Side effects of meditation: be warned!

In the professional medical world, Medscape is probably the most trusted up to date online resource. I am delighted to see that yesterday they published an article that highlights some of the more challenging and distressing aspects of meditation based on a recent scientific paper in PLOS One.

The reason I am so glad is that it means we’re moving to a different approach to meditation, one with more well-warranted rigour in how people talk about this intervention and away from the perception that this is something without side-effects.

Crux of the study:

  • the challenging aspects of Buddhist-derived meditation practices are well described in Buddhist tradition but are less so in Western scientific literature
  • the researchers interviewed nearly 100 meditators and meditation teachers from each of three main traditions: Theravāda, Zen, and Tibetan.dangers of meditation, side effects of mindfulness
  • the researchers developed a taxonomy of 59 experiences organised into seven domains: cognitive, perceptual, affective (emotions and moods), somatic (relating to the body), conative (motivation or will), sense of self, and social.
  • all meditators reported multiple unexpected experiences across the seven domains of experience. 
  • the duration of the effects people described in their interviews varied widely, ranging from a few days to months to more than a decade, the investigators report.
  • some meditators reported their feelings, even the desirable ones, went too far or lasted too long, or they felt violated, exposed, or disoriented. 
  • meditation experiences that felt positive during retreats sometimes persisted and interfered with their ability to function or work when they left the retreat and returned to normal life.
  • the meditator’s practice intensity, psychiatric history, trauma history and the quality of supervision are important factors that influence the meditators experience, but not for everyone.factors that influence quality of meditation
  • the study highlights that the one size fits all approach isn’t ideal: “The good news is that there are many different programs out there and different practices available, and with a little bit of homework and informed shopping, someone could find a really good match for what they are after,” she said. “But I think often people just sign up for whatever is the most convenient or the best marketed, and it’s not always a good match for their constitution or their goals.”

Dissecting the side effects 

Here are the reported side effects with the percentage of people who reported them in brackets:

side effects of meditation cognitive, perceptual, affective, somatic, sense of self, social

It’s fascinating to note that nearly 50% noted a change in worldview. Open mind, new philosophy – fair enough. I would be on the fence about saying that I have a different world view because of meditation. It’s clearer, it’s calmer, it’s more adaptable, but it’s not really changed. Thus, it is possible that people who try to meditate are often looking for a new worldview or are quite suggestible.

Nearly the same number of people reported delusional, irrational and paranormal beliefs! I guess this is all based on Buddhism and there is a strong religious element to it. However, people were clearly made uncomfortable by it. I certainly experienced this: this is why I tread carefully when I go exploring meditation resources. A huge number of them are zealous, either for reasons of unquestioning devotion, or commercial ones. Snake oil requires faith.

Again, over 40% reported hallucinations. Just as a reminder – delusions and hallucinations are the key ingredients of psychosis and good reason to admit someone to a psychiatric ward. Obviously, these must not be quite as persistent as those associated with psychiatric disease, but if I had seen this table before starting mindfulness, I would have thought much more carefully. In this sample, 32% of people had a prior psychiatric history. This doesn’t explain how common all these DSM-sounding symptoms are among them.

Fear, anxiety, panic or paranoia came up for over 80% of people. I think is more a reflection on the sample than on meditation. Why to people meditate? Often they come upon it as a cure for anxiety. Indeed, in my experience, besides actually getting rid of the anxiogenic stimulus, meditation is a great method to deal with it. Depression was very common too at over 50%. Anhedonia and avolition – being unable to experience pleasure and not having any desire to do anything – are hallmarks of depression and were experienced by 18%. Personally, anxiety has always accompanied meditation in some way or another, but not in a bad way. It’s a little bit like saying that exercise cause shortness of breath. However, panic and paranoia are step to far.

Where there are mood changes, there are autonomic function changes and indeed they seem to have been affected too: level of energy, quality of sleep, appetite, etc. It’s unfortunate to note that many of those changes were negative with common reports of fatigue and pain.

As expected, 75% of meditators had their mind bent by Buddhist approaches to the self. We also know from MRI studies, that the anatomical self, seated in default mode network is modified by meditation, so this is expected.

Clarity, meta-cognition and increased cognitive processing – that’s our thinking clearly box ticked.

What does all of this mean?

To meditate or not? Meditate, but proceed with caution, a healthy balance of open-mindedness and scepticism – and preferably with supervision. In the words of Dr Walsh, it’s important to be challenged, but not overwhelmed.

