Self-awareness, self-regulation, and self-transcendence (S-ART): a framework for understanding the neurobiological mechanisms of mindfulness methods
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Contemporary definitions of mindfulness
Contemporary psychology and psychiatry have adopted secularized forms of mindfulness practice as an approach for increasing awareness and responding skillfully to mental processes that contribute to emotional distress and maladaptive behavior (Kabat-Zinn,; Bishop et al.,; Carmody, ). In mainstream clinical literature, mindfulness has been described as a form of attention that is purposeful, non-reactive, non-judgmental, and in the present moment (Kabat-Zinn,; Baer,; Bishop et al.,; Carmody, ). This conceptualization for mindfulness originally proposed by Kabat-Zinn has been successfully incorporated into a number of evidenced-based clinical interventions, namely MBSR (Kabat-Zinn, ), Mindfulness-based Cognitive Therapy (MBCT) for prevention of depression relapse (Segal et al., ), Mindfulness-based Relapse Prevention (MBRP) for prevention of substance use relapse in addiction (Bowe...
Contemporary definitions of mindfulness
In attempts to measure the psychotherapeutic outcomes of MBIs, metrics for quantifying states and traits related to the construct of mindfulness have been created. Dispositional mindfulness is currently measured by at least eight scales, items of which were originally generated by psychology faculty and graduate students reportedly familiar with the construct of mindfulness and mindfulness-based psychotherapies (Feldman et al.,; Cardaciotto et al., ). The scales include the Mindful Attention Awareness Scale Brown (MAAS) (Brown and Ryan, ), Southampton Mindfulness Questionnaire (SMQ) (Chadwick et al., ), Philadelphia Mindfulness Scale (PHLMS) (Cardaciotto et al., ), Toronto Mindfulness Scale (TMS) (Lau et al., ), Freiburg Mindfulness Inventory (FMI) (Walach et al., ), Revised Cognitive and Affective Mindfulness Scale (CAMS-R) (Feldman et al., ), Kentucky Inventory of Mindfulness Skill...
Biased self-processing: a contemporary model for suffering
The common thread that ties the historical and contemporary models of mindfulness together in the S-ART framework is an element of suffering and a distorted or biased sense of self, one's relation to others, events, and the external world. In studies of attention to emotion in the general population or in a clinical population, bias has referred to the tendency or extent to which emotional stimuli with either a negative or positive valence may be processed differently in comparison to neutral material. Interestingly, one of the goals of mindfulness-based practice is to make no such distinction between positive, negative, or neutral valence and treat all incoming stimuli with impartiality and equipoise. In relation to self-processing, affect-biased attention is associated with distortions in initial attention allocation toward momentary experience and/or subsequent information processi...
Networks for self-processing that support S-ART
The EES network integrates efferent and reafferent processes and highlights the fact that representational content can be actively mediating behavior while being completely outside the focus of awareness (Roeser and Peck, ). Current research suggests non-conscious processes related to self/identity involve repeated associative conditioning of interactions between the body, the environment, and the processes involving exteroception, proprioception, kinesthesia, and interoception (Damasio,; Legrand,; Craig,; Lenggenhager et al., ). Exteroception includes the processing of information from all the five senses (vision, audition, olfaction, taste, touch), proprioception-the body in space, kinesthesia-the sense of movement from musculoskeletal feedback, and interoception-the sensation and perception from the internal milieu and visceral organs, including heart rate, dig...
The experiential phenomenological self (EPS)
A number of recent studies investigating neurobiological substrates of mindfulness have indicated very specific changes in the function and structure of the insula and its connectivity with other structures related to experiential self-processing and body awareness. In terms of morphometry, two cross-sectional studies comparing GM morphometry between experienced meditators (8 weeks) and naïve controls have shown greater cortical thickness and GM concentration in the right anterior insula (Lazar et al.,; Holzel et al., ). A more recent study however (Holzel et al., ) did not find such a change. Long-term vipassana meditation practitioners (>6000 h experience) have shown increased GM concentration in the AIC (Holzel et al., ), and functional increases in insular cortex have been found during mindfulness and compassion meditative states (Farb et al.,; Lutz et al.,; Manna et al.,...
The experiential phenomenological self (EPS)
In the context of pain, there has been mixed results in terms of insular activity. For example one study of experienced meditators (39-1820 weeks of meditation practice), in comparison to non-meditators, showed decreased left PIC and SII activation in the anticipation period that continued through the experience of pain (Brown and Jones, ). In contrast, two studies showed no difference during anticipation and stronger activation in pain-related areas (mid-cingulate, insula, SII, and thalamus) during experience of pain and while maintaining a "mindful state" (Grant et al.,; Gard et al., ). Greater bilateral activation in the PIC, along with somatosensory areas corresponding to the nose and throat, was found in meditators given brief training experience (4 × 20 min sessions) while practicing FA meditation (Zeidan et al., ). Zeidan et al. ( ) also showed decreased...
