes in behaviour, brain structure and function11–14,20–25. A lack of similar changes in the control group suggests that meditation has caused the observed changes, especially when other potentially confounding variables are controlled for properly20–22.

횡단적 연구 대 종단적 연구.
초기 명상 연구는 대부분 횡단적 연구였습니다: 즉, 특정 시점에서 명상 그룹의 데이터와 대조 그룹의 데이터를 비교했습니다. 이러한 연구는 수백 시간 또는 수천 시간의 명상 경험을 가진 명상자(예: 불교 승려)를 대상으로 하며, 다양한 차원에서 일치시킨 비명상자 대조 그룹과 비교했습니다9,18. 이 연구 설계의 근거는 명상의 효과가 경험이 풍부한 실천자에서 가장 쉽게 관찰될 수 있다는 점입니다. 여러 단면 연구는 명상과 관련된 뇌 구조 및 기능의 차이를 밝혀냈습니다(아래 참조). 그러나 이러한 차이는 훈련에 의한 효과일 수 있으며, 단면 연구 설계는 인과 관계를 입증할 수 없습니다: 명상 실천자의 뇌에 이미 존재하는 차이가 명상에 대한 관심, 성격 또는 기질과 연관될 수 있기 때문입니다2,19. 상관관계 연구는 명상 경험이 뇌 구조나 기능의 변화와 관련이 있는지 탐구했지만, 이러한 상관관계는 명상 실천이 변화를 초래했다는 것을 증명할 수 없습니다. 왜냐하면 이러한 특정 뇌 특성을 가진 개인이 더 긴 명상 실천에 끌릴 수 있기 때문입니다. 최근 연구에서는 한 그룹 또는 여러 그룹의 데이터를 여러 시점에서 비교하고, 이상적으로는 (가능하면 활동적인) 대조 조건과 조건 간 무작위 배정을 포함하는 종단적 설계를 사용했습니다11–14,20–25. 명상 연구에서는 종단적 연구가 여전히 상대적으로 드뭅니다. 이러한 연구 중 일부는 몇 일간의 마음챙김 훈련 효과를 조사했으며, 다른 연구는 1~3개월 프로그램의 효과를 조사했습니다. 일부 연구는 행동, 뇌 구조 및 기능의 변화를 보여주었습니다11–14,20–25. 대조군에서 유사한 변화가 관찰되지 않은 것은 명상이 관찰된 변화를 초래했다는 것을 시사하며, 특히 다른 잠재적 혼란 변수를 적절히 통제했을 때 더욱 그렇습니다20–22.

Novice meditators versus expert meditators.

Although most cross-sectional studies included long-term meditators9,17, longitudinal studies are often conducted in beginners or naive subjects. Thus, differences in the results of cross-sectional and longitudinal analyses might be attributed to the different brain regions used during learning of meditation versus those used during the continued practice of an acquired skill. It would be interesting to follow subjects over a long-term period of practice to determine whether changes induced by meditation training persist in the absence of continued practice. However, such long-term longitudinal studies would be compromised by feasibility constraints, and it is likely that future longitudinal studies will remain restricted to relatively short training periods2 .

초보 명상가와 전문가 명상가.
대부분의 단면 연구는 장기 명상가를 대상으로 진행되었지만9,17, 장기 추적 연구는 초보자나 경험이 없는 대상자를 대상으로 진행되는 경우가 많습니다. 따라서 단면 분석과 장기 추적 분석의 결과 차이는 명상 학습 시 사용되는 뇌 영역과 습득된 기술을 지속적으로 연습할 때 사용되는 뇌 영역의 차이에서 기인할 수 있습니다. 명상 훈련으로 인한 변화가 지속적인 연습이 없는 상태에서도 지속되는지 확인하기 위해 대상자를 장기간 추적하는 것이 흥미로울 것입니다. 그러나 이러한 장기적 종단 연구는 실행 가능성 제약으로 인해 제한될 것이며, 미래의 종단 연구는 상대적으로 짧은 훈련 기간에 제한될 가능성이 높습니다2.

Control groups and interventions.

It is important to control for variables that may be confounded with meditation training, such as changes in lifestyle and diet that might accompany the meditation practice or the expectancy and intention that meditation beginners bring to their practice. Researchers must carefully determine which variables are integral aspects of the meditation training and which can be controlled for. Some earlier studies only controlled for the length of time that the individual has practised meditation and the effects of repeated testing, but more recent studies have developed and included active interventions in control groups — such as stress management education26, relaxation training14,23,27 or health enhancement programmes20–22 — that can control for variables such as social interaction with the group and teachers, amount of home exercise, physical exercise and psychoeducation. These studies are therefore better able to extract and delineate the meditation-specific effects. For example, one study investigating short-term meditation training used a ‘sham meditation’ condition in which participants thought they were meditating, but did not receive proper meditation instructions, which allowed the researchers to control for factors such as expectancy, body posture and attention from the teacher28. Mechanistic studies ideally need to use interventions that are as effective as mindfulness meditation in producing the beneficial effects on target variables but that allow for assessment of the unique mechanism underlying the mindfulness practice23,29.

대조군과 개입 방법.
명상 훈련과 혼란을 일으킬 수 있는 변수들을 통제하는 것이 중요합니다. 예를 들어, 명상 실천과 동반될 수 있는 생활 방식이나 식습관의 변화, 또는 명상 초보자들이 실천에 가져오는 기대감과 의도 등이 이에 해당됩니다. 연구자들은 명상 훈련의 필수적인 요소인 변수와 통제 가능한 변수를 신중하게 구분해야 합니다. 일부 초기 연구는 개인이 명상을 실천한 기간과 반복 테스트의 효과를 통제하는 데만 초점을 맞췄지만, 최근 연구들은 대조군에 스트레스 관리 교육26, 이완 훈련14,23,27 또는 건강 증진 프로그램20–22와 같은 적극적인 개입을 개발하고 포함시켜 그룹 내 사회적 상호작용, 교사와의 상호작용, 가정에서의 운동량, 신체 운동, 심리 교육과 같은 변수를 통제할 수 있도록 했습니다. 이러한 연구들은 따라서 명상 특유의 효과를 추출하고 구분하는 데 더 적합합니다. 

예를 들어, 단기 명상 훈련을 조사한 한 연구에서는 참가자들이 명상을 하고 있다고 생각했지만 적절한 명상 지침을 받지 않은 '가짜 명상' 조건을 사용해 기대감, 신체 자세, 교사로부터의 주의력 등 요인을 통제할 수 있었습니다28. 기전 연구는 이상적으로 대상 변수에 대한 유익한 효과를 유발하는 데 명상 명상과 동일한 효과를 가진 개입을 사용해야 하며, 동시에 명상 실천의 독특한 기전을 평가할 수 있도록 해야 합니다23,29.

Control conditions in functional imaging.

Although all functional neuroimaging studies must use appropriate comparison conditions, this challenge is particularly important when imaging meditative states (BOX 2). The comparison condition should be one in which a state of mindfulness meditation is not present. Many studies use resting comparison conditions, but a problem with this is that experienced practitioners are likely to enter into a state of meditation when at rest. However, other active tasks introduce additional brain activity that renders the comparison difficult to interpret. Using imaging protocols that do not rely on blood-oxygen-level-dependent contrasts (BOLD contrasts), such as arterial spin labelling, might be a possible solution for this problem30.

기능적 영상 검사에서의 대조 조건.
모든 기능적 신경영상 연구는 적절한 대조 조건을 사용해야 하지만, 명상 상태를 영상화할 때 이 문제는 특히 중요합니다(BOX 2). 대조 조건은 명상 상태가 존재하지 않는 상태여야 합니다. 많은 연구에서 휴식 비교 조건을 사용하지만, 이 방법의 문제는 경험이 풍부한 수행자들이 휴식 상태에서 명상 상태에 들어갈 가능성이 높다는 점입니다. 반면, 다른 활동적인 작업은 추가적인 뇌 활동을 유발하여 비교 해석을 어렵게 만들 수 있습니다. 혈액 산소 수준 의존 대비(BOLD 대비)에 의존하지 않는 영상 프로토콜, 예를 들어 동맥 스핀 라벨링을 사용하는 것이 이 문제의 해결책이 될 수 있습니다30.

Changes in brain structure

In the past decade, 21 studies have investigated alterations in brain morphometry related to mindfulness meditation17. These studies varied in regard to the exact mindfulness meditation tradition under investigation31–34,36–52, and multiple measurements have been used to investigate effects on both grey and white matter. Studies have captured cortical thickness32,51, grey-matter volume and/or density33,40, fractional anisotropy and axial and radial diffusivity38,39. These studies have also used different research designs. Most have made cross-sectional comparisons between experienced meditators and controls32–34; however, a few recent studies have investigated longitudinal changes in novice practitioners38–40. Some further studies have investigated correlations between brain changes and other variables related to mindfulness practice, such as stress reduction40, emotion regulation39 or increased well-being47. Most studies include small sample sizes of between 10 and 34 subjects per group31-42. Because the studies vary in regard to study design, measurement and type of mindfulness meditation, it is not surprising that the locations of reported effects are diverse and cover multiple regions in the brain31–34,36–52. Effects reported by individual studies have been found in multiple brain regions, including the cerebral cortex, subcortical grey and white matter, brain stem and cerebellum, suggesting that the effects of meditation might involve large-scale brain networks. This is not surprising because mindfulness practice involves multiple aspects of mental function that use multiple complex interactive networks in the brain. TABLE 1 summarizes the main findings of structural neuroimaging studies on mindfulness meditation (grey and white matter).

