Adverse Effects of Mindful Meditation

Introduction

These are my thoughts after having read Defining and measuring meditation-related adverse effects in mindfulness-based programs.

In the study, the authors are testing three types of mindfulness based meditations (open monitoring, focused attention, and standard MBCT), which i am personally not familiar with. The key points i will focus on, are these (MBP=Mindfulness Based Practice):

1. The current study is an attempt to bring MBP harms monitoring up to the standards of other treatments so that providers can identify events that require monitoring and intervention in order to maximize the safety and efficacy of MBPs.
2. The target sample was intended to represent Americans seeking mindfulness meditation training for the management or alleviation of clinical, sub-clinical and transdiagnostic expressions of affective disturbances, including anxiety, depression and stress. It is worthwhile noting that the study has properly excluded those patients with conditions that the tested mindfulness methods considered not be adequate.
3. All treatments met for three hours once per week for eight weeks, with a full-day silent retreat during week seven. Prescribed formal meditation practice homework was 45 min/day, six days/week, with additional informal practice as needed. Participants received basic training in targeted practices (FA, OM, or the combination in MBCT) during weeks 1–4 and then learned how to apply these practices to regulate negative emotions in weeks 5–8.
4. The current study found that the active ingredient in MBPs, mindfulness meditation practice—including focused attention and open-monitoring practices alone or in combination—was associated with both transient distress and enduring negative impacts on life and functioning at similar rates to other psychological treatments.

Like the authors, I am in favor of a better, more scientific, approach to measuring alternative, esoteric or otherwise considered “harmless” therapies. However, i do not think mindfulness should be used at therapy or treatment.

My thoughts

I think that a mindful way of living entails using the brain in a completely different way with respect to the conventional, more popular, way we are used to using it, which is based on seeking pleasant sensations as a way to reduce suffering. The mindful person reduces suffering with awareness without judgement (by being aware of him/her self, by being aware of their suffering, by being aware of their surroundings and of all the sensations that appear and disappear. And by doing so simply accepting it as a reality, as a fact, without judgement).

As you can probably see, these are fundamentally two very different ways of using the brain. This is because both the mindful and the non-mindful person both live their life with the same common goal: to reduce suffering. Which means that both their brains spend their entire decision-making time thinking of the best solution to suffer less. Both consciously and unconsciously. Every time there is a decision to make, both you and i and everyone else use our past experiences to help us make the decision which we believe will result in the least amount of suffering.

1: Reason for the study

I do agree that there is a need for making sure that Mindfulness Based Practices are properly assessed, and i have in the past proposed similar thinking for other practices which might be considered as esoteric by some. For example, practices i have encountered which make use of testing muscle strengths in order to measure something going on in the body (immune system, allergies, healing, …), the practitioner is the one applying force and measuring resistance with their own body, making absolutely no use of any kind of device to help them measure objectively. Even though many such devices would be relatively low cost: a simple spring could be used.

2: The target

I personally do not think that learning a mindfulness way of thinking for the above mentioned reasons to be sustainable: at the very least, when one seeks mindfulness to heal from something, they will be very tempted to quit practicing as soon as the healing improves, and only work when the suffering is highest.

I believe this to be a problem because the training of mindfulness (which is no different than any other skill) requires a balanced mind, which is a lot harder to achieve when one is in a state of higher stress or suffering. Therefore it very little progress can be expected in these situations.

The alleviation of clinical, sub-clinical and transdiagnositic expression of affective disturbances including anxiety, depression and stress will inevitable be reduced when the brain is properly being used in a mindful way. The problem lies in learning how to use the brain in a mindful way. By definition, when the mind is in a mindful state, it cannot be depressed. A depressed mind cannot be in a mindful state. Learning how to achieve that state is the hard part.

3: Treatment application

The treatments were performed very similar to any other medical or physical treatment: once per week with instructor, then every day exercise for 45 minutes. This kind of method has proven to work well for learning those skills which require improving the performance of something we already know.

