Background:Persisting symptoms affect about one-third of youth following concussion. Mental health history, distress, and coping style are key predictors of prolonged recovery. Early and scalable psychological interventions, such as mindfulness-based intervention (MBI) delivered via smartphones, may improve patients' ability to regulate their emotions and neurophysiologically recover, reducing overall symptom burden. However, no digital therapeutic (DTx) trials in adolescents experiencing concussion exist. Objective:This study primarily aimed to assess the feasibility of conducting a larger randomized controlled trial (RCT) evaluating the effectiveness of a DTx-MBI in adolescents with a concussion compared with an attention-matched sham intervention. Methods:This was a Health Canada-regulated, parallel-group, blinded, single-crossover feasibility RCT. Adolescents aged 12 to <18 years presenting to a Pediatric Emergency Department or interdisciplinary concussion clinic within 7 days of a physician-diagnosed concussion were approached for participation from November 2022 to June 2024. After providing consent, participants were randomized (1:1), stratified by sex, to either the experimental group (DTx-MBI) or the control group (sham, attention-matched math puzzle game). The DTx-MBI was delivered via the AmDTx platform (Mobio Interactive Pte Ltd, Singapore) as a custom-designed 4-to-8-week program of 8 standardized modules for adolescents with concussion, including audio-recorded guided mindfulness exercises, goal setting, journaling, and psychoeducation. The control intervention, delivered through the same interface, excluded mindfulness content and instead featured the open-source game "2048". Participants in both groups were encouraged to engage with the app for at least 10 minutes/day, at least 4 days/week. Feasibility criteria to support progression to a full-scale RCT included: eligibility rate >40% of those screened; recruitment rate >50% of eligible participants randomized; intervention credibility >70% scoring above the midpoint on the credibility and expectancy questionnaire (CEQ) at 1 week; retention >75% of randomized participants completing 4-week outcomes; and adherence >70% completing 10 minutes of intervention on at least 4 days/week for 4 weeks. Results:A total of 124 out of 195 (63.6%) screened youth met eligibility criteria. Of these, 99/124 (79.8%) consented and were randomized to either the DTx-MBI group (n=49, median [IQR] age=15.28 [13.66-16.19] years, 30 [61.2%] female) or the Sham group (n=50, median [IQR] age=14.92 [13.32-16.71] years, 30 [60.0%] female). Credibility was high, with 62/83 (74.7%) of participants scoring above the credibility midpoint (DTx-MBI: 75.0%; Sham: 74.4%). Retention was strong, with 89/99 (89.9%) of participants completing the 4-week outcomes (DTx-MBI: 89.8%; control: 90.0%). Overall adherence was moderate (54/99 [54.5%]; DTx-MBI: 59.2%; control: 50.0%), and a little higher among outcome assessment completers (53/89 [59.6%]; DTx-MBI: 63.6%; Sham: 55.6%). Feasibility indicators were similar between groups. Conclusions:This feasibility trial supports the implementation of a larger RCT, with modifications to enhance adherence, to rigorously evaluate the clinical efficacy of the DTx-MBI. By targeting modifiable psychological risk factors through a scalable digital platform, DTx-MBI could be a low-burden, cost-effective adjunct to pediatric concussion care.

Musicians rely on working memory to perform but this can be impacted by performance anxiety. This exploratory study examined whether a mindfulness training program would show beneficial effects on working memory in musicians with music performance anxiety (MPA). Twenty musicians underwent fMRI while performing a common working memory task, a letter n-back task (time 1). Ten of these musicians then participated in two weeks of mindfulness training, while the other ten did not. All participants then completed the same fMRI session two weeks later (time 2). The mindfulness group had significantly less neural activity than controls after the intervention in bilateral middle occipital gyri, bilateral lingual gyri, and in the right cuneus, suggesting improved attention regulation abilities. The mindfulness group also showed a significant reduction in activity following the mindfulness training in the right dorsolateral prefrontal cortex and in the right supplementary motor area, suggesting enhanced attentional and cognitive efficiency. No differences were observed in the control group from pre-to post-training. These results suggest that the mindfulness group revealed more efficient working memory neural processing following mindfulness training. Results are preliminary and exploratory but do warrant replication and justify further investigation of mindfulness as a tool to help musicians with performance anxiety.

