Mechanisms of Mindfulness: A Buddhist Psychological Model

Abstract

Several models have explored the possible change mechanisms underlying mindfulness-based interventions from the perspectives
of multiple disciplines, including cognitive science, affective neuroscience, clinical psychiatry, and psychology. Together,
these models highlight the complexity of the change process underlying these interventions. However, no one model appears
to be sufficiently comprehensive in describing the mechanistic details of this change process. In an attempt to address this
gap, we propose a psychological model derived from Buddhist contemplative traditions. We use the proposed Buddhist psychological
model to describe what occurs during mindfulness practice and identify specific mechanisms through which mindfulness and attention
regulation practices may result in symptom reduction as well as improvements in well-being. Other explanatory models of mindfulness
interventions are summarized and evaluated in the context of this model. We conclude that the comprehensive and detailed nature
of the proposed model offers several advantages for understanding how mindfulness-based interventions exert their clinical
benefits and that it is amenable to research investigation.

KeywordsMindfulness–Meditation–Psychological model–Buddhism–Insight

Full text

ORIGINAL PAPER
Mechanisms of Mindfulness: A Buddhist Psychological Model
Andrea D. Grabovac & Mark A. Lau &
Brandilyn R. Willett
#
Springer Science+Business Media, LLC 2011
Abstract Several models have explored the possible
change mechanisms underlying mindfulness-based inter-
ventions from the perspectives of multiple disciplines,
including cognitive science, affective neuroscience, clinical
psychiatry, and psychology. Together, these models high-
light the complexity of the change process underlying these
interventions. However, no one model appears to be
sufficiently comprehensive in describing the mechanistic
details of this change process. In an attempt to address this
gap, we prop ose a psychological model derived from
Buddhist contemplative traditions. We use the proposed
Buddhist psychological model to describe what occurs
during mindfulness practice and identify specific mecha-
nisms through which mindfulness and attention regulation
practices may result in symptom reduction as well as
improvements in well-being. Other explanatory models of
mindfulness interventions are summarized and evaluated in
the context of this model. We conclude that the compre-
hensive and detailed nature of the proposed model offers
several advantages for understanding how mindfulness-
based interventions exert their clinical benefits and that it is
amenable to research investigation.
Keywords Mindfulness
.
Meditation
.
Psychological
model
.
Buddhism
.
Insight
Introduction
Several models of change have been proposed to explain
the processes by which mindfulness-based interventions
(MBIs) exert their physical, psychological, and emotional
effects. Each of these models posits one or more possible
mechanisms of change: cognitive mediators, such as
metacognitive awareness (Teasdale et al. 2002), decentering
(Fresco et al. 2007 ), defusion (Fletcher and Hayes 2005),
reperceiving (Shapiro et al. 2006), and decreased rumina-
tion (Deyo et al. 2009); attentional mediators, such as
modulation of attentional focus (Carmody 2009) through
focused attention or open monitoring (Lutz et al. 2008); and
neurobiological mediators, such as neurofunctional changes
(see Fletcher et al. 2010 for review; Lutz et al. 2008).
Collectively, these models further our understanding of
specific aspects of MBIs while highlighting the complexity
of the individualized change process resulting from partic-
ipation in MBIs. However, no one model appears to be
sufficiently comprehensive in describing the mechanistic
details of this change process. Furthermore, there has been
a call in the literature to reconstruct various aspects of
current mindfulness models, including establishing a clear
operationalization of the term “mindfulness,” with identifi-
cation of its use as a trait, state, or practice in a given
context (Davidson 2010); clarifying the precise mecha-
nisms of mindfulness, preferably in a way that is amenable
to neuroimaging research (Fletcher et al. 2010); and further
elucidating how each component of mindfulness leads to
specific outcomes (Coffey et al. 2010).
In an effort to address these issues, we turned to
Buddhist psychological theories as many of the techniques
used in MBIs have been adapted from Buddhis t contem-
plative traditions. However, for the most part, the psycho-
logical model that accompanies these techniques has not
A. D. Grabovac (*)
Department of Psychiatry, University of British Columbia,
Suite 552-600 West 10th Avenue,
Vancouver, BC, Canada V5Z 4E6
e-mail: agrabovac@bccancer.bc.ca
M. A. Lau
:
B. R. Willett
BC Mental Health and Addiction Services,
Department of Psychiatry, University of British Columbia,
Vancouver, BC, Canada
Mindfulness
DOI 10.1007/s12671-011-0054-5

