Processes of Mindfulness

Fletcher and Hayes (2005) define mindfulness in terms of four interrelated processes:
acceptance, defusion, present moment awareness, and the observer self.
Acceptance is the allowing of thoughts and feelings to be as they are without trying to
change their content, form, or frequency. Acceptance is the antidote to avoidance of
unwanted internal experience.
Defusion is 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.
Present moment awareness is 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.
These processes function and interact together to undermine the dominance of
language and lead to broad behavioral repertoires that support chosen values.
 Neuroimaging Meditation
Lazar et al. (2005) found that meditators had greater cortical thickness in several
areas of the brain (insula, medial prefrontal cortex (mPFC), somatosensory cortex,
auditory cortex, and occipito-temporal lobe) compared to non-meditators by using
magnetic resonance imaging (MRI) to measure the volume of cortical gray matter.
Gray matter represents areas of the brain that contain neuronal cell bodies and
function to relay sensory information. Furthermore, the amount of meditation
experience was found to correlate with cortical thickness, and no difference was
found in cortical thickness between young and older meditators, indicating that
meditation practice may prevent the usual decline in cortical thickness that comes
with age.
Hölzel et al. (2008) replicated and extended this study with voxel-based
morphometry. This allowed for measurement of deeper subcortical structures than
the previous study. This group found that meditators had greater gray matter
concentration in the right anterior insula, left inferior temporal gyrus, and right
hippocampus.
A third study showed that regular Zen meditators did not have the expected
correlation between age and decline of cerebral gray matter and attentional
performance that was found in control subjects (Pagnoni and Cekic 2007).
 Neuroimaging Meditation
Two studies examining brain activity during meditation found nearly opposite patterns
of activity. The first study took positron emission tomography (PET) scans, while yoga
teachers practiced Yoga Nidra meditation guided with an audiotape. While meditation
was associated with increased activity in the hippocampi and posterior sensory and
associative systems that are activated by imagery, when the meditators were resting,
there were increases in the systems of executive attention, including dorsal lateral,
orbital frontal cortex (OFC), and anterior cingulate cortex (ACC) (Lou et al. 1999).
In a second study, Lazar et al. (2000) looked at the neural responses when five
experienced meditators practiced a simple form of meditation that involved observing
the breath. They found signal increases in the dorsolateral prefrontal cortex (dlPFC)
and the ACC during meditation, as well as several other areas (parietal cortex,
hippocampus/parahippocampus, temporal lobe, striatum, and pre- and post-central
gyri). Systems of executive attention that correspond to meditation practice in Lazar
et al. (2000) were active during the control condition in the Lou et al. (1999) study.
 Neuroimaging Meditation
Different meditation techniques seem to involve disparate psychological processes.
Some practices, such as Yoga Nidra, encourage relaxation and guided visual imagery
(Lou et al. 1999). Others encourage awareness of the breath (Lazar et al. 2000).
Though there may be similar effects from these two practices, there are differences in
the techniques, and they are expected to produce different neural responses. The task
in the Yoga Nidra study is different from practices in other traditions, such as Zen or
Vipassana, which are largely unguided, or a mantra-focused practice such as TM.
Some authors have been interested in studying different meditation practices in order
to reveal the underlying difference in processes, for example comparing a compassion
objectless meditation to a breath awareness practice (Lutz et al. 2008a).
Present Moment Awareness
Training in contacting the present moment is traditionally a starting point for
mindfulness practice in contemplative traditions and clinical approaches. In these
traditions, mindfulness is often spoken of as a method of directing and stabilizing
one’s attention to the present. These instructions will often start with directing
attention to one’s bodily sensations, often suggesting the breath as a focus of
attention.
A present moment focus refers to the use of flexible, voluntary, and functional
attention allowing contact with aspects of the internal and external context based on
one’s goal. Attention is a way of talking about deliberate processes of altering stimulus
control, much as deliberate looking can modify contact with visual stimuli or
deliberate touching with tactile stimuli. Attention is not a mental event—it is a quality
of action.
Attentional networks have been natural targets for researchers investigating the
neural correlates of mindfulness. Study of attentional processes has uncovered
dissociable cerebral networks and pathways implicated in discrete attentional
processes: engaging, disengaging, redirecting, and sustaining attention (Raz and Buhle
2006).
