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Track your submitted article. Global Resources for Buddhist Studies. Online Conferences. In some cases, depression became sufficiently severe to result in suicidal ideation. In other cases, intense positive affect did not alternate with low arousal states, but instead escalated into destabilizing conditions resembling mania and psychosis, which often required hospitalization.

Changes in doubt and faith as well as self-conscious emotions guilt, shame, pride, etc. Although typically a secondary response, shame in particular was a large contributor to levels of distress. For practitioners with a trauma history, it was not uncommon for them to report a re-experiencing of traumatic memories , and even practitioners without a trauma history similarly reported an upwelling of emotionally-charged psychological material. Practitioners reported involuntary crying or laughter in response to positive affective content such as bliss or joy, in response to negative affective content like grief or sadness, or in some cases without content altogether.

Other states of negative affect included increased agitation or irritability , which could become intensified to either transient outbursts or long-term expressions of anger and aggression. The somatic domain included observable changes in bodily functioning or physiological processes. The study documented a large number of physiological changes, many of which were infrequently reported across subjects. Dizziness or syncope , gastrointestinal distress , cardiac irregularity , breathing irregularity , fatigue , headaches and sexuality-related changes were all reported by fewer than 20 participants.

A more commonly reported physiological effect was changes in sleep need, amount, or quality, with practitioners tending to report loss of sleep need, decreased sleep amount, or insomnia see also [ ]. Other sleep-related changes included parasomnias such as nightmares and vivid or lucid dreams. Sleep-related changes frequently co-occurred with appetitive changes , especially a decrease in appetite or food intake.

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Thermal changes included both feeling warmer and colder throughout the body, and more localized sensations of heat and cold. One principal set of changes in the somatic category included reports of pressure and tension in the body, or sometimes intense pain , which would become more acute or release in the course of contemplative practice.

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The release of pressure or tension was sometimes associated with positive affect and surges in energy; however, it was also associated with the re-experiencing of traumatic memories and other forms of negative affect. This was the most commonly reported experience in the somatic domain and was associated with a wide range of other somatic changes as well as changes in other domains. For instance, when surges in somatic energy were particularly strong, involuntary body movements sometimes followed. The conative domain primarily denotes changes in motivation or goal-directed behaviors.

This change frequently co-occurred with changes in worldview and changes in the social domain. Another conative change was the reported amount of effort or striving associated with meditation practice. On the one hand, practices that previously required great effort sometimes became effortless, a change generally reported as a positive. The two phenomena practitioners reported as impairing in the conative domain were the lack of desire for activities one previously enjoyed anhedonia and the loss of motivation to pursue goals avolition.

These often co-occurred with other functional impairments, such as changes in social or occupational behaviors. When conative phenomena were described less as changes in and of themselves and more as causal factors for the onset or alleviation of difficulties, they were coded as influencing factors see Influencing factors: Domains and categories.

Given that the sense of self is construed in multiple ways—from fundamental embodied sensorimotor activity to more complex conceptual judgments—various changes in sense of self were differentiated according to data-driven reports and theory-driven perspectives from phenomenology and cognitive science e. Changes in the narrative self refer to shifts in how a practitioner conceives of himself or herself over time, often in relation to the identities, worldviews, values, goals or behaviors both within and beyond their Buddhist tradition.

Other changes in sense of self occurred at more fundamental levels that had a corresponding impact on cognitive, affective, somatic, or perceptual domains. The most common change in sense of self reported by practitioners was a change in self-other or self-world boundaries , which took many related forms.

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Some practitioners reported boundaries dissolving and general permeability with the environment or with other people; others felt like their self had expanded out from their body and merged with the world; still others used the inverse language, reporting that the world had become merged with their sense of self. A range of different affective responses were associated with this change, from neutral curiosity, to bliss and joy, to fear and terror. Loss of sense of ownership was commonly reported in relation to thoughts, emotions, and body sensations.


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Some practitioners reported even more fundamental changes in their sense of self akin to a loss of the sense of basic self [ ] or the minimal self [ ] such that they felt like they no longer existed at all or that they would disappear or be invisible to others. The social domain includes any changes in interpersonal activities or functioning, including level of engagement, quality of relationships, or periods of conflict, isolation or withdrawal. The social domain tends to involve either experiences that catalyzed meditation difficulties or, conversely, were the consequence of meditation difficulties.

