The Shadow Side of Meditation — what the science really says

Because meditation is now used with people who have depression, anxiety and other psychiatric issues. In any clinical science, drug or behavioral, researchers are obligated to look honestly for harm as well as benefit.

To predict who might have a negative effect, so practices can be tailored to the people most likely to benefit.

A reaction to the public picture of meditation as a panacea. People who had hard experiences pushed back, and that story became powerful in public, which prompted the causal questions this group asks.

He was a participant in one of the first studies on difficult meditation experiences, led by Willoughby Britton, and was interviewed for it years ago.

Negative experiences during digital meditation training, specifically the Healthy Minds Program app. Earlier work looked at intensive retreats or 8-week courses like MBSR.

An adverse experience is something negative that happened while someone was meditating. An adverse effect is something meditation actually caused. Calling it an effect needs strong causal evidence.

Most studies did not use methods that separate experiences from effects, yet many claimed from observational data that meditation caused harm. The evidence does not support that.

Put 1,000 people on an exercise program and some get injured. But some would get injured anyway. The questions are whether exercise makes injury more likely, less likely, and how people relate to an injury when it happens.

The randomized trial. It is the standard for FDA drug approval, and the same design can test whether meditation raises the rate of side effects compared with a control group.

About 30% of participants across both studies. That does not mean meditation caused it, only that they attributed it to practice.

About 6% in one study and 3% in the other, again as they themselves attributed it.

About 50%, from Simon's cross-sectional work, a finding since replicated almost to the exact percent.

Because keeping your attention on your breath is challenging for nearly everyone, and that is not what anyone means by an adverse experience.

No. Some, like increased sensitivity to sound, were rated more positive than negative. Even ones that sound bad, like poor sleep or feeling isolated, were rated across a range, never uniformly negative.

No. Across the Healthy Minds app trials and reanalyses of MBSR and MBCT data, they have found no evidence of increased symptom worsening.

Yes. In many cases people assigned to meditation had lower rates of increased symptoms than the control group.

On some outcomes the meditation group gets worse at first, then recovers, and by the end does much better than controls. These analyses are not yet in the published paper.

Early practice can feel like a flood of thoughts and feelings. Meditation is not creating them; it is making you aware of what was already there. Over time the mind settles.

She has argued that randomized trials are not a good setting for evaluating harm, partly because they may not measure the things that actually get disrupted. Simon acknowledged that symptom worsening is a fairly gross measure.

Meditation may increase sensitivity to anxiety, not anxiety itself. People notice more of what is already there and report it as more anxiety.

It may be an early benefit, a marker that someone is engaging with the practice in the right way.

Early on he had a lot of social anxiety. Feeling it during practice is what let him stay grounded when it showed up in real life. On a survey, though, it would have counted as an adverse experience.

Exposure therapy for anxiety is deliberately unpleasant yet one of the most effective techniques there is. Ruth Baer's work names exposure as one mechanism of mindfulness.

People who started with higher anxiety and depression. They tended to report those same feelings throughout training.

Loneliness.

Social support: talking with friends, family and therapists. Polina was struck by how much resilience and self-kindness came through.

The vast majority said they were still glad they learned, even those who reported difficult experiences.

Practices were passed down in community, sangha, with teachers. Today many people learn alone through apps, without that support.

Light-touch programs most people actually do: apps and courses like MBSR. It does not cover intensive retreats.

Almost always from people who did very intensive practice, such as long retreats. Matt says the two get conflated.

Proper pre-training, the right context, a good teacher, and the right practices.

Stories of manic episodes in retreat settings, possibly triggered when sleep is reduced alongside intensive practice. His trials have not recruited people with psychosis for this reason.

Simon does not see one in the data. Programs adapted for psychosis and trauma-informed mindfulness for PTSD show benefit, and people with adverse childhood experiences sometimes benefit more. But those studies have structure and support, not someone alone in a room.

There is no causal evidence of harm from the trials, but challenges do happen. Pay attention, and don't barrel ahead treating meditation as a panacea.

Kindness and compassion toward yourself. Sometimes keep going and see what comes up; sometimes step away for a moment, recover, and come back.

Two questions for future research: motivation (why are you meditating?) and view (what do you think meditation is for?). The same sadness means something very different if you expect equanimity training rather than the absence of sadness.

Meditating even a few minutes with a difficult situation can matter more than months of peaceful practice. Richie finds that bad, distracted days may be just as helpful as good ones.

Breakthroughs often came right after periods when practice felt like it was going backwards.

The overall findings are encouraging. Very few serious adverse effects are caused by practice, it is freely available, and there is a lot of evidence of benefit. Try it, investigate, and continue if you find it helpful.