When meditation goes wrong: part two

Meditation sickness, meditation-related adverse effects or meditators in distress – you probably haven't heard these terms, even if you do meditate. Yet research finds adverse effects occur in half of all meditators. For one in 10, it impairs their functioning or lasts more than a month. Experts say many people can benefit from meditation, but it can also come with harms. Today, the second episode of a two-part special on the research into those harms and the personal stories of those who've experienced them. You can hear part one of the series here https://www.abc.net.au/listen/programs/allinthemind/when-meditation-goes-wrong-part-one/107016730. Guests: Willoughby BrittonAssociate Professor, Brown University Medical School; Director of the Clinical and Affective Neuroscience Lab Nicholas Van DamAssociate Professor, Melbourne School of Psychological Sciences; Director of the Contemplative Studies Center at the University of Melbourne Willem KuykenProfessor of Mindfulness and Psychological Science, University of Oxford Jane ReedExperienced adverse effects from meditation and the author of First Telling SueExperienced adverse effects from meditation Credits: Presenter: Sana QadarReporter/Producer: Fiona PepperSenior Producer: James BullenProducer: Rose KerrExtra info: Defining and measuring meditation-related adverse effects in mindfulness-based programs https://pmc.ncbi.nlm.nih.gov/articles/PMC8845498/The varieties of contemplative experience: A mixed-methods study of meditation-related challenges in Western Buddhists https://pmc.ncbi.nlm.nih.gov/articles/PMC5443484/Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial https://mentalhealth.bmj.com/content/25/3/99Cheetah 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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  People don't understand because everybody thinks meditation's hunky dory, you know? Or you must be doing it wrong, or there's just this automatic assumption that it couldn't possibly come in and totally blow up your brain.

• 1:00Speaker 03

  Meditation sickness, meditation-related adverse effects, or meditators in distress. These are terms you probably haven't heard before, whether you meditate or not, and yet?

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  Meditation-related adverse effects occur in half of all meditators, and one in 10 will experience a meditation-related adverse effect that lasts more than a month or is associated with impairment in functioning.

• 1:25Speaker 03

  One in 10. That is staggering when you consider how many millions of people meditate. And in the past two decades in the US, the number of people meditating has increased from 10 to 20% of the population, while in Australia, it's estimated that every year, one-third of us do some form of meditating.

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  A lot of people can benefit from meditation, but my concern is that there are some people who are harmed, and we cannot discount that, and we should absolutely respect those individuals.

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  From ABC Radio National, this is All in the Mind with me, Sana Qadar. Today, the second part of our special exploring the adverse effects of meditation. Episode two, enthusiasm over evidence.

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  Science reporter Fiona Pepper is covering this one for us. Hey, Fee. Hi, Sana. So in the first episode, we learnt about the adverse effects of meditation, what they can be, what they can look like, and I have to say, you put me a little bit off trying to meditate. Sorry about that. But just remind us, what can it look like? Yes, so really, really broadly speaking, these symptoms can kind of be housed into two categories, hypo and hyper arousal, so overstimulation and understimulation. There's other categories like insomnia, even psychosis. So the symptoms really range. Yeah. Have you spoken to people who've had these experiences?

• 2:52Speaker 03

  Yes, I've spoken to a number of people, and there's been a real range of experiences. So some have experienced meditation-related adverse effects while on or after an intense meditation retreat, whereas others might have been exposed to short sessions of meditation at, you know, the end of a yoga class. Wow. So there's been a real range and, and very different symptoms that have cropped up too.

• 3:24Speaker 02

  I'm a very active person, so sitting still, like I would have flunked out of Buddhist school because I just cannot sit still long enough to do that. So I think part of it was finding the right kind of meditation.

• 3:39Speaker 03

  Sue is in her early 70s. She's semi-retired and lives in Florida. More than 40 years ago, Sue struggled with alcoholism, and she says she's been part of the recovery community ever since. A self-described spiritual seeker, it was about three years ago when Sue first came across the meditation practice known as Pranayama Breathwork.

