Frequency of Self-reported Unpleasant Events and Harm in a Mindfulness-Based Program in Two General Population Samples

Abstract

Objectives Evidence-based mindfulness programs have well-established benefits, but the potential for harmful effects is understudied. We explored the frequency and severity of unpleasant experiences and harm in two nonclinical samples participating in an adaptation of mindfulness-based cognitive therapy (MBCT) for the general population. Methods Study 1 included 84 schoolteachers; study 2 included 74 university students. Both studies were uncontrolled. Participants completed self-report questionnaires about psychological symptoms before and after the 8-week mindfulness course. After the course, they responded to a survey designed for this study that included Likert ratings and free-text questions about unpleasant experiences and harm. All data were collected online. Results In both samples, about two-thirds of participants reported unpleasant experiences associated with mindfulness practice during the course. Most participants (85–92%) rated these experiences as not at all or somewhat upsetting; some indicated that difficult experiences led to important learning or were beneficial in some way. The proportion of participants reporting harm from the mindfulness course ranged from 3 to 7%. The proportion showing reliable deterioration on symptom questionnaires ranged from 2 to 7%. Those reporting harm and those showing reliable deterioration on questionnaires were largely separate subgroups; only one participant fell in both. Conclusions Findings highlight the need for mindfulness teachers to manage expectations about benefits and difficulties that may occur in mindfulness-based programs and to work skilfully with participants experiencing difficulties. Experiences of harm may not be captured by symptom questionnaires and should be explicitly assessed in other ways.

Defining and Measuring Meditation-Related Adverse Effects in Mindfulness-Based Programs

“…Nearly 60% of the sample experienced at least one MRAE with a negative valence, suggesting that at least some transient distressing experiences during meditation are the norm and should be expected for most participants. Likewise, Baer et al (2021) found that 67% to 73% of MBP participants reported having unpleasant experiences associated with mindfulness practice during or after the course. High rates of transient mood deterioration (60%-65%) similarly have been found following a single session of group therapy for depression or anxiety (Schneibel et al, 2017).…”

“…A recent meta-analysis of meditation studies found that AE rates ranged from 4% to 33% depending on study design (Farias et al, 2020). In MBP trials, nonsystematic and passive monitoring of serious AEs produced rates of < 1% (Wong et al, 2018), systematic queries of "unpleasant experiences" produced rates of 67% to 73% (Baer et al, 2021), and percentage of "participants with increased symptoms" produced rates of 15% to 44% (Hirshberg et al, 2020). In addition, some RCTs have found that average symptom severity significantly worsened in MBP arms compared with control arms (Britton et al, 2010;Johnson et al, 2016;Lomas et al, 2017;Reynolds et al, 2017).…”

Adverse or therapeutic? A mixed-methods study investigating adverse effects of Mindfulness-Based Cognitive Therapy in bipolar disorder

“…Overreporting of AEs also became apparent in a recent study exploring the prevalence and severity of (S)AEs following MBCT in teachers and students, showing that 67% of participants reported unpleasant experiences (e.g. unpleasant emotions, thoughts, and sensations), but only 2–7% were considered harmful [ 23 ]. However, we cannot rule out the possibility of underreporting either.…”

A Delphi Study Investigating Clinicians’ Views on Access to, Delivery of, and Adaptations of MBCT in the UK Clinical Settings

“…There are many unknowns regarding the potential harm from MBCT, and somewhat in line with our clinicians' ratings, others have cautioned against MBIs for people with current suicidal ideation, psychosis, and substance dependence (Kuyken et al, 2012;Santorelli et al, 2017). Two studies have suggested that the most common harmful experiences arising from MBCT are (new-onset of) depression and anxiety as well as depersonalisation and reexperiencing of trauma, and psychotic experiences; although these studies either included non-clinical participants or participants taking part in different MBIs or more intense meditations (Baer et al, 2021;Farias et al, 2020). Whilst unpleasant experiences are an expected natural consequence of taking part in meditation, it remains that there are unknowns regarding the potential for longer-lasting harm from MBCT in clinical populations.…”