Interoceptive Mindful Breathing: The ISAAA Model for Attentional–Autonomic Alignment

Abstract Objectives Mindful breathing is widely practiced for health, well-being, and contemplative development, yet novices often experience confusion, tension, or frustration when instructions lack neurophysiological clarity. This theoretical paper introduces the Interoceptive Sensitivity for Attentional–Autonomic Alignment (ISAAA) model as a structured, neurophysiology-informed framework for understanding and addressing these difficulties. Method The ISAAA model was developed through an interdisciplinary synthesis of respiratory physiology, affective neuroscience, active interoceptive inference, neurovisceral integration, and the early steps of the Ānāpānasati Sutta. Its core constructs are operationalized using measures including the Multidimensional Assessment of Interoceptive Awareness-2 (MAIA-2), Toronto Mindfulness Scale, heartbeat-counting tasks, respiratory-adjusted vagal heart-rate variability, respiratory sinus arrhythmia, and EEG–ECG brain–heart coherence. Preregistration: This study is not preregistered. Results ISAAA conceptualizes mindful breathing as a two-phase process: first, establishing a metacognitive platform for passive, non-interfering observation of natural autonomic breathing; and second, introducing skillful, minimal-effort breath modulation after interoceptive sensitivity and attentional–autonomic alignment have developed. The model proposes that premature top-down cortical control can disrupt autonomic respiratory rhythms, contributing to attentional–autonomic misalignment and interoceptive prediction error. Four falsifiable predictions are specified to guide future randomized, dismantling, and feasibility studies. Conclusions By integrating Buddhist contemplative instructions with contemporary neurophysiology, the ISAAA model provides a scalable instructional framework and a testable account of how voluntary attention and autonomic processes may become progressively aligned. Its neurophysiological formulation may help practitioners refine mindful breathing, particularly during the early stages of practice.