How Does Mindfulness Meditation Work?

How Does Mindfulness Meditation Work?
Proposing Mechanisms of Action From a

Conceptual and Neural Perspective
Author(s): Britta K. Hlzel, Sara W. Lazar, Tim Gard, Zev Schuman-Olivier, David R. Vago
and Ulrich Ott
Source: Perspectives on Psychological Science, Vol. 6, No. 6 (NOVEMBER 2011), pp. 537-559
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Perspectives on Psychological Science

6(6) 537-559
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Conceptual and Neural Perspective http://pps.sagepub.com
dSAGE
Britta . Holzel1,2, Sara W. Lazar2, Tim Gard1'2,

Zev Schuman-Olivier2, David R.Vago3, and Ulrich Ott1
Bender Institute of Neuroimaging, Justus Liebig-University, Giessen, Germany; Massachusetts General Hospital,
Harvard Medical School, Boston, MA; and 3Brigham and Women's Hospital, Harvard Medical School, Boston, MA
Abstract
Cultivation of mindfulness, the nonjudgmental awareness of experiences in the present moment, produces beneficial
well-being and ameliorates psychiatric and stress-related symptoms. Mindfulness meditation has therefore increasi
incorporated into psychotherapeutic interventions. Although the number of publications in the field has sharply i
over the last two decades, there is a paucity of theoretical reviews that integrate the existing literature into a compr
theoretical framework. In this article, we explore several components through which mindfulness meditation exer
effects: (a) attention regulation, (b) body awareness, (c) emotion regulation (including reappraisal and exposure, exti
and reconsolidation), and (d) change in perspective on the self. Recent empirical research, including practitioners' self
and experimental data, provides evidence supporting these mechanisms. Functional and structural neuroimaging stu
begun to explore the neuroscientific processes underlying these components. Evidence suggests that mindfulness p
associated with neuroplastic changes in the anterior cingulate cortex, insula, temporoparietal junction, fronto-limbic
and default mode network structures.The authors suggest that the mechanisms described here work synergistically, es
a process of enhanced self-regulation. Differentiating between these components seems useful to guide future basic
and to specifically target areas of development in the treatment of psychological disorders.
Keywords
anxiety disorders, attention, cognition, consciousness, neuroscience, positive psychology, stress disorders
Mindfulness meditation has been reported to produce beneficial treatment of disorders and improvement of health; it has also
effects on a number of psychiatric, functional somatic, and been shown to produce positive effects on psychological well-
stress-related symptoms and has therefore increasingly been being in healthy participants (Carmody & Baer, 2008; Chiesa &
incorporated into psychotherapeutic programs (cf., Baer, 2003; Serretti, 2009) and to enhance cognitive functioning (Jha,
Grossman, Niemann, Schmidt, & Walach, 2004). A large body Krompinger, & Baime, 2007; Ortner, Kilner, & Zelazo, 2007;
of research documents the efficacy of mindfulness-based inter- Pagnoni & Cekic, 2007; Slagter et al., 2007). Historically, mind-
ventions in the treatment of a number of clinical disorders, fulness is a concept stemming from ancient Buddhist philoso-
including anxiety (Hofmann, Sawyer, Witt, & Oh, 2010; phy (Bhikkhu, 2010), and is practiced to achieve enduring
Roemer, Orsillo, & Salters-Pedneault, 2008), depression (Hof- happiness (Ekman, Davidson, Ricard, & Wallace, 2005) and to
mann et al., 2010; Teasdale et al., 2000), substance abuse gain insight into a view of the true nature of existence (Olen-
(Bowen et al., 2006), eating disorders (Tapper et al., 2009), and dzki, 2010).
chronic pain (Grossman, Tiefenthaler-Gilmer, Raysz, & Kesper,
2007). Furthermore, mindfulness meditation positively influ-
ences aspects of physical health, including improved immune
function (Carlson, Speca, Faris, & Patel, 2007; Davidson et al.,
Corresponding Author:
2003), reduced blood pressure and Cortisol levels (Carlson et al.,
Britta . Holzel, Bender Institute of Neuroimaging, Justus Liebig-University,
2007), and increased telomerase activity1 (Jacobs et al., 2010). Otto-Behaghel-Str. 10 H, 35394 Giessen, Germany
Not only has mindfulness successfully been used in the E-mail: britta@nmr.mgh.harvard.edu
538 Holzel et al.
Table I. Previous Theoretical Accounts That Describe Mechanisms of Mindfulness Meditation
Publication Suggested components
Shapiro, Carlson, Astin, and Freedman (2006) Attention, intention, attitude

Brown, Ryan, and Creswell (2007) Insight, exposure, nonattachment, enhanced mind-body functioning,
integrated functioning
Baer (2003) Exposure, cognitive change, self-management, relaxation, acceptance
Five Facet Mindfulness Questionnaire (Baer, Smith, Hopkins, Observing, describing, acting with awareness,
Krietemeyer, & Toney, 2006) experience, nonreactivity to inner experience
Definition of Mindfulness including (a) insight, (b) exposure, (c) nonattachment, (d

enhanced mind-body functioning, and (e) integrated function-
ing. Similarly, in her 2003 review, Ruth Baer summarized sev-
In current research contexts, mindfulness is typically defined
as nonjudgmental attention to experiences in the present
eral mechanisms that may explain how mindfulness skills can
moment (Kabat-Zinn, 1990). Bishop et al. (2004) suggest a symptom reduction and behavior change, namely (a)
lead to
exposure, (b) cognitive change, (c) self-management, (d)
two-component model of mindfulness, where the first compo-
nent is the regulation of attention in order to maintain itrelaxation,
on the and (e) acceptance. A valuable empirical accoun
for the description of the facets of mindfulness is the Five
immediate experience, and the second component involves
Facet Mindfulness Questionnaire (Baer, Smith, Hopkins, Kri-
approaching one's experiences with an orientation of curiosity,
openness, and acceptance, regardless of their valence and
etemeyer, & Toney, 2006), which was developed based on an
item
desirability. Mindfulness is typically cultivated in formal pool of previously existing mindfulness questionnaires.
med-
Factor analyses over these items yielded five facets of mind-
itation practices, such as sitting meditation, walking medita-
tion, or mindful movements (Kabat-Zinn, 1990). The practice
fulness: observing (attending to or noticing internal and exter
nal stimuli,
of mindfulness meditation encompasses focusing attention on such as sensations, emotions, cognitions, sights,
sounds,
the experience of thoughts, emotions, and body sensations, and smells); describing (noting or mentally labeling
simply observing them as they arise and pass away. these stimuli with words); acting with awareness (attending to
one's current actions, as opposed to behaving automatically or
absentmindedly); nonjudging of inner experience (refraining
Need for a Theoretical Framework
from evaluation of one's sensations, cognitions, and emo-
It is striking that this seemingly simplistic practicetions); and nonreactivity to inner experience (allowing
can have
such a wide range of applications and effects. Alongthoughts
with theand feelings to come and go, without attention get-
many positive implications of mindfulness arises the ting caught in them).
question:
How does mindfulness work; what are its mechanisms?
The field has produced a number of studies utilizing psycho-
logical
Although there is currently a large body of literature, scales or behavioral tasks that provide empirical suppor
covering
for some
a wide range of research, including qualitative research, of the proposed components. Simultaneously, a grow-
feasi-
ing body
bility trials, controlled clinical trials, behavioral studies, andof neuroimaging literature begins to describe brain
neuroscientific research, there is a relative paucity of theoreti-
activity during the meditative state as well as changes in neural
structure
cal reviews that consolidate the existing literature into a com-and function associated with meditation practice. To
prehensive theoretical framework. our knowledge, no one has previously tried to consolidate the
existing empirical literature. Our goal is to consolidate existing
Existing research on mindfulness includes a few theoretical
accounts describing mechanisms of mindfulness meditation
findings and address several components that have been empiri-
(see Table 1). Several of these accounts expound on thecally supported. Furthermore, whereas the previous models
central
role of attention in meditation practice (Brown & Ryan,have described
2003; the process of mindfulness almost exclusively
from
Carmody, 2009; Lutz, Slagter, Dunne, & Davidson, a conceptual, psychological perspective, this presen
2008).
reviewthe
Others have suggested that several components mediate will also integrate a neuroscientific perspective. This
beneficial effects of mindfulness practice. For instance,
reviewShap-
is meant not as a complete description of the research in
iro, Carlson, Astin, and Freedman (2006) posit that the field but to stimulate scientific debate.
attention,
In this
intention, and attitude are the three critical components ofreview, we first describe what we believe to be the
mindfulness. Intentionally paying attention with acomponents
nonjudg- of mindfulness meditation. We then discuss how
these components
mental attitude leads to a significant change in perspective, a are integrated during mindfulness medita-
so-called decentering (Fresco et al., 2007) or reperceiving.
tion and suggest how they might interact with each other dur
Brown, Ryan, and Creswell (2007) also describe several
ing apro-
given situation. Finally, the relationship of self-compassion
cesses underlying the beneficial effects of mindfulness,
with the components is addressed.
How Does Mindfulness Meditation Work? 539
Table 2. Components Proposed to Describe the Mechanisms T
Self-reported and experimental

