Dissociation is a multifaceted, transdiagnostic, and disabling phenomenon that involves detachment from the self or surroundings. It is prevalent in trauma-exposed people with posttraumatic stress disorder, occurs in other disorders (e.g., depression, anxiety), and is a barrier to recovery in first-line treatments. Dissociation is characterized by disruptions in body awareness, or interoception, and some research suggests that highly dissociative individuals also have higher inflammatory tone. Mindfulness-based meditative practices, including breath- focused mindfulness meditation (BFM), are designed to enhance interoceptive awareness to physiological signals (breath) and are also shown to reduce inflammation. However, mindfulness is often a difficult 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 facilitate changes in inflammation in conjunction with mindfulness interventions. As such, the goal of this supplement is to examine potential changes in inflammation with changes in interoception 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 45 trauma-exposed people with clinically significant dissociation symptoms, divided in four equal groups to yield a 2x2 (BFM or non-judgmental awareness x with or without vibroacoustic stimulation) design. All participants attend 8 sessions of their assigned intervention. We will collect blood samples for inflammatory assays pre and post-intervention (2 time points) to examine change in inflammation with interoception, measured clinically as well as during an interoception task during fMRI pre- and post-intervention. We will examine: Aim 1) whether changes in inflammatory markers, including c-reactive protein, interleukin-1 and -6, and tumor necrosis α, are significant from pre- to post intervention; Aim 2) whether changes in inflammatory markers are associated with change in interoception (measured clinically and via neural network response), and whether BFM with exteroceptive feedback significantly moderates these changes; Aim 3) whether change in inflammation is associated with change in dissociation, and whether BFM with exteroceptive feedback significantly moderates these changes.

We propose to examine potential changes in inflammation in response to an intervention that uses breath-synched vibration during breathing meditation to enhance interoception in dissociative trauma-exposed people. We will investigate how inflammation change may be linked to dissociation change as well. We will assess interoception through self-report as well as via neural network response during an interoceptive functional magnetic resonance imaging task.