[10]: 173 In the late-1990s she suffered a further collapse in her health, confining her to home for long periods and requiring her to start using a wheelchair, which led her to re-evaluate her meditation practice.
The "core theoretical basis" of MBPM is the distinction between "primary" and "secondary" suffering, as explicated in the Buddha's parable of the two arrows in the Sallatha Sutta.
[10]: 169–70 Although the underlying principles of MBPM are drawn from Buddhism, it is presented in secular language accessible to all and suitable for a modern healthcare intervention.
[10]: 154 The well-established "gate control theory", for instance, suggests that the experience of pain is connected with the operation of neural "gateways" that are affected by "emotional states, mental activity, and where attention is focused".
[19] Mindfulness is considered the branch of its root practice meditation and is used extensively in Wuxing heqidao,Taiqi, Qigong, Neigong and by Chinese medicinal physicians as part of an integrative mind/body therapy for the prevention and treatment of injury, pain, disease and suffering.
[23][3][24] The process is as follows: Breathing anchor Mindful movement The course begins by establishing basic meditation skills — in particular the ability to apply focused awareness (Samatha) to physical, mental, and emotional experience — then goes on to train participants in the cultivation of a broader, non-reactive awareness (Vipassanā), and the bringing an attitude of compassion and kindliness (Metta) to oneself and others.
[10]: 164 In addition to learning various forms of meditation — which constitute the core of the course — participants engage in mindful movement, diary-based activity management, three-minute "breathing spaces", and habit-releasing practices.
[4][1][3] This emphasis has been connected by some observers with a sensitivity to concerns about removing mindfulness teaching from its original ethical framework within Buddhism, while at the same time providing a secular evidence-based approach appropriate for people of all faiths, and none.
[5][6] A 2018 literature review found that research on Breathworks MBPM courses has shown them "to be very helpful for people with severe chronic pain and illness", while also noting that further randomized controlled trials were needed.