Meditation and negative side effects: the latest research

A 2020 review of mindfulness research highlights a reluctance to acknowledge potential adverse effects.

contrasting emotions
The effects of meditation based brain training are neither uniform nor universal

Scientists and clinicians, generally speaking, attempt to make the world a better place. Many of us working with mindfulness have confidence that this human technology has significant curative potential. But a health and wellbeing intervention cannot be built on my confidence or compassionate aspiration. It requires objective results produced through reliable scientific methods. Such results should offer a comprehensive understanding, including indications of problematic side effects. This summer, perhaps for the first time, a journal article has summarised adverse events linked to meditation practice (MAE).1

In a recent review of Richard Layard’s manifesto for happiness, I highlighted the tension between wanting mindfulness to be an effective panacea and making the scientific case for its widespread use. This dilemma is well known to psychologists. We direct our research towards a desired outcome, a plausible hypothesis, reliant on the scientific method to ensure our work remains objective and unbiased. Methodologically robust results of experiments and clinical trials should deliver a balanced and replicable set of data. If the data is not objective or if a later investigation cannot repeat the results, the scientific reliability may be open to question. Within the psychological sciences, these conflicting forces have long been a major source of concern.

Psychology has been locked into a so called replication crisis for several decades.2 Meditation research shares characteristics of this malaise, but scientists working in this field have highlighted several additional concerns. Meditation based mind training ultimately mediates brain function and structure; none of our higher (cortical) brain functions work in isolation. When activity in one area attenuates, we may see a correlated augmentation in an anatomically separate region. Put simply: brain training can simultaneously have different effects, these effects can vary from person to person. This truism of neuroscience should ensure that when meditation based health interventions are studied, both beneficial and adverse potentials are considered.

In August of this year, a research team (Farias, Maraldi, Wallenkampf and Lucchetti) published a strategic review of meditation studies in Acta Psychiatrica Scandinavica. ‘Adverse events in meditation practices’ investigated almost half a century of meditation research, a total of 6,742 citations. Of those papers, only 83 met the project’s inclusion criteria. Across this sample, the study found MAEs in 8.3% of cases. That meditation practice has been scientifically correlated with problems in some practitioners is a significant finding in its own right. But a second issue, the tendency of meditation and mindfulness research to focus on positive outcomes to the exclusion of other considerations also an needs to be taken very seriously. When the science of meditation is explored from a historical perspective, this lack of objectivity has been a recurrent problem for a long time, at least fourty years. It’s root causes go back to early engagements between non-positivist knowledge systems and psychology.

The Farias et al. paper signposts a potential new trajectory for the science of meditation. It doesn’t, however, offer any explanation of why adverse side effects receives a low research priority. Given the codes of ethics and conduct underpinning experimental and clinical psychology, future research will need to take the question of MAEs more seriously. However, two overarching consideration require urgent attention. Firstly, on the theoretical and operational level what happened to spiritual meditation when it relocated to psychology? And why despite thousands of experiments over at least eighty years, is our scientific knowledge of meditation still described as ‘preliminary’?

Notes

1 Farias, M., Maraldi, E., Wallenkampf, K. C., & Lucchetti, G. (2020). Adverse events in meditation practices and meditation‐based therapies: a systematic review. Acta Psychiatrica Scandinavica.

2 Maxwell, S. E., Lau, M. Y., & Howard, G. S. (2015). Is psychology suffering from a replication crisis? What does “failure to replicate” really mean?. American Psychologist, 70(6), 487.

Meditation, mindfulness, quantum physics and duality

Mindfulness meditation finds itself under sustained scientific criticism, could quantum physics explain why?

Meditation and quantum physics
How far can a reductive mechanistic scientific ontology measure organic processes?

Experimental psychology has been the main object of The Science of Meditation project. The scientific papers featured in this blog are recent, generally published after 2010. But yesterday evening I came across a study from 1975 that addresses many of the issues which are currently limiting the research and practice of contemporary meditation. Fritjof Capra’s paper, Modern Physics and Eastern Mysticism describes the world views of Buddhism, Hinduism and Taoism, comparing them with Western equivalents.1 In doing so, Capra highlights more than a dozen problems manifest in the contemporary (positivist) scientific understanding of Buddhist meditation. One of which I’m going to discuss here briefly; world views as either organic or mechanistic.

person walks towards temple

Having experienced the benefits of meditation first hand, I find the failure of psychology to demonstrate the potential of meditation both wasteful and confusing. As many as ten thousand meditation and mindfulness experiments have been conducted over the last forty years. Yet cognitive psychology describes research in this area as preliminary! Over time two questions have shaped my academic and scientific work; i) how does a spiritual practice become a secular (scientific) practice and ii) what is lost and gained in this transition? Put concisely, how well has the West understood traditional meditation systems?

