Abstract
ObjectivesEvidence-based mindfulness programs have well-established benefits, but the potential for harmful effects is understudied. We explored the frequency and severity of unpleasant experiences and harm in two nonclinical samples participating in an adaptation of mindfulness-based cognitive therapy (MBCT) for the general population.MethodsStudy 1 included 84 schoolteachers; study 2 included 74 university students. Both studies were uncontrolled. Participants completed self-report questionnaires about psychological symptoms before and after the 8-week mindfulness course. After the course, they responded to a survey designed for this study that included Likert ratings and free-text questions about unpleasant experiences and harm. All data were collected online.ResultsIn both samples, about two-thirds of participants reported unpleasant experiences associated with mindfulness practice during the course. Most participants (85–92%) rated these experiences as not at all or somewhat upsetting; some indicated that difficult experiences led to important learning or were beneficial in some way. The proportion of participants reporting harm from the mindfulness course ranged from 3 to 7%. The proportion showing reliable deterioration on symptom questionnaires ranged from 2 to 7%. Those reporting harm and those showing reliable deterioration on questionnaires were largely separate subgroups; only one participant fell in both.ConclusionsFindings highlight the need for mindfulness teachers to manage expectations about benefits and difficulties that may occur in mindfulness-based programs and to work skilfully with participants experiencing difficulties. Experiences of harm may not be captured by symptom questionnaires and should be explicitly assessed in other ways.
Highlights
Reviews of randomized trials have shown that adverse effects, when reported, are no more common in mindfulness-based programs (MBPs) than in control groups (Kuyken et al 2016; Wong et al 2018). These findings suggest that the practice of mindfulness meditation in evidence-based MBPs can be uncomfortable and difficult, but that harm is probably rare
A free-response question asked them to describe their unpleasant experiences during the mindfulness course in more detail
Eleven participants (13%) showed reliable improvement; 71 participants (85%) showed no reliable change; and 2 participants (2%) showed reliable deterioration
Summary
Findings highlight the need for mindfulness teachers to manage expectations about benefits and difficulties that may occur in mindfulness-based programs and to work skilfully with participants experiencing difficulties. In the minority of studies providing such data, increases in symptoms or the appearance of new symptoms occurred in 0–10.6% of participants These effects were generally described as transitory, not clinically significant, or as opportunities to learn to work skilfully with difficult symptoms (Banks et al 2015), rather than as harmful. Reviews of randomized trials have shown that adverse effects, when reported, are no more common in MBPs than in control groups (Kuyken et al 2016; Wong et al 2018) Overall, these findings suggest that the practice of mindfulness meditation in evidence-based MBPs can be uncomfortable and difficult, but that harm is probably rare. The purpose of this study, was to add to the literature on unpleasant experiences and harmful effects of evidence-based MBPs by posing a set of questions about such experiences to participants in 8-week group mindfulness programs. We explored relationships between unpleasant experiences and harm and scores on measures of psychological symptoms
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