Mechanism Exemplar/ instructions behavioral findings Associated brain areas
I .Attention regulation Sustaining attention on the Enhanced performance: executive A

chosen object; whenever attention (Attention Network
distracted, returning attention Test and Stroop interference),
to the object orienting, alerting, diminished
attentional blink effect
2. Body awareness Focus is usually an object of Increased scores on the Observe Insula, temporo-parietal
internal experience: sensory subscale of the Five Facet Mind- junction
experiences of breathing, fulness Questionnaire; narrative
emotions, or other body self-reports of enhanced body
sensations awareness
3. 1 Emotion regulation: Approaching ongoing em

reappraisal reactions in a different way (Cognitive Emotion Regulation (PFC)
(nonjudgmentally, with ac- Questionnaire)
ceptance)
3.2 Emotion regulation: Exposing oneself to whatever is Increases in nonreactivity to inner Ventro-medial PFC,
exposure, extinction, and present in the field of aware- experiences (Five Facet Mind- hippocampus, amygdala
reconsolidation ness; letting oneself be affected fulness Questionnaire)
by it; refraining from internal
reactivity
4. Change in perspective on Detachment from identification Self-reported changes in self-con- Medial PFC, posterior
the self with a static sense of self cept (Tennessee Self-Concept cingulate cortex, insula,
Scale, Temperament and Char- temporo-parietal
acter Inventory) junction
Components of Mindfulness Meditation

the Theravada Buddhist tradition [Hart, 1987]; samatha in
Tibetan Buddhist traditions [Lutz, Dunne, & Davidson, 2007];
or dharana in mechanisms
We believe that an array of distinct but interacting Indian Yoga traditions [Vishnu Devananda,
are at play in producing the benefits of mindfulness meditation
1999]). They often recommend a focused attention meditation
practice and propose that the combination ofmoving
before the on following
to other types of meditations later in the
components - some of which have been identified in
learning process, previous
such as those that focus on cultivating posi-
accounts - describe much of the mechanism of action
tive emotions. through
In focused attention meditation ( HYPERLINK
which mindfulness works: M,f '1 "bibl48" 'o Mbibl48" Lutz, Slagter, et al., 2008), attention
is supposed to rest on a single object. Whenever the practitio-
1. Attention regulation ner notices that the mind has wandered off, she or he returns it
2. Body awareness to the chosen object. A typical instruction for a focused atten-
3. Emotion regulation, including tion meditation in the mindfulness meditation tradition is the
a. Reappraisal following: "Focus your entire attention on your incoming and
b. Exposure, extinction, and reconsolidation outgoing breath. Try to sustain your attention there without
4. Change in perspective on the self distraction. If you get distracted, calmly return your attention
to the breath and start again" (Smith & Novak, 2003; p.77).
These components interact closely to constitute a process Illustrating the effects of repeated practice of focused attention
of enhanced self-regulation (Carver & Scheier, 2011; Vohs & meditation, meditators report that the regular practice enables
Baumeister, 2004). However, the different components might them to focus their attention for an extended period of time
come into play to varying degrees within any specific moment (Barinaga, 2003), and distractions disturb this focus less fre-
during mindfulness meditation. In the following sections, we quently during formal meditation practice and in everyday
address each of these components individually (see Table 2 for life. In accordance with such self-reports, a number of studies
a list of the components and their characteristics). have empirically documented enhanced attentional perfor-
mance in meditators (e.g., Jha et al., 2007; Slagter et al., 2007;
Valentine & Sweet, 1999; van den Hurk, Giommi, Gielen,
/. Attention regulation
Speckens, & Barendregt, 2010).
Many meditation traditions emphasize the necessity to culti- Behavioral findings on meditation and executive attention . Dur-
vate attention regulation early in the practice (e.g., samadhi in ing focused attention meditation, distracting external events as
540 Holzel et al.
well as identified when individuals engaged in a mindfulness prac-

memories o
flicts totice while
taskawaiting unpleasant electric stimulation (Gard
goals
et al., 2010). Five days of Integrative
concentrates on Body-Mind Training
th
sations, may thoughts,
lead to greater activation of the rostral ACC during the
tainingrestingthe focu
state (Tang et al., 2009). Although ACC activation
might initially be enhanced when acquiring
disregarding distr greater atten-
or executive attent
tional control, it might later decrease with higher levels of
proposed
expertise, when
by the focus of attention
Posne
is so steady that moni-
toring distractions becomes measu
specifically superfluous (Brefczynski-Lewis,
tion Lutz, Schaefer,
task of Levinson, & Davidson,
the 2007). In addition A
to
mer, these functional findings,
Raz, &structural MRI data also indicate
Posne
that meditation practice might
meditators exert an influence on the ACC.
showed
tion Cortical thickness
task when in the dorsal ACC was greater in experi-
co
smaller enced
errormeditators compared with control subjects
scor in an analy-
and sis of brain gray matter
lower (Grant, Courtemanche, Duerden,
reaction
gitudinalDuncan, & Rainville,
study 2010), and 11 hr of Integrative sh
Body-
tice Mind Training led to an increase in white matter integrity in B
(Integrative
this the ACC (Tang
test (Tanget al., 2010). In line with the assumption
et that
fulness ACC function is strengthened through concentrative medita-
practice on
task (Stroop, tion, electroencephalogram data document 1935increased frontal
effects of an 8-week Mindfulness-Based Stress Reduction midline theta rhythm during meditation (Aftanas & Golo-
cheikine, 2002; Kubota et al., 2001). Frontal midline theta is
course on Stroop interference (Anderson, Lau, Segal, & Bishop,
associated
2007), others using this test found lower Stroop interference in with attention demanding tasks and presumably
reflects ACC (and medial prefrontal cortex) activity (Asada,
experienced meditators compared with controls (Chan & Wool-
Fukuda,
lacott, 2007; Moore & Malinowski, 2009) and a reduction in Tsunoda, Yamaguchi, & Tonoike, 1999).
Clinical relevance. The strengthening of attention regulation
Stroop interference following a brief meditation intervention
(Wenk-Sormaz, 2005). and accompanying ACC performance through mindfulness
Neural mechanism of executive attention. Neuroimagingpractice is especially promising for the treatment of disorders
that suffer from deficiencies in these functions, such as
research has established that the anterior cingulate cortex
attention-deficit/hyperactivity disorder (ADHD; e.g., Passa-
(ACC) enables executive attention (van Veen & Carter, 2002)
rotti, Sweeney, & Pavuluri, 2010) or bipolar disorder (Foun-
by detecting the presence of conflicts emerging from incom-
toulakis, Giannakopoulos, Kovari, & Bouras, 2008). Although
patible streams of information processing. During meditation,
when distracting external events or memories conflict with there is currently insufficient evidence to support the effec-
tiveness of any type of meditation for ADHD (Krisanapra-
task goals, ACC activation may contribute to the maintenance
of attention by alerting the systems implementing top-down kornkit, Ngamjarus, Witoonchart, & Piyavhatkul, 2010),
initial feasibility studies have shown promising effects on
regulation to resolve this conflict (van Veen & Carter, 2002).
improvements
Together with the fronto-insular cortex, the ACC constitutes a in attention (Zylowska et al., 2008). Bipolar
network that is involved in switching between activations disorder
of is also associated with impairments in sustained
attention and executive function, as has been established by a
different brain networks, thereby facilitating cognitive control
(Sridharan, Levitin, & Menon, 2008). Neurons in these brain
large number of empirical investigations (Ancin et al., 2010;
regions have specific properties that enable a rapid relayClark,
of Iversen, & Goodwin, 2002; Kolur, Reddy, John, Kan-
davel, & Jain, 2006; Kravariti et al., 2009; Maalouf et al.,
control signals to multiple areas of the brain (Allman, Watson,
2010). Neuroanatomical models of bipolar disorder propose a
Tetreault, & Hakeem, 2005) to initiate responses during cogni-
tively demanding tasks (Sridharan et al., 2008). key role of the ACC, and a meta-analysis has confirmed vol-
Neuroscientifc findings on meditation praice. Severalume
neu-changes in the ACC as well as state-dependent alterations
in resting state activity in this region (Fountoulakis et al.,
roscientific studies have reported the ACC to be implicated
in meditation (Cahn & Plich, 2006). Using functional2008). MRI Furthermore, ACC activation decreases during cogni-
(fMRI), Holzel et al. (2007) pursued the question of whichtive tasks in bipolar patients (Gruber, Rogowska, & Yurgelun-
brain region would be distinctly activated when meditatorsTodd, 2004). Mindfulness meditation practice might therefore
performed focused attention meditation. Compared be with
beneficial to ameliorate these deficits in cognitive function-
age-, gender-, and education-matched controls, experienceding and accompanying ACC function by strengthening these
meditators showed greater activation in the rostral skillsACC in bipolar patients (Stange et al., in press). In line with
(Holzel et al., 2007), suggesting an effect of meditation
this hypothesis, a few pilot studies have shown beneficial
practice on ACC activity. A similar effect (greater rostral
effects on symptoms in patients with bipolar disorder (Deck-
ACC activation in meditators compared with controls) was et al., in press; Miklowitz et al., 2009; Williams et al.,
ersbach
How Does Mindfulness Meditation Work? 54 1
2008). However, further research is needed