OBJECTIVES:Pain in PsA is common and multifactorial, involving nociceptive, neuropathic and nociplastic mechanisms. We hypothesized that PsA patients with entheseal pain exhibit distinct brain activation patterns on functional MRI (fMRI), depending on the presence of US-detected inflammation. METHODS:PsA patients underwent clinical evaluation, US assessment of the Achilles tendon and fMRI brain imaging. Participants were grouped as follows: Group 1-clinical Achilles enthesitis with active US findings (hypoechogenicity and Doppler ≥grade-2); Group 2-clinical enthesitis but negative US; Group 3-no clinical or US evidence of enthesitis. The primary comparison (Groups 1 vs 2) evaluated whether US-confirmed inflammation is associated with distinct fMRI patterns. The secondary comparison (Groups 1 vs 3) aimed to distinguish inflammation-specific responses from general disease-related changes. RESULTS:Sixteen PsA patients were included. Group 1 showed significantly higher activation in brain regions involved in pain modulation, cognitive processing and attention compared with Group 2 [(middle frontal gyrus T-score: 6.92, P-value: 0.009), (inferior triangularis T-score: 4.53, P-value: 0.009), (inferior parietal lobule triangularis T-score: 5.94, P-value: 0.015), (supramarginal gyrus T-score: 5.28, P-value: 0.015), (superior medial FG T-score: 4.88, P-value: 0.022)]. Regarding comparison for pain-positive vs pain-negative patients, Group 1 had more activity than Group 3 in the supramarginal gyrus and inferior parietal lobule. CONCLUSION:US-detected entheseal inflammation may be associated with distinct central pain-processing features, supporting the role of US as a useful tool for identifying underlying inflammatory mechanisms in PsA-related pain. Understanding the interaction between peripheral inflammation and central sensitization may guide more personalized and effective pain management strategies.

As concern for student well-being grows, this research strived to investigate a cost-effective, engaging method to alleviate stress while enhancing mental health. Although peer-reviewed research on Laughter Yoga is limited, findings suggest benefits including stress reduction, improved mental well-being, and positive physiological effects. This study evaluated the effects of 14 online Laughter Yoga sessions (curated YouTube videos, maximum of one a day) on perceived stress, happiness, and mindfulness among university students. The participants (n = 75) followed sessions led by certified Laughter Yoga instructors: 31 students completed them in 2–3 weeks, while 44 took more than 3 weeks. Data was acquired from the Perceived Stress Scale (PSS), the Oxford Happiness Questionnaire (OHQ), and the Mindful Attention Awareness Scale (MAAS) both before and after the intervention. Paired samples t-tests revealed significant improvements across all measures, no matter how long was taken to watch all 14. Participants reported lower PSS scores and greater happiness and mindfulness post-intervention. Correlational analyses suggested that stress reductions were strongly associated with increased happiness and mindfulness. This study is one of the first to provide evidence for the utility of Laughter Yoga as an online, individual and low-cost intervention in post-secondary settings and suggests it could be integrated in future student wellness programmes.