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  The app was only, start to finish, 17 minutes. So I thought, well, that just fits right into my day. So I wanted to be able to abandon myself to it, you know, so I waited until I was alone in our home. And I would lay on my bed, put an eye mask on, and I would, you know, light a candle and do all that kind of stuff. And then I would put in my earbuds with the 17-minute version, and the message was generally that this is a way to align, you know, to arrive at your best self. So I mean, it was just lovely words, beautifully written.

• 4:39Speaker 03

  Sue was using the app about three times a week, and although the sessions were short, the experience of the breathwork was intense.

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  I was having these very strong, expanded consciousness kind of experiences where I felt they were very full of sacredness and connection and all that, you know, awe, spiritual awe.

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  But then Sue says she...

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  Started to get dysregulated.

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  Then while driving, Sue says she had one particularly frightening experience.

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  I was all by myself in my car, and I had this profound sense of my, sense of self dissolving. My reality just sort of, it shattered, you know, there was, it dissolved too, like, because it was me in the void. But even me, but I wasn't there. So it was just the void, and I was the void, and the whole thing was a void. Yeah, it was really terrifying.

• 5:34Speaker 03

  Sue immediately stopped meditating, but she says she remained in this dysregulated space for about a year and a half.

• 5:41Speaker 02

  I was so terribly sad, just, you know, not just lost and bewildered, but just,

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  just heavy. It was very, very, like I didn't, I was, I didn't know what to do, you know?

• 5:54Speaker 03

  So that's one experience of meditation-related adverse effects that arose while using an app. Sue says she eventually came across Cheetah House. Now, Cheetah House is a support service designed to cater specifically for meditators in distress, and that has helped immensely. Willoughby Britton is the founder of Cheetah House and world-leading expert in meditation-related adverse effects, and she says plenty of people, just like Sue, seek treatment after using meditation apps.

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  It wouldn't be surprising if people got into trouble with using apps where there's no teacher and there's no tailored instructions.

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  But generally, it's those with more of an intense meditation practice who experience adverse effects. So the bulk of the people that come to Cheetah House have been on meditation retreats.

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  All right. Well, I'm Jane Reed. I'm age 75 years. I've lived in Britain all my life, and I really introduced to meditation through yoga teaching. And in 1997, I sort of followed that more seriously by going to a Zen group.

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  Jane then started going to Zen meditation retreats.

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  And I attended retreats for four years.

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  And this was the general structure of these retreats.

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  You do eight hours meditation a day for five days, no talking to anybody, head down, as it were.

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  But then in 2001, on Jane's fourth retreat, things didn't go as they had in the past. Now, on reflection, Jane says in the years before attending that particular course, she was under a lot of stress. She was dealing with menopausal symptoms, her grown-up children had moved away, she was feeling anxious about retirement, and then she experienced the death of her father.

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  I probably wasn't coping with this stress very well. I actually arrived at this 2001 retreat, actually looking back now, I was slightly psychotic.

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  And Jane distinctly remembers the first night of that retreat.

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  I hardly slept twice, slept about three hours. My mind was just fizzing like a sort of lemonade bottle, and I knew something, I'd never had that before. I knew something wasn't right. So I went to the teacher, I made an appointment the next morning with the teacher, and she just looked at me and said, "Oh, you don't need to sleep when you meditate." And that was it.

• 8:27Speaker 03

  So Jane continued with the retreat.

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  I outwardly, probably didn't seem very different from usual because I kept up with all the routines. I went to the meals, I went to all the sessions.

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  But Jane says over the course of the five-day retreat, things got worse.

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  I became increasingly manic and psychotic, but I still could function.

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  Jane completed the course, and a few days after getting home...

