When meditation goes wrong: part one

Meditation has a lot of benefits, but could it also have risks? Over the past decade, meditation and mindfulness have been promoted to reduce stress and increase relaxation. But there is another story of meditation that rarely gets told... one that involves anxiety, insomnia — even psychosis. Today, how one person went from being an evangelical mindfulness meditator, to a leading researcher on the adverse effects of meditation. Guests: Willoughby BrittonAssociate professor, Brown University Medical School and director of the Clinical and Affective Neuroscience Lab Pawan SharmaAssistant professor in the Department of Psychiatry at the Pattan Academy of Health Sciences School of Medicine Pierce SalgueroProfessor of Asian History and Health Humanities at Penn State University Credits: Presenter: Sana QadarReporter/producer: Fiona PepperSenior producer: James BullenProducer: Rose KerrExtra information: Defining and measuring meditation-related adverse effects in mindfulness-based programs https://pmc.ncbi.nlm.nih.gov/articles/PMC8845498/Prevalence and 20-year trends in meditation, yoga, guided imagery and progressive relaxation use among US adults from 2002 to 2022 https://pmc.ncbi.nlm.nih.gov/articles/PMC11217305/Prevalence and predictors of meditation use in Australia and New Zealand: results from a nationally representative survey https://pubmed.ncbi.nlm.nih.gov/41345610/Mindfulness-based cognitive therapy improves polysomnographic and subjective sleep profiles in antidepressant users with sleep complaints https://pubmed.ncbi.nlm.nih.gov/22832540/Meditation-induced psychosis: a narrative review and individual patient data analysis https://www.researchgate.net/profile/Pawan-Sharma-7/publication/336922683_Meditation-induced_psychosis_a_narrative_review_and_individual_patient_data_analysis/links/5dbaf4fe92851c81801ac5b2/Meditation-induced-psychosis-a-narrative-review-and-individual-patient-data-analysis.pdfPsychiatric Problems Precipitated by Transcendental Meditation https://journals.sagepub.com/doi/abs/10.2466/pr0.1976.39.2.601?src=getftrThe varieties of contemplative experience: A mixed-methods study of meditation-related challenges in Western Buddhists https://pmc.ncbi.nlm.nih.gov/articles/PMC5443484/Cheetah House https://www.cheetahhouse.org/To explore more great episodes from the award-winning psychology podcast All in the Mind with host Sana Qadar, download the ABC Listen app (Australia) or search 'ABC All in the Mind podcast' wherever you get your podcasts. There you'll find more episodes on mental health, trauma, attachment theory, wellness hacks, and family relationships. You'll also hear interviews with experts like Esther Perel, Billy Garvey and Ethan Kross. All in the Mind is created for ABC's Radio National by specialist journalists and reporters at the Australian Broadcasting Corporation.

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  Over the past decade, meditation and mindfulness have been promoted to reduce stress and anxiety and increase relaxation.

• 0:49Speaker 03

  Meditation and mindfulness, those are two things that, from what we understand, can really help us during very stressful moments, during this unprecedented times that we are living through right now.

• 1:02Speaker 02

  Improve sleep and concentration.

• 1:05Speaker 04

  Meditation is something more people are including in their daily routines. And we're actually learning now that the benefits go far beyond just keeping us calm.

• 1:12Speaker 05

  Which we need that too.

• 1:14Speaker 02

  From the outside, it can feel like meditation is a fix for a lot of life's biggest challenges. GPs recommend it, corporate companies, schools, prisons and universities have dedicated meditation programs. And the advice has been taken. For example, in the US, in the past two decades, meditation practice has doubled. But what if for some people, meditation can be harmful?

• 1:41Speaker 06

  I spent my first 20 years of meditation research promoting it, promoting the benefits, stating that there were no adverse effects, even though I never measured them. I did all the things that all the other researchers probably still do that really didn't help the field at all and really kind of hid the fact that there are some downsides.

• 2:04Speaker 00

  In best practice in any kind of care for another person, you typically provide informed consent. But I think we have a similar obligation in meditation, such that those individuals have the ability to make an educated, informed decision as to whether they feel the possible benefits outweigh the possible harms or risks.

• 2:25Speaker 01

  I think the tradition has known about the potential for, you know, negative side effects or dangers of spiritual practice. The tradition has known about this really since the beginning.

