MINDFULNESS-INTEGRATED CBT FOR
GR W TH
Four Steps to Enhance Inner Calm,
Self-Conﬁdence and Relationships.
BRuno A. CAyoun
“This is a beautiful book.
Bruno Cayoun explains clearly,
guides gently, and answers
questions skilfully.” Mark WilliaMs
Mindfulness-integrated CBT for
Well-being and Personal Growth
This is a beautiful book. Bruno Cayoun has distilled the deepest wisdom of an ancient Buddhist
meditation tradition and combined it with the best modern clinical science to offer this program.
As he says, with mindfulness training, you can tune your attention so that you can perceive your
experiences, understand them and respond to them without needing to react in order to change
them. He explains clearly, guides gently, and answers questions skilfully. Using problems as tools
through which to learn, he shows you a way to respond wisely to difficulties that can destroy the
quality of your personal, family and working life. With this book as a trusted guide, he invites
you to discover how you can let go of suffering, restore equilibrium, and rediscover peace.
Teachers, students and practitioners everywhere, whether new to or experienced in the practice
of mindfulness, will greatly value this book.
Mark Williams, Emeritus Professor of Clinical Psychology,
University of Oxford, and Co‐author of The Mindful Way Workbook
Bruno Cayoun is a master of mindful living. Here he skillfully blends age‐old wisdom, recent
research, and practical methods into four essentially helpful steps for all who wish to live a
fulfilling life. I have learnt heaps from it – and am sure you will, too.
George W Burns, Adjunct Professor of Psychology,
Cairnmillar Institute, Melbourne, Australia
Author of 101 Healing Stories and Happiness, Healing, Enhancement
This book marries powerful tools from Buddhist meditative practice with contemporary
behavioral science for a comprehensive look at transforming suffering. The result is an
important contribution to a growing interdisciplinary field.
Sharon Salzberg, Co‐Founder of the Insight Meditation
Society and author of Real Happiness at Work
What an amazing book! I could feel the years of wisdom and practice flowing out of each
chapter. Mindfulness‐integrated Cognitive Behavior Therapy is a jewel that honours both the
Buddhist and Western psychological traditions of turning suffering into well‐being. You will
treasure what Bruno Cayoun offers whether you are looking for a way through personal distress
or wish to learn how to bring the elements of Buddhist Psychology into your professional work.
Each chapter clearly describes how to cultivate the ancient practice of meditation and supports
the practice with solid science. The “question and answer” sections are informative, gentle and
direct their guidance making them indispensable to novice and ongoing practitioners alike. You
will find this book opens the gate to a sustainable way of living with challenges and a quiet,
composed approach to life as it presents itself to you, moment by moment. All you have to do is
Lynette Monteiro, PhD
Co‐Director of Ottawa Mindfulness Clinic
Clinical Professor, University of Ottawa
Co‐Author of Mindfulness Starts Here: An eight‐week guide to skillful living
At last! A self‐help book incorporating mindfulness that does not treat the reader as a simpleton.
Dr Cayoun carefully explains the science behind practicing mindfulness combined with right
thinking to live a happier and more satisfying life. It is highly practical with easy exercises and
lots of guidance from a perspective informed by Buddhist spirituality and Clinical Psychology.
Dr Bruce A Stevens, Associate Professor in Clinical Psychology,
University of Canberra
Co‐author of Happy Ever After? A Practical Guide to Relationship
Counselling for Clinical Psychologists
CBT for Well-being and
Four Steps to Enhance Inner
Bruno A. Cayoun, PsyD
This edition first published 2015
© 2015 John Wiley & Sons, Ltd.
John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
350 Main Street, Malden, MA 02148-5020, USA
9600 Garsington Road, Oxford, OX4 2DQ, UK
The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
For details of our global editorial offices, for customer services, and for information about
how to apply for permission to reuse the copyright material in this book please see our
website at www.wiley.com/wiley-blackwell.
The right of Bruno A. Cayoun to be identified as the author of this work has been asserted in
accordance with the UK Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted, in any form or by any means, electronic, mechanical, photocopying,
recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act
1988, without the prior permission of the publisher.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in
print may not be available in electronic books.
Designations used by companies to distinguish their products are often claimed as
trademarks. All brand names and product names used in this book are trade names, service
marks, trademarks or registered trademarks of their respective owners. The publisher is not
associated with any product or vendor mentioned in this book.
Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their
best efforts in preparing this book, they make no representations or warranties with respect
to the accuracy or completeness of the contents of this book and specifically disclaim any
implied warranties of merchantability or fitness for a particular purpose. It is sold on the
understanding that the publisher is not engaged in rendering professional services and neither
the publisher nor the author shall be liable for damages arising herefrom. If professional
advice or other expert assistance is required, the services of a competent professional should
Library of Congress Cataloging-in-Publication Data
Cayoun, Bruno A.
Mindfulness-integrated CBT for well-being and personal growth : four steps to enhance inner
calm, self-confidence and relationships / Bruno A. Cayoun.
Includes bibliographical references and index.
ISBN 978-1-118-50913-5 (pbk.)
1. Mindfulness-based cognitive therapy. 2. Mental health. 3. Self-confidence.
4. Interpersonal relations. I. Title.
A catalogue record for this book is available from the British Library.
