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Prevalence of harm in mindfulness-based stress reduction

Published online by Cambridge University Press:  18 August 2020

Matthew J. Hirshberg Open the ORCID record for Matthew J. Hirshberg [Opens in a new window] ,
Simon B. Goldberg ,
Melissa Rosenkranz  and
Richard J. Davidson
Matthew J. Hirshberg*
Affiliation:
Center for Healthy Minds, University of Wisconsin Madison, 625 West Washington Avenue, Madison, WI 53703, USA
Simon B. Goldberg
Affiliation:
Center for Healthy Minds, University of Wisconsin Madison, 625 West Washington Avenue, Madison, WI 53703, USA Department of Counseling Psychology, University of Wisconsin Madison, Madison, WI, USA
Melissa Rosenkranz
Affiliation:
Center for Healthy Minds, University of Wisconsin Madison, 625 West Washington Avenue, Madison, WI 53703, USA Department of Psychiatry, University of Wisconsin Madison, Madison, WI, USA
Richard J. Davidson
Affiliation:
Center for Healthy Minds, University of Wisconsin Madison, 625 West Washington Avenue, Madison, WI 53703, USA Department of Psychiatry, University of Wisconsin Madison, Madison, WI, USA
*
Author for correspondence: Matthew J. Hirshberg, E-mail: hirshberg@wisc.edu
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Abstract

Background

Mindfulness meditation has become a common method for reducing stress, stress-related psychopathology and some physical symptoms. As mindfulness programs become ubiquitous, concerns have been raised about their unknown potential for harm. We estimate multiple indices of harm following Mindfulness-Based Stress Reduction (MBSR) on two primary outcomes: global psychological and physical symptoms. In secondary analyses, we estimate multiple indices of harm on anxiety and depressive symptoms, discomfort in interpersonal relations, paranoid ideation and psychoticism.

Methods

Intent-to-treat analyses with multiple imputations for missing data were used on pre- and post-test data from a large, observational dataset (n = 2155) of community health clinic MBSR classes and from MBSR (n = 156) and waitlist control (n = 118) participants from three randomized controlled trials conducted contemporaneous to community classes in the same city by the same health clinic MBSR teachers. We estimate the change in symptoms, proportion of participants with increased symptoms, proportion of participants reporting greater than a 35% increase in symptoms, and for global psychological symptoms, clinically significant harm.

Results

We find no evidence that MBSR leads to higher rates of harm relative to waitlist control on any primary or secondary outcome. On many indices of harm across multiple outcomes, community MBSR was significantly preventative of harm.

Conclusions

Engagement in MBSR is not predictive of increased rates of harm relative to no treatment. Rather, MBSR may be protective against multiple indices of harm. Research characterizing the relatively small proportion of MBSR participants that experience harm remains important.

Keywords

Behavioral interventionharmmindfulnessphysical symptomspsychological symptoms
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 6 , April 2022 , pp. 1080 - 1088
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

