The benefits of mindfulness practice are increasingly well documented, but little attention has been paid to potential risks. The prevention of harm to people learning mindfulness skills requires the field to study both the benefits and the risks. We offer the following discussion with the understanding that perspectives may change as research on benefits and risks continues to evolve. We begin with parallels between mindfulness practice and physical exercise, for which the risk/benefit analyses are better understood. We then describe factors to consider in understanding the safety of mindfulness practice and conclude with suggestions for ensuring safety of those undertaking mindfulness programs, as well as directions for future research.
Physical Exercise: The Benefits and Risks
Physical exercise is a popular pursuit. Gyms and fitness classes are everywhere. Books, magazines, and blogs tell us how to get stronger and fitter. Public health campaigns encourage us to exercise more, and wearable devices and apps enhance motivation by keeping track of physical activity. There are good reasons for this enthusiasm. Research shows that exercise improves many aspects of physical and psychological health. It strengthens the heart, lungs, bones, and muscles. It helps people control their weight and manage diabetes and arthritis. It reduces the risk of colon and breast cancer, heart disease and stroke. Exercise improves sleep, increases energy levels, boosts mood, and reduces the risk of depression and the impact of stress. It sharpens thinking and concentration while helping to prevent dementia and Alzheimer’s disease. It increases confidence, self-esteem, and quality of life.
Exercise also has significant risks. People sprain joints, tear tendons, and have painful muscle spasms while exercising. Some suffer from asthma, others from heat stroke or heart attacks. Occasionally these consequences are fatal. Deaths are most likely when people do vigorous activities that they aren’t accustomed to, particularly in hot weather, but sometimes in the cold. Shoveling snow, for example, causes at least 100 fatal heart attacks every winter in the US, mostly in people who don’t realize the intensity of this form of exercise. Not surprisingly, research also shows that working with a well-trained fitness professional reduces the risks of exercise, especially for people with medical conditions.
Experts have reached a consensus that physical exercise, when it’s done carefully, has numerous important benefits and prevents much more harm than it causes. The risks, though potentially serious, can be substantially reduced through consideration of three important factors: the intensity of the exercise, the vulnerability of the person, and the quality of the instruction.
Mindfulness Practice: The Benefits and Risks
Mindfulness practice is sometimes compared to physical exercise. The analogy is not perfect and the science is at a much earlier stage. Nonetheless, experts often describe mindfulness practice as a form of mental exercise. Regular and sustained mindfulness practices are described as helping to strengthen our attentional muscles and change the way we think and behave.
Like physical exercise, mindfulness practice has become a popular pursuit. Classes, books, magazines, blogs, and apps are widely available. Research shows that practicing mindfulness has many benefits. Although the empirical literature is much smaller than for physical exercise, we have strong evidence that mindfulness-based programs reduce anxiety, depression, and stress and help people cope with illness and pain. Some studies show that the practice of mindfulness increases positive moods and cultivates compassion for self and others. It may also improve some forms of attention and memory, although findings are mixed. There is also preliminary evidence that practicing mindfulness has measurable effects on the brain.
Although the empirical literature is much smaller than for physical exercise, we have strong evidence that mindfulness-based programs reduce anxiety, depression, and stress and help people cope with illness and pain.
On the other hand, we have very little scientific information about the potential risks of mindfulness practice. Descriptions are emerging of problems brought on by mindfulness practice, including panic, depression, and anxiety. In some more extreme cases, mania and psychotic symptoms have been reported. These problems seem to be rare, but nonetheless significant, and require further investigation and guidance.
Temporary discomfort versus lasting harm:
In psychological treatment research, harm, adverse events and risk are defined as follows:
Harm is defined as a sustained deterioration in a person’s functioning that is caused by the treatment program, or an outcome that is damaging, injurious, or worse than it would have been in the absence of treatment.
Serious Adverse events are specific occurrences, such as hospitalizations or suicide attempts; they might be caused by the program, or they might be unrelated to the program. For example, some patients with severe depression kill themselves during a course of treatment, but this does not necessarily mean that the treatment caused the suicide. In clinical trials, an independent committee evaluates the causes of adverse events and judges whether the events are attributable to the treatment(s) being studied.
Risk is the likelihood that particular adverse events will occur if the program is undertaken.
Just as physical exercise can cause soreness and fatigue, psychological treatment is often uncomfortable, because it requires psychological and behavioral change, confronting painful experiences, learning new skills, and applying the skills, often in challenging situations. When treatment is successful, the discomfort is temporary and doesn’t mean that the program is harmful, but rather that psychological change is difficult.
Unfortunately, psychological treatment is not always successful and occasionally it causes harm. In fact, research consistently shows that 5-10% of clients get worse with psychotherapy (Crawford et al., 2016; Lilienfeld, 2007). In most studies, it is difficult to know why, because participants may have gotten worse with or without the therapy. However, a few treatments have been shown in randomized trials to be worse than no treatment at all. For example, critical incident stress debriefing (CISD) is intended to prevent post-traumatic stress disorder in people exposed to extreme stressors, but has the opposite effect in some people, possibly because