What are the potential harms of mindfulness and strategies for mitigating or preventing disorientation, depersonalization, psychosis, anxiety attacks, and panic attacks?

From the Guidelines

Mindfulness practices can sometimes lead to adverse effects like disorientation, depersonalization, psychosis, anxiety, and panic attacks in certain individuals, and to mitigate these risks, it is essential to start with brief, guided sessions under qualified instruction and establish a consistent but moderate routine. To minimize the potential harms of mindfulness, it is crucial to begin with short, guided sessions (5-10 minutes) under the supervision of a qualified instructor, rather than engaging in intense retreats or prolonged practice 1. Establishing a consistent but moderate routine, practicing in a safe and comfortable environment, is also vital. If an individual has a history of trauma, psychosis, or severe anxiety disorders, it is recommended that they consult a mental health professional before starting mindfulness practice. Warning signs such as increasing anxiety, detachment from reality, or disturbing thoughts should be closely monitored, and practice should be discontinued immediately if these occur. Grounding techniques like focusing on physical sensations, the 5-4-3-2-1 technique, or simple physical activities can help manage disorientation. For those experiencing adverse effects, cognitive behavioral therapy (CBT) or trauma-informed therapy may be beneficial, as noted in studies on mindfulness-based interventions 1. These precautions are essential because mindfulness involves heightened awareness that can sometimes amplify underlying psychological vulnerabilities or bring repressed traumatic memories to consciousness, particularly in intensive settings without proper support. Some key points to consider when practicing mindfulness include:

• Starting with brief, guided sessions under qualified instruction
• Establishing a consistent but moderate routine
• Practicing in a safe and comfortable environment
• Consulting a mental health professional before beginning practice if you have a history of trauma, psychosis, or severe anxiety disorders
• Monitoring for warning signs and discontinuing practice if adverse effects occur
• Using grounding techniques to manage disorientation
• Considering CBT or trauma-informed therapy for those experiencing adverse effects. It is also important to note that while mindfulness-based interventions have been associated with improvements in physical and mental health outcomes, including reduced stress, depressive symptoms, and anxiety, the quality of studies remains inconsistent, and not all studies have found benefit 1.

From the Research

Potential Harms of Mindfulness

• Disorientation, depersonalization, psychosis, anxiety attacks, and panic attacks are potential harms associated with mindfulness practices 2, 3, 4
• These adverse effects can be triggered by intense mindfulness practices, particularly in individuals with a history of trauma or mental health conditions 3, 4

Strategies for Mitigating or Preventing Harm

• Gradual and gentle introduction to mindfulness practices can help prevent overwhelming experiences 3
• Working with an experienced therapist or instructor can provide a safe and supportive environment for mindfulness practice 2, 4
• Focusing on psychological flexibility and acceptance, rather than solely on mindfulness, may be beneficial in reducing depression and anxiety following psychosis 4
• Interoceptive exposure techniques, such as repeated exposure to bodily sensations, may be effective in reducing depersonalization and derealization symptoms 3

Treatment of Panic Disorder and Related Symptoms

• Antidepressants and benzodiazepines are commonly used to treat panic disorder, with selective serotonin reuptake inhibitors (SSRIs) being a first-line treatment option 5, 6
• Benzodiazepines, such as alprazolam and clonazepam, may be effective in reducing panic symptoms and anxiety, but their use should be carefully considered due to potential risks of dependence and withdrawal 5, 6
• Cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) may be beneficial in reducing symptoms of panic disorder and related conditions, such as depression and anxiety 4