Cover image: Family illustration © Leontura /iStockphoto; hand-drawn circle
© chocoma87 /iStockphoto
Set in 10/12pt Sabon by SPi Publisher Services, Pondicherry, India
About the Author vii
Step 1 Personal Stage 7
1 Committing to Learn andChange 9
2 Week 1: Establishing Self-Care and Feeling Grounded 22
3 Inheritance and Maintenance of Unhappiness 30
4 Integrating Western Science and Eastern Wisdom 45
5 Week 2: Regulating Attention and Gaining Mastery
Over Your Mind 60
6 Learning About Your Mind 81
7 Week 3: Understanding and Regulating Emotions 92
8 The Deeper Nature of Your Emotions 108
9 Week 4: Applying Mindfulness Skills in Daily Life 119
Step 2 Exposure Stage 145
10 Week 5: Regulating Behavior to Overcome Avoidance 147
11 Week 6: Improving Self-Confidence 168
Step 3 Interpersonal Stage 187
12 Week 7: Improving Relationships with Interpersonal
13 Week 8: Improving Relationships with Mindful
Step 4 Empathic Stage 233
14 Week 9: Feeling Compassionate and Connected with Others 235
Shaping Your Future 263
15 Maintaining Well-Being and Personal Growth 265
About the Author
Dr. Bruno Cayoun is Director of the MiCBT Institute, a registered training
organization, and leading provider of training and professional development
services in Mindfulness-integrated Cognitive Behavior Therapy (MiCBT) to
mental health services. The Institute provides training in MiCBT to various
services and professional associations in Australia, New Zealand, Ireland,
North America and South East Asia.
Dr. Cayoun is also a registered clinical psychologist in private practice
inHobart, Australia, and mindfulness researcher, in collaboration with
several universities and health organizations. He has practiced mindfulness
meditation and participated in many intensive training courses in Vipassana
centers in various countries (France, Nepal, India, and Australia) for over
25 years. He is the principal developer of MiCBT, which integrates mind-
fulness skills training with well-established principles of traditional
Cognitive Behavior Therapy.
His mindfulness training CDs are used worldwide and he is the principal
developer of several questionnaires, including the Short Progress Assessment
and the Mindfulness-based Self Efficacy Scale. His book, Mindfulness-
integrated CBT: Principles and Practice, published in 2011, is widely used
for the training of mental health professionals.
Bruno Cayoun has written a fascinating and practical book which will lead
you into an evidence-based program that has helped thousands of people
around the world experience a genuine sense of personal growth, peace and
fulfillment. It is timely, in a world of multitasking, chronic stress and
agitation, where mental health cannot be taken for granted.
A leading teacher of mindfulness meditation with over 25 years of
personal meditation practice and an expert in clinical psychology, Bruno
transports you into a world of sincerity and clarity for a conversation: one
you are able to pace and retrace guided by your own internal wisdom. This
book offers information and guidance for both individuals working towards
self-improvement on their own, and professionals assisting clients in
individual or group therapy. The clarity and warmth of Bruno’s writing
leads us to feel as if we are with him in the room – that he is reaching out
beyond conventional boundaries to help us develop skills to deal with life’s
Bruno skillfully integrates the core principles of Eastern mindfulness
practice with Western-based techniques of Cognitive Behavior Therapy,
providing step-by-step guidance to understanding and implementing the
four stages of Mindfulness-integrated Cognitive Behavior Therapy. His
practical and yet nuanced instructions equip us to view the world through a
clearer, kinder and more mindful lens.
I trust you will find Bruno’s unique wisdom, voice and experience illumi-
nating in the words on the pages to follow. Enjoy the journey, and may you
always hold yourself with compassion.
Shauna Shapiro PhD
Professor, Santa Clara University
Co-Author of The Art and Science of Mindfulness and Mindful Discipline
This book would not have been possible without the invaluable teaching I
received from my principal teacher of mindfulness meditation, Satya
Narayan Goenka, a celebrated teacher in the Burmese Vipassana tradition.
His psychological approach to mindfulness training has inspired me to inte-
grate this method with the scientific, clinical and humanist aspects of modern
Western psychology. I am also immensely grateful for the teachings of the
wise and respected traditional teachers, especially Ajahn Cha and Ajahn
Jayasaro, who have broadened and deepened my understanding of mindful-
ness practice in daily life.
I am deeply grateful to my dear colleagues Sarah Francis, Alice Shires and
Karen Clark for reading the early drafts of the entire book and offering
invaluable suggestions and encouragement. I also deeply thank Luke Hortle,
Richard Hulme, Alec McAulay and Adele Vincent for their editing and
comments at a later stage of the book, and express my deep appreciation of
Garson O’Toole’s assistance for investigating the accurate source of quotes.
My profound gratitude also goes to my beloved daughters, Gabrielle and
Juliette, for their patience and tolerance of my absences during the writing
of the book. I am also indebted to Gabrielle Cayoun for her precious
assistance with the design of figures in Chapter5, and to my dear and com-
passionate wife, Karen Cayoun, whose support, patience, and suggestions
on the earlier draft of the book have been invaluable. I also express my deep
thanks and gratitude to the supportive team at Wiley (UK), especially Darren
Reed for encouraging me to write the book, and Karen Shield for her useful
guidance and great patience. Although I have received advice from many,
any errors and shortcomings in the text are entirely my own.
I express wholeheartedly my gratitude and profound respect to the inspiring
people who were once my clients for allowing me to share their experience
through this book, and others for their willingness to have their moving and
inspiring letters included in this book. Finally, I would also like to express my
sincere admiration for all those who have the curiosity to learn, the courage
to practice and the generosity to teach this life-changing program.