 Attention
An fMRI study of concentration meditation suggests that object-centered meditation
activates regions implicated in attentional processes such as the dlPFC, involved in
stimulus monitoring, visual cortex, involved in engaging visual attention, as well as
regions involved in the orienting of attention, such as the intraparietal sulcus and the
superior frontal sulcus (Brefczynski-Lewis et al. 2007). Brain activity was measured
during a concentration meditation task alternating with a period of rest in three
groups: nonmeditators, experienced meditators with an average of 19,000 hours of
practice, and experienced meditators with an average of 44,000 hours of practice.
The difference in activation of regions associated with sustained attention in non-
meditators and experienced meditators yielded a u-shaped curve. The authors
reasoned meditation training has been compared to skill acquisition in other areas,
where more effort is needed for beginners and experts can perform the skill with
much less effort. They suggest a greater efficiency of attentional networks in experts
for whom trained stability of attention would implicate fewer cognitive resources.
 Attention
Results from this study suggest building attentional skills may result in reduced
reactivity. In response to distractions during meditation, expert meditators showed
more activation in areas associated with response inhibition and less activation in
areas related to discursive thoughts and emotion (Brefczynski-Lewis et al. 2007).
The authors found a negative correlation with hours of practice and right amygdala,
MeFG/ACC, and PCC activity in response to distractions indicating incompatibility
between sustained attention and emotional reactivity (Lutz et al. 2008a).
The authors noted areas more activated in experienced meditators overlap with areas
affected by ADD. Meditation may be useful for individuals who would benefit from
improvements in attention, though in the absence of behavioral evidence of greater
performance in sustained attention tasks, one may argue that long-term meditators
have evolved a specific way of doing the task of meditating that differs from novices.
 Attention
An EEG study conducted around a 3-month Vipassana retreat yielded evidence of
increased efficiency of attentional processing as measured by an attentional blink task
(Slagter et al. 2007). In attentional blink paradigms, stimuli are rapidly presented (50
images a second). The task is to identify target stimuli (e.g., a particular number or
letter) from the flow. When targets are separated by intervals of between 200 and
600 ms, the second target is less reliably detected. This is taken to evidence time
needed for attentional allocation. After the retreat, the attentional blink had been
reduced in novices performing the task in a non-meditative state, and the reduction
was larger in expert meditators. EEG recordings evidenced a reduction in the first
target- evoked P3b wave recorded by parietal electrodes (Pz), correlated with the
observed reduction in attentional blink. This appears to support more efficient
allocation of resources as a result of training. These results are important as they
correlate electrophysiological results with behavioral performance improvements.
 Interoception
Studies suggesting meditation-induced plasticity converge to indicate an effect on the insula
(Lazar et al. 2005; Hölzel et al. 2008). Gray matter volume in the insula might be correlated to
fine-grained interoception (Critchley et al. 2004), and meditation experience is associated with
increased cortical thickness correlated with meditation practice hours (Lazar et al. 2005).
In addition to increases in insular gray matter observed in long-term mindfulness practitioners
and correlated to hours of practice (Hölzel et al. 2008), an fMRI study showed more activations
of viscero-somatic regions during meditation practice in trained subjects (Farb et al. 2007).
This last study suggests the importance of training discrimination of bodily sensations and
highly verbal self-referential constructions. In clinical practice, many patients appear unable to
operate this discrimination in the present moment and habitually become trapped in their
verbal constructions (also known, in the cognitive therapy literature, as automatic thoughts)
and futile attempts to change these constructions. Training present moment awareness of
bodily sensations as they are would thus be an important discrimination, and the insula would
be largely implicated in this process. The insula thus appears importantly implicated in
mindfulness meditation practice and in mediating some of the clinically relevant effects.
Training finer perception of bodily sensations and bodily correlated emotion might be one of
the mediators of the clinical effects of mindfulness meditation, by increasing tolerance of
avoided sensations.
 The Observer Self
(Self-as-Context)
In Acceptance-Commitment Therapy (ACT) / Relational Frame Therapy (RFT), self-as-context, or
the observer self, is distinguished from self-as-content, or the conceptualized self, with the
former occurring in more mindful states. Self-as-context corresponds to an “experiential focus.”
