Journal Pre-proof

Technology Supported Mindfulness for Obse ssive Compulsive Disorder: Self-

Reported Mindfulness and EEG Correlates of Mind Wandering

Lance L. Hawley, Neil A. Rector, Andreina Da Silva, Judith M. Laposa, Margaret A.

Richter

PII: S0005-7967(20)30211-4
DOI: https://doi.org/10.1016/j.brat.2020.103757
Reference: BRT 103757

To appear in: Behaviour Research and Therapy

Received Date: 19 November 2019

Revised Date: 14 September 2020
Accepted Date: 16 October 2020

Please cite this article as: Hawley, L.L., Rector, N.A., Da Silva, A., Laposa, J.M., Richter, M.A.,
Technology Supported Mindfulness for Obse ssive Compulsive Disorder: Self-Reported Mindfulness
and EEG Correlates of Mind Wandering, Behaviour Research and Therapy, https://doi.org/10.1016/
j.brat.2020.103757.

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 CRediT Author Statement
Dr. Lance Hawley: Conceptualization, Methodology, Formal Analysis, Investigation,
Data curation, Writing – Original draft preparation, Writing – Review & Editing,
Visualization, Supervision, Project Administration.

Dr. Neil Rector.: Conceptualization, Methodology, Formal Analysis, Investigation, Data

curation, Writing- Original draft preparation, Writing – Review & Editing, Visualization,
Supervision, Project Administration.

Ms. Andreina Da Silva: Investigation, Data curation, Writing – Review & Editing,
Visualization, Project Administration.

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Dr. Judith Laposa: Investigation, Resources, Writing – Review & Editing, Visualization.

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Dr. Margaret Richter: Conceptualization, Methodology, Investigation, Writing – Original
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draft preparation, Writing – Review & Editing, Visualization, Supervision, Project
Administration.
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Running head: Mindfulness and EEG Correlates of Mind Wandering in OCD 1

Technology Supported Mindfulness for Obsessive Compulsive Disorder:

Self-Reported Mindfulness and EEG Correlates of Mind Wandering

Lance L. Hawley1, 2, Neil A. Rector1,2 , Andreina Da Silva 1, 2, Judith M. Laposa2, 3

Margaret A. Richter 1, 2

1
Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre,

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Toronto, Ontario, Canada

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2
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
3
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Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto,
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Ontario, Canada
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Correspondence can be directed to:

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Dr. Lance Hawley, C. Psych.

Psychologist, Clinical Lead – Outpatient Psychological Service
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Frederick W. Thompson Anxiety Disorders Centre

2075 Bayview Avenue, K3W46
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Toronto, Ontario, Canada M4N3M5

Ph: (416) 480-6100 x84076, Fax: (416) 480 5766

The authors have no competing interests to declare.

Acknowledgements: We thank the participants for their participation in this study, as well as

Alexander Theodorou (Research Assistant).

EEG Correlates of Mind Wandering in OCD 2

Abstract

Cognitive Behavior Therapy (CBT) incorporating Exposure with Response Prevention (ERP) is

the most efficacious treatment intervention for Obsessive Compulsive Disorder (OCD); however,

there is a growing literature indicating the mindfulness based approaches can also be beneficial

in terms of managing OCD symptoms.The current study examined the potential benefits of using

a consumer grade EEG-based biofeedback device (called “Muse”) that permits individuals to

engage in mindfulness meditation practices while at home. In this randomized controlled study,

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participants with a principal DSM-5 diagnosis of OCD (N=71) were randomly assigned to eight

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weeks of: 1) a meditation program involving daily use of the “Muse” device, or 2) waitlist
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control. At weeks 1, 4, and 8, participants completed a five minute “open monitoring” practice in
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which EEG data were recorded, and they completed self-report measures of mindfulness
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(FFMQ: Five Factor Mindfulness Questionnaire) and OCD symptoms (YBOCS: Yale-Brown
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Obsessive Compulsive Scale). Latent Difference Score (LDS) models demonstrated that the

FFMQ “Non-Reactivity” facet and EEG-derived correlates of “Mind Wandering” (i.e., alpha,
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beta, but not delta or theta band power) were temporally associated with subsequent changes in
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YBOCS symptom scores. Participants in the Muse group (in comparison to the control group)

experienced increased FFMQ “Non-Reactivity” and decreased mind wandering (increased alpha

and beta band power), and in each case, these variables were associated with subsequent OCD

symptom improvement. These results suggest that technology supported mindfulness training for

OCD is associated with improvements in OCD symptoms, mindfulness and mind wandering.

Keywords: obsessive compulsive disorder; mindfulness; technology supported mindfulness;

mind wandering; EEG; meditation.

EEG Correlates of Mind Wandering in OCD 3

Obsessive Compulsive Disorder (OCD) is a severe and often chronic illness characterized

by the presence of obsessions (intrusive unwanted thoughts, images and/or impulses) and

compulsions (repetitive ritualistic covert and/or overt behaviors), with a reported lifetime

prevalence in the range of 2-3% (Kessler et al., 2012). For individuals experiencing OCD, their

functioning can be significantly impaired (Cassin et al., 2009; Fineberg et al., 2015), making

OCD one of the 10 leading causes of disability worldwide (Murray & Lopez, 1997).

Pharmacotherapy with selective serotonin reuptake inhibitors and Cognitive Behavioral Therapy

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(CBT) are both considered first-line treatments, however medication typically has a modest

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effect for those who benefit (Skapinakis et al, 2016). OCD is most effectively treated with
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Cognitive Behavioral Therapy (CBT), which involves both behavioral (Exposure with Response
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Prevention (ERP; Meyer 1966) and cognitive strategies. CBT for OCD is a highly effective first-
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line treatment, with up to 67% of patients experiencing significant symptom reduction (e.g.,
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Olatunji et al., 2012; Ost et al., 2015; Rosa-Alcázar et al., 2008).

There are also limitations to CBT treatment; some patients can find the process of ERP to
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be distressing and challenging, and this may lead to difficulties with fully engaging in treatment,
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as well as increased attrition (Kozak, Liebowitz & Foa, 2000). Therefore, there is a need to

consider other effective, tolerable, and accessible treatment options such as Mindfulness-based

Interventions (MBIs). MBIs encourage individuals to cultivate a present-focused, acceptance-

based approach to their symptoms as opposed to engaging in experiential avoidance strategies.

MBIs involve engaging in both formal and informal mindfulness practices during treatment, in

order to help individuals develop the ability to “pay attention, on purpose and without judgment,

to the present moment” (Bishop et al., 2004). Meta-analyses of MBIs have examined the efficacy

of this approach, demonstrating moderate to large effect sizes in change from pre- to post-
EEG Correlates of Mind Wandering in OCD 4

treatment anxiety or depression, and small to moderate effect sizes when compared to active

control groups (Hofmann et al., 2010; Khoury et al., 2013).

There is an emerging literature supporting the efficacy of MBIs for OCD. The initial

research in this area involved qualitative case studies that indicated positive treatment results

(Patel et al., 2007; Wilkinson-Tough et al., 2010). There are also several randomized, controlled

trials; for example, Hanstede, Gidron & Nyklícek (2008) reported treatment-related OCD

symptom improvement in comparison to a control group in a non-clinical student population.

