Thus far, the literature offers conceptualisations, empirical evidence and theories on clinical work that highlight the benefits of breath awareness and mindfulness. However, findings also point to negative aspects related to mindfulness practice. Baker (2012), in his qualitative research that explored brief mindfulness training intervention on trainee therapists, found that there were a range of positive outcomes. However, one participant experienced a greater sense of embodied sensations and emotions, which had an adverse effect at times. She described experiencing her vulnerability and the possibility of being overwhelmed by feelings that she stated she had ‘taken in’ from her client. Baker (2012) discusses the potential danger of embodied countertransference awareness without the development of a corresponding ability to remain present and accept such difficult feelings.
Bhanji (2017), similar to Baker, investigated mindfulness in therapists. Her study offers a qualitative exploration into the personal and professional experiences of having a long-term daily practice, of informal mindfulness, for third wave therapists. She highlighted 6 themes derived from semi-structured interviews that pointed to several benefits and some challenging experiences. Bhanji (2017) states acceptance, which is considered part of mindfulness practice, is a gradual process and potentially painful.
Her work informs us that efforts to reduce pain with intensive mindfulness, could inadvertently lead to over-detachment and an increase in suffering.
‘The challenges themselves are not new and have been identified in relation to the misunderstanding or misapplication of mindfulness meditation’ (Bhanj, 2017 pp. 122),
Her study makes references to how meditation can be misapplied when it is utilised as an isolated strategy to cope, or, when a practitioner meditates too intensively for extensive periods of time, without actually meditating.
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Prior to Baker’s and Bhanj’s contributions to our understanding of potential adverse effects, Lustgk et al. (2009) produced a paper that summarised safety concerns regarding Mindfulness Meditation (MM). One of the goals of this paper was to define categories of possible adverse reactions and side effects of meditation. Lustgk et al. refers to negative consequences to mental, physical and spiritual health. Findings suggest that mental health concerns have included MM delivery contributing to anxiety disorders, temporary dissociative states and psychosis. These investigators argue that the practice of MM is contrary to the avoidance that is symptomatic of conditions such as post-traumatic stress disorder (PTSD). This means that when an individual takes part in mindfulness practice, they might experience previously avoided effects, such as intrusive thoughts or flashbacks. These experiences can then lead to an individual being traumatised. Further psychological and physical health effects were described to include experiences of depersonalisation and psychosis. Lustgk et al. (2009) advises that when researchers consider participants for their studies in connection to mindfulness, they need to be screened carefully in terms of their suitability.
More recently, NHS Choices (2017) added to our understanding and the concerns raised by authors such as Lustgk et al. (2009). NHS Choices suggest that when individuals practice intensive meditation, they can encounter experiences that are difficult and challenging. References are made to religious teachers within Buddhism who view such challenges as part of the path of religious experience. However, individuals that meditate for health benefits not involving a context of religion, can find experiences arising from mediation as unexpected and difficult to cope with (NHS Choices, 2017).
When exploring the negative findings related to breath awareness and mindfulness Baer and Kuyken (2016), state that there is very little scientific information regarding possible risks involving mindfulness practices. Similar to Lustgk et al. (2009), Baer and Kuyken (2016) inform us that difficulties, such as depression, anxiety and panic (and more seriously, mania and psychotic symptoms) have been linked to mindfulness practices. While these difficulties are rare, they are significant and need further investigation. I also consider that individuals’ vulnerability in terms of pre-existing
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mental health difficulties - such as, trauma or psychosis - could increase the risks of adverse effects related to mindfulness practices (NHS Choices, 2017). At the same time, studies such as Chadwick et al. (2005), reveal highly vulnerable individuals who experience psychotic symptoms can safely practice mindfulness of the breath when their needs are carefully addressed. With the above points in mind, it seems apparent that adverse and negative experiences of mindfulness need to be explored further.
2.7 Conclusion
The different areas outlined above reveal that there are several concepts that try to explain how mindfulness works. Investigations endeavour to conceptualise mindfulness such as non-judgement, and more measurable factors found in neurobiology. However, more ancient views pay particular emphasis to the experience of breathing, providing a basis in which to develop mindfulness. Empirical evidence points to the various ways in which mindfulness can be applied clinically, such as the influences to treatment outcomes and therapists’ self-care. Findings also reveal potential adverse effects and indicate that more investigations are needed to explore the difficulties of mindfulness practices. I see the conceptualisation of mindfulness, research and clinical theory trying to piece together their understanding of present moment awareness. However, without a clear agreement on the definition of mindfulness, and what it involves, it appears establishing a clear consensus, on what mindfulness is, remains a challenge.
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