It is the experience of self as an observer of thoughts, feelings, and bodily sensations as passing
events occurring in the present moment rather than as solid entities that define the self. Also
known as the “transcendent self,” self-as-context transcends static conceptual verbal
descriptors such as “I am smart” or “I am lazy” and is defined simply by the perspective of being
the one who is here, now. RFT has shown that this sense of self emerges from relational frames,
such as I/you, or here/there, or now/then. Although the study of relational framing is
advancing, at present there are no neurobiological studies of the effects of training in relational
frames per se. However, there are relevant studies on the sense of self it is thought to help
establish.
 Self-As-Content
Self-as-content maps onto the construct of the “narrative self-focus”, and is a process whereby an
individual experiences the self as defined by verbal descriptors and ongoing evaluation. This persistent
commentary creates a cohesive sense of self based on the “story” of who we are. New and old
information are filtered through this view of self to create a cohesive content-based story that reflects a
verbal knowing of self based on continual evaluation and comparison. Identifying with the self-as-
content constricts behavior and is thought to lead to psychopathology. Personality disorders and
depression have been defined by various traditions in terms of problems with self-content. Depression
can be conceptualized as domination by a negative self-view and is often accompanied by the wish for
self-obliteration via suicide, an idea that only makes sense if the self is solid and unchanging.
Identification with the self-as-content may correspond to activity in a pathway comprising the mPFC,
the precuneus, posterior cingulate, and other regions identified as the “default mode network”. Tonic
activity in these areas decreases with goal-directed activity, and activity in these areas appears to
correspond to discursive thought (Raichle et al. 2001). Activity during this “resting” state may provide
important insights into the nature of mental functions when a person is not engaged in goal-directed
behavior and thus may be important for understanding psychopathology and tailoring interventions.
The default mode network is more active during a task in depressed than in non-depressed individuals,
suggesting that hyper-activity in this network and related processes are components of depression
(Sheline et al. 2009). The depressed participants demonstrated an inability to reduce activity in default
mode areas during passive viewing and reappraisal of negative pictures compared to non-depressed
subjects. Abnormal activity in the default mode network has also been associated with several other
mental disorders, including schizophrenia, ADHD, and autism (Broyd et al. 2009).
 Self-As-Context
Meditation practices instill a sense of self that is defined by context rather than content, and
neuroscience research has shown that meditation corresponds with activity in the mPFC.
Neuroimaging has been used to show that meditators have greater cortical thickness of gray
matter in mPFC, as well as several other areas, when compared to non-meditators (Lazar et al.
2005), and that dorsal mPFC and ACC are more active in meditators engaged in mindfulness of
breathing than in non-meditators (Hölzel et al. 2007). These results indicate that meditation
practice may strengthen pathways that include the mPFC. It is also noteworthy that the study
by Brefczynski-Lewis et al. (2007) discussed earlier found that experienced meditators had less
activity in the default network areas associated with discursive thought.
Two different pathways involving the medial prefrontal cortex have been found to correspond
with processing of self-relevant verbal material (Gusnard and Raichle 2001; Schmitz and
Johnson 2007). This first extends along the dorsal region of the mPFC and is related to self-
referential processing, whether task-related or introspective, and is inclusive of the “default
network.” The other includes of the ventromedial prefrontal cortex (vmPFC) and is responsible
for integrating sensory and motor information from the external and internal environments or
orienting to salient sensory information that is determined to be self-relevant. This pathway
may correspond to the observing self or knowing oneself as the one who experiences what
arises in the present moment. This sense of self is not confined by verbal content.
 Self-As-Context
Farb et al. (2007) investigated the neural correlates of two modes of self-reference in
meditators and nonmeditators. The first mode they termed “narrative self-focus”, resulting in
activation in the “default mode.” The other mode they called “experiential focus,” which refers
to paying attention to psychological experiences in the present moment. The study compared
meditators who completed an 8-week course in mindfulness meditation to non-meditators and
found only meditators displayed a neural signature for narrative focus different from the
experiential focus. In meditators, experiential focus was correlated with greater reductions in
mPFC activation and increased activity in a right lateralized network composed of the lateral
PFC and viscero-somatic areas such as the insula, secondary somatosensory cortex, and the
inferior parietal lobule. In the non-meditators, there was a strong coupling between activity in
the mPFC and the insula that was uncoupled in meditators. This uncoupling may represent the
capacity of people trained in mindfulness meditation to distinguish between the self as an
observer of one’s experiences in the moment and the self consisting of a verbal narrative based
on past experiences.
