From Default Mode to Action Mode: Biphasic Network Reconfiguration with Meditation in Schizophrenia

Background: Whether meditation can benefit individuals with chronic schizophrenia over clinically meaningful timescales remains unclear. Neuroimaging studies exploring the underpinning of meditation are limited.

Methods: We embedded longitudinal neuroimaging within an eight‑month, parallel‑group, randomized clinical trial (ChiCTR1800014913) of 64 male inpatients with chronic schizophrenia. Participants received either daily clinician‑guided meditation plus rehabilitation or rehabilitation alone. The primary outcome was PANSS (Positive and Negative Syndrome Scale) decrease rate. The cognitive improvement was measured with RBANS (Repeatable Battery for the Assessment of Neuropsychological Status) increase rate. Their interplay and treatment heterogeneity were assessed. Resting‑state fMRI was conducted at baseline, 3, and 8 months. Neuroimaging analyses included brain networks complexity, functional connectivity and their predictive roles for symptom improvements at different stages.

Findings: Meditation produced clinically significant symptom improvements: 11.8% after 3 months and 20.8% after 8 months. The cognitive improvement was 7.6% after 3 months, plateauing thereafter. Early cognition improvement predicted, but did not mediate, later symptom relief. Marital status and low medication burden predicted good responders. Neuroimaging revealed a biphasic brain network reconfiguration: default‑mode–cerebellar complexity predicted short-term symptom improvement, while action‑mode-sensorimotor complexity predicted longer-term gains. Functional connectivity models corroborated these findings.

Interpretation: Daily clinician‑guided meditation, as an adjunct to rehabilitation, produces progressive symptom improvement in chronic schizophrenia, engaging phase-specific brain network reconfiguration: early default‑mode cerebellar involvement followed by action-mode sensorimotor engagement, providing phase‑specific, information‑based markers for personalized meditation in schizophrenia.