Much-hyped therapy can reduce relapses into depression – but it can have
troubling side effects
The Guardian, Monday 25 August 2014 11.13 EDT
a meditation class in mindfulness
MBCT courses are proliferating across the UK – but research in the US found some
who practised some types of Buddhist meditation were assailed by traumatic
memories and impairment in social relationships. Photograph: Luis Alvarez/Getty
In a first floor room above a gridlocked London street, 20 strangers shuffle on
to mats and cushions. There's an advertising executive, a personnel manager, a
student and a pensioner. A gong sounds softly and a session of sitting
meditation begins. This is one of more than 1,000 mindfulness courses
proliferating across the UK as more and more people struggling with anxiety,
depression and stress turn towards a practice adapted from a 2,400-year-old
Enthusiasm is booming for such mindfulness-based cognitive therapy (MBCT)
courses, which an Oxford University study has found can reduce relapses into
depression by 44%. It is, say the researchers, as effective as taking
antidepressants. It involves sitting still, focusing on your breath, noticing
when your attention drifts and bringing it back to your breath – and it is
Lifestyle magazines brim with mindfulness features and the global advertising
giant JWT listed mindful living as one of its 10 trends to shape the world in
2014 as consumers develop "a quasi-Zen desire to experience everything in a more
present, conscious way".
But psychiatrists have now sounded a warning that as well as bringing benefits,
mindfulness meditation can have troubling side-effects. Evidence is also
emerging of underqualified teachers presenting themselves as mindfulness
experts, including through the NHS.
The concern comes not from critics of mindfulness but from supporters, such as
Dr Florian Ruths, consultant psychiatrist at the Maudsley hospital in south
London. He has launched an investigation into adverse reactions to MBCT, which
have included rare cases of "depersonalisation", where people feel like they are
watching themselves in a film.
"There is a lot of enthusiasm for mindfulness-based therapies and they are very
powerful interventions," Ruths said. "But they can also have side-effects.
Mindfulness is delivered to potentially vulnerable people with mental illness,
including depression and anxiety, so it needs to be taught by people who know
the basics about those illnesses, and when to refer people for specialist help."
His inquiry follows the "dark night" project at Brown University in the US,
which has catalogued how some Buddhist meditators have been assailed by
traumatic memories. Problems recorded by Professor Willoughby Britton, the lead
psychiatrist, include "cognitive, perceptual and sensory aberrations", changes
in their sense of self and impairment in social relationships. One Buddhist
monk, Shinzen Young, has described the "dark night" phenomenon as an
"irreversible insight into emptiness" and "enlightenment's evil twin".
Mindfulness experts say such extreme adverse reactions are rare and are most
likely to follow prolonged periods of meditation, such as weeks on a silent
retreat. But the studies represent a new strain of critical thinking about
mindfulness meditation amid an avalanche of hype.
MBCT is commonly taught in groups in an eight-week programme and courses sell
out fast. Ed Halliwell, who teaches in London and West Sussex, said some of his
courses fill up within 48 hours of their being announced.
"You can sometimes get the impression from the enthusiasm that is being shown
about it helping with depression and anxiety that mindfulness is a magic pill
you can apply without effort," he said. "You start watching your breath and all
your problems are solved. It is not like that at all. You are working with the
heart of your experiences, learning to turn towards them, and that is difficult
and can be uncomfortable."
Mindfulness is spreading fast into village halls, schools and hospitals and even
the offices of banks and internet giants such as Google. The online meditation
app Headspace now has 523,000 users in the UK, a threefold increase in 12
months. But mounting public interest means more teachers are urgently needed and
concern is growing about the adequacy of training. Several sources have told the
Guardian that some NHS trusts are asking health professionals to teach
mindfulness after only having completed a basic eight-week beginners' course.
"It is worrying," said Rebecca Crane, director of the Centre for Mindfulness
Research and Practice in Bangor, which has trained 2,500 teachers in the past
five years. "People come along to our week-long teacher training retreat and
then are put under pressure to get teaching very quickly."
Exeter University has launched an inquiry into how 43 NHS trusts across the UK
are meeting the ballooning demand for MBCT.
Marie Johansson, clinical lead at Oxford University's mindfulness centre,
stressed the need for proper training of at least a year until health
professionals can teach meditation, partly because on rare occasions it can
throw up "extremely distressing experiences".
"Taking the course is quite challenging," she said. "You need to be reasonably
stable and well. Noticing what is going on in your mind and body may be
completely new and you may discover that there are patterns of thinking and
acting and behaving that no longer serve you well. There might be patterns that
interfere with living a healthy life and seeing those patterns can bring up lots
of reactions and it can be too much to deal with. Unless it is handled well, the
person could close down, go away with an increase in self-criticism and feeling
they have failed."
Finding the right teacher is often difficult for people approaching mindfulness
for the first time. Leading mindfulness teaching organisations, including the
universities of Oxford, Bangor and Exeter, are now considering establishing a
register of course leaders who meet good practice guidelines. They expect
mindfulness teachers to train for at least a year and to remain under
supervision. Some Buddhists have opposed the idea, arguing it is unreasonable to
regulate a practice rooted in a religion.
Lokhadi, a mindfulness meditation teacher in London for the past nine years, has
regular experience of some of the difficulties mindfulness meditation can throw
"While mindfulness meditation doesn't change people's experience, things can
feel worse before they feel better," she said. "As awareness increases, your
sensitivity to experiences increases. If someone is feeling vulnerable or is not
well supported, it can be quite daunting. It can bring up grief and all kinds of
emotions, which need to be capably held by an experienced and suitably trained
"When choosing a course you need to have a sense of the training of the teacher,
whether they are supervised and whether they themselves practise meditation.
Most reputable teacher training courses require a minimum of two years'
meditation practice and ensure that teachers meet other important criteria."