Strategic reviews of research published since 2016 generally identify two limitations in the science of meditation. An absence of theoretical frameworks and widespread methodological flaws. The lack of a cohesive ontology (framework) is the greater of the two problems. Without a guiding rationale, the scientific method can become directionless, entangling the means with the ends. Capra’s paper sets out his interpretation of the characteristics of ‘Eastern’ spiritual understandings, thus offering signposts to how the West could shape meditation research.

high angle photo of robot

So what are these organic and mechanistic world views that could alter the trajectory of research? Capra’s paper is 45 years old; much has changed in physics, psychology and our understandings of meditation.3 But as a theoretical study, Modern Physics and Eastern Mysticism deals with overarching concerns that are timeless. Capra argues that the view of ‘reality’ developed in the West rests on certain principles, such as those set out by the anatomist Democritus. It was the progression of this view that led to the creation of classical physics and established dualism as the ‘Western’ way of understanding almost everything.

Conversely Eastern understandings see nature as much more interconnected, that the categories and laws of nature are constructs, built by mental processes rather than absolute ‘truths’. Capra offers a deal of evidence from quantum physics to demonstrate how this proposition might work with the inanimate. But for the psychological sciences, the value of this insight is self-evident, humans rarely respond to complex phenomena in a universally predictable manner. And where experiments reveal ‘universality’ in complex human behaviours, there are generally several factors influencing the data, including society and the experimental method.

So what does this piece of ‘dated’ quantum physics mean for our contemporary understanding of meditation? The essence of this work highlights fundamental differences between ontologies (theories of being) between the societies where meditation was created and is now investigated. That the West follows a culturally relevant mechanistic presumption of causality, even when considering human nature.4  Not to suggest that Newtonian physics doesn’t ‘work’, rather that it is part of a much more sophisticated understanding of nature. Psychology’s failure to recognise that different ontologies exist in different cultures, even when appropriating their technologies has implications to the study of meditation and mindfulness.5

 

Notes:

1 Capra, F. (1976). Modern physics and eastern mysticism. Journal of Transpersonal Psychology, 8(1).

2 Capra also discusses Hinduism and Taoism in this paper. Although grouping ideas from different Buddhist schools or diverse religio-philosophical systems can lead to over-generalisations, each of the points made needs to considerer on its individual merit.

3 I’m unfamiliar with Capra’s later studies; his views may have changed radically since this paper was published. I’d be delighted to hear from you if you are familiar with his recent work, feel free to email me or post comments in the text box below.

4 Capra’s thinking embraces physics generally, the emphasis on human behaviour here is my focus rather than a reflection of the paper under discussion.

5 While the existing positivist ontologies present in cognitive psychology offer investigatory potential, there are two problems if traditional meditation is based on a Western world view.  Firstly without cognisance of the spiritual frameworks, the contemporary interpretation of the original practices may lack elements foundational to its understanding. Secondly, while positivist approaches will produce data, what is being measured, and how it is understood may be unrelated to the spiritual meditation.

If mindfulness works, we have to be able to produce the evidence

The longer the science of mindfulness resists reforms, the greater the risks to the technology.

Buddhism and mindfulness
Making sense of mindfulness research

Leading UK economist Richard Layard has drawn further attention to the growing controversy surrounding mindfulness meditation. In his recent book Can we be happier?, Layard sends a number of uncertain messages about the role and benefits of mindfulness. The central premise contained in the Introduction is that by increasing levels of altruism, a new age of increased happiness can be established. Throughout the book, mindfulness and meditation are used as examples of technologies able to support the ‘happiness revolution’. But confusingly, Layard highlights concerns that the altruism present in traditional meditation methods, has been erased from secular forms of mindfulness. According to Layard’s hypothesis, if mindfulness decreases altruism it might reduce happiness. The same problem may be present with any self-focused form of mind training, self-compassion or CBT for example.

man wearing black crew neck top

Can we be happier? also misses the opportunity to discuss the lack of replicated data in mindfulness research. Several scientific reviews have argued that revisions to the methodologies used to study meditation are required.1 Given the status of Layard as a leading authority in the science of happiness, his failure to mention this growing problem is surprising. Leaving the book open to accusations of a lack of scientific objectivity.2 A tendency to ignore critical reviews from academics and scientists is causing increasing damage to the reputation of the contemplative sciences. If action isn’t taken by the scientific and clinical communities, there is a danger that the progress of mindfulness will be stalled further. There are three pressing issues that need to be addressed by professionals working in this field.