been explicitly incorporated into the theory or implemen-
tation of MBIs, nor into current mechanistic models of
MBIs. This has resulted in an unnecessary loss of the
context that explains how these techniques work and why
they are used (Grossman 2010 ). We propose a new
approach based on Buddhist psychological theories which
we have termed the Buddhist psychological model (BPM).
We begin by using the BPM to describe both the
relationship between mindfulness and cognitive processes
and the changes to those processes that are brought about
by mindfulness training. We then use the BPM to
hypothesize the mechan isms by which mindfulness practice
leads to symptom reduction. This is followed by a
discussion of the relationships of the BPM to current
Western models in an attempt to clarify current areas of
overlap.
Part I: Description of BPM
The BPM as described in this paper is based on
commentaries on, and translations of, a set of Buddhist
texts called the Abhidhamma Pitaka (Philosophical Collec-
tion; Mendis 2006; Narada Maha Thera 1987). While these
texts are extremely detailed and extensive in their analysis
and classification of awareness and mental states, we have
simplified the concepts to present the foundations of the
BPM.
We begin our presentation of the proposed model with a
description of the components of mental activity. In the
BPM, awareness of an object occurs when either a stimulus
enters our field of perception and makes contact with a
sense organ (i.e., sense impression) or when an object of
cognition (a thought, memory, emotion) arises in the mind.
This awareness lasts for a brief moment in time and then
ceases (see Fig. 1). In the BPM, no practical distinction is
made between awareness brought to sense impressions (i.e.,
physical sensations) versus cognitions (i.e., mental events)
as they are worked with in the same manner du ring
mindfulness practice. However, referring to both events as
simply “sensations” is a foreign concept in Western
psychology; thus, we will maintain a distinction between
the two in our discussion of the BPM in an effort to
enhance comprehensibility. It is important to realize,
however, that this distinction is for the sake of clarity
rather than being intrinsic to the BPM itself.
According to the BPM, attentional resources are limited:
an individual can only be aware of one object at a time.
The experience of a continuous stream of consciousness is
produced by the rapid series of sense impressions and
mental events arising and passing away, similar to how
movement in a film is created by a rapid succession of
individual still images (see Fig. 1). This process occurs
extremely quickly with dozens of discrete mental events
and sense impressions occurring in a given second.
With the awareness of any object, there is a concomitant
feeling tone, which falls into one of three categories:
pleasant, unpleasan t, or neutral (neither pleasant nor
unpleasant). The term “feeling tone,” as used in this
context, does not refer to complex physiocognitive states,
often called emotions, such as fear, joy, or anger; rather it is
the immediate and spontaneous affective experience of this
awareness of a physical sensation or mental event (Mendis
2006). Due to the rapid and transient nature of these
feelings, constantly arising and passing away, they often go
unnoticed and can serve as the key trigger to a chain
reaction of thoughts (including emotions) and actions that
can lead to suffering.
Our habitual reactions to feelings are to pursue those that
are pleasant and to avoid those that are unpleasant. The
Buddhist terms for these reactions are attachment and
aversion, respectively. These habitual reactions are
expressed as mental events (thought, memory, emotion)
that rapidly follow the initial sense impression (Fig. 2). A
commonly held assumption is t hat we d es ire, or are
repulsed by, an object of awareness. However, integral to
the BPM is that attachment and aversion arise in reaction
to the feeling state itself rather than to the object. For
example, seeing a slice of cake is accompanied by a feeling
tone. Depending on one’s past experiences, culture, and
other influences, that feeling will either be pleasant,
unpleasant, or neutral. Those who experience the cake as
pleasant will habitually react with thoughts, emotions, and/
Fig. 1 Moment-by-moment awareness
Mindfulness

or actions (e.g., the procurement of the cake) related to the
desire to perpetuate the pleasant feeling. Similarly, those
who experience the cake as unpleasant will habitually react
with thoughts, emotions, and/or actions (e.g., avoidance of
the cake) oriented toward ending the unpleasant feeling.
The mental events (see B in Fig. 2) that follow the initial
feeling also have associated feelings (since a mental event
is itself the awareness of an object of cognition and thus is
accompanied by an inseparable concomitant feeling).
Further mental elaboration occurs when there is attachment
or aversion to the feelings arising with the mental events
themselves. This is experienced as the production of
additional mental events. Mental proliferation is simply a
series of these mental events that has been triggered by an
initial mental event or sense impression. Thus, in some
cases, mental proliferation can feed on itself, with subse-
quent mental events having little to do with the sense
impression that started the process. According to the BPM,
not being aware of how this pattern of attachment and
aversion can lead to mental proliferation helps to keep the
entire process habitual.
Finally, at the crux of the BPM are three main foci of
mindfulness practice that are common to all sense impres-
sions an d mental events (see Fig. 3):
1. Sense impressions and mental events are transient (they
arise and pass away)
2. Habitual reactions (i.e., attachment and aversion) to the
feelings of a sense imp ression or mental event, and a
lack of awareness of this process, lead to suffering
3. Sense impressions and mental events do not contain or
constitute any lasting, separate entity that could be
called a self
These are termed the “three characteristics ” in Buddhist
thought and are usually referred to as: (1) impermanence,
(2) suffering, and (3) not-self (Nyanaponika 2010).
In summary, the BPM holds that the subjective sense of
a continuous stream of consciousne ss is made up of
Fig. 2 Attachment/aversion to
feelings creates mental
proliferation
Mindfulness

