Why Mindfulness and Meditation May Be Harmful For Trauma Survivors

Mindfulness has become the treatment du jour for mental health conditions of all kinds. It has been dubbed as a veritable panacea for curing all that ails us from addiction to chronic illness, to post-traumatic stress disorder (PTSD). But what is mindfulness? The most basic definition according to Oxford Languages is “the quality or state of being conscious or aware of something” and “a mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations, used as a therapeutic technique.” This practice can take numerous forms from conscious methodical deep breathing and deliberate eating to gratitude or feelings journaling and communing with nature. For the purposes of this article, I will focus on meditation, both guided and individual.

• What is PTSD?

Disclaimer: As with virtually every treatment modality that is utilized within the context of psychotherapy, and in particular trauma treatment, every patient is unique and no two patients will respond to any particular treatment the same way. What may work for one individual may not work for another and vice versa. I am mindful (word choice deliberate) that many individuals find meditation not only useful but life-enhancing. I don’t want to discourage anyone from trying any modality that they can to help treat their symptoms, nor do I wish to vilify an entire modality like meditation simply because it can come with some risks.

With that, there has been increasing scrutiny within the medical community as to the safety of meditation for those with a trauma history, and who have been diagnosed with post-traumatic stress disorder. Even proponents of yoga and meditation as integral to mind-body work in trauma treatment like Bessel Van Der Kolk, author of the New York Times bestseller “The Body Keeps The Score,” have noted that due to the fact that those with PTSD don’t experience their trauma as something in the past but rather as something they are experiencing in the present, meditation may not just be impossible but harmful. Patients can become emotionally deregulated, experience flashbacks, dissociate, have increased nightmares, or even develop psychosis.

While there are numerous articles citing these concerns, perhaps the most comprehensive analysis of meditation and its potential dangers was done by researchers from Brown University in 2017. The study carefully followed both practitioners and clients across a myriad of different types of predominantly Buddhist meditative practices, experience levels and lengths of time. The analysis suggests that while many experience positive effects from meditation, an aggregate 45% of experts and practitioners reported reexperiencing of traumatic memories. Other negative outcomes cited included (and I recognize that this list sounds a bit like the side effect list of a really bad pharmaceutical commercial but I digress) delusional/irrational paranormal beliefs, dissolution of perception of sight and sound, derealization, hallucinations, anxiety, panic, paranoia, suicidal ideation, mania, psychosis (sometimes requiring hospitalization), anger/irritability, dizziness, gastrointestinal distress, cardiac irregularities, fatigue, sexual dysfunction, appetite changes, nightmares, involuntary body movements, anhedonia, social impairment, and loss of sense of self… amongst others. That is by no means a comprehensive list but a snippet of the highlights. Additionally, 88% of clients reported that their negative symptoms affected them in their daily lives beyond the context of the meditation experience for anywhere from one to three years to varying degrees of impairment. Preexisting psychiatric or trauma history was noted as one of the primary causes in this analysis and the type, duration, and length of practice did factor into the development of difficulties.

While this is by no means conclusive, it does highlight the potential pitfalls of engaging in meditation for trauma survivors. In my own experience, I have had both positive and negative results from varying types of meditation. I grew up doing yoga and meditation and frequented a yoga summer camp. While some of my experiences were positive, I also had some experiences that left me feeling uneasy about the situation. A small part of me felt like I was being indoctrinated into some kind of a cult. That along with some other more ambiguous spiritual trauma in my childhood have left me skeptical at best and somewhat averse at worst to meditative practices that tend to feel more religious in nature. So I generally avoid those if I can.

I have also engaged in yoga for its physical benefits, particularly as an ex-dancer with a myriad of old injuries. Yoga can be a fantastic low-impact exercise regimen that can help reduce stress, increase flexibility/strength and help me connect with my body in a healthy way. Yet, even with my background as a dancer who has done yoga on and off for the majority of my life, I have gotten triggered in yoga classes by certain poses which caused me distress and subsequent flashbacks to my sexual abuse. And I often find that at the end of class when we lie down for “shavasana,” which is the meditative portion of a yoga class, I cannot quiet my mind. It races uncontrollably and the more I try to regulate my breath, the more I feel like I’m hyperventilating. It doesn’t happen every time, but it has happened where I felt lightheaded and like I was going to pass out or throw up. Anecdotally, I have discussed the challenges of doing yoga and meditation with other sexual abuse survivors who have had similar experiences with being triggered or otherwise retraumatized in session.

I’d say the key is not necessarily avoiding meditation per se, but rather beginning a meditative practice with the presence of a trauma-informed practitioner who can monitor you during your practice to ensure that you are safe, remaining calm, and are not in any way dissociating or experiencing a trauma response. For me, it was helpful to have my therapist do a guided meditation in her office. We started with a shorter exercise lasting about 10 minutes the first time and then did a kind of debriefing where I was able to identify what I was thinking, feeling in my body, and noted any red flags or concerns. The next week we recorded a slightly longer one and then did the same type of debriefing. I was instructed to try it at home but to stop immediately if I began feeling dysregulated in any way. The first time I did it alone, I did feel a bit triggered so I stopped. We discussed what changes we could make to help ground me better in the practice. Once I did that, I was able to successfully complete a session on my own. 

With that said, even though I have the guided meditation recorded on my phone with her voice (and I find the sound of her voice calming and soothing), I don’t do them very often. I don’t find the meditative practice to be a magical cure for some of my more persistent PTSD symptoms including ongoing nightmares and hyperarousal at night, anxiety, and dissociation, so I only use the recordings when I’m having a panic attack and need to hear a familiar safe voice. For my ongoing trauma symptoms, however, we have moved on to other modalities to try to address these more effectively. But… I do continue utilizing other mindfulness techniques that do not involve meditation, particularly physical activity, journaling, and deep conscious methodical breathing, which I find especially helpful at night when I wake up from a nightmare and my heart rate is elevated.

If you are a trauma survivor inclined to investigate meditation, start slowly, gently, observantly, and most importantly don’t go it alone. If it’s not working for you, know that you aren’t doing it wrong and there’s not something amiss just because you aren’t benefiting from it. It’s quite a common and well-documented phenomenon that I wish mental health and wellness practitioners were more aware of and cautious of before recommending meditation as a cure-all for everyone. By not informing trauma survivors of potential negative consequences, clinicians are not only doing their patients a disservice, but they also may be putting them directly in harm’s way which is irresponsible and unethical.