Mechanisms of Mindfulness

Mechanisms of Mindfulness. 

A review of:
Hölzel, B. K., Lazar, S. W., Gard, T., Schuman, Z.-O., 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(6), 537-559. doi:10.1177/174569

by Susan Thorn. 

Considering the wave of emerging research investigating the effects mindfulness and/or meditation has on mental health and physiological functioning, Holzel, Lazar, Gard, Schuman-Olivier, Vago, & Ott (2011) identified a need in the literature that provides a more comprehensive framework for reference of the functions of mindfulness. They propose a definition, more specifically, that includes both a conceptual and neural perspective of the mechanisms that take action toward effectiveness, particularly creating a multi-faceted model that can be interchanged when analyzing effects among specific mental health disorders or when analyzing the relationship with various types of neuronal-functioning.

Holzel, et al. (2011) propose the benefit of creating a working model of mindfulness meditation would not only assist in propelling the scientific knowledge base toward further understanding of all aspects of this research area, but also aid in gaining progress in building mental health treatment practices that better utilize specific meditation regimens focusing on primary symptomology. They specify the objective of this paper is neither meant to be seen as a concrete explanation of how mindfulness meditation works nor a complete account of the literature, but meant to provoke debate regarding the subject within the scholarly community while creating a base for the construction of future research. The need is discussed in relation to the majority of the literature reviewed focused exclusively on the process and effects of mindfulness meditation and not identifying possible explanation to how it works and how it can be used to work more efficiently.

Mindfulness is defined within this article as “nonjudgmental attention to experiences in the present moment (Holzel, et al., 2011, pg. 538).” Some of the more simplistic attempts within the literature to create a description of the mechanisms of mindfulness are described as containing two parts related to the regulation of attention and experiential openness. The authors further these descriptions including the four components (comprised through the review of existing literature): 1. Attention Regulation; 2. Body Awareness; 3. Emotion Regulation; 4. Change in Perspective on the Self. Each of these components is described in detail including a theoretical framework of the possible neural functioning. They are also described in their interrelationship with one another in comparison to various forms of meditation practice (i.e. focused attention meditation; physiologically focused meditation; experiential mindfulness).

Attention Regulation

In light of the original teachings of Eastern Buddhist traditions, Holzel, et al. (2011) described attention regulation as the theoretical framework from which more advanced mindfulness skills develop. Simplistically, the authors defined this identified component of mindfulness as the act of directing and redirecting attention freely to maintain focus on a specific subject, a mantra or thought, bodily function such as breath, or another external entity such as the sound of the wind. The authors provided detailed information of supporting research indicating the relationship this form of meditation has with attention abilities.

Holzel, et al. (2011) outlined research findings indicating benefits of regular practice of attention-focused meditation shown as primarily including the increased ability to engage in focused tasks for longer periods of time with fewer tendencies to be distracted. The authors also described findings indicating other possible benefits such as an increased ability to more quickly reorient focus from one task to another if needed and finer tuned ability to recognize when attention should be adjusted. Additionally, the authors outline research findings using neuroimaging techniques investigating the possible differences in the neural processes of participants that regularly engaged in attention-focused meditation practices versus client who did not. They presented the research findings as concluding that participants who regularly engage in attention-focused meditation practices had shown stronger neural activity among the various parts of the brain formerly established as having responsibilities in managing attention, focus, and other executive functioning. For example: increased activation in the anterior cingulate cortex, which has been identified as having a significant role in noticing the emergence of discordant tributaries of information processing in order to send messages the other parts of the brain to manage the confliction. Thus, indicating the possibility that meditation assists in strengthening the ACC’s ability to conduct this function more quickly and efficiently while decreasing the effects of incoming distraction or the dilution of the minds focus on the intended subject.

Finally, the component of attention awareness is further discussed as possibly having relevance when considering clinical practices with patients diagnosed with mental health disorders characterized with difficulties in attention and focus such as ADHD or Bipolar Disorder. As previously indicated, these skills are further identified as a base for the development of other mindfulness skills as the increased ability to focus brings about the other components of body awareness, emotion regulation, and change in the perspective of self (Holzel, et al., 2011).