• 2:37Speaker 02

  From ABC Radio National, this is All in the Mind with me, Sana Qadar. Today, the story of meditation that rarely gets told and how one person went from being an evangelical mindfulness meditator to a leading researcher on the adverse effects of meditation.

• 2:58Speaker 02

  Science reporter Fiona Pepper is in the studio for this one. Hi, Fee.

• 3:02Speaker 05

  Hi, Sana.

• 3:03Speaker 02

  I have a confession to make. I'm a failed meditator. I've definitely tried at various times in my life and I've never really managed to do it consistently. And I've definitely struggled to do it at all. I cannot make my mind shut up. What about you, though? Are you into meditation?

• 3:19Speaker 05

  Yes. Look, not for many, many years now, but that's partly because I was, I was raised in a meditating household, I suppose you could describe it as.

• 3:29Speaker 02

  Okay.

• 3:30Speaker 05

  My, my parents, for decades now, have practised Vipassana meditation.

• 3:37Speaker 02

  Oh, that's intense.

• 3:38Speaker 05

  Yeah. So as a kid, it was quite normal for them to disappear on 10-day silent retreats. And we had a meditation room in our house. They have a thing called a group sit on a Sunday morning where a bunch of middle-aged people come over and meditate for 45 minutes and then.

• 3:56Speaker 02

  I mean, it sounds lovely.

• 3:57Speaker 05

  Exactly. So, yeah, growing up, meditation was kind of normal in my household, which is probably unusual for most Australian households. And that meant that myself and my sisters did attend these 10-day silent retreats.

• 4:13Speaker 02

  I've heard vaguely of Vipassana, but I've never done it. I don't think I could survive it, but yeah, tell me what goes on.

• 4:18Speaker 05

  Yeah, sure. So the first one I did, I was 18 years old. And basically you meditate solidly eight, nine hours a day. And what that involves is you're concentrating on your breath, going in and out of your nose, and you're observing sensations that you might feel. And the idea is that you observe these sensations, you don't react to them.

• 4:44Speaker 02

  Hmm. And so you said you haven't meditated for a while now. What made you want to look into the adverse effects of meditation?

• 4:51Speaker 05

  So it was a little while ago, I came across the term meditation sickness. And it really jumped out at me because I suppose, you know, growing up meditation, we were around a lot of people who went on these meditation retreats. And anecdotally, people, you know, they might leave a course halfway through, they might talk about, you know, kind of not being the same after doing a meditation retreat. So this idea of meditation sickness was really quite interesting to me. So I dived into it and came across the work of Dr Willoughby Britton.

• 5:36Speaker 06

  When I was in college, a friend of mine committed suicide, a very old, like, childhood friend. And I was really devastated and anxious and I didn't know what to do. And I really didn't want to take medication. And so my father sent me a book called A Path with Heart. That was by a very famous meditation teacher, Jack Kornfield. And the first half of that book was really just about how to work with difficult thoughts and emotions. And it really just spoke to me.

• 6:17Speaker 06

  And that book became kind of my bible for probably the next 10 years.

• 6:23Speaker 05

  So that's Willoughby Britton. She's an associate professor of psychiatry at Brown University Medical School and the director of the Clinical and Effective Neuroscience Lab. In her early twenties, that book transformed both Willoughby's personal and professional life.

• 6:40Speaker 06

  And so, yeah, that's, that was my gateway drug.

• 6:44Speaker 05

  Can I ask what, what meditation were you practising?

• 6:47Speaker 06

  Kind of a range, but I did take the John Kabat-Zinn's mindfulness-based stress reduction. I actually got trained as a teacher in that tradition. So mindfulness, which means a lot of things, but, you know, following your breath, learning how to label thoughts and emotions.

• 7:06Speaker 05

  So intense retreats or more kind of daily practice?

• 7:11Speaker 06

  I mean, more daily practice. I was in graduate school, but I did, I definitely did retreats as well.

• 7:16Speaker 05

  Then, while at graduate school, for her dissertation, Willoughby looked at the effects of mindfulness meditation on sleep.

