New Research Focuses on the Harmfulness of Mindfulness

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Willoughby Britton, assistant professor of psychiatry and human behavior at Brown University and director of their Clinical and Affective Neuroscience Laboratory, is a mindfulness researcher and practitioner on a mission to debunk myths about mindfulness-meditation practices and counteract the hype.

In 2017, she was part of a 15-person panel of scholars who published a paper, "Mind the Hype," in the peer-reviewed journal Perspectives on Psychological Science. This paper warned: "Misinformation and poor methodology associated with past studies of mindfulness may lead public consumers to be harmed, misled, and disappointed." (See "Is Mindfulness Being Mindlessly Over-Hyped?")

This week, Britton and colleagues from Brown's Mindfulness Center published another paper that tackles the potentially taboo topic of defining and measuring the meditation-related adverse effects of a mindfulness-based training program. These findings (Britton et al., 2021) were published on May 18 in the peer-reviewed journal Clinical Psychological Science.

Shedding Light on the Adverse Effects of Mindfulness May Disrupt the Status Quo

"Mindfulness-based meditation programs have emerged as a promising treatment for conditions ranging from stress to sleeplessness to depression," Britton and co-authors explain in a news release. "In some cases, they're even offered to people—schoolkids or employees, for example—who aren't actively seeking help or who haven't been screened for suitability. Yet most research and discourse about these programs focuses only on their benefits, with little investigation of the risks or the potential for adverse effects."

Acknowledging that mindfulness-meditation isn't always helpful—and may actually be harmful in some cases—disrupts the status quo. Over the past few decades, the popularity of mindfulness-based practices (MBPs) has skyrocketed. In some circles, saying anything negative about mindfulness or meditation is blasphemous.

That said, understanding when, why, and how mindfulness or meditation can be harmful goes hand-in-hand with identifying when it's helpful.

For example, a recent study (Poulin et al., 2021) found that mindfulness may increase selfishness and decrease prosociality in those who are more individualistic but can have the opposite effect on collectivists.

Another study (Saltsman et al., 2020) suggests that being more "in the moment" via mindfulness can be beneficial after an active stressor subsides. However, if mindfulness causes someone to overthink their current situation during an active stressor, it may increase anxiety by causing mindfulness practitioners to "sweat the small stuff."

Last year, a systematic review (Farias et al., 2020) of meditation adverse events (MAEs) occurring during meditation‐based therapies found that less than 1% of the 6,742 studies reviewed defined or measured MAEs.

Of the 83 studies that did evaluate MAEs, this review found that the most common adverse events associated with meditation were anxiety (33%), depression (27%), cognitive anomalies (25%), and gastrointestinal problems or suicidal ideation (both 11%). Farias et al. sum up, "[Our] results are relevant both for practitioners and clinicians, and contribute to a balanced perspective of meditation as a practice that may lead to both positive and negative outcomes."

Pinpointing Why and When Mindfulness Is Harmful Can Improve Its Overall Beneficiality

In their latest study, Britton and colleagues set out to assess adverse effects (i.e., "harms monitoring") with the ultimate goal of identifying ways to mitigate the potential harmfulness of mindfulness. Britton's research team followed two dozen harms-monitoring guidelines while assessing the nature and frequency of meditation-related adverse effects (MRAEs) in mindfulness-based programs.

"Our ultimate goal is to maximize the efficacy of mindfulness-based meditation while minimizing harms," Britton said in the news release. "In order to address risks and modify treatment accordingly, you need thorough and detailed knowledge about potential harms. Our study, the most comprehensive of its kind, provides a blueprint for how to accurately assess the risks of mindfulness-based meditation programs."

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For this study, Britton's team used the 44-item Meditation Experiences Interview (MedEx-I) to measure meditation-related side effects (MSREs) after a cohort of 96 study participants had completed an 8-week mindfulness-based program. Notably, 83% of the MBP participants reported at least one meditation-related side effect.

The researchers also found that there was hesitancy among many study participants "to report negative reactions to treatment because of feelings of shame or a desire to please the researcher or instructor."

"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."

The results of this clear-eyed reporting suggest that the same ingredients that make mindfulness-based practices helpful in some situations are the same factors that can make it harmful in others. It's important to note that the adverse effects and benefits of MBPs are not mutually exclusive; oftentimes the same participants who experience one adverse effect related to mindfulness also report benefits.

Mindfulness Has Benefits and Risks

Britton makes an analogy between mindfulness and aspirin. Just as aspirin is a medicine-cabinet staple that can be pain-relieving and potentially life-saving in some situations, it can also cause heartburn, stomach cramps, and even gastrointestinal bleeding in some individuals.

Therefore, having evidence-based knowledge of aspirin's benefits and risks makes it easier to avoid its adverse side effects. Well-informed doctors and practitioners can make safe and effective dosage recommendations when prescribing aspirin to specific patients.

Expanding on this aspirin metaphor, Britton said: "That's where we need to get with mindfulness, too. Our study is an attempt to bring harms monitoring up to the standards of other treatments so that providers can identify events that require monitoring and intervention in order to maximize the safety and efficacy of mindfulness-based meditation."

In closing, Britton reiterates that the intent of this recent (2021) paper "is not to discourage mindfulness-based meditation programs—rather, it is to generate findings on both the positive and negative effects so that providers and meditators can make informed decisions."

"In order to address risks and modify treatment accordingly, you need thorough and detailed knowledge about potential harms," Britton concludes.

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