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Case Study
Brain Activation During Compassion Meditation:
A Case Study
Maria Engstro¨ m, Ph.D.,
1,2
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, ap-
plying a paradigm with meditation and word repetition blocks.
Results: The most significant finding was the activation in the left medial prefrontal cortex extending to the
anterior cingulate gyrus. Other significant 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
Meditation is a conscious mental process that influ-
ences attention and emotional regulation.
1
It has also
been shown that meditation involves health-promoting ben-
efits such as stress reduction,
2
decreased blood pressure,
3
and
higher pain threshold.
4
However, the biological mechanisms
behind the body’s response to meditation are poorly under-
stood. Neuroimaging is regarded as one of the most promis-
ing 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 tomog-
raphy,
8
and functional magnetic resonance imaging (fMRI),
9–13
studies on the regional neural response to meditation have
been published in the last decade. Previous neuroimaging
studies have, however, reported mismatching results. Dis-
crepancies 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 re-
cruited 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 mindful-
ness of breathing [vipassana]).
12
Despite this, some converg-
ing 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 classified into two groups: (1) focused attention
and (2) mindfulness meditation.
1,6,14
Many meditational
modes have features from both groups. Compassion medi-
tation, on the other hand, is a common meditational practice
among Buddhists, and it cannot be classified into either of the
two groups. In this type of meditation, the meditator uses
different techniques to generate a feeling of love and com-
passion. In a recent study by Lutz et al.,
13
the emotional re-
sponse to auditory stimuli was studied in subjects who were
practicing compassion meditation. The authors found in-
creased emotional-mediated activation in the insulae and the
cingulate cortex during meditation. Since activation differ-
ences 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 med-
itator. A case study on the neural correlates to this kind of
1
Center for Medical Image Science and Visualization (CMIV), Linko
¨ping University, Linko
¨ping, Sweden.
2
Department of Radiological Sciences, Linko
¨ping University Hospital, Linko
¨ping, Sweden.
3
Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 16, Number 5, 2010, pp. 597–599
ªMary Ann Liebert, Inc.
DOI: 10.1089=acm.2009.0309
597
meditation might provide one further step toward the un-
derstanding of the biological mechanisms of different medi-
tational modes and techniques.
Methods
One (1) active Buddhist (B.L., female, 59 years) partici-
pated 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 Bud-
dhist 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 ¼2.7 seconds, echo time ¼40
milliseconds, matrix ¼8080, field of view ¼24 cm, number
of slices ¼31, slice thickness ¼3 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 medita-
tion 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 move-
ment 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
thresholdofmorethan10voxelswereusedintheanalysis.
Results
Mantra versus baseline
Significant 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 post-
central gyrus.
Mantra versus Sanskrit
Significant 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 parietal–frontal lobe junction.
Mantra versus Swedish
Similar activation as in the baseline comparison was ob-
served. In addition, the left inferior frontal gyrus and the
right insula were activated.
Swedish versus Sanskrit
Significant activation in the orbital part of the left inferior
frontal gyrus was found.
Sanskrit versus Swedish
A significant locus of activation was noted in the right
insula.
Discussion
In this study on the compassion meditation state, we
found a large significant activation cluster in the left medial
prefrontal cortex extending to the anterior cingulate gyrus.
Almost identical activation was reported in the meditation
study by Ho
¨lzel et al.,
12
where subjects who were trained at a
Vipassana center were practicing mindfulness of breathing
during fMRI. The authors propose that activation in the
dorsomedial prefrontal cortex reflects a strong emotional
engagement during meditation. Previous neuroimaging
studies have also identified the medial prefrontal cortex,
especially the left hemisphere, as important for empathy.
15–17
Other imaging studies have found anterior cingulate acti-
vation 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 acti-
vation in this area except for a small activation cluster in the
superior frontal gyrus. The explanation for this nonoccurring
FIG. 1. Activation in the left medial prefrontal cortex and
anterior cingulate gyrus from the meditation–baseline condition.