뇌 구조의 변화
지난 10년간, 

마음챙김 명상과 관련된 뇌 형태학의 변화를 조사한 

21개의 연구가 진행되었습니다17. 

이 연구들은 조사된 마음챙김 명상 전통에 따라 다양했으며³¹⁻³⁴,³⁶⁻⁵², 

회백질과 백질에 미치는 영향을 조사하기 위해 

다양한 측정 방법을 사용했습니다. 

연구들은 

피질 두께³²,⁵¹, 

회백질 부피 및/또는 밀도³³,⁴⁰, 

분수 이방성 및 축방향 및 방사형 확산도³⁸,³⁹를 측정했습니다. 

cortical thickness

grey-matter volume and/or density

fractional anisotropy and axial and radial diffusivity

이 연구들은 또한 다양한 연구 설계를 사용했습니다. 대부분의 연구는 경험이 풍부한 명상자와 대조군 사이의 단면 비교를 수행했습니다32–34; 그러나 최근 몇몇 연구는 초보자 명상자의 장기적 변화를 조사했습니다38–40. 일부 추가 연구는 뇌 변화와 마음챙김 실천과 관련된 다른 변수 간의 상관관계를 조사했습니다, 

예를 들어 스트레스 감소40, 감정 조절39 또는 행복감 증가47. 대부분의 연구는 그룹당 10명에서 34명의 작은 표본 크기를 포함했습니다31-42. 연구 설계, 측정 방법 및 명상 유형이 다양하기 때문에 보고된 효과의 위치가 다양하고 뇌의 여러 영역을 포함한다는 것은 놀랍지 않습니다31–34,36–52. 

개별 연구에서 보고된 효과는 

대뇌 피질, 피질 하부 회백질 및 백질, 뇌간, 소뇌 등 여러 뇌 영역에서 발견되었으며,

 이는 명상의 효과가 대규모 뇌 네트워크를 포함할 수 있음을 시사합니다. 

Effects reported by individual studies have been found in multiple brain regions, including the

cerebral cortex,

subcortical grey and white matter,

brain stem and cerebellum,

suggesting that the effects of meditation might involve large-scale brain networks.

이는 명상 실천이 뇌의 복잡한 상호작용 네트워크를 활용하는 정신 기능의 다중 측면을 포함하기 때문에 놀랍지 않습니다. 

표 1은 마음챙김 명상에 대한 구조적 신경영상 연구의 주요 결과를 요약합니다(회백질 및 백질).

An activation likelihood estimation meta-analysis, which also included studies from traditions other than mindfulness meditation, was conducted to investigate which regions were consistently altered in meditators across studies17. The findings demonstrated a global medium effect size, and eight brain regions were found to be consistently altered in meditators: the frontopolar cortex, which the authors suggest might be related to enhanced meta-awareness following meditation practice; the sensory cortices and insula, areas that have been related to body awareness; the hippocampus, a region that has been related to memory processes; the anterior cingulate cortex (ACC), mid-cingulate cortex and orbitofrontal cortex, areas known to be related to self and emotion regulation; and the superior longitudinal fasciculus and corpus callosum, areas involved in intra- and inter-hemispherical communication17. Thus, some initial attempts have been undertaken to investigate the brain regions that are structurally altered by the practice of meditation. However, our knowledge of what these changes actually mean will remain trivial until we gain a better understanding of how such structural changes are related to the reported improvements in affective, cognitive and social function. Very few studies have begun to relate findings in the brain to selfreported variables and behavioural measures34,39,47,48,51. Future studies therefore need to replicate the reported findings and begin to unravel how changes in the neural structure relate to changes in well-being and behaviour. Growing evidence also demonstrates changes in the functional properties of the brain following meditation. Below, we summarize such findings in the context of the framework of core mechanisms of mindfulness meditation (BOX 1; FIG. 1).

마음챙김 명상 이외의 전통에서 진행된 연구도 포함된 활성화 가능성 추정 메타분석이 수행되어, 연구 간에 명상 실천자들이 일관되게 변화된 뇌 영역을 조사했습니다¹⁷. 

연구 결과는 전체적으로 중간 정도의 효과 크기를 보여주었으며, 

명상 실천자에서 일관되게 변화된 8개의 뇌 영역이 확인되었습니다: 

전두극 피질(frontopolar cortex) : 명상 실천 후 향상된 메타인지와 관련될 수 있다고 저자들이 제안한 영역

감각 피질과 섬엽(insula) : 신체 인식과 관련이 있는 것으로 알려진 영역; 

기억 과정과 관련이 있는 해마

자기 조절과 감정 조절과 관련이 있는 것으로 알려진 전대상피질(ACC), 

중간대상피질 및 전두엽 피질; 

그리고 반구 간 및 반구 내 통신에 관여하는 상부 장축 속과 뇌량. 

frontopolar cortex, which the authors suggest might be related to enhanced meta-awareness following meditation practice;

sensory cortices and insula, areas that have been related to body awareness;

the hippocampus, a region that has been related to memory processes;

the anterior cingulate cortex (ACC), mid-cingulate cortex and orbitofrontal cortex, areas known to be related to self and emotion regulation;

and the superior longitudinal fasciculus and corpus callosum, areas involved in intra- and inter-hemispherical communication

따라서 명상 실천에 의해 구조적으로 변화하는 뇌 영역을 조사하기 위한 초기 시도가 이루어졌습니다. 그러나 이러한 구조적 변화가 보고된 정서적, 인지적, 사회적 기능의 개선과 어떻게 관련되는지 이해하지 못한다면, 이러한 변화의 의미는 여전히 미미할 것입니다. 뇌의 변화와 자기보고 변수 및 행동 측정치를 연관시킨 연구는 매우 드뭅니다34,39,47,48,51. 따라서 향후 연구는 보고된 결과를 재현하고 신경 구조의 변화가 웰빙과 행동의 변화와 어떻게 관련되는지 밝혀내는 것이 필요합니다. 

명상 후 뇌의 기능적 특성 변화에 대한 증거도 점차 증가하고 있습니다. 

아래에서는 이러한 결과를 마음챙김 명상의 핵심 메커니즘 프레임워크(BOX 1; FIG. 1) 내에서 요약합니다.

Mindfulness and attention

Many meditation traditions emphasize the necessity to cultivate attention regulation early in the practice9,53. A sufficient degree of attentional control is required to stay engaged in meditation, and meditators often report improved attention control as an effect of repeated practice10,14. Multiple studies have experimentally investigated such effects54.

마음챙김과 주의력 

많은 명상 전통은 

명상 초기 단계에서 주의력 조절을 기르는 것이 필수적이라고 

강조합니다9,53. 

명상에 집중하기 위해서는 

충분한 주의력 조절 능력이 필요하며, 

명상 실천자들은 반복된 연습을 통해 주의력 조절 능력이 향상되었다고 보고합니다10,14. 

여러 연구에서 이러한 효과를 실험적으로 조사했습니다54.

Components of attention.

Attention is often subdivided into three different components: alerting (readiness in preparation for an impending stimulus, which includes tonic effects that result from spending time on a task (vigilance) and phasic effects that are due to brain changes induced by warning signals or targets); orienting (the selection of specific information from multiple sensory stimuli); and conflict monitoring (monitoring and resolution of conflict between computations in different neural areas, also referred to as executive attention)55,56. Other distinctions between types of attention refer to combinations of these three components. For example, sustained attention refers to the sense of vigilance during long continued tasks and may involve both tonic alerting and orienting, whereas selective attention may involve either orienting (when a stimulus is present) or executive function (when stored information is involved).

Performance in these three basic domains can be measured with the attention network test (ANT)57. This test uses as a target an arrow pointing left or right. The target is surrounded by flankers, and subtracting reaction times to congruent stimuli (that is, those on the side of the screen indicated by the arrow) from reaction times to incongruent stimuli produces a measure of the time to resolve conflict. The inclusion of cues that indicate when or where the target will occur allows the measurement of alerting and orienting. These measures are used to quantify efficiency in each of the three networks that support the individual components of attention. Alerting involves the brain’s noradrenaline system, which originates in the locus coeruleus. Orienting involves frontal and parietal areas, including the frontal eye fields and inferior and superior parietal lobe. The executive network involved in conflict resolution involves the ACC, anterior insula and basal ganglia58,59.

주의의 구성 요소.

주의는 일반적으로 세 가지 다른 구성 요소로 구분됩니다: 

경계(경고 신호나 목표물에 의해 유발된 뇌 변화로 인한 일시적 효과와 작업에 시간을 투자함으로써 발생하는 지속적 효과(경계력)를 포함하는, 임박한 자극에 대비한 준비 상태); 

방향 설정(다중 감각 자극으로부터 특정 정보를 선택하는 과정); 

및 갈등 모니터링(다양한 신경 영역 간의 계산 간 갈등의 모니터링과 해결, 실행 주의력으로도 불림) 

alerting (readiness in preparation for an impending stimulus, which includes tonic effects that result from spending time on a task (vigilance) and phasic effects that are due to brain changes induced by warning signals or targets);

orienting (the selection of specific information from multiple sensory stimuli); and

conflict monitoring (monitoring and resolution of conflict between computations in different neural areas, also referred to as executive attention)

주의의 유형 간 다른 구분은 이 세 구성 요소의 조합에 기반합니다. 

