Expanding interoceptive awareness and neuroplasticity in at-risk adolescents as assessed by real-time fMRI neurofeedback

Overview

This study will test whether simple, low-cost activities—mindfulness and exercise—can improve mental health in teens at risk for anxiety or depression. Through this research, investigators aim to identify how these practices affect emotional well-being and brain function, and when they are most effective, offering scalable tools to support youth in schools and communities.

Abstract

Adolescents are facing a growing mental health crisis, with rising rates of anxiety and depression and limited access to effective, scalable interventions. This study evaluates two accessible, non-invasive approaches: mindfulness and exercise, in adolescents at high risk for internalizing disorders. Both interventions are thought to enhance interoceptive awareness, a core Perception Box mechanism referring to the ability to sense, interpret, and respond to internal bodily states. Interoceptive awareness is closely linked to internalizing symptoms and supported by brain networks that may be modifiable through targeted intervention.

To capture intervention-driven change, we will introduce two novel indices. The Perception Box Expansion Index (PBEI) will quantify changes in interoceptive awareness using behavioral assessments. The Perception Box Neural Plasticity Index (PBNI) will measure neuroplasticity as changes in resting-state network activity during an interoception-based real-time neurofeedback task. Sixty adolescents will be randomized to a short-term mindfulness or exercise program. Pre- and post-intervention assessments will evaluate interoceptive awareness, internalizing symptoms, and neural plasticity.

We hypothesize that both interventions will reduce symptoms and expand the Perception Box, but through distinct neurobiological pathways. We also expect that baseline neuroplasticity will predict individual differences in treatment response. We will also explore: (1) Who benefits most - can we predict which teens do best with each activity? and (2) When it helps most - are there moments when teens are especially likely to benefit from mindfulness or exercise?

By integrating behavioral and neural markers of change, this project offers a novel framework for evaluating the impact of accessible interventions on adolescent mental health. Findings may inform the development of low-cost, scalable strategies that can be implemented in schools and communities to prevent or reduce anxiety and depression in youth.

Broader Impact

This study will transform adolescent mental health by exploring how accessible interventions—mindfulness and exercise—reshape the brain to enhance interoceptive awareness and subsequent mental health outcomes. By introducing novel markers (PBEI and PBNI), we provide an approach for quantifying intervention-driven changes in Perception Box constructs, which could have significant translational value beyond this study. Finally, these non-invasive, cost-effective practices could be integrated into preventative mental health programs, improving access to effective, scalable interventions that support mental health.