to Theravadan to assess the ef
interpretations
tiveness of mindfulness-based
ness treatments
of the body on attention
was taught re
as
tion in these disorders. (foundation of mindfulness). In
tionon
Effects of meditation practice of the Satipatthana
further componentsSutta
of att
tion. Aside from the documented
guides theimprovements
monks with thein exec
follo
attention through mindfulness, effects have also been rep
In this way he [the monk] rem
on other attention capacities. Within
body the
in and offramework of the
itself, or externa
work components described or by
bothPosner and Petersen
internally (199
and external
enhanced performance in Or "orienting" (directing and
he remains focused on the limp
attention to a subset of possible inputs) has been found
regard to the body, on the phe fo
ing an 8-week mindfulness-based
regardstress
to thereduction
body, orcourse
on the(Jhp
al., 2007) and in experienced meditators, as compared
passing away with regard to thewith
trols (van den Hurk et al., "There
2010). An improvement
is a in "aler
body" is maintained
(achieving and maintaininganda vigilant state of preparedness
remembrance. And he rem
found in experienced meditators following
by (not a to)
clinging 1 -month mind
anything in
ness retreat (Jha et al., 2007), as well
remains as a on
focused 3 -month
the bodysamin
retreat (MacLean et al., 2010). At a neurobiological
Self-report level, t
findings. Practition
findings may relate to functional
practicechanges in the dorsal
of attending and
to body se
tral attention systems (Corbetta
awareness& Shulman,
of bodily2002;
statesFox,
andC
betta, Snyder, Vincent, &subtle
Raichle, 2006). TheseIn
interoception. data sugg
qualitat
that early stages of mindfulness practice meditators
mindfulness (represented by aas
were s
mindfulness course) may lead to improvement
enced in
in their lives the functi
since they
the dorsal attention system
theinvolved in orienting,
10 meditators and m
spontaneously
intensive open monitoring meditation on a 1 -month
more differentiated retreat
experience
additionally result in improvements in the function
them reported of the v
greater emotion
tral attention system involved in
pel, & alerting.
Stark, 2006).
Participants
Other types of attention reduction
tests have course
shown further
that 3 month
illust
intensive mindfulness meditation lead to a smaller
body awareness, attent
as measured b
blink effect (a lapse in attention following
Questionnaire. a stimulus
Body with
awareness
rapid stream of presented stimuli)
Observeand modified
subscale of distributi
the ques
brain resources (Slagter awareness
et al., 2007;
of also
bodysee van Leeu
sensations (e
Wilier, & Melloni, 2009). ing,
Varying meditation
I deliberately practices
notice the se
differentially affect thesehearing,
specific attentional component
smelling, seeing, inter
Lutz, Slagter, et al., 2008,tions
for a(e.g.,
review of focused attent
Item 11: "I notice ho
versus open monitoring meditation). Future sensations,
thoughts, bodily research is an
ne
sary to assess the impact ofthe
different types of meditation
mindfulness-based p
stress re
tice on these other attentional components.
increases in scores on this scale
Attention regulation - in Behavioral
particular findings.
conflict Although
monitorin m
seems to be an important improved
mechanism that is often
capability for bodydevel
a
early in mindfulness practice.
thereA has
sufficient
been nodegree of atten
empirical evid
regulation is necessary in order to stay engaged
fact, studies in medita
that tested this c
as opposed to drifting off on
into day dreaming. Thus, succes
a heartbeat detection task,
attention regulation might interoceptive awareness,
be a building block found
for practition
to also benefit from the other mechanisms
had superior of mindfuln
performance co
practice, which will be described
(Khalsa etbelow. This
al., 2008; connect
Nielsen &
between attention regulation and other
awareness mechanisms
of heartbeat shoul
sensatio
tested in future research. mindfulness practice and thus m
awareness cultivated by the pr
studies are needed that test oth
2. Body awareness
such as tactile acuity, which ha
Body awareness can be understood asTai
experienced the ability
Chi to n
practition
subtle bodily sensations (Mehling
controlset(Kerr
al., 2009). In
et al., mindful
2008).
practice, the focus of attention is usually findings
Neuroscientific an object: of inte
Functio
experience: sensory experiences of breathing,
findings sensory exp
from the mindfulness
ences related to emotions, changes
or otherin
body
the sensations.
function andAccor
str
542
to own emotional life; in turn,

body aware an awareness of one's emotions is
tasks of inter
a precondition for being able to regulate those emotions. Help-
gray ing individuals increase their body awareness can thereforev
matter be
visceral aware
considered a relevant aspect in the treatment of psychological
Dolan, 2004).
disorders. For example, a lack of awareness of internal experi- I
in individuals after a mindfulness-based stress reduction ence - along with problems in emotion regulation - is a cru-
course (compared with individuals who had not practiced
cial problem for individuals with borderline personality
mindfulness) when they focused on their momentary experi-
disorder, and helping patients increase their internal awareness
might be one key element in its treatment (Linehan, Arm-
ence (i.e., employed an experiential focus; Farb et al., 2007).
strong, Suarez, Alimn, & Heard, 1991; Wupperman, Neu-
This study also found increased activation of the secondary
somatosensory area, which is relevant for the processing of & Axelrod, 2008). Furthermore, the increase of body
mann,
exteroceptive sensory events. In another study, a group ofawareness
par- is also relevant in the treatment of eating disorders
ticipants that had undergone mindfulness training showed (Hill, Craighead, & Safer, 2011) as well as substance abuse
disorders. In a pilot study of 16 heroin users in early recovery,
greater activation of the right insula when being presented
high levels of the Observe subscale of the Five Facet Mindful-
with sad movie clips (Farb et al., 2010). Further neuroscien-
tific evidence along the same lines comes from studies nessonQuestionnaire were associated with decreased heroin use
mindfulness in the context of pain. When presentedamong with those at high risk for relapse (Schuman-Olivier, Alba-
nese, Carlini, & Shaffer, 2011), suggesting a role for body
unpleasant stimuli during a mindful state, mindfulness medita-
awareness
tors show stronger brain activation in the (posterior) insula and in the recovery process.
Body awareness and empathy. Internal awareness of one's
secondary somatosensory cortex (Gard et al., 2010). Similarly,
mindfulness meditators more robustly activated the leftown ante-
experience has also been suggested to be an important pre-
condition for empathie responses. Accurate observations of the
rior, posterior, and mid-insula as well as the thalamus (Grant,
Courtemanche, & Rainville, 2010). The enhanced sensory
self are required for the appropriate understanding of others
(Decety & Jackson, 2004). Self-report studies provide empirical
processing has been suggested to represent increased bottom-
up processing of the stimulus, that is, awareness of the support
actual for the existence of this relationship. A higher level of
sensation of the stimulus as it is. mindful observation, as assessed with the Observe scale of the
Kentucky Inventory of Mindfulness Skills (Baer, Smith, &
Neurosdentific findings: Structural neuroimaging. Two cross-
sectional studies comparing the gray matter morphometry Allen,
of 2004), has been found to be associated with more engage-
the brains of experienced meditators and controls showed ment
thatin empathy (Dekeyser, Raes, Leijssen, Ley sen, & Dewulf,
2008), as assessed with the Interpersonal Reactivity Index
meditators had greater cortical thickness (Lazar et al., 2005)
(Davis,
and greater gray matter concentration (Holzel et al., 2008) in 1980). Neuroscientific research shows that a subset of
the right anterior insula. Although 8 weeks of mindfulness
brain regions (namely, the insula and temporo-parietal junction)
is impacted
practice did not reveal changes in gray matter concentration in both in awareness of one's own body sensations and
the insula (Holzel et al., 2011), the same study did reveal
in that
social cognition and empathie responses (Singer et al., 2004).
Enhanced function of these structures following mindfulness
8 weeks of practice led to increases in gray matter concentra-
tion in the temporo-parietal junction. It has been suggested
training might therefore also correspond to improved empathie
that the temporo-parietal junction is a crucial structureresponses
for and compassion attributed to meditation training
(Shapiro, Schwartz, & Bonner, 1998). Supporting this assump-
mediating the first-person perspective of bodily states (Blanke
et al., 2005), or embodiment (Arzy, Thut, Mohr, Michel, &
tion, research has found that Tibetan monks with over 10,000 hr
of meditation experience showed greater activation of both
Blanke, 2006), and that impaired processing at the temporo-
parietal junction may lead to the pathological experience of
regions during compassion meditation (a meditation that aims at
the self, such as out-of-body experiences (Blanke & cultivating
Arzy, feelings of empathy toward the suffering of other
2005). Morphological changes in the temporo-parietalbeings
junc-and the wish to alleviate their suffering) while they were
tion might be associated with an increased awareness of the
presented with auditory stimuli of people suffering (Lutz, Bref-
czynski-Lewis,
experience of oneself within the body. Such changes seem to Johnstone, & Davidson, 2008).
To summarize, body sensations are a common object of
correspond with translations of meditation instructions
ascribed to the historical Buddha (Bhikkhu, 2010): "His attention
mind- during mindfulness meditation, and practitioners
fulness that 'There is a body' is maintained to the extent of improved body awareness. Although there have been no
report
knowledge and remembrance." objective behavioral data supporting the increased awareness,
neuroscientific data on mindfulness practice point to the modi-
Body awareness and emotion regulation . Body sensations
fication of brain regions involved in first-person conscious
have been ascribed a crucial role in the conscious experience
experience
of emotions (feelings), not only historically (James, 1884), but of body awareness. The enhancement of body
awareness might have relevance for affect regulation and
also currently (Bechara & Naqvi, 2004; Damasio, 1999, 2003).
An increased awareness of the body's response to anempathie
emo- processes and thus may be particularly relevant in
tional stimulus might thus lead to greater awareness of one's
the mindfulness-based treatment of patients with such deficits.
Physiological
Ongoing attempts to advance studies also support the proposition
the development of instrumthat
for the valid assessment of body
meditation awareness
training (Mehling
leads to decreased emotional reactivity et
2009) will help to further and
illuminate this
facilitates a return to connection.
emotional baseline after reactivity.
For example, experienced mindfulness meditators have
shown a faster decrease in skin conductance in response to
3. Emotion regulation aversive stimuli (Goleman & Schwartz, 1976), as well as less
enhancement ofthe
In this section, we first describe the startle response byfindings
general aversive stimuli reg
(Zeidler, 2007).on
ing the effects of mindfulness An electroencephalogram
emotion regulation. study found that T
we focus on two different emotion
mindfulness-based regulation
stress strategies
reduction training led to increases in
seem to be involved in mindfulness, namely,
left-sided anterior brain activation reappraisal
after the course compared
extinction. with a wait-list control group (Davidson et al., 2003). This pat-
Role of emotion regulationterninof lateralization
meditation has previously been associatedA
practice. withgrowi
the
body of literature suggests that
experience of mindfulness
positive emotions (Davidson, practice
1992). Similarly, resu
improvements in emotion regulation.
stronger relative left prefrontal Emotion regula
activation was also recently
found as a state effect
refers to the alteration of ongoing in previously depressed
emotional individuals fol-
responses thro
the action of regulatory processes (Ochsner
lowing a short practice & Gross,
of mindful breathing 2005
and loving kind-
Theravadan translations ofnessBuddhist teachings,
meditation (Barnhofer, the
Chittka, Nightingale, alterat
Visser, &
of emotional responses is Crane, 2010). These findings
addressed in thesupportSatipatthana
the proposition that S
in terms of the overcoming of practice
mindfulness sorrow and
has an effect distress
on the as par
physiological aspects
meditation practice: of positive emotions and thus positively influences emotional
processing.
This is the direct path for the purification of beings, for
the overcoming of sorrowNeural
and mechanisms of emotion regulation.
lamentation, for the Duringdisap-
emo-
pearance of pain and distress, for
tion regulation, the
prefrontal attainment
control of the
systems modulate emotion-
generative systems, such as the amygdala, which is responsible
right method, and for the realization of Unbinding
[the monk] remains focused on feelings . .detection

