Effect of app-based mindfulness on extinction recall – a 7T-fMRI study

Fear-based disorders affect millions worldwide, yet current treatments show limited effectiveness for many patients. While mindfulness is increasingly used clinically for anxiety and trauma disorders, the neural mechanisms underlying its effects on fear processing remain unclear. We conducted a randomized controlled trial using 7T fMRI to test whether mindfulness training enhances fear extinction recall-a process critical for recovery from these disorders. Healthy participants received four weeks of app-based mindfulness meditation (n = 27) or served as waitlist controls (n = 28), then underwent fear conditioning and extinction recall testing. Mindfulness training specifically enhanced extinction recall, reducing threat responses to extinguished cues by both physiological (skin conductance, p=.028) and neural measures. Critically, our findings reveal a candidate mechanism: mindfulness reduced activation in subcortical threat-processing regions (amygdala, striatum, supplementary motor area) without enhancing cognitive control areas, a pattern consistent with direct modulation of fear circuits rather than top-down inhibition, though top-down contributions cannot be excluded. This pattern is consistent with mindfulness enhancing safety memory retrieval through implicit rather than explicit emotion regulation, providing preliminary neurobiological evidence relevant to optimizing mindfulness-based treatments. Our findings suggest that mindfulness training, whether administered before or alongside exposure therapy, could potentially enhance therapeutic outcomes by improving the consolidation and retrieval of safety memories, although replication in larger clinical samples is needed.