  • The body of research needs to be reviewed and a distinction made between reliable (fully replicated studies) and unreplicated (unreplicable) work.
  • Any systemic problems must be acknowledged and a plan of action to eliminate them agreed.
  • Robust theoretical frameworks need to be established.

“Those of us with a long experience of meditation, know how valuable a technology it is. But if we wish that meditation and mindfulness are treated as scientifically reliable, we must meet the required standards of evidence. Including a need for extensive replication.”

Stephen Gene Morris

Notes:

1 Nicholas T. Van Dam and others, ‘Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation’, Perspectives on Psychological Science, 13.1 (2018), 36–61.

2 https://www.theguardian.com/books/2020/jan/23/can-we-be-happier-richard-layard-review

Mindfulness study retracted: Problems with MBSR/MBCT paper

Earlier this year Plos One took the step of retracting a well known and widely cited mindfulness related study.

It's getting harder to make sense of mindfulness research
Is it getting harder to make sense of mindfulness research?

This particular study is a first for the Science of Meditation blog. Whilst we have featured a number of papers that have highlighted methodological problems in meditation and mindfulness research, this is the first time that we have drawn attention to a retraction of a peer-reviewed study.

The basis for the retraction is outlined in detail on the Plos One website, but we have paraphrased the three main points.

  • The handling Academic Editor shared an affiliation with three of the authors, although this didn’t emerge until post-publication.
  • Two of the authors hold or had held positions at an institute offering mindfulness related products and services in clinical contexts.
  • The paper has a number of errors including pooling of results which led to double counting and incorrect effect estimates in figures contained in the study.

There’s not a lot more we need to add to the identified issues, they speak for themselves. However, when considered as part of the ongoing crisis in mindfulness research they make troubling reading.

A general defence used in cognitive psychology when the findings of mindfulness studies are criticised is, the peer review system is self-regulating. That when studies are found to be below the expected standard, they are usually rejected during review. Or at the very least other experts working in the field have the opportunity to raise concerns in print. This retraction challenges this basic notion. Significant issues with both the methodology and the editorial process can endure, thus, have the ability to influence the scientific and popular understanding of mindfulness. According to Google Scholar, this Gotink et al. study has been cited over 400 times, the citing publications, in turn, used by thousands more papers. The details provided on the Plos One website indicate the study has received 50,000 views.

Rather than simply criticize this study or the journal, I would like to ask what this retraction show us about the way that meditation technologies are being treated by clinical and scientific institutions?

Authors: Gotink, R. A., Chu, P., Busschbach, J. J., Benson, H., Fricchione, G. L., & Hunink, M. M.

Year: 2015

Title: Standardised mindfulness-based interventions in healthcare: an overview of systematic reviews and meta-analyses of RCTs

Summary: This is a research paper that (at the time of writing) had been retracted by PLOS ONE.

“In light of the methodological issue and concerns about the validity of the study’s results, the PLOS ONE Editors retract this article. We regret that these issues were not fully addressed prior to the article’s publication.”

An extensive explanation of the reasons behind the retraction are published on the Plos One website which can be reached by following the link below.

Link: https://journals.plos.org

How far can we trust meditation research?

Strategic reviews are challenging the popular perception of the beneficial effects of mindfulness

How far can we trust meditation research?
Looking for answers from meditation?

How far can we trust meditation research?

No matter how I tried to write the headline it came out as provocative. My intention wasn’t to be controversial, rather I wanted to articulate concerns that have been rumbling around the science of meditation and mindfulness for decades. At the heart of this story are two important yet unresolved issues. Firstly how does psychology and neuroscience understand meditation and what do the results of meditation research really mean?