• 7:24Speaker 06

  At that point, I'd been meditating, you know, five years and was in the phase where I was extremely enthusiastic. You could call me probably an evangelist. And I was going to prove to everyone that not only was meditation good for sleep, but how it also improved depression. Because lingering sort of problems with sleep can lead to relapse and depression. And there weren't that many studies that measured sleep in the lab with brainwaves. So I was going to be one of the first to sort of show conclusively in the lab that meditation improved sleep. So after several years and many hundreds of nights of staying up watching people sleep,

• 8:08Speaker 06

  I got the data back and it was exactly the opposite of what I thought.

• 8:15Speaker 05

  Much to Willoughby's surprise, meditation was actually making people more awake.

• 8:21Speaker 06

  No matter how I looked at it, if I looked at how fast their brainwaves got, their brainwaves got faster, which means that they were more awake, they had less low-wave sleep, they had more awakenings. And so in the middle of my quest to prove and promote meditation, I got some, you know, sort of negative results.

• 8:43Speaker 05

  But at the time, this evangelical meditator wasn't interested in engaging with these results.

• 8:50Speaker 06

  My first confession is that I did not publish them. One, I might have done something wrong. And two, it was definitely not promoting the practice, which was kind of what I thought I was doing.

• 9:01Speaker 05

  Then, a couple of years later, a conversation with a meditation teacher started to change the way Willoughby felt about the results from that sleep study.

• 9:11Speaker 06

  And I mentioned my data and she kind of chastised me and said, you know, all you psychologists are just trying to make meditation into a relaxation technique. Everyone knows that if you meditate enough, you stop sleeping.

• 9:26Speaker 05

  Then, not long after that conversation, Willoughby was doing a clinical residency at Brown University's inpatient psychiatric hospital.

• 9:34Speaker 06

  And during that one year, there were two meditators that came off retreat who were psychotic. And that seemed like a lot to me in one year. It was like some of the most extreme patients that I saw in that hospital all year, and they were both meditators.

• 9:51Speaker 05

  So Willoughby went back to that same teacher to get their advice.

• 9:56Speaker 06

  And I said, well, have you ever seen this before? And she didn't say anything, but I remember the look on her face was like, oh yes, this is definitely a thing that she's seen before. And she was really sorry that I asked.

• 10:12Speaker 06

  And so that was very shocking to me. And I thought about that a lot and wondered what other assumptions psychologists and other sort of healthcare providers are making about meditation. And then also, what other information are meditation teachers sitting on that is not getting to the public?

• 10:34Speaker 02

  From ABC Radio National, you're listening to All in the Mind. I'm Sana Qadar. Today, reporter Fiona Pepper is digging into the untold story of meditation and the adverse effects it can have for some people. Willoughby's arc is so fascinating, Fiona, and also very interesting how she didn't publish those results initially because they contradicted what she expected. You know, I'm so curious how often that actually happens in research.

• 11:00Speaker 05

  Oh, absolutely. Because I imagine you research something because you have a natural kind of draw to it. But when the results don't match with your attitude towards that practice, puts you in a difficult position. Interestingly, though, Willoughby's now considered a world leader in this area, but she is far from the first person to have recognized this issue.

• 11:25Speaker 06

  It was in my second year of med school that I came across a patient. While taking history, we found that he was, he was meditating more than his usual self, like up to six to eight hours a day.

• 11:37Speaker 05

  That's Parwan Sama. He's an assistant professor in the Department of Psychiatry at the Patn Academy of Health Sciences School of Medicine in Kathmandu. And I spoke to him from his home. The recording isn't great. Now, because Nepal is considered the home of Buddha and Buddhism, I was keen to hear a non-Western perspective on these potential side effects of meditation. And Parwan says this patient presented with active schizophrenic symptoms, including delusions and auditory hallucinations.

• 12:10Speaker 06

  We treated him as like a usual case of schizophrenia. And after that, when he went back to his place and he again started meditating, then he again came back with the symptoms. So we thought that it could be induced by meditation.

• 12:24Speaker 05

  This encounter left such an impression on Parwan and his team that in 2019, they published a research paper titled Meditation-Induced Psychosis, based on treating that one patient. Since that initial case, Parwan says...

• 12:40Speaker 06

  Meditation-induced kind of things are not very common. So we see one or two cases in a year.

