Progress or Pathology? Differential Diagnosis and Intervention Criteria for Meditation-Related Challenges: Perspectives From Buddhist Meditation Teachers and Practitioners

Altered states of consciousness caused by a mindfulness-based programme up to a year later: Results from a randomised controlled trial

BACKGROUND

Mindfulness-based programmes (MBPs) have shown beneficial effects on mental health. There is emerging evidence that MBPs may also be associated with marked deviations in the subjective experience of waking consciousness. We aimed to explore whether MBPs can have a causal role in different types of such states.

METHODS

We conducted a pragmatic randomised controlled trial (ACTRN12615001160527). University of Cambridge students without severe mental illness were randomised to an 8-week MBP plus mental health support as usual (SAU), or to SAU alone. We adapted the Altered States of Consciousness Rating Scale (OAV, 0-100-point range) to assess spontaneous experiences in daily life, and included it as a post-hoc secondary outcome at the end of the one-year follow-up questionnaire. Two-part model analyses compared trial arms, and estimated dose-response effects of formal (meditation) and informal (daily activities) mindfulness practice during the year. Sensitivity analyses correcting for multiple comparisons were conducted.

RESULTS

We randomised 670 participants; 205 (33%) completed the OAV. In comparison with SAU, MBP participants experienced unity more frequently and intensively (two-part marginal effect (ME) = 6.26 OAV scale points, 95% confidence interval (CI) = 2.24, 10.27, p = 0.006, Cohen's d = 0.33) and disembodiment more frequently (ME = 4.84, 95% CI = 0.86, 8.83, p = 0.019, Cohen's d = 0.26). Formal practice predicted spiritual, blissful and unity experiences, insightfulness, disembodiment, and changed meanings. Informal practice predicted unity and blissful experiences. Trial arm comparisons and informal practice effects lost significance after corrections for multiple comparisons, but formal practice dose-response effects remained significant.

CONCLUSIONS

Results provide a novel suggestion of causal links between mindfulness practice and specific altered states of consciousness. To optimise their impact, practitioners and teachers need to anticipate and handle them appropriately. Future studies need to confirm findings and assess mechanisms and clinical implications.

Documenting and defining emergent phenomenology: theoretical foundations for an extensive research strategy

Meditation, psychedelics, and other similar practices or induction methods that can modulate conscious experience, are becoming increasingly popular in clinical and non-clinical settings. The phenomenology associated with such practices or modalities is vast. Many similar effects and experiences are also reported to occur spontaneously. We argue that this experiential range is still not fully described or understood in the contemporary literature, and that there is an ethical mandate to research it more extensively, starting with comprehensive documentation and definition. We review 50 recent clinical or scientific publications to assess the range of phenomena, experiences, effects, after-effects, and impacts associated with a broad variety of psychoactive compounds, meditative practices, and other modalities or events. This results in a large inventory synthesizing the reports of over 30,000 individual subjects. We then critically discuss various terms and concepts that have been used in recent literature to designate all or parts of the range this inventory covers. We make the case that specialized terminologies are needed to ground the nascent research field that is forming around this experiential domain. As a step in this direction, we propose the notion of "emergence" and some of its derivatives, such as "emergent phenomenology," as possibly foundational candidates.

Mindfulness Teacher Trainees' Experiences (MTTE): An investigation of intense experiences in mindfulness-based interventions

With the increasing interest in mindfulness practices within clinical as well as non-clinical settings and the increasing body of research on the positive effects of mindfulness, concerns have been raised that mindfulness might also produce adverse effects including intense experiences and psychosis. The aim of this study was to investigate if intense experiences occur as a natural part of mindfulness practice, and if so to examine the characteristics of such experiences. We conducted a qualitative analysis based on fortnightly meditation reports from 13 mindfulness teacher trainees for 4 months. Intense experiences in meditation were frequently expressed in the reports of most of the practitioners and in some individuals these experiences were similar to psychotic-like experiences. This study presents suggestive evidence that mindfulness practices can produce intense experiences and that for some individuals these intense experiences may resemble psychotic-like experiences.