예를 들어, 

지속적 주의는 장시간 지속되는 작업 중의 경계감으로, 토닉 경계와 방향 설정 모두를 포함할 수 있으며, 

선택적 주의는 자극이 존재할 때 방향 설정이나 저장된 정보가 관여될 때 집행 기능을 포함할 수 있습니다. 

이 세 기본 영역에서의 수행은 주의 네트워크 테스트(ANT)57로 측정될 수 있습니다. 

attention network test

이 검사는 왼쪽이나 오른쪽으로 가리키는 화살표를 목표물로 사용합니다. 목표물은 주변에 방해물이 둘러싸여 있으며, 화살표가 가리키는 화면 쪽의 자극에 대한 반응 시간에서 불일치 자극에 대한 반응 시간을 빼면 갈등 해결에 소요된 시간을 측정합니다. 목표물이 발생할 때나 위치를 나타내는 단서가 포함되면 경계와 방향 전환을 측정할 수 있습니다. 이 측정값은 주의의 개별 구성 요소를 지원하는 세 가지 네트워크의 효율성을 정량화하는 데 사용됩니다. 

경계 네트워크는 뇌의 노르아드레날린 시스템과 관련되며, 이는 locus coeruleus에서 기원합니다. 

방향 전환 네트워크는 전두엽과 후두엽 영역, 특히 전두엽 눈 운동 영역과 하부 및 상부 후두엽을 포함합니다. 

갈등 해결에 관여하는 실행 네트워크는 ACC, 전방 섬엽 및 기저핵을 포함합니다.

Effects of mindfulness meditation on attention.

The ANT and other experimental paradigms have been used to investigate the effects of meditation on attentional performance60. Improved conflict monitoring was reported in several studies14,61–64. For example, a longitudinal study showed that only 5 days (20min per day) of integrative body–mind training (IBMT) led to improved conflict monitoring14. In addition, cross-sectional studies of 3 months of mindfulness meditation showed a reduced attentional blink (a lapse in attention following a stimulus within a rapid stream of presented stimuli that has been related to executive function65,66) following training64 (also see REF. 67). Better performance in conflict monitoring has also been demonstrated in experienced meditators in cross-sectional studies68. However, although altered attention is a common finding in these well-designed meditation studies, some studies investigating mindfulness-based stress reduction (MBSR) have not observed effects on conflict monitoring69,70. Most of the studies on the effects of short-term (1 week) mindfulness meditation on alerting have not found significant effects, but studies investigating long-term meditators (ranging from months to years) did detect changes in alerting27,70–72. Enhanced orienting has been reported in some cross-sectional studies using longer periods of training. For example, 3 months of Shamatha mindfulness training improved tonic alertness (the ability to remain alert over time) and allowed for improved orienting towards a visual target in comparison to controls71. However, 8 weeks of MBSR did not improve measures of sustained attention in a continuous performance task that measured aspects of tonic alertness, but did show some improvement in orienting22. We do not know whether the differences in the findings of these studies are due to the type of training, type of control or other subtle factors. A systematic review that compiled the findings of these studies (as well as the effects on other measures of cognition) concluded that early phases of mindfulness meditation might be associated with improvements in conflict monitoring and orienting, whereas later phases might be mainly associated with improved alerting60. It is currently still unclear how different meditation practices differentially affect the specific attentional components2,9,53. In addition, the length of practice needs to be defined more consistently in future research.

마음챙김 명상이 주의력에 미치는 영향. 

ANT 및 기타 실험적 패러다임은 명상이 주의력 수행에 미치는 영향을 조사하기 위해 사용되었습니다60. 여러 연구에서 갈등 모니터링의 개선이 보고되었습니다14,61–64. 예를 들어, 장기적 연구에서 통합적 신체-마음 훈련(IBMT)을 5일(하루 20분)만 실시해도 갈등 모니터링이 개선되었다고 나타났습니다14. 또한, 3개월간의 마음챙김 명상 연구에서 훈련 후 주의력 블링크(빠른 자극 흐름 속에서 자극에 대한 주의력 결손으로, 실행 기능과 관련이 있다고 알려져 있음65,66)가 감소했다는 결과가 나왔습니다64(참고문헌 67도 참조). 경험이 풍부한 명상가에서 갈등 모니터링 성능이 개선되었다는 결과는 횡단면 연구에서도 확인되었습니다68. 그러나 이러한 잘 설계된 명상 연구에서 주의력 변화가 흔히 관찰되지만, 마음챙김 기반 스트레스 감소(MBSR)를 조사한 일부 연구에서는 갈등 모니터링에 대한 효과를 관찰하지 못했습니다69,70. 단기(1주) 마음챙김 명상이 경계 기능에 미치는 영향을 조사한 대부분의 연구는 유의미한 효과를 발견하지 못했지만, 장기 명상자(수개월에서 수년에 이르는 기간)를 대상으로 한 연구에서는 경계 기능의 변화를 관찰했습니다27,70–72. 일부 횡단면 연구에서는 더 긴 훈련 기간을 사용해 방향 전환 기능의 개선이 보고되었습니다. 

예를 들어, 3개월간의 Shamatha 마음챙김 훈련은 시간에 따른 경계 상태(tonic alertness)를 개선했으며, 시각적 목표물에 대한 방향 전환 능력도 대조군보다 향상되었습니다71. 그러나 8주간의 MBSR은 지속적 주의력 측정 항목(tonic alertness의 일부를 측정하는 연속 수행 과제)에서 개선을 보이지 않았지만, 방향 전환 능력에서는 일부 개선이 관찰되었습니다22. 이 연구들의 결과 차이는 훈련 유형, 대조군 유형 또는 기타 미묘한 요인에 기인하는지 여부는 알 수 없습니다. 이 연구들의 결과를 종합한 체계적 문헌 고찰(인지의 다른 지표에 대한 영향도 포함)은 마음챙김 명상의 초기 단계가 갈등 모니터링과 방향 전환의 개선과 연관될 수 있으며, 후기 단계는 주로 경계 능력의 개선과 연관될 수 있다고 결론지었습니다60. 현재까지 다양한 명상 실천이 특정 주의력 구성 요소에 어떻게 차이를 일으키는지는 여전히 명확하지 않습니다2,9,53. 또한 향후 연구에서는 실천 기간을 더 일관되게 정의할 필요가 있습니다.

Neural mechanisms of enhanced attention control.

Several functional and structural MRI studies on mindfulness training have investigated neuroplasticity in brain regions supporting attention regulation. The brain region to which the effects of mindfulness training on attention is most consistently linked is the ACC11,23,38,39,73–76. The ACC enables executive attention and control77–79 by detecting the presence of conflicts emerging from incompatible streams of information processing. The ACC and the fronto-insular cortex form part of a network that facilitates cognitive processing through long-range connections to other brain areas11,80. Cross-sectional studies have reported enhanced activation of regions of the ACC in experienced meditators compared to controls during focused attention meditation76 or when mindfully anticipating delivery of a painful stimulus81. Greater activation of the ventral and/or rostral ACC during the resting state following 5 days of IBMT was also found in an actively controlled, randomized, longitudinal study23. Although ACC activation may be enhanced in earlier stages of mindfulness meditation, it might decrease with higher levels of expertise, as demonstrated in a cross-sectional study18. Structural MRI data suggest that mindfulness meditation might be associated with greater cortical thickness51 and might lead to enhanced white-matter integrity in the ACC38,39. Other attention-related brain regions in which functional changes have been observed following mindfulness meditation include the dorsolateral prefrontal cortex (PFC), where responses were enhanced during executive processing82, as revealed by a randomized longitudinal study, and parietal attention regions, which showed greater activation following an MBSR course in people with social anxiety, as demonstrated by an uncontrolled longitudinal study83. Furthermore, a diminished agerelated decline of grey-matter volume in the putamen as well as diminished age-related decline in sustained attention performance were found in a cross-sectional study of Zen meditation practitioners34.

주의 조절의 신경 메커니즘. 

마음챙김 훈련에 대한 여러 기능적 및 구조적 MRI 연구는 주의 조절을 지원하는 뇌 영역에서의 신경 가소성을 조사해 왔습니다. 

마음챙김 훈련이 주의에 미치는 영향이 가장 일관되게 연관된 뇌 영역은 

ACC입니다11,23,38,39,73–76. 

ACC는 

서로 호환되지 않는 정보 처리 흐름에서 발생하는 충돌의 존재를 감지함으로써 

실행 주의와 조절을 가능하게 합니다77–79. 

ACC와 전두-측두 피질은 

다른 뇌 영역과의 장거리 연결을 통해 

인지 처리를 촉진하는 네트워크의 일부를 형성합니다11,80. 