• 12:49Speaker 05

  As early as 1976, a key figure in the development of cognitive behavioral therapy, Arnold Lazarus, published a paper called Psychiatric Problems Precipitated by Transcendental Meditation. He suggested that indiscriminate meditation could induce depression, agitation, and even schizophrenic decompensation. But the earliest understandings of these potential problems came way before the 1970s.

• 13:19Speaker 01

  Yeah, I think the tradition has known about the potential for, you know, negative side effects or dangers of spiritual practice. The tradition has known about this really since the beginning.

• 13:34Speaker 05

  That's Pierre Sargero. He's a professor of Asian history and health humanities at Penn State University.

• 13:41Speaker 01

  About 20 years ago, when I was working on my dissertation, I came across some writings from about 1,500 years ago that were talking about meditation as a form of healing or as a form of therapy for different kinds of ailments. And what I noticed, though, was that those texts were also talking about meditation as a source of illness, as a source of both mental and physical problems and conditions. And so that was when I first became aware that this was a thing that was talked about, known about within the Buddhist tradition.

• 14:17Speaker 05

  Historically, there's even a range of names given to the issue. For example, in Chinese, it's known as...

• 14:24Speaker 01

  Chan Bing, which translates to directly as meditation sickness, is the, is the native term there. That term in Japanese, the same term is Zenbiyo, and that is often translated into English as zen sickness. Zen just means meditation in Japanese. In sort of the Tibetan world, as well as in Southeast Asia, it's understood through a framework, a medical framework of winds. So it's considered to be a wind disorder. So it's one of the common terms that you find across cultures as well.

• 14:59Speaker 02

  See, that is fascinating for me to hear because as someone who kind of only really has a pop psychology level understanding of meditation and what it's about and what it can do, this is really interesting to know that the tradition, it's a known thing that things can go very wrong with meditation. Why hasn't that bubbled up into the pop psychology version of how it's communicated? Why don't people know about this more generally?

• 15:22Speaker 05

  I mean, I think it counters what we want to think meditation does for us, right? I think the other thing is meditation is like a very solo practice. So it can be hard to know, you know, maybe I'm doing it wrong or...

• 15:35Speaker 02

  Yeah.

• 15:36Speaker 05

  It's, we're all doing it as individuals. But yeah, I found it fascinating, speaking to someone like Parwan, who's based in Kathmandu, in Nepal, the home of Buddha, and there's a lack of awareness. But interestingly, talking to him, if he kind of associates any kind of negative side effects to meditation, there's pushback. And that's relatively common, too. It's not necessarily welcome information.

• 16:06Speaker 02

  Yeah, and I guess, you know, pop psychology generally likes easy fixes as well. The nuance can get lost.

• 16:12Speaker 05

  Yeah. So getting back to Willoughby Britton, two decades after discovering this issue, she published the first significant research that she had conducted with a team. It took almost 10 years to complete, and it was called the Varieties of Contemplative Experience Study. The team interviewed more than 60 Buddhist meditation practitioners and more than 30 Buddhist meditation teachers about the types of challenges they had experienced personally or observed in their students. The study then identified what these meditation-related adverse effects could look like, and difficulties with sleep was just one of them.

• 16:56Speaker 06

  Insomnia is actually one of the most common meditation-related challenges. And so that was, that was a pretty easy one. And that there were even, you know, Buddhist texts that said that a good meditator only sleeps for four hours. It's actually a sign of concentration, which was basically my neurological understanding of why it happens.

• 17:21Speaker 05

  Because despite this common belief that meditation has a relaxing effect, Willoughby instead found that meditation can lead to hyperarousal and alertness. But beyond sleep, that Varieties of Contemplative Experience Study published back in 2017 identified more than 50 categories of meditation-related challenges across seven different domains. And the key domains identified included somatic, cognitive, perceptual, cognitive, sense of self, and social. So there was a real range of experiences.

• 18:01Speaker 05

  But generally speaking, these adverse effects fell into two categories of either hypoarousal or hyperarousal responses. Hyperarousal meaning...

• 18:13Speaker 06

  Anxiety, fear, insomnia, involuntary movements, tics, emotional flooding, like think, everything that's sort of, you'd call them positive symptoms, meaning that there's something added, there's something extra.

• 18:26Speaker 05

  In contrast, the hypoarousal symptoms were more along the lines of...

