How too much mindfulness can spike anxiety

For around 20 years, I’ve struggled with periods of anxiety, and turned to mindfulness meditation as a means of quelling those feelings. At its best, the benefits would often perfectly match the hype. Focusing my attention on my breath or my body would calm my nagging internal voice, and I’d return to normal life feeling energised and invigorated.

Far too often, however, I’d end the session feeling much worse than when I began. Rather than relaxing, my heart would begin to accelerate, or my inner monologue would take a nasty turn, as unpleasant memories and feelings of failure and hopelessness flooded my mind. These events became so frequent that I now only use mindfulness occasionally.

I had assumed that I was just uniquely bad at taming my thoughts. Yet a growing body of research suggests that such stories may be surprisingly common, with one study from 2019 showing that at least 25% of regular meditators have experienced adverse events, from panic attacks and depression to an unsettling sense of “dissociation”.

Given these reports, one researcher has even founded a non-profit organisation, Cheetah House, that offers support to ‘meditators in distress’. “We had more that 20,000 people contact us in the year 2020,” says Willoughby Britton, who is an assistant professor in psychiatry and human behaviour at Brown University. “This is a big problem.”

How could something that is apparently so beneficial for so many people turn out to have such disturbing effects for others? And are there any ways to gain the benefits of meditation without running into these risks?

‘You can only crank up your attention dial so far’

In any discussion of mindfulness, it’s important to remember that there are many different techniques that train particular types of thinking and being. The best-known strategies are mindful breathing, in which you focus on the feelings of respiration, and the body scan, in which you pass your attention from head to toe, noting any physical sensations that arise in the course of the session.

These kinds of practices are meant to ground you in the present moment and the effects can be seen in brain scans, with growth in the insula cortex, a region that is involved in bodily perception and emotion. As a result, mindfulness training can leave us more in touch with our feelings, which is important for good decision making. Many mindfulness practices also encourage a more general “observing awareness”, in which you train yourself to notice your thoughts and feelings without reacting or judging. With practice, this can increase your capacity for emotional regulation so that you are no longer as susceptible to flashes of anger, for instance.

Ideally, these changes should complement each other and result in greater wellbeing. But that’s only possible if they occur in balance and moderation. Unfortunately, some meditators may pass the optimum point on either one of these elements, leading to distress.

Take the effects of body scan, with the heightened activity in the insular cortex. “It’s like somebody turned up the volume knob, and the intensity of all your emotions is going to be louder,” says Britton, whose recent paper reviewed the potential ways that meditation could backfire. Eventually, your sensitivity to every slight change could become overwhelming. The result could be full-on panic attacks, as, indeed, around 14% meditators reported in a Portuguese study.

Other meditators might have the opposite problem. Studies have shown that meditation can increase activity in the dorsolateral prefrontal cortex, for instance, which in turn regulates the limbic system, and the amygdala, another region where emotional salience is processed. In the right amount, prefrontal control over the limbic system can result in better focus and less emotional reactivity, says Britton. But when that’s taken beyond optimal levels, it can blunt all emotions, both negative and positive, so that they no longer feel extreme joy or happiness. In extreme cases, this can result in the unsettling sense of “dissociation” from their life – which affected around 8% of meditators in the Portuguese study.

Through Cheetah House, Britton has heard from many people experiencing this sense of numbness. “We’ve had an overwhelming number of people contacting the lab and saying, ‘I can't feel anything, I don't feel any love for my family. What do I do?’”

Besides these more extreme reactions, Britton has shown that overzealous meditation can even damage sleep. Among people undergoing an eight-week mindfulness course, those who meditated for more than 30 minutes a day, five days a week, tended to have worse sleep quality than those who spent less time in mindful contemplation.

“Similar to attention-enhancing drugs like coffee, Ritalin and cocaine, meditation can increase focus and alertness,” says Britton. “But when taken too far that can lead to anxiety, panic and insomnia, because there is both neuroanatomical and neurochemical overlap between attention and arousal systems in the brain. You can only crank up your attention dial so far before you start feeling anxious or stop sleeping.”

The bigger picture

Still, mindfulness does appear to benefit many people.

“Probably, for the average person, it can help with mental health promotion,” says Julieta Galante at the University of Cambridge, who recently conducted a meta-analysis reviewing the evidence to date. Overall, she found that there was a positive effect, though there was large variation between studies. Like Britton, she thinks that we need more nuance in our understanding of the specific situations in which mindfulness may or may not be useful, alongside a greater investigation of the potential adverse effects.

“We really haven’t even started to unpack this,” says Galante. She notes that most of the studies have only looked at the effects over relatively short time periods, whereas some of the adverse effects may not emerge until much later – which is important to understand, since she points out that the standard advice is to continue meditating every day for the rest of your life. “My concern is that more and more people are practising meditation every day. And maybe it’s all fine during an eight-week course, but what happens then?”

Looking outward?

What can we do if our own mindfulness practice is no longer working as anticipated? Galante’s meta-analysis showed that in many cases, mindfulness was no better for mental health than many other positive interventions, like physical exercise. In which case, the simplest option may be to switch to another activity that is also known to boost your overall wellbeing.

For those who still like the idea of contemplation, it may be time to consider a broader range of techniques. Certain religious traditions encourage practitioners to focus on things outside your body, for instance – such as a bunch of flowers on your desk or even a passage from a poem. These may be better at calming overwhelming feelings of anxiety, or coaxing yourself out of those feelings of dissociation than observing your body or your breathing, says Britton. There’s also a growing interest in meditative techniques that encourage you to think about others’ perspectives and to cultivate feeling of compassion – strategies that are especially effective against feelings of loneliness.

At the moment, some people may feel like they have to stick with one particular strategy – like mindful breathing or the body scan – without considering the alternatives. But this is a mistake, says Britton. “We should really honour the diversity of contemplative practices that are available, because they all do different things, and people would have a much better chance of matching what they need, if they had a bigger buffet of choices.” Each person should choose the best technique – and the correct “dose” – for their particular situation, rather than doggedly pursuing a plan that is not working.

Ultimately, Britton thinks that these issues should be incorporated into all mindfulness courses – in much the same way that the visitors to a gym are taught about the potential for injury. “It comes down to giving meditators a bit more agency.”

And as I discovered myself with my own ill-fated attempts to gain mindfulness, this may sometimes include the decision that enough is enough.