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Strauss et al. (2018) compared mindfulness-based ERP with ERP in a clinical population;

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although both interventions resulted in OCD symptom improvement, the MB-ERP group did not
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experience greater improvements in OCD symptom severity when compared to ERP. Sguazzin,
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Key, Rowa, Bieling, and McCabe (2017) examined the efficacy of MBCT for treatment of
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residual OCD symptoms following CBT using a clinical population; patients reported a decrease
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in perceived OCD symptoms, and increased mindfulness and coping skills. Further, Key, Rowa,

Bieling, McCabe and Pawluk (2017) examined MBCT as an augmentation treatment for residual
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OCD symptoms following CBT treatment; participants reported significant decreases in OCD
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symptoms, obsessive beliefs and trait mindfulness in comparison to the waitlist control group.

Our research team (Selchen, Hawley, Regev, Richter & Rector (2018)) conducted pilot research

on an MBCT for OCD intervention, comparing patients who previously received CBT (but remained

symptomatic) to patients who had never received CBT. Both MBCT treatment alone and MCBT

following CBT resulted in large, significant OCD symptom reductions (d = 1.10 and d = 1.31

respectively) as well as reductions in obsessive beliefs and increases in trait mindfulness. Taken

together, these studies suggest that mindfulness-based interventions for OCD may represent a

viable and efficacious treatment option.

EEG Correlates of Mind Wandering in OCD 5

Considering the limitations of traditional outpatient based treatment approaches (e.g.,

accessibility, wait times, treatment acceptability, clinician expertise), it may be important to

explore alternative, technology based treatment models for OCD symptom management. There is

growing evidence that MBIs can be effective in non-traditional formats, including “Technology

Supported Mindfulness” (TSM) options such as web-based online interventions (Spijkerman,

Pots & Bohlmeijer, 2016), and smart phone applications (Flett, Hayne, Riordan, Thompson &

Connor, 2019; van Emmerik, Berings, & Lancee, 2018). These studies suggest that TSM

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interventions offered in more easily accessible formats are associated with increases in

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mindfulness and reductions in depression and anxiety in comparison to control conditions.
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In order to optimize treatment response, it is not only important to evaluate whether
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technology supported mindfulness treatment is effective; it is also important to understand the
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mechanisms underlying treatment response. According to the CBT model, when individuals
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experience intrusive, disturbing, obsessive thoughts and the associated urges to ritualize, they

often direct their attention away from these experiences, engaging in ongoing efforts to ignore,
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suppress, and/or neutralize their thoughts (Abramowitz, Taylor & McKay, 2009). Unfortunately,
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these “experiential avoidance” strategies are associated with increased OCD symptom severity

over the longer term, thereby maintaining the OCD cycle (Purdon, Rowa & Antony, 2007).

Alternatively, a mindfulness-based approach involves promoting experiential acceptance, as

individuals make a conscious effort to observe important mood related experiences that occur in

the present moment while adopting a non-evaluative and “decentered” orientation involving

acceptance, openness to experience, and curiosity (Bieling et al., 2012; Bishop et al., 2004).

Mindful awareness and experiential acceptance can be assessed using the Five Facet

Mindfulness Questionnaire (FFMQ; Baer, Smith, Hopkins, Krietemeyer & Toney, 2006). The
EEG Correlates of Mind Wandering in OCD 6

FFMQ is a self-report measure of mindfulness that assesses five “mindfulness facets”: Observing

(attending to or noticing internal and external stimuli, such as sensations, emotions, cognitions,

sights, sounds, and smells), Describing (noting or mentally labeling these stimuli with words),

Acting with Awareness (attending to one’s current actions, as opposed to behaving

automatically), Non-Judging of Inner Experience (refraining from evaluation of one’s sensations,

cognitions, and emotions), and Non-Reactivity to Inner Experience (allowing thoughts and

feelings to “come and go without getting caught up in them”).

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Specifically, three of the five FFMQ facets (Acting with Awareness, Non-Judging, Non-

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Reactivity) are associated with OCD symptom changes. Emerson, Heapy and Garcia-Soriano,
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(2018) found that these three facets predicted decreases in obsessive thoughts, as well as less
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difficulty with controlling these thoughts. Didonna & Bosio (2012) found that individuals
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experiencing OCD scored significantly lower than a control group on the “Acting with
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Awareness” facet. Didonna (2009), Didonna & Bosio (2012) and Didona et al. (2019) found that

individuals experiencing OCD had lower scores on the FFMQ Non-Judging facet in comparison
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to healthy controls. Didonna and Bosio (2012) and Hawley et al. (2017) demonstrated an
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association between the “Non-Reactivity to Inner Experience” facet and OCD symptom changes.

Specifically, Hawley et al. (2017) found that the Non-Reactivity facet was negatively correlated

with YBOCS scores for individuals experiencing OCD, post CBT treatment.

Another possible mechanism underlying the efficacy of MBIs is that mindfulness

practices are associated with changes in attentional processes. For example, Seli, Risko, Purdon

and Smilek (2015) used self-report measures of attentional changes (termed “mind wandering”),

and demonstrated that mind wandering is associated with OCD symptom changes. The authors

propose that OCD thought suppression strategies and mind wandering might be conceptually
EEG Correlates of Mind Wandering in OCD 7

similar, involving executive control difficulties, and/or efforts to disengage from distressing

obsessive thoughts or images.

Considering the dynamic nature of attentional processes, there may be advantages to

assessing attention by utilizing neurophysiological methods as well as incorporating self-report

inventories . Electroencephalography (EEG) is a commonly used, non-invasive, relatively cost-

effective approach that can identify neurophysiological markers related to attention. Braboszcz

and Delorme (2011) reported EEG-derived markers of mind wandering in experienced

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meditators involve decreases in Alpha and Beta band power and increases in Delta and Theta

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band power. These researchers recorded brain activity using a 128-channel EEG from subjects
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performing a breath-counting task. Theta (4–7 Hz) and delta (2–3.5 Hz) EEG activity increased,
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while alpha (9–11 Hz) and beta (15–30 Hz) decreased during periods of mind wandering. There
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is an emerging literature that describes the EEG derived neurophysiological attentional changes
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that are associated with OCD symptomatology. Several EEG studies have shown that OCD

subjects exhibit changes in frontal cortical activity as demonstrated by decreased alpha and beta
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power in frontal, parietal and limbic lobes in comparison to healthy controls, predominantly for
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the frontal electrode positions (Bucci et al., 2004; Karadag et al., 2003; Pogarell et al., 2006).

EEG derived markers of mind wandering can be evaluated using large-scale medical

grade devices which are often available in hospitals and clinical research settings. However,

frontal EEG activity can also be reliably evaluated by using a consumer-grade EEG device called

“Muse”, created by Interaxon Inc. (RRID:SCR_014418). This EEG headset and accompanying

mobile device software application is a form of Technology Supported Mindfulness (TSM) that

allows users to engage in mindfulness practices at home, while also monitoring EEG derived

markers of mind wandering. “Muse” incorporates four dry sensors (frontal and over the mastoid
EEG Correlates of Mind Wandering in OCD 8

laterally) which generate an EEG biometric signal, which is used to inform neurofeedback to the

user. The device also affords an opportunity to assay EEG signaling in real-time when the user is

wearing the headset. Krigolson et al., (2017) validated the MUSE, using a standard reward-

learning task. These results demonstrated that they could reliably quantify the electrical activity

of the cerebral surface during cortical processing, which suggests that this device can accurately

measure EEG-derived attentional indicators of mind wandering. Further, use of the “Muse”

device has been associated with improved attention and well-being (Bhayhee et al., 2016).