횡단면 연구에서는 집중 주의 명상76 중이나 통증 자극의 의식적anticipation 시 경험이 풍부한 명상가에서 대조군에 비해 ACC의 활성화가 증가했다는 보고가 있습니다81. 5일간의 IBMT 후 휴식 상태에서 복부 및/또는 전방 ACC의 활성화가 증가했다는 결과가 적극적으로 통제된 무작위 장기 추적 연구23에서 보고되었습니다. 마음챙김 명상의 초기 단계에서 ACC 활성화가 증가할 수 있지만, 전문성 수준이 높아질수록 감소할 수 있다는 것이 단면 연구18에서 보여졌습니다. 구조적 MRI 데이터는 마음챙김 명상이 ACC의 피질 두께 증가51와 백질 무결성 향상38,39와 연관될 수 있음을 시사합니다. 마음챙김 명상 후 기능적 변화가 관찰된 다른 주의 관련 뇌 영역에는 실행 기능 처리 중 반응이 강화된 dorsolateral prefrontal cortex (PFC)가 포함되며, 이는 무작위 장기 추적 연구에서 밝혀졌습니다. 또한, 사회적 불안이 있는 사람들이 MBSR 과정 후 parietal 주의 영역에서 더 높은 활성화가 관찰되었으며, 이는 통제되지 않은 장기 추적 연구에서 입증되었습니다. 

또한,

선 명상 실천자들을 대상으로 한 횡단적 연구에서

뇌의 putamen 부위에서 연령 관련 회백질 부피 감소가 감소했으며,

지속적 주의력 성능의 연령 관련 감소도 감소한 것으로 나타났습니다³⁴.

Although there is evidence that brain regions relevant for the regulation of attention show functional and structural changes following mindfulness meditation practice, it has not yet been determined whether these changes are actually related to the improved attentional performance. Longitudinal studies that use measures of attentional performance along with functional MRI (fMRI) are needed. If supported by more rigorous future research, the evidence of improved attention regulation and strengthened brain activity in the regions underlying attentional control following mindfulness meditation might be promising for the treatment of psychiatric disorders in which there are deficiencies in these functions74,84,85.

마음챙김 명상 연습 후 주의력 조절과 관련된 뇌 영역에서 

기능적 및 구조적 변화가 관찰되었지만, 

이러한 변화가 실제로 주의력 성능의 개선과 관련이 있는지 여부는 

아직 명확히 밝혀지지 않았습니다. 

주의력 성능을 측정하는 지표와 

기능적 자기공명영상(fMRI)을 결합한 

장기적 연구가 필요합니다. 

향후 더 엄격한 연구로 뒷받침된다면, 

마음챙김 명상 후 주의력 조절 개선과 주의력 통제와 관련된 뇌 영역에서의 뇌 활동 강화 증거는 

이러한 기능에 결함이 있는 정신질환의 치료에 유망할 수 있습니다74,84,85.

Mindfulness and emotion regulation

Enhanced emotion regulation has been suggested to underlie many of the beneficial effects of mindfulness meditation. Emotion regulation refers to strategies that can influence which emotions arise and when, how long they occur, and how these emotions are experienced and expressed. A range of implicit and explicit emotion regulation processes has been proposed86, and mindfulnessbased emotion regulation may involve a mix of these processes, including attentional deployment (attending to mental processes, including emotions), cognitive change (altering typical patterns of appraisal regarding one’s emotions) and response modulation (decreasing tonic levels of suppression).

마음챙김과 감정 조절  
마음챙김 명상의 많은 유익한 효과의 기반이 될 수 있다고 제안되어 왔습니다. 

감정 조절은 

어떤 감정이 발생하고 언제 발생하며, 얼마나 오래 지속되는지, 

그리고 이러한 감정이 어떻게 경험되고 표현되는지에 영향을 미치는 전략을 의미합니다. 

암묵적 및 명시적 감정 조절 과정의 

다양한 유형이 제안되었습니다86, 

그리고 마음챙김 기반 감정 조절은 

이러한 과정의 조합을 포함할 수 있으며, 

주의력 배분(감정 포함 정신 과정에 주의 집중), 

인지 변화(감정에 대한 평가의 일반적인 패턴 변경), 

반응 조절(억압의 기본 수준 감소) 등이 포함됩니다.

Effects of mindfulness meditation on emotion regulation.

Improvements in emotion regulation associated with mindfulness meditation have been investigated through various approaches, including experimental studies, selfreporting studies, measurement of peripheral physiology and neuroimaging10. These studies have reported various positive effects of mindfulness meditation on emotional processing, such as a reduction in emotional interference by unpleasant stimuli87, decreased physiological reactivity and facilitated return to emotional baseline after response to a stressor film88, and decreased self-reported difficulties in emotion regulation89. Consequently, lowered intensity and frequency of negative affect90,91 and improved positive mood states14,91,92 are reported to be associated with mindfulness meditation.

마음챙김 명상이 감정 조절에 미치는 영향.

마음챙김 명상과 관련된 감정 조절의 개선은 

실험 연구, 자기보고 연구, 주변 생리 측정 및 신경영상 연구10 등을 통해 조사되었습니다. 

이러한 연구들은 

마음챙김 명상이 감정 처리 과정에 미치는 

다양한 긍정적 효과를 보고했습니다. 

예를 들어, 

불쾌한 자극에 의한 감정 간섭 감소87, 

스트레스 유발 영상에 대한 반응 후 생리적 반응 감소 및 감정 기저 수준으로의 회복 촉진88, 

감정 조절 어려움의 감소89 등이 포함됩니다. 

결과적으로, 

부정적 정서의 강도와 빈도 감소90,91 및 긍정적 기분 상태의 개선14,91,92가 

마음챙김 명상과 연관되어 보고되었습니다.

Neural mechanisms of improved emotion regulation.

Neuroimaging studies that have probed the enhanced emotion regulation associated with mindfulness meditation in an attempt to identify the underlying brain activation patterns typically present study participants with emotional pictures82,93–97, words and/or statements29,98 and instruct them to encounter these with a state of mindfulness or a simple baseline state. The hypothesis that drives many of these studies is that mindful emotion regulation works by strengthening prefrontal cognitive control mechanisms and thus downregulates activity in regions relevant to affect processing, such as the amygdala. Present-moment awareness and non-judgemental acceptance through mindfulness meditation8,10 are thought to be crucial in promoting cognitive control because they increase sensitivity to affective cues that help to signal the need for control99. Studies have therefore investigated whether mindfulness training exerts its effects through enhanced top-down control or facilitated bottom-up processing100. The findings (outlined below) suggest that the level of expertise is important, with beginners showing a different pattern from expert meditators. However, although several studies have pointed to the involvement of fronto-limbic regions, very few studies have begun to relate changes in these regions to changes in measures of behaviour or well-being10. A frequently reported finding is that mindfulness practice leads to (or is associated with) a diminished activation of the amygdala in response to emotional stimuli during mindful states83,94,95 as well as in a resting state93, suggesting a decrease in emotional arousal. However, although such results have been reported for meditation beginners, they have less consistently been detected in experienced meditators95 (but see REF. 18). Prefrontal activations are often enhanced as an effect of mindfulness meditation in novice meditators (but see REF. 29): for example, greater dorsolateral PFC responses were found during executive processing within an emotional Stroop task in healthy individuals after 6 weeks of mindfulness training82. Enhanced dorsomedial and dorsolateral PFC activation was also detected when participants expected to see negative images while engaging in a mindful state94. Moreover, after an MBSR course, an enhanced activation in the ventrolateral PFC in people suffering from anxiety was found when they labelled the affect of emotional images97. By contrast, experienced meditators have been found to show diminished activation in medial PFC regions95. This finding could be interpreted as indicating reduced control (disengagement of elaboration and appraisal) and greater acceptance of affective states.

Neuroimaging studies of ameliorated pain processing through mindfulness meditation have also pointed to expertise-related differences in the extent of cognitive control over sensory experience. Meditation beginners showed increased activity in areas involved in the cognitive regulation of nociceptive processing (the ACC and anterior insula) and areas involved in reframing the eval‎uation of stimuli (the orbitofrontal cortex), along with reduced activation in the primary somatosensory cortex in a 4-day longitudinal study with no control group30, whereas meditation experts were characterized by decreased activation in dorsolateral and ventrolateral PFC regions and enhancements in primary pain processing regions (the insula, somatosensory cortex and thalamus) compared with controls in two cross-sectional studies35,81. These findings are in line with the assumption that the process of mindfulness meditation is characterized as an active cognitive regulation in meditation beginners, who need to overcome habitual ways of internally reacting to one’s emotions and might therefore show greater prefrontal activation. Expert meditators might not use this prefrontal control. Rather, they might have automated an accepting stance towards their experience and thus no longer engage in top-down control efforts but instead show enhanced bottom-up processing100. In the early stages of meditation training, achieving the meditation state seems to involve the use of attentional control and mental effort; thus, areas of the lateral prefrontal and parietal cortex are more active than before training11,16,100,101. This may reflect the higher level of effort often found when participants struggle to obtain the meditation state in the early stages11,73,98,102. However, in the advanced stages, prefrontal–parietal activity is often reduced or eliminated, but ACC, striatum and insula activity remains9,10,53,73,76,101–103. Whether effort has a key role in PFC and ACC activation during or following meditation needs further investigation. 