numerous, discrete sense impressions and mental events,
most of which occur outside of one’s awareness. Habitual
reactions of a tt achm en t and aversion to the pleasant,
unpleasant, and neutral feelings of prior sense impressions
and mental events are expressed as a proliferation of mental
events. All sensory and mental events are seen to share the
three characteristics of impermanence, suffering, and not-
self. Moreover, suffering, including clinical symptoms, is a
direct result of the habitual attachment/aversion reaction to
transient feelings and their concomitant mental prolifera-
tion. Although the BPM does not focus on symptom
reduction (in the clinical sense), since this is not the aim
of Buddhist practice, reduction in symptoms resulting from
practices such as mindfulness meditation is explainable as a
reduction in these habitual reactions and resulting mental
proliferation. From this perspective, improvement in well-
being occurs when sensory and mental events are allowed
to naturally arise and fall away, w ithout subsequent
cognitive pro cessing arising from eithe r attachment or
aversion. Sense impressions and mental events are still
experienced as pleasant, unpleasant, or neutr al; however, if
there is no attachment, aversion, and thus no mental
proliferation, adventitious suffering is not experienced.
BPM Part II: Effects of Attention Regulation
and Mindfulness Practices
Based on the above and for the purposes of this model, we
define mindfulness as the moment-by-moment observing of
the three characteristics (impermanence, suffering, and not-
self) of the meditation object. This definition is synony-
mous with the traditional definition for vipassana or insight
meditation (Mahasi 2006). We have intentionally limited
our mindfulness definition to a description of insight
practice (i.e., mindfulness, as we define it in this paper, is
an intervention; see Davidson 2010 ). This definition high-
lights the important distinction between mindfulness, or
vipassana (an insight-oriented practice), and concentration,
or samatha (an attention regulation practice). In addition,
we do not want to confound this definition with the results
of mindfulness practice. Thus, we have been careful (as
much as possible) not to include in the definition possible
consequences of insight practice itself, such as the sequelae
of increased mindfulness in day-to-day living or conse-
quences of decreased proliferation of mental events as all of
these possible outcomes of mindfulness practice have many
other factors influencing them. We are careful not to
include acceptance in our definition of mindfulness as this
is an attitude that is brought to both insight and concentra-
tion practices and is not an inherent aspect of mindfulness
itself (Mikulas 2011).
We begin with a general description of the effects of
attention regulation on m ental proliferation and then
distinguish between the different effects of concentration
and mindfulness practices on cognitive processes in the
context of the BPM.
Effects of Attention Regulation
According to the BPM, attentional resources are limited,
which means that only one object can be held in awareness
at a time. Thus, if attention is sufficiently sustained o n an
object, the BPM posits that this prevents the awareness of
other objects in that moment. Therefore, any form of
attention regulation that results in sustained attention on an
object h as the effect of momentarily inte rrupting mental
proliferation (Fig. 4). However, once attention lapses from
the object, mental proliferation can resume, or other sense
impressions or mental events can arise.
Distinguishing Between Concentration and Mindfulness
Practices
Although mindfulness and concentration practices are often
confused in the literature (Mikulas 2011), the BPM offers a
Fig. 3 The three characteristics
Mindfulness

clear way to distinguish between these practices as it
highlights the critical difference between the two. Whether
implicitly or explicitly, mindfulness (as we have defined it
in this model) involves observing the three characteristics
with respect to the object of meditation, whereas concen-
tration practice does not.
In concentration pract ice, the goal is to focus atte ntion
on the object of meditation to the exclusion of everything
else. Using the breath as an example, the breathing process
is meant to be experienced as continuously and uninter-
rupted as possible. The meditator attempts to maintain
continuous awareness on the sensations of breathing, from
the start of an inhalation, to the end of the inhalation, to the
pause between inhalation and exhalation, to the beginning
of the exhalation, to the end of the exhalation, to the pause
between the exhalation and subsequent inhalation, and so on
(an example of this is “focused attention” in Lutz et al. 2008).
Any awareness of the three characteristics with respect to the
object of meditation is actively ignored, and if they are
experienced, attention is refocused on the object of meditation
in an effort to make attention on the object seem as stable and
unchanging as possible (Snyder and Rasmussen 2009).
In mindfulness practice, on the other hand, the intention
is to directly experience the three characteristics of
sensations as they appear in awareness. Again using the
breath as an example, the meditator will also focus on the
inhale, pause, exhale, pause cycle of breathing. However,
unlike in concentration practice, the focus of the meditation
is the direct experiencing of the three characteristics of the
breath. By noting the qualities of the breath, the meditator
attempts to become aware of the three characteristics of the
breath. In this way, the meditator experiences the breath as
changing all the time (fast, slow, rough, smooth, short,
long) and may become aware that no two breaths are the
same—which corresponds to the first characteristic (imper-
manence). The meditator may also notice that they prefer
one style of breath to another (e.g., slow and smooth to the
fast and rough), and thus notice attachment to that, and
perhaps become aware of efforts to change the breath to be
of the preferred type—which corresponds to the second
characteristic (suffering). Over time, the meditator will
likely also notice that if they do not do anything to control
the breath, breathing still occurs, without their intervention
—which corresponds to the third characteristic (not-self).
With continued practice, noticing the three characteristics
becomes less conceptual and more experiential, with the
individual sensations that make up the breath being
experienced as a rapid sequence of small, discrete sensa-
tions, each of which arise and pass away in a very brief
moment. T hus, over time, the object of mi ndfulne ss
meditation becomes dissected or decomposed into smaller
and faster discrete sensations in which the three character-
istics are experienced directly.
This distinction between min dfulness and concentration
meditation is reinforced by recent work on the neurobio-
logical correlates of meditation practices demonstrating that
different neural systems are used in concentration versus
insight practices (Lutz et al. 2008).
It is common, however, for a mix of concentration and
mindfulness meditation to be employed during mindfulness
practice. Typically, this involves using concentration to help
focus and calm the mind, followed by mindfulness practice.
Periodically, the meditator will switch from mindfulness
practice to concentration practice if attention needs refocus-
ing, or if the mindfulness practice brings up sensations or
thoughts that are too difficult to observe without getting lost
in their content.
Fig. 4 How attention regulation affects moment-by-moment awareness
Mindfulness