• 18:32Speaker 06

  Something's missing or taken away from your normal experience. That's often hypoarousal. So lack of emotions, not having a sense of self, losing your sense of self. Those would be like more on the hypoarousal or dissociation.

• 18:50Speaker 05

  And Willoughby says these hypo or hyperaroused symptoms impacted people's motivation levels.

• 18:56Speaker 06

  So people either became super motivated, like, you know, shave your head, go join a monastery, like meditate as many hours as you can a day, or the complete lack of motivation where people like literally stared at a wall for two years and didn't leave their house.

• 19:13Speaker 05

  As well as this, Willoughby says she saw many examples of dysregulated arousal, where individuals experienced a mix of the hyper and hypoaroused symptoms. Additionally, she treats people with symptoms of psychosis.

• 19:31Speaker 06

  Yeah, a much smaller percentage are people that are struggling with a kind of psychotic syndrome.

• 19:38Speaker 05

  In terms of how long these various symptoms lasted, Willoughby says the median duration was generally between one to three years. But...

• 19:47Speaker 06

  Some people's symptoms lasted for more than a decade. And there was a considerable amount of impairment, where some people were hospitalized, some people became suicidal, many people had to take time off work, or were fired, or had to take time off school. So it can be, you know, quite a significant impairment in functioning.

• 20:08Speaker 05

  And I was curious to know why. What is actually happening to the brain when you meditate?

• 20:17Speaker 06

  So there's a lot of different possibilities. I think one of the more intuitive ones is to think of meditation like a attention-enhancing drug. And if you think of the other intention-enhancing drugs that we use, like coffee and caffeine and Ritalin and amphetamines and cocaine, they're all stimulants. And they work through different mechanisms, but all of them are the case that if you take a little bit of it, you become more alert and your attention does improve. You take a little more and you start to not be able to sleep. Take a little more and you're going to get anxious. Take a little more, you're going to probably have a panic attack.

• 20:59Speaker 06

  And you take a little more and you might become psychotic. So there is a sort of a continuum there of your attention systems and your arousal systems are very overlapping in where the brain, in the brain. Some of them are exactly the same, like the reticular activation system. And then a number of neurotransmitters like norepinephrine and dopamine, they are related to both arousal and, and attention. And so if you start to crank up one, then you will also crank up the other. And it's, you know, some people can drink coffee, like my mother, she can drink coffee and go to bed right afterwards. Other people can't touch it.

• 21:43Speaker 06

  And so I think there's an individual, you know, sort of constitutional sensitivity to certain kinds of, you know, you could say agents, drugs or, or practices that cause that. So that's one mechanism.

• 21:57Speaker 05

  The other theory is around homeostatic neuroplasticity.

• 22:01Speaker 06

  Which is the idea that brain cells like to have a certain level of stimulation and that meditation, you know, you're sitting quietly in a, usually in a room that's quiet. Your eyes are closed or fixed, so you're not getting a lot of visual input. And you're using your concentration to, to basically block out, you know, external stimulation. And so it, it acts in a kind of sensory deprivation type of way. And, and so, and you're not moving either. So there's no kinesthetic stimulation. And when you do that, the various parts of the brain are kind of deprived of input.

• 22:43Speaker 06

  And so they will upregulate themselves in order to maintain this set point of stimulation. It's very similar to like, when you go into a dark room, you come out and it's very, very bright and you can barely see. It takes a while to adjust. Same kind of idea. But that can happen in pretty much any brain area.

• 23:00Speaker 05

  Right. Okay. So your brain is generating its own activity to make up for the lack of sensory input or stimulation, and that can be the cause of these adverse effects. But there was something else that I needed to clarify. Was there a definite causal relationship with meditation?

• 23:21Speaker 06

  So that's a great question. And in our study, we used 11 causality criteria that federal agencies use to be able to establish causality for sort of medical procedures, like vaccines or something like that, that you want to be able to prove that, that that caused the problem without having to do a randomized control trial where you're going to harm a bunch of people. They're called the Bradford Hill criteria. And some of the criteria are things like it happened after meditation. The person thinks that it was meditation related. The teachers think it was meditation related. When they stopped meditating, the effect went away.