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This study examined whether TSM (using the “Muse” headset) can promote OCD

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symptom alleviation, as indicated by increased self-reported mindfulness and EEG derived
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indicators of mind wandering. We hypothesized that individuals in the “Muse” condition (in
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comparison to the control condition) who engaged in eight weeks of daily mindfulness practices
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would experience OCD symptom improvement as indicated by their scores on the Yale-Brown
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Obsessive Compulsive Inventory (YBOCS). Further, we hypothesized that the individuals in the

“Muse” condition (in comparison to the control condition) would demonstrate increased self-
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reported mindfulness, as measured by the FFMQ facets of Acting with Awareness,

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Nonjudgement, and Nonreactivity, and these facets would be longitudinally associated with

OCD symptom improvement. We also hypothesized that EEG-derived indicators of mind

wandering (i.e., band power differences within the frontal sensor of the device (labelled “FP1”

on Supplementary Figure 1) as represented by the frequency bands within Alpha, Beta, Delta and

Theta) would be associated with OCD symptom alleviation. We hypothesized that individuals in

the “Muse” condition would demonstrate EEG related longitudinal changes in brain activity

related to reduced mind wandering (increased Alpha, Beta, and decreased Delta, and Theta band

power), while individuals in our “Control” condition would not exhibit EEG attentional changes.
EEG Correlates of Mind Wandering in OCD 9

Method

Participants

Participants responded to recruitment flyers posted at our hospital clinic, as well as

another mood and anxiety disorders outpatient clinic located in Toronto, Canada. Eligible

participants did not receive any form of psychological treatment during the study. Seventy-one

treatment-seeking individuals with a primary diagnosis of OCD as established by the Diagnostic

and Statistical Manual of Mental Disorders (5th ed.; DSM-V, American Psychiatric Association,

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2013) were selected for participation in the study. The Structured Clinical Interview for Mental

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Disorders (SCID-5) (APA, 2013) was used to determine diagnostic status. The SCID-5 was
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administered by graduate level research assistants who completed extensive training in the
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administration of the SCID V. All interviews were reviewed in weekly supervision meetings
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with the study P.I., and each assessment was discussed in order to ensure accurate diagnoses.
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Exclusion criteria for the study included: a) active substance use disorder, b) recent suicide

attempt/active suicidality, c) active bipolar, psychotic disorder or post-traumatic stress disorder,

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and d) organic pathology.

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Participants were primarily Caucasian (77%), single (63%), and adult (26 years; SD=

4.61). The following comorbid diagnoses were also present in this sample: major depression

(56%), dysthymia (12%), social anxiety disorder (13%), generalized anxiety disorder (38%), and

panic disorder with/without agoraphobia (26%). The hospital’s research ethics board approved

the study and participants provided informed consent to participate. Interaxon Inc. supplied the

devices for the study, free of charge. This research did not receive any grant from funding agencies

in the public, commercial, or not-for-profit sectors.

EEG Correlates of Mind Wandering in OCD 10

The study adhered to all CONSORT guidelines (see Figure 1). There were no gender or

age-related differences between groups at any point during the study, and Chi-square analyses of

participant dropout showed no differences in gender or age. The intention to treat (ITT) sample

consisted of 71 participants (N=36 Muse, N=35 Control) and the post-treatment sample was

N=69 (two dropouts). All participants were included in all data analyses.

Materials and Measures

EEG Recording: The Muse wireless EEG headset (InteraXon Inc.) is shown in

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Supplemental Figure 1. This headset was used to record the EEG data continually throughout

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each mindfulness practice. There are four electrodes in the Muse, two are located at the frontal
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lobe areas (FP1 and FP2) and the other two are at the temporal lobe (TP9 and TP10) areas. The
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Muse was connected to the user’s phone through Bluetooth; the data output was uploaded to the
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Interaxon servers anonymously following each practice. At the start of each meditation session,
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participants completed an initial calibration process in which the device determined the user’s

baseline EEG profile during a period of time involving concentration in comparison to

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distraction. Following calibration, guided meditation instructions were provided to the user,
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through their cellphone. “Mind wandering” auditory biofeedback was incorporated into each

mindfulness meditation session dynamically, and the volume of this feedback was adjusted in

real time based on the user’s attention level. The auditory feedback included auditory cues (e.g.,

storm sounds), which increased in volume when the user was distracted, and decreased in

volume when the user maintained a stable level of attention. For the open monitoring practice,

we asked participants to wear the Muse headset, and maintain focus on their breath and body –

they did not receive any guided meditation instructions.

EEG Correlates of Mind Wandering in OCD 11

Five-facet mindfulness questionnaire (FFMQ; Baer et al., 2006). The FFMQ is a 39-

item self-report measure that assesses five facets of mindfulness (Observing, Describing, Acting

with Awareness, Non-Reactivity to Inner Experience, and Non-Judging of Inner Experience).

Each item is rated on a 5-point scale, ranging from 1 (never or very rarely true) to 5 (very often

or always true). The FFMQ has demonstrated good psychometric properties, including

acceptable internal consistency in meditating and non-meditating samples (Baer et al., 2008). In

the current sample, internal consistencies were as follows: Acting with Awareness (α = .87),

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Describing (α= .89), Nonreactivity (α =.78), Nonjudging (α= .86), and Observing (α= .78).

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Yale-Brown Obsessive-Compulsive Scale – Self Report (YBOCS-SR; Steketee, Frost
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& Bogart, 1996). The YBOCS-SR assesses the severity of OCD symptoms with 10 items. It has
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excellent psychometrics, including good internal consistency and reliability, and it yields similar
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scores to the interviewer-administered version of the YBOCS (Baer et al., 1993; Steketee, Frost,
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& Bogart, 1996). Internal consistency (Cronbach’s Alpha) for the YBOCS total score at each

time point were: YBOCSt1 α = .92, YBOCSt2 α = .87, YBOCSt3 α = .88.

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Procedure
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The study was completed at a large university-affiliated hospital clinic specializing in the

assessment and treatment of OCD and related disorders. Following the SCID V assessment,

participants were randomly assigned to one of two conditions: 1) “Muse”: an eight week

meditation program involving use of an EEG-based biofeedback device, or 2) “Control”: eight

weeks of a waitlist condition (participants did not receive any psychological treatment during

this time). Group randomization was determined using the “GraphPad Quick Calcs” online

calculator which offers random allocation into equal-sized groups. All subjects were assigned a

de-identified study ID, in order to maintain the study blind. During the study, participants
EEG Correlates of Mind Wandering in OCD 12

completed online surveys using the “Survey Monkey” web portal. All participants attended three

sessions (weeks 1, 4, and 8) and completed an unguided “open monitoring” mindfulness practice

for five minutes while wearing a Muse headset, in order to collect EEG data. Participants in the

Muse condition completed a daily guided mindfulness practice (provided by the “Muse”

smartphone application) lasting for 20 minutes, throughout the eight week study. All de-

identified mindfulness practice data from the EEG headsets was automatically uploaded to an

encrypted server hosted by Interaxon (creators of the device), based on the serial number of the

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headset, in order to maintain the study blind. All participant data were de-identified; individuals

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at Interaxon were not aware of any participant personal information, nor were they aware of the
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study condition – they only knew the serial number of the headset used by the participant.
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Data Analysis
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EEG-Derived Indicators of “Mind Wandering”: EEG derived band powers for each
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frequency band (Delta: 1-4 Hz, Theta: 4-8 Hz, Alpha: 7.5-13 Hz, Beta: 13-30 Hz) were

computed as follows. EEG signals sampled at 256 Hz were epoched using a 2 second non-
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overlapping moving window. A Fourier transform was applied on the epoched EEG signals. The
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power spectral density, representing the band power at each frequency bin, was computed by

squaring the absolute value of the Fourier spectrum. The mean power spectral density was

computed by averaging the power spectral densities across all epochs within a session. Each

band power was then computed as the log of the sum of mean power across frequency bins in the

respective frequency band. Band powers are presented in units of log10(uV^2/Hz). For example,

alpha band power represents the log sum of power of all frequency bins between 7.5 Hz and 13

Hz. We have provided the band powers for the alpha frequency range in decibels (log of power

spectral density, log(uV^2/Hz)).