What emerges from these studies are two different constructs related to the self, one that
seems to occur on its own through the conditioning of living in the world and the second as a
result of practicing mindfulness skills that undermine this persistent chattering. The study by
Farb et al. (2007) is perhaps the best example we encountered of how to use neuroimaging to
elucidate the potent psychological processes that occur during meditation training.
 Acceptance
In some Buddhist traditions, compassion meditation is considered one of the most advanced
practices. The practice often consists of trying to imagine others, starting with loved ones, in
extremely painful or life-threatening situations. The meditator develops the ability to open her
heart to the perceived suffering of the other and cultivates the intention to alleviate suffering.
In an fMRI study, auditory stimuli denoting another person’s emotional state (negative, positive,
and neutral) were presented to expert meditators (with over 10,000 practice hours) during
compassion meditation practice (Lutz et al. 2008b). As hypothesized, increased activations were
found for the negative auditory stimuli, i.e., those most likely to elicit compassion, in the
“empathy” pathways including insula, ACC, somatosensory cortices, PCC, and precuneus, as well
as other regions of the broad network of regions activated by empathic responses and the
representation of others’ mental states. We speculate that these pathways might also be
activated by tasks that foster self- acceptance. Our hope is that researchers soon start
correlating brain activity with clinically relevant acceptance and self-compassion processes.
 Defusion
Fusion refers to the domination of verbal events over other sources of regulation due to
difficulty separating the verbal constructions that shape perception of any private event.
Defusion refers to processes that undermine that domination by becoming aware of the process
of thinking and being able to become aware of thoughts, emotions, etc. as passing events.
A meditation exercise uses a technique to help the meditator become aware of the process of
thinking. The instructions are to note whatever is happening in the moment and to repeat the
label. For example, if the practitioner notices pain in his or her leg, they would note “pain, pain,
pain.” Next, the person notices tension in their body and thus notes “tension, tension, tension,”
then “thinking, thinking, thinking,” and so on. By repeating the label, the experience becomes
distinct from the verbal label and is allowed to arise and cease without perpetuating a “story”.
In one study, participants were evaluated for dispositional mindfulness and then placed in an
fMRI machine where they were instructed to apply affect labels to pictures of people with
various facial expressions (Creswell et al. 2007). Participants high in mindfulness displayed
greater activation in prefrontal cortex, including ventrolateral prefrontal cortex (vlPFC), and
reduced amygdala activity during affect labeling. Those higher in mindfulness had strong
negative associations between prefrontal activation and amygdala. This study illuminates a
neural correlate of the ability to disengage from autopilot, reducing the impact of verbal
activity.
 Defusion
Two areas repeatedly activated in meditation are the ACC and the dlPFC (Cahn and Polich
2006). A leading theory is that this network is involved in emotional processing (Davidson
2000).
Beauregard et al. (2001) had subjects viewed erotic stimuli and instructed them to respond
normally or inhibit reaction by being a detached observer of their own experience. In the
arousal condition, there was activation in limbic structures, including amygdala. In the inhibition
condition, there was an absence of activity in the amygdala and increases in the ACC and dlPFC.
Wyland et al. (2003) examined effects of three tasks involving cognitive regulation on brain
activity: suppression of one thought, suppression of all thoughts, and a control condition of free
thought. Comparing suppression of a thought to free thought resulted in greater activation of
the ACC, while suppression of all thoughts resulted in activation of a network including ACC and
insula. These authors viewed suppression as important for maintaining psychological health.
In a study by Levesque et al. (2003), female subjects were instructed to suppress or allow their
feelings after viewing pictures to induce sadness. The suppress condition involved taking the
position of a detached observer. They found relative activation for the suppress condition in the
right dlPFC and right OFC, but not the ACC. On further examination, they found activation in the
right ACC in 75% of subjects, revealing considerable inter-individual variation.