Clarifying and measuring the characteristics of experiences that involve a loss of self or a dissolution of its boundaries

Mystical experience, non-dual awareness, selflessness, self-transcendent experience, and ego-dissolution have become increasingly prominent constructs in meditation and psychedelic research. However, these constructs and their measures tend to be highly overlapping, imprecise, and poorly integrated with similar pathological experiences. The present study seeks to clarify the common factors involved in the characteristics of these experiences using precise distinctions across an array of experience contexts (including meditation, psychedelics, and psychopathology). Participants (N = 386) completed an online survey about an experience that involved either a dissolution of self-boundaries or a loss of selfhood. Confirmatory factor analyses resulted in 16 experience characteristics, including multiple types of changes in sense of self, co-occurring phenomenology, and cognitive and affective responses. Qualitative thematic analysis provided rich descriptions of experience characteristics. Taken together, results lead to a more specific measurement model and descriptive account of experiences involving a loss of self or self-boundary.

The roles and impacts of worldviews in the context of meditation-related challenges

Previous research has shown that worldviews can serve as a coping response to periods of difficulty or struggle, and worldviews can also change on account of difficulty. This paper investigates the impacts worldviews have on the nature and trajectory of meditation-related challenges, as well as how worldviews change or are impacted by such challenges. The context of meditation-related challenges provided by data from the Varieties of Contemplative Experience research project offers a unique insight into the dynamics between worldviews and meditation. Buddhist meditation practitioners and meditation experts interviewed for the study report how, for some, worldviews can serve as a risk factor impacting the onset and trajectory of meditation-related challenges, while, for others, worldviews (e.g., being given a worldview, applying a worldview, or changing a worldview) were reported as a remedy for mitigating challenging experiences and/or their associated distress. Buddhist meditation practitioners and teachers in the contemporary West are also situated in a cultural context in which religious and scientific worldviews and explanatory frameworks are dually available. Furthermore, the context of "Buddhist modernism" has also promoted a unique configuration in which the theory and practice of Buddhism is presented as being closely compatible with science. We identify and discuss the various impacts that religious and scientific worldviews have on meditation practitioners and meditation teachers who navigate periods of challenge associated with the practice.

Cessations of consciousness in meditation: Advancing a scientific understanding of nirodha samāpatti

Absence of consciousness can occur due to a concussion, anesthetization, intoxication, epileptic seizure, or other fainting/syncope episode caused by lack of blood flow to the brain. However, some meditation practitioners also report that it is possible to undergo a total absence of consciousness during meditation, lasting up to 7 days, and that these "cessations" can be consistently induced. One form of extended cessation (i.e., nirodha samāpatti) is thought to be different from sleep because practitioners are said to be completely impervious to external stimulation. That is, they cannot be 'woken up' from the cessation state as one might be from a dream. Cessations are also associated with the absence of any time experience or tiredness, and are said to involve a stiff rather than a relaxed body. Emergence from meditation-induced cessations is said to have profound effects on subsequent cognition and experience (e.g., resulting in a sudden sense of clarity, openness, and possibly insights). In this paper, we briefly outline the historical context for cessation events, present preliminary data from two labs, set a research agenda for their study, and provide an initial framework for understanding what meditation induced cessation may reveal about the mind and brain. We conclude by integrating these so-called nirodha and nirodha samāpatti experiences-as they are known in classical Buddhism-into current cognitive-neurocomputational and active inference frameworks of meditation.

A neurophenomenological approach to non-ordinary states of consciousness: hypnosis, meditation, and psychedelics

No contemporary unifying framework has been provided for the study of non-ordinary states of consciousness (NSCs) despite increased interest in hypnosis, meditation, and psychedelics. NSCs induce shifts in experiential contents (what appears to the experiencer) and/or structure (how it appears). This can allow the investigation of the plastic and dynamic nature of experience from a multiscale perspective that includes mind, brain, body, and context. We propose a neurophenomenological (NP) approach to the study of NSCs which highlights their role as catalysts of transformation in clinical practice by refining our understanding of the relationships between experiential (subjective) and neural dynamics. We outline the ethical implications of the NP approach for standard conceptions of health and pathology as well as the crucial role of experience-based know-how in NSC-related research and application.