Music Performance Anxiety (MPA) negatively impacts musicians’ personal lives, professional functioning, and performance quality, and is most prevalent in young adulthood. This mixed methods study investigated whether two weeks of a novel intervention called Environmental Vocal Exploration (EVE; Oddy, 2022), combining mindfulness and vocal improvisation, could alter neural activity associated with MPA in young musicians. The EVE intervention was compared with 1) a traditional two-week mindfulness program and 2) no intervention. Pre- and post-intervention, 27 musicians aged 18–28 (n = 7: EVE, n = 10: mindfulness, n = 10: no intervention) completed an anxietyprovoking task and a letter N-back working memory task during fMRI. A thematic analysis was also conducted on discussion transcripts from EVE sessions. During the anxietyprovoking task, blood flow in emotional processing and attention-related brain areas (e.g., limbic and salience network areas) increased from pre- to post-EVE, consistent with themes (e.g., present-moment awareness). During the post-intervention N-back, EVE participants showed less activity than the other groups in cognitive processing areas (e.g., middle cingulate gyrus), indicating enhanced neural efficiency. Both interventions may impact neural activation linked to MPA, through increased attentional and emotional regulation. Vocal improvisation in a mindfulness intervention seemed to augment such effects. Results support further study of EVE’s use for MPA. Acknowledgements The authors would like to acknowledge the Brain Imaging Centre, including Rahim Ismaili, Katie Dinelle, and Reggie Taylor, for their support.

Objective: Mindfulness-Based Interventions (MBIs) may help normalize functional brain connectivity (FC) affected by concussion, but no pediatric trials exist. This study investigated whether an app-based MBI produced greater FC changes than a sham across the default mode (DMN), salience (SN), and central executive (CEN) networks. Methods: This randomized clinical trial (Clinicaltrials.gov ID# NCT05105802) recruited participants aged 12.00–17.99 years from the emergency department or interdisciplinary concussion clinic, then randomly assigned them to MBI or a sham app. Brain imaging sessions occurred at 72 hours and 4 weeks post-concussion. Region-of-interest and seed-to-voxel analyses examined Group × Time interactions in FC across DMN, SN, and CEN ( p < .050 FDR ). Results: Thirty-six participants were included (MBI: n = 16, median [IQR] age = 14.23 [13.52–15.65] years, 31% female; Sham: n = 20, median [IQR] age = 14.05 [13.13–16.26] years, 45% female). Intention-to-treat analyses revealed significant Group × Time interactions across networks. DMN-CEN FC patterns differed, with MBI participants showing diminished FC. Within DMN, four clusters showed significant interactions ( p < .050 FDR ), three exhibiting larger FC reductions at 4 weeks in MBI participants. MBI participants showed greater FC increase in one SN cluster ( p = .040 FDR ) and larger FC decrease in one CEN cluster ( p = .024 FDR ) at 4 weeks. Per-protocol analyses identified one significant DMN cluster ( p < .001 FDR ) where MBI participants exhibited greater FC increases. Conclusions: MBI training led to significant changes in FC in networks implicated in concussion recovery. Larger trials are needed to support these findings.

BACKGROUND:Childhood sexual abuse (CSA) can cause lasting neurodevelopmental changes, posing significant challenges for survivors. Its specific impact on men remains heavily stigmatized and under-researched. This study examined neurophysiological correlates of CSA in men using diffusion tensor imaging (DTI). METHODS:A community-based sample of men with CSA histories (n = 15) and controls (n = 13) were recruited from urban centers across Canada. All participants underwent DTI, which measures white matter integrity through fractional anisotropy (FA) values. Group comparisons were conducted using whole-brain voxel-wise and post-hoc region-of-interest (ROI) analyses with Bonferroni correction. Effect sizes (Cohen's d) and power were reported. RESULTS:Compared to controls, the CSA group showed significantly lower FA values in the right posterior cingulum (d = 1.28, p = 0.002), superior frontal gyrus (d = 1.13, p = 0.006), anterior thalamic radiation (d = 1.19, p = 0.004), and superior longitudinal fasciculus (d = 1.90, p < 0.001). These differences remained significant after Bonferroni adjustment. Lower FA values were also observed in the left anterior cingulum and right forceps minor, though these did not meet adjusted significance thresholds. CONCLUSIONS:This study provides empirical evidence of the long-lasting neurophysiological impact of CSA in men. The observed white matter differences may underlie the behavioral, emotional, and cognitive difficulties often experienced by this population. These results are discussed in the context of destigmatizing male CSA and helping clinicians better understand the neurophysiological factors affecting their patients.