Analysis of functional connectivity between regions of the fronto-limbic network could help to further elucidate the regulatory function of executive control regions. Only a few studies have included such analyses. One cross-sectional study on pain processing in meditators demonstrated decreased connectivity of executive and pain-related brain regions35, and one study of mindfulness-naive smokers demonstrated reduced connectivity between craving-related brain regions during a mindfulness condition compared to passive viewing of smokingrelated images during cigarette craving96, suggesting a functional decoupling of involved regions. Another longitudinal, randomized study reported that people suffering from anxiety showed a change from a negative correlation between the activity of frontal regions and that of the amygdala before intervention (that is, negative connectivity) to a positive correlation between the activity of these regions (positive connectivity) after a mindfulness intervention97. Because such a negative correlation will occur when prefrontal regions downregulate limbic activation104,105, it was speculated that the positive coupling between the activity of the two regions after mindfulness intervention might indicate that meditation involves monitoring of arousal rather than a downregulation or suppression of emotional responses, and that it might be a unique signature of mindful emotion regulation. Importantly, this study also investigated the correlation between neural and self-reported findings and demonstrated that the changes in PFC–amygdala connectivity were correlated with anxiety symptom improvement. Further studies are needed to elucidate the complex interplay between regions of the fronto-limbic network in mindfulness meditation. Although the proposed similarities between mindfulness and the reappraisal strategy of emotion regulation have been much debated, there is some evidence that mindfulness also shares similarities with extinction processes (BOX 3). Brain regions involved in motivation and reward processing also show functional alterations that are related to mindfulness training, such as stronger activity of the putamen and caudate during a resting state following mindfulness training23 and lower activation in the caudate nucleus during reward anticipation in experienced meditators106. These studies might indicate altered self-regulation in the motivational realm, with possibly reduced susceptibility to incentives and enhanced reward-related activity during rest. Brain regions involved in the regulation of emotions have also shown structural changes following mindfulness meditation31,32,38–41,48,51. Although these findings provide some initial evidence that these brain regions are related to mindfulness practice, the question of whether they are involved in mediating the beneficial effects of mindfulness meditation remains largely unanswered.

신경학적 메커니즘을 통한 감정 조절의 개선.
마음챙김 명상과 관련된 감정 조절의 개선을 탐구하기 위해 수행된 신경영상 연구들은 일반적으로 연구 참여자들에게 감정적인 이미지82,93–97, 단어 및/또는 문장29,98을 제시하고, 이를 마음챙김 상태나 단순한 기준 상태로 경험하도록 지시합니다. 이러한 연구의 많은 부분을 주도하는 가설은 마음챙김 감정 조절이 전전두엽 인지 통제 메커니즘을 강화함으로써 감정 처리와 관련된 영역(예: 편도체)의 활동을 억제한다는 것입니다. 마음챙김 명상을 통해 얻는 현재 순간에 대한 인식과 비판 없는 수용은99 인지 통제를 촉진하는 데 중요하다고 여겨집니다. 이는 감정적 단서에 대한 민감성을 높여 통제의 필요성을 신호하기 때문입니다. 따라서 연구들은 마음챙김 훈련이 상향식 통제 강화나 하향식 처리 촉진을 통해 효과를 발휘하는지 조사해 왔습니다100. 결과(아래에 요약됨)는 전문성 수준이 중요하며, 초보자와 전문가 명상가 사이에 다른 패턴이 나타남을 보여줍니다. 그러나 전두-한계 부위의 관여를 지적한 연구는 많지만, 이러한 부위의 변화와 행동 또는 웰빙 지표의 변화를 연관시킨 연구는 매우 적습니다10. 자주 보고되는 결과는 마음챙김 연습이 마음챙김 상태에서 감정적 자극에 대한 편도체의 활성화 감소와 연관되어 있다는 점입니다⁸³,⁹⁴,⁹⁵, 휴식 상태에서도 마찬가지입니다⁹³, 이는 감정적 각성의 감소로 해석될 수 있습니다. 

그러나 이러한 결과는 명상 초보자에서 보고되었지만, 경험이 풍부한 명상가에서는 일관되게 관찰되지 않았습니다⁹⁵ (하지만 REF. 18 참조). 마음챙김 명상은 초보자에서 전전두엽 활성화가 증가하는 효과를 자주 보입니다(하지만 REF. 29 참조): 예를 들어, 건강한 개인이 6주간의 마음챙김 훈련 후 감정적 스트루프 과제에서 실행 기능 처리 중 dorsolateral PFC 반응이 더 강하게 나타났습니다82. 참가자들이 부정적 이미지를 볼 것으로 예상할 때 마음챙김 상태에서 dorsomedial 및 dorsolateral PFC 활성화가 증가한 것도 관찰되었습니다94. 또한 MBSR 과정 후 불안 장애를 겪는 사람들이 감정적 이미지의 감정을 라벨링할 때 복측측두 전전두엽의 활성화가 증가했다는 결과가 나왔습니다97. 반면 경험이 풍부한 명상자들은 내측 전전두엽 지역의 활성화가 감소했다는 결과가 나왔습니다95. 이 결과는 통제 감소(세부적 평가와 판단의 해제)와 감정 상태에 대한 수용 증가를 의미할 수 있습니다.

마음챙김 명상을 통해 통증 처리 개선을 연구한 신경영상 연구는 감각 경험에 대한 인지 통제의 정도에 있어 전문성 관련 차이를 지적했습니다. 명상 초보자들은 통각 처리의 인지 조절에 관여하는 영역(ACC와 전방 섬엽)과 자극 평가 재구성 관련 영역(전두엽 피질)에서 활동이 증가했으며, 4일간의 장기 추적 연구에서 대조군이 없는 경우30, 명상 초보자들은 일차 체감각 피질의 활성화가 감소한 반면, 두 개의 횡단면 연구35,81에서 명상 전문가들은 대조군에 비해 측두측 및 복측 전전두엽 피질(PFC) 지역의 활성화가 감소하고 일차 통증 처리 영역(섬엽, 체감각 피질 및 시상)의 활성화가 증가했습니다. 이러한 결과는 명상 초보자의 명상 과정이 습관적인 감정 반응을 극복하기 위한 적극적인 인지 조절로 특징지어진다는 가설과 일치합니다. 따라서 이들은 전전두엽 활성화가 더 높을 수 있습니다. 명상 전문가들은 이 전전두엽 통제를 사용하지 않을 수 있습니다. 오히려 그들은 경험에 대한 수용적인 태도를 자동화했으며, 따라서 상향식 통제 노력 대신 하향식 처리 능력이 향상되었을 수 있습니다100. 명상 훈련의 초기 단계에서 명상 상태를 달성하는 것은 주의력 조절과 정신적 노력의 사용을 포함하는 것으로 보이며, 따라서 훈련 전보다 측두전두엽과 후두엽 피질의 활동이 더 활발합니다11,16,100,101. 이는 초기 단계에서 참가자들이 명상 상태를 얻기 위해 노력하는 과정에서 높은 수준의 노력이 필요하기 때문일 수 있습니다11,73,98,102. 그러나 고급 단계에서는 전전두엽-두정엽 활동이 감소하거나 사라지지만, ACC, 스트라이ATUM 및 섬엽 활동은 유지됩니다9,10,53,73,76,101–103. 명상 중 또는 이후에 PFC 및 ACC 활성화에 노력이 핵심 역할을 하는지 여부는 추가 연구가 필요합니다. 

전두-한계 네트워크의 지역 간 기능적 연결성을 분석하면 실행 통제 지역의 조절 기능을 더욱 명확히 이해하는 데 도움이 될 수 있습니다. 이와 같은 분석을 포함된 연구는 매우 적습니다. 명상자의 통증 처리 과정을 대상으로 한 한 가지 횡단면 연구는 집행 기능과 통증 관련 뇌 영역 간의 연결성이 감소했음을 보여주었습니다35, 그리고 명상 경험이 없는 흡연자를 대상으로 한 한 연구는 담배 갈망 시 명상 조건에서 흡연 관련 이미지 수동 시청 시보다 갈망 관련 뇌 영역 간의 연결성이 감소했음을 보여주었습니다96, 이는 관련 영역 간의 기능적 분리 가능성을 시사합니다. 또 다른 장기적 무작위 연구에서는 불안 장애를 겪는 사람들이 개입 전에는 전두엽 영역의 활동과 편도체 활동 사이의 음의 상관관계(즉, 음의 연결성)가 개입 후에는 이 두 영역의 활동 사이의 양의 상관관계(양의 연결성)로 변화했다는 보고가 있었습니다. 이러한 음의 상관관계는 전전두엽이 편도체 활성화를 억제할 때 발생하기 때문에104,105, 마음챙김 개입 후 두 영역의 활동 간 양의 결합은 명상이 감정 반응의 억제나 억압이 아닌 각성 모니터링을 포함할 수 있으며, 이는 마음챙김 감정 조절의 독특한 특징일 수 있다는 추측이 제기되었습니다. 중요하게도, 이 연구는 신경학적 결과와 자기보고 결과 간의 상관관계를 조사했으며, 전전두엽-편도체 연결성의 변화가 불안 증상 개선과 상관관계가 있음을 보여주었습니다. 마음챙김 명상에서 전두-편도체 네트워크의 복잡한 상호작용을 명확히 하기 위해 추가 연구가 필요합니다. 마음챙김과 감정 조절의 재평가 전략 사이의 유사성에 대한 논의는 활발히 진행 중이지만, 마음챙김이 소거 과정과도 유사성을 공유한다는 일부 증거가 있습니다(BOX 3). 동기 부여와 보상 처리와 관련된 뇌 영역도 마음챙김 훈련과 관련된 기능적 변화를 보여줍니다. 예를 들어, 마음챙김 훈련 후 휴식 상태에서 putamen과 caudate의 활동이 강화되었으며106, 경험이 풍부한 명상가에서 보상anticipation 시 caudate nucleus의 활성화가 감소했습니다106. 이러한 연구는 동기 부여 영역에서의 자기 조절 변화, 즉 보상 관련 활동 감소와 휴식 시 보상 관련 활동 증가를 시사할 수 있습니다. 감정 조절에 관여하는 뇌 영역도 마음챙김 명상 후 구조적 변화를 보였습니다³¹,³²,³⁸–⁴¹,⁴⁸,⁵¹. 이러한 결과는 이러한 뇌 영역이 마음챙김 실천과 관련이 있음을 일부 초기 증거로 제공하지만, 마음챙김 명상의 유익한 효과를 매개하는 데 관여하는지 여부는 여전히 대부분 미해결 상태입니다.

