Looking Inward and Its Excesses: Addressing the Risks of Mindfulness
Willoughby Britton, a licensed clinical psychologist, is doing important research into the dangers, or dark side, of meditation. In a paper published in Current Opinion in Psychology, she points to evidence indicating that too much mindfulness — too much of a good thing — can have deleterious effects. She concludes, “Mindfulness researchers and program developers have recognized that reversal of deficiencies in MRPs [mindfulness-related processes] enhance wellbeing, but have paid less attention to how excesses in these processes could also undermine wellbeing.” This runs counter to the popular notion that the more you meditate, the closer you will be to achieving a state of serenity.
MRPs (and deficiencies in them — which mindfulness can correct — and adverse effects of their excesses, caused by too much mindfulness) include:
A deficiency in this is low self-awareness, while excesses (i.e. high self-focus) can lead to anxiety, depression, dissociation, substance abuse, increased symptom distress, and social avoidance.
A deficiency shows up as low body or emotional awareness, whereas the opposite of this can be a source of anxiety, flashbacks, stress reactivity, and pain.
Emotion regulation/prefrontal control
When you’re deficient in this MRP, you will struggle with poor emotion regulation and high emotional reactivity, but too much emotion regulation can lead to emotional blunting/flat affect and dissociation.
Psychological distance and decentring
High fusion with thoughts or emotions indicates a deficiency in this process, whereas dissociation, depersonalisation, and out-of-body experiences can come from its excess.
Exposure (attending to threat)
People deficient in this MRP may suffer from high experiential avoidance, while those who experience the excess of it from too much mindfulness can experience negative attention bias, anxiety, and depression.
In a piece on the connection between philosophy and mental health, I referred to one paper from Britton and Jared R. Lindahl, which describes how meditation can lead to depersonalisation (the feeling that you are unreal, or a feeling of being disconnected from yourself, observing your actions, feelings, or thoughts from a distance).
This can happen because vipassana meditation, a type of practice common to many meditation retreats, is meant to allow you to see things as they really are. Vipassana means, literally, “special seeing”. And a core teaching of Buddhist philosophy is anatta (meaning “not-self”): this is the idea that there is no self. By cultivating mindfulness — detachedly observing thoughts and emotions without judgement — you can see through the illusion of selfhood; but for some, this can lead to a persisting (and distressing) feeling of depersonalisation. The retreat may be over, but this doesn’t mean the radical shift in consciousness you experienced will as well.
In her studies, Britton has discovered that about 10% of people who practise meditation experienced a meditation-related adverse effect that lasts more than a month. This includes people who only meditate for a few minutes each day. So it’s not just intensive, prolonged meditation that carries a risk (varying depending on the individual) of worsening mental health for practitioners; meditating for a short period of time each day can negatively affect (to a lesser degree) some individuals as well.
Britton has mapped over 60 different types of adverse events. The most common are hyperarousal, where your attention is so intensified that ordinary life becomes disturbing (note that students in the MYRIAD study had higher levels of hyperactivity and panic than the control group); dissociation; emotional flattening; social impairment; and executive impairment (problems making decisions or remembering things). These negative effects vary in their severity — executive dysfunction, for instance, is more likely to have lasting repercussions than other kinds of adverse effects. In her dissertation, Britton also found that mindfulness worsened people’s sleep, running contrary to the widespread notion that mindfulness has the opposite effect. This can occur if meditation makes you hyper-aroused and over-sensitive.
One of the largest-ever mindfulness studies — the MYRIAD trial, led by Dr Mark Williams of the Oxford Mindfulness Centre — published its results last year. It took eight years, involved teams at six universities, with 100 researchers working with 28,000 students in 650 schools. The aim of the study was to see if a mindfulness course (10 lessons, 30–50 minutes in length) could reduce anxiety and depression and improve educational outcomes in teenagers.
The study found that mindfulness meditation only helped a minority of students (who got into it and practised it in their own time). The mindfulness intervention actually made some young people’s mental health worse. The paper states:
Only for five of 28 secondary outcomes was there some evidence of a difference between the trial arms. Intervention arm students had higher self-reported hyperactivity/inattention on the SDQ subscale at both postintervention and 1 year follow-up, and higher panic disorder and obsessive-compulsive scores on the RCADS measure at postintervention, lower levels of mindfulness skills on the CAMM postintervention only plus higher teacher-reported emotional symptoms on the SDQ at 1 year follow-up only, suggesting that they are doing worse, although marginally, on these outcomes than the control arm.
In response to these findings, philosopher and writer Jules Evans said:
Can you imagine if you’re one of the researchers working on the trial and, after eight years, that’s what you discover. Your intervention actually harmed teenagers. One year after the intervention and their mental health is worse. Imagine reading that if you’re one of the countless mindfulness evangelists of the last 30 years, utterly convinced that the answer to all the world’s problems is: mindfulness, mindfulness, more mindfulness. And then, in the biggest study yet of mindfulness in schools, it turns out it harms some kids’ mental health.
This is the risk when people get evangelical and dogmatic about their particular mental health intervention, whether it’s Christianity or eugenics or psychoanalysis or lobotomies or insulin-induced comas or ‘the rest cure’ or Prozac or CBT or mindfulness or Stoicism or psychedelic therapy or ‘trauma-informed therapy’. When they become convinced it will ‘save the world’. They never ask themselves: ‘could this actually do harm?’
According to Dr Julieta Galante, the students in the trial whose mental health suffered were those with pre-existing mental health problems. She told The Educator:
it’s important to note that the students who got worse tended to have existing, underlying mental health difficulties. From here, if we think about how mindfulness actually works, there is a fairly simple and plausible explanation. Consider that many mindfulness activities involve the person bringing their attention to bodily sensations, the breath, or to thoughts. For those with existing mental health issues, or a history of trauma, sustained attention like this can actually bring about unwelcome thoughts, feelings and sensations more clearly into awareness. This, understandably, can be unpleasant. In short, mindfulness is unlikely to cause trauma, but it certainly can cause the re-experiencing of traumatic memories for some meditators.
Sometimes, for some individuals, it’s best not to focus too much on distressing thoughts, feelings, or somatic sensations, which can occur during mindfulness meditation. While mindfulness is meant to encourage a non-reactive attitude with respect to the contents of one’s mind, actually doing so is difficult; so it’s important for at-risk individuals to know when to put the brakes on their meditation practice if it isn’t helping. Meditating more is not always the answer. This can just make things worse.
Mindfulness can, for many, be a profoundly therapeutic and life-changing practice. But the hype surrounding mindfulness — the uncritical promotion of it and the hope that it will drive a well-being and calmness revolution — is being challenged by evidence relating to its potential risks. There is no risk-free intervention and any consciousness-altering practice should certainly be approached with care.