From default-mode to action-mode: biphasic network reconfiguration with meditation in schizophrenia

Whether and how meditation benefits severe psychosis over clinically meaningful timescales remains unclear. We embedded longitudinal neuroimaging in an eight-month, parallel group randomized clinical trial (ChiCTR1800014913) of male inpatients (n=64) with schizophrenia receiving daily clinician-guided meditation plus rehabilitation versus rehabilitation alone. Meditation improved the symptoms by 11.8% at 3 months and 20.8% at 8 months (average treatment effects of PANSS decrease rates) and increase the cognition (RBANS) by 7.6% at 3 months that plateaued. Early cognition improvement predicts but not mediates later symptom relief. Resting-state fMRI revealed a biphasic pattern related to symptom improvement: baseline default-mode-cerebellar complexity predicted 3-month benefit, whereas 3-month action-mode/sensorimotor-executive complexity predicted 8-month gains, which was mirrored by functional connectivity prediction models. These findings support a biphasic network reconfiguration model for meditation: early default-mode-cerebellar involvement followed by later action-mode engagement, and provide phase-specific, information-based markers for personalized meditation in schizophrenia.