Attention regulation is used in both concentration and
mindfulness practices, and both can lead to momentary
reductions in mental proliferation. For example, in formal
concentration meditation on the breath, awareness of the
sensations of breathing disrupts mental proliferation. In
informal practice, such as paying attention to daily physical
sensations of touch, awareness of touch sensations inter-
rupts mental proliferation. In formal mindfulness medita-
tion on the breath, awareness of the three characteristics
with respect to the sensations of breathing interrupts mental
proliferation. In this case, the reduction in mental prolifer-
ation (strictly due to attention regulation) is momentary and
not the same as the reduction brought about as a result of
the development of insight. Finally, with cognitive activi-
ties, such as intentionally replacing an existing thought with
a different, more skillful, thought, it is the awareness of the
new thought that interrupts mental proliferation. Examples
of this can be found in cognitive therapies and metacogni-
tive awareness (see below).
Effects of Mindfulness Meditation and the Development
of Insight
The purpose of mindfulness training in Buddhist practice is
to achieve enlightenment, defined in this paper as a
permanent, radical change in perception that stops the
habitual process of identification that turns certain aspects
of sensate and mental experience into a separate self. This
is achieved through the development and exploration of a
series of insights into the natu re of one’s physic al
sensations and mental activities (Mahasi 2006). One of
the side effects of the development of insight is a long-term
reduction in habitual attachment/aversion reactions and a
consequent decrease in mental proliferation. Insight, as
used here, do es not refer to conscious reflection, but rather
a direct, non-conceptual understanding (Dorjee 2010)
achieved through the repeated examinati on of the three
characteristics (impermanence, suffering, and not-self) in
the objects of meditation (Pa Auk 2000). As insight
develops, the meditator begins to understand, on a
nonverbal, experiential level, the transience of mental
activity and, indeed, of all sensate phenomena, including
even those that make up sensations of space, attention, the
body, and so on. The meditator eventually comes to realize
that chasing after pleasure or trying to avoid pain cannot
bring any lasting sense of contentment (due to their
transient nature) and that fleeting mental and sensory
activities are simply mental or sensorial events rather than
aspects of self. Unlike the changes that result from attention
regulation, the changes resulting from the development of
insight are more last ing in nature and allow for a different
relationship to feelings and attachment/aversion in daily life
outside of formal meditation practice.
One of the interesting, and potentially very clinically
useful, by-products of insight into the three characteristics
is the development of equanimity (Mahasi 2006). In the
BPM, equanimity is defined as a quality of awareness that
views its object (sensory or cognitive) with neither
attachment nor aversion. It can also be described as a
balanced state of mind in which an equal interest is taken in
the pleasant, unpleasant, and neutral. From the perspective
of Buddhist practice, “equani mity prevents identification
with as well as attachment [and aversion] to experience.
This results in pleasant experiences being known without
any gratification. And this is the point of equanimity, there
is no reification of a sense of self” (Steve Armstrong,
personal communication). Because equanimity is a quality
of awareness, it is concomitant with the awareness of a
sensation or object of cognition and is not a follow-on
mental event or cognition (i.e., equanimity, as used in this
paper, does not involve thinking “ I will not attach to/push
away this experience”).
For completeness, it should be noted that according to
Buddhist psychology, insight into the three characteristics is
not the only way to develop equanimity. Skilled practi-
tioners may enter a state of equanimity via concentration
(samatha) practices alone (Pa Auk 2000; Nar ada Maha
Thera 1987). Equanimity achieved in this manner tends to
be short-lived and difficult to maintain during daily life.
Summary of Mechanisms in BPM
The BPM, due to its detailed description of mental
processes and the effects of various practices on these
processes, allows us to propose a set of relationships to
explain how mindfulness and attention regulation practices
result in clinical symptom reduction (see Fig. 5).
Figure 5 summarizes the many mechanisms (including
acceptance an d eth ical practices, d iscussed below) by
which mental proliferation can be reduced, thus reducing
symptoms and increasing well-being.
BPM Part III: Effects of Acceptance and Ethical
Practices
Effects of Acceptance/Compassion
The BPM provides an explanation for the essential role of
acceptance/compassio n in training both mindfulness and
attention regulation. During training, an attitude of accep-
tance and curiosity is used to bring a sense of lightness to
the repeated refocusing of attention on the chosen o bject
(see Fig. 5). As an untrained mind is easil y distracted by
ruminative or narrative thought processes, attention must be
refocused many times. During this repeated refocusing, an
Mindfulness