For example, if somebody would like to become more fit or regain control of a limb, they can go to the Gym and work with a therapist once or twice a week, then do their exercises at home every day. They will see positive results, that works, because the patient already knows how to move the body in the correct way. The exercise will only show them how to correct the way they move their body.

But when we want to learn something completely new, we usually go all-the-way full-immersion full-time for some time. For example, to become a doctor, one obtains best results when one studies as a young person full time 8-12h per day, at a University, where the life is basically surrounded by learning medicine. Even more so during residency, to really pick up the completely different life style/work environment of the hospital.

When we need to re-learn how to use something we are already using, especially when it is something basic, fundamental to daily operations, it takes a great deal of effort. A drummer playing traditionally needs to train very hard for at least a year to learn how to play open-handed. When doing so, she will most likely be pausing concerts and rehearsals during that time. A computer programmer who wants to improve his or her typing by learning how to type with an alternative more efficient keyboard layout (like Dvorak or Charachorder) will have to pause and fully immerse for period of time, before being able to benefit from it. It would be unreasonable to expect the drummer to learn how play open-handed if they were to keep playing their concerts and rehearsals cross-handed and then only spend 3% of their drumming time per day (about 7 minutes per day, considering an average of 4h per day playing time) practicing open-handed.

If 3% of the time might seem an exaggeratedly small amount, consider how much the patient uses the brain traditionally, and how much the patient is expecting results by using it mindfully (or trying to do so) for 45 minutes per day. The patient uses the brain 24h per day, even in sleep, the brain keeps rolling, and it keeps doing so the way it knows how to do so, certainly not mindfully. Then these 45 minutes are like the 7 minutes of the drummer above.

But not even that. At least the drummer above has an idea of what it is like to play open-handed: they just have to practice it in order for it to become second nature. The drummer could not expect any progress if he or she had really not quite grasped what it meant to play open-handed. Just like you reading this article right now, could make no progress in becoming an open-handed drummer without knowing what i am writing about, or even having read the Wikipedia article about it that i linked above. In the case of developing a new skill like playing the drums open-handed, it is fairly easy to understand the theory, and try it out a little bit to understand the benefits and the potential. But it is a quite different thing, often much harder, when it comes to using the brain.

In the case of re-learning how to operate the brain, the patient, needs to reach a point where they actually understand for the first time what it means for the mind to be in a mindful state, and to understand how to get it there. This is an essential milestone and breakthrough moment, which, until the patient is not capable of grasping that concept, will not allow the patient to train for this skill to become second nature.

Do you see where i’m trying to go with this? Expecting progress with only 45 minutes per day and three hours per week with an instructor is asking too much from a person. And especially one that is only there with the expectation to heal from something (as described in 2 above).

Progress in mindfulness is achieved differently from other skills. To progress, one must reach a stage of accepting reality as it is (including failure to make progress), without craving for progress. For most other skills, the mind can improve even while craving for improvements.

While i do believe that a mindful mind will either not develop the above mentioned disturbances or slowly heal them, i do not see mindfulness as a treatment and it probably should not be applied as a therapy or used as a treatment. An individual who seeks treatment is an individual who has some kind of illness, and therefore most likely has developed and is currently developing large aversion for this illness. The patient will therefore naturally have large craving for such illness to heal, and will crave for the treatment to have an effect in the reduction of the illness. Such craving will prevent the patient from being able to progress in understanding and developing mindfulness skills. It is probably asking too much from a patient to learn how to accept suffering while their mind is in an unbalanced suffering state. At that stage, all one can expect is for the mind to rely on whatever skill it has previously already learned.

Progress in mindfulness can therefore be expected mostly when the mind is in a balanced and serene state, and is therefore not indicated as treatment or therapy for the above mentioned disturbances.

