REVIEW ARTICLE
Mechanisms of Mindfulness
䊲
Shauna L. Shapiro
Santa Clara University
䊲
Linda E. Carlson
University of Calgary
䊲
John A. Astin
California Pacific Medical Center
䊲
Benedict Freedman
Occidental College
Recently, the psychological construct mindfulness has received a great
deal of attention. The majority of research has focused on clinical studies
to evaluate the efficacy of mindfulness-based interventions. This line of
research has led to promising data suggesting mindfulness-based inter-
ventions are effective for treatment of both psychological and physical
symptoms. However, an equally important direction for future research is
to investigate questions concerning mechanisms of action underlying
mindfulness-based inter ventions . This theoretical paper proposes a model
of mindfulness, in an effort to elucidate potential mechanisms to explain
how mindfulness affects positive change. Potential implications and future
directions for the empirical study of mechanisms involved in mindfulness
are addressed. © 2005 Wiley Periodicals, Inc. J Clin Psychol 62: 373–
386, 2006.
Keywords: mindfulness; meditation; mechanisms; reperceiving; intention;
attention
The authors would like to thank Deane Shapiro, whose wisdom and insight greatly contributed to clarifying the
original ideas for this paper. The authors would also like to acknowledge the Center for Mindfulness in Med-
icine, Health Care and Society, whose invitation to present at the Second Annual Conference led to the writing
of this manuscript. Finally, we are grateful to the Fetzer Institute, the Center for Contemplative Mind and
Society, and the American Council of Learned Societies for supporting this work.
Correspondence concerning this article should be addressed to: Shauna L. Shapiro, Ph.D., Santa Clara Univer-
sity, Depar tment of Counseling Psychology, 500 El Camino Real, Santa Clara CA 95053-0201; e-mail:
slshapiro@scu.edu
JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 62(3), 373–386 (2006) © 2006 Wiley Periodicals, Inc.
Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jclp.20237
Recently, the psychological construct mindfulness has received a great deal of attention,
and has even been proposed as a common factor across all schools of psychotherapy
(Martin, 1997). Mindfulness has its roots in Eastern contemplative traditions and is most
often associated with the formal practice of mindfulness meditation. In fact, mindfulness
has been called the “heart” of Buddhist meditation (Kabat-Zinn, 2003; Thera, 1962).
Mindfulness, however, is more than meditation. It is “inherently a state of consciousness”
which involves consciously attending to one’s moment-to-moment experience (Brown &
Ryan, 2003). Meditation practice is simply a “scaffolding” used to develop the state, or
skill, of mindfulness (Kabat-Zinn, 2005). The intention of this paper is to refine the
exploration of this particular state of mindfulness and to explore the questions: “What
exactly is mindfulness? And, how does it work?”
Over the past 20 years, the majority of research has focused on clinical intervention stud-
ies to evaluate theefficacy of mindfulness-basedinterventionssuchastheMindfulness Based
Stress Reduction (MBSR) program ( Kabat-Zinn, 1990). This line of research has primarily
addressed the first order question “Are mindfulness-based interventions effective?” These
studies have led to promising data suggesting that MBSR is an effective intervention for treat-
ment of both psychological and physical symptoms (see Baer 2003; Bishop 2002; Gross-
man, Niemann, Schmidt, & Walach, 2004). Clearly this line of research is fundamental to
validating mindfulness as an efficacious psychological intervention, and controlled clinical
trials across diverse populations should continue. However, an equally important direction
for future research is to address the second order question “How do mindfulness-based inter-
ventions actually work?”
Investigating questions concerning the mechanisms of action underlying mindful-
ness based interventions will require two different but complementary lines of inquiry.
Dismantle studies are necessary in order to separate and compare the various active
ingredients in mindfulness-based interventions such as social support, relaxation, and
cognitive behavioral elements. A second line of inquiry is examining the central construct
of mindfulness itself to determine if the development of “mindfulness” is what actually
leads to the positive changes that have been observed. This step can be facilitated through
the recent development of valid and reliable measures of mindfulness (see Baer, 2003;
Bishop, 2002; Brown & Ryan, 2003—the KIMS), allowing measurement of mindfulness
for use in statistical models of mediation. A testable theory of the mechanisms involved in
the process of mindfulness itself is needed to explicate whether and how mindfulness
affects change and transformation. The aim of this paper is to propose a first draft of such
a theory, focusing on the construct of mindfulness itself, as opposed to the whole package
of MBSR and other mindfulness-based interventions. We would like to emphasize that
this is a beginning, a first attempt at understanding the mysterious and complex process
that is mindfulness. Further, it is “a” theory, not “the” theory—it is a search for common
ground on which to build a more precise understanding of the primary mechanisms of
action involved in mindfulness practices that have become increasingly prominent in
contemporary psychology and behavioral medicine. Our intention is to open a dialogue.
