Pitfalls of Mindfulness

Written by: Marie Chesaniuk, PhD

You are about to read the most negative article you’ve read all day about mindfulness. ‘Mindfulness,’ as in the evidence based practice that has helped tons of people and is widely known, widely used, and widely trusted? Yes. That mindfulness. While nothing in this article takes away from the beneficial effects many have received from mindfulness and mindfulness based interventions, there is another side to mindfulness that is less discussed: the harmful side.

The mindfulness based stress reduction programs that defined what we in America know as secular mindfulness were originated by Jon Kabat Zinn in the late 1970s. According to Kabat Zinn (2011), his goal was to make mindfulness accessible and useful to those who would not access it via its original Buddhist tradition. There is an ongoing discourse about whether Kabat Zinn’s repackaging of mindfulness constitutes cultural appropriation. But that’s a whole other article…

How does mindfulness pose a harm?

By harm, I mean any unwanted experience that causes either a temporary or ongoing deterioration in functioning or increase in symptoms. 

At the outset, mindfulness asks all participants to attend to their own inner experience, nonjudgmentally. This means confronting positive, neutral, and also negative thoughts, feelings, and bodily sensations. Mindfulness asks all participants to be open to experiencing something negative in order to even attempt this practice. The image of a pleasantly relaxing meditation moment is a little misleading. If someone is not accustomed to attending to their own negative experiences, they may experience an initial increase in negative affect.

Britton (2020) suggests that mindfulness may have an inflection point – as in, a point beyond which there are either diminishing returns or increasing harms. For example, some studies of meditation report meditation-induced dampening of the amygdala tones down both negative and positive emotions. Other studies report participant experiences of dissociation and depersonalization. 

The above are just general effects of mindfulness and meditation – that it does require openness to negative experiences and that there can be too much of a good thing. What follows are some more specific harmful effects of mindfulness.

Some research suggests there are some more specific pitfalls to mindfulness. One study found that participants who paid attention, but did so judgmentally rather than nonjudgmentally, reported the worst emotional outcomes (highest reported levels of depression, anxiety, and emotional instability in the study.) This suggests that participant adherence to all the elements of mindfulness are required in order to get the desired effect, and that instructors should make this clear in their instructions and check in with practitioners accordingly.

There are some diagnoses that have appeared on lists of those who may be more prone to harmful effects of mindfulness. These include: chronic pain, generalized anxiety disorder, major depressive disorder, neurodivergent individuals, post traumatic stress disorder, psychotic disorders, and those experiencing suicidality. The symptoms of these conditions can lend themselves to harmful mindfulness experiences. 

For example, some people with chronic pain may notice and experience more pain during a mindfulness exercise. Some people with anxiety feel more anxious during mindful practices. People with post traumatic stress disorder may experience intrusive thoughts during mindful practice. Similar to the above example, some people with major depressive disorder may struggle to adhere to the nonjudgmental part of mindfulness and thus experience increased feelings of guilt and negative affect. Neurodivergent individuals may have unusual and unpleasant sensory experiences related to mindfulness practice and may struggle with over- versus under-stimulation. People experiencing psychotic symptoms already may have unusual sensory or perceptual experiences that mindfulness may increase attention to or exacerbate. And those experiencing suicidal ideation may experienced increased suicidal ideation due to the tenets of mindfulness asking them to allow any thought to occur without any judgment or intervention on the part of the participant.

How can you protect against potential harms of mindfulness?

Before engaging in mindful activities, it could be helpful to screen participants and attempt to match mindful methods to client characteristics. This goes beyond participant diagnosis. Britton provides a handy chart of participant indications and the adverse effects to look out for related to those indications. It would also help to explain risks and benefits before asking for consent and to remind participants that they can ask for assistance at any time if they experience an unwanted effect or hit a limit for their tolerance of mindfulness. Providers should consider either not administering a mindfulness based intervention or referring to an adapted program for conditions that typically appear on lists of exclusion criteria for mindfulness based programs (e.g., trauma, psychosis, suicidality.) Instructors can provide guidance ahead of an exercise about how to respond to unpleasant or unwanted thoughts/feelings. For example, one study found that of meditators who experienced unwelcome effects, these effects were mostly transitory.

During and following a mindfulness exercise, providers and instructors should check in with clients about their experience and help debrief. Providers should be aware of what harmful effects they should monitor for and explain to participants what to expect from different types of harm and how to cope with it. For example, practicing mindfulness for longer durations can inhibit sleep rather than encourage it, so make sure future practice is limited to 30min or less to stay in the sleep-facilitating range. 

If providers and participants both acknowledge the potential for harm in mindfulness, everyone can achieve a better result. Being aware of the risks and benefits allows for precision tailoring of mindfulness practices to best target the challenges facing practitioners.

Sources

Apollo, M. (2023, January 31.) Is Mindfulness a Fit for You? 5 Groups Mindfulness Can Hurt. Resources. https://www.mindfulinstitute.org/blog/article-is-mindfulness-a-fit-for-you-5-groups-mindfulness-can-hurt

Baer, R., Crane, C., Miller, E., & Kuyken, W. (2019). Doing no harm in mindfulness-based programs: Conceptual issues and empirical findings. Clinical psychology review, 71, 101–114. https://doi.org/10.1016/j.cpr.2019.01.001

Britton W. B. (2019). Can mindfulness be too much of a good thing? The value of a middle way. Current opinion in psychology, 28, 159–165. https://doi.org/10.1016/j.copsyc.2018.12.011

Britton, W. B., Haynes, P. L., Fridel, K. W., & Bootzin, R. R. (2010). Polysomnographic and subjective profiles of sleep continuity before and after mindfulness-based cognitive therapy in partially remitted depression. Psychosomatic medicine, 72(6), 539–548. https://doi.org/10.1097/PSY.0b013e3181dc1bad

Britton, W. B., Lindahl, J. R., Cahn, B. R., Davis, J. H., & Goldman, R. E. (2014). Awakening is not a metaphor: the effects of Buddhist meditation practices on basic wakefulness. Annals of the New York Academy of Sciences, 1307, 64–81. https://doi.org/10.1111/nyas.12279

Cebolla, A., Demarzo, M., Martins, P., Soler, J., & Garcia-Campayo, J. (2017). Unwanted effects: Is there a negative side of meditation? A multicentre survey. PloS one, 12(9), e0183137. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0183137Pearson, M. R., Lawless, A. K., Brown, D. B., & Bravo, A. J. (2015). Mindfulness and emotional outcomes: Identifying subgroups of college students using latent profile analysis. Personality and individual differences, 76, 33-38. https://w