Mindfulness-integrated CBT for Well-being and Personal Growth: Four Steps to Enhance
Inner Calm, Self-Confidence and Relationships, First Edition. Bruno A. Cayoun.
© 2015 John Wiley & Sons, Ltd. Published 2015 by John Wiley & Sons, Ltd.
Integrating Western Science
and Eastern Wisdom
Great balance sustains all things.
Integrating Buddhist and Western psychology with current findings in
neuroscience, this chapter describes crucial aspects of how our mind
and body process emotional information, and how to overcome our
emotional reactivity. It also explains how we become attached to
immediate pleasures, which we rely on to feel “happy” at the cost of a
more reliably fulfilling life. This chapter provides a scientifically
informed explanation for how mindfulness training can benefit you
and is, therefore, more theoretical than the rest of the book. Please
bear with me during this important chapter and take your time to
reread it if necessary. It will make even more sense once you have
started your mindfulness practice – the advantage of experiential
learning. Leave aside whatever may seem a little obscure at this stage
until your training develops, as we will return to these concepts in the
next few weeks with some useful illustrations.
Mental Functions and their Relationship
with WhoWe Are
In the previous chapter, we discussed the unproductive ways by which
people seek lasting happiness. Now it is time to relate the macro level of our
attempts to find happiness to the micro level of our experiences in day-to-day
life. As a visual guide, I will refer frequently to the five boxes in Figure4.1,
which is a representation of what is known as the co-emergence model of
46 step 1 personal stage
reinforcement . The term “co-emergence” simply means two or more
things emerging at the same time; they cannot emerge otherwise.
This new understanding in Western psychology is based on what is known
as “interdependent origination” of all phenomena in Buddhist psychology;
 the notion that everything is dependent upon something else to exist. To
better explain how this applies to our mind, the co-emergence model of rein-
forcement combines Western psychological understanding of emotions and
behavior with the so-called “five aggregates”  of the mind in Buddhist
psychology to describe how our mind works when we learn to respond in a
This explanation belongs to a category of models of mind called
“embodied cognition” [4, 5] which propose that mind and body cannot be
separated during an experience. Each box in Figure4.1 represents a specific
function of the mind that is intimately dependent on the others. We will first
look at a brief description of each of these functions and then discuss the
adverse consequence that identifying with our views and emotional experi-
ences can have on our well-being. This will provide a useful rationale for
mindfulness training as a vehicle for improving well-being.
The first box is called “situation” because it represents the stimulus or event
that triggers our senses. It is the world we live in, including our physical body.
This can be anything from the external world – the rain falling on the roof,
someone speaking to you, a cat on your lap, or a grizzly bear chasing you. The
Figure 4.1 The Co-emergence Model of Reinforcement in equilibrium state.
Adapted from Cayoun, B. A. (2011). Mindfulness-integrated CBT: Principles and
practice. Chichester, UK: Wiley-Blackwell.
integrating western science and eastern wisdom 47
situation may also be an internal experience, like pain, a thought or an image,
or the experience of all of these through the recall of events from memory.
Then we need to know that the event is taking place, for which we need
sensory perception, which appears in the second box. This refers to our stan-
dard six physical senses and to a seventh: our perception of thoughts as they
enter our consciousness before we start thinking about them. Our six
physical senses are smell, sight, taste, touch, hearing, and ability to feel body
sensations directly produced by a situation, such as feeling hot or cold
because of the temperature of the room, feeling heavy in the stomach after
we eat too much, or feeling pain caused by an injury or disease.
Our perception of thoughts is also classified as a sense when we simply
notice that a thought has entered our mind. However, engaging with a
thought and actively thinking it is not a sensory perception in itself. As you
begin the practice of mindfulness of breath next week, becoming aware of
thoughts entering your mind, you will notice this difference very clearly.
Hence, the perception of a thought, such as the spontaneous recall of a pain-
ful memory, is also a mechanism of sensory perception.
These are the seven basic perceptual senses that most people are able to
experience, unless there is a specific impairment. Apart from the fact that
some people are more responsive to certain senses than others, most of us
taste salt as salt, not as sugar, see black as black, not as white, smell perfume
as perfume, not as sewage, etc. As such, our senses respond to the environ-
ment in similar ways, unless we are challenged by a stressful experience, as
we will discuss in the disequilibrium section below.
We then need to make sense of the world we have just perceived. This is the
evaluation component of the mind, which is represented by the third box in
the chart. Many situations only require our physical senses to dictate an
action and can be addressed effectively without making a conscious evalua-
tion (like catching a fast-moving ball). However, despite the immediacy of a
situation and action there is an underlying evaluation that we have learned
and automated over time, however unnoticed this may be. Before being able
to make a mental or physical task automatic and “mindless,” we first learn
it consciously, evaluating many of its aspects.
Evaluating, assessing, or judging a situation is personal and peculiar to
the individual, and does not obey the same direct perception–action rules.
The role of evaluation is not simply to perceive and translate information
objectively. We need to be able to know what “rain” means in general but
48 step 1 personal stage
we also need to obtain a more personal impression of its implications, which
allows our response to be highly adaptive.