Mindfulness and self-awareness

According to Buddhist philosophy, the identification with a static concept of ‘self’ causes psychological distress. Disidentification from such a static self-concept results in the freedom to experience a more genuine way of being. Through enhanced meta-awareness (making awareness itself an object of attention), mindfulness meditation is thought to facilitate a detachment from identification with the self as a static entity3,10,107 and a tendency to identify with the phenomenon of ‘experiencing’ itself is said to emerge15,108–112. Currently, empirical research into this area is only just emerging111,113, and the few interpretations of connections between neuroimaging findings and selfreported data — which we will summarize briefly below — are suggestive at best.

마음챙김과 자기인식
불교 철학에 따르면, 고정된 '자아' 개념과의 동일시(identification)는 심리적 고통을 초래합니다. 이러한 정적인 자아 개념과의 분리(탈동일시)는 더 진정성 있는 존재 방식을 경험할 수 있는 자유를 가져옵니다. 메타인지(의식 자체를 주의의 대상으로 삼는 것)를 통해 마음챙김 명상은 정적인 실체로서의 자아와의 동일시에서 벗어나게 하며, '경험' 현상 자체와의 동일시 경향이 나타난다고 알려져 있습니다. 현재 이 분야에 대한 실증적 연구는 이제 막 시작 단계에 있습니다111,113, 신경영상 연구 결과와 자기보고 데이터 간의 연결을 해석한 소수의 연구 — 아래에서 간략히 요약할 것입니다 —는 가장 긍정적으로 해석되더라도 단서적 수준에 머물고 있습니다.

Self-referential processing.

Altered self-representation has been investigated with questionnaire studies. Early studies reported mindfulness training to be associated with a more positive self-representation, higher self-esteem, higher acceptance of oneself 114 and styles of self-concept that are typically associated with less-severe pathological symptoms115. Meditators have also been shown to score higher than non-meditators on a scale that measures non-attachment116: a construct that is based on insight into the constructed and impermanent nature of mental representations. Although such concepts are not easy to capture in experimental and neuroscientific studies, findings from a few recent studies seem to suggest that brain structures supporting self-referential processing might be affected by mindfulness meditation98,117,118.

Although there is much debate about its exact function, a widespread view holds that the default mode network (DMN)119,120 is involved in self-referential processing. This network includes midline structures of the brain, such as areas of the medial PFC, posterior cingulate cortex (PCC), anterior precuneus and inferior parietal lobule121,122. These structures show high activity during rest, mind wandering and conditions of stimulus-independent thought121 and have been suggested to support diverse mechanisms by which an individual can ‘project’ themselves into another perspective123. fMRI studies have investigated activity in the DMN in association with mindfulness practice. Regions of the DMN (the medial PFC and PCC) showed relatively little activity in meditators compared to controls across different types of meditation, which has been interpreted as indicating diminished self-referential processing117. Functional connectivity analysis revealed stronger coupling in experienced meditators between the PCC, dorsal ACC and dorsolateral PFC, both at baseline and during meditation, which was interpreted as indicating increased cognitive control over the function of the DMN117. Increased functional connectivity was also found between DMN regions and the ventromedial PFC in participants with more compared to less meditation experience118. It has been speculated that this increased connectivity with ventromedial PFC regions supports greater access of the default circuitry to information about internal states because this region is highly interconnected with limbic regions118.

자기 참조적 처리.
자기 표현의 변화는 설문조사 연구를 통해 조사되었습니다. 초기 연구에서는 마음챙김 훈련이 더 긍정적인 자기 표현, 더 높은 자존감, 자기 수용도가 높다는 결과와 함께, 일반적으로 병리적 증상이 덜 심각한 것과 연관된 자기 개념의 스타일을 보고했습니다114. 명상가는 비명상가보다 '부착되지 않음'을 측정하는 척도에서 더 높은 점수를 받았습니다116: 이는 정신적 표현의 구성적·일시적 본질에 대한 통찰에 기반한 개념입니다. 이러한 개념은 실험적 및 신경과학적 연구에서 포착하기 어렵지만, 최근 몇 가지 연구 결과는 마음챙김 명상이 자기 참조적 처리 지원을 담당하는 뇌 구조에 영향을 미칠 수 있음을 시사합니다98,117,118.

그 정확한 기능에 대해 많은 논쟁이 있지만, 널리 받아들여지는 견해는 기본 모드 네트워크(DMN)119,120이 자기 참조적 처리와 관련되어 있다는 것입니다. 이 네트워크는 뇌의 중간선 구조물, 예를 들어 내측 전전두엽(mPFC), 후부 cingulate 피질(PCC), 전방 precuneus 및 하부 후두엽 소엽121,122 등을 포함합니다. 이 구조들은 휴식, 마음 방황, 자극 독립적 사고 상태에서 높은 활동을 보이며121, 개인이 다른 관점으로 자신을 '투영'하는 다양한 메커니즘을 지원한다는 제안이 있습니다123. fMRI 연구는 명상 실천과 연관된 DMN의 활동을 조사했습니다. DMN의 특정 영역(내측 PFC와 PCC)은 다양한 유형의 명상에서 대조군에 비해 명상자에서 상대적으로 낮은 활동을 보였으며, 이는 자기 참조적 처리의 감소로 해석되었습니다117. 기능적 연결성 분석은 경험이 풍부한 명상자에서 PCC, 후부 ACC 및 측두측 PFC 간의 연결성이 기저 상태와 명상 중 모두에서 더 강하게 나타났으며, 이는 DMN의 기능에 대한 인지적 통제의 증가를 의미한다고 해석되었습니다117. 명상 경험이 더 많은 참가자에서 DMN 영역과 복측 내측 전전두엽(ventromedial PFC) 사이의 기능적 연결성이 더 높게 나타났습니다118. 이 연결성 증가는 이 영역이 편도체와 밀접하게 연결되어 있기 때문에 기본 회로가 내부 상태에 대한 정보에 더 쉽게 접근할 수 있음을 지원한다는 추측이 제기되었습니다118.

Awareness of present-moment experiences.

Eval‎uative self-referential processing is assumed to decrease as an effect of mindfulness meditation, whereas awareness of present-moment experiences is thought to be enhanced. Mindfulness practitioners often report that the practice of attending to present-moment body sensations results in an enhanced awareness of bodily states and greater perceptual clarity of subtle interoception. Empirical findings to support this claim are mixed. Although studies that assessed performance on a heartbeat detection task — a standard measure of interoceptive awareness — found no evidence that meditators had superior performance to non-meditators124,125, other studies found that meditators showed greater coherence between objective physiological data and their subjective experience in regard to an emotional experience126 and the sensitivity of body regions127. Multiple studies have shown the insula to be implicated in mindfulness meditation: it shows stronger activation during compassion meditation128 and following mindfulness training23,52,98, and has greater cortical thickness in experienced meditators32. Given its known role in awareness129, it is conceivable that enhanced insula activity in meditators might represent the amplified awareness of present-moment experience. Similarly, a study reported an uncoupling of the right insula and medial PFC and increased connectivity of the right insula with dorsolateral PFC regions in individuals after mindfulness training98. The authors interpret their findings as a shift in self-referential processing towards a more self-detached and objective analysis of interoceptive and exteroceptive sensory events, rather than their affective or subjective self-referential value. Furthermore, a preliminary analysis from a study of a state of ‘non-dual awareness’ (a state of awareness in which perceived dualities, such as the distinction between subject and object, are absent) showed a decreased functional connectivity of the central precuneus with the dorsolateral PFC. The author speculates that this finding might be indicative of a state in which awareness is itself the subject of awareness111. Together, the findings from these studies have been taken to suggest that mindfulness meditation might alter the self-referential mode so that a previous narrative, eval‎uative form of self-referential processing is replaced by greater awareness98,111. We suggest that this shift in self-awareness is one of the major active mechanisms of the beneficial effects of mindfulness meditation. However, because these interpretations are built on a still-fragmentary understanding of the function of the involved brain regions, future research will need to test and elaborate these assumptions. Across the functional and structural MRI studies that have been published to date, especially those based on the longitudinal, randomized, controlled studies with active control groups and meta-analyses, the ACC, PFC, PCC, insula, striatum (caudate and putamen) and amygdala seem to show consistent changes associated with mindfulness meditation9–11,13,17,23,34,73,108,130 (FIG. 1; TABLE 2). We consider these areas to be the core regions involved in self-regulation of attention, emotion and awareness following mindfulness training. However, we acknowledge that many other brain areas are also involved in mindfulness practice and warrant further investigation using rigorous randomized and controlled designs.