attitude of acceptance prevents negative thoughts, such as
self-judgment and resultan t m ental proliferation, from
arising and prevents the practice itself from becoming a
source of aversion. Indeed, an attitude of acceptance and
curiosity is a nascent form of loving-kindness, a Bud dhist
compassion practice that is used to gradually prevent the
formation of mental states that have their origin in aversion.
As practice deepens, acceptance helps relax the attention
and allows rapid, discrete sensations to be more easily
noticed and followed during mindfulness practice. Without
acceptance, awareness tends to become tighter and less
flexible and so has more difficulty noticing the arising and
passing away of a rapid series of sense impressions and
mental events.
It should be noted that acceptance, as we are using the
term here, is a quality of awareness: it does not involve
cognition. As such, it is not equivalent to thinking accept-
ing thoughts about one’s self or others. In fact, cognitive
forms of acceptance are really a form of attention
regulation. An example may help clarify this distinction.
When meditating, the meditator notices that their attention
has wandered. If the awareness of that wandering has the
quality of accept ance, then no judgment arises (and no
follow-on mental prolifera tion arises) and the meditator can
redirect their attention to the object of their meditation
without any intervening thoughts. If the meditator’s
awareness, howe ver, did not have the quality of acceptance,
then judgment may arise, followed by a series of mental
events related to that initial judgment. The meditator may
then recognize the judging thoughts and use attention
regulation to be more accepting and replace the judging
thoughts with more accepting thoughts.
Effects of Ethical Practices
In addition to training in concentration and mindfulness,
Buddhist practices prescribe a code of ethics for practi-
tioners to follow, such as not inte ntionally killing, stealing,
having illicit sex, lying, and using intoxicants that can
cloud judgment (Thanissaro 1997). In essence, from the
perspective of the BPM, one of the major purposes of the
ethical guidelines is to reduce the baseline amount of
mental proliferation, thus aiding both concentration and
mindfulness practices (see Fig. 5). Leading an ethical life,
in the context of the BPM, implies that the meditator
experiences less guilt, doubts, worries, etc. that can often be
a source of mental proliferation.
Feedback Loops
Mindfulness practices, concentration practices, ethical
practices, and acceptance are all closely related, however,
and feedback loops (see Fig. 6) exist between these
components of the BPM, as well as between decreases in
attachment/aversion and mental proliferation. These feed-
back loops show h ow the various practices and their
salutary effects reinforce one another.
Examples of such feedback loops include the positive
effect that decreased attachment/aversion and mental
Fig. 5 Buddhist psychological model
Fig. 6 Feedback loops in the Buddhist psychological model
Mindfulness

proliferation have on mindfulness practice due to the
increased clarity of awareness they engender. This decrease
in attachment/aversion and mental proliferation also posi-
tively affects concentration and ethical practices in a similar
way. Additionally, increased mindfulness practice improves
concentration (via improving the ability to be aware of
when concentration lapses), ethical practices (via improving
the ability to notice when ethics are about to be trans-
gressed), and acceptance (via improving the ability to be
aware of a lack of accepta nce in situations whe re
acceptance would be beneficial).
In summary, we are proposing the BPM as a model of
the underlying mechanisms of mindfulness. The BP M
describes in detail the processes by which attachment/
aversion to intrinsic pleasant/unplea sant feelings lead to
mental proliferation and adventitious suffering. It also
explains how concentration, mindfulness, and other practi-
ces, such as acceptance/compassion and ethical practices,
affect this process. The next section reviews metacognitive
awareness and associated concepts as they relate to the
BPM.
Relationship of the BPM to other Mindfulness Models
We place the BPM in relation to other proposed models of
change mechanisms and explore areas of congruence, as
well as important differences, between the BPM and
existing models. From a clinical perspective, the BPM
offers severa l advantages for understanding how MBIs
exert their clinical effects; based on these, we make
suggestions for refinements of MBIs to improve their
clinical effectiveness. Research implications of the BPM
and relationship of the BPM to current challenges in the
research field are outlined.
Definitions of Terms: Metacognitive Awareness,
Decentering, Defusion
There are many terms in the MBI literature that refer to the
ability to observe one’s thoughts and feelings as temporary
events in the mind rather than as reflections of the self that
are true or accurate (Fresco et al. 2007). Some of these
terms are: metacognitive awareness, decentering, defusion,
distancing, and reperceiving. Current proposed models of
change mechanisms (see below for summaries) give these
concepts a central role. In order to understand the differ-
ences and similarities of the BPM to these other models, we
will first explain how metacognitive awareness and the
other related terms map onto the BPM.
The term metacognitive awareness, often used inter-
changeably with the term metacognition, was first coined
by Flavell in the field of educational psychology to describe
one’s knowledge of one’s own cognitive processes and
products. This definition emphasized the executive role of
metacognition as a regulatory process (Flavell 1976). The
therapeutic importance of this concept was identified over
50 years ago by Rogers, who wrote “the thoughts and
emotions that we take to be so real and are so worried about
do not exist in the way that we imagine them… they do
exist but we can know them in a way that is different from
identifying with them” (Rogers 1959, as cited in Corcoran
and Segal 2008). More recently, metacognitive awareness
was identified as a key component of change in cognitive
behavioral therapies and spurred the development of
therapies such as mindfulne ss-bas ed cognitive therapy
(MBCT; Segal et al. 2002), which aims to enhance this
capacity in order to decrease rumination. For example,
Teasdale et al. (1995) defined metacognitive awareness as
the process whereby “negative thoughts and feelings are
seen as passing events in the mind rather than as inherent
aspects of self or as necessarily valid reflections of reality”
(p. 285).
Other proposed definitions of metacognitive awareness
utilize the concept of decentering, defined as “the capacity
to take a present-focused, nonjudgmental stance in regard to
thoughts and feelings and to accept them” (Fresco et al.
2007, p. 448). For example, metacognitive awareness has
been defined as “the process of experiencing negative
thoughts and feelings within a decentered perspective”
(Teasdale et al. 2002, p. 276). Metacognitive awareness was
also described in the same paper as a form of metacognitive
insight, referring to
“…the way mental phenomena are
experienced as they arise” (ibid, p. 286). Defusion, a similar
concept, has been defined as “the recognition of thoughts,
feelings, and bodily sensations as passing events without
buying into the literal content of the temporal and
evaluative language that accompanies these experiences”
(Fletcher et al. 2010, p. 43). Finally, reperceiving has been
described by the authors (Shapiro et al. 2006) as akin to
decentering. The above definitions encompass a wide range
of processes, ranging from pure metacognition (as in
Flavell’s definition) to a process that appears to be very
similar or identical to acceptance (as in Fresco and Segal’s
definition of decentering).
Comparing Metacognitive Awareness, Defusion,
and Insi ght
Although the terms metacognitive awareness and defusion
may, from a Western psychological standpoint, appear to be
similar to insight or its sequelae (such as equanimity), a
clear distinction between them is made in the BPM. When a
practitioner of a MBI develops a degree of metacognitive
awareness or defusion, they are able to use these skills to
intercept undesirable thoughts and choose a more skillful
response. Metacognition involves focusing attention on a
Mindfulness