BackgroundDespite the promising benefits of self-guided digital interventions for adolescents recovering from concussion, attrition rates for such interventions are high. Evidence suggests that adults can develop therapeutic alliance with self-guided digital interventions, which is in turn associated with intervention engagement. However, no research has examined whether adolescents develop therapeutic alliance with self-guided digital interventions and what factors are important to its development. Additionally, social presence—the extent to which digital encounters feel like they are occurring in person—may be another relevant factor to understanding the nature of the connection between adolescents and a self-guided digital intervention, though this has yet to be explored. ObjectiveThis qualitative study explored the extent to which adolescents recovering from concussion developed therapeutic alliance and social presence during their use of a self-guided digital mindfulness-based intervention. Additionally, this study aimed to determine factors important to adolescents’ development of therapeutic alliance and social presence with the intervention. MethodsAdolescents aged between 12 and 17.99 years who sustained a concussion were recruited from 2 sites: a pediatric emergency department up to 48 hours after a concussion and a tertiary care clinic over 1 month following a concussion to capture adolescents who had both acute and persisting symptoms after concussion. Participants (N=10) completed a 4-week mindfulness-based intervention delivered through a smartphone app. Within the app, participants listened to audio recordings of mindfulness guides (voice actors) narrating psychoeducation and mindfulness practices. At 4 weeks, participants completed questionnaires and a semistructured interview exploring their experience of therapeutic alliance and social presence with the mindfulness guides in the intervention. ResultsThemes identified within the qualitative results revealed that participants developed therapeutic alliance and social presence by “developing a genuine connection” with their mindfulness guides and “sensing real people.” Particularly important to the development of therapeutic alliance and social presence were the mindfulness guides’ “personal backgrounds and voices,” such that participants felt more connected to the guides by knowing information about them and through the guides’ calm tone of voice in audio recordings. Quantitative findings supported qualitative results; participants’ average score for therapeutic alliance was far above the scale midpoint, while the mixed results for social presence measures aligned with qualitative findings that participants felt that the mindfulness guides seemed real but not quite as real as an in-person connection would. ConclusionsOur data suggest that adolescents can develop therapeutic alliance and social presence when using digital interventions with no direct human contact. Adolescents’ development of therapeutic alliance and social presence with self-guided digital interventions can be bolstered by increasing human-like qualities (eg, real voices) within interventions. Maximizing therapeutic alliance and social presence may be a promising way to reduce attrition in self-guided digital interventions while providing accessible treatment.

Purpose This study investigated the association between psychological resilience and resting-state network functional connectivity in pediatric concussion. Methods This was a substudy of a randomized controlled trial, recruiting children with concussion and orthopedic injury. Participants completed the Connor-Davidson Resilience 10 Scale and underwent magnetic resonance imaging at 72 hours and 4-weeks post-injury. Seed-to-voxel analyses were used to explore associations between resilience and connectivity with the default-mode, central executive, and salience networks longitudinally and at both timepoints separately. Regions-of-interest analyses were used to explore associations between resilience and within-network connectivity. Results A total of 69 children with a concussion (median age = 12.81 [IQR: 11.79–14.36]; 46% female) and 30 with orthopedic injury (median age = 12.27 [IQR: 11.19–13.94]; 40% female) were included. Seed-to-voxel analyses detected a positive correlation between 72-hour resilience and central executive network connectivity in the concussion group, and a positive correlation between 72-hour resilience and salience network connectivity in the orthopedic injury group. Group was a moderator of 72-hour resilience and salience network connectivity, and a moderator of longitudinal resilience and default-mode network connectivity. Regions-of-interest analyses identified group as a moderator of longitudinal resilience and within-default-mode network connectivity. In the orthopedic injury group, longitudinal resilience was associated with within-default-mode network connectivity, while 72-hour resilience was associated with within-salience network connectivity. Conclusions These results suggest that resilience may be implicated in functional neuroimaging outcomes in pediatric concussion and should further be investigated for its clinical utility as a protective or restorative factor following injury.

