PrefaceIt has been argued that emotion, pain, and cognitive control are functionally segregated in distinct subdivisions of the cingulate cortex. But recent observations encourage a fundamentally different view. Imaging studies indicate that negative affect, pain, and cognitive control activate an overlapping region of dorsal cingulate, the anterior midcingulate cortex (aMCC). Anatomical studies reveal that aMCC constitutes a hub where information about reinforcers can be linked to motor centers responsible for expressing affect and executing goal-directed behavior. Computational modeling and other kinds of evidence suggest that this intimacy reflects control processes that are common to all three domains. These observations compel a reconsideration of dorsal cingulate's contribution to negative affect and pain. † Manuscript Correspondence: Alexander J. Shackman (shackman@wisc.edu) or Tim V. Salomons (tvsalomons@gmail.com) Competing Interests StatementThe authors declare no competing financial interests. NIH Public Access Author ManuscriptNat Rev Neurosci. Author manuscript; available in PMC 2011 September 1. IntroductionIn humans and other primates, the cingulate, a thick belt of cortex encircling the corpus callosum, is one of the most prominent features on the mesial surface of the brain ( Figure 1a). Early research suggested that the rostral cingulate gyrus (Brodmann's 'precingulate' 1 ; architectonic areas 24, 25, 32, and 33) plays a key role in affect and motivation (Figure 1b) 2 .More recent research has enlarged the breadth of functions ascribed to this region; in addition to emotion 3 , the rostral cingulate plays a central role in contemporary models of pain 4, 5 and cognitive control 6,7 . Work in these three basic domains has, in turn, strongly influenced prominent models of social behavior 8 , psychopathology [9][10][11] , and neurological disorders 12 .Despite this progress, key questions about the functional organization and significance of activity in the rostral cingulate remain unresolved. Perhaps the most basic question is whether emotion, pain, and cognitive control are segregated into distinct subdivisions of the rostral cingulate or are instead integrated in a common region. In a pair of landmark reviews, Devinsky et al. 13 and Bush et al. 14 marshaled a broad range of functional imaging, electrophysiological, and anatomical data in support of functional segregation, arguing that the anterior cingulate cortex (ACC or 'rostral' ACC) is specialized for affective processes, whereas the midcingulate cortex (MCC or 'dorsal' ACC) is specialized for cognitive processes (Figure 1c, 1d). Subsequent meta-analyses of imaging studies have provided some support for this claim 15 .Although the segregationist model remains highly influential, new data suggests that it is no longer tenable. For instance, recent imaging data implicate MCC in the regulation of autonomic activity 16,17 and the perception and production of emotion 3,18 . Likewise, neuronal recordings demonstrate that MCC is responsive to ...

Human minds often wander away from their immediate sensory environment. It remains unknown whether such mind wandering is unsystematic or whether it lawfully relates to an individual's tendency to attend to salient stimuli such as pain and their associated brain structure/function. Studies of pain-cognition interactions typically examine explicit manipulation of attention rather than spontaneous mind wandering. Here we sought to better represent natural fluctuations in pain in daily life, so we assessed behavioral and neural aspects of spontaneous disengagement of attention from pain. We found that an individual's tendency to attend to pain related to the disruptive effect of pain on his or her cognitive task performance. Next, we linked behavioral findings to neural networks with strikingly convergent evidence from functional magnetic resonance imaging during pain coupled with thought probes of mind wandering, dynamic resting state activity fluctuations, and diffusion MRI. We found that (i) pain-induced default mode network (DMN) deactivations were attenuated during mind wandering away from pain; (ii) functional connectivity fluctuations between the DMN and periaqueductal gray (PAG) dynamically tracked spontaneous attention away from pain; and (iii) across individuals, stronger PAG-DMN structural connectivity and more dynamic resting state PAG-DMN functional connectivity were associated with the tendency to mind wander away from pain. These data demonstrate that individual tendencies to mind wander away from pain, in the absence of explicit manipulation, are subserved by functional and structural connectivity within and between default mode and antinociceptive descending modulation networks.pain modulation | salience network | stimulus-independent thought | ventral attention network | experience sampling H umans spend nearly half their time on thoughts unrelated to their present sensory environment (1), a phenomenon referred to as "mind wandering." These thoughts can persist even when engaged in salient and challenging everyday activities (1, 2), such as driving a car through traffic. In such situations, mind wandering can be deleterious. However, in some situations, mind wandering may be beneficial, such as when an individual needs to cope with pain.Cognitive manipulations, such as alterations of attention/distraction (3-5), placebo effects (6-9), changing expectations, and other strategies (10), have shown some efficacy in altering perceptions and neural responses elicited by painful stimuli. It is generally assumed that these effects involve enhanced endogenous analgesic activity within the descending pain modulatory system [e.g., prefrontal cortex, perigenual cingulate cortex, periaqueductal gray (PAG), and rostroventral medulla] and decreased activity in regions that support the salience of pain [e.g., insula and midcingulate cortex (MCC)] (10).A crucial assumption in previous studies of explicit pain manipulation is that there is a static, invariant neurocognitive state during incoming nociceptive activit...

Most of the extant literature investigating the health effects of mindfulness interventions relies on wait-list control comparisons. The current article specifies and validates an active control condition, the Health Enhancement Program (HEP), thus providing the foundation necessary for rigorous investigations of the relative efficacy of Mindfulness Based Stress Reduction (MBSR) and for testing mindfulness as an active ingredient. 63 participants were randomized to either MBSR (n=31) or HEP (n=32). Compared to HEP, MBSR led to reductions in thermal pain ratings in the mindfulness- but not the HEP-related instruction condition (η2=.18). There were significant improvements over time for general distress (η2=.09), anxiety (η2=.08), hostility (η2=.07), and medical symptoms (η2=.14), but no effects of intervention. Practice was not related to change. HEP is an active control condition for MBSR while remaining inert to mindfulness. These claims are supported by results from a pain task. Participant-reported outcomes (PROs) replicate previous improvements to well-being in MBSR, but indicate that MBSR is no more effective than a rigorous active control in improving these indices. These results emphasize the importance of using an active control condition like HEP in studies evaluating the effectiveness of MBSR.