Clarke, T.C., Stussman, B.J., & Nahin, R.L.(2015). Trends in the use of complementary health approaches among adults: United States, 2002–2012. National Health Statistics Reports, 79 (1), 16.Google Scholar
American Mindfulness Research Association. (2019). Mindfulness scientific publications. https://goamra.org/resources/.Google Scholar
Baer, R., Crane, C., Miller, E., & Kuyken, W. (2019). Doing no harm in mindfulness-based programs: Conceptual issues and empirical findings. Clinical Psychology Review, 71, 101–114.CrossRefGoogle ScholarPubMed
Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society. Series B (Methodological), 57(1), 289–300.CrossRefGoogle Scholar
Britton, W. B. (2019). Can mindfulness be too much of a good thing? The value of a middle way. Current Opinion in Psychology, 28, 159–165. https://doi.org/10.1016/j.copsyc.2018.12.011.CrossRefGoogle ScholarPubMed
Buuren, S., & Groothuis-Oudshoorn, K. (2011). mice: Multivariate imputation by chained equations in R. Journal of Statistical Software, 45(3), 1–67. http://doc.utwente.nl/78938/.CrossRefGoogle Scholar
Clarke, T. C., Barnes, P. M., Black, L. I., Stussman, B. J., & Nahin, R. L. (2018). Use of yoga, meditation, and chiropractors among U.S. adults aged 18 and over. NCHS Data Brief, 325, 8.Google Scholar
Crane, R. S., Brewer, J., Feldman, C., Kabat-Zinn, J., Santorelli, S., Williams, J. M. G., & Kuyken, W. (2017). What defines mindfulness-based programs? The warp and the weft. Psychological Medicine, 47(6), 990–999.CrossRefGoogle ScholarPubMed
Derogatis, L. R. (1992). SCL-90-R: Administration, scoring and procedures manual for the R (evised) version and other instruments of the psychopathology rating scale series. Clinical Psychometric Research, 1–16.Google Scholar
Dimidjian, S., & Hollon, S. D. (2010). How would we know if psychotherapy were harmful? American Psychologist, 65(1), 21.CrossRefGoogle ScholarPubMed
Erzegovesi, S., Cavallini, M. C., Cavedini, P., Diaferia, G., Locatelli, M., & Bellodi, L. (2001). Clinical predictors of drug response in obsessive-compulsive disorder. Journal of Clinical Psychopharmacology, 21(5), 488.CrossRefGoogle ScholarPubMed
Freiman, J. A., Chalmers, T. C., Smith, H., & Kuebler, R. R. (1992). The importance of beta, the type II error, and sample size in the design and interpretation of the randomized controlled trial. Medical Uses of Statistics, 357–373.Google Scholar
Goldberg, S. B., Tucker, R. P., Greene, P. A., Davidson, R. J., Wampold, B. E., Kearney, D. J., & Simpson, T. L. (2018). Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis. Clinical Psychology Review, 59, 52–60.CrossRefGoogle ScholarPubMed
Goyal, M., Singh, S., Sibinga, E. M., Gould, N. F., Rowland-Seymour, A., Sharma, R., & Haythornthwaite, J.A., … . (2014). Meditation programs for psychological stress and well-being: A systematic review and meta-analysis. JAMA Internal Medicine, 174(3), 357–368.CrossRefGoogle ScholarPubMed
Graham, J. W. (2009). Missing data analysis: Making it work in the real world. Annual Review of Psychology, 60, 549–576.CrossRefGoogle ScholarPubMed
Grant, A. (2018). Opinion Can We End the Meditation Madness? The New York Times, January 19. https://www.nytimes.com/2015/10/10/opinion/can-we-end-the-meditation-madness.html.Google Scholar
Hayes, D., Moore, A., Stapley, E., Humphrey, N., Mansfield, R., Santos, J., … Deighton, J. (2019). Promoting mental health and wellbeing in schools: Examining mindfulness, relaxation and strategies for safety and wellbeing in English primary and secondary schools: Study protocol for a multi-school, cluster randomised controlled trial (INSPIRE). Trials, 20(1), 640. https://doi.org/10.1186/s13063-019-3762-0.CrossRefGoogle Scholar
Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12.CrossRefGoogle ScholarPubMed
Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. General Hospital Psychiatry, 4(1), 33–47, Hatchette; UK.CrossRefGoogle ScholarPubMed
Kabat-Zinn, J. (2013). Full catastrophe living, revised edition: How to cope with stress, pain and illness using mindfulness meditation. UK: Hachette.Google Scholar
Khoury, B., Sharma, M., Rush, S. E., & Fournier, C. (2015). Mindfulness-based stress reduction for healthy individuals: A meta-analysis. Journal of Psychosomatic Research, 78(6), 519–528.CrossRefGoogle ScholarPubMed
Lindahl, J. R., Fisher, N. E., Cooper, D. J., Rosen, R. K., & Britton, W. B. (2017). The varieties of contemplative experience: A mixed-methods study of meditation-related challenges in Western Buddhists. PLoS ONE, 12(5), e0176239. https://doi.org/10.1371/journal.pone.0176239.CrossRefGoogle ScholarPubMed
Linden, M. (2013). How to define, find and classify side effects in psychotherapy: From unwanted events to adverse treatment reactions. Clinical Psychology & Psychotherapy, 20(4), 286–296. https://doi.org/10.1002/cpp.1765.CrossRefGoogle ScholarPubMed
Linden, M., & Schermuly-Haupt, M.-L. (2014). Definition, assessment and rate of psychotherapy side effects. World Psychiatry, 13(3), 306–309. https://doi.org/10.1002/wps.20153.CrossRefGoogle ScholarPubMed
Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12(1), 38–48. https://doi.org/10.4278/0890-1171-12.1.38.CrossRefGoogle ScholarPubMed
Revicki, D., Hays, R. D., Cella, D., & Sloan, J. (2008). Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. Journal of Clinical Epidemiology, 61(2), 102–109. https://doi.org/10.1016/j.jclinepi.2007.03.012.CrossRefGoogle ScholarPubMed
Rubin, D. B. (2004). Multiple imputation for nonresponse in surveys (Vol. 81). New Jersey: John Wiley & Sons.Google Scholar
Schmitz, N., Hartkamp, N., & Franke, G. H. (2000). Assessing clinically significant change: Application to the SCL-90–R. Psychological Reports, 86(1), 263–274.CrossRefGoogle Scholar
Schomaker, M., & Heumann, C. (2018). Bootstrap inference when using multiple imputation. Statistics in Medicine, 37(14), 2252–2266. https://doi.org/10.1002/sim.7654.CrossRefGoogle ScholarPubMed
Segal, Z. V., Williams, M., & Teasdale, J. (2018). Mindfulness-based cognitive therapy for depression. New York: Guilford Publications.Google Scholar
Taylor, S., Abramowitz, J. S., & McKay, D. (2012). Non-adherence and non-response in the treatment of anxiety disorders. Journal of Anxiety Disorders, 26(5), 583–589. https://doi.org/10.1016/j.janxdis.2012.02.010.CrossRefGoogle ScholarPubMed
Team, R. C. (2014). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria, 2012. ISBN 3-900051-07-0.Google Scholar
Thompson, B. (2002). “Statistical,” “practical,” and “clinical”: How many kinds of significance do counselors need to consider? Journal of Counseling & Development, 80(1), 64–71. https://doi.org/10.1002/j.1556-6678.2002.tb00167.x.CrossRefGoogle Scholar
Travis, J. W. (1977). Wellness workbook: A guide to attaining high level wellness for health professionals. Berkeley, CA: Wellness Resource Center.Google Scholar
Van Dam, N. T., van Vugt, M. K., Vago, D. R., Schmalzl, L., Saron, C. D., Olendzki, A., … Gorchov, J. (2017). Mind the hype: A critical evaluation and prescriptive agenda for research on mindfulness and meditation. Perspectives on Psychological Science, 13(1), 36–61.CrossRefGoogle ScholarPubMed
Wallace, B. A. (2011). Stilling the mind: Shamatha teachings from Dudjom Lingpa's Vajra essence. New York: Simon and Schuster.Google Scholar
Witkiewitz, K., Marlatt, G. A., & Walker, D. (2005). Mindfulness-based relapse prevention for alcohol and substance use disorders. Journal of Cognitive Psychotherapy, 19(3), 211–228.CrossRefGoogle Scholar
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