BackgroundConcussion in children and adolescents is a significant public health concern, with 30% to 35% of patients at risk for prolonged emotional, cognitive, sleep, or physical symptoms. These symptoms negatively impact a child’s quality of life while interfering with their participation in important neurodevelopmental activities such as schoolwork, socializing, and sports. Early psychological intervention following a concussion may improve the ability to regulate emotions and adapt to postinjury symptoms, resulting in the greater acceptance of change; reduced stress; and recovery of somatic, emotional, and cognitive symptoms. ObjectiveThe primary objective of this study is to assess the feasibility of conducting a parallel-group (1:1) randomized controlled trial (RCT) to evaluate a digital therapeutics (DTx) mindfulness-based intervention (MBI) in adolescents aged 12 to <18 years. The attention-matched comparator intervention (a math game also used in previous RCTs) will be delivered on the same DTx platform. Both groups will be provided with the standard of care guidelines. The secondary objective is to examine intervention trends for quality of life; resilience; self-efficacy; cognition such as attention, working memory, and executive functioning; symptom burden; and anxiety and depression scores at 4 weeks after concussion, which will inform a more definitive RCT. A subsample will be used to examine whether those randomized to the experimental intervention group have different brain-based imaging patterns compared with those randomized to the control group. MethodsThis study is a double-blind Health Canada–regulated trial. A total of 70 participants will be enrolled within 7 days of concussion and randomly assigned to receive the 4-week DTx MBI (experimental group) or comparator intervention. Feasibility will be assessed based on the recruitment rate, treatment adherence to both interventions, and retention. All outcome measures will be evaluated before the intervention (within 7 days after injury) and at 1, 2, and 4 weeks after the injury. A subset of 60 participants will undergo magnetic resonance imaging within 72 hours and at 4 weeks after recruitment to identify the neurophysiological mechanisms underlying the potential benefits from MBI training in adolescents following a concussion. ResultsThe recruitment began in October 2022, and the data collection is expected to be completed by September 2024. Data collection and management is still in progress; therefore, data analysis is yet to be conducted. ConclusionsThis trial will confirm the feasibility and resolve uncertainties to inform a future definitive multicenter efficacy RCT. If proven effective, a smartphone-based MBI has the potential to be an accessible and low-risk preventive treatment for youth at risk of experiencing prolonged postconcussion symptoms and complications. Trial RegistrationClinicalTrials.gov NCT05105802; https://classic.clinicaltrials.gov/ct2/show/NCT05105802 International Registered Report Identifier (IRRID)DERR1-10.2196/57226

