Unpleasant meditation-related experiences in regular meditators: Prevalence, predictors, and conceptual considerations

RESEARCH ARTICLE Unpleasant meditation-related experiences in regular meditators: Prevalence, predictors, and conceptual considerations Marco Schlosser ID1*, Terje Sparby2, Sebastjan Vörös3, Rebecca Jones1, Natalie L. Marchant1 1 Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom, 2 Department of Psychology and Psychotherapy, Faculty of Health, Witten/Herdecke University, Witten, Germany, 3 Department of Philosophy, Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia * a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Schlosser M, Sparby T, Vörös S, Jones R, Marchant NL (2019) Unpleasant meditation-related experiences in regular meditators: Prevalence, predictors, and conceptual considerations. PLoS ONE 14(5): e0216643. https://doi.org/10.1371/ journal.pone.0216643 Editor: Dusana Dorjee, Bangor University, UNITED KINGDOM Received: August 24, 2018 Accepted: April 26, 2019 Published: May 9, 2019 Copyright: © 2019 Schlosser et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All data are available at the Open Science Framework: https://osf.io/ gj7z2/. Abstract So far, the large and expanding body of research on meditation has mostly focussed on the putative benefits of meditation on health and well-being. However, a growing number of reports indicate that psychologically unpleasant experiences can occur in the context of meditation practice. Very little is known about the prevalence and potential causes of these experiences. The aim of this study was to report the prevalence of particularly unpleasant meditation-related experiences in a large international sample of regular meditators, and to explore the association of these experiences with demographic characteristics, meditation practice, repetitive negative thinking, mindfulness, and self-compassion. Using a cross-sectional online survey, 1,232 regular meditators with at least two months of meditation experience (mean age = 44.8 years ± 13.8, 53.6% female) responded to one question about particularly unpleasant meditation-related experiences. A total of 315 participants (25.6%, 95% CI: 23.1 to 28.0) reported having had particularly unpleasant meditation-related experiences, which they thought may have been caused by their meditation practice. Logistic regression models indicated that unpleasant meditation-related experiences were less likely to occur in female participants and religious participants. Participants with higher levels of repetitive negative thinking, those who only engaged in deconstructive types of meditation (e.g., vipassana/insight meditation), and those who had attended a meditation retreat at any point in their life were more likely to report unpleasant meditation-related experiences. The high prevalence of particularly unpleasant meditation-related experiences reported here points to the importance of expanding the scientific conception of meditation beyond that of a (mental) health-promoting and self-regulating technique. We propose that understanding when these experiences are constitutive elements of meditative practice rather than merely negative effects could advance the field and, to that end, we conclude with an overview of methodological and conceptual considerations that could be used to inform future research. Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. PLOS ONE | https://doi.org/10.1371/journal.pone.0216643 May 9, 2019 1 / 18 Unpleasant meditation-related experiences Introduction Meditation practices and their psychological and neurobiological effects have been studied extensively [1]. Much of the research output of the nascent field of contemplative science has focussed on the beneficial aspects of meditation [2]. This narrow investigative scope has implicitly and explicitly constructed an image of meditation as a panacea for an ever-increasing host of psycho-physical ailments. However, until recently, contemporary research has paid little attention to particularly unpleasant meditation-related experiences (e.g., anxiety, fear, distorted emotions or thoughts). In fact, a careful study of the literature reveals that most studies on meditation have not explored experiences that meditators would describe as particularly unpleasant or difficult [3]. Some researchers have recently tried to remedy this investigative lacuna by expanding the range and diversity of meditative experiences that fall within the ambit of empirical science [4, 5]. However, from a clinical and scientific perspective, it is still largely unclear whether, and how, meditation is implicated in particularly unpleasant meditation-related experiences and how to properly measure, investigate, or even define them. The discussion of particularly unpleasant meditation-related experiences through the lens of traditional contemplative traditions is similarly opaque. Traditional Buddhist textual sources indeed contain vivid accounts of particularly unpleasant meditation-related experiences and elaborate interpretative frameworks to help meditators understand them; yet these accounts vary widely, are couched in tradition-specific terms, and often revert to polemic and prescription [6–8]. Consequently, no single authoritative Buddhist account of what constitutes particularly unpleasant meditationrelated experiences can be straightforwardly extracted from historical sources to be conveniently operationalised in contemporary empirical research. For example, whether particularly unpleasant meditation-related experiences are framed as inherent stages of the contemplative path and even markers of progress towards liberation, or whether they are viewed as avoidable hindrances caused by, for instance, excessive striving, can differ between and within Buddhist traditions. These are just two examples amongst a myriad of traditional meaning-making narratives (for further discussion see [9]). Further complicating matters is the fact that an open and mutually enriching discussion between Buddhist, scientific, and clinical camps around particularly unpleasant meditation-related experiences has not yet occurred. However, models for how such an interdisciplinary and cross-cultural dialog can be encouraged have recently been proposed [10, 11]. The small body of literature on meditation-related difficulties and extreme states associated with meditation consists mostly of case reports and case series that have linked meditative practices with instances of anxiety, panic, depersonalisation, mania, psychosis, suicidality, and an exacerbation of clinical symptoms [12–27]. Notwithstanding their importance for illuminating unchartered (...truncated)