stream of mental events (mental prolifera tion) and volition-
ally interrupting that stream with a new series of mental
events whose objects are the preceding thoughts that were
part of the mental proliferation. These are cognitive
processes and thus, from the perspective of the BPM, fall
under the rubric of attention regulation. Definitions of
metacognitive awareness that include “decentering” (as
defined by Fresco et al. 2007) would also map onto the
acceptance component of the BPM. In contrast, insight and
its side effects are non-conceptual and non-cognitive in
their origin and result in reductions in attachment/aversion
or mental proliferation without requiring any cognitive
intervention or proces sing.
Models of Change
Current MBIs and explanatory models focus on attention
regulation, acceptance, and decreased mental prolifera-
tion, which lead to symptom red uctio n and well-being.
The main d ifference between the BPM and other
mechanistic models of mindfulness is the ident ification
in the BPM of the central role of attachment/aversion to
feelings (defined as the immediate and spontaneous
affective exper ience of the awareness of a physi cal
sensation or object of cognition; Mendis 2006)inthe
production of adventitious suffering and symptoms. The
BPM proposes that addr es sing experience at the le vel of
feelings is another way of decreasing adventitious suffering
and reducing symptoms. Below, we show how some of the
other models map onto the BPM.
Mindfulness-Based Cognitive Therapy
The theoretical rationale underlying the development of
MBCT identifies the key mechanism of change as being
decreased rumination through the development of meta-
cognitive awareness (Segal et al. 2002; Teasdale et al.
2002). In addition, observation of the arising and passing of
thoughts and sensations, and labeling of qualities of
sensation is taught. In MB CT sessions, participants learn,
in part, to identify mental events that are consistent with
their depressive relapse signatures and use this recognition
as an opportunity to consci ously choose skillful self-care,
whether this involves the deliberate switching of attention
to a neutral focus, such as the breath, or consciously
engaging in a positive self-care action that provides
pleasure or a sense of mastery. A kind and gentle approach
toward one’s experience is embodied and modeled by
MBCT therapists.
From the perspective of the BPM, the more concentration-
oriented MBCT meditation practices map onto the attention
regulation and acceptance components of the BPM. In
addition, the BPM highlights the importance of investigating
the three characteristics of all objects as an explicit focus of
meditation in MBCT. With this focus, participants may notice
aspects of the three characteristics and thus begin to develop
some degree of insight and reduction of attachment/aversion
to unpleasant/pleasant/neutral feelings.
Reperceiving
The reperceiving model (Shapiro et al. 2006) asserts that
mindfulness practices (component ized as intention, atten-
tion, and attitude) lead to an increase in dispositional
mindfulness (a greater clarity and objectivity when viewing
moment-by-moment internal and external experiences).
This results in increases in four areas: self-regul ation,
values clarification, exposure, and cognitive and emotional
and behavioral flexibility. This fundamental shift in
perspective is posited to lead to disidentification with
thoughts. The authors state that reperceiving is akin to
decentering. As such, reperceiving maps onto attention
regulation and acceptance in the BPM.
Acceptance and Commitment Therapy
In acceptance and commitment therapy (ACT), based on
relational frame theory, mindfulness is defined in terms of
four interrelated processes: acceptance, defusion (defined
above), presen t moment awareness, and the observ er self
(Fletcher and Hayes 2005). Acceptance is described as the
allowing of thoughts and feelings to be as they are without
trying to change their content, form, or frequency. Present
moment awareness is defined as contact with stimuli
occurring in the present moment and includes awareness
of thoughts, feelings, and bodily sensations. The observer
self is the experience of self as an observer of one’s
experiences rather than becoming identified with them.
ACT maps onto the BPM components of acceptance and
attention regulation. The observer self does not map onto
the BPM as a separate component; rather, it is implicitly
present in the various components, such as mindfulness and
attention regulation. From a Buddhist perspective, during
the progress of insight, the concept of a separate observer
self that is aware of one’s experience is abandoned (Mahasi
2006) and is replaced by “the understanding that each
moment is nothing but ‘something being known’ preclud-
ing any identification of the process with [an observ er self]
”
(Steve Armstrong, personal communication).
Attention Regulation Model
The attention regulation model (Carmody 2009) proposes
that sensations of the breath are affect-neutral for most
people; thus, intentionally directing attention to the breath
when subjectively adverse symptoms arise (and redirecting
Mindfulness