현재 순간의 경험에 대한 인식.
마음챙김 명상이 평가적 자기 참조적 처리 과정을 감소시킨다는 가설이 제기되지만, 현재 순간의 경험에 대한 인식은 향상된다고 여겨집니다. 마음챙김 실천자들은 현재 순간의 신체 감각에 집중하는 연습이 신체 상태에 대한 인식이 향상되고 미묘한 내감각의 지각 명확성이 증가한다고 자주 보고합니다. 이 주장을 뒷받침하는 실증적 연구 결과는 혼합되어 있습니다. 심장 박동 감지 과제(내감각 인식의 표준 측정 도구)를 평가한 연구에서는 명상 실천자가 비명상 실천자보다 우수한 성능을 보였다는 증거가 발견되지 않았습니다124,125. 그러나 다른 연구에서는 명상 실천자가 감정 경험에 대한 객관적 생리적 데이터와 주관적 경험 간의 일치도가 더 높았으며126, 신체 부위의 민감도가 더 높았다는 결과가 나왔습니다127. 다수의 연구는 명상에서 섬엽이 관여함을 보여주었습니다: 자비 명상 중 섬엽의 활성화가 더 강했으며128, 명상 훈련 후에도 마찬가지였습니다23,52,98, 경험이 풍부한 명상가에서 섬엽의 피질 두께가 더 두꺼웠습니다32. 섬엽의 알려진 역할인 인식129을 고려할 때, 명상가에서 증가된 섬엽 활동은 현재 순간 경험의 강화된 인식을 나타낼 수 있습니다. 유사하게, 한 연구는 마음챙김 훈련 후 개인에서 우측 섬엽과 내측 전전두엽 피질의 연결이 분리되고 우측 섬엽과 측두측 전전두엽 피질 영역 간의 연결이 증가했다고 보고했습니다98. 저자들은 이 결과를 자기 참조적 처리의 변화로 해석했으며, 이는 내감각적 및 외감각적 감각 사건에 대한 자기 분리적이고 객관적인 분석으로의 전환을 의미하며, 감정적 또는 주관적인 자기 참조적 가치보다는 이러한 사건의 본질에 초점을 맞춘 것입니다. 또한, '비이원적 인식 상태'(주체와 대상의 구분과 같은 지각된 이원성이 없는 인식 상태)를 연구한 연구의 예비 분석에서 중앙 전두엽과 dorsolateral PFC 간의 기능적 연결성이 감소한 것으로 나타났습니다. 저자는 이 결과가 인식 자체가 인식의 대상이 되는 상태를 나타낼 수 있다고 추측했습니다. 이러한 연구 결과들은 마음챙김 명상이 자기 참조 모드를 변화시켜 이전의 서사적, 평가적 자기 참조 처리 방식이 더 큰 인식으로 대체될 수 있음을 시사합니다. 우리는 이 자기 인식의 변화가 마음챙김 명상의 유익한 효과의 주요 활성 메커니즘 중 하나일 수 있다고 제안합니다. 그러나 이러한 해석은 관련 뇌 영역의 기능에 대한 여전히 불완전한 이해에 기반을 두고 있으므로, 미래 연구는 이러한 가정을 검증하고 구체화해야 합니다. 현재까지 발표된 기능적 및 구조적 MRI 연구, 특히 장기적, 무작위, 통제 그룹을 포함한 연구와 메타분석에서, ACC, PFC, PCC, 섬엽, 스트라이ATUM (caudate와 putamen) 및 편도체는 마음챙김 명상과 관련된 일관된 변화를 보여줍니다9–11,13,17,23,34,73,108,130 (그림 1; 표 2). 우리는 이러한 영역을 마음챙김 훈련 후 주의력, 감정, 인식의 자기조절에 관여하는 핵심 영역으로 간주합니다. 그러나 마음챙김 실천에 관여하는 다른 많은 뇌 영역이 존재하며, 엄격한 무작위 대조군 설계를 통해 추가 연구가 필요함을 인정합니다.

Future questions

Mechanisms of mindfulness-induced changes.

A number of studies seem to suggest that mindfulness meditation induces changes in brain structure and function, raising the question of which underlying mechanisms support these processes. It is possible that engaging the brain in mindfulness affects brain structure by inducing dendritic branching, synaptogenesis, myelinogenesis or even adult neurogenesis. Alternatively, it is possible that mindfulness positively affects autonomic regulation and immune activity, which may result in neuronal preservation, restoration and/or inhibition of apoptosis14,23,131. It is well known that mindfulness-based techniques are highly effective in stress reduction, and it is possible that such stress reduction may mediate changes in brain function14,48,132–137 (BOX 4). A combination of all of these mechanisms may even occur. It is also important to realize that the direction of the observed effects of mindfulness meditation has not been consistent across all studies. Although larger values in meditators compared to controls are predominantly reported, a cross-sectional study also revealed smaller fractional anisotropy and cortical thickness values in meditators in some brain regions, including the medial PFC, postcentral and inferior parietal cortices, PCC and medial occipital cortex138. Along these lines, mindfulness-induced increases are predominantly observed in longitudinal studies. However, it was also tation, larger decreases in perceived stress were associated with larger decreases in grey-matter density in the amygdala48. Thus, the underlying mechanisms seem to be more complex than currently assumed, and further research is necessary.

Although neuroimaging has advanced our understanding of the individual brain regions involved in mindfulness meditation, most evidence supports the idea that the brain processes information through the dynamic interactions of distributed areas operating in large-scale networks139,140. Because the complex mental state of mindfulness is probably supported by alterations in large-scale brain networks, future work should consider the inclusion of complex network analyses, rather than restricting analyses to comparisons of the strength of activations in single brain areas. Recent studies have explored functional network architecture during the resting state using these new tools141,142.

미래의 질문
마음챙김에 의한 변화의 메커니즘.
여러 연구 결과는 마음챙김 명상이 뇌 구조와 기능에 변화를 일으킨다는 것을 시사하며, 이러한 과정에 어떤 근본적인 메커니즘이 작용하는지 궁금증을 제기합니다. 마음챙김에 뇌를 집중시키는 것이 신경세포의 가지 분지, 시냅스 형성, 미엘린 형성 또는 성인 신경생성과 같은 뇌 구조에 영향을 미칠 수 있습니다. 대안적으로, 마음챙김이 자율 신경 조절과 면역 활동에 긍정적인 영향을 미쳐 신경 세포의 보존, 회복 및/또는 세포 사멸 억제14,23,131에 기여할 수 있습니다. 마음챙김 기반 기술이 스트레스 감소에 매우 효과적이라는 것은 잘 알려져 있으며, 이러한 스트레스 감소가 뇌 기능 변화의 매개체 역할을 할 수 있습니다14,48,132–137 (BOX 4). 이러한 모든 메커니즘이 결합되어 발생할 수도 있습니다. 또한, 마음챙김 명상의 관찰된 효과의 방향이 모든 연구에서 일관되지 않았다는 점을 인식하는 것이 중요합니다. 명상 그룹이 대조군보다 높은 값이 주로 보고되었지만, 단면 연구에서는 명상 그룹에서 내측 전전두엽 피질, 후중심 피질, 하부 후두엽 피질, PCC 및 내측 후두엽 피질 등 일부 뇌 영역에서 분수 이방성 및 피질 두께 값이 더 낮은 것으로 나타났습니다138. 이와 유사하게, 마음챙김에 의한 증가 효과는 주로 장기적 연구에서 관찰됩니다. 그러나 다른 연구에서는 마음챙김에 따른 스트레스 감소가 편도체 회백질 밀도의 감소와 연관되어 있다는 결과가 나왔습니다. 따라서 현재 가정되는 것보다 기저 메커니즘이 더 복잡할 수 있으며, 추가 연구가 필요합니다.

신경영상 기술은 마음챙김 명상에서 관여하는 개별 뇌 영역에 대한 이해를 진전시켰지만, 대부분의 증거는 뇌가 대규모 네트워크 내에서 작동하는 분산된 영역 간의 동적 상호작용을 통해 정보를 처리한다는 아이디어를 지지합니다139,140. 마음챙김의 복잡한 정신 상태는 대규모 뇌 네트워크의 변화에 의해 지원될 가능성이 높기 때문에, 향후 연구는 단일 뇌 영역의 활성화 강도 비교에 국한되지 않고 복잡한 네트워크 분석을 포함해야 합니다. 최근 연구들은 이러한 새로운 도구를 활용해 휴식 상태에서의 기능적 네트워크 구조를 탐구했습니다141,142.