As for me, I often take breaks from meditation. If it’s not happening, I don’t force myself too much. Thirty seconds of mindfulness is better than ten minutes of desperate striving effort and then feeling exposed, lonely and inadequate. To give it a Buddhist twist, we can think of the experience as if it is the weather. You may have decided that you are jogging today, but if it is stormy outside, it’s better to be a bit more adaptable, stay at home and practice your planks. Same here.

Reference:

Lindahl JR, Fisher NE, Cooper DJ, Rosen RK, Britton WB (2017) The varieties of contemplative experience: A mixed-methods study of meditation-related challenges in Western Buddhists. PLoS ONE 12(5): e0176239. https://doi.org/10.1371/journal.pone.0176239

P.S. Have a look at this Christian blogger explaining the emotional conflict she experienced when exploring yoga. It’s not important to be religious to understand that imposing one system of beliefs over another, whatever it may be, can be highly distressing.

negative effects of meditation
Just a picture of Dublin in the sun

 

The darker side of mindfulness: being overwhelmed, side effects and the difficulty of finding a good teacher

It was my pleasure to speak to Dr Chris Walsh, an Australian mindfulness pioneer since the 1980’s and a respected psychiatrist. Dr Walsh has trained with leading Western mindfulness figures such as Jon Kabatt Zinn, Mark Williams, Kristin Neff and Daniel Siegal. Dr Walsh and I spoke about the darker side of mindfulness.

As with any area experiencing such strong growth, mindfulness is surrounded by myths and misconceptions. What is one that you feel particularly strongly about?

It’s used by business to make people work harder. It’s not so much a myth, it’s just the way it is being used.

People think it’s a relaxation technique. This is tricky to address. Mindfulness does help people to relax, but that’s not the main game. It’s about training your awareness.

You cannot count on mindfulness to make you relax.

If occasionally mindfulness doesn’t help you relax, you will feel that it’s not working and are missing out on an opportunity to learn to hold an unpleasant feeling. This can be destructive.

Chris Walsh mindfulness expert tips

Mindfulness can bring out negative emotions, especially during the initial stages. How would you recommend that a person deals with that?

The first thing is to have a good teacher. It’s a delicate balance and it can be hard to know when to lean into the negative emotion and when to stand back from it.

The basic principle is that it is ok to feel challenged, but it’s not okay to feel overwhelmed.

With any kind of learning, including learning to be mindful, it is normal to oscillate between feeling comfortable and feeling challenged. If you’re never challenged, especially with something experiential like mindfulness or a sport, the learning isn’t in its optimal state. Getting overwhelmed in mindfulness is the equivalent of getting injured when training, and this sets back the progress.

I have a few tricks on how to deal with being overwhelmed during mindfulness.

  • The feeling of being overwhelmed is most likely to occur when doing a body scan, especially when focusing on the chest and abdomen as this is where we tend to feel anxiety. I encourage people to find “safe places” where they are less likely to feel this anxiety: such as the resting one’s attention on the sensation of breath in their nose. Even this can be too much for some people.
  • Awareness of sounds can also help, as the attention is then focused on something outside the body.
  • Allowing oneself to move can also help to deal with the sense of being overwhelmed. In the Tibetan mindfulness tradition you can move; in the Zen tradition you are meant to be still no matter how much one’s knees hurt. This stillness doesn’t work for people with a lot of agitation. Doing walking mindfulness or exercising before doing mindfulness can help greatly. Some people think that this is an avoidance behaviour. I believe, it is taking a distance, while still still remaining present to the difficult experience.
  • Sometimes it is okay to let one’s mind wander off. When I run classes with inpatients, I tell them that it’s okay to daydream if it gets too much. The important thing is: come back because this way you can learn what has changed. This is very empowering: we don’t always have to do something to change things. They change by themselves.

These tips work for patients with mental health issues, e.g. PTSD, as well as people with no mental health issues.

the darker side of mindfulness chris walsh

Have you ever had any experiences when mindfulness had side effects? The “decentering” in mindfulness may impact an individual’s concept of the “self”. There are anecdotal reports of some vulnerable individuals developing dissociation and psychosis after reading self-help books or attending seminars – and more recently after practicing mindfulness. Do you see any risks in “trying it at home” when it comes to mindfulness?

It is damaging when people use mindfulness to dissociate or disconnect in some way. Two patients I encountered were attached to ecstatic states.