• 24:04Speaker 06

  When they started meditating again, it came back. You meditate more and it happens more often. One of the other ones is there wasn't an alternative explanation. So if somebody had maybe like, sense of self is a really good example. If they had like a dissolution of their sense of self, but they'd previously had that same experience on a drug, then, and it was just kind of repeating itself during meditation, then they were excluded from the study. So there were rules that there couldn't be a better explanation. Or if the person was like, oh, and I had hepatitis at the same time, it was like, nope, that could have accounted for some of your symptoms. So we were really careful about that.

• 24:46Speaker 05

  On top of that, Willoughby says that each of the 59 categories had at least four meditators who had spontaneously reported these symptoms.

• 24:55Speaker 06

  So we're pretty confident. And also I've seen it now thousands of more times.

• 25:00Speaker 05

  And in terms of who was most susceptible to these adverse effects of meditation, initially, Willoughby says there were a lot of assumptions made about the meditator.

• 25:11Speaker 06

  The most common response is to, to locate the problem within the meditator. And that could be a pre-existing condition, a mental health issue, a trauma history. It could also be that they didn't meditate correctly, they meditated too much, they weren't adequately prepared, they didn't have correct supervision.

• 25:32Speaker 05

  But for starters, Willoughby says the majority of the participants in the study were considered meditation experts with over 10,000 hours' practice behind them. So this idea that they weren't practicing properly was easily dismissed. And?

• 25:48Speaker 06

  I think it's important to understand that psychiatric history and trauma history are risk factors, meaning that they, they do increase the likelihood of having adverse effects. But that doesn't mean that people who don't have psychiatric or trauma histories won't have any problems. And a lot of the people that have psychiatric and trauma history do really well with meditation.

• 26:14Speaker 02

  Okay. So there's really a wide variety of ways that things can go wrong for people when meditating.

• 26:20Speaker 05

  Absolutely. There are so many different symptoms that Willoughby identified.

• 26:26Speaker 02

  And so what happened next? Like, what was the response to the study?

• 26:29Speaker 05

  So as we've established, Willoughby wasn't the first to discover this issue. But when that specific paper was published in 2017, it got picked up by the press and the response was massive.

• 26:41Speaker 06

  The lab started getting phone calls of people who were like, you're the only ones I've ever seen who knew anything about this. You know, everyone I've been to was like, meditation doesn't have side effects. It was like, you know, there's, there's no problem there and no one had ever heard of it. And so, I mean, we got hundreds of calls. We had so many calls at the lab that we had to turn off our phone because it was like interfering with research.

• 27:08Speaker 05

  And that was when the idea for Cheetah House first began. It's a not-for-profit service that offers support to meditators in distress and aims to educate meditation teachers and clinicians about the risk of meditation.

• 27:23Speaker 06

  We have 150 appointments a month and we've serviced thousands of meditators in more than 20 countries.

• 27:33Speaker 02

  Next time in part two of this two-parter on what they don't usually tell you about meditation, we hear from people who have accessed the Cheetah House support services after experiencing these side effects while on retreats or even after using meditation apps.

• 27:52Speaker 06

  My reality just sort of, it shattered. It was really terrifying. I was so terribly sad, just, you know, not just, not just lost or bewildered, but just, just heavy. It was very, very like I didn't, I was, I didn't know what to do, you know?

• 28:08Speaker 04

  I hardly slept until I slept about three hours. My mind was just fizzing like a sort of lemonade bottle. I became increasingly manic and psychotic, but I still could function.

• 28:18Speaker 02

  Plus, mindfulness meditation is used in a lot of schools, but does it help at all? We look at the evidence.

• 28:25Speaker 00

  We did the Myriad trial because there was a lot of interest in teaching mindfulness to children in schools. And our view was that the evidence was way behind the enthusiasm.

• 28:39Speaker 02

  In today's episode, you heard from Associate Professor Willoughby Britton from the Brown University Medical School. You also heard from Assistant Professor Paughan Sarmah from the Patan Academy of Health Sciences in Kathmandu, and Professor Pierce Salguero from Penn State University. This episode of All in the Mind was reported by science reporter Fiona Pepper. And thanks to producer Rose Kerr, senior producer James Bullen, and sound engineer Isabella Tropiano. I'm Sana Qadar. Thank you for listening. I will catch you next time.