 Defusion
It is not clear what process leads to greater emotion regulation. Many authors have looked at
the role of suppression, although the behavioral task may involve defusion, that is, noticing the
emotion and/or the thought from a distancing perspective rather than allowing the experience
to dominate what the participant is experiencing in the present moment. Redirecting attention
could be a way to suppress or avoid an unwanted emotion or thought, or a move to attend to
something else. These behaviors differ in functions; the former is avoidant and the latter is
approaching. Defusion, noticing the thought as a thought or feeling as a feeling, creates enough
distance from the experience to make other options available. Thinking of defusion this way,
and distinguishing it from suppression or avoidance, opens the door to more precise studies.
In studies reviewed on emotion regulation, suppression is considered important for emotional
health. However, the instructions in the suppress conditions suggested that participants take
the position of an outside observer. This is similar to mindfulness instructions, and thus,
participants may not have been actively trying to push thoughts or feelings out of their mind,
but might instead have come to mindfully observe them. We see this as illustrative of the
confusions that can arise when researchers concentrate on the outcome of behavior rather
than process, with suppression defined here in terms of reduced emotional arousal. It is
important that the behavior that leads to this outcome be clearly defined and measured at the
process level.
 Interaction of Mindfulness
Processes
Contact with the present moment increases awareness of the here and now and thus facilitates
defusion and acceptance, as thoughts arising in the present are observed as thoughts, emotions as
emotions, and so on. It also allows for observation of self-relevant thoughts as they arise and fall away,
thus promoting awareness of the transcendent sense of self.
Contact with the self-as-context provides a basis from which to safely experience private content. It
allows for a fuller acceptance of previously avoided cognitions and provides distance from verbal
processes to promote defusion. It enhances contact with the present moment and chosen values. From
the perspective of the “observer,” what is present in the moment is natural and non-threatening.
Acceptance undermines avoidance and expands the scope of defusion, allowing previously avoided
content to be evoked. It allows fuller contact with the present moment as acceptance undermines the
struggle to control private experiences, reducing escape into ruminations or anxious anticipations. As it
reduces the power of private events, acceptance allows for direct experience of self-as-context.
By undermining the impact of verbal processes, defusion makes acceptance easier as evaluations of
private content as negative are put in perspective and seen for the evaluations they are rather than a
reflection of “reality.” Thus, feelings and emotions are taken less literally, which promotes acceptance
and contact with the present moment. By distancing one from one’s thoughts, conceptualized
constructions of self, and personal history, defusion also acts to promote contact with self-as-context.
 Meditation and Cerebral Context
An intriguing possibility, suggested by evidence of neural plasticity and investigations of the default-
mode network, is long-term modification of the “cerebral context” that interacts with the wider social
context. Specificities in default network functioning are correlated to psychopathology (Broyd et al.
2009) and improvements in functioning may correlate to changed patterns of default-mode activity.
In one study, EEG recordings of long-term meditators found that they displayed very high levels of
synchrony in the gamma frequency band, with the amplitude of these waves being some of the highest
ever recorded (Lutz et al. 2004). The participants practiced an objectless meditation during the
recordings that focused on a state of compassion. These findings are significant because neural
synchrony in the gamma band frequencies is associated with attention and working memory, learning,
and conscious perception. This activity is thought to represent integration of neural processes into
higher order functions that could induce synaptic changes (Lutz et al. 2004; Lutz et al. 2008a).
Numerous meditative traditions insist on the decreasing need, as practice becomes more habitual, to
seek to control perceptions, thoughts, or the focus of attention. Focused practice is but a starting point
in a learning process, the aim of which is to gradually broaden one’s attention to encompass the whole
of one’s present moment experience without undue capture by a particular salient stimulus. In that
regard, training the four mindfulness processes might recruit the broad interoceptive, attentional,
cognitive, empathy, and self networks, and thus, it might be more useful to think of the cerebral
correlates of such broad training in terms of training a global dynamic cerebral state. Such is the
proposal of Lutz et al. (2008a) who speak of “dynamical global states that, in virtue of their dynamical
equilibrium, can influence the processing of the brain from moment to moment” (Lutz et al. 2008a).
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