for the . mind of .affectively
. . arousing stimuli (Ochsner &
mental qualities in and of themselves Gross,
- ardent, alert,
2005). More and
specifically, these prefrontal structures
mindful - putting aside greed and distress with
include dorsalreference
regions of the lateral prefrontal cortex (PFC)
to the world. (Bhikkhu, 2010) that have been implicated in selective attention and working
memory; ventral parts of the PFC implicated in response inhi-
Behavioral and peripheral physiological finding.
bition; the ACC, whichStudies
is involved in monitoring control pro-
from the field of mindfulness research have addressed
cesses; and the dorso-medial PFC implicated in monitoring
improvements in emotion regulation through a variety of affective state (Modinos, Ormel, & Aleman, 2010; Och-
one's
approaches, including experimental, self-report, peripheral
sner & Gross, 2008). Atypical pattern detected when individu-
physiological, and neuroimaging data. Healthy novices
als deliberately regulate affective responses is increased
enrolled in a 7- week mindfulness training program showed activation
a within the PFC and decreased activation in the
reduction in emotional interference (assessed as the delayamygdala
in (Beauregard, Levesque, & Bourgouin, 2001; Haren-
reaction time after being presented with affective versus neu-
ski & Hamann, 2006; Schaefer et al., 2002), suggesting that
tral pictures) compared with those who followed a relaxation
PFC projections to the amygdala exert an inhibitory top-down
meditation protocol and those in a wait-list control group
influence (Banks, Eddy, Angstadt, Nathan, & Phan, 2007;
(Ortner et al., 2007). Both the mindfulness and relaxation
Davidson, Jackson, & Kalin, 2000).2
meditation groups also displayed significant reductions in
physiological reactivity during the task. Furthermore, inPsychological
a disorders and emotion regulation. A variety
of psychological disorders are associated with reduced emo-
group of long-term practitioners, participants with more mind-
fulness meditation experience showed less emotional interfer-
tion regulation capacity (Cicchetti, Ackerman, & Izard, 1995;
ence than did less experienced practitioners. Studies using
Davidson, 2000; Gross, 1998; Hayes, Wilson, Gifford, Fol-
self-report data from healthy individuals have shown that
lette, & Strosahl, 1996; Mennin, Heimberg, Turk, & Fresco,
mindfulness meditation decreased negative mood states (Jha,
2002). Disorders characterized by a deficit in emotion regula-
Stanley, Kiyonaga, Wong, & Gelfand, 2010), improved posi-
tion are frequently associated with dysfunction in the frontal-
tive mood states, and reduced distractive and ruminative
limbic network, that is, reduced prefrontal activation and
thoughts and behaviors (Jain et al., 2007). A questionnaire
exaggerated amygdala activation (e.g., depression, H. C.
study investigating the immediate effects of brief (15-min)
Abercrombie et al., 1998; borderline personality disorder, Sil-
bersweig et al., 2007; bipolar disorder, Pavuluri, O'Connor,
stress management interventions found that mindful breathing
Harral, & Sweeney, 2007; social phobia, Phan, Fitzgerald,
may help to reduce reactivity to repetitive thoughts (Feldman,
Greeson, & Senville, 2010). Nathan, & Tancer, 2006; obsessive-compulsive disorder,
544 Holzel et al.
Breiter & regulation

Rauch, 19
2005; practice.
impulsive ag
Phan, 2007;There are several proposed classifications
addicti for different
et al., kinds of emotion regulation (Ochsner
2008; and & Gross, 2005; Parkin- tra
son & Totterdell, 1999). Ochsner and Gross (2005) have sug-
gested a distinction between behavioral regulation (e.g.,
Neuroscientific f
ulation.suppressing
In expressive behavior)
contras and cognitive regulation.
ized by Cognitive regulation can rely on attentional control (e.g.,
suboptima
and selective inattention to emotional stimuli, performing distract-
corresponding
few ing secondary tasks) or on cognitive change. Cognitive change
neuroimaging
strategies include the controlled
activation and regulation of an ongoing im
emotional
responses response, such
in (i.e., reinterpreting
as reappraisal assoc
dence the meaning of a stimulus
for the to change one's emotional response
neu
tion to it)
regulationand extinction (stimulus-response reversal). As discussed acc
was in Section 1, attentional controlin
found plays a crucial role in mindful-
a st
tional ness meditation. Whereas typical contemporarymind
(trait) descriptions
regard attentional control in emotion regulation
participants labele as adaptive
when attention is directedWay,
(Creswell, away from emotionally distressing E
material, mindfulnessmindfu
positional usually involves bringing attention to
the stimulus. Keeping attentionScale,
Awareness on an emotional reaction leads p
sitesof to athe
situation of exposure with a subsequent
prefro extinction pro-
medial PFC,
cess. Extinction plays a crucial role in producing theand
beneficial
effects of mindfulness
activity, and meditation and will be discussed (c) in
detail below. The
amygdala following section explores the role of
activity
reappraisal.
Although the abo
tional mindfulnes
Reappraisal . Reappraisal
training, other has been suggested to be one of the st
ness ways in which emotion gets regulated during mindfulness.
meditation in
for Garland et al. (201 1) described mindful emotion
emotion regulation as
regu
might "positive reappraisal," or modifi
be the adaptive process through which
stressful events are reconstrued as beneficial, meaningful,
mindfulness medi or
show benign (e.g., thinking that one will learn something from
greater a dif-
acti
ACC ficult situation). A very recent self-report study showed that wi
compared
mindfulness practice leads to increases in positive
participants comp reappraisal
and that these increases
reduction mediate an improvement in stress lev-
course,
els (Garland et al., 201 1).
participants' ventr
as augmented inh
Neuroscientific findings. Cognitive reappraisal of aversive
mindfulness-bas
patientsstimuli has been found to coincide with activity in the dorso-
presented
decreaselateral PFC,
of orbitofrontal PFC, and ACC (Eippert et al., 2007;
activat
sures Ochsner, Bunge, Gross, & Gabrieli, befor
taken 2002; Ochsner et al.,
The 2004),
observed and dorsal PFC activity has been found to go imp
along
ated with reappraisal mindfuln
with success (Modinos et al., 2010; Wager, David-
tive son, Hughes, Lindquist, & Ochsner, 2008).
effects of Thus, whereas mi
extinction
improved processes may depend
emotion more upon ventral frontal
systems (such as the ventromedial PFC) that pract
mindfulness are directly con-
nected with the subcortical systems (see Exposure,
Fredrickson, 2011extinction ,
(Shahar,and reconsolidation
Britton, for details), reappraisal may depend more
on dorsal frontal systems (Ochsner & Gross, 2008).
Different To investigate the neural correlates
strate of dispositional mind-
seems fulness in the context of reappraisal,
well establis Modinos et al. (2010)
assessed
emotion fMRI study participants'
regulati individual differences in
dispositional mindfulness with the Kentucky Inventory of
improvements s
Mindfulness Skills
umbrella term and asked the participants to either attendfor
tional responses
to or reappraise negative pictures. Findings showed that levels
of dispositional mindfulness"positive reappraisal,"