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  My husband realised that I wasn't quite right. But you see, a lot of it's hidden in your head. I remember taking the car out, and I could still drive and things. There was a sort of brimming noise when you accelerated, and I sort of felt there was some evil influence in the car, you know, it was all that sort of stuff going on in your mind. And, you know, my husband realised something wasn't right. I wasn't, you see, you mask it, you know yourself it's not right, but you still go along with it. It's a very peculiar thing.

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  Jane's husband raised the alarm.

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  Yeah, he got the GP who was, you know, family GP and knew me very well. So he gave me a two-hour interview, and he diagnosed me as being psychotic and manic.

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  Jane didn't know it at the time, but this was the beginning of a very long journey of recovery. Over the course of the next two decades, Jane was hospitalized multiple times and treated with a range of antipsychotic medications.

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  You know, I've had 20 years of sorting all this out, and I'm now more recovered, but it's taken 20 years.

• 10:00Speaker 03

  Because the trouble is you're given psychotropic medication and it does address the problems, but it also gives you enormous side effects. On reflection. People who do these practices, they almost feel it's a panacea, you know, it's the answer to everything. And it just isn't. Sometimes it doesn't suit a certain person.

• 10:25Speaker 03

  Those stories are incredibly disturbing and frightening. Jane, I can't believe it took so long to recover, but Sue is really disturbing to me because it was just using an app that sent her, you know, off in a not very good direction. Yeah, it's interesting. She was using that 17 minute app every two, three days. But it was sort of such a powerful practice that, yeah, she, she slipped into this void that she describes. It sounds quite terrifying. Okay. So in terms of Cheetah House, is that the kind of demographic that's most likely to access their services, older women? No. Interestingly, talking to Dr. Willoughby Britton, she describes a real

• 11:09Speaker 03

  range of demographics that she sees quite often coming through Cheetah House, such as...

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  Males 18 to 35. I think that has a lot to do with this sort of military striving, macho mindfulness sort of thing. We also see sort of middle aged women in juxtaposition to this sort of younger male.

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  In 2017, Willoughby and her team published the Varieties of Contemplative Experience Study. You might remember us mentioning it in episode one. In this study, they interviewed more than 90 meditation practitioners and were able to identify some predictors or risk factors for meditation related adverse effects.

• 11:55Speaker 02

  One of the things that was sort of surprising to us was when we got all the data back and we looked at the people, 75% of them had graduate degrees and like JDs, MDs, PhDs, like, you know, were CEOs of, of major companies. And so the opposite of what you might have thought, like, oh, this happens to people who are already kind of broken or weak or deficient in some way. It was like the complete opposite. It was like the overachievers. And so for a long time, you know, we couldn't figure out why that was the case. And then it started to kind of make sense, is that people who are overachievers, they are extremely

• 12:39Speaker 02

  attuned to external standards, that when they meditate, they're the first ones in the meditation hall and the last ones to leave. They follow the instructions exactly the way that the teacher says that you should do them, and they would never think of modifying them for their own needs. And this is what leads to the problem, is that not having an internal compass and, and being a rule follower and a people pleaser, a recipe for, you know, doing well in life is sort of a recipe for getting into trouble with meditation.

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  Potentially a less surprising risk factor were pre-existing psychological conditions and a history of trauma.

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  So essentially, we're talking about traumatic childhood experiences, neglect, abuse, things like that, and mental health.

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  That's Associate Professor Nicholas Van Dam. He's the Director of the Contemplative Study Centre at the University of Melbourne. And Nicholas has also researched adverse effects of meditation.

• 13:42Speaker 04

  Mental ill health or, or having mental health problems is very strongly related to adverse effects in meditation. And it's, I guess it's very unclear whether people who have mental health issues are potentially using meditation as a means of addressing them and it's not working versus whether or not meditation is actually causing those mental health problems or mental ill health. We haven't, we don't really have the studies to necessarily disentangle that. Additionally, there, there does seem to be some evidence that meditation retreats may put people at higher risk for these experiences. And our best understanding of that is retreats typically are much more intense forms of practices. We think that it's probably just the fact that you're, you're, you're engaging in so

• 14:26Speaker 04

  much more practice that there's so many more opportunities for you to kind of have these experiences. And that's probably why.