EEG Correlates of Mind Wandering in OCD 13

A Latent Difference Score analytical approach (LDS; see McArdle, 2001; McArdle &

Hamagami, 2001) was used to examine the longitudinal and temporal dynamics of OCD

symptoms and FFMQ facets as related to EEG derived band powers associated with mind

wandering (i.e., alpha, beta, delta, theta). LDS models incorporate latent growth curve analysis

(Meredith & Tisak, 1990) with cross-lagged regression (Joreskog & Sorbom, 1979). This allows

researchers to examine how each variable independently changes over time (e.g., univariate

analyses), considering temporal relationships between each univariate series (e.g., bivariate

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analyses) and group effects (e.g., multigroup bivariate analyses).

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Longitudinal measurement invariance was evaluated, and was considered to be
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acceptable.1 A univariate model was established, clarifying how each longitudinal variable
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independently changed over time (Hamagami & McArdle, 2001; McArdle, 2001; McArdle &
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Hamagami, 2001). Next, bivariate LDS analyses evaluated cross-lagged “coupling” regressions
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between each univariate model. Bivariate coupling occurs if two univariate processes

demonstrate a temporal relationship in which one univariate time series (e.g., EEG “mind
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wandering”, FFMQ facets) predicts the subsequent rate of change in another (e.g., OCD
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symptoms). Bivariate LDS analyses examine four possible coupling relationships between OCD

symptoms, FFMQ facets and EEG-derived indicators of mind wandering. The four models are:

a) in the “no coupling” model, the two univariate series are not dynamically related, b) in the

“Mindful Focus” model, EEG band power values lead to subsequent changes in OCD symptoms

over each time period, c) in the “Symptom Driven” model, OCD symptoms lead to subsequent

changes in EEG band powers over each time period, or d) a “Reciprocal” model in which both b)

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Longitudinal measurement invariance was evaluated. A confirmatory factor analysis (CFA) was conducted for
each study variable, and all items were retained. Measurement invariance was evaluated and determined to be
acceptable, testing the null hypothesis of weak (i.e., equal factor loadings over time) in comparison to strong (i.e.,
equal measurement intercepts over time) longitudinal measurement invariance
EEG Correlates of Mind Wandering in OCD 14

and c) co-occur. Interested readers can consider Hawley, Ho, Zuroff and Blatt (2006) for a more

detailed overview of LDS modelling.

Analyses were conducted using AMOS 25.0 (Arbuckle, 2016). Model parameters were

estimated using the maximum-likelihood method. Indices of absolute and relative model fit were

considered including RMSEA (root mean square error of approximation) (Steiger, 1998).

RMSEA is a measure of model discrepancy in comparison to the degree of freedom, and values

less than .05 indicate a “close fit” (Browne & Cudeck, 1993). The chi-square (χ2) index of

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absolute model fit was assessed; chi-square to degrees of freedom ratio values (χ2/df) below two

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are considered acceptable (Byrne, 2004). The Akaike Information Criterion (AIC; Akaike, 1973)
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indicator of relative model fit considers model complexity relative to the number of parameters;
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the model with smaller AIC is preferable. The Comparative Fit Index (CFI) was assessed; CFI
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values greater than .90 indicate a “good fit” when comparing models (CFI; Bentler, 1990). The
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“cross-lagged” regression coupling parameter (γ) is also considered when comparing models; if

this is not significant, the model may not be accepted (Hamagami, & McArdle, 2001).
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Results
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Table 1 presents means, standard deviations, and correlations among study variables at

weeks 1, 4, and 8. The mean YBOCS scores decreased over time, while the EEG bandwidth

indicators demonstrated relatively non-linear change over time. Measures from consecutive

assessments were positively correlated for each variable, and there were several significant

correlations between YBOCS variables and EEG markers of “Mind Wandering”.

Data involving 71 participants (N=36 Muse, N=35 Control) was examined (ITT sample

N=71, Final N=69 (two dropouts). In the control group, 13 participants reported they were taking

SSRI’s (37.1%). In the Muse group, 11 participants reported they were taking SSRI’s, with one
EEG Correlates of Mind Wandering in OCD 15

participant not reporting this item (31.4%). A chi-square analysis was used to compare the

groups based on SSRI medication use, and was not significant (Χ2= 20.62, p = 0.48). In the

control group, 21 clients experienced MDD (58.3%). In the Muse group, 19 clients experienced

MDD (54.3%). A chi-square analysis was used to compare the groups based on MDD, and was

not significant (Χ2= 9.05, p = 0.91).

A Generalized Linear Model (GLM) was used to examine change over time. Results

indicated a significant Time (week 1 vs. week 8) by Condition (Muse vs. Control) two-way

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interaction involving OCD symptom improvement over 8 weeks, with significantly greater

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changes in the MUSE condition versus the WL condition: F (1, 69) = 1.94, p=.003; partial η2 =
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.118, observed power = .84. Considering FFMQ “facets”, the only statistically significant
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difference occurred for the “Non-Reactivity” facet, with greater changes occurring in the MUSE
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condition vs. WL: (F (1, 69) = 7.32, p =.009; partial η2 = .11, observed power = 0.76).
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Considering EEG indicators of mind wandering, there was a statistically significant

difference in Alpha band power over 8 weeks, with significantly greater changes occurring in the
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MUSE condition in comparison to the control condition (Alpha power increased): (F (1, 69) =
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9.69, p =.003; partial η2 = .12, observed power = .87). Next, GLM results indicated there was a

significant difference in Beta band power favoring the Muse condition (Beta power increased):

(F (1, 69) = 3.93, p=.05, partial η2 = .06, observed power = .51) (see Figures 2 and 3). GLM

results indicated there was no significant difference in Delta band power, comparing the two

conditions: (F (1, 69) = .96, p=.33, partial η2 = .02, observed power = .16). GLM results

indicated there was no significant difference in Theta band power, comparing the two conditions:

(F (1, 69) = 1.12, p = .30, partial η2 = .02, observed power = .19).