were positively and co
correlated w
activations in the left and right dorsomedial
enhanced PFCin
brain activity during
mult
in cognitive
reappraisal condition. Therefore, change strategies.
trait mindfulness seems
positively associated not conceptualized
only with reappraisal
the changessuccess
as "
fied
also with increased activation indecreased brain
brain regions activity
that supportin
kind of emotion regulation. research is needed to test the h
required prefrontal control dec
Does mindfulness involve In thereappraisal or nonappra
following section, we wil
Although the above findings tion, and reconsolidation
suggest as a fu
increased "reapprai
mindfulness meditation.
related to mindfulness (Garland et al., 2011), there also se
to be some inconsistency in the literature. Other work h
Exposure, extinction,
identified decreased cognitive control and reconsolidation.
associated During mind-
with mi
fulness meditation, interpreted as nonappraisal.
fulness, practitioners expose themselves to whatever As menti
is present
earlier in the section on body
in the fieldawareness,
of awareness, including external
experienced
stimuli as well as med
tors, when presented withbody sensations and emotional
unpleasant or experiences.
painful They letstimuli
them- du
a mindful state (Gard et al.,
selves be2010) or
affected by the a baseline
experience, refraining fromstate
engaging (Gr
Courtemanche, & Rainville, in internal
2011) reactivity
showed
toward it, and instead
enhancedbringing accep-senso
processing, that is, increased
tance to bodilybottom-up processing
and affective responses (Hart, 1987). Practitio- of
stimulus. At the same time,ners are decreased prefrontal
instructed to meet unpleasant activat
emotions (such as fear,
was observed in meditators in
sadness, both
anger, studies
and aversion) when
by turning towards they w
them, rather
presented with the painful stimuli.
than turning away (Santorelli,These findings
2000). Those people who are w
explained with a decrease new
intotop-down control,
meditation often initially representi
find this process counterintui-
lack of reappraisal. tive, but many practitioners discover that the unpleasant emo-
This discrepancy brings tions
to pass away and a
light a sense of safety or well-being
question: Does can emotio
be
regulation during mindfulness
experienced in involve
their place. cognitive control
corresponding prefrontal engagement), or is
Parallels between the process described here it character
and exposure
instead by its absence? Whereas the
therapy are evident. acceptance
Exposure of one's e
therapy is a highly effective
behavioral therapy
tional response is characterized by technique
the absence for reducing fearof and anxiety
active co
tive control over the emotional reaction,
responses (Chambless & Ollendick, 2001). bringing
Its core element is mind
awareness to emotional responses
to expose patients might
to fear-provoking initially
stimuli and prevent require
their s
cognitive control, in order to
usual overcome
response in order for them habitual ways
to extinguish the fear response of in
nally reacting to one's emotions.
and to instead acquire
Although
a sense of safety in currently
the presence of the spec
formerly
tive, it seems possible that the feared stimuli (st,of
degree 1997). meditation
Clinical studies on expo- expe
of the individual might besurerelevant
therapy show thatwhen considering
access to safety behaviors can interfere the
tion of whether mindfulnesswith the beneficial
involves effects of cognitive
an exposure situation (Lovibond,
control o
absence. Whereas beginners Mitchell,
mightMinard, Brady, & Menzies, 2009;
require moreSalkovskis, Clark,
active cog
tive regulation in order toHackmann,
approachWells, & Gelder, ongoing
1999; Wells et al., 1995).
emotional
Safety r
tions in a different way and
behaviors might
include not onlytherefore
overt behavior (such asshowavoiding grea
eye contact
prefrontal activation, expert in social phobia) but
meditators also cognitive
might avoidance.
not employ
prefrontal control. Rather,Mindfulness
they meditation
might includes
use refraining from engaging in
different strateg
they may have automated cognitive avoidance or other safety
an accepting stance behaviorstoward
by using th
experience so they no longer
enhanced require cognitive
attention regulation control
skills, thereby maximizing the eff
and they could have different
exposure to the baseline
experienced emotion. blood flow as a co
quence of plastic processes. Additionally,
A similar meditation interpretation
is often associated with high lev- has p
ously been suggested byelsBrefczynski-Lewis et al.
of relaxation in the form of increased parasympathetic tone (200
and decreased sympathetic activity (Benson, 2000). Peripheral
regard to attentional control.
physiological have
To summarize, several studies changes have been observed with some consis-
demonstrated improv
ments in emotion regulationtency (but see Shapiro, 1982), with
associated including decreased heart rate
mindfulness.
(Zeidan, Johnson, Gordon,
chological disorders characterized by & Goolkasian,
problems 2010), decreased
in emo
blood pressure (de la anxiety
regulation, such as mood disorders, Fuente, Franco, &disorders,
Salvator, 2010), or
decreased
derline personality disorder, canCortisol
benefitlevels (Carlson
from et al., 2007),
thedecreased
enhancem
of emotion regulation capacities. Different
breathing rate (Lazar et al., 2005), loweredemotion
oxygen and carbonregul
strategies might show improvements
dioxide consumption (Young &following
Taylor, 1998), decreasedmindful
skin
practice. Some studies have
conductanceconceptualized the
response (Austin, 2006), and decreased impr
muscle
tension (Benson,
emotion regulation associated with 2000). Since extinction mechanisms
mindfulness are
practice
546 Holzel et al.
thought to
2005) be
positively correlated suppo
with extinction recall. In addition,
ation while the individual encounters the feared stimuli hippocampal activation has also been found to be involved in
(Wlpe, 1958), the relaxation component of meditation might
fear extinction recall. Functional connectivity analysis reveals
serve to maximize the effects of the extinction process. that the vmPFC and hippocampus work in concert during
In the Five Facet Mindfulness Questionnaire, the capacity
extinction recall to inhibit fear, suggesting that they comprise
to expose oneself to internal experience without reactivity is
a network that mediates the expression of extinction memory
captured in the Non-Reactivity to Inner Experience Scale. in the appropriate context (Milad et al., 2007). Hippocampal
Example items are "In difficult situations, I can pause without
activation during extinction recall is likely related to signaling
immediately reacting" (Item 21), or "When I have distressing
the extinguished context (contextual safety; Corcoran, Des-
thoughts or images I am able just to notice them without mond,
react- Frey, & Maren, 2005; Corcoran & Maren, 2001). The
ing" (Item 29). With completion of a mindfulness-based stress
amygdala has been implicated in both human and animal stud-
reduction course, scores on this scale increase with large effect
ies as playing a crucial role during the acquisition and expres-
sizes (Carmody & Baer, 2008), corroborating the theory sion that of conditioned fear (Davis & Whalen, 2001; LeDoux,
mindfulness practice leads to the self-perception of decreased
2000; Pare, Quirk, & Ledoux, 2004; Phelps & LeDoux, 2005),
reactivity. This likely is a mechanism for facilitating
including the detection of stressful and threatening stimuli and
exposure. the initiation of adaptive coping responses (Hasler et al.,
2007). When individuals regulate their emotions, the amyg-
Fear conditioning, extinction , and reconsolidation . The pro-
dala is thought to be down-regulated by the vmPFC and hip-
pocampus (Banks et al., 2007; Davidson et al., 2000; Milad,
cess of fear extinction has been studied extensively in the con-
text of conditioned fear. Fear conditioning is a learning process
Rauch, Pitman, & Quirk, 2006), both of which have extensive
in which a neutral conditioned stimulus (e.g., a tone) is paired
connections with the amygdala. This inhibition of the amyg-
with an aversive unconditioned stimulus (e.g., a shock). After
dalaa serves to suppress fear (Milad et al., 2006; Rauch, Shin,
& Phelps, 2006), thereby allowing control over behavioral
few pairings, the presentation of the conditioned stimulus comes
to also elicit various fear responses (e.g., freezing in animals;
reactions to emotions (Price, 2005). Deficits in fear extinction
sympathetic arousal in humans). Repeated presentations ofare thethought to be related to a number of psychiatric disorders,
conditioned stimulus in the absence of the unconditioned stimu-
and neuroimaging studies have shown that the aforementioned
lus result in the extinction of the conditioned responses. Extinc-
structures are dysfunctional in several psychiatric disorders,
tion does not erase the initial association between conditionedsuch as posttraumatic stress disorder (Milad et al., 2009),
and unconditioned stimuli but is thought to form a new memory
schizophrenia (Holt et al., 2009), and depression (Anand et al.,
trace (Quirk, 2002; Rescorla, 2001) or reconsolidate the2005).
old
memory with new contextual associations (Inda, Muravieva, &
Effects of meditation practice on the neural network
Alberini, 2011; Nader & Einarsson, 2010; Rossato, Bevilaqua,
Izquierdo, Medina, & Cammarota, 2010). After extinction train-
underlying extinction. There is recent evidence from ana-
ing, extinction memory is thought to compete with conditioned
tomical MR! studies that the aforementioned brain regions
memory for control of fear expression (Myers & Davis, 2007).
show structural changes following mindfulness meditation
Recent research has shown that successful extinction memory
training. Cross-sectional studies comparing mindfulness med-
itators and nonmeditators found that meditators showed
reliably differentiates healthy from pathological conditions
(Holt et al., 2009; Milad et al., 2008). Extinction learning and its
greater gray matter concentration in the hippocampus (Holzel
etof
retention may thus be a critical process in the transformation al., 2008; Luders, Toga, Lepore, & Gaser, 2009). Further-
maladaptive states. It allows individuals to learn not to have a
more, Holzel et al. (2011) recently observed that structural
fear response to neutral stimuli, when there is no adaptive func-
changes in the hippocampus were detectable within a period
of only 8 weeks in participants that underwent mindfulness-
tion for the fear response. Rather, individuals can flexibly elicit
other more adaptive emotional and behavioral responses. based stress reduction, and Holzel et al. (2008) found that
cumulative hours of meditation training were positively
Neural mechanisms of fear extinction and extinction correlated with gray matter concentration in the vmPFC in
retention. Recent fMRI research on fear conditioning experienced
has meditators. In a longitudinal study enrolling par-
identified a network of brain regions that are crucial for ticipants
the in an 8-week mindfulness-based stress reduction
extinction of conditioned fear responses and its retention.course,
As Holzel et al. (2010) found an impact of the stress-
outlined below, this network seems to strengthen through
reducing effects of mindfulness meditation on the amygdala;
mindfulness practice. The ventromedial prefrontal cortex
the greater the decrease in participants' scores on perceived
(vmPFC) has been shown to be important for the successful
stress over the 8 weeks, the greater a decrease they showed in
recall of the extinction (Milad & Quirk, 2002; Morgan, gray matter concentration in the right amygdala. Modified
Romanski, & LeDoux, 1993; Quirk, Russo, Barron, & Lebrn,
gray matter concentration in these regions that is dependent on
2000), with the magnitude of vmPFC activation (Milad et meditation
al., training might potentially be related to the improved
2007) and the cortical thickness of the vmPFC (Milad et al.,
ability to regulate emotional responses. Furthermore, fMRI
(Olendzki,involves
studies show that meditation 2010). When internal awareness becomes enhanced
activation of the h
campus and medial PFC (Lazar etmeditators
through meditation, al., 2000; Lou
report that they et al., 1
can observe
mental processes that
Newberg et al., 2001), suggesting with increasing clarity (cf. MacLean
regular et al.,
meditation
tice enhances the function20 of these
1 0) and brain
increasing temporal regions.
resolution. Addition
Within this enhanced
for those with social anxiety disorder,
clarity, the amygdala
process of a repeatedly activatio
arising sense of self becomes
reduced following 8 weeks observable
of to the meditator through development
mindfulness practice of meta- (Gold
Gross, 2010). There thusawareness.
appear to isbe
Meta-awareness a form striking similar
of subjective experience
in the brain regions beingandinfluenced
executive monitoring, in bywhich one takes a nonconceptual
mindfulness me
tion and those involved in mediating
perspective fear
as a distributed form extinction.
of attention toward the con- Th
tents of conscious experience
findings suggest that mindfulness meditationand the processes could
involved. dire
influence one's capacity Meta-awareness
to extinguish is not entangled in the conditioned
contents of awareness fea
(Deikman,
enhancing the structural and 1982; Raffone & Pantani,
functional 2010; Varela, Thompson,
integrity of the
network involved in safety& Rosch, 1991) and facilitatesThe
signaling. a detachment from identifica-
neuroscientific
siderations described heretionsupport
with the static sense of self. previously
the Rather than as a static entity
held v
or structure, the sense
that extinction might contribute toof self
somecan be experienced
of the as an event
benefic
effects of mindfulness (Olendzki, practice 2006). It has been postulated
(Baer, 2003;that paying close
Brown e
2007). attention to the transitory nature of this sense of self leads to
the "deconstruction of the self' (Epstein, 1988). The Dalai
The impact of extinction processes within meditation Lama describes the resulting understanding that practitioners
practice . The role of extinction processes in the improve- reach: "This seemingly solid, concrete, independent, self-
ments following mindfulness-based treatments is most obvi- instituting I under its own power that appears actually does not
ous in the treatment of anxiety disorders, which have reliably exist at all" (Gyatso, 1984, p.70). In place of the identification
been found to benefit from mindfulness practice (Kabat-Zinn with the static self, there emerges a tendency to identify with
et al., 1992; Kimbrough, Magyari, Langenberg, Chesney, & the phenomenon of "experiencing" itself.3
Berman, 2010; Roemer et al., 2008). Nonreactivity and the From a Buddhist perspective, identification with the static
successive extinction mechanism presumably also play a cru- sense of self is the cause of psychological distress, and dis-
cial role in the stress-reducing effects of mindfulness and identification results in less afflictive experience and the free-
might mediate decreased perceived stress scores (Carmody & dom to experience a more genuine way of being (Olendzki,
Baer, 2008; Chang et al., 2004). They might also be highly 2010). As the psychologist Jack Engler (2004) puts it:
relevant for the benefits of mindfulness in the treatment of When it is realized that no self is to be found in the ele-
substance abuse (Brewer et al., 2009). Beyond that, exposurements of our experience, it begins the process of liberation.
is pursued toward whatever emotions present themselves, Understanding that our sense of "I" is not as solid, permanent,
including sadness, anger, and aversion, as well as pleasant or substantial as we habitually hold it to be ultimately uproots
clinging, attachment, and hostility. Understanding this burns
emotions, such as happiness. We therefore suggest that extinc-
tion is effective during all of these emotional experiences, up the fuel that runs our repetitive habits. Those who have
leading to an overwriting of previously learned stimulus- understood this report a sense of spacious lightness and free-
response associations. Buddhist teachings claim that the non-dom. They exhibit deep concern and tenderness for others.
clinging to unpleasant and pleasant experiences leads to According to Buddhist philosophy, a change in perspective
liberation (Olendzki, 2010). Framed in Western psychological on the self is thus the key in the process to enduring forms of
happiness.
terminology, one could say that nonreactivity leads to unlearn-
ing of previous connections (extinction and reconsolidation) Whereas more advanced meditation practices are required
and thereby to liberation from being bound to habitual emo-to experience this drastic disidentification from the static sense
tional reactions. of self, a de-identification from some parts of mental content
is often experienced even in the earliest stages of meditation
practice. In mindfulness practice, all experiences are observed
4. Change in perspective on the self as they arise and pass. By closely observing the contents of
The essence of Buddhist psychology lies in the teaching that consciousness, practitioners come to understand that these are
there is no such thing as a permanent, unchanging self (Olen- in constant change and thus are transient. The mindful, non-
dzki, 2010). Rather, the perception of a self is a product of anjudgmental observation fosters a detachment from identifica-
ongoing mental process. This perception reoccurs very rapidlytion with the contents of consciousness. This process has been
in the stream of mental events, leading to the impression thattermed "reperceiving" or "decentering" (Carmody, Baer,
the self is a constant and unchanging entity. The self is experi-Lykins, & Olendzki, 2009; Fresco et al., 2007; Shapiro et al.,
enced as being the one who inhabits the body, being the one 2006) and has been described as the development of the
who is thinking the thoughts, being the one experiencing emo-"observer perspective" (Kerr, Josyula, & Littenberg, 2011).
tions, and being the agent of actions; having free will We suggest that although this stage is not yet the full
548 Holzel et al.
including areas of the medial PFC (Gusnard, Akbudak, Shul-