Emerging evidence suggests that advanced neuroimaging modalities such as arterial spin labelling (ASL) might have prognostic utility for pediatric concussion. This study aimed to: 1) examine group differences in global and regional brain perfusion in youth with concussion or orthopedic injury (OI) at 72 h and 4 weeks post-injury; 2) examine patterns of abnormal brain perfusion within both groups and their recovery; 3) investigate the association between perfusion and symptom burden within concussed and OI youths at both time-points; and 4) explore perfusion between symptomatic and asymptomatic concussed and OI youths. Youths ages 10.00-17.99 years presenting to the emergency department with an acute concussion or OI were enrolled. ASL-magnetic resonance imaging scans were conducted at 72 h and 4 weeks post-injury to measure brain perfusion, along with completion of the Health Behavior Inventory (HBI) to measure symptoms. Abnormal perfusion clusters were identified using voxel-based z-score analysis at each visit. First, mixed analyses of covariance (ANCOVAs) investigated the Group*Time interaction on global and regional perfusion. Post hoc region of interest (ROI) analyses were performed on significant regions. Second, within-group generalized estimating equations investigated the recovery of abnormal perfusion at an individual level. Third, multiple regressions at each time-point examined the association between HBI and regional perfusion, and between HBI and abnormal perfusion volumes within the concussion group. Fourth, whole-brain one-way ANCOVAs explored differences in regional and abnormal perfusion based on symptomatic status (symptomatic vs. asymptomatic) and OIs at each time-point. A total of 70 youths with a concussion [median age (interquartile range; IQR) = 12.70 (11.67-14.35), 47.1% female] and 29 with an OI [median age (IQR) (=) 12.05 (11.18-13.89), 41.4% female] were included. Although no Group effect was found in global perfusion, the concussion group showed greater adjusted perfusion within the anterior cingulate cortex/middle frontal gyrus (MFG) and right MFG compared with the OI group across time-points (ps <= 0.004). The concussion group showed lower perfusion within the right superior temporal gyrus at both time-points and bilateral occipital gyrus at 4 weeks, (ps <= 0.006). The number of hypoperfused clusters was increased at 72 h compared with 4 weeks in the concussion youths (p < 0.001), but not in the OIs. Moreover, Group moderated the HBI-perfusion association within the left precuneus and superior frontal gyrus at both time-points, (ps <= 0.001). No association was found between HBI and abnormal perfusion volume within the concussion group at any visits. At 4 weeks, the symptomatic sub-group (n = 10) showed lower adjusted perfusion within the right cerebellum and lingual gyrus, while the asymptomatic sub-group (n = 59) showed lower adjusted perfusion within the left calcarine, but greater perfusion within the left medial orbitofrontal cortex, right middle frontal gyrus, and bilateral caudate compared with OIs. Yet, no group differences were observed in the number of abnormal perfusion clusters or volumes at any visit. The present study suggests that symptoms may be associated with changes in regional perfusion, but not abnormal perfusion levels.

BackgroundAs the prevalence of chemotherapy-related cognitive impairment rises, investigation into treatment options is critical. The objectives of this study were to test the effects of an aerobic exercise intervention initiated during chemotherapy compared to usual care (wait list control condition) on (1) objectively measured cognitive function and self-reported cognitive function, as well as on (2) the impact of cognitive impairment on quality of life (QOL) postintervention (commensurate with chemotherapy completion).MethodsThe Aerobic exercise and CogniTIVe functioning in women with breAsT cancEr (ACTIVATE) trial was a two-arm, two-center randomized controlled trial conducted in Ottawa and Vancouver (Canada). Fifty-seven women (Mage, 48.8 +/- 10 years) diagnosed with stage I-III breast cancer and awaiting chemotherapy were randomized to aerobic exercise initiated with chemotherapy (nEX = 28) or usual care during chemotherapy with aerobic exercise after chemotherapy completion (nUC = 29). The intervention lasted 12-24 weeks and consisted of supervised aerobic training and at-home exercise. The primary outcome was objective cognitive function measured via 13 neuropsychological tests (standardized to M +/- SD, 0 +/- 1); secondary outcomes of self-reported cognitive function and its impact on QOL were assessed via questionnaires. Data collected pre- and postintervention (the primary end point) were analyzed.ResultsAlthough no significant differences between groups were found for objective cognitive function outcomes postintervention after accounting for multiple testing, four of six self-reported cognitive function outcomes showed significant differences favoring the aerobic exercise group.ConclusionsAmong women initiating chemotherapy for breast cancer, aerobic exercise did not result in significant differences in objective cognitive function postintervention after chemotherapy completion; however, the results do support the use of this intervention for improving self-reported cognitive function and its impact on QOL. As the prevalence and consequences of chemotherapy-related cognitive impairment rise, investigation into treatment options for patients is critical. Findings of this randomized controlled trial support the use of a 12- to 24-week aerobic exercise intervention for women initiating chemotherapy for breast cancer to improve self-reported cognitive function and its impact on QOL.