Body Awareness

Holzel, et al. (2011) define body awareness as “the ability to notice subtle bodily sensations (pg. 541).” In other words: the ability to recognize the sensation of your lungs inflating and deflating when taking a breath; the gurgling of your stomach when hungry; or even the decrease in the performance of an activity because you are feeling tired. On the other hand, the authors also include in the definition of this component of meditation as also incorporating focus on the presence of the body itself, the body’s place within the environment, and visualization practices such as imagining the body’s aging process and change toward death. The authors identified body awareness as being different than attention awareness in that it incorporates a more specific level of attention primarily focused on an internal experience. This is described as being important in the strengthening of the mind-body connection and the ability to attend to bodily needs as a result of awareness. Moreover, they presented this component in relation to its philosophical origins historically taught as the “first frame of reference” because of the body’s role in housing all of the other abilities of mindfulness and the need for individuals to become connected with their body in order to fully tap into their potential. Meditation practices included in facilitating body awareness

A thorough review of the literature was described as incomplete considering the lack of empirically designed studies and the majority of the information based on self-report data or case studies. However, Holzel, et al. (2011) also described the resulting information as informative in providing insight into the possibility of benefits ranging from a general increase in insight into bodily functions to more advanced skills in improving physical health and mental health through an increase in the ability to become more consciously active in bodily functioning and skills in recognizing the physiological responses of stress and emotion.

Holzel, et al. (2011) presented the results of functional and structural neuroimaging studies showing increases in neural activity in areas of the brain related to the process of body awareness and higher densities in grey matter within these areas. More specifically, these studies pointed out an increase in the activation of the insula, which has been established as being activated when “executing tasks of interceptive awareness with the volume of grey matter in this area of the brain being correlated with interceptive accuracy and visceral awareness (pg. 542).” Also, these studies provided findings indicating an increase in activation of the secondary somatosensory area (responsible for processing outside bodily sensations such as the experience of wind blowing against the skin on your face) among participants who engaged in meditation versus participants who had not. Lastly, the authors presented findings indicating the increase in grey matter concentration at the temporal-parietal junction in participants who had engaged in a series of meditation practices. They described this as a particularly important finding considering this junction of the brain has been established as having a role in facilitating an individual’s intuition of bodily statuses. Also, this information is important considering studies showing the functioning of this area of the brain as being abnormal among persons conveying a pathological experience of the self.

Emotion Regulation

One of the fundamental attributes of mindfulness is the ability to gain a more active role in the experience of emotions rather than a distant observer through the skills of emotional regulation. Holzel, et al. (2011) defined emotional regulation within the reviewed article as “the alteration of ongoing emotional responses through the action of regulatory processes (pg. 543).” The authors further described emotional regulation as comprising of two types of approaches related to mindfulness: reappraisal and extinction (including also the terms exposure and reconsolidation).

Reappraisal refers to the act of reframing your thoughts to counteract negative interpretations of situations in order to gain insight into the possible positive elements being disregarded in order to change an emotional response. Extinction refers to the use of mindfulness practices in a way that brings attention to the experience of an emotion despite the positive or negative nature of the emotion while avoiding the tendency to create labels and become emotionally reactive. More specifically, it involves the ability to just experience an emotion until it passes freely, which has been described as assisting in producing less physiological reactivity over time in order to avoid the negative related consequences that have been shown to occur from such emotions like fear, anxiety, sadness, etc. Extinction is also presented as teaching the mindfulness or meditation practitioner to refrain from avoidance or dissociation (Holzel, et al., 2011).

The benefits of mindfulness practices related to emotional regulation were listed as: “decreased negative mood states, improved positive mood states, reduced distractive and ruminative thoughts and behaviors, and reductions in physiological reactivity (Holzel, et al., 2011, pg. 543).” Overall, mindfulness meditation was shown to be primarily related to stress reduction and co-related to emotional regulation and management of depressive symptoms. Additionally, various studies were discussed in showing increases in the activation level of the left-sided anterior portion of the brain, which is described as being related to the experience of positive emotion; thus, alluding to the possibility that mindfulness meditation practices are related to the increase in the experience of positive emotions.

