Neuromechanistic Pathways Underlying Mindfulness-Based Interventions for Core Post-Traumatic Stress Disorder Symptoms: A Systematic Review

Background: Prior reviews indicate mindfulness-based interventions (MBIs) alleviate PTSD symptoms through fear extinction and cognitive restructuring, yet critical gaps remain in clarifying their neural mechanisms. Objective: This systematic review integrates empirical evidence on the neural correlates of standardized MBIs (e.g., MBSR, MBCT) in ameliorating core PTSD symptoms (intrusions, avoidance, and negative cognitions) to inform clinical translation and future research. Method: The review systematically searched PubMed, Web of Science, and Google Scholar (2015–2025) for English-language studies examining neurobiological mechanisms of MBIs for PTSD, using terms PTSD, mindfulness interventions, and neurobiological measures. Results: MBIs reduced intrusive symptoms by regulating limbic hyperactivity, enhancing prefrontal control over traumatic memory activation, strengthening amygdala-prefrontal connectivity, and attenuating autonomic reactivity. For avoidance behaviors, MBIs increased insular and temporoparietal junction (TPJ) activation during emotion regulation, restored connectivity between default mode, salience, and executive control networks, and modulated FKBP5 methylation to optimize hypothalamic-pituitary-adrenal (HPA) axis function. MBIs alleviated negative cognitions by optimizing neural oscillations (theta, alpha) and cortisol dynamics, reducing hypervigilance and cognitive rigidity.

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