Introduction

—a core consideration is one of the distress and destabilization that can result from these practices. This is relatively well-known in spiritual circles which prioritize meditative practice; only recently has the clinical literature begun to understand these adverse effects.[1] 

The relationship between contemplative practice and psychotherapeutic healing can be symbiotic, but it can just as easily be contradicting and contraindicated depending on the conditions of the client and their life. In other words, the (soteriological) goals/aims/realizations of any given contemplative practice may compound and complicate the emotional and psychological issues with which the client is facing. This post explores the various intersections that can risk our client's psychological stability if we fail to address contemplative experiences appropriately. Specifically, this post focuses on how practice can intersect with traumatic materials.

The Buddhist Roots of Therapeutic Mindfulness

The loss of self is the essence of trauma
- Gabor Mate[2]

The most popular contemplative practice in therapeutic circles and the research literature is mindfulness. Mindfulness, however scrubbed and decontextualized it has become, nevertheless has a rich history in several Buddhist meditation traditions. Within these traditions, mindfulness served as a meditative tool to understand the three "marks of existence," or aspects of reality that the historical Buddha claimed were the cause of our suffering: Impermanence, Unsatisfactorieness, and Not-Self.

This exploration into Buddhist philosophy is not simply an academic detour; it is vital context to understand exactly how this contemplative practice is supposed to function. In other words, "the end of suffering" is not a therapeutic aim, it is a claim of salvation in a world which is inherently full of chaos and pain. However, much intellectual work has been invested into the project of making Buddhism[3] compatible with Western goals and values, especially the use of scientific rhetoric to make meditation appear to be a "science of the mind."

So, while there are demonstrable benefits for certain clients in therapy,[4] the full cultural and psychological implications of these practices have yet to be fully acknowledged and understood by therapists.

What was once a means of escaping samsara became a method of complete engagement with the world, with undertones of Romantic wonderment.[5] This process―of washing away the religious language―was likely inescapable if mindfulness was to become known as the powerhouse panacea that it is today.

However, as Kabat-Zinn has aged, he consistently claims that his method leads to entering a universal "Dharma," a gateway into the "reality of things" (as posited by Buddhism).[6] Indeed, our modern mindfulness interventions can and do lead to some of the particularly-Buddhist psychological consequences of such practices: including the loosening or loss of the self. 

Defense of the Self and Traumatic Experiences

Clinically, the loss of self poses a psychological hazard for our clients with histories of extensive and intensive trauma. 

We are still learning the many ways in which humans cope with traumatic events. For example, it is well-documented that the number of traumatic experiences that one experiences as a child (aka adverse childhood events, sometimes abbreviated as ACE/s) is associated with significantly worsened health outcomes. The original study that revealed the depths of impairment speaks for itself:

"Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4 to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, [greater than] 50 sexual intercourse partners, and sexually transmitted disease; and a 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease." [7]

The myriad ways that trauma shows itself in our minds and bodies is complex, and our sciences are still wading into its mysteries. And given the prevalence of trauma in our society, it is imperative for the clinician to thoroughly examine each client, student, and patient for their history with such events.

For some clients, their coping skills may have included psychological phenomena that can impair their ability to form relationships, hold stable jobs, and otherwise function in daily life. These include depersonalization/derealization, dissociation, and hypervigilance. These dissociative and hypervigilant states have also been documented to occur through mindfulness practice. Even relatively low doses of mindfulness practice (through the use of apps, for example) have been documented to provoke "adverse meditation experiences."[8]

So, any clinician who wishes to offer mindfulness to their clients has a responsibility to understand how to conceptualize, mitigate, and work through adverse events if and when they occur.

Loosening the Self as a Potential Triggering Mechanism

In the "Forward and Warning" to his handbook of Buddhist meditative practice, Dr. Daniel Ingram writes that intensive practice can provoke "explicitly severe mood instability and psychotic episodes, as well as other odd biological and energetic disturbances, with some practitioners occasionally ending up in inpatient psychiatric facilities."[9]

I, like many others, found mindfulness first as a coping skill for severe, persistent depression. As I waded into the world of other Buddhist meditation techniques (especially emptiness practices) I had some major breakthroughs―and major break downs. Given my experiences, and in combination with the emerging research literature, I have the following hunch:

I openly wonder about the extent to which relaxing the core processes of self-hood opens a doorway into emotional, somatic, and psychological responses to trauma. 

"Relaxing the core processes of self-hood" is an explicitly Buddhist notion, and requires some explanation.

Gently is important, because the longer you sit in these practices, the more subtle the thoughts, emotions, and sensations become. You begin to notice associations between sensations and emotions and thoughts. It can sometimes feel that you understand a thought pre-verbally. Other times it seems like certain areas of your body have specific memories and emotions twisted into the sensations. You can even begin to notice how much tension you hold in your jaw or lower back or your right pinky toe; even more so, you can tune into how certain thoughts seem to instantly generate emotional tension in your body.

This practice of building awareness of your mind, body, and emotions—this is roughly what I mean about relaxing the core processes of the self. There is something about this way of open observation which is relaxing, perhaps because you are not reacting to what are usual, automatic habits of the mind and body. You can begin to observe quite fundamental ways in which you think and feel in the world. This can provoke deep levels of insight, but it also has great potential to destabilize our sense of self.

Remember those associations, the subtlety of noticing, that I was talking about? It is in this space that traumatic material can and does emerge. For those of us with incredible amounts of abuse or violence or instability in our pasts, the idea of relaxing the core processes of the self has become a danger itself. In other words, that level of existential openness and vulnerability was locked away―behind dissociation or hypervigilance―in order to psychologically protect our self from the environment.

Tentative Conclusions, Resources

Perhaps this post was more exploratory than explanatory. There is no final through-line, other than to help clinicians become aware of the myriad ways that mindfulness and trauma can intersect for our clients. However, there is at least one important, concrete takeaway: If you (or your clients) are encountering adverse meditative experiences that resurface traumatic materials, cease meditation practice immediately. This doesn't foreclose the prospect of using meditative practice in the future; however, stabilization is a priority for clinicians in these situations.

As a both a clinician and researcher, I believe our profession is currently ill-equipped to understand the breadth and depth of experiences that can occur during mindfulness and other contemplative practices. This knowledge exists in other forms in religious, philosophical, spiritual, and monastic circles, but that knowledge has yet to be translated into our profession in any meaningful way. So, when roadblocks like these occur, caution is imperative. Therapeutically, we are still learning about the road ahead of these meditative experiences, how it twists and turns, about its speed bumps and potholes.

If you are interested in learning more about the negative consequences of meditation practice, I highly recommend the researchers Willoughby Britton and Jared Lindahl, both of whom are cited in the footnotes. The videos I've linked are great introductions into their work. Additionally, Cheetah House is an excellent resource for supporting meditators currently in distress, as they offer consultation and training services. For the specific intersection of trauma and contemplative practice, one resource (that is on my to-read list) is David Treleavem's Trauma Sensitive Mindfulness, which is both a podcast and book. 

Finally, if you are in the Sacramento area and need support in finding meditation communities or therapists that can help you through adverse meditation experiences, please contact me. I would love to help if I can.

Footnotes