Mindfulness: How Does It Work?

Our colleagues Mark Lau and Andrea Grabovac have written a fascinating and groundbreaking paper introducing a Buddhist psychological model of mindfulness that we think is worth reading. Here is a brief introduction (and link to the full paper).

By Mark Lau, Ph.D. and Andrea Grabovac, MD, FRPCP


Mark Lau
Mark Lau

Interest in mindfulness-based interventions (MBIs) continues to grow, fueled by studies demonstrating their clinical effectiveness.  More recently, researchers have been examining specific psychological and cognitive mechanisms by which MBIs may exert their clinical effects.  Clarification of specific mechanisms will allow further optimization of these therapies.  With this goal in mind we introduce a Buddhist psychological model (BPM) in the June issue of the journal Mindfulness based on the psychological framework of the Theravada Buddhist contemplative traditions from which many of the techniques used in MBIs are adapted.

Andrea Grabovac
Andrea Grabovac

Briefly, the BPM provides a detailed, step by step description of how the habitual reactions of attachment and aversion to feelings are the genesis of a cascade of mental events that lead to suffering.  According to the BPM, the subjective sense of a continuous stream of consciousness is made up of numerous, discrete sense impressions and mental events (sensations), most of which occur outside of one’s awareness.  Each sensation inexorably carries with it a feeling tone, which falls into one of three categories: pleasant, unpleasant, or neutral (neither pleasant nor unpleasant). The term “feeling tone,” as used in this context, is not synonymous with emotions, such as fear, joy, or anger; rather it is an immediate and spontaneous experience that arises with each sensation.  These rapid and transient feeling tones, which are often unnoticed, are the key trigger for habitual attachment (holding onto a sensation) and aversion (pushing away a sensation) reactions.

According to the BPM, mindfulness has its effect by short circuiting the above process. It does this in two main ways:

  1. training attention regulation skills
  2. insight

Training attention results in an improved ability to selectively orient one’s attention away from the proliferation of mental events following attachment/aversion reactions.  This is possible because attentional resources are limited: one cannot be focused intently on an object (such as the breath) and engaging in ruminative thought patterns simultaneously.  Mindfulness training improves both the ability to recognize the occurrence of unhelpful mental proliferation, and the ability to stop rumination by focusing attention elsewhere.  Facility with these skills allows ruminative thoughts to be treated as mental events rather than aspects of reality of self.  All current MBIs train attention regulation as their primary mode of therapeutic action.

The other mechanism by which mindfulness reduces suffering (mental proliferation) is via insight.  Insight is a direct, non-conceptual understanding achieved through the repeated examination (via mindfulness practice) of the following three characteristics that are present in all sensations:

  1. impermanence (sensations are transient – they arise and pass away)
  2. unsatisfactoriness (attachment/aversion to the feeling of sensations leads to suffering)
  3. not-self (sensations do not contain or constitute any lasting, separate entity that could be called a self)

Mindfulness of these characteristics results in progression through a series of insights leading to enlightenment, as described in the Theravada Buddhist tradition.  A side effect of such insight is a long-term reduction in habitual attachment/aversion reactions and a consequent decrease in mental proliferation and rumination.

For a more detailed description of the above, please see the free, full version of an article describing the Buddhist Psychological Model here, online first.   We hope that this model will help clarify the mechanisms of mindfulness as taught in MBIs and stimulate further discussion and understanding of the complex, multifaceted nature of mindfulness and its allied disciplines.

You can reach Andrea Grabovac, the first author on the paper, via email at agrabovac@bccancer.bc.ca