Understanding the various forms of mindfulness meditation related to improvements in emotional regulation is addressed by Holzel, et al., 2011 as being important considering the wide range of mental health disorders comprising of symptomology rooted in problems with the regulation or expression of emotional responses. Information in this area is discussed as providing a foundation for treatment approaches addressing these issues. The authors identified deficits with emotional regulation among psychopathology related to functions of the ventromedial prefrontal cortex, hippocampus, and amygdala, where mindfulness meditation has been observed as showing structural changes and an increase in grey matter density within these areas of the brain. One form of mindfulness technique presented by the authors with a focus in the extinction category used in clinical treatment approaches for phobia implicates a process of repeated exposure to prompt behavior in mindfulness practicing the ability to allow one to experience their fears while increasing their ability to reduce their emotional and physiological responses.

Change in Perspective on the Self

Holzel, et al., 2011 initially presented the final component of mindfulness meditation, change in perspective of the self, by describing its more philosophical, theoretical, and experiential structure conveyed in the literature. It is described as being the ability to hold the concept of self as a fluctuating process as opposed to a solid and defined entity. This characteristic is acknowledged as aiding a person’s ability to gain overall clarity in awareness and enabling the capacity to be fully open to an experience without judgment or the fundamental principal of mindfulness mediation. Thus, despite its lack of empirical evidence and difficulty in defining operationally, the authors further stress the importance of this component when developing a complete working framework of mindfulness mediation. Furthermore, they aid in providing additional support for the inclusion of this component considering the self-reported benefits of increasing positive self-representation, self-esteem, and acceptance of self. Finally, the authors presented findings indicating analysis of interviews indicating the operation of a self-concept on a level further away from patterns associated with mental illness.

Areas of the brain including the medial prefrontal cortex, posterior cingulate cortex/ anterior precuneus, and the inferior parietal lobule have been identified as having roles in the self-referencial process and organizationally and operationally impacted by mindfulness meditation (Holzel, et al., 2011). Additional related neuroimaging studies were presented indicating influences of meditation on areas of the brain involved in regulating attention toward stimuli in reference of the self. The authors discussed some of the findings as showing a decrease in activation within these areas among practitioners of meditation versus non-meditators and deliberated as possibly related to a decline in the tendency to engage in defining and interpreting an experience essentially opposing the fundamental objective of mindfulness meditation.


As previously indicated, Holzel, et al., 2011 prefaced their presentation of each of the proposed components of mindfulness meditation as coexisting within a reciprocal working model that fully illustrates the effects process of practice. The authors concluded with a discussion leading into information regarding the relationship between mindfulness and self-compassion with an argument of the possibility that mindfulness meditation may facilitate a greater sense of self-compassion, particularly within the component of emotional regulation. More specifically, they address an emergence of self-compassion research indicating this characteristic as cultivating personal motivation, perseverance, and resiliency. Overall, it is suggested that further research should be conducted, including scientific debate in response to this article, in order to further understand this relationship and to increase the knowledge of how mindfulness mediation works including studies exploring the use of the various proposed components in treatment approaches designed to address specific mental health symptoms. They also suggest a need for further research in neuroscience to aid in gaining a clear and empirically based reference for body awareness and change in perspective of the self. Article Analysis 

The general organization and integration of the related research presented in formulated their theoretical framework addressing the subject of a working model of mindfulness meditation seemed represented thoroughly and demonstrated in a logical and objective manner. There is some hesitancy in concluding with this formulation as a completely solid base in which to use as reference in providing a definition of the working process of mindfulness mediation considering there appears to be a need in developing a stronger argument, which was initially pointed out by the authors when introducing the article as a discussion intended to provoke scientific debate. However, the components proposed appear to be well defined with little question toward the need for additional inclusions considering the efficient use of available information.

This article is highly recommended for clinicians as mindfulness practices have become very popular in treatment approaches worldwide with what seems to be diminutive emphasis on the ability or even need to specify a treatment in relation to the various components addressing specific symptomology. More specifically, it seems to be overly generalized as a simple form of relaxation and stress reduction as opposed to its more complex nature and versatility in creating a wide range of effects. Finally, the authors provided an in-depth and clear description of the research indicating the effects mindfulness meditation has on neuro-functioning and structure; thus, proving useful information regarding the physiological components related to the process and area to build upon when considering the neurological deficits related to various mental health disorders with the possibility of using meditation as a way to essentially rewire the brain.

To cite this review, please use this reference: 
Thorn, S. (2012). Mechanisms of Mindfulness.Psychology Alert (4).