attention to the breath when it naturally wanders) results in
a decrease in the usual emotional arousal accompanying the
patients’ symptoms. The model states that with practice,
people develop proficiency at noticing when their attention
has gone somewhere that they do not want it to go, and
they get good at bringing it to an affect-neutral object such
as the breath. As such, this model maps onto the attentional
regulation component of the BPM.
Carmody (2009) states that metacognitive awareness can
be developed once attention is allowed to move beyond the
restricted confines of the affect-neutral object, such as the
breath. Although metacognitive awareness is seen as an
ultimately more effective method of symptom reduction,
Carmody makes a convincing case that in practice, as
current MBIs are taught, most of the benefits of the MBIs
are likely due to attentional redirection to affect-neutral
objects.
A possible clinical pitfall of the attention regulation
modelisthatpatientsmaybecome“ave rse to aver sion ”;
if indeed they are frequently using aversi ve sti muli a s a
cue to switch their attention to n eutral stimuli in order to
decrease their levels of arousal, they are at risk of
strengthening self -referential processes and a sense of
narrative self while at the sametimeincreasingthesense
of “ da ng e r” and a ve rsio n when unwa nted experience s,
including symptoms, arise.
Self-Focused Attention
In a recent review of mechanisms of mindfulness (Baer
2009), the author states that “It is still not clear how
observing one’s present moment experience nonjudgmen-
tally and nonreactively is beneficial” (p. 17) and suggests
that self-focused attention may exert beneficial effects as it
“emphasizes experiential awareness of present moment
details and is nonjudgmental and nonreactive” (p. 18).
The BPM suggests that this description is actually a
description of concentration practice with an attitude of
acceptance rather than mindfulness practice. The paper
concludes that increased mindfulness (as defined in the
paper) mediates improved psychological functioning via
self-focused attention that results in: (1) reduced rumina-
tion; (2) reduced emotional avoidance; and (3) improved
behavioral self-regulation, which, in the BPM, are proposed
to occur as a result of attention regulation and acceptance
practices.
Statistically Derived Model
Coffey et al. (2010) used a path analysis approach to
explore the mediating roles of clarity about one’s internal
life, the ability to manage negative emotions, rumination,
and the extent to which one’s happiness is independent of
specific outcomes and events, between mindfulness and
mental health. They utilized the definition of mindfulness
of Bishop et al. (2004) as present-focused attention with an
attitude of acceptance. They found that acceptance exerted
much stronger effects on other variables in the model than
did attention in individuals with little or no exposure to
attention regulation practice.
The model of Coffey et al. demonstrates that in the
absence of specific training to investigate the three
characteristics or train concentration, one’s ability to
alleviate symptoms and enhance well-being is predomi-
nantly due to acceptance and, to a lesser degree, attention
regulation.
Positive Reappraisal
The mindful coping model (Garland et al. 2009) proposes
that events that are perceived as negative can be responded
to by the deliberate initiation of a decentered mode of
broadened awareness and increased attentional flexibility,
from which the given event is reappraised in a positive
manner by attributing to it a new meaning. In this model,
positive reappraisal, rather than mindfulness, is understood
to be the key mediator of therapeutic change. Mindfulness
is identified as a tool to be used for the construction of a
positive reappraisal. Positive reappraisal can be mapped
onto the BPM as attention regulation since it is volitionally
replacing existing thoughts with different thoughts.
One possible concern with this model is that t he
emphasis on positive reappraisal, which is embedded in
the narrative experience of self over time, may actually
increase vulnerability to cognitive processes underlying
mood and anxiety symptoms as it reinforces the narrative
experience of self.
Summary of Models of Change and their Relation
to the BPM
We conclude that the majority of existing models of change
can, from the perspective of the BPM, be reduced to a
model of how attention regulation, with the addition of
acceptance, decreases mental proliferation and thus
improves symptoms and well-being. This view is supported
by Mikulas (2011) who argues that current definitions of
mindfulness used in Western psychology are actually
definitions of concentration practice and that many of the
benefits ascribed to mindfulness are actually benefits
derived from training in concentration. The BPM disam-
biguates concentration-based practices and insight practi-
ces, highlights that both concentration and insight practices
can result in a momentary reduction in rumination, and
describes how symp tom reduction can result from insight
gained during mindfulness training.
Mindfulness