How does mindfulness work? We posit three components (axioms) of mindfulness:
(1) intention, (2) attention, and (3) attitude (IAA). We then introduce a meta-mechanism
of action, “reperceiving” and discuss the significance of this shift in perspective in terms
of the transformational effects of mindfulness. Finally, we highlight four potential mech-
anisms, which may stem from reperceiving.
A Model Of Mindfulness
The Axioms. In an attempt to break mindfulness down into a simple, comprehensible
construct, we reflected on the core components of the practice, the essential building
374 Journal of Clinical Psychology, March 2006
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blocks of mindfulness, and examined the literature on this topic. An often cited definition
of mindfulness”—paying attention in a particular way: on purpose, in the present moment,
and non-judgmentally” ( Kabat-Zinn, 1994, p. 4)— embodies the three axioms of
mindfulness:
1. “On purpose” or intention,
2. “Paying attention” or attention,
3. “In a particular way” or attitude (mindfulness qualities).
Axioms are fundamental building blocks out of which other things emerge. From an
understanding of IAA, we can deduce how mindfulness might work. Intention, attention,
and attitude are not separate processes or stages—they are interwoven aspects of a single
cyclic process and occur simultaneously (See Figure 1). Mindfulness is this moment-to-
moment process.
Axiom I. Intention
When Western psychology attempted to extract the essence of mindfulness practice from
its original religious/ cultural roots, we lost, to some extent, the aspect of intention, which
for Buddhism was enlightenment and compassion for all beings. It seems valuable to
explicitly bring this aspect back into our model (Shapiro & Schwartz, 2000). As Kabat-
Zinn writes, “Your intentions set the stage for what is possible. They remind you from
moment to moment of why you are practicing in the first place” (p. 32). He continues, “I
used to think that meditation practice was so powerful . . . that as long as you did it at all,
you would see growth and change. But time has taught me that some kind of personal
vision is also necessary” (p. 46, 1990). This personal vision, or intention, is often dynamic
and evolving (Freedman, 2005). For example, a highly stressed businessman may begin
a mindfulness practice to reduce hypertension. As his mindfulness practice continues, he
may develop an additional intention of relating more kindly to his wife.
The role of intention in meditation practice is exemplified by Shapiro’s study (1992),
which explored the intentions of meditation practitioners and found that as meditators
continue to practice, their intentions shift along a continuum from self-regulation, to
Figure 1. The three axioms of mindfulness, Intention, Attention, and Attitude, are not separate stages. They
are interwoven aspects of a single cyclic process and occur simultaneously. Mindfulness is this moment-to-
moment process.
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self-exploration, and finally to self-liberation.
1
Further, the study found that outcomes
correlated with intentions. Those whose goal was self-regulation and stress management
attained self-regulation, those whose goal was self-exploration attained self-exploration,
and those whose goal was self-liberation moved toward self-liberation and compassion-
ate service. These findings correspond with our definition of intentions as dynamic and
evolving, which allows them to change and develop with deepening practice, awareness,
and insight. The inclusion of intention (i.e., why one is practicing) as a central component
of mindfulness is crucial to understanding the process as a whole, and often overlooked
in other contemporary definitions (Bishop et al., 2004).
Axiom II. Attention
A second fundamental component of mindfulness is attention. In the context of mindful-
ness practice, paying attention involves observing the operations of one’s moment-to-
moment, internal and external experience. This is what Husserl refers to as a “return to
things themselves,” that is, suspending all the ways of interpreting experience and attend-
ing to experience itself, as it presents itself in the here and now. In this way, one learns to
attend to the contents of consciousness, moment by moment. Attention has been sug-
gested in the field of psychology as critical to the healing process. For example, Gestalt
therapy emphasizes present moment awareness, and its founder, Fritz Perls claimed that,
“attention in and of itself is curative.” The importance of attention can also be seen in
cognitive-behavior therapy, which is based on the capacity to attend to (i.e., observe)
internal and external behaviors. At the core of mindfulness, is this practice of paying
attention.
