Should mindfulness meditation come with a warning label?

Since mind­ful­ness it’s some­thing you can prac­tice at home for free, it often sounds like the per­fect ton­ic for stress and men­tal health issues. Mind­ful­ness is a type of Bud­dhist-based med­i­ta­tion in which you focus on being aware of what you’re sens­ing, think­ing and feel­ing in the present moment.

The first record­ed evi­dence for this, found in India, is over 1,500 years old. The Dharmatr?ta Med­i­ta­tion Scrip­ture, writ­ten by a com­mu­ni­ty of Bud­dhists, describes var­i­ous prac­tices and includes reports of symp­toms of depres­sion and anx­i­ety that can occur after med­i­ta­tion. It also details cog­ni­tive anom­alies asso­ci­at­ed with episodes of psy­chosis, dis­so­ci­a­tion and deper­son­al­i­sa­tion (when peo­ple feel the world is “unre­al”).

Growing evidence of (some) adverse effects

In the past eight years there has been a surge of sci­en­tif­ic research in this area. These stud­ies show that adverse effects are not rare. A 2022 study, using a sam­ple of 953 peo­ple in the US who med­i­tat­ed reg­u­lar­ly, showed that over 10% of par­tic­i­pants expe­ri­enced adverse effects which had a sig­nif­i­cant neg­a­tive impact on their every­day life and last­ed for at least one month.

Accord­ing to a review of over 40 years of research that was pub­lished in 2020, the most com­mon adverse effects are anx­i­ety and depres­sion. These are fol­lowed by psy­chot­ic or delu­sion­al symp­toms, dis­so­ci­a­tion or deper­son­al­i­sa­tion, and fear or terror.

Research also found that adverse effects can hap­pen to peo­ple with­out pre­vi­ous men­tal health prob­lems, to those who have only had a mod­er­ate expo­sure to med­i­ta­tion and they can lead to long-last­ing symptoms.

The west­ern world has also had evi­dence about these adverse affects for a long time. In 1976, Arnold Lazarus, a key fig­ure in the cog­ni­tive-behav­iour­al sci­ence move­ment, said that med­i­ta­tion, when used indis­crim­i­nate­ly, could induce “seri­ous psy­chi­atric prob­lems such as depres­sion, agi­ta­tion, and even schiz­o­phrenic decompensation”.

There is evi­dence that mind­ful­ness can ben­e­fit people’s well­be­ing. The prob­lem is that mind­ful­ness coach­es, videos, apps and books rarely warn peo­ple about the poten­tial adverse effects.

The Rise of “McMindfulness”

Pro­fes­sor of man­age­ment and ordained Bud­dhist teacher Ronald Purs­er wrote in his 2023 book McMind­ful­ness that mind­ful­ness has become a kind of “cap­i­tal­ist spir­i­tu­al­i­ty”. In the US alone, med­i­ta­tion is worth US$2.2 bil­lion (£1.7 bil­lion). And the senior fig­ures in the mind­ful­ness indus­try should be aware of the prob­lems with med­i­ta­tion. Jon Kabat-Zinn, a key fig­ure behind the mind­ful­ness move­ment, admit­ted in a 2017 inter­view with the Guardian that “90% of the research [into the pos­i­tive impacts] is subpar”.

In his fore­word to the 2015 UK Mind­ful­ness All-Par­ty Par­lia­men­tary Report, Jon Kabat-Zinn sug­gests that mind­ful­ness med­i­ta­tion can even­tu­al­ly trans­form “who we are as human beings and indi­vid­ual cit­i­zens, as com­mu­ni­ties and soci­eties, as nations, and as a species”.

This reli­gious-like enthu­si­asm for the pow­er of mind­ful­ness to change not only indi­vid­ual peo­ple but the course of human­i­ty is com­mon among advo­cates. Even many athe­ists and agnos­tics who prac­tice mind­ful­ness believe that this prac­tice has the pow­er to increase peace and com­pas­sion in the world.

Media dis­cus­sion of mind­ful­ness has also been some­what imbal­anced. In 2015, my book with clin­i­cal psy­chol­o­gist Cather­ine Wikholm, Bud­dha Pill, includ­ed a chap­ter sum­maris­ing the research on med­i­ta­tion adverse effects. It was wide­ly dis­sem­i­nat­ed by the media, includ­ing a New Sci­en­tist arti­cle, and a BBC Radio 4 documentary.

But there was lit­tle media cov­er­age in 2022 of the most expen­sive study in the his­to­ry of med­i­ta­tion sci­ence (over US$8 mil­lion fund­ed by research char­i­ty the Well­come Trust). The study test­ed more than 8,000 chil­dren (aged 11–14) across 84 schools in the UK from 2016 to 2018. Its results showed that mind­ful­ness failed to improve the men­tal well­be­ing of chil­dren com­pared to a con­trol group, and may even have had detri­men­tal effects on those who were at risk of men­tal health problems.

Ethical implications & informing the public

Is it eth­i­cal to sell mind­ful­ness apps, teach peo­ple med­i­ta­tion class­es, or even use mind­ful­ness in clin­i­cal prac­tice with­out men­tion­ing its adverse effects? Giv­en the evi­dence of how var­ied and com­mon these effects are, the answer should be no.

How­ev­er, many med­i­ta­tion and mind­ful­ness instruc­tors believe that these prac­tices can only do good and don’t know about the poten­tial for adverse effects. The most com­mon account I hear from peo­ple who have suf­fered adverse med­i­ta­tion effects is that the teach­ers don’t believe them. They’re usu­al­ly told to just keep med­i­tat­ing and it will go away.

Research about how to safe­ly prac­tice med­i­ta­tion has only recent­ly begun, which means there isn’t yet clear advice to give peo­ple. There is a wider prob­lem in that med­i­ta­tion deals with unusu­al states of con­scious­ness and we don’t have psy­cho­log­i­cal the­o­ries of mind to help us under­stand these states.

But there are resources peo­ple can use to learn about these adverse effects. These include web­sites pro­duced by med­i­ta­tors who expe­ri­enced seri­ous adverse effects and aca­d­e­m­ic hand­books with ded­i­cat­ed sec­tions to this top­ic. In the US there is a clin­i­cal ser­vice ded­i­cat­ed to peo­ple who have expe­ri­enced acute and long term prob­lems, led by a mind­ful­ness researcher.

For now, if med­i­ta­tion is to be used as a well­be­ing or ther­a­peu­tic tool, the pub­lic needs to be informed about its poten­tial for harm.

–Miguel Farias leads the Brain, Belief and Behav­iour Lab at the Cen­tre for Trust, Peace & Social Rela­tions at Coven­try Uni­ver­si­ty. This arti­cle was orig­i­nal­ly pub­lished on The Con­ver­sa­tion.

To Learn More:

• Debate: Can mind­ful­ness and med­i­ta­tion be harmful?
• 8‑week Mind­ful­ness-Based Stress Reduc­tion (MBSR) course found to be as effec­tive as Lexapro (esc­i­talo­pram) to treat adults with anx­i­ety dis­or­ders, and with far few­er side effects