Influencing Factors

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.

Practitioner IFs.  This domain captures reported influencing factors occurring at the practitioner level.  The identities category refers to demographic variables such as gender, age, ethnicity, religion, and so forth when these were reported as having an impact on a practitioner’s meditation experience or degree of social support received by a meditation community.  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.  Personality characteristics and temperaments were identified as being potentially either a risk factor or a remedy, depending on the particular characteristics mentioned. Experts often explained certain difficulties as due to the way meditation practices are thought to affect personality structures. Similarly, certain intentions, motivations, and goals, as well as certain worldviews and explanatory frameworks were characterized as helpful and supportive of contemplative development, whereas others were attributed as being harmful and as intersecting with other risk factors in the practice domain. Worldviews and explanatory frameworks were also influencing factors in that certain interpretations of the meaning of meditation-related difficulties could lead to further difficulties or the alleviation of certain dimensions of difficulties. Practitioners who reported holding or being offered multiple, conflicting worldviews were particularly likely to report on the influential—and often confusing—role of such interpretive frameworks.

Practice IFs. Practice-level influencing factors pertain to how a practitioner engaged in a particular contemplative practice.  The amount, intensity, or consistency of practice was identified as a risk factor when intensive periods converged with certain practitioner-level influencing factors such as personality or other practice-level factors such as type of practice; however, experts in particular also promoted consistency of practice as a remedy for meditation difficulties expected to be transient in nature.  Practice approach referred to incorrect ways of practicing meditation that were characterized as risk factors as well as the use of correct methods posited as remedies.  A related category called response to experience referred to how practitioners either did or should respond to meditation-related changes that endure beyond the formal practice session.  Type of practice could be identified as a risk factor for particular meditation experiences simply due to the nature of the practice, or due to a mismatch between type of practice and practitioner dispositions.  Changing type of practice or complementing one practice with another was offered as a potential remedy for the latter type of difficulties.  Certain difficulties were interpreted, especially by experts, as a necessary stage of practice, only to be resolved by passing through the stage signified by specific meditation-related experiences or by integrating stage-related changes into one’s experience.  An assumption articulated in this context was that subsequent stages of practice could or would resolve challenging or difficult meditation-related experiences.

Relationship IFs. Relationships pervade the life and context of practitioners, ranging from the impact of their early life family relationships, to the quality of relationships with meditation teachers and communities, to the amount of social support outside of the context of meditation. Some early life relationships were associated with practitioner-level psychiatric or trauma history; conversely, supportive early life relationships also were described as having an impact on personality traits.  Relationships within meditation communities and especially to relationships to teachers were reported as being both risk factors for difficulties when teachers and communities were absent, unhelpful, or not sympathetic, as well as being remedies if teachers and communities were supportive, helpful and understanding. Experts also often commented on the importance of healthy dynamics in the student-teacher relationship for the student’s negotiation of meditation-related difficulties.  Relationships beyond the meditation community also had a range of impacts—from risk factor to remedy—depending on whether or not those relationships were stable or supportive. The practice surroundings or environment, especially in a retreat context of silence and social isolation, was commonly described as a risk factor, such that changes in environment were necessary for alleviating certain challenges that emerged during retreat.  So too, changes from a retreat context to certain destabilizing or challenging environments were also reported as risk factors for social and occupational difficulties in particular.  Another prevalent theme was practitioners’ perceived degree of compatibility between the worldviews, values, and goals shaped by meditation experiences and meditation teachings and the broader sociocultural context they inhabited.  When there was compatibility and fit, sociocultural contexts could be part of a remedy.  However, experts and practitioners alike also suggested that certain sociocultural contexts could be risk factors, particularly when there was a mismatch between a practitioner’s and a teacher’s cultural background and social customs. Another interpretation offered was that mismatches between practitioners’ meditation experiences and worldviews and values of their sociocultural context could create a tension that would lead to or compounded difficulties. 

Health behavior IFs. Health behaviors were generally categorized as potential risk factors when absent or out of balance and as remedies when present or in balance. For example, lack of sleep, inadequate diet, and lack of exercise tended to be associated with (or preceded) destabilizing experiences, and could be corrected as remedies by increasing sleep amount, dietary changes, or exercise, as well as by engaging in other activities described as grounding, calming, or embodying.  Recreational drugs were sometimes cited as risk factors for certain experiences, although prior drug-related experiences were also reported as a helpful foundation to have for negotiating certain types of destabilizing meditation-related experiences.  Drug use was also occasionally reported as an attempt to alleviate meditation difficulties, with mixed results.  More commonly cited as helpful was a regimen of medication, especially for severe meditation-related difficulties requiring other intensive treatments and hospitalization.  Other remedies included psychotherapy or medical treatment, and experts in particular interpreted certain meditation difficulties as requiring the temporary suspension of meditation practice in order to address them psychotherapeutically.  For certain symptoms in the somatic domain, body-based healing regimens (such as massage, acupuncture, or healing techniques that manipulate the subtle “energy” of the body) were also attempted and reported as helpful by some but not others

As with phenomenology, the degree to which certain influencing factors or remedies were appraised as helpful or harmful was highly variable and case specific. While some remedies were enthusiastically endorsed, many of the remedies that were attempted or prescribed by others were described by practitioners as ineffective or harmful.

Excerpt from:

Lindahl JR, Fisher NE, Cooper DJ, Rosen RK, 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.