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Cited by 267Mindfulness and Compassion InterventionsPsychological Well-being and Life SatisfactionReligion, Spirituality, and Psychology

Can mindfulness be too much of a good thing? The value of a middle way

Open access
Britton, Willoughby B·2019·Current Opinion in Psychology
DOI 10.1016/j.copsyc.2018.12.011PMC PMC6612475

Published version of a preprint

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Abstract

Previous research has found that very few, if any, psychological or physiological processes are universally beneficial. Instead, positive phenomena tend to follow a non-monotonic or inverted U-shaped trajectory where their typically positive effects eventually turn negative. This review investigates mindfulness-related processes for signs of non-monotonicity. A number of mindfulness-related processes-including, mindful attention (observing awareness, interoception), mindfulness qualities, mindful emotion regulation (prefrontal control, decentering, exposure, acceptance), and meditation practice-show signs of non-monotonicity, boundary conditions, or negative effects under certain conditions. A research agenda that investigates the possibility of mindfulness as non-monotonic may be able to provide an explanatory framework for the mix of positive, null, and negative effects that could maximize the efficacy of mindfulness-based interventions.

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Crossref · 10.1016/j.copsyc.2018.12.011

Cites

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Claims the paper makes

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  • Premisecitation

    High levels of self-focused attention are associated with psychopathology and negative affect.

    “However, high levels of self-focused attention have also been found to be associated with psychopathology and negative affect [14,15].”
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    • cites [14] Ingram RE: Self-focused attention in clinical disorders: review and a conceptual model. Psychol Bull 1990, 107: 156– 176. 2181521 source

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    • cites [15] Mor N, Winquist J: Self-focused attention and negative affect: a meta-analysis. Psychol Bull 2002, 128: 638– 662. 12081086 source

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  • Premisecitation

    Mindfulness-related increases in body awareness are associated with greater wellbeing for chronic pain patients who tend to avoid their bodies.

    “In support of this hypothesis, mindfulness-related increases in body awareness are associated with greater wellbeing for chronic pain patients who tend to avoid their bodies [19].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] de Jong M, Lazar SW, Hug K, Mehling WE, Holzel BK, Sack AT, Peeters F, Ashih H, Mischoulon D, Gard T: Effects of Mindfulness-Based Cognitive Therapy on Body Awareness in Patients with Chronic Pain and Comorbid Depression. Front Psychol 2016, 7: 967. 27445929 PMC4927571 source

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  • Premisecitation

    The correlation between observing awareness and negative outcomes is reduced when observing awareness is correlated with non-judgment and non-reactivity.

    “However, a few studies have suggested that the correlation between observing awareness and negative outcomes is reduced when observing awareness is correlated with non-judgment and non-reactivity, qualities that are often (but not always) considered essential dimensions of mindfulness [8,16].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [8] Sahdra B, Ciarrochi J, Parker P, Basarkod G, Bradshaw E, Baer R: Are people mindful in different ways? Disentangling the quantity and quality of mindfulness in latent profiles and exploring their lnks to mental health and life effectiveness. European Journal of Personality 2017, 31: 347– 365. source

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    • cites [16] Eisenlohr-Moul TA, Walsh EC, Charnigo RJ Jr., Lynam DR, Baer RA: The “what” and the “how” of dispositional mindfulness: using interactions among subscales of the five-facet mindfulness questionnaire to understand its relation to substance use. Assessment 2012, 19: 276– 286. 22589412 PMC3715554 source

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  • Premisecitation

    Intentionally directing attention to present-moment experience is associated with many positive outcomes.

    “Intentionally directing attention to one’s present-moment experience—a central aspect of mindfulness—has been associated with many positive outcomes [4].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] Brown KW, Ryan RM: The benefits of being present: mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology 2003, 84: 822– 848. 12703651 source

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  • Premisecitation

    The inverted U-shaped or non-monotonic relationship between psychological or physiological processes and wellbeing or performance may be fundamental and ubiquitous, representing a meta-theoretical principle.