Clinical Implications of the BPM
We propose that refining the techniques currently employed
in MBIs to include the key elements of the BPM may result
in the enhanced efficacy of such treatments. The four areas
we consider are:
1. Insight: We propose that the explicit investigation of
the three characteristics during both formal and
informal practice could be a practical method of
optimizing the effectiveness of the MBIs, providing
that the potential risks and how to mitigate them are
well understood (see below). Although there is a
commonly held belief that attaining insight is a rarified
and uncom mon occurrence (and therefore impractical),
we propose that with clear instruction and diligent
practice, insight into the three characteristics can be
developed by most individuals. Furthermore, given that
even small accruals of insight could lead to lasting and
highly beneficial salutary effects resulting in symptom
reduction, it would be propitious for clinicians with the
proper training to guide patients to engage in these
practices.
The risks involved in insight practice are well known
to advanced practitioners, but not commonly openly
discussed; thus, clinicians involved in delivering MBIs
may not be fully aware of them. We will introduce the
risks here; however, it should be understood that a
detailed examination of the potential negative side
effects of insight practice is beyond the scope of this
paper. In summary, insight practices tend to proceed in
a series of stages that are robust across traditions and
individuals, and these stages are described in detail in
the Theravada tradition (Mahasi 2006). Typically, as
skill in insight practice develops, meditation moves
from a conceptual understanding of the three character-
istics to a more direct experience of impermanence,
suffering and not-self, in which the sensate world of the
meditator is decomposed into a rapid sequence of
small, discrete sensations. Side effects of these early
stages of insight can include an increase in physical
pain and tension. As insight practice develops further
and the meditator experiences the three characteristics
with more clarity, a high point in the practice is reached
that may be accompanied by intensely pleasurable
feelings. Following this high point, insights that are
particularly associated with suffering are experienced,
which, while powerful and illuminating, can be very
destabilizing for some meditators. Side effects of these
late r stages can include e xperiencing a variety of
intense negative emotional states, including experiences
similar to depressive symptoms. If these side effects do
occur, management includes continued pract ice with
the guidance and support of someone experienced
with these stages and their side effects; progress in
insight can then continue, which alleviates the
symptoms. Given t he potential f or these challenging
side effects, we strongly suggest that clinicians who
use insight practice must be sufficiently experienced
that they can s afely and effectively guide practi-
tioners through the potentially destab ili zi ng stag es of
this practice. If proper ly manag ed in this way, insight
practice can be a clinically valuable addition to MBIs
due to the salutar y effects of i ns ight described earlier
in this paper.
2. Acceptance: Although current MBIs vary in their
emphasis on teaching acceptance, the BPM highlights
the importance of expli citly teaching a cceptance to
optimize the efficacy of MBIs due to the role of
acceptance in reducing mental proliferation and
facilitating attention regulati on and mindfulness prac-
tice. Instruction and practice of acceptance should
clearly delineate cognitive versus insight-based qualities
of acceptance, and the important role of cognitively
based forms of acceptance should be acknowledged
while not overlooking the development of insight-based
acceptance.
3. Attention regulation: Attention regulation strategies
are effective, us ef ul, and popular wit h patie nt s (e. g.,
3-min breathing space ). A potential risk when over-
emphasizing attention regulati on in MBIs is that
patients may inadvertently strengthen their aversive
reactions to unpleasant feelings; for example, during
an aversive reaction, patients may preferentially
redirect their attention to the breath in an attempt to
achieve imme diate s ympt om reducti on via attention
regulation rather than carefull y examining the tran-
sience, suffering and not-self characteristics of the
feeling.
4. Theoretical transparency: Providi ng patients wit h a
theoretical grounding in insight and concentration
practices is advantageous as it serves to both
motivate as well as to orient the intention of practice.
It can also help the clinician clarify goals of
mindfulness training and address common misper-
ceptions. One example o f a f re quen t mi sp erce pt ion is
the expectation by p atients that they can use
mindfulness or other techniques to eliminate the
experience of unpleasant feelings, which is impossi-
ble. Patients someti mes have the impression, when
engaging in MBIs, that if they are doing the practices
correctly, they will no longer experience uncomfortable
thoughts or physical sensations. Thus, they can feel that
they are “not doing it right”
when they continue to
experience sensations or mental events associated with
the arising of an unpleasant feeling. The BPM can be used
Mindfulness

clinically to explain that the continual arising of unpleasant
or pleasant feelings with the awareness of sense impres-
sions and mental events is an intrinsic part of experience
and will never cease, i.e., participants are “doin g it right”
even when this keeps happening. Understanding the
theory, on an intellectual level, that both pleasant and
unpleasant feelings are unavoidable and that we habitually
cling to them helps reduce attachment/aversion. An
understanding of the theory of the BPM can support the
clinician in guiding patients to progress from attention
regulation using an affect-neutral object to observing
feelings directly with skill and courage while observing
the three characteristics in them and decrease habitual
attachment/aversion reactions.
Research Implications
Though much progress has been made in the last 20 y ears
with regards to measures of mindfulness related con-
structs, recent studies have found very high correlations
between self-report measures s uch as the Five Facet
Mindfulness Questionnaire (Smith et al. 2008)andthe
Experiences Questio nna ire (Fresc o et al. 2007)usedto
measure decentering as well as other emotional regulation
measures (Carmody et al. 2009;Coffeyetal.2010). This
overlap highlights the need to develop more precise
instruments in order to disce rn the vari ous component s
of these constructs. From the perspective of the BPM,
these measures seem to be quantifying a combination of
both aspects of practice as well as consequences of
practice. In order to test the pathway in the BPM of how
insight leads to increased well-being, measures will need
to b e developed for e ac h of t he specific components
influencing mental proliferation (acceptance, attention
regulation, insight, ethical practices) as well as attachment/
aversion to pleasant/unpleasant/neutral feelings.
The BPM provides clarity regarding the components
comprising insight and concentration practices (see Fig. 5)
that may permit more precise component analysis studies of
MBIs. The next steps would be to examine the proposed
synergistic effects from combining the above components
in an MBI to determine whether greater symptom reduction
could be obtained through synergistic effects than that
produced by simple additive effects alone. Such research, in
addition to evaluating the validity of the BPM, would
provide data useful to clinicians for optimiz ing MBIs since
they would be able to quantify the relative contributions of
acceptance, insight, attention regulation, and ethical practi-
ces on symptom reduction.
From the perspective of neurobiological research, the
components of mindfulness practice and concentration
practice in the BPM are a nalogous to the open
monitoring and focused attention meditations, respec-
tively, as defined in Lutz et al. (2008). As such, res earc h
employing these definitions can explore the neural
correlates of these two practices in the BPM (for example,
see Manna et al. 2010).
Conclusion
The BPM outlines multiple mechanisms by which mental
proliferation is reduced. It provides a detailed description
of the stream of consciousness and demonstrates how
mindfulness and other practices alter that flow. We hope
that this model will help stimulate further discussion and
understandi ng of t he co mp lex, multifaceted nature of
mindfulness and its allied disciplines.
Acknowledgments The authors would like to thank Steve Armstrong
and Susan Woods for reviewing an earlier version of this manuscript and
for providing insightful feedback.
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