Blog #52 – Mindfulness – Part 5
In recent weeks, we have focused on mindfulness, with an emphasis on looking at research evidence pointing to its potential well-being benefits among diverse populations. However, as alluded to briefly last time, not all researchers and mental health professionals are necessarily eager to roll the red carpet out and see mindfulness interventions implemented in our schools, workplaces, and other settings. These individuals have raised concerns around mindfulness as delivered in the West on a number of fronts, ranging from the qualifications of those leading interventions to the actual effects themselves.
In the 2017 review paper on the state of research into mindfulness referred to in our last post, J. David Creswell devotes a section to the potential risks involved in such interventions. He begins by highlighting that it is not uncommon for participants “to report various unpleasant reactions, such as agitation, anxiety, discomfort, or confusion” during formal exercises. He adds that advocates regard such reactions as a valuable part of the “psychotherapeutic change process”, in that this goes back to the core point of cultivating awareness in the here and now, and that by encouraging this level of attention, participants can come to understand why they feel as they do and also come to appreciate the temporary nature of such negative feelings.
Creswell describes the above as “benign risks”, but goes on to cite researchers who have raised more serious questions. One such concern expressed is whether an individual with a traumatic past would be at risk of reliving that trauma during mindfulness training, and would that then trigger a depressive episode? Creswell also points to concerns around the increased peril individuals at risk for psychosis or seizures might face if exposed to mindfulness practices, and notes the relative paucity of research into the prevalence, type, and severity of what he terms as “dark night” experiences associated with such interventions. However, he stresses that what evidence there is suggests that the more common mindfulness approaches, e.g., MBSR led by trained instructors over a relatively short period of time, pose the smallest risk and tend to offer the most benefits to “high-trauma and high-stress populations”.
A few weeks ago, we looked specifically at positive results arising from the use of mindfulness interventions among adolescents in school settings. While there is a growing body of research pointing to the potential of mindfulness in schools, concerns have been expressed on this front too. In 2012, Mark Greenberg and Alexis Harris urged caution in the implementation of mindfulness-based strategies for young people, suggesting that while there is encouraging evidence as to the potential benefits, a body of work had yet to emerge which would justify the level of enthusiasm expressed for such interventions. In their review of research on contemplative practices with young people, the authors stated that most of the mindfulness and yoga research thus far conducted has been with participants in middle childhood and adolescence, but note that quality issues have arisen around the proper reporting of instructor qualifications, attrition rates, randomisation methods, and approaches used to analyse data. They also noted that previous reviews of the area reported that very few meditation-based intervention trials have been conducted with universal populations of young people. However, they also acknowledge that relevant findings report that mindfulness practice may help improve the social skills of school-age children and also school-related functioning. That said, the authors stressed that most such studies have issues around design, sample size, and measurement, and this, they maintain, impacts negatively on the confidence that can be attached to such findings.
Writing at the Psychology Today website in 2016, Utpal Dholakia challenges what he calls the “unalloyed positive spin” used in most conversations on mindfulness practice, and instead draws attention to its potentially negative consequences. Among the pitfalls he highlights are:
• Discarding positive thoughts as well as negative in the process of separating ourselves from our thoughts;
• Retreating into a meditative mindset when faced with everyday challenges, and thus not dealing with them effectively.
He goes on to point to research suggesting a range of possible negative side-effects, including depersonalisation, psychosis, anxiety, loss of appetite, and insomnia, while also making the point that individuals with pre-existing conditions such as PTSD should be particularly cautious about mindfulness practice. The key point being that with some populations, pre-screening may be desirable.
Dholakia also stressed that he practices mindfulness and had no intention of stopping based on what he had discovered, but added that he was going to “adopt a more sceptical stance and pay attention to both positive and negative outcomes of mindfulness practice.”
This perhaps offers us the most rational conclusion. There is a lot of encouraging evidence on the benefits of mindfulness, but research is ongoing, and it is important to also be aware of potential downsides and proceed with appropriate caution.
Dr. Mark Barry
Mark Barry was awarded a PhD by University College Cork in 2015 for his research into adolescent well-being. He has lectured psychology at UCC since 2013 and is also a freelance writer.