598 ENGSTRO
¨M AND SO
¨DERFELDT
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 frontal–parietal circuit was
identified to be involved with religious experience. Beau-
regard 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 pre-
frontal cortex, the anterior cingulate cortex, insula, caudate,
the parietal lobe, and the left brainstem. The most domi-
nating feature in the present study was, however, the pre-
vailing 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 medi-
tation in 1 experienced meditator is accompanied by activa-
tion 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
County Council in O
¨stergo
¨tland and the Strategic research
area of Medical Image Science and Visualization are ac-
knowledged for financial support.
Disclosure Statement
No competing financial interests exist.
References
1. Lutz A, Slagter HA, Dunne JD, Davidson RJ. Attention
regulation and monitoring in meditation. Trends Cogn Neu-
rosci 2008;12:163–169.
2. Tang Y-Y, Ma Y, Wang J, et al. Short-term meditation
training improves attention and self-regulation. PNAS 2007;
104:17152–17156.
3. Rainforth MV, Schneider RH, Nidich SI, et al. Stress reduc-
tion programs in patients with elevated blood pressure: A
systematic review and meta-analysis. Current Hypertens
Rep 2007;9:520–528.
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;134:310–319.
5. Newberg AB, Iversen J. The neural basis of the complex
mental task of meditation: Neurotransmitter and neuro-
chemical considerations. Med Hypothesis 2003;61:282–291.
6. Cahn BR, Polich J. Meditation states and traits: EEG, ERP,
and neuroimaging studies. Psychol Bull 2006;132:180–221.
7. Newberg A, Alavi A, Baime M, et al. The measurement of
regional cerebral blood flow during the complex cognitive
task of meditation: A preliminary SPECT study. Psychiatry
Res Neuroimaging 2001;106:113–122.
8. Lou HC, Kjaer TW, Friberg L, et al.
15
O-H
2
O PET study of
meditation and the resting state of normal consciousness.
Hum Brain Mapping 1999;7:98–105.
9. Lazar SW, Bush G, Gollub RL, et al. Functional brain map-
ping of the relaxation response to meditation. Neuroreport
2000;7:1581–1585.
10. Farb NAS, Segal ZV, Mayberg H, et al. Attending to the
present: Mindfulness meditation reveals distinct neural
modes of self-reference. SCAN 2007;2:313–322.
11. Brefczynski-Lewis JA, Lutz A, Schaefer HS, et al. Neural
correlates of attentional expertise in long-term meditation
practitioners. PNAS 2007;104:11482–11488.
12. Ho
¨lzel BK, Ott U, Hempel H, et al. Differential engagement
of anterior cingulate and adjacent medial frontal cortex in
adept meditators and non-meditators. Neurosci Lett 2007;
421:16–21.
13. 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;
3:1–10.
14. Ivanovski B, Malhi GS. The psychological and neu-
ropsychological concomitants of mindfulness forms of
meditation. Acta Neuropsychiatr 2007;19:76–91.
15. Farrow TFD, Zheng Y, Wilkinson LD, et al. Investigating the
functional anatomy of empathy and forgiveness. Neurore-
port 2001;12:2433–2438.
16. Vo
¨llm BA, Taylor ANW, Richardson P, et al. Neuronal
correlates of theory of mind and empathy: A functional
magnetic resonance imaging study in a nonverbal task.
Neuroimage 2006;29:90–98.
17. Seitz RJ, Nickel J, Azari NP. Functional modularity of the
medial prefrontal cortex: Involvement in human empathy.
Neuropsychology 2006;20:743–751.
18. Rolls ET, Grabenhorst F, Parris BA. Warm pleasant feelings
in the brain. Neuroimage 2008;41:1504–1513.
19. Habel U, Klein M, Kellerman T, et al. Same or different?
Neural correlates of happy and sad mood in healthy males.
Neuroimage 2005;26:206–214.
20. Azari NP, Nickel J, Wunderlich G, et al. Neural correlates of
religious experience. Eur J Neurosci 2001;12:1649–1652.
21. Beauregard M, Paquette V. Neural correlates of a mystical
experience in Carmelite nuns. Neurosci Lett 2006;405:
186–190.
Address correspondence to:
Maria Engstro
¨m, Ph.D.
Medical Image Science and Visualization (CMIV)
Linko
¨ping University=US
SE-581 85 Linko
¨ping
Sweden
E-mail: maria.engstrom@liu.se
FMRI AND COMPASSION MEDITATION 599
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