Social factors were described as catalysts for difficulties in integration following retreat or intensive practice where transitioning from a practice context whether in daily life or on retreat to a non-practice and often social context were experienced as destabilizing. For example, perceptual, affective, and cognitive changes that were not problems in the practice context became difficulties that were reported as negatively valenced or impairing of functioning at work or with family. Social impairment includes both these instances as well as instances where practice-related difficulties continued into daily life.

This domain also includes changes in occupational functioning , which often requires social interactions. A generally positive but less commonly reported change was an increased sociality , defined as an increased extraversion or valuing of social connections.

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Changes in relationship to meditation community including both teachers and other practitioners included feelings of support and encouragement as well as feelings of estrangement or rejection, often co-occurring with changes in worldview and changes in doubt or faith, especially when challenging meditation experiences resulted in significant distress or functional impairment.

Other aspects of social relationships described as contributing to the onset or resolution of challenging meditation experiences were coded as Influencing Factors under the Relationship domain see Influencing factors: Domains and categories. Causal attribution to meditation was assessed with 11 criteria see above Additional instruments and quantitative measures: Causality assessment.

Prior published reports included more than 40 published reports, including case reports or studies [ 64 , 65 , 67 — 73 , 77 — 79 , 82 , 84 — 86 , — ], reviews of meditation-related risks, adverse effects or contraindications, [ 63 , — ], medical textbooks [ 74 — 76 , ] and MBI implementation guidelines [ 62 ]. Expert judgment was derived from interviews with 32 meditation teachers and clinicians who reported 56 categories of meditation-related experiences that they had observed in their students.

Through the causality assessment section of the demographic and attributes follow-up questionnaire, practitioners reported on six causality criteria: subjective attribution , temporal proximity challenge , exacerbation , consistency , de-challenge , and re-challenge. Table 5 shows the percent of the sample meeting each individual criterion.

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Inter-subjective consistency was assessed through evaluating how many practitioners reported each category see Table 4 above. Each category of experience was reported by an average of 20 practitioners, indicating that the same or a similar experience occurring in temporal proximity to meditation was reported by multiple individuals.

Cross-modal consistency was assessed by comparing the phenomenology reported in practitioner interviews to the phenomenology reported in expert interviews. As reported above, similarities between practitioner and expert reports were not impacted by the 11 participants who provided both practitioner and expert interviews.

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Fig 1 shows the duration of symptoms and their associated impairment. The median duration of symptoms was 1—3 years, ranging from a few days to more than 10 years. Thematic content analysis of both practitioner and expert interviews for influencing factors IF captured the contextual factors that practitioners or experts associated with the onset of meditation-related experiences and the way those experiences changed over time. Twenty-six categories of influencing factors were clustered into 4 higher-order domains.

The average number of influencing factors reported per person was Each category was reported by an average of 35 different practitioners and 19 different experts, indicating high consistency across both practitioners and experts. Table 6 displays the 4 domains of IFs horizontally from left to right.

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The categories of each IF domain are listed vertically in descending order of frequency percent of practitioners reporting [percent of experts reporting]. The following summary aims to clarify how influencing factors were defined and operationalized, which was primarily data-driven from practitioner and expert interviews.

This enumeration of influencing factors should not be taken as a theory or hypothesis about risk factors and remedies for meditation-related difficulties put forth by the authors; rather, it reflects the views and experiences of the practitioners and experts who were subjects in our study. Further analysis, as well as research in controlled conditions, is necessary in order to evaluate whether these influencing factors are in fact correlated with a category of experience, the duration of challenging or difficult experiences, or the associated degree of distress or impairment. For a comprehensive description of each category, including descriptions, inclusion criteria, and exclusion criteria, see S5 File.

This domain captures reported influencing factors occurring at the practitioner level. Medical history , psychological history , and trauma history were reported as having an impact on the presence of particular meditation experiences in somatic, cognitive, and affective domains, respectively, as well as on the duration of meditation-related difficulties.

The interaction between meditation and pre-existing psychiatric or trauma history was a common interpretation and causal attribution put forth by experts for certain meditation-related challenges.