Dissociation is a multifaceted, transdiagnostic, and disabling phenomenon that involves detachment from the self or surroundings. It is prevalent in traumatized people with posttraumatic stress disorder (PTSD), occurs in other disorders including depression, anxiety, and schizophrenia, and is a barrier to recovery in first-line treatments. Dissociation is characterized by attentional impairments and disruptions in body awareness, or interoception. Mindfulness-based meditative practices, including breath-focused mindfulness meditation (BFM), are designed to enhance attentional control through focused awareness on interoceptive cues (breath). However, this is a nearly impossible task for dissociative people, who experience disruptions in body agency and are unable to access or trust body signals. Exteroceptive feedback enhances interoceptive awareness and body agency in experimental studies and may similarly enhance attentional control with minimal cognitive effort. As such, the goal of this study is to address deficits in interoception and attentional control in dissociative traumatized patients via BFM augmented with exteroceptive feedback. This is delivered by a unique device that vibrates in concert with respiration, yielding non-ignorable mechanoreceptor reactivity to breathing. Using a stimulus-driven mechanism, our device is expected to enhance body agency and efficiently engage attention and interoception networks. We will recruit 200 traumatized people with clinically significant dissociation symptoms, divided in four equal groups to yield a 2x2 (breath-focused meditation or rest x with or without vibroacoustic stimulation) design. All participants will attend 8 sessions of their assigned intervention. We will administer attentional control and interoception tasks during fMRI pre- and post-intervention to examine: Aim 1) whether BFM with exteroceptive feedback engages attentional control and interoceptive networks to a significantly greater degree than the other treatment conditions from pre- to post- intervention. We will also examine: Aim 2) whether changes in neural network response correspond with changes in dissociation (and secondarily, other trauma-related problems) to a greater degree in BFM with exteroceptive feedback as compared to the other treatment conditions. The immediate impact of this research is to overcome neurobiological barriers to treatment response in dissociation using novel technology. The long-term impact will be to inform the development of publicly-disseminable devices that can augment current interventi ons.

We propose the use of a vibroacoustic device to enhance attention and interoception brain networks during breath-focused mindfulness meditation in dissociative traumatized people. Impairments in attention, particularly to body cues, interfere with treatment success in dissociative traumatized people. We will assess how this device, which vibrates in proportion to the breath, can target these networks and address neurobiological barriers to successful treatment engagement.