The first was a man with a background of heroin and alcohol addiction. He was able to stay away from drugs and alcohol for 10 years and then relapsed – which is when he came to me. He told me he was using mindfulness to stay away from his addictions and meditated for 8 hours a day! Just before the relapse he got a job: this stopped him from meditating for 8 hours a day, and so he relapsed.

When I questioned him about his mindfulness practice, he told me that he would just got into a blissful state for 8 hours, never experiencing any negative emotions.

I asked him to deliberately call to mind some unpleasant experiences while practicing mindfulness and pay attention to how it felt in his body rather than holding on to these blissful states. The lesson here is to get comfortable with feeling uncomfortable. In Tibetan Buddhism, they talk about samadhi. It is a blissful state – and sometimes people get addicted to this state. Some people this is enlightenment, but the Buddhist teachers say that that’s a delusion, an unhealthy attachement to something.

The second case that comes to mind was of a man with schizophrenia. Many of my patients with schizophrenia derived a great benefit from mindfulness. This man was having a Kundalini experience, where energy was going up and down his spine. They talk about it in the Hindu tradition. He would go through this experience for many hours a day and it made him more delusional and psychotic. It was very hard to persuade him to do less meditation!

I wouldn’t’ call either of these experiences mindfulness, as they weren’t this open, non-judgemental states. This is why having a teacher is important: so that you can reflect on your experience and receive some guidance.

how to choose mindfulness teacher

How should one go about choosing their mindfulness teacher?

There are no absolute guarantees. I am aware of some highly trained psychiatrists who teach mindfulness, but don’t practice it. They say they do, but by talking to them, you quickly realise they don’t: they have a kind of striving attitude.

For people with psychiatric conditions, it is better to have someone who understands both the Western and the Eastern traditions. If you have a teacher, a psychologist or psychiatrist, who comes from the Western tradition only, it is important that they practice mindfulness themselves. It’s important for a teacher to be able to tune into the problems that arise for people as they go through their mindfulness journey rather than sticking to a rigid program.

does mindfulness have side effects

There is a one size fits all approach to mindfulness among the public at the moment. Do you feel that that it’s appropriate for someone to use an app or should they find a teacher?

In my classes, I have a handout that reviews the apps and advises my patients to beware of any apps that tell them what to feel or that they should relax. People can play with apps – it gives them experiential information that allows them to commit to go to a class. Some people learn a lot from the apps. I haven’t seen the good apps causing any harm. Headspace is quite good. Buddhify is great for getting past the idea that mindfulness only happens on a cushion and has lots of shorter meditations that people like. Insight timer has nice mindfulness bells and nice soundtracks. Some are a bit New Age-y, so people need guidance in choosing the right ones. iTunes U UCLA meditations are quite good too. I send people to my website as I have some soundtracks there.

how to deal with feeling overwhelmed during mindfulness

What are your thoughts on transcendental meditation? It became commercialised quite quickly once it reached the West. Do you worry that mindfulness is headed in that same direction?

I did TM for a few years and found it helpful. I studied Buddhist meditation before that and it gave me the impression that the mind has to be completely quiet – which caused a lot of agitation. TM helped me to get past that as it involved returning to the mantra without trying to eliminate thoughts. TM also taught me about preliminary practices such as exercise.

In the East, mindfulness is used to investigate the mind as well as everything else. A lot of the insights of Buddhist psychology are now being confirmed using Western methods, such as fMRI. I believe this aspect of the Eastern tradition doesn’t get enough attention. However, we need to separate the psychology, philosophy and the religion. Those who say that Buddhism isn’t a religion are lying: it is a religion, but as well as that there are psychological and a philosophical components. These can be separated out, just like has happened in the West.

The tradition in the East is 2,500 years old, so we run into a lot of interpretation and translation problems. The Eastern languages have changed in meaning and nuance in that time just as much as Western languages have. Jus think how much trouble we have interpreting Shakespeare and his writing was only 500 years ago. Furthermore, Buddhist psychology is based on  human investigation that has evolved over time, so it’s not like the Bible that has been “handed down” and and passed on as some kind of unchanging truth. The Eastern mindfulness tradition, in fact, has a lot in common with the Western scientific tradition. This tradition has evolved from the Socratic tradition which is based on debate and questioning. rather than prescriptive rote learning. I believe that if we start paying more attention to what is already known in the East our progress in understanding the mind will be accelerated and our meditation practices will become even more effective.

Dr Walsh’s own website contains a lot of case studies and blog articles on mindfulness that I would highly recommend: mindfulness.org.au