disidentification
above, man, & Raichle,
it is 2001 ; Kelley et
a al., 2002; Sajonz
chan et al., 2010),
an posterior cingulate cortex /anterior precuneus
alteration in (Sajonz et al., fi
2010), and also the inferior parietal lobule (Sajonz etcon
Philosophical al.,
2010). The medial PFC has been shown
experiential to support an array of
repor
the self self-related
acapacities, including memory for self-traits (Kel-
crucial r
tion. However, ley et al., 2002; Macrae, Moran, Heatherton, Banfield, & Kel-pe
operationalize, ley, 2004) or reflected self-knowledge (Lieberman, Jarcho, & an
lished thatSatpute, 2004). The posterior docum
cingulate cortex and precuneus
fulness meditation. This area of research could benefit from are engaged when individuals assess the relevance or signifi-
the introduction of clear and consistent definitions of self- cance of a stimulus for themselves (Gusnard et al., 2001;
related processes as well as terms that until now have been Schmitz & Johnson, 2007) and have been suggested to be par-
applied inconsistently among various authors and disciplinesticularly important for the integration of self-referential stim-
uli in the emotional and autobiographical context of one's own
(e.g., I, me, ego, self, etc.). Although a clarification of the defi-
person (Northoff & Bermpohl, 2004). All of these structures
nitions, theories, and conceptualization is far beyond the scope
of this article and is not its focus (but see Legrand & Ruby,show high activity during rest, mind wandering, and condi-
2009, and Strawson, 2000), we summarize the few self-report tions of stimulus-independent thought (Northoff et al., 2006)
and neuroimaging studies that touch on a change in the per- and have therefore also been characterized as the "default
spective on the self through mindfulness practice. mode" of the brain or as the default mode network (Buckner,
Andrews-Hanna, & Schacter, 2008; Gusnard & Raichle,
Self-report findings. Self-report studies have begun to docu-
ment the experienced changes in perspective on the self fol- 2001).
lowing mindfulness practice. In a qualitative analysis of A few MRI studies have begun looking at activity in the
diaries, Kerr and colleagues focused on the development of an default mode network in association with mindfulness prac-
tice. Comparing brain activation during mindfulness medita-
"observing self," or meta-perspective on experience, and have
described how participants experience this shift over the tion versus a resting state reveals decreased brain activity in
course of an 8-week mindfulness-based stress reduction course subsystems of the default mode network (Ott, Walter, Geb-
(see Kerr et al., 2011, for a description of participants' self- hardt, Stark, & Vaiti, 2010). The authors interpret this decrease
reports). Questionnaire studies have also documented changes as a diminished involvement in the habitual mode of self-
in individuals' self-concept following mindfulness meditation reference during meditation practice. Meditators show greater
practice. Participants' self-reports of internal and external resting-state functional connectivity within the default mode
aspects of self-representation (assessed with the Tennesseenetwork than do nonmeditators (Jang et al., 2010). Another
Self Concept Scale; Roid & Fitts, 1988) showed highly sig- study of experienced meditators also reports increased func-
nificant changes on almost all of the subscales after comple- tional connectivity between posterior cingulate cortex and
tion of a 7-day mindfulness retreat (Emavardhana & Tori, dorsal ACC and dorso-lateral PFC both during rest and during
1997). Changes can be summarized as a more positive self- mindfulness meditation among experienced meditators com-
representation, more self-esteem, and higher acceptance of pared with novices, suggesting increased conflict monitoring
oneself. A cross-sectional study (Haimerl & Valentine, 2001) and cognitive control over the function of default mode net-
that examined the Self-Concept scales of the Temperament work after significant meditation training (Brewer et al.,
and Character Inventory (Cloninger, Svrakic, & Przybeck,2011). Although still limited in scope, these studies suggest
1993) of Buddhist meditators with varying levels of medita- that default-mode network activity and connectivity might be
tion experience found that increased meditation experience affected in some way by mindfulness meditation practice.
was associated with positive development on each of the three Probably the most insightful neuroimaging study to address
scales. More experienced meditators showed self-concept the neural correlates of a change in perspective on the self is by
styles that are typically associated with less pathological Farb et al. (2007), which investigated brain activity during
symptoms. Although these studies do not describe the drastic two forms of self-reference in participants who completed a
change in sense of self that highly experienced meditators mindfulness-based stress reduction training; these participants
have reported following deep states of meditation, they sug-were compared with another group of individuals who had not
gest that some beneficial changes in the perspective on the selfyet undergone training; the forms of self-reference included a
can happen resulting from mindfulness meditation practice. narrative focus (evaluative monitoring of enduring traits) and an
Neuroscientific findings : Funional neuroimaging. Neuroim- experiential focus (momentary first-person experience). Indi-
aging studies of mindfulness meditation have demonstrated viduals with the mindfulness training showed larger reductions
that brain structures that support self-referential processing in the medial PFC during the experiential (compared with the
are structurally and functionally impacted by mindfulness narrative) focus, along with increased engagement of the right
meditation. Self-referential processing robustly activates cor- lateral PFC, the right insula, secondary somatosensory cortex,
tical midline structures of the brain (Northoff et al., 2006), and inferior parietal lobule. Functional connectivity analyses
between
revealed an uncoupling of the each component
right insulamight seem
andartificial. We want to PFC, and
medial
illustrateof
there was increased connectivity the interaction
the of the components
right with an example:
insula with dorso-
During mindfulness meditation,
lateral PFC regions in the experiential focusthe meditator's the
after goal is to mindful-
maintain attention
ness training. The authors interpret to currentfindings
these internal and externalas
experiences
representing
with a nonjudgmental
a shift in self-referential processing, stance, manifesting
namely, asacceptance,
a shift curios- "toward
ity, and
more lateral prefrontal regions openness. When an emotional
supporting a morereaction getsself-detached
triggered
by thoughts, sensations, memories,
and objective analysis of interoceptive (insula)or external stimuli
and(e.g., a
exterocep-
tive (somatosensory cortex) memory
sensory events,
of a frightening rather
event), the executive than their
attention system
(Section 1) detects the conflictvalue
affective or subjective self-referential to the task goal of maintaining is repre-
[which
a mindful state. (Farb
sented by medial PFC activation]" Heightened body
et awareness
al.,(Section
2007, 2) helps p. 319).
to detect activity
Furthermore, given the higher physiological aspectsof
of the regions
feelings present (e.g.,
supporting
body and internal awareness, these
body tension, data
rapid heartbeat, also
short shallow suggest
breath), and the that
increased body awareness mightprovided information
be closely about the internal
relatedreaction to the
to stimu-
changes in
lus is a prerequisite for accurate
the perspective on the self, consistent with Buddhist philosophy.identification of the triggered
emotional response
Greater internal awareness might replace (i.e., fear).
theEmotion regulation processes narrative
previous,
form of self-reference. (Section 3) then become engaged, in order to relate to the
experience differently
Neuroscientific findings: Structural rather than with a habitual In
neuroimaging. reaction
the(i.e., recent
longitudinal structural studysimplymentioned
noticing the fear as opposed to engaging (Holzel
above in avoidance et al.,
mechanisms).
2011), the posterior cingulate cortex, The first two
the mechanisms (sustained attention
temporo-parietal
junction, and the hippocampus[1] to body awareness [2]) lead
showed to a situation of exposure,
increased gray and matter
the third mechanism (regulating for nonreactivity)
concentration following mindfulness-based stress facilitates
reduction.
Given the relevance of these response
brain prevention, leading to extinction and
structures forreconsolidation
the experi-
(3). Rather thanthat
ence of the self, it seems possible being stuckthein the habitual reactions to the changes
structural
external and internal
might be associated with changes in environment, the meditator can experi- on the
the perspective
encethat
self. It is interesting to note the transitory
thenaturehippocampus,
of all related perceptions, emotions,
temporo-
or cognitions in each moment
parietal junction, posterior cingulate cortex, of experience.
and The awareness
parts of of the
medial prefrontal cortex form the transitory
a brain nature of the self and one's momentary
network (Vincentexperi- et al.,
ence leads to a change
2006) that supports diverse forms of inprojecting
the perspective on the selfthe(4), where
self onto
another perspective (Buckner & processing
self-referential Carroll, 2007),
(i.e., the narrative including
of the relevance
of the stimulusabout
remembering the past, thinking for oneself) becomes
thediminished,
future while first-
(Schacter,
person experiencing
Addis, & Buckner, 2007), and conceiving becomes enhanced.
theThe entire process
viewpoint of
represents enhanced
others, also referred to as a theory ofself-regulation,
mind (Saxe which - according to
& Kanwisher,
Karoly (1993)
2003). These abilities have been - is defined as a process
suggested to thatshare
enables individu-
a common
als to guide their goal-directed activities information
set of processes, by which autobiographical by modulation of is
thought,
used adaptively to enable the affect, behavior, or attention
perception of via deliberate or auto-
alternative per-
mated use 2007).
spectives (Buckner & Carroll, of specific mechanisms.
Structural changes in
this brain network (involved in As illustrated
the by the example, the described
projection of components
the self onto
another perspective) may be mutually facilitate each other.
associated Attention regulation
with is espe-
the perceptual
cially important
shift in the internal representation ofand,the
as the basis
self of allfollowing
meditation tech- mind-
fulness practice. niques, appears to be a prerequisite for the other mechanisms
The change in the perspective onattention
to take place. Focused the selfevents
on internal isis precisely
neces-
sary in order forbut
described in the Buddhist literature practitioners
has to gain
yet an increased
to be awareness
rigorously
tested in empirical research. ofThe
bodily sensations
findings with the resultant ability to recognize
reviewed here exem-
the emergence
plify early steps in the process of emotions. The ability
of changing the to keep attention
perspective on
focused on conditioned
the self but are still far from addressingstimuli is also a prerequisite
the for the
experiences
described by highly trained successful
meditation extinction of conditioned responses. Enhanced Research
practitioners.
body awarenessway
studies that are currently under might be very
willcloselyhelp
related to the changes
elucidate this
process further and will givein us
the perspective
more on the self and might replace
insight into a narrative
the underly-
form
ing neuroscientific mechanisms. of self-reference. The change in perspective on the self
may result in reappraisal of situations in specific ways, which
might provide motivation for further development of atten-
Integration tion regulation and body awareness. As the components
The above described components (see Table 2 for a summariz- mutually facilitate each other, the occurring process could be
ing overview) are presumably highly interrelated. In fact, they understood as an upward spiral process (cf. Garland et al.,
might interact so closely with one another that a distinction 2011).
550 Holzel et al.
Self-Compas
practices vary in the degree to which they foster its increase.
Some types of practices are pursued with the primary goal of
The cultivating (self-) compassion (Germer, 2009; Salzberg,
concept of 1995), s
ness. while others strongly emphasize self-compassion within the
According t
self-compassion
context of traditional mindfulness meditation (Brach, 2003).
(being In mindfulness-based stress reduction, even and
kind though it is not u
perceivedthe declared primary goal of the program, self-compassion is
inadequ
self-critical),
implicitly and explicitly interwoven into meditation instruc- co
ences as tions, exemplified
part by reminders included in focusedofattention t
them asmeditation: "whenever
separatinyou notice that the mind has wandered
context off, bringdefined
it back with gentleness and kindness." The gentle
ings in yogabalanced
stretches are practiced with an emphasis on "exploring a
them" what feels good for oneself and one's body in this moment."200
(Neff,
(2003a), Whenever participants encounter physical pain or emotional
mindfuln
nents ofsuffering, they are encouraged to "take care of themselves."
self-com
In line with these practices, self-report studies show that
self-compassion scores increase over an 8-week mindfulness-
The relations
based stress reduction course (Birnie et al., 2010; Shapiro,
mindfulness Astin, Bishop, & Cordova, 2005; Shapiro, Brown, &
In their current conceptualization and operationalization Biegel, 2007; but also see P. D. Abercrombie, Zamora, &
within contemporary research contexts (Baer et al., 2006; Korn, 2007).
Neff, 2003a), mindfulness and self-compassion are highly cor-
related. The total score of the Five Facet Mindfulness Ques-
tionnaire and the total score of the Self-Compassion Scale
Self-compassion within the theoretical
have been found to be correlated (r = .69) in a sample of non- framework proposed here
meditators (Hollis-Walker & Colosimo, 2011). Assumptions Within the framework of mechanisms proposed in this study,
have been put forth about the nature of their relationship, and self-compassion is presumably most related to emotion regu-
it has been suggested that mindfulness is required in order for lation as well as to the change in perspective on the self. The
self-compassion to develop because the former enables one to generation of feelings of kindness toward oneself in instances
clearly see mental and emotional phenomena as they arise of perceived inadequacy or suffering (self-kindness) is an act
(Neff, 2003b). In line with this assumption, changes in mind- of emotion regulation. When cultivating self-compassion,
fulness have been found to predict changes in self-compassion seeing one's difficult experiences as part of the larger human
(Birnie, Speca, & Carlson, 2010). It has also been suggested experience rather than seeing them as separating and isolat-
that self-compassion partially mediates the relationship ing (common humanity) might initially require reappraisal.
between mindfulness and well-being (Hollis-Walker & Colo- This reframing might ultimately result in a change in the per-
simo, 2011). Furthermore, the cultivation of self-compassion spective on the self, where one relates to oneself in a less
has been suggested to explain much of the success of identified manner. However, there is currently only a very
mindfulness-based interventions. Kuyken et al. (2010) found small empirical basis for the explanation of the mechanisms
that the positive effects of a mindfulness-based cognitive ther- of self-compassion, and it is possible that unique aspects of
apy intervention on depressive symptoms were mediated by self-compassion are not addressed within the suggested
the enhancement of self-compassion across treatment. In components.
patients with anxious distress, scores on the Self-Compassion We are unaware of any published data on the neural corre-
Scale have been found to correlate more strongly with symp- lates of self-compassion in the context of mindfulness training
tom severity and quality of life than scores on the Mindful or on the neural basis of self-compassion (but see Lutz,
Attention Awareness Scale (Van Dam, Sheppard, Forsyth, & Brefczynski-Lewis, et al., 2008, for altruistic compassion).
Earleywine, 201 1). However, given the strong interrelatedness However, with the availability of the Self-Compassion Scale
of both constructs, it might be difficult to tease their effects (Neff, 2003a), there has been a drastic increase in the investi-
and relationship apart. gation of self-compassion in the context of mindfulness-based
interventions in the last few years, and a considerable body of
literature documents the improvement of self-compassion
The cultivation of self-compassion in with mindfulness meditation practice. The question about the
meditation practice exact nature of the relationship between both constructs and
Meditation is typically practiced with an intention - implicit their interconnection from an empirical and neuroscientific
or explicit - to cultivate self-compassion as well as compas- perspective will have to be revisited once more research is
sion toward other beings. Different types of meditation available.
How Does Mindfulness Meditation Work ? 55 1
Further Considerations In the progression of meditation expertise, the different