An integrative fronto-parietal control network for S-ART
The three most widely cited brain areas of activity and gross morphological change during and in response to both FA and OM meditation training has been the DLPFC, the ACC, and the insula [see Lutz et al. ( ); Chiesa and Serretti ( ); Rubia ( ); Holzel et al. ( ) for review], suggesting FPCN and EPS-related processing is heavily influenced through training. Across nine different MBI studies (Lazar et al.,; Pagnoni and Cekic,; Holzel et al.,,,; Luders et al.,; Vestergaard-Poulsen et al.,; Grant et al.,; Manna et al., ), differences in GM volume and density (in comparison to non-meditating controls) have been found using MRI in the dorsal and rostral ACC, suggesting a prominent role for the FPCN. Tang et al. (,, ) show that as little as five days (20 min/day) of Integrated Body Mind Training (IBMT), involving components of FA and OM produces greater activation in the rACC duri...
Mindfulness-based mental training: methods for adaptive self-functioning and integrating self-specific networks suppo...
FA practice involves sustained attention on a specific mental or sensory object: a repeated sound or mantra, an imagined or physical image, or specific viscerosomatic sensations. The object of focus can be anything, but the method described by the Satipatthāna Sutta identifies a naturally occurring breath focus. In fact, breath is a particularly apt foundation because it integrates conscious awareness with ongoing, dynamic viscerosomatic function. The goal of FA practice is to stabilize the mind from distraction, torpor, and hyperexcitability, all of which are predicted to be negatively correlated with practice. Effort is hypothesized to be inversely correlated with practice duration, providing a neurobiological mechanism for advancement of the practitioner and resulting in decreased allocation of explicit cognitive resources over time. A process model for FA is illustrated in Fi...
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Contemporary psychology and psychiatry have adopted secularized forms of mindfulness practice as an approach for increasing awareness and responding skillfully to mental processes that contribute to emotional distress and maladaptive behavior (Kabat-Zinn,; Bishop et al.,; Carmody, ). In mainstream clinical literature, mindfulness has been described as a form of attention that is purposeful, non-reactive, non-judgmental, and in the present moment (Kabat-Zinn,; Baer,; Bishop et al.,; Carmody, ). This conceptualization for mindfulness originally proposed by Kabat-Zinn has been successfully incorporated into a number of evidenced-based clinical interventions, namely MBSR (Kabat-Zinn, ), Mindfulness-based Cognitive Therapy (MBCT) for prevention of depression relapse (Segal et al., ), Mindfulness-based Relapse Prevention (MBRP) for prevention of substance use relapse in addiction (Bowen et al., ), Relaxation Response for cardiovascular health and wellness (Benson, ), Acceptance and Commitment Therapy (ACT) for a wide range of psychological problems (Hayes et al., ), and Dialectical Behavior Therapy (DBT) for the treatment of borderline personality disorder (Linehan, ). The succes...
In attempts to measure the psychotherapeutic outcomes of MBIs, metrics for quantifying states and traits related to the construct of mindfulness have been created. Dispositional mindfulness is currently measured by at least eight scales, items of which were originally generated by psychology faculty and graduate students reportedly familiar with the construct of mindfulness and mindfulness-based psychotherapies (Feldman et al.,; Cardaciotto et al., ). The scales include the Mindful Attention Awareness Scale Brown (MAAS) (Brown and Ryan, ), Southampton Mindfulness Questionnaire (SMQ) (Chadwick et al., ), Philadelphia Mindfulness Scale (PHLMS) (Cardaciotto et al., ), Toronto Mindfulness Scale (TMS) (Lau et al., ), Freiburg Mindfulness Inventory (FMI) (Walach et al., ), Revised Cognitive and Affective Mindfulness Scale (CAMS-R) (Feldman et al., ), Kentucky Inventory of Mindfulness Skills (KIMS) (Baer et al., ), and Five Facet Mindfulness Questionnaire (FFMQ) (Baer et al., ). The FFMQ has the advantage over other measures given that it was developed based on the items of five existing self-report measures. Factor analyses of these measures resulted in five facets of mindfulness inc...
The common thread that ties the historical and contemporary models of mindfulness together in the S-ART framework is an element of suffering and a distorted or biased sense of self, one's relation to others, events, and the external world. In studies of attention to emotion in the general population or in a clinical population, bias has referred to the tendency or extent to which emotional stimuli with either a negative or positive valence may be processed differently in comparison to neutral material. Interestingly, one of the goals of mindfulness-based practice is to make no such distinction between positive, negative, or neutral valence and treat all incoming stimuli with impartiality and equipoise. In relation to self-processing, affect-biased attention is associated with distortions in initial attention allocation toward momentary experience and/or subsequent information processing that either follows immediately after an emotional stimulus or is associated with real or imagined stimuli from the past or distant future. The capture of perceptual resources by a given stimulus is influenced not only by the characteristics of the stimulus itself, but also by higher control syst...