Tuning into musicians' wellbeing: Research on music performance anxiety (MPA) The Music and Mental Health Research Clinic (MMHRC) at the University of Ottawa's Institute of Mental Health Research (IMHR) at The Royal is investigating how to reduce music performance anxiety (MPA) and the benefits of specific coping strategies for musicians. The audience cheers, and smiles are on every face. The music performance was incredible; it emotionally moved the audience, got their toes tapping, and made them forget their worries. On the other hand, the musicians are thinking about the note they missed or their tempo not being quite perfect. The audience does not see the musicians worrying before the performance, the state of anxiety during the performance, or the negative rumination that will occur afterwards. Biologically wired with an innate tendency to default to negative assumptions to avoid dangerous situations, our bodies react to stressors as if our lives are at stake (Baumeister, 2001; Rozin & Royzman, 2001; Ito & Cacioppo, 2005). This negativity bias is a key reason why changing our habits, behaviours, and thought patterns is so challenging. It often results in automatic negative thoughts, such as underestimating available opportunities and resources, and increased sensitivity to perceived threats.

Background The ability to cope with concussion symptoms and manage stress is an important determinant of risk for prolonged symptoms. Objective This open-label mixed-methods pilot study assessed the acceptability and credibility of a mindfulness-based intervention delivered through a digital therapeutic (DTx; therapeutic smartphone app) for pediatric concussion. Methods Participants aged 12 to 18 years were recruited from an emergency department within 48 hours of a concussion (acute cohort) or from a tertiary care clinic at least 1-month post-concussion (persisting symptoms cohort). Participants completed a novel 4-week mindfulness-based intervention, for 10 to 15 minutes/day, at a minimum of 4 days/week. At 2 weeks, participants completed a credibility and expectancy questionnaire. At 4 weeks, participants completed questionnaires assessing satisfaction, usability and working alliance, as well as a semi-structured phone interview. Results Ten participants completed the study outcomes (7 acute; 3 persisting symptoms). The intervention was perceived as credible (median/max possible = 6.50/9.00 [6.83,8.75]) and DTx was usable (median/max possible = 70.00/100.00 [55.00,82.50]). Participants rated their satisfaction with the DTx (median/max possible = 27.00/32.00 [24.50,29.50]) and the working alliance with the digital mindfulness guides (median/max possible = 3.92/5.00 [3.38–4.33]) as high. Four themes were identified from the qualitative data: (a) positive attributes; (b) negative attributes; (c) ideas for modifications; and (d) technical issues. Conclusion Results show modifications to the DTx, instructions and mindfulness intervention, and potential ways to increase adherence by leveraging positive attributes. A randomized control trial will assess the effectiveness of the DTx MBI to decrease the risk of persisting symptoms and reduce the symptom burden following pediatric concussion.

Many musicians live with music performance anxiety (MPA), which may affect their psychological and physiological functioning. Mindfulness, being aware in the present moment without judgment, has been found to help ease anxiety. Mindfulness may also help alleviate the negative effects of MPA, but what is the neurophysiological basis for this effect? Core components of mindfulness, including emotional processing and acceptance, are related to specific patterns of brain activity. In the current study, 20 musicians with MPA underwent a resting-state functional magnetic resonance imaging (MRI) scan (Time 1), a method to examine the communication between brain regions at rest. Notably, 10 musicians then underwent 2 weeks of mindfulness training, while 10 did not. The same scan sequence was repeated in all participants 2 weeks later (Time 2). Compared with Time 1, participants in the mindfulness group exhibited decreased resting-state functional connectivity between areas of the prefrontal cortex and the vermis-6 and crus-II at Time 2. These two areas of the cerebellum are related to emotional processing and acceptance. Changes in communication between these brain regions and the prefrontal cortex suggest the neurophysiological influences of mindfulness and how mindfulness can be used to strengthen emotion regulation networks in musicians with MPA.