Decoding mental states.

Mindfulness meditation approaches can be divided into those involving focused attention and those involving open monitoring. Even within the same meditation style, practitioners can be at different stages of mindfulness practice2 . Investigating the distinction between these different stages in terms of brain function will require new advanced tools and methods. For instance, simultaneous multi-level recording — using fMRI and electrophysiology — could provide information on how the brain and body interact to support the meditation practice143. Electroencephalography feedback has been used to aid training and study meditation by providing the practitioners with information on the brain waves they are producing. Similarly, real-time fMRI has been used to provide subjects with feedback of the brain activity they are producing and allows the experimenter to examine pain, cognitive control, emotion regulation and learning of meditation. This dynamic recording and feedback technique may help to train the subjects effectively and allow their mental states at different stages of mindfulness training to be decoded from their brain activity144–146, possibly by applying techniques such as multivariate pattern analysis147. Interpretations of study outcomes remain tentative until they are clearly linked to subjective reports or behavioural findings. Future studies should therefore increasingly draw connections between behavioural outcomes and neuroimaging data using the advanced multi-level analyses mentioned above.

정신 상태 해독.
마음챙김 명상 접근법은 집중적 주의력을 요구하는 방법과 열린 관찰을 요구하는 방법으로 나눌 수 있습니다. 동일한 명상 스타일 내에서도 실천자들은 마음챙김 연습의 서로 다른 단계에 있을 수 있습니다2. 이러한 서로 다른 단계 간의 차이를 뇌 기능 측면에서 조사하려면 새로운 고급 도구와 방법이 필요합니다. 예를 들어, fMRI와 전기생리학을 동시에 사용하는 다중 수준 기록은 뇌와 몸이 명상 실천을 지원하기 위해 어떻게 상호작용하는지에 대한 정보를 제공할 수 있습니다143. 뇌파 피드백은 수행자에게 생성하는 뇌파에 대한 정보를 제공함으로써 명상 훈련과 연구를 돕기 위해 사용되어 왔습니다. 마찬가지로 실시간 fMRI는 피험자가 생성하는 뇌 활동에 대한 피드백을 제공하며, 실험자는 통증, 인지 통제, 감정 조절, 명상 학습 등을 분석할 수 있습니다. 이 동적 기록 및 피드백 기술은 피험자를 효과적으로 훈련하는 데 도움을 줄 수 있으며, 명상 훈련의 다양한 단계에서 그들의 정신 상태를 뇌 활동으로부터 해독하는 데 기여할 수 있습니다144–146. 이는 다변량 패턴 분석147과 같은 기술을 적용함으로써 가능할 수 있습니다. 연구 결과의 해석은 주관적 보고나 행동적 발견과 명확히 연결될 때까지 잠정적입니다. 따라서 향후 연구는 위에서 언급된 고급 다중 수준 분석을 활용해 행동적 결과와 신경영상 데이터 간의 연결을 더욱 강화해야 합니다.

Investigating individual differences.

People respond to mindfulness meditation differently. These differences may derive from temperamental, personality or genetic differences. Studies in other fields have suggested that genetic polymorphisms may interact with experience to influence the success of training148. Because mindfulness meditation affects the activation and connectivity of the ACC, PFC and other brain regions involved in cognitive control and emotion regulation, it might be helpful to examine these polymorphisms to determine their possible influence on the success of meditation practice2,59,149. Moreover, individual differences in personality, lifestyle, life events and trainer–trainee dynamics are likely to have substantial influence on training effects, although little is known about these influences. Mood and personality have been used to predict individual variation in the improvement of creative performance following mindfulness meditation150. Capturing temperament and personality differences may serve to predict success in mindfulness training150,151 because different temperament and personality traits are reported to be associated with different electroencephalography patterns and heart-rate variability in Zen meditators152.

Clinical application.

Self-regulation deficits are associated with diverse behavioural problems and mental disorders, such as increased risk of school failure, attention deficit disorder, anxiety, depression and drug abuse78,153. Convergent findings indicate that mindfulness meditation could ameliorate negative outcomes resulting from deficits in self-regulation and could consequently help patient populations suffering from diseases and behavioural abnormalities. Several clinical trials have explored the effects of mindfulness meditation on disorders such as depression154, generalized anxiety26, addictions155, attention deficit disorders156 and others42, and have begun to establish the efficiency of mindfulness practice for these conditions. Only a few recent studies, however, have investigated the neuroplastic changes underlying these beneficial effects of mindfulness in clinical populations29,41,42,74,97,142,157. Although these studies are promising, future work needs to replicate and expand the emerging findings to optimally tailor interventions for clinical application.

개인 차이의 탐구.
사람들은 마음챙김 명상에 다르게 반응합니다. 이러한 차이는 기질, 성격 또는 유전적 차이로 인해 발생할 수 있습니다. 다른 분야의 연구들은 유전적 다형성이 경험과 상호작용하여 훈련의 성공에 영향을 미칠 수 있음을 제안했습니다148. 마음챙김 명상은 인지 통제와 감정 조절에 관여하는 ACC, PFC 및 기타 뇌 영역의 활성화와 연결성에 영향을 미치기 때문에, 이러한 다형성이 명상 연습의 성공에 미치는 가능성 있는 영향을 확인하기 위해 이를 조사하는 것이 도움이 될 수 있습니다2,59,149. 또한, 성격, 생활 방식, 인생 사건 및 트레이너-트레이니 동력학의 개인 차이는 훈련 효과에 상당한 영향을 미칠 가능성이 있지만, 이러한 영향에 대한 지식은 아직 부족합니다. 기분과 성격은 마음챙김 명상 후 창의적 성능 개선의 개인 차이를 예측하는 데 사용되었습니다150. 기질과 성격 차이를 포착하는 것은 마음챙김 훈련의 성공을 예측하는 데 도움이 될 수 있습니다150,151. 왜냐하면 다양한 기질과 성격 특성이 선명 명상 수행자에서 다른 뇌파 패턴과 심박 변이도와 연관되어 보고되었기 때문입니다152.

임상적 적용.
자기 조절 결핍은 학교 실패 위험 증가, 주의력 결핍 장애, 불안, 우울증, 약물 남용 등 다양한 행동 문제와 정신 장애와 연관되어 있습니다78,153. 수렴된 연구 결과는 마음챙김 명상이 자기 조절 결핍으로 인한 부정적 결과를 완화할 수 있으며, 따라서 질병과 행동 이상을 겪는 환자 집단에게 도움을 줄 수 있음을 시사합니다. 여러 임상 연구는 우울증154, 일반화된 불안26, 중독155, 주의력 결핍 장애156 등 다양한 장애에 대한 마음챙김 명상의 효과를 탐구했으며, 이러한 조건에 대한 마음챙김 실천의 효율성을 확립하기 시작했습니다. 그러나 최근 연구 중 임상 인구에서 마음챙김의 유익한 효과에 대한 신경가소성 변화를 조사한 연구는 극히 드뭅니다29,41,42,74,97,142,157. 이러한 연구는 유망하지만, 임상 적용을 위해 개입을 최적화하기 위해서는 향후 연구에서 이러한 결과를 재현하고 확장해야 합니다.

Conclusions

Interest in the psychological and neuroscientific investigation of mindfulness meditation has increased markedly over the past two decades. As is relatively common in a new field of research, studies suffer from low methodological quality and present with speculative post-hoc interpretations. Knowledge of the mechanisms that underlie the effects of meditation is therefore still in its infancy. However, there is emerging evidence that mindfulness meditation might cause neuroplastic changes in the structure and function of brain regions involved in regulation of attention, emotion and self-awareness. Further research needs to use longitudinal, randomized and actively controlled research designs and larger sample sizes to advance the understanding of the mechanisms of mindfulness meditation in regard to the interactions of complex brain networks, and needs to connect neuroscientific findings with behavioural data. If supported by rigorous research studies, the practice of mindfulness meditation might be promising for the treatment of clinical disorders and might facilitate the cultivation of a healthy mind and increased well-being.

결론
지난 20년간 마음챙김 명상의 심리학적 및 신경과학적 연구에 대한 관심이 급격히 증가했습니다. 새로운 연구 분야에서는 흔히 그렇듯이, 연구들은 방법론적 품질이 낮고 사후 추론적 해석을 제시하는 경우가 많습니다. 명상의 효과를 뒷받침하는 메커니즘에 대한 지식은 여전히 초기 단계에 있습니다. 그러나 마음챙김 명상이 주의력, 감정, 자기 인식 조절과 관련된 뇌 영역의 구조와 기능에 신경가소성 변화를 유발할 수 있다는 증거가 점차 나타나고 있습니다. 추가 연구는 복잡한 뇌 네트워크 간의 상호작용에 대한 이해를 진전시키기 위해 장기적, 무작위 배정, 적극적으로 통제된 연구 설계와 더 큰 표본 규모를 활용해야 하며, 신경과학적 발견을 행동 데이터와 연결해야 합니다. 엄격한 연구로 뒷받침된다면, 마음챙김 명상 실천은 임상적 장애의 치료에 유망할 수 있으며 건강한 마음의 양성과 증가된 웰빙을 촉진할 수 있습니다.