For example, rain may mean something very different to you than to me
if you recently had a bad car accident in the rain and I haven’t. This may
result in you being more careful driving under rainy conditions in the
future. Similarly, feeling tightness in the chest may mean something very
different to you than to someone else if the last time you felt chest pain was
just before a heart attack. The personal differences in how we evaluate the
same event enable us to adapt our decision and actions, often for survival
purposes. This applies to all situations that we perceive in the world and
Hence, when we try to make sense of a situation, we automatically inter-
pret it according to our own frame of reference. We do so based on the
information we have collected throughout our life and stored in memory in
the form of “filters.” These filters include our beliefs, values and preferences,
culture, needs, religion, memories of personal events, personality, and other
aspects of our lives that provide us with an ability to interpret situations.
These filters process information in a habitual way, a way that is consistent
with our sense of who we are – our sense of self – and are updated periodi-
cally when we learn something new.
This judgmental part of the mind functions like a giant database with
extremely complex interactions with other components; the simpler the
computations, the quicker and easier the response. Usually, quick and easy
are attractive options in our way of thinking because they don’t require
much energy and effort. We usually don’t like to make things slow and com-
plex, especially when we perceive potential threats. The more rapid your
judgment about a potential threat, the quicker you start running (or fighting)
and, therefore, the more chances you have of saving yourself. Nonetheless,
even though quick judgment is the most efficient way of preserving our
species in a threatening environment, it may also be inaccurate and produce
a false alarm. Thus, we categorize the world in ways we understand and
apply similar judgments to assess situations that are sometimes extremely
different, often resulting in getting it wrong.
At the most subtle level, we create systems of beliefs which we sometimes
call “schemas”  in Western psychology. We construct many of these
throughout our life. These include beliefs that manifest consciously, such as
“kind people should not suffer,” “I shouldn’t have to put up with my part-
ner’s attitude,” and other typical judgments about life. Many day-to-day
assumptions have emerged from more fundamental beliefs about ourselves
that we created earlier in life. In cognitive therapy, these are called “core
Typical examples of unhelpful core schemas are “I’m not good enough,”
“there’s something fundamentally wrong about me,” “nobody loves me,” or
“people I love will abandon me.” You will note that core schemas are char-
acterized by an emphasis on the “I” or “me,” and maintain our attachment
integrating western science and eastern wisdom 49
to our sense of self. As discussed in the previous chapter, these schemas are
irrational views not so much because they are not based on evidence in daily
life, but more because there is an overly high focus on the “I” and the “me.”
Accordingly, they are the source of great suffering. We will discuss this topic
further a little later.
The direct consequence of our judgments is an immediate effect on the body.
When it is sufficiently intense to be caught by our attention, we can experi-
ence a sensation emerging in the body every time we feel a strong emotion,
like fear or anger. Body sensation is the next component of information
processing, represented in the fourth box in figure4.1. Modern emotion
research shows that body sensations are crucial elements of emotional
processing . However, it is important to differentiate body sensations that
are caused by physical discomfort, like physical pain due to injury or dis-
ease, from those that are caused by mental discomfort, like the rising heat
and agitation that accompany anger or the so-called “butterflies in the
stomach” that accompany fear.
Body sensations caused by conditions such as arthritis, indigestion,
injuries, or simple physical movements, are caused by direct contact bet-
ween sensory perception and the physical world. This very early and rapid
stage of processing precedes our evaluation of the event. We would all feel
extreme heat if we were to put our hand in the fire, no matter who we are
and how educated or wise we are. Accordingly, these body sensations are
related to the consequence of the stimulus and are therefore part of the
previous component, sensory perception. In contrast, sensations that arise
immediately because of our conscious or our well-learned (automatic) judg-
ments are “co-emergent” with our mental state – they are triggered by our
judgments. Accordingly, these body sensations are related to the consequence
of our thoughts and are placed after the evaluation box. Whilewe all feel
burning sensations when our hand is in the fire, we evaluate the situation
very differently to each other. This is because we don’t all judge the same
things in the same way.
Co-emergent body sensations are experienced through “interoception,”
which is the sensory perception of the body interior, including the physical
experience of our emotions. This is what neuroscientists often call our “sixth
sense,” which makes us feel that we exist, that our sense of self is real 
Neutral thoughts, those that don’t involve personally important matters,
produce only neutral body sensations. These are very subtle and cannot be
felt unless we are very deeply relaxed or a skilled mindfulness practitioner.
However, the more our evaluation of a circumstance has personal impor-
tance, thereby activating our “me network”  in the brain, the more intense
the sensation we feel in the body – though this does not mean that we pay
50 step 1 personal stage
attention to it or that we are aware of it . This constitutes one relation-
ship between mind and body; more self-referential information leads to a
greater intensity of body sensation, which prepares us for a reaction.
Indeed, it all starts with the “I.” The more we identify with the circumstance
that we evaluate, the stronger the sensation in the body, and the more emo-
tional we feel. This includes my reputation, my philosophy, my car, my family,
my health, etc. Since anything I call “my” is a part of “I,” thinking about it will
trigger body sensations. In other words, the more we evaluate something as
having personal implications, and therefore connected to our sense of self (the
“I”), the more intense will be the sensations in the body. There is little doubt
that you have been aware of this experience at some stage, which is repeatedly
supported by modern research in neuroscience .
Moreover, the more our evaluation is agreeable, the more the body sensa-
tion is pleasant. Equally, the more our evaluation is disagreeable, the more
the body sensation is unpleasant. This is the second relationship between
mind and body; the agreeableness of the thought determines the type or
quality of the body sensation (the “hedonic tone”). Body sensations are the
building blocks of emotions . Indeed, you cannot feel an emotion unless
you feel specific sensations in the body, even if you are only vaguely or not
at all aware of it.
