Research

Detecting spirituality using brain imaging – implications for addiction recovery?

Writings in prominent addiction recovery organizations such as Alcoholics Anonymous (AA) prioritize the role of enhanced spirituality in the resolution of substance use problems and other health behavior changes. This study provides a framework for how hard-to-study constructs like spirituality can be assessed with brain imaging, so that they can be integrated into the study of addiction recovery. This study shows that activity in the parietal cortex – an area of the brain involved in awareness of self and others, as well as attention processing – plays a key role in processing spiritual experiences. Authors suggest that specific brain activation patterns may inform us about the brain mechanisms associated with personally–experienced spirituality. 

WHAT PROBLEM DOES THIS STUDY ADDRESS?

In this study, authors set out to examine the brain regions that underlie personalized spiritual experiences, using a modern definition of spirituality that may be independent of religiousness. Research shows that enhanced spirituality is associated with reduced risk of substance use and helps explain benefit from AA attendance for individuals with severe alcohol use disorder. Many experts, however, challenge the relevance of spirituality within the contemporary, medical-psychological conceptualization of addiction recovery. A potential challenge in studying spiritual experiences involves the vast variety of spiritual experiences that may have varying degrees of relevance or meaning to different individuals. A potential solution involves the generation of personally-relevant, individually-tailored scripts that relate to spiritual experiences ranging from formal religious-type occurrences to less formal ones, such as connections with nature. In this study, authors adapted a widelyused guided imagery task that has been used to study motivational and emotional processing relating to substance cravings and stress, and then used this guided imagery task in the scanner to evoke brain activation. 

HOW WAS THIS STUDY CONDUCTED?

27 young adults (mean age: 22, range 18–27 years; 12 female) completed an fMRI scan. fMRI brain scans measure the magnetic properties of blood cells to indicate which parts of the brain are active  and at what level they are active  during various cognitive tasks. 

Approximately one week prior to scanning, with the help of study staff, each participant developed personalized guided imagery scripts for spiritual, stressful, and neutral-relaxing, conditions. The spiritual imagery script was developed from a participant’s own account of one of the most personally spiritual events experienced in the past 12 months. Participants had diverse spiritual backgrounds; examples of spiritual situations included participating in a religious service at a house of worship, experiencing a connection with nature, and meditating. Participants also had diverse perspectives on the divine, with individual script themes including unity/oneness, infinity/wonder and relationality, and communion. 

Stress and neutral-relaxing scripts were also generated. The stress imagery script was developed from a participant’s account of one of the most personally stressful events occurring in the past 12 months. Examples include situations such as illness/death of a loved one, unemployment-related stress, or strife with family. A neutral-relaxing script was developed from individual’s experience of neutral-relaxing situations, including reading in bed at night, watching television, or walking in nature. The research team then read these scripts aloud and recorded them so that they could be played to the subjects later (in the scanner). 

The subjects then underwent fMRI scans while listening for the first time to recordings based on their personalized experiences. The fMRI session consisted of participants being exposed to the three imagery conditions: spiritual, stress, and neutral-relaxing. Two scripts of each type were read aloud to them (i.e., two spiritual, two stress, two neutral-relaxing). 

WHAT DID THIS STUDY FIND?

The authors found that spiritual cues relative to neutral-relaxing cues were associated with reduced activation in the inferior parietal lobe (IPL)This brain region contributes to multiple processes, including attention, impulse control, reasoning, and sensory processing. Additionally, compared with the stress condition, the spirituality condition was associated with reduced activity in the medial thalamus and striatum, brain regions implicated in sensory and emotional processing. These results suggest neural foundations for spiritual experiences across different traditions and practices. 

Figure 1. Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org. From the case rID: 46670

WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

Spiritual experiences may have profound impacts on people’s lives. Showing that re-experiencing spiritual experiences activates the brain’s inferior parietal lobe indicates that spirituality engages the same brain regions as attention, impulse control, reasoning, and sensory processing. Additionally, compared with the stress condition, the spirituality condition was associated with reduced activity in the medial thalamus and striatum, brain regions implicated in sensory and emotional processing, indicating that spirituality may help us focus and control our emotions. 

This study provides a concrete example of how brain imaging can be used to understand the neural bases of spiritual experiences. As the science of spirituality and its relationship to health behavior change in addiction recovery becomes more sophisticated, scientists may be able to use brain imaging to better understand their roles in resilience and recovery from mental health and addictive disorders, potentially informing targets for prevention and treatment. 

LIMITATIONS
  1. The study sample was a relatively small group of young adults. Although participants’ religious and spiritual backgrounds were generally diverse, further studies could include larger samples of participants from multiple cultures, backgrounds, and age groups in order to understand better individual differences in the neural correlates of spirituality. 
  2. Participants in this study were all generally healthy, with no substance use or other clinical disorders. Future investigations of spiritual experiences in longitudinal studies or among clinical populations would produce further insights about such relationships. 

BOTTOM LINE

  • For individuals and families seeking recovery: Many individuals with substance use disorders believe that enhanced spirituality is a mechanism of change for the effectiveness of popular twelve-step and other treatment programs. Here, researchers show that specific brain regions, such as the inferior parietal lobe, thalamus, and caudate nucleus may play key roles in processing spiritual experiences. Many approaches to recovery, such as mindfulness-based therapies, incorporate spiritual practices without a requirement to believe in a higher power or religion. This study shows that a diversity of spiritual experiences are reflected in the brain, and highlights the potential neural locations and their function that relate to spiritual practices. Though the precise mechanisms by which spiritual experience aid in recovery is not well-understood, it is likely that these practices confer a great deal of benefit to some, with little risk of harm. 
  • For treatment professionals and treatment systems: Although the precise mechanism by which spiritual experiences aid in recovery is not well-understood, many approaches to recovery, such as mindfulness-based therapies and 12-step programs, incorporate spiritual practices. Future research should investigate whether incorporating spirituality into a daily routine would provide long-term benefit. This study demonstrates that spirituality, broadly defined, is reflected in activation of specific brain regions, and can be studied using brain imaging to better characterize mechanistic manifestations of spirituality. 
  • For scientists: Spirituality is an effective – and free  component of recovery support for individuals with alcohol and other substance use disorders. Policy makers should fund rigorous research to understand if and how spirituality drives recoveryrelated health behavior change. 
  • For policy makers: This study is an excellent illustration of how brain imaging can be used to study elusive concepts like spirituality. More work is needed that more deeply explores the underlying mediators influencing effectiveness of treatment programsas well as for whom and under what conditions different programs work best. Greater knowledge in this regard could inform the nature of recovery processes more broadly and enhance recovery management interventions. This study provides a framework for how spirituality can be assessed with imaging, so that it can be integrated into the modern study of addiction recovery. 

CITATIONS

Miller, L., Balodis, I. M., McClintock, C. H., Xu, J., Lacadie, C. M., Sinha, R., & Potenza, M. N. (2019). Neural correlates of personalized spiritual experiencesCerebral Cortex, 29(6), 2331-2338. doi10.1093/cercor/bhy102 

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