mechanisms might play different roles. For example, it is pos-
We have suggested here that mindfulness meditation sible that an improvement in attention regulation evolves first
practice
comprises a process of enhanced self-regulation that can facilitate other processes. Conversely, the change in
and helps
be differentiated into distinct but interrelated components,
perspective on the self might develop rather late, following the
namely, attention regulation, body awareness, emotion establishment
regula- of increased body awareness and improved
emotion regulation. Beyond the mechanisms formulated here,
tion (reappraisal and extinction), and the change in perspective
on the self. Previous work has often focused on one of these it is possible that increased experience in mindfulness practice
facilitates the flexible access to the different components. Pos-
components, neglecting the others and attempting to describe
the beneficial effects of mindfulness-based interventions sibly the greatest effect of mindfulness practice for adaptive
functioning in daily life might be found in this behavioral
solely through one of the mechanisms (Brown & Ryan, 2003;
Carmody, 2009). Other work has suggested an array of distinct
flexibility.
components, but these components were not related to oneFuture clinical psychological research should establish
another (Baer, 2003; Brown et al., 2007). Our work in estab- what roles the different components play for different psycho-
lishing relations between identified components of mindful- logical disorders. Disorders that manifest as the dysfunction of
ness meditation practice is a step toward a more complex a certain component could especially benefit from the cultiva-
framework. Such a framework describing a comprehensive tion of that particular component. For example, strengthening
process and simultaneously considering the role of subcompo- attention regulation might be most beneficial for patients suf-
fering from attention deficit disorders, while borderline per-
nents will help advance the field in several ways. First, when
conducting basic mindfulness meditation research, differenti-sonality disorder patients, people in addiction recovery, or
ating between distinct components will facilitate a more patients with alexithymia might benefit much from increased
detailed understanding of the process and stimulate multifac-internal awareness. Likewise, patients with mood disorders,
eted research questions. Second, a detailed understandinganxiety
of disorders, borderline personality disorder, or aggres-
sion might benefit from improved emotion regulation. Change
the different components and their relevance for clinical disor-
ders will be conducive for the flexible and more targeted in self-perspective might be beneficial for patients with mood
application of mindfulness training in psychiatric treatment disorders and might also enhance general sense of well-being
and will in turn facilitate the establishment of targetedasand well as overall quality of life in healthy populations. Rather
cost-effective programs specifically utilizing componentsthan thatsolely testing the usefulness of mindfulness-based inter-
ventions for symptom reduction for these disorders in general,
are most relevant for a specific disorder. Third, a better under-
future research should focus more on establishing the mecha-
standing of the state and trait effects of mindfulness practice
will also be conducive to a better understanding of the func-
nisms underlying these beneficial effects.
Different mechanisms might be relevant for different per-
tioning and cultivation of a healthy mind, thereby contributing
to the newly emerging field of positive psychology. sonality types. Individuals likely differ in the extent to which
Presumably, the distinct components differ in their they rele-are attracted to the practice of each of these components,
vance for types of mindfulness-based meditation practices, and they might differ in the extent to which they can benefit
from each of the described mechanisms. For example, it has
levels of meditation expertise, specific psychological disor-
been found that a self-compassion intervention for smoking
ders, personality types, and specific situations. In the follow-
reduction was particularly beneficiai for individuals high in
ing section, we will suggest connections between the described
components and these variables. The suggested connections self-criticism and low in readiness to change (Kelly, Zuroff,
mostly lack empirical support thus far and are mainly meant Foa,
to& Gilbert, 2010). In the same way, individual differences
stimulate further research questions. should be taken into account in meditation research. Future
Various types of mindfulness practice may place diiferentstudies should try to identify traitlike predictors as well as bio-
emphasis on the described components. For example, during logical
the markers for (a) attraction to specific kinds of practice
practice of breath awareness or the body scan (Hart, 1987),and
the(b) benefits from particular aspects of such practices.
components of attention regulation and body awareness mightAside from differing in relevance between different disor-
be most involved. Observing one's emotions in emotionally
ders, personality types, levels of expertise, and types of prac-
tices, these mechanisms will have distinct relevance for
challenging situations (Kabat-Zinn, 1990) may involve body
awareness and extinction. Open awareness practice might different contextual situations. Depending on the kind of situ-
mostly involve the change in perspective on self, whereasation
lov- to which a practitioner is being exposed, one of the
mechanisms might move into the foreground, while others
ing kindness and compassion meditation (Salzberg, 1995) might
rely on emotion regulation and the change in perspective onbecome
the less relevant.
Mindfulness as a state, trait, and clinical intervention has
self. Investigating which components are involved in mindful-
been extensively researched over the last two decades; how-
ness meditation and which are potentially strengthened by these
different types of practice can help individuals in selecting
ever, knowledge of the underlying mechanisms of mindfulness
which they would like to specifically cultivate. is still in its infancy. Future work should identify additional
552 Holzel et al.
components of
Anand, A., Li, Y., Wang, Y., Wu, J., Gao, S., Bukhari, L., . . . Lowe, m
components descr
M.J. (2005). Activity and connectivity of brain mood regulating
nisms or how
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A functional magnetic resonance study. Bio-
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ate eachAncin, I., Santos,
compone J.L., Tijeira, C., Sanchez-Morla, E.M., Bescs,
prehensiveM.J., Argudo, I., . . . Cabranes-Daz, mode
J.A. (2010). Sustained atten-
order to optimal
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and to chiatric Scandinavica, 122, 235-245.
advance t
mind Anderson, N.D., Lau, M.A.,
and Segal, Z.V., & Bishop, S.R. (2007).
increas
Mindfulness-based stress reduction and attentional control. Clini-
Acknowledgme
cal Psychology & Psychotherapy, 14, 449-463.
The Arzy, S., Thut, G., Mohr, ., Michel, C.M.,
authors would & Blanke, . (2006).
Brach, Neural basis of embodiment: Distinct contributions of
Patricia temporo-
Pop
this article.
parietal junction and extrastriate body area. Journal of Neurosci-
ence, 26, 8074-808 1 .
Declaration
Asada, H., Fukuda, Y., Tsunoda, S., Yamaguchi, M.,of
& Tonoike, M. C
The (1999). Frontal midline theta rhythmsdeclar
authors reflect alternative activa-
respect tion of prefrontal
to cortex and anterior cingulate cortex in humans.
their aut
Neuroscience Letters, 274, 29-32.
Funding Austin, J.H. (2006). Zen-brain reflections. Cambridge, MA: MIT
Britta . Holzel was supported by a Marie Curie International Press.
Outgoing Fellowship within the Seventh European Community Baer, R.A. (2003). Mindfulness training as a clinical intervention: A
Framework Programme. conceptual and empirical review. Clinical Psychology: Science
and Practice, 10, 125-143.
Notes
Baer, R.A., Smith, G.T., & Allen, K.B. (2004). Assessment of mind-
fulness by self-report. Assessment, 11, 191-206.
1 . Telomeres are protective DNA sequences at the ends of chromo-
somes that ensure genomic stability during cellular replication.
Baer, R.A., Smith, G.T., Hopkins, J., Krietemeyer, J., & Toney, L.
Telomerase is the cellular enzyme responsible for telomere(2006).
lengthUsing self-report assessment methods to explore facets
of mindfulness. Assessment, 13, 27-45.
and maintenance. Telomerase activity has been found to be a predic-
Banks,
tor of long-term cellular viability that decreases with chronic S.J., Eddy, K.T., Angstadt, M., Nathan, P.J., & Phan, K.L.
psycho-
logical distress (Epel et al., 2004). (2007). Amygdala-frontal connectivity during emotion-regulation.
2. For the sake of completeness, it should be noted that someSocial Cognitive and Affective Neuroscience, 2, 303-312.
studies
Barinaga,
have not found this pattern of higher PFC and lower amygdala M. (2003). Buddhism and neuroscience. Studying the well-
acti-
trained
vation while participants were decreasing negative affect (Urry et al.,mind. Science, 302, 44-46.
2006). Barnhofer, T., Chittka, T., Nightingale, H., Visser, ., & Crane, .
3. Of note, this decreased identification with the self is fundamen- (2010). State effects of two forms of meditation on prefrontal
tally different from pathological versions of depersonalization. For a EEG asymmetry in previously depressed individuals. Mindful-
detailed discussion of this distinction, see Engler (1995). ness (NY), 7,21-27.
Beauregard, M., Levesque, J., & Bourgouin, P. (2001). Neural cor-
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How Does Mindfulness Meditation Work?