Consider three scenarios. In the first, you hear that the cousin of your
friendly neighbor has just been diagnosed with an incurable disease. If you
don’t know this person, how would your evaluation of this news make you
feel? It is likely that you could still go about your day normally. In the
second scenario, you hear that it is your friendly neighbor who has just been
diagnosed with an incurable disease. How would your evaluation of this
news make you feel now? Probably much more discomfort than in the first
case, in which the person was more remote from you.
In the third scenario, you hear that you have just been diagnosed with an
incurable disease. There is little doubt that the intensity of your body sensa-
tions would increase. You may feel anxious, typically characterized by a
combination of temperature change, agitation, and constricted areas in the
body. If the news is really shocking, you may even dissociate from the whole
experience and feel numb, so that you can cope with it. Or you may feel sad,
typically characterized by feeling heavy and constricted in various parts of
your body. When my health is threatened, I suffer emotionally, even though
a stranger’s health is just as valuable and costly to lose. It is only when the
issue relates to me or whoever I identify with (e.g., my child) that suffering
starts, through the medium of intense and unpleasant body sensations.
The same applies to pleasant situations, in which case the body sensation
is pleasant. Again, let us put this in context through the following three
scenarios. In the first, you hear that a friend of your sister is very fond of a
man she met a few months ago and that he recently said to her, “You mean
everything to me, I really love you.” Since you don’t know this person, how
would your evaluation of this news make you feel in the body? In the
integrating western science and eastern wisdom 51
second scenario, you hear that it is the new boyfriend of your sister who
said to her, “You mean everything to me, I really love you.” Will you feel the
same as you did in the first scenario? In the third scenario, a person whom
you are really fond of tells you, “You mean everything to me, I really love
you.” How will your evaluation of these words make you feel in the body
this time? My guess is, much more intense. The same words, and the same
potential for love, yet such a different experience in each case. This obser-
vation will be consistent if you take any other example of pleasant events,
such as three people who’ve just won the lottery or realized a great achieve-
ment. The more personally important their positive views are, the stronger
their pleasant body sensations will be.
Our usual way of decreasing distress or increasing pleasure is to react in a
way that decreases unpleasant sensations or increases pleasant ones in the
body. This is the reactive part of the mind, represented by the reaction box
in figure4.1. As is the case between evaluation and body sensation, there is
also a dual relationship between body sensation and reaction, i.e., between
experience and behavior. First, the more intense the sensation, the more
likely we are to react. We can easily predict that you will react one way or
the other if your body sensation becomes sufficiently intense, unless you are
trained otherwise. Pain is a good example of this. Of course, the stronger the
sensation, the stronger the reaction. This is a relationship of intensity.
The second relationship between body sensation and reaction is deter-
mined by the quality or type of bodily experience. The more the body sensa-
tion is pleasant, the more we value it. Because we value it, the reaction will
be a craving, a desire to be attached to the experience, to be at one with the
experience and, of course, to have more of it. This is what I referred to as the
“craving to obtain” in chapter3. In contrast, the more the body sensation is
unpleasant, the more the reaction will be an aversion, a desire to separate
ourselves from the experience and to avoid it. This is what I referred to as
the “craving to avoid,” or aversion, in chapter3. Keep in mind that a reac-
tion is often simply a thought.
On to the Next Loop and the Process of Learning
The time needed from the perception of a stimulus (situation) to the reaction
stage is less than a second. Once we have reacted, the reaction itself becomes
the stimulus, trigger, or situation for the next perception. Perception never
stops, even during sleep. The reactive information is then evaluated as more
or less agreeable, which creates the next body sensation, to which we react
again. In line with Buddhist thought,  research findings from affective
52 step 1 personal stage
neuroscience and behavioral studies show that this flow of co-emergent
mind and body does not cease [14–17]. This aspect of information processing
is central to the principles of conditioning, because it is at this point that our
choice can either reinforce or transform entirely the way in which we have
learned to react to situations.
For instance, whether a very pleasurable body sensation is associated
with a desirable or undesirable behavior, it is likely that we will want to con-
tinue to perform the behavior just to obtain pleasure. For example, if a
pleasant body sensation is associated with a desirable behavior, such as
being kind to someone, then it is likely that we will enjoy being kind to
people and want to do it a lot. Similarly, if overeating or smoking is associ-
ated with pleasant body sensations, then it is likely that we will use over-
eating or smoking to obtain more of these pleasant sensations in the body.
This is called “positive reinforcement” because the behavior is reinforced
through obtaining a reward (the pleasurable sensation). Moreover, if over-
eating or smoking relieves me from unpleasant body sensations, then I will
continue overeating and smoking to relieve myself from feeling such dis-
comfort in the body, even if I react in this way subconsciously . This is
called “negative reinforcement” because the behavior is reinforced through
taking away an unpleasant (or “negative”) experience.
Common habits, like emotional eating and TV or computer addiction, are
really an attempt to feel body sensations which we have become attached to.
If watching TV or playing virtual games on a computer stimulates pleasant
body sensations, then we can easily become “addicted” to these sensations.
The same applies to consumerism in general, where buying things stimulates
pleasant body sensations, which becomes a push for the next buying spree.
Remember, we are not addicted to the stimulus or situation. We are addicted
to the sensations, which are the consequences of our judgment of the stim-
ulus. The same applies to more dysfunctional behavior. Understanding
conditioning in this way has strong implications for our understanding of
behavior that we learn subconsciously.