    “accumulating evidence across multiple disciplines suggests that the inverted U-shaped curve or non-monotonic relationship between psychological or physiological processes and wellbeing or performance may be so “fundamental and ubiquitous” [1] as to represent a “meta-theoretical principle” [3].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1] Grant AM, Schwartz B: Too Much of a Good Thing: The Challenge and Opportunity of the Inverted U. Perspect Psychol Sci 2011, 6: 61– 76. 26162116 source

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    • cites [3] Pierce J, Aguinis H: The too-much-of-a-good-thing effect in management. Journal of Management 2013, 39: 313– 338.

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    Premisecitation

    High levels of the observing awareness facet of mindfulness are associated with worse mental health, including increased depression, anxiety, dissociation, and substance abuse, and decreased ability to tolerate pain.

    “Indeed, high levels of the observing awareness facet of mindfulness have been repeatedly found to be associated with worse mental health, including increased depression, anxiety, dissociation, and substance abuse [8,16] and decreased ability to tolerate pain [17].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [8] Sahdra B, Ciarrochi J, Parker P, Basarkod G, Bradshaw E, Baer R: Are people mindful in different ways? Disentangling the quantity and quality of mindfulness in latent profiles and exploring their lnks to mental health and life effectiveness. European Journal of Personality 2017, 31: 347– 365. source

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    • cites [16] Eisenlohr-Moul TA, Walsh EC, Charnigo RJ Jr., Lynam DR, Baer RA: The “what” and the “how” of dispositional mindfulness: using interactions among subscales of the five-facet mindfulness questionnaire to understand its relation to substance use. Assessment 2012, 19: 276– 286. 22589412 PMC3715554 source

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    • cites [17] Evans DR, Eisenlohr-Moul TA, Button DF, Baer RA, Segerstrom SC: Self-Regulatory Deficits Associated with Unpracticed Mindfulness Strategies for Coping with Acute Pain. J Appl Soc Psychol 2014, 44: 23– 30. 25843972 PMC4383260 source

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    Premisecitation

    Increases in the size and activation of the insular cortex result from both short and long-term meditation training and correlate with the amount of practice.

    “Increases in the size and activation of the insular cortex have been found to result from both short and long-term meditation training, and correlate with the amount of practice [20–22].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [20] Fox KC, Nijeboer S, Dixon ML, Floman JL, Ellamil M, Rumak SP, Sedlmeier P, Christoff K: Is meditation associated with altered brain structure? A systematic review and meta-analysis of morphometric neuroimaging in meditation practitioners. Neurosci Biobehav Rev 2014, 43: 48– 73. 24705269 source

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    • cites [21] Fox KC, Dixon ML, Nijeboer S, Girn M, Floman JL, Lifshitz M, Ellamil M, Sedlmeier P, Christoff K: Functional neuroanatomy of meditation: A review and meta-analysis of 78 functional neuroimaging investigations. Neurosci Biobehav Rev 2016, 65: 208– 228. 27032724 source

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    • cites [22] Gotink RA, Meijboom R, Vernooij MW, Smits M, Hunink MG: 8-week Mindfulness Based Stress Reduction induces brain changes similar to traditional long-term meditation practice -A systematic review. Brain Cogn 2016, 108: 32– 41. 27429096 source

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  • Probably not a substantial claim: may not pass S1 (asserted). May combine two claims.

    Premisecitation

    Grant and Schwartz hypothesized that mindfulness is likely to have non-monotonic effects and recommended studying its boundary conditions more carefully.

    “In concluding “there is no such thing as an unmitigated good,” Grant and Schwartz [1] hypothesize that mindfulness is also likely to have non-monotonic effects and recommend that researchers study its boundary conditions more carefully.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Grant AM, Schwartz B: Too Much of a Good Thing: The Challenge and Opportunity of the Inverted U. Perspect Psychol Sci 2011, 6: 61– 76. 26162116 source

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    