LDS Analyses: YBOCS and EEG Derived Markers of “Mind Wandering”

EEG Correlates of Mind Wandering in OCD 16

Summary results for the YBOCS/EEG band power (Alpha, Beta) LDS analyses are

presented in Table 2. We did not conduct LDS analyses of Delta or Theta, considering the lack

of significant GLM results (see above). For the first model, examining longitudinal associations

between YBOCS and Alpha power, examination of goodness of fit and parameter estimates

demonstrated that the “mindful focus” model was the best model among the four candidate

models. This model had the lowest AIC and RMSEA, the lowest χ2 /df ratio, and the highest CFI,

χ2(19, N = 71) = 28.57; χ2/df = 1.50; AIC = 98.57, CFI = .90, RMSEA = .07. This suggests that

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Alpha power (mind wandering at time t) leads to subsequent changes in OCD symptoms between

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time t and time t+1. The coupling coefficient (γybocs/alpha) in which Alpha power leads
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subsequent change in YBOCS scores was significant, while the coupling coefficient in which
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YBOCS leads to subsequent change in Alpha power was non-significant. This suggests that the
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no-coupling model, the symptom-driven model, and the reciprocal models are not supported. See
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Figure 4 for the path diagram for the “mindful focus” model. All parameter estimates were

statistically significant (ps ranging from < .001 to < .05). The coupling coefficient from Alpha
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power to YBOCS (γalpha/ybocs) was significant, with the unstandardized estimate being γybocs = -
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1.21. The magnitude of this coefficient can be interpreted as following: for every one unit

increase in Alpha at time t, there is a subsequent 1.21 unit decrease in YBOCS between time t

and time t+1. Using this bivariate model, a multigroup LDS analysis compared the Muse and

Control conditions. First, considering the possibility of parameter equivalence across groups;

parameter estimates of the time varying β parameters, and the mean and variance of time 1 mean

and variance of the (α x sn) term differed between the two groups, while the remaining parameter

estimates (i.e., mean, variance and error estimates) did not significantly differ between the two

groups. Nonredundant parameters included the mean and variance of the YBOCS (α x sn) term,
EEG Correlates of Mind Wandering in OCD 17

and the mean and variance of time 1 Alpha and YBOCS. However, the time-invariant γ coupling

term differed between conditions, with the γ coupling effect being stronger for the Muse

condition (γ = -1.98) compared to the Control condition (γ = -1.01). Table 5 presents the

resulting parameter and goodness of fit indices for this multigroup LDS model, which provided

the best model fit to the data (χ2[19] = 28.57; χ2/df = 1.51; AIC = 98.57, CFI = .91, RMSEA =

.05). In this model, “mindful focus” coupling (Alpha is negatively associated with the subsequent

rate of change in YBOCS), has a greater impact on YBOCS scores in the Muse condition

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compared to the control condition, although the coupling is significant in both conditions.

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Next, we examined longitudinal YBOCS and Beta band power. Examination of goodness
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of fit and parameter estimates demonstrated that the “mindful focus” model was the best model
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among the four candidate models, particularly given that this model had the lowest AIC and
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RMSEA, the lowest χ2 /df ratio, and the highest CFI, χ2(19, N = 71) = 29.21; χ2/df = 1.54; AIC =
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99.21, CFI = .91, RMSEA = .07. This suggests that Beta band power (mind wandering at time t)

leads to subsequent changes in OCD symptoms between time t and time t+1. The coupling
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coefficient (γocd/beta) in which Beta band power leads to subsequent change in YBOCS scores
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was significant, while the coupling coefficient in which YBOCS leads to subsequent change in

Beta band power was non-significant. This suggests that the no-coupling model, the symptom-

driven model, and the reciprocal models are not supported. All parameter estimates were

statistically significant (ps ranging from < .001 to < .05). The coupling coefficient from Beta

band power to YBOCS (γbeta/ybocs) was significant, with the unstandardized estimate being γ = -

.42. The magnitude of this coefficient can be interpreted as following: for every one unit increase

in Beta at time t, there is a subsequent .42 unit decrease in YBOCS between time t and time t+1.

Using this bivariate model, a multigroup LDS analysis compared the Muse and Control
EEG Correlates of Mind Wandering in OCD 18

conditions. Considering parameter equivalence across groups; parameter estimates of the time

varying β parameters, the mean and variance of time 1, and the mean and variance of the Beta

term differed between the two groups, while the remaining parameter estimates (i.e., mean,

variance and error estimates) did not significantly differ between the two groups. The time-

invariant γ coupling term differed between conditions; the γ coupling effect for the Muse

condition was γ = -0.45 and -0.42) while in the Control condition, γ = -0.31 and 0.21 (non-

significant). Table 5 presents the resulting parameter and goodness of fit indices for this

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multigroup model, which provided the best model fit to the data (χ2[19] = 29.21; χ2/df = 1.53;

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AIC = 99.21, CFI = .87, RMSEA = .06). Results from this analysis indicate that “mindful focus”
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coupling, in which Beta is negatively associated with the subsequent rate of change in YBOCS,
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has a greater impact on YBOCS scores in the Muse condition compared to the Control condition,
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and the coupling in the Control condition becomes non-significant over time.
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Next, we examined longitudinal YBOCS and FFMQ “Non-Reactivity”. Examination of

goodness of fit and parameter estimates demonstrated that the “mindful focus” model was the
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best model among the four candidate models. This model had the lowest AIC and RMSEA, the
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lowest χ2 /df ratio, and the highest CFI, χ2(24, N = 71) = 6.77; χ2/df = 1.69; AIC = 51.96, CFI =

.97, RMSEA = .07. The coupling coefficient (γocd/ffmq) in which FFMQ leads to subsequent

change in YBOCS scores was significant, while the coupling coefficient in which YBOCS leads

to subsequent change in FFMQ was non-significant. This suggests that the no-coupling model,

the symptom-driven model, and the reciprocal models are not supported. All parameter estimates

were statistically significant (ps ranging from < .001 to < .05). The coupling coefficients from

FFMQ to YBOCS (γFFMQ/ybocs) were significant, with unstandardized estimates being γ = -1.01

and -1.48. This indicates that for every one unit increase in FFMQ at time t, there is a subsequent
EEG Correlates of Mind Wandering in OCD 19

1.01/1.48 unit decrease in YBOCS between time t and time t+1. For the multigroup analysis,

parameter estimates of the time varying β YBOCS parameters, and the mean and variance of

time 1 FFMQ variable differed between the two groups, while the remaining parameter estimates

(i.e., mean, variance and error estimates) did not significantly differ. The time-invariant γ

coupling term differed between conditions; the γ coupling effect for the Muse condition was γ = -

1.12 and -1.49) while in the Control condition, γ = 0.59 and -0.74 (non-significant). Table 5

presents the resulting parameter and goodness of fit indices for this multigroup model, which

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provided the best model fit to the data (χ2[20] = 25.72; χ2/df = 1.29; AIC = 93.72, CFI = .97,

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RMSEA = .06). Results from this analysis indicate that “mindful focus” coupling, in which
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FFMQ is negatively associated with the subsequent rate of change in YBOCS, has a greater
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impact on YBOCS scores in the Muse condition compared to the Control condition, and
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furthermore, coupling in the Control condition is non-significant.

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Discussion

In this RCT, we compared a technology supported mindfulness-based intervention with a

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waitlist control group, examining mindfulness (FFMQ facets) and EEG-derived correlates of
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mind wandering (alpha, beta, delta, and theta band power) as related to OCD symptom change

(YBOCS). Our results indicated that EEG correlates of mind wandering attentional changes (i.e.,

alpha, beta but not delta or theta) were more significantly related to longitudinal changes in OCD

symptomatology in the mindfulness condition when compared to the control condition. Our

observation of increased alpha and beta power over time suggests there was a decrease in mind

wandering associated with reduction in OCD symptom severity over time. Further, we found that

FFMQ Non-Reactivity was longitudinally related to subsequent changes in OCD symptoms in

the mindfulness condition.