System in Disequilibrium
To the extent that we experience a stressful situation, disequilibrium bet-
ween the aforementioned four functions of the mind takes place. Figure4.2
is a representation of the system in disequilibrium. The unequal size of the
boxes shows that our attention is withdrawn from our senses and body sen-
sations and reallocated to the judgmental and reactive parts of the mind, 
as shown by neuroaffective research. This increases our tendency to rely on
knowledge and assumptions stored in memory and react rapidly. However,
it also decreases our ability to perceive the situation more objectively, in
the present, and to feel the early signs of emotions arising in the body.
Neurological research shows that this disequilibrium state occurs during
integrating western science and eastern wisdom 53
distressing experiences and can also be learned by the brain over time when
our distress is habitual, as in chronic depression [19, 20].
You may have noticed that when you are stressed it is more difficult to
use your senses. For instance, in an emergency situation we are less able to
smell, taste, hear, and see as clearly as in a normal everyday situation. This
reduced sensory ability has been consistently reported in studies investi-
gating eyewitness testimony following a crime [21, 22]. Witnesses’ visual
memory is often poor. Similarly, it is difficult to feel common body sensa-
tions when we are distressed; the more you are distressed, the more it
becomes difficult to feel common sensations in the body. For example, if a
bear or a shark was chasing you, would you feel a mosquito bite on your
forehead? I would assume that you would not. In contrast, would you feel a
mosquito bite on your forehead now, as you’re reading this chapter? This is
not dissimilar to high-impact sports, during which players may harm their
body without feeling the impact of the hit during the action, but feel a lot of
pain once the match is over.
When we assume that what we perceive is a potential threat, we tend to
“dissociate” from the body to varying degrees, thereby reducing our ability
to feel body sensations. This is a coping mechanism that allows us to fight
or flee potentially threatening situations, unhindered by intense body sensa-
tions. For example, brief dissociation allows us to run from a fire unhin-
dered by the pain caused by small burns or the symptoms of panic. It allows
a paramedic to “get on with the job” while witnessing an atrocious injury,
etc. We can also observe this phenomenon occurring during traumatic expe-
riences in a more extreme way. People who have experienced a traumatic
event can later have real difficulties remembering aspects of the event, especially
the most distressing ones. They cannot retrieve parts of the memory or, in
some cases, the whole of it. People may remember fragments like a smell, a
shape, or a sound to varying degrees, but not easily recall their response.
For most of us, this disequilibrium state is just as common in our daily
lives as the aforementioned equilibrium state. Our nervous system is geared
Factual information is
information is maximized
Figure 4.2 The Coemergence Model of Reinforcement in disequilibrium state.
Adapted from Cayoun, B. A. (2011). Mindfulness-integrated CBT: Principles and
practice. Chichester, UK: Wiley-Blackwell.
54 step 1 personal stage
to handle short-term stress and usually recovers well from it. A stress
response is not necessarily a problem and can also be functional when it is
short lived , but not when it is prolonged and habitual. When we expe-
rience an ongoing disequilibrium between these components, it becomes
chronic. It becomes our normality. This is because brain regions associated
with our continually evaluative and reactive mental states become progres-
sively and more strongly connected and established . We inadvertently
teach our brain to maintain a judgmental and reactive habit. We can even
feel that we have become overjudgmental and overreactive. This is also what
shapes our personality. There is neurological evidence that our brain acti-
vates patterns of neural networks that reflect this disequilibrium and that it
learns to establish these unhelpful pathways .
The Role of Body Sensations in Attention and Memory
Feeling sensations is extremely important for memory . Since early
childhood, every personally important experience is processed and stored in
memory with a co-emerging body sensation. As per the example of trauma
above, one of the consequences of disequilibrium in the way we process
information is a loss of capacity to pay attention to sensations. Consequently,
memory becomes less efficient. This is because it is not possible to remember
an emotional event clearly without experiencing associated body sensations.
One of the common complaints from people who experience clinical levels
of stress, anxiety, or depression is poor concentration and poor memory .
Simple tasks, like reading and remembering what we read, become difficult.
This is because the things we remember best are coupled with body sensations
and we cannot easily feel common sensations when we are distressed – though
we feel intense ones. Until our nervous system re-establishes sufficient balance
between sensory perception, evaluation, body sensation, and reaction, being
attentive and remembering things are likely toremain difficult tasks. Basically,
the more relaxed and able to feel body sensations we are, the more able we
are to recall benign, subtle, or older memories. This will be discussed further
in the context of mindfulness meditation, in the following chapters.
Body Sensations and the Sense of Self
As mentioned earlier, we identify wholly with body sensations. It is precisely
because our sense of self is continually associated with sensations in the
body that we rely on them to know who we are,  both emotionally and
physiologically. A good example of this is commonly reflected in people
who have experienced traumatic experiences during childhood. Some, espe-
cially if they have been emotionally abused or neglected, have learned to
avoid feeling body sensations related to emotional pain. Although this is
integrating western science and eastern wisdom 55
meant to act as a protective reaction, it often leads people to develop clinical
conditions such as chronic depression and the inability to understand
emotions when they eventually emerge.
Given that we rely so much on body sensations to feel a complete sense
of self,  some people’s lifelong avoidance of sensations leads to a
fragmentation of their sense of self. For example, young adults with bor-
derline personality disorder, where people often report having experienced
sustained and complex trauma, commonly report not being able to recog-
nize their emotions because they live a “dissociated life,” sometimes to the
extent of needing to self-harm to feel “normal,” to feel real, to feel that they
exist . Maintaining a state of disequilibrium in the way we process
information not only prevents us from recalling traumatic memories, it also
prevents us from feeling present and alive.