The limited prosocial effects of meditation is a recent systematic review of research undertaken by Ute Kreplin, Miguel Farias and Inti Brazil. The study has been discussed in the meditation community at some length so I’m not going to review it here. But to summarize, the positive effects of meditation on prosocial behaviours (compassion, empathy, aggression, connectedness and prejudice) in healthy adults were only observed in compassion and empathy scores. However, increases to compassion were just seen when the meditation teacher was one of the co-authors of the research paper or when the study used a ‘passive’ control group (this means the control group were on a waiting list). These findings are suggestive of flaws and possibly ‘bias’ in some of those studies that demonstrated significant results. In an interview with Ute Kreplin published in the international Buddhist journal Tricycle, a number of broader issues have been highlighted, it’s those that I’d like to push around a little now. Leaving to one side the methodological flaws which are the main focus of the Tricycle interview, let me draw attention to the potential causes of the ongoing limitations in our attempts to evidence the effects of meditation.

woman meditating

It should be stressed that the Kreplin, Farias and Brazil paper is one of a number of reviews that came to similar conclusions, that many (possibly most) of the published studies reporting significant effects in non-clinical populations had methodological and/or theoretical flaws. And as Kreplin hinted, published research tends only to be the tip of the iceberg, studies that fail to show measurable changes in meditators rarely see the light of day. So the examples analyzed in strategic reviews are not the full picture of meditation research, they offer a very selective (positive) account of the scientific landscape. And yet the common perception grows that meditation is a panacea able to deliver a range of desirable outcomes to almost anyone willing to practice a method.

“At this moment in time the science generally isn’t helping us to understand the benefits of meditation…”

Stephen Gene Morris

By way of transparency, I should make it clear that I’m an experienced meditator and confident of the great benefits of the practice. My interest in contemplative science comes from the perspectives of both a trained cognitive psychologist and a practising Buddhist. From my experience of teaching traditional meditation systems, it is unrealistic to claim that a few weeks of meditation practice automatically leads to ‘significant’ change. Some practitioners do progress rapidly, embracing the transformative potential of meditation, but others fall away after only a few weeks, sometimes disillusioned and unfulfilled. This is a difficult subject to address coming from a traditional meditation perspective because judging or criticizing the progress of another practitioner is something of a taboo. But to enhance the wider understanding of meditation this point needs to be stressed. There is no reason to assume that the meditation method alone leads to change, the method is an integral part of a firmly established theoretical framework. The effects of meditation tend to be meditated by several factors such as individual capacity, participant motivation and qualitative differences between the teacher or teaching systems.

The contemporary scientific investigation of meditation typically takes the reductionist approach, stripping out components that might confound the results of an experiment, such as variability in the method or differences in the environment. But isolating the cause (meditation method) and the effect (empirical change in the participant) is difficult, and in complex aspects of human behaviour such as empathy or compassion, it may be beyond the scope of many experiments. Consider that large numbers of the participants in meditation studies are likely to be undergraduates ‘pressed’ into research projects, obliged to participate in return for course credits. If meditation doesn’t always work for the people who choose to attend classes in the wider community why should things be any different in an experimental setting?

ancient architecture art asia

The ‘expectation’ that a meditation method in itself leads to change is not supported by human history. This idea may eventually be confirmed by science but the data gathered so far is inconclusive. We know that a number of meditation scientists are committed practitioners, so perhaps they have first-hand experience of the benefits of meditation or mindfulness. Is this as Kreplin suggests, part of the problem? Could the experiential knowledge of the results of meditating introduce subconscious bias into research methodology? I’m a meditator I know about the benefits of regular practice but I can see dangers to the credibility of meditation systems if claims based on poor science are over-hyped. The lack of long term studies for secular forms of meditation should also be a serious concern.

The failure to establish robust findings in meditation research begs a further question, without reliable replicated science how does the delivery of meditation technologies continue to grow in society? If scientists are raising questions about the claims made in individual studies why isn’t this filtering down more into health care, public policy and the media? If meditation and mindfulness interventions cannot be shown to work, or deliver predictable results, confidence in meditation generally may decline. It might also lead to an erosion in the status of experimental psychology as a provider of independent and reliable data.

These few paragraphs are simply an introduction to the subject, the start of a very long road. It can be argued that the contemporary western scientific investigation of meditation began in the 1970s, since when perhaps as many as 10,000 studies have been published. But based on the findings from recent strategic reviews our scientific understanding of meditation is at a surprisingly preliminary stage.

Notes

The Kreplin, Farias and Brazil study can be found here.