“Often the mindfulness teacher will ask the class, ‘Did anyone have any challenges with your meditation practice this week?’” Britton said. “But participants, in general, tend to avoid answering open-ended questions asked by the teacher in a public setting. Research has shown that having someone other than the teacher ask specific questions in a private setting will increase the likelihood of honest reporting.”
Finally, she highlighted the fact that term “adverse” is a highly subjective judgment that can vary across people and even across the same person in different contexts.
“The re-living of a previous trauma may be healing for some and destabilizing for others, in the same way that the drowsiness caused by cold medicine — or meditation — may be undesirable or ‘adverse’ in the morning but highly desirable before bed,” she said. What’s more, Britton added, the literature shows that mental health treatment providers (like therapists or doctors) may dismiss patient complaints or reframe them as a sign that the therapy is working.
Designing a model assessment
Britton’s research team followed 24 current harms monitoring guidelines to assess the nature and frequency of meditation-related adverse effects in mindfulness-based programs. The study participants were representative of typical meditators in the U.S.: predominantly middle-age women seeking methods to self-manage mild to severe levels of anxiety, depression and stress. After completing one of three versions of an eight-week mindfulness meditation program, participants were interviewed by a researcher unaffiliated with the treatment about their experiences, with 44 questions based on previous research of meditation-related challenges.
To more accurately and thoroughly capture patient perspectives, this study allowed each participant to evaluate the emotional tone or “valence” of each of 44 meditation-related experiences as well as the impact it had on their life and functioning. By asking participants specific questions about duration and impact, researchers were able to differentiate temporary distress, negative-impact side effects and “lasting bad effects.” In this way, the researchers sought to clarify which effects were experienced as “adverse” on a case-by-case basis.
To accommodate the varying definitions of harm, results were reported in tiers of severity ranging from “transient distress during meditation” (i.e., temporary) to “enduring impairment in functioning” — or “lasting bad effects.”
The “what” is as important as the “how”
The significance of the study, Britton said, has as much to do with what it found as how it found it.
“The fact that meditation can cause altered states, for example, isn’t news: It’s something that people have been talking about for centuries,” Britton said. “What we haven’t been very good about is measuring the impact and significance of these states on individual participants.”
Of the 96 participants, 58% reported at least one meditation-related adverse effect, which ranged from perpetual hypersensitivity to nightmares to traumatic re-experiencing. Meditation-related adverse effects with negative impacts on functioning occurred in 37% of the sample. Six percent of the sample had “lasting bad effects,” or impairments in functioning lasting more than one month. Notably, the researchers say, this rate is similar to those of other psychological treatments.
In the study, meditation-related effects with negative impacts tended to be associated with signs of what’s called dysregulated arousal — for example, the participants reported feeling anxious, hyper-stimulated or emotionally flat or disconnected after meditating.