The Role of Mindfulness
Restoring Equilibrium, Abandoning Suffering
From the above description, the last thing we would want is to maintain
disequilibrium between our mental functions. Thirty years of psychological
research has shown that mindfulness meditation uses skillfully applied
mental effort to specifically recreate a balance between the four components
discussed above . This is because practicing mindfulness meditation is
practicing equilibrium. In whichever way we practice it, correct mindfulness
meditation requires us to pay attention to our bodily experience (increasing
awareness of body sensation) in an objective way (increasing sensory percep-
tion), without making judgments about the experience (decreasing evalua-
tion), and without reacting in any way (decreasing reaction).
The more we practice it, the stronger and more established is the
equilibrium. Over time, we become more aware and less judgmental of the
way things are, we become less emotionally reactive and consequently more
proactive. This also means that we change as a person. Even our personality
can change, as it is not a fixed phenomenon if we learn to let go of what
maintains it . These changes are very real, as they are reflected biologi-
cally in the reduction of brain connections that maintain unhelpful mental
habits and in the creation of new brain connections associated with
well-being . Brain studies of mindfulness meditation in the past 9 years
have been able to trace those changes in specific parts of the brain [31–33].
Body Sensations and Emotional Freedom
From the above explanation, it may be clear to you that unless we feel
unpleasant sensations in the body, however subtle they may be, we are not
likely to react. On the other hand, as long as we feel unpleasant sensations in
56 step 1 personal stage
the body and we are not trained to perceive them and address them skillfully,
we are likely to react. A helpful understanding springs from this important
observation. Body sensations constitute the locus of reinforcement,  the
very place from which reinforcement of our conditioned sense of self emerges.
It is also the place from which our conditioned well-being can emerge.
If we learn to feel body sensations while not reacting to them, not identi-
fying with them, desensitization takes place. No matter what the situation
is, not reacting to body sensations neutralizes our response and we are free
from our habitual reaction. No matter how often we find ourselves in the
same situation, we are free from the emotional pain and the need to avoid
it. Can you imagine the transformation that could occur in our lives if we
were to train in developing these skills, and by the same token teach our
brain to minimize emotional reactivity? Mindfulness meditation is precisely
We all want to be happy, but how aware are we of what maintains unhap-
piness and what can create lasting happiness? We are what we create. As
human beings, we have the choice and the capacity to change. However, we
need to go beyond what we learn in Philosophy 101 and become realistic
about “free will.” Free will can mean something so different once we have
developed skillful means to investigate who we are and who we are not.
Through careful attention and discernment we can begin to understand why
our will is not so free after all. Much of our motivation and emotions remain
subconscious  until specific skills allow us to observe how disequilibrium
between mental states takes place every time we take things personally or
otherwise lack insight. Once the mind is set in a disequilibrium state, our
inability to resist reactive habits compounds our problems. Once we have
reacted and feel better for it, we soon feel worse because of it, as we feel
trapped in a cycle of reactivity. This is not a paradox. It is the very basis of
psychological reinforcement and is the driving force behind what is called
“karma” in Eastern traditions. By the same token, it is also the basis of
reinforcement for our perception of who we are, our sense of self.
Thus, the very core of all learning principles is based on body sensations.
One who is able to prevent reaction to body sensations has limitless human
potential. Therein lies true free will. However, knowing this intellectually is
insufficient. Researching it in a lab and concluding that our mind is embodied
doesn’t cut it either. This may make for interesting philosophy, good modeling
of theory, and interesting research topics but no real change can take place.
Actually, we can’t really understand these mechanisms intellectually because
they lie beneath conscious awareness . Counterarguments and confusion
keep on arising because a thousand intellectualized facts cannot replace a
single personal experience. The skills have to be developed personally so that
integrating western science and eastern wisdom 57
subtle sensations can be felt early in the sequence of an emotion, when it is
easy to prevent old habits of reacting with craving and aversion. Without the
skillful means that allow us to discover what has been discussed in this chapter,
we are unlikely to develop the ability to detect early cues of distress and min-
Fortunately, the practice of mindfulness helps us develop the means to
discover and modify mind–body dynamic interactions in a way that will
make a tangible difference in our lives. In doing so, we enhance personal
growth by learning to abandon illegitimate suffering and construct lasting
well-being. Accordingly, we now turn to the practice of mindfulness so that
what you have read so far becomes real for you and provides genuine and
1. Cayoun, B. A. (2011). Mindfulness-integrated CBT: Principles and practice.
Chichester, UK: Wiley-Blackwell.
2. Nyanaponika, T. (1996). Abhidhamma studies: Researches in Buddhist psy-
chology. Kandy, Sri Lanka: Buddhist Publication Society.
3. Narada, M. (1968). A manual of Abhidhamma. Kandy, Sri Lanka: Buddhist
4. Varela, F. J. (1999). Steps to a science of inter-being: Unfolding the Dharma
implicit in modern cognitive science. In G. Watson, S. Batchelor, & G. Claxton
(Eds.), The psychology of awakening (pp. 71–89). London: Rider.
5. Wilson, M. (2002). Six views of embodied cognition. Psychonomic Bulletin &
Review, 9, 625–636.
6. Young, J. E., Klosko, J. S., & Weishaar, M. (2003). Schema therapy: A practitio-
ner’s guide. New York: Guilford Press.