As humans, we need to work on developing mindfulness always when the mind is fit for it, taking advantage of every moment that the mind is fit, with the awareness that eventually the mind will not be fit for it anymore. Just like with money, we need to save money when we can work honestly, when our minds and body allow us to do so, so that we can then use the saved money when we are no longer capable or willing to work (retirement). But to a person who has issues making or holding on to money and ran out of it, we don’t suggest them to retire. They could try as much as they like, but if there is no money in their retirement fund, it would be unreasonable and unfair to give them such advice. Instead, they need help finding alternative ways for funding their own lives (disability, another job, addressing the issue, …)

4: Results similar to other treatments

Mindfulness should be used as a way of living, not as a therapy for healing. It should therefore not substitute other methods for healing, and it should not be mixed with that. Confusing mindfulness as a tool for healing could very easily lead to aversion towards the practice of mindfulness, because the patient will not see any effects coming.

The path of mindfulness is a path towards a state without any craving or aversion. If the patient is craving for healing, the patient is running in the opposite direction of mindfulness and will develop aversion for it. One can therefore expect the patient to regress, or to worsen his or her condition. I am therefore not surprised to see adverse effects, or no improvement whatsoever in this study. Actually, i would expect results to fall in the following categories:

1. Positive progress can be expected for those individuals who are somehow “talented” or have natural or innate inclination to already use the brain in a mindful way. When they are able to keep the mind in that state, progress is expected.
2. Some neutral or positive progress is to be expected when the mind is in a state of light distraction taking a break from life. It can provide the same benefit than a 45 minute nap could, or a 45 minute warm bath, or a 45 minute massage. When the mind is stopping the intake of new information and taking time off for one self, stopping to digest, the mind can benefit.
3. Negative progress is to be expected when the mind is in a state of craving and aversion. And if this exercise is done with the expectation of healing, than craving and aversion are bound to increase. When the mind rolls in craving and aversion, increase of suffering is expected.

Each individual will have their mind in a mixture of these states (and maybe others as well), depending on their skills and experiences. For most individuals, the easiest place for the mind to go into, is in the third state, the state of craving and aversion, because that is how we constantly use our minds all of the time.

It is therefore not surprising to me that there are adverse effects, and i would not expect any progress until the mind is able to dwell more and more in the first state, which it will not be able to before it has a direct experience of that state, which its disturbances will make very difficult to occur.

Final Thoughts

Good paper, and don’t use mindfulness as a therapy. By publishing a paper on others using mindfulness as a therapy, there is the risk of acknowledging it as a therapy. Care should be given when writing, in order to explicitly avoid possible misuse of this paper (like using it as a reference in another paper as a proof that mindfulness is a therapy).

In my opinion, in order to see results, the individual needs to:

1. Understand what it means for the mind to be mindful. In order for this to happen, it is very useful to attend 10-day retreats during which the student has nothing else to do with their mind but to work on mindfulness. Only mindfulness, 24h/day.
2. The individual needs to have a very strong determination, because this path is very hard, and requires a lot of effort. The main drive cannot be, therefore, to simply heal whatever illness or disturbance they might have. Eventually the disturbances will go away, but this is a side-effect. If the individual is solely driven by their disturbance, they will not have motivation to work during the time when the disturbance is at its lowest, and they will not have a clear and open mind to be able to make progress when their disturbance is at its highest.
3. A wise mindfulness teacher will refuse to take up a student if the student is not determined to come out of their misery eradicating their suffering from the roots regardless of their physical or mental condition. Mindfulness is a strange state of mind in which things happen in a way that is not immediately intuitive. For example, we cannot crave for progress. We can only accept a lack of progress, or a presence of it. We cannot force ourselves to work harder and expect progress. This works when developing other skills, but not with mindfulness. With mindfulness we can only work as hard as we can, before it becomes suffering. We do not torture ourselves. And we need to work enough so that we don’t feel guilty for not having worked enough. We must find the proper balance, the right way. That’s what mindfulness is about.

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