EEG Correlates of Mind Wandering in OCD 20

These results suggest that a relatively brief mindfulness intervention involving daily

technology-supported mindfulness practices can increase mindfulness, decrease mind wandering,

and reduce OCD symptoms, with small to medium magnitudes of effect (for the intention to treat

analysis). On the mean level, considering the entire sample, individuals experienced OCD

symptom improvement as a result of eight weeks of TSM (see Table 1), with a medium effect

size. These treatment related effect sizes are relatively similar to previous findings reported by

our group regarding the efficacy of eight weeks of MBCT for OCD treatment (Selchen et al.,

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2018). In addition, these TSM related changes in OCD symptoms are separate from any non-

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specific therapeutic processes (e.g., therapeutic alliance, group cohesion), and this distinguishes
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our findings from other MBI studies involving OCD treatment.
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The FFMQ analyses suggest that one mechanism underlying the effects of MBIs involves
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cultivating a non-reactive, accepting stance towards OCD related experiences. As mentioned

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previously, researchers have identified the FFMQ facets of Non-Judgment, Non-Reactivity, and

Acting with Awareness to be related to OCD symptom changes (e.g., Emerson et al., 2018).
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However, in this study, we only found support for the Non-Reactivity facet, which is consistent
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with research by Didonna and Bosio (2012) and Hawley et al. (2017). One possible reason for

this discrepancy is that we evaluated TSM and utilized longitudinal cross-lagged models when

testing our hypotheses, which differs from previous study designs and methodologies. This

suggests that engaging in mindfulness practices may allow individuals to develop the ability to

become less reactive to their inner experiences (e.g., distressing obsessive thoughts and images),

which may represent a mechanism underlying the effects of MBIs on OCD symptom alleviation.

Considering the EEG analyses, we found support for the hypotheses that changes in EEG

derived indicators of mind wandering (e.g., alpha and beta) lead to subsequent longitudinal OCD
EEG Correlates of Mind Wandering in OCD 21

symptom change. However, we did not find support for the hypothesis that changes in delta and

theta lead to OCD symptom change. Considering the LDS analyses, the “mindful focus” model

was supported in which improved alpha and beta “mind wandering” (i.e., reduced mind

wandering for the Muse group) led to subsequent improvements in YBOCS scores for clients

who engaged in technology supported mindfulness. Our results involving EEG derived neural

correlates of mind wandering are relatively consistent with Braboszcz and Delorme (2011); alpha

and beta power band frequencies (but not delta and theta) increased in the Muse condition,

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suggesting that these individuals experienced less mind wandering as a result of engaging in

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eight weeks of mindfulness practices. These results are also relatively consistent with previous
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work by Seli et al., (2015); examining self-report data, the researchers found that spontaneous
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mind wandering is associated with higher levels of self-reported OCD symptoms. Our research
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may be considered to build on this research by considering both self-report information as well
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as EEG derived indicators of attentional change. These results suggest that a shift in attentional

focus may represent a failure in executive control that temporally precedes subsequent intrusive,
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ego-dystonic, task-unrelated thoughts (e.g., Kane & McVay, 2012). This also has implications
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for understanding the mechanisms underlying mindfulness treatment efficacy in OCD. Perhaps

the attentional shift that occurs during a mindfulness practice (e.g., noticing an obsessive

thought, image and/or the “urge to ritualize”, then redirecting attention one’s current inner

experience) may underlie the efficacy of MBIs.

This study also has several limitations. Ideally, the sample size would be larger, in order

to ensure that our results are replicable and generalizable. Although we believe that there are

benefits to utilizing self-report questionnaires as well as EEG derived indicators, self-report

information may be prone to the typical limitations of self-report questionnaires (e.g., response
EEG Correlates of Mind Wandering in OCD 22

bias, retrospective bias, etc.) We did not include an active control group, which would have

allowed us to differentiate the therapeutic impact of engaging in mindfulness practices alone

(i.e., without biofeedback) in comparison to the therapeutic impact of receiving auditory

biofeedback alone. Our findings may not be directly comparable to previous research involving

individual or group MBIs (e.g., MBCT, MBSR) since the efficacy of these interventions may

also involve non-specific factors (e.g., therapeutic alliance, group cohesion) as well as the

benefits of collaborating with an experienced therapist who may promote experiential learning as

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a result of an effective inquiry process following each mindfulness practice. However, an

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advantage of the current design is that it permitted the evaluation of mindfulness-based skill
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development and subsequent symptom and cognition change independently of other therapeutic
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processes. Participants completed their mindfulness practice on their own throughout the
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duration of the study with no introduction or exposure to common OCD treatment elements such
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as psychoeducation, exposure practice, cognitive restructuring or relapse prevention.

Our intention was to determine whether a more accessible, flexible approach to

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meditation may have therapeutic benefits for individuals experiencing OCD - as opposed to
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providing evidence for the potential therapeutic efficacy of this device. Nonetheless, perhaps the

results of this study may be considered to provide meaningful evidence suggesting that

mindfulness based interventions represent a viable, flexible, accessible treatment option for

individuals experiencing OCD, as indicated by self-reported symptom alleviation as well as

changes in EEG derived biomarkers. In this context, this study may represent a noteworthy

contribution to the existing literature as it combines self-report information with biomarker

information suggesting that "mind wandering" may represent a mechanism underlying the

efficacy of mindfulness treatment, and this may represent another treatment option that could be
EEG Correlates of Mind Wandering in OCD 23

worth considering. Considering future directions, an ideal study design would include three

conditions - using the Muse, a waitlist control condition in which individuals do not receive

treatment, and an active control condition in which individuals engage in "open monitoring"

using the Muse headset without engaging in any guided meditation practices." Further, previous

EEG analyses have examined these issues at TP9, FP1 and FP2. Although our current analyses

are restricted to TP9, future analyses can involve examining these same hypotheses based on

data involving FP1, FP2, while also examining frontal asymmetry.

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From a “health economics” perspective, technology based treatment approaches could

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represent a more efficient use of our limited healthcare resources. Further, independent home-
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based treatment would offer substantially easier access for those who live far away from
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treatment centres. Considering future research, it may be helpful to examine other easily
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accessible, technology supported MBIs for the treatment of OCD at each stage of the clinical
na

process. While clients are waiting for treatment, TSM may be an easily accessible therapeutic

option that could prevent symptom worsening. During CBT or MBCT treatment, engaging in
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additional TSM practices between sessions may have an adjunctive effect by further enhancing
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the efficacy of these empirically validated treatments. Following treatment, it may be that TSM

could help individuals to better manage their symptoms autonomously and maintain their

progress over the longer term. Considering our results, it may be that TSM approaches are

relatively consistent with the National Institute for Health and Clinical Excellence (NICE) OCD

treatment guidelines for adults experiencing mild to moderate functional impairment. Perhaps

TSM could represent a viable “low intensity”, easily accessible treatment option for adults

experiencing mild to moderate functional impairment resulting from OCD symptoms.