7. Nummenmaa, L., Glerean, E., Hari, R., & Hietanen, J. K. (2013). Bodily maps
of emotions. Proceedings of the National Academy of Sciences of the USA.
Retrieved July 23, 2014 from www.pnas.org/cgi/doi/10.1073/pnas.1321664111.
8. Craig, A. D. (2003). Interoception: the sense of the physiological condition of
the body. Current Opinion in Neurobiology, 13, 500–505.
9. Schwartz, J., & Gladding, R. (2011). You are not your brain: The 4-step solution
for changing bad habits, ending unhealthy thinking and taking control of your
life. New York: Penguin.
10. Berridge, K. C., & Winkielman, P. (2003). What is an unconscious emotion?
(The case for unconscious “liking”). Cognition and Emotion, 17, 181–211.
11. Craig, A. D. (2010). The sentient self. Brain Structure and Function, 214, 563–577.
12. Damasio, A. R. (1994). Descartes’ error: Emotion, reason, and the human brain.
New York: Putnam.
13. Goenka, S. N. (1998). Satipaṭṭhāna Sutta discourses: Talks from a course in
Mahā-satipaṭṭhāna Sutta. Seattle, WA: Vipassana Research Publications.
14. Damasio, A. R., Grabowski, T. J., Bechara, A., Damasio, H., Ponto, L. L. B.,
Parvizi, J., et al. (2000). Subcortical and cortical brain activity during the feeling
of self-generated emotions. Nature Neuroscience, 3, 1049–1056.
58 step 1 personal stage
15. Damasio, A. (2003). Mental self: The person within. Nature, 423, 227.
16. Damasio, A. (2006). Feelings of emotion and the self. Annals of the New York
Academy of Sciences. DOI: 10.1196/annals.1279.014
17. Modinos, G., Ormel, J., & Aleman, A. (2009). Activation of anterior insula during
self-reflection. PLoS ONE 4(2): e4618. doi:10.1371/journal.pone.0004618
18. Farb, N. A. S., Segal Z. V., Mayberg, H., Bean, J., McKeon, D., Fatima, Z., et al.
(2007). Attending to the present: Mindfulness meditation reveals distinct neural
modes of self-reference. Social Cognitive Affective Neuroscience, 2, 313–322.
19. Farb, N. A. S., Anderson, A. K., Mayberg, H., Bean, J., McKeon, D., & Segal, Z.
V. (2010). Minding one’s emotions: Mindfulness training alters the neural
expression of sadness. Emotion, 10, 25–33.
20. Avery, J. A., Drevets, W. C., Moseman, S. E., Bodurka, J., Barcalow, J. C., &
Simmons, W. K. (2014). Major depressive disorder is associated with abnormal
interoceptive activity and functional connectivity in the insula. Biological
Psychiatry, 76, 258–266.
21. Brewer, N., Potter, R., Fisher, R. P., Bond, N., & Luszcz, M. A. (1999). Beliefs and
data on the relationship between consistency and accuracy of eyewitness testi-
mony. Applied Cognitive Psychology, 13, 297–313.
22. Garrett, B. (2011). Convicting the innocent. Cambridge, MA: Harvard University
23. Benson, H. (1985). Beyond the relaxation response. London: Fount.
24. Farb, N. A. S., Segal, Z. V., & Anderson, A. K. (2011). Towards a neuroimaging
biomarker of depression vulnerability. Translational Neuroscience, 2, 281–292.
25. Farb, N. A. S., Anderson, A. K., Bloch, R., & Segal, Z. V. (2011). Mood-linked
responses in medial prefrontal cortex predict relapse in patients with recurrent
unipolar depression. Biological Psychiatry, 70, 366–372.
26. Pollatos, O., & Schandry, R. (2007). Emotional processing and emotional
memory are modulated by interoceptive awareness. Cognition and Emotion,
27. Matthews, A. J., & Bruno, R. (2011). Prospective and retrospective memory
problems in regular ecstasy consumers: Is it just about the ecstasy? Open
Addiction Journal, 4, 17–18.
28. Gratz, K. L., Dukes-Conrad, S. D., & Roemer, L. (2002). Risk factors for delib-
erate self-harm among college students. American Journal of Orthopsychiatry,
29. Chandiramani, K., Verma, S. K., & Dhar, P. L. (1995). Psychological effects of
Vipassana meditation on Tihar Jail inmates: Research report. Igatpuri, India:
Vipassana Research Institute.
30. Davidson, R. J., & McEwen, B. S. (2012). Social influences on neuroplasticity:
Stress and interventions to promote well-being. Nature Neuroscience, 15,
31. Hölzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U.
(2011). How does mindfulness meditation work? Proposing mechanisms of
action from a conceptual and neural perspective. Perspectives on Psychological
Science, 6, 537–559.
32. Fox, K. C. R., Nijeboer, S., Dixon, M. L., Floman, J. L., Ellamil, M., & Rumak, S.
P. (2014). Is meditation associated with altered brain structure? A systematic review
integrating western science and eastern wisdom 59
and meta-analysis of morphometric neuroimaging in meditation practitioners.
Neuroscience & Biobehavioral Reviews. DOI: 10.1016 j.neubiorev.2014.03.016
33. Farb, N. A. S., Segal, Z. V., & Anderson, A. K. (2013). Mindfulness meditation
training alters cortical representations of interoceptive attention. Social
Cognitive and Affective Neuroscience, 8, 15–26.