Cognitive psychology delineates many different aspects of attentional abilities, includ-
ing the capacity to attend for long periods of time to one object (vigilance or sustained
attention, Parasuraman, 1998; Posner & Rothbart, 1992), the ability to shift the focus of
attention between objects or mental sets at will (switching; Posner, 1980), and the ability
to inhibit secondary elaborative processing of thoughts, feelings and sensations (cogni-
tive inhibition; Williams, Mathews, & MacLeod, 1996). The self-regulation of attention
as described in this mindfulness axiom would be predicted to result in the enhancement
of all three of these skills.
Axiom III. Attitude
How we attend is also essential. The qualities one brings to attention have been referred
to as the attitudinal foundations of mindfulness (Kabat-Zinn, 1990, Shapiro & Schwartz,
1999, 2000). This axiom asserts that the attitude one brings to the attention is essential.
Often, mindfulness is associated with bare awareness, but the quality of this awareness is
not explicitly addressed. However, the qualities one brings to the act of paying attention
is crucial. For example, attention can have a cold, critical quality, or it can include an “an
affectionate, compassionate quality . . . a sense of openhearted, friendly presence and
interest” (Kabat-Zinn, 2003, p. 145). It is helpful to note the Japanese characters of
mindfulness are composed of two interactive figures: one mind, and the other heart (San-
torelli, 1999). Therefore, perhaps a more accurate translation of “mindfulness” from the
Japanese is heart-mindfulness (Shapiro & Schwartz, in preparation), which underlines
1
Self-liberation refers to the experience of transcending (i.e., becoming free of or dis-identifying from) the
sense of being a separate self.
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the importance of including “heart” qualities in the attentional practice of mindfulness
(see Shapiro & Schwartz, 2000, for review).
We posit that persons can learn to attend to their own internal and external experi-
ences, without evaluation or interpretation, and practice acceptance, kindness and open-
ness even when what is occurring in the field of experience is contrary to deeply held
wishes or expectations. However, it is essential to make the attitudinal quality of attention
explicit. It is important for the practitioner to consciously commit, e.g. “may I bring
kindness, curiosity, and openness to my awareness, may I infuse my awareness with . . .”
With intentional training, one becomes increasingly able to take interest in each
experience as it arises and also allow what is being experienced to pass away (i.e., not be
held on to). Through intentionally bringing the attitudes of patience, compassion and
non-striving to the attentional practice, one develops the capacity not to continually strive
for pleasant experiences, or to push aversive experiences away. In fact, attending without
bringing the hear t qualities into the practice may result in practice that is condemning or
judgmental of inner experience. Such an approach may well have consequences contrary
to the intentions of the practice; for example cultivating the patterns of judgment and
striving instead of equanimity and acceptance.
Bishop et al. (2004) also propose an attitudinal component in the operational defini-
tion of mindfulness, referred to as the orientation to experience, which involves curiosity,
nonstriving and acceptance.
Proposing “a” Theory
We suggest that the three axioms, IAA, are the fundamental components (or internal
behaviors from a Behaviorist perspective) of mindfulness. We posit that they account
directly or indirectly for a large amount of the variance in the transformations that are
observed in mindfulness practice. Building on these behaviors, we propose a model of the
potential mechanisms of mindfulness, which suggests that intentionally (I) attending (A)
with openness and non-judgmentalness (A) leads to a significant shift in perspective,
which we have termed reperceiving. We believe reperceiving is a meta-mechanism of
action, which overarches additional direct mechanisms that lead to change and positive
outcome. We highlight four of these additional mechanisms: (1) self-regulation, (2) val-
ues clarification, (3) cognitive, emotional, and behavioral flexibility, and (4) exposure.
These variables can be seen as both potential mechanisms for other outcomes, such as
psychological symptom reduction, or as outcomes in and of themselves. Furthermore,
this is by no means a linear pathway; each variable supports and affects the others.
Reperceiving as Meta Mechanism
Through the process of mindfulness, one is able to disidentify from the contents of con-
sciousness (i.e., one’s thoughts) and view his or her moment-by-moment experience with
greater clarity and objectivity. We term this process reperceiving as it involves a funda-
mental shift in perspective. Rather than being immersed in the drama of our personal
narrative or life story, we are able to stand back and simply witness it. As Goleman
suggests, “The first realization in “meditation” is that the phenomena contemplated are
distinct from the mind contemplating them” (1980, p. 146).
Reperceiving is akin to the western psychological concepts of decentering (Safran &
Segal, 1990), deautomatization (Deikman, 1982; Safran & Segal, 1990) and detachment
(Bohart, 1983). For example, Safran and Segal define decentering as the ability to “step
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