EEG Correlates of Mind Wandering in OCD 24

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 EEG Correlates of Mind Wandering in OCD 32
Table 1

Correlations, Means and Standard Deviations for Study Measures

Variable 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
1. YBOCS t1 1.00 --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- ---
2. YBOCS t2 .72** 1.00 --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- ---
3. YBOCS t3 .51** .54** 1.00 --- --- --- --- --- --- --- --- --- --- --- --- --- --- ---
* ** *
4. Alpha t1 .31 .32 .24 1.00 --- --- --- --- --- --- --- --- --- --- --- --- --- ---
* ** ** *

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5. Alpha t2 .26 .31 .26 .23 1.00 --- --- --- --- --- --- --- --- --- --- --- --- ---

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6. Alpha t3 .23* .35** .30* .21* .30* 1.00 --- --- --- --- --- --- --- --- --- --- --- ---

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* * * ** **
7. Beta t1 .30 .28 .29 .35 .19 .53 1.00 --- --- --- --- --- --- --- --- --- --- ---

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* * * ** **
8. Beta t2 .33 .27 .31 .34 .32 .12 .07 1.00 --- --- --- --- --- --- --- --- --- ---
* * * * ** **
9. Beta t3 .27 .28 .32* .30 .26 .63 .46 .06 1.00 --- --- --- --- --- --- --- --- ---

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* * **
10. Delta t1 -.04 -.11 .11 -.01 -.01 .30 .54 .25 .44 1.00 --- --- --- --- --- --- --- ---

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* **
11. Delta t2 .14 .04 .19 .31 .03 .06 -.14 .44 .22 .14 1.00 --- --- --- --- --- --- ---
** ** ** ** *
12. Delta t3 .04 .11 .20 .42 .14 .77 .45 -.13 .77 .34 .25 1.00 --- --- --- --- --- ---

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** ** ** ** **
13. Theta t1 -.09 -.06 .07 -.16 .15 .41 .49 .22 .41 .72 .04 .39 1.00 --- --- --- --- ---
14. Theta t2 .11 .13 .17 .06 -.06 .08 -.19 .02 -.05 -.09 -.20 -.15 -.04 1.00 --- --- --- ---
15. Theta t3 -.12
**
.08
**
.08
*
.54**
*
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.71** .54** -.13 .63**
*
.36* .02 .66**
**
.42** -.11 1.00
*
--- --- ---
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16. FFMQ t1 -.38 -.43 -.31 .22 .16 .18 .07 .06 -.25 .08 -.13 .34 -.04 .23 .28 1.00 --- ---
** ** ** * * ** * * ** **
17. FFMQ t2 -.36 -.51 -.26 .24 .22 .71 .03 .11 -.30 .36 .01 -.04 -.16 .08 .41 .62 1.00 ---
** * * ** ** ** ** ** **
18. FFMQ t3 -.44 -.24 -.37** .31 .36 .38 .54 -.07 .09 -.21 .20 -.05 -.09 .12 .44 .51 .69 1.00
M 28.16 26.87 24.98 .93 .87 .96 .80 .82 .94 .93 .97 .89 .84 .62 .68 17.28 18.04 18.59
SD 5.73 7.48 6.12 .20 .16 .33 .37 .28 .31 .41 .26 .43 .39 .20 .19 4.91 4.42 5.13
Notes YBOCS = Yale Brown Obsessive Compulsive Symptom Inventory, Total Score; Alpha = Alpha EEG Band Power; Beta = Beta EEG Band Power ;
Delta = Delta EEG Band Power ; Theta = Theta EEG Band Power ; FFMQ = Five Factor Mindfulness Questionnaire, Non-Reactivity Subscale; t1 =
Week 1; t2 = Week 4; t3 = Week 8; M = Mean, SD = Standard deviation.
* p < .05. ** p < .01.
EEG Correlates of Mind Wandering in OCD 33
Table 2

LDS Bivariate Models of Alpha Band Power and YBOCS

Parameters and No Coupling “Mindful Focus” “Symptom Driven” Reciprocal

Fit Indices Alpha YBOCS Alpha YBOCS Alpha  YBOCS Alpha  YBOCS
Additive coefficient
E(sn) . 36a 2.71 a .34a 1.98 a .31a 1.48 a .40a 1.24 a
σ2 (sn) .02 .27 .01 .62 .21 .41 .14 .36

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Proportional coefficients

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βa -.39c -..50b -.38c -.45b -.32c -.41b -.35c -.38b

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βb -.33c -.61b -.34c -.55b -.31c -.43b -.38c -.40b

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Coupling coefficient
γAlpha /Ybocs 0 (=) 0 (=) -0.52a 0 (=) 0 (=) .13 -0.67a .13

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Goodness-of-fit indices

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Parameters 22 23 23 24
Degrees of Freedom
RMSEA (p close fit)
5
.09(.46) ur 4
.07(.29)
4
.09(.32)
3
.11(.18)
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CFI .90 .97 .91 .94
AIC 55.81 51.79 54.56 53.71
χ2 7.53 5.79 6.14 5.69
χ2/df 1.51 1.44 1.54 1.91
Note. YBOCS = Yale Brown Obsessive Compulsive Symptom Inventory; Alpha = (total alpha frequency (7.5 to 13 Hz) band power for TP9) 0 (=) indicates
parameter is not estimated. “p close fit” = p value for testing the null hypothesis that the population RMSEA is not greater than .05; CFI = comparative fit
index; AIC = Akaike information criterion; E(sn) = additive change coefficient; β = proportional change coefficient. γ = cross-lag coupling coefficient
between two univariate series.
a
p < .05. b p < .01. c p < .001.
EEG Correlates of Mind Wandering in OCD 34

Table 3

LDS Bivariate Models of Beta Band Power and YBOCS

Parameters and No Coupling “Mindful Focus” “Symptom Driven” Reciprocal

Fit Indices Beta YBOCS Beta YBOCS Beta  YBOCS Beta  YBOCS
Additive coefficient
E(sn) .91a .85a .69a .87a .89a .79a .56 .86a
σ2 (sn) .12 .34 .01 .36 .12 .36 .33 .34

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Proportional coefficients

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βa -.38c -.45b -.67c -.75b -.32c -.37c -.58b -.91b
βb -.47c -.57b -.73c -.68b -.27a -.42b -.31a -.80b

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Coupling coefficient

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γBeta /Ybocs 0 (=) 0 (=) -0.89a 0 (=) 0 (=) .19 -1.01a -0.16

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Goodness-of-fit indices

Parameters
Degrees of Freedom
22
5 ur 23
4
23
4
24
3
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RMSEA (p close fit) .08(.32) .07(.22) .09(.30) .09(.29)
CFI .91 .97 .86 .83
AIC 53.24 51.96 57.14 58.58
χ2 7.89 5.96 6.89 11.56
χ2/df 1.57 1.49 1.72 3.85
Note. YBOCS = Yale Brown Obsessive Compulsive Symptom Inventory; Beta = (total beta frequency (13 to 30 Hz) band power for TP9) 0 (=) indicates
parameter is not estimated. “p close fit” = p value for testing the null hypothesis that the population RMSEA is not greater than .05; CFI = comparative fit
index; AIC = Akaike information criterion; E(sn) = additive change coefficient; β = proportional change coefficient. γ = cross-lag coupling coefficient
between two univariate series.
a
p < .05. b p < .01. c p < .001.
EEG Correlates of Mind Wandering in OCD 35
Table 4

LDS Bivariate Models of FFMQ Non-Reactivity and YBOCS

Parameters and No Coupling “Mindful Focus” “Symptom Driven” Reciprocal

Fit Indices FFMQ YBOCS FFMQ YBOCS FFMQ  YBOCS FFMQ  YBOCS
Additive coefficient
E(sn) 2.91a -4.93 a 3.06a -3.06 b -3.08 a .73a 3.11 a -2.92a
σ2 (sn) .12 .34 .01 .62 .22 .37 .13 .41