The EES network integrates efferent and reafferent processes and highlights the fact that representational content can be actively mediating behavior while being completely outside the focus of awareness (Roeser and Peck, ). Current research suggests non-conscious processes related to self/identity involve repeated associative conditioning of interactions between the body, the environment, and the processes involving exteroception, proprioception, kinesthesia, and interoception (Damasio,; Legrand,; Craig,; Lenggenhager et al., ). Exteroception includes the processing of information from all the five senses (vision, audition, olfaction, taste, touch), proprioception-the body in space, kinesthesia-the sense of movement from musculoskeletal feedback, and interoception-the sensation and perception from the internal milieu and visceral organs, including heart rate, digestion, body temperature, and perspiration, among others. The self-specifying sensory-motor convergence that is proposed to contribute to the EES network can be localized to a distributed set of interconnected spinothalamocortical regions [including the periaqueductal gray (PAG) and parabrachial nuc...
A number of recent studies investigating neurobiological substrates of mindfulness have indicated very specific changes in the function and structure of the insula and its connectivity with other structures related to experiential self-processing and body awareness. In terms of morphometry, two cross-sectional studies comparing GM morphometry between experienced meditators (8 weeks) and naïve controls have shown greater cortical thickness and GM concentration in the right anterior insula (Lazar et al.,; Holzel et al., ). A more recent study however (Holzel et al., ) did not find such a change. Long-term vipassana meditation practitioners (>6000 h experience) have shown increased GM concentration in the AIC (Holzel et al., ), and functional increases in insular cortex have been found during mindfulness and compassion meditative states (Farb et al.,; Lutz et al.,; Manna et al.,; Ives-Deliperi et al., ). A number of MBI studies have demonstrated the functional role of insular cortex in states associated specifically with the EPS. For example, meditators using an experiential FPP (in comparison to an evaluative focus) toward a group of valenced trait descriptive words resul...
In the context of pain, there has been mixed results in terms of insular activity. For example one study of experienced meditators (39-1820 weeks of meditation practice), in comparison to non-meditators, showed decreased left PIC and SII activation in the anticipation period that continued through the experience of pain (Brown and Jones, ). In contrast, two studies showed no difference during anticipation and stronger activation in pain-related areas (mid-cingulate, insula, SII, and thalamus) during experience of pain and while maintaining a "mindful state" (Grant et al.,; Gard et al., ). Greater bilateral activation in the PIC, along with somatosensory areas corresponding to the nose and throat, was found in meditators given brief training experience (4 × 20 min sessions) while practicing FA meditation (Zeidan et al., ). Zeidan et al. ( ) also showed decreased activity in the PIC and somatosensory areas corresponding to the site of pain stimulus while meditating in the context of noxious stimuli. Interestingly, right AIC and dACC negatively correlated with pain intensity, while OFC activity negatively correlated with pain unpleasantness (Zeidan et al., )...
The three most widely cited brain areas of activity and gross morphological change during and in response to both FA and OM meditation training has been the DLPFC, the ACC, and the insula [see Lutz et al. ( ); Chiesa and Serretti ( ); Rubia ( ); Holzel et al. ( ) for review], suggesting FPCN and EPS-related processing is heavily influenced through training. Across nine different MBI studies (Lazar et al.,; Pagnoni and Cekic,; Holzel et al.,,,; Luders et al.,; Vestergaard-Poulsen et al.,; Grant et al.,; Manna et al., ), differences in GM volume and density (in comparison to non-meditating controls) have been found using MRI in the dorsal and rostral ACC, suggesting a prominent role for the FPCN. Tang et al. (,, ) show that as little as five days (20 min/day) of Integrated Body Mind Training (IBMT), involving components of FA and OM produces greater activation in the rACC during rest. From as little as 11 h (over 1 month) of IBMT, increases in structural connectivity were found indicated by increased fractional anisotropy, an MRI diffusion tensor imaging index indicating the integrity and efficiency of white matter connecting ACC to other cortical and subcortical structu...
FA practice involves sustained attention on a specific mental or sensory object: a repeated sound or mantra, an imagined or physical image, or specific viscerosomatic sensations. The object of focus can be anything, but the method described by the Satipatthāna Sutta identifies a naturally occurring breath focus. In fact, breath is a particularly apt foundation because it integrates conscious awareness with ongoing, dynamic viscerosomatic function. The goal of FA practice is to stabilize the mind from distraction, torpor, and hyperexcitability, all of which are predicted to be negatively correlated with practice. Effort is hypothesized to be inversely correlated with practice duration, providing a neurobiological mechanism for advancement of the practitioner and resulting in decreased allocation of explicit cognitive resources over time. A process model for FA is illustrated in Figure.
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