Prevalence of meditation-related adverse effects in a population-based sample in the United States

OBJECTIVE

Meditation practice and meditation-based psychotherapies have become increasingly popular. Although psychological benefits associated with meditation are well-documented, potential risks are unclear.

METHOD

We conducted a population-based survey to evaluate the occurrence of a broad range of meditation-related adverse effects (MRAE).

RESULTS

Nine hundred and fifty three participants completed our screening survey, 470 endorsed lifetime exposure to meditation practice, and 434 completed a follow-up survey assessing MRAE (92.3% response rate). A higher proportion than hypothesized reported occurrence of MRAE (general item = 32.3%, 1+ specific item = 50.0%) and MRAE duration ≥1 month (10.4%). Anxiety, traumatic re-experiencing, and emotional sensitivity were the most common MRAE. Some degree of functional impairment was reported by 10.6% of participants, with impairment lasting ≥1 month for 1.2%. Childhood adversity was associated with elevated risk for MRAE. Participants reporting MRAE were equally glad to have practiced meditation as those not reporting MRAE. Additional correlates of MRAE were identified in exploratory analyses.

CONCLUSION

MRAE are common, even in a sample with relatively modest amounts of experience. Identifying individuals at elevated risk for MRAE, being transparent and realistic about the possible range of effects, and increasing trauma-sensitivity are warranted to maximize benefits and minimize risks of meditation.

Prevalence, predictors and types of unpleasant and adverse effects of meditation in regular meditators: international cross-sectional study

Background

Meditation is commonly implemented in psychological therapies since the ‘third wave’ of cognitive–behavioural therapy has increased the focus on mindfulness-based interventions. Although extensive research literature demonstrates its benefits, little is known about potential adverse effects.

Aims

The aim of this study is to report the prevalence, type and severity of particularly unpleasant meditation-related experiences in the largest cross-sectional study on this topic to date, with 1370 regular meditators.

Method

The participants were asked whether they ever encountered particularly unpleasant experiences as a result of their meditation experience. For the first time, the type and severity of those experiences were assessed and the association with several predictors, such as pre-existing mental disorders, were explored via logistic and linear regression.

Results

Similar to previous studies, 22% of participants (95% CI 20–24) reported having encountered unpleasant meditation-related experiences, and 13% of participants (95% CI 3–5) reported experiences that were categorised as adverse. Those were mostly of affective, somatic and cognitive nature. Unpleasant meditation-related experiences were more likely to occur in participants with pre-existing mental illnesses (P = 0.000, 95% CI 1.25–2.12).

Conclusions

This study demonstrates that unpleasant meditation-related experiences are prevalent among meditators and, to a relevant extent, severe enough to warrant further scientific inquiry. Longitudinal studies are needed to examine whether the unpleasant meditation-related experiences are merely negative and thus should be avoided, or are an inherent part of the contemplative path.

Defining and measuring meditation-related adverse effects in mindfulness-based programs

BACKGROUND

Research on the adverse effects of mindfulness-based programs (MBPs) has been sparse and hindered by methodological imprecision.

METHODS

The 44-item Meditation Experiences Interview (MedEx-I) was used by an independent assessor to measure meditation-related side effects (MRSE) following three variants of an 8-week program of mindfulness-based cognitive therapy (n = 96). Each item was queried for occurrence, causal link to mindfulness meditation practice, duration, valence, and impact on functioning.

RESULTS

Eighty-three percent of the MBP sample reported at least one MRSE. Meditation-related adverse effects (MRAEs) with negative valences or negative impacts on functioning occurred in 58% and 37% of the sample, respectively. Lasting bad effects occurred in 6-14% of the sample and were associated with signs of dysregulated arousal (hyperarousal and dissociation).

CONCLUSION

Meditation practice in MBPs is associated with transient distress and negative impacts at similar rates to other psychological treatments.