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Proportional coefficients

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βa -.38c -.45b -.67c -.86b -.61c -.51c -.44c -.62c

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βb -.47c -.57b -.73c -.49a -.52c -.68c -.79c -.57c

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Coupling coefficient

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γFFMQ /Ybocs t1 to t4 0 (=) 0 (=) -1.01b 0 (=) 0 (=) .09 -0.63b .09
b b
0 (=) 0 (=) -1.48 0 (=) 0 (=) .06 -0.82 .07

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γFFMQ /Ybocs t4 to t8

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Goodness-of-fit indices

Parameters
Degrees of Freedom
23
5 ur 24
4
24
4
25
3
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RMSEA (p close fit) .08(.32) .07(.28) .09(.38) .11(.42)
CFI .91 .97 .86 .66
AIC 53.24 51.96 49.81 62.37
χ2 8.81 6.77 7.98 12.61
χ2/df 1.76 1.69 1.99 4.20
Note. YBOCS = Yale Brown Obsessive Compulsive Symptom Inventory; FFMQ = Five Factor Mindfulness Questionnaire, Non-Reactivity Subscale.
0 (=) indicates parameter is not estimated. “p close fit” = p value for testing the null hypothesis that the population RMSEA is not greater than .05; CFI =
comparative fit index; AIC = Akaike information criterion; E(sn) = additive change coefficient; β = proportional change coefficient. γ = cross-lag coupling
coefficient between two univariate series.
a
p < .05. b p < .01. c p < .001.
EEG Correlates of Mind Wandering in OCD 36
Table 5

LDS Multigroup Bivariate “Mindful Focus” Models of EEG Band Power (Alpha, Beta), FFMQ Non-Reactivity and YBOCS,
by Group (Control vs. Muse)

E(sn) βa βb RMSEA AIC

Model γ Parameters χ2/df (p close fit)
CFI

Bivariate Alpha & YBOCS

Control: Alpha .92 a -0.76 a -0.81 a -1.01 b , -1.01 b 35 1.51 .05 (.21) 98.57 .91

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Control: YBOCS 2.94 a 0.97 a -1.04 a -1.01 b , -1.01 b 35 1.51 .05 (.21) 98.57 .91
.92 a -0.92 a -1.06 a -1.98 a , -1.98 a

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Muse: Alpha 35 1.51 .05 (.21) 98.57 .91
Muse: YBOCS 2.94 a -1.14 a -1.01 a -1.98 a , -1.98 a 35 1.51 .05 (.21) 98.57 .91

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Bivariate: Beta & YBOCS
Control: Beta 1.02 a -0.28a -1.14 a -0.31b , 0.21 35 1.54 .06 (.28) .87
.84 b 1.06 a -0.33a -0.31 b , 0.21

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Control: YBOCS 35 1.54 .06 (.28) .87
Muse: Beta 1.02 a -0. 28a -0.99a -0.45 b , -0.42 b 35 1.54 .06 (.28) .87
Muse: YBOCS .84 b -1.06a -0.33a -0.45 b , -0.42 b 35 1.54 .06 (.28) .87

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Bivariate: FFMQ & YBOCS
Control: FFMQ
Control: YBOCS
0.59 a
4.98 b
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-0.74 a
.86 a
-0.74 a
.77 a
-0.59 , - 0.74
-0.59 , - 0.74
34
34
1.29
1.29
.06 (.34)
.06 (.34)
.97
.97
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Muse: FFMQ 0.62 a -0.71 a -0.71 a -1.12b , - 1.49b 34 1.29 .06 (.34) .97
Muse: YBOCS 5.13 b 2.43 a 1.06 a -1.12b , - 1.49b 34 1.29 .06 (.34) .97

Note. YBOCS = Yale Brown Obsessive Compulsive Symptom Inventory; FFMQ = Five Factor Mindfulness Questionnaire, Non-Reactivity Subscale.
0 (=) indicates parameter is not estimated. “p close fit” = p value for testing the null hypothesis that the population RMSEA is not greater than .05; CFI =
comparative fit index; E(sn) = additive change coefficient; β = proportional change coefficient. γ = cross-lag coupling coefficient between two univariate
series.
a
p < .05. b p < .01. c p < .001.
 EEG Correlates of Mind Wandering in OCD 37

Enrollment Assessed for eligibility (n= 344)

Excluded (n= 273)

♦ Not meeting inclusion criteria
(n= 186)
♦ Declined to participate (n= 56 )
♦ Other reasons (i.e., did not
return voicemail, did not own
cellphone (n= 31)

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Randomized (n=71)

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Allocation
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Allocated to Muse (n= 36) Allocated to Control (n= 35)
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Follow-Up
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Completed follow-up (n= 35) Completed follow-up (n=34)

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Analysis
Analyzed (n=35) Analyzed (n=34)

Figure 1. Consort Diagram of Study Participants

EEG Correlates of Mind Wandering in OCD 38

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Figure 2. The first two graphs above illustrate the change in mean alpha and beta band power
between the week 0 and week 8 sessions for each group. Data from TP9 (Channel 1: left ear
electrode) is presented. Band powers for the alpha and beta frequency range are in decibels
(log of power spectral density, log(uV^2/Hz)). The third graph shows the change in FFMQ
Non-Reactivity between the week 0 and week 8 sessions for each group.
EEG Correlates of Mind Wandering in OCD 39

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Figure 3. Band power in frequency bands is calculated as the area under the curve (sum of
powers across frequency bins) within that frequency band. Alpha and beta frequency bands were
defined as 7.5 – 13 Hz and 13 – 30 Hz respectively. The PSD estimates are expressed in
log10(uV^2) based on the Fourier Transform. The power spectrum for subjects in the Muse and
Control condition were calculated and averaged across subjects of the respective conditions.
EEG Correlates of Mind Wandering in OCD 40

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Figure 4. Path diagram of the bivariate “mindful focus” LDS models, illustrating the
longitudinal association of EEG band power (alpha, beta, delta, theta) and YBOCS
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symptoms (YBOCS[t]) through cross-lagged coupling (γ[t]) for each time period. The same
path diagram was supported for the FFMQ Non-Reactivity analysis. Squares represent
observed variables. Circles represent latent variables. Single-headed arrows represent
regression coefficients. Double-headed arrows represent a correlation or covariance.
YBOCS[t] represent the total obsession and compulsion scores at time t. ybocs[t], alpha[t],
beta[t], delta[t], and theta[t] represent the associated latent scores at time t. e(t) represents the
error term at time t. (α x sn) represents a fixed slope score. β(t) indicates the time-varying
proportional effect, while γ[t] indicates the coupling effect between the univariate series.
In this randomized controlled study, participants experiencing OCD were randomly assigned to a
“technology supported” meditation program or wait list control.

At weeks 1, 4, and 8, participants completed a five minute “open monitoring” practice in which EEG data
was recorded, and they completed self-report measures of mindfulness and OCD symptoms.

Longitudinal models demonstrated that the FFMQ “Non-Reactivity” facet and EEG-derived correlates of
“Mind Wandering” (i.e., alpha, beta, but not delta or theta band power) were temporally associated
with subsequent changes in YBOCS symptom scores.

Participants in the Muse group (in comparison to the control group) experienced increased FFMQ “Non-
Reactivity” and decreased mind wandering (increased alpha and beta band power), and in each case,
these variables were associated with subsequent OCD symptom improvement.

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