• 14:32Speaker 03

  And it's worth pointing out here that it is standard practice. Whenever students sign up for any type of meditation retreat, there is some sort of screening process, which generally asks about pre-existing mental health conditions and whether that individual has tried the practice before. So that information is being gathered. But Willoughby adds that it's important to understand that although these risk factors exist, it doesn't rule out other people from experiencing adverse effects.

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  And a lot of the people that have psychiatric and trauma history do really well with meditation. So I think that there's, there's such a, an urge and a pressure to make some kind of sweeping generalization about who shouldn't meditate. And I think we just have to take it more on a case by case basis.

• 15:27Speaker 03

  Okay. Now, at this point, if you're wondering, how would I recognize these adverse effects of meditation in myself? And what would I do about it if I did? Willoughby's first tip is to actually ignore this common piece of advice.

• 15:41Speaker 02

  Just go back and keep meditating. Like do exactly what you were doing. Don't even change it up. Just continue. This is a, you know, this is a good sign that something unpleasant is happening.

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  Nicholas Van Dam also says recognizing when your experience is becoming distressing is also important.

• 15:58Speaker 04

  Some discomfort with your experience probably is necessary. You probably do need to challenge some existing ideas. You probably need to be exposed to some things about yourself that maybe you don't really want to think about and maybe you don't really like. But that's really different to experiencing distress, right? And I'm thinking about sort of the kind of distress that we think of as, you know, related to kind of psychological harm. This idea sort of not so much of, you know, I feel distressed, but like I'm actually experiencing a panic attack or, you know, I'm having a break from reality, like that level of distress. And my position would be that that's not okay.

• 16:42Speaker 03

  From ABC Radio National, you're listening to All in the Mind. I'm Sana Qadar. Science reporter Fiona Pepper is looking into what can happen when meditation goes wrong. Okay, Sophie, on an individual level, the impact of meditation is pretty varied. But, you know, one thing I've noticed is there seems to be this uptick in mindfulness programs being rolled out across organizations and schools. Like my five year old has come home talking about the meditation they do at school. Wow, that's amazing. Yes, you're, you're not imagining it. There has definitely been an increase in these mindfulness programs in corporate and educational settings, universities, schools, that kind of thing.

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  So what's the evidence to suggest that this approach actually works? Well, interestingly, not a lot was known about the effectiveness of these programs being rolled out until very recently.

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  So 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.

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  That's Willem Kuyckens, Professor of Mindfulness and Psychological Science at the University of Oxford. In 2022, Willem and his team conducted one of the largest and most costly studies in the history of meditation science. It was called the Myriad Trial. Willem says the impetus for this study was the growing number of schools right around the world, including Australia, implementing mindfulness programs for their students.

• 18:21Speaker 05

  So we wanted to do a really high quality and systematic bit of research and ask, was this actually effective? Was it safe? Did the young people like it? And would it live up to its kind of hopes and, and expectations?

• 18:35Speaker 03

  You said that there was a lot of enthusiasm, probably more enthusiasm than evidence. Can you describe what you mean by that?

• 18:44Speaker 05

  Well, it's a very simple premise, isn't it? That actually, young people are experiencing a lot of challenges and foundational skills of being able to pay attention, particularly with all of the kind of distractions that are around for young people and all the pressures. Teaching that kind of foundational skill of focus and self-regulation is likely to be helpful and help people manage not only their mental health, but also their academic studies. And mindfulness seems like something that is without risks and is, you know, a bit like motherhood and, and apple pie. It's something that we, we think is going to be accessible and acceptable to people. And I think that's what was driving the enthusiasm.

• 19:27Speaker 03

  So the aim of the Myriad Trial was to answer this one question. Can mindfulness meditation being taught in schools to 11 to 16 year olds by school teachers improve students' self-regulation, reduce the risk for depression, and improve social and emotional functioning?