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How Does Mindfulness Meditation Work?

Proposing Mechanisms of Action From a

Perspectives on Psychological Science

Proposing Mechanisms of Action From a sagepub.com/journalsPermissions.nav

Conceptual and Neural Perspective http://pps.sagepub.com

Britta . Holzel1,2, Sara W. Lazar2, Tim Gard1'2,

Table I. Previous Theoretical Accounts That Describe Mechanisms of Mindfulness Meditation

Publication Suggested components

Shapiro, Carlson, Astin, and Freedman (2006) Attention, intention, attitude

Definition of Mindfulness including (a) insight, (b) exposure, (c) nonattachment, (d

Table 2. Components Proposed to Describe the Mechanisms T

Self-reported and experimental

I .Attention regulation Sustaining attention on the Enhanced performance: executive A

3. 1 Emotion regulation: Approaching ongoing em

Components of Mindfulness Meditation

well as identified when individuals engaged in a mindfulness prac-

2008). However, further research is needed

to own emotional life; in turn,

[the monk] remains focused on feelings . .detection

Breiter & regulation

of dispositional mindfulness"positive reappraisal,"

including areas of the medial PFC (Gusnard, Akbudak, Shul-

Further Considerations In the progression of meditation expertise, the different

Bishop, S.R., Lau, M., Shapiro,

Engler, J. (2004). Ego, ego on the

Goleman, D.J., & Schwartz, Hollis-

Legrand, D., & Ruby, P. (2009). What is self-specific?

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