• 19:48Speaker 05

  We recruited 84 schools, 28,000 children, and we ran a, what's called a cluster randomized control trial, which means that we randomly allocated schools to either the mindfulness intervention or whatever they would normally do around social and emotional education. And then we followed them up for a year to see how the young people got on over the course of a year.

• 20:12Speaker 03

  And the way it worked was all the children in the schools randomly selected to conduct mindfulness were required to attend 10 mindfulness classes across the 12 month study. And outside of those classes, the students were also invited to practice a range of brief meditation exercises.

• 20:31Speaker 03

  After following these students for a year, this is what they found.

• 20:35Speaker 05

  Well, the findings were incredibly striking. On each of our main outcomes, there was absolutely no effect on the young people's mental health or social, emotional functioning or wellbeing, no signal whatsoever.

• 20:52Speaker 03

  On top of this, there were some sobering secondary outcomes discovered.

• 20:56Speaker 05

  The children in the mindfulness group actually got a little bit worse. And these effects are small, so I don't want to overstate them. But we explored that a little bit more in terms of what's called sort of moderator analysis, trying to understand which children perhaps were most affected in this way. And it looked like it was the children who had more mental health problems who actually potentially got a little bit worse. And my hypothesis about this is that what we're doing is we are raising young people's awareness, but we're not doing anything necessarily about the issues at home or the stress they're experiencing or the bullying that they're experiencing. And I think that maybe is what explains this sort of slight worsening that we see

• 21:41Speaker 05

  in our trial, but in other trials as well.

• 21:43Speaker 03

  Now, Willem also wanted to point out that this was a mandatory mindfulness programme for the students involved in the trial. He says an opt-in scenario where the participants were invested in the programme and its potential benefits might have given different results. Because there is, of course, plenty of evidence supporting the benefits of meditation, specifically mindfulness meditation.

• 22:09Speaker 04

  It can help with a wide variety of mental health issues, anxiety, depression, some substance use problems.

• 22:14Speaker 03

  Here's Associate Professor Nicholas Van Dam again.

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  It can also help with physical health conditions.

• 22:19Speaker 03

  Things like chronic pain, cancer recovery and arthritis. Now, there isn't a complete consensus on the reasons why meditation has these benefits, but there are a few theories.

• 22:32Speaker 04

  The main kind of things that we think may be happening in terms of active ingredients, one of them kind of pertains to attention. So how we train our attention, where we focus or situate our attention. So in the example of pain, allowing your attention to stay fixated on a painful experience obviously can amplify that experience. So there's the pain itself, but then there's sort of also the elaboration of the processing or the kind of continued focus on the pain, which is not to say you ought to distract yourself from it, but you can also make that pain worse. And so there's an element of particularly mindfulness-based meditation where you're not necessarily elaborating as much on the experience.

• 23:14Speaker 04

  You're becoming aware of the experience, you're noting that it's there, but you're kind of seeing if you can't kind of preempt yourself from building a whole narrative or a story about how awful it is before you get into it.

• 23:25Speaker 03

  And there's the relaxation component of meditation too.

• 23:30Speaker 04

  Many times in meditation, and not all meditation, but many times in meditation, you're engaged in a process where you're slowing down your breathing, you're potentially seeing the mind potentially quiet. And so there is that kind of relaxation element. That's not necessarily the intended goal per se of all practices, certainly is of some practices, but that can also be a mechanism by which these things are helping people.

• 23:52Speaker 03

  And then there's, of course, people who meditate to try and manage mental health conditions like depression and anxiety.

• 24:01Speaker 04

  In particular, comparing mindfulness-based programmes to, say, antidepressant medication or to cognitive behavioural therapy. And in those circumstances, what we actually find is that those mindfulness-based programmes are essentially equivalent, so they work about as well as kind of gold standard treatments. That said, there are some individual differences that people should take note of. And so it can be hard to sort of say what those are, but it's really important, I think, to check with, you know, a medical provider, sort of if you're an individual who's thinking, I might want to use meditation and mindfulness to manage my mental health condition, given that what we know is largely about one particular set of programmes. It's not necessarily advisable to go out and use meditation as a first approach to managing these kinds of conditions.

• 24:42Speaker 03

  So I'm curious to know, what do you make of the idea that mindfulness meditation does seem to improve the wellbeing of a lot of people who practise it? That's undeniable. So how do we then make sense of the fact that it could cause others harm?

• 25:00Speaker 04

  So much like a lot of other treatments that we're aware of in medicine and mental health, we would be remiss not to acknowledge that what we do know about meditation is that it's potent, it's powerful, it can have effects. And it can have pretty pronounced effects and those effects, you know, can be objectively measured. And so anything that can have that level of potency or can have measurable effects can work either in a helpful or harmful way. It is something that sort of is readily acknowledged in medicine, that the fact that something is having any effects at all, it can be, even if they're not good effects, can mean that whatever that intervention is, it's potent enough to do something, whether that thing is useful or not.

• 25:42Speaker 03

  And yet, the extensive research that someone like Willoughby Britton has conducted over the past decades, highlighting the potential risks of meditation, hasn't always been well received or widely accepted within meditation communities or by the mindfulness industry.

• 26:00Speaker 02

  One of the biggest obstacles that I've found is that talking about difficulties is not good marketing. And most companies are built on how do we get more people to use our product? They're not like, how do we help people in the best way and most responsible way? They just have a very simple, like, our product is great, you should buy it.

• 26:24Speaker 03

  And following Jane's experience on that Zen meditation retreat, she believes that meditation organisations need to take more responsibility for their participants too.

• 26:36Speaker 00

  You should be aware that if someone's going down the cul-de-sac of ill health, they should not continue the practice and they should advise them to get medical help and, you know, do some mental health first aid and make sure they're safe and all the rest.

• 26:51Speaker 03

  Because without an awareness or knowledge of the problem, the responsibility falls back on the meditator in distress, which, as Sue experienced, can just compound the problem.

• 27:04Speaker 02

  After the sort of response I got from some of the people around me, I was like, I did something wrong. That really was torturous, you know, to think about, okay, because if you think I did something wrong, then I should be able to fix it.

• 27:17Speaker 03

  An increasing awareness of the issue is a big motivation for both Willoughby and Nicholas to do the work that they do.

• 27:24Speaker 02

  There is a problem that is being sort of systematically ignored. And there is a system of like denial and gaslighting that is sort of the most common response. And so it's just very frustrating to see that. So it's a very understudied and under-supported kind of group, which is, makes me want to do something.

• 27:49Speaker 04

  I guess when I think about kind of the main reason why I've been doing the research that I've been doing and why I am having these kinds of conversations, it's not because I want to scare people away from meditation. As I said, I think a lot of people can benefit from meditation, but what I think is potentially really missing is the conversation around informed consent. And informed consent, I think, is really important because it gives the participant or the patient the autonomy to make the decision about the likely benefits of a practice and the likely risks or harms. And to my mind, that's kind of the cornerstone of modern medicine, is we give the patients or the participants the autonomy to make that choice for themselves. And I'm concerned that that's not necessarily something that, within the meditation mindfulness

• 28:34Speaker 04

  community, is necessarily happening.

• 28:39Speaker 03

  That is All in the Mind for this week. In this episode, you heard from Associate Professor Willoughby Britton from the Brown University Medical School, you also heard from Associate Professor Nicholas Van Dam, Director of the Contemplative Study Centre at the University of Melbourne, and Willem Keiken, Professor of Mindfulness and Psychological Science at the University of Oxford. Finally, big thanks to Jane and Sue, who shared their experiences with meditation. This episode was reported and produced by science reporter Fiona Pepper. Thanks also to producer Rose Kerr, Senior Producer James Bullen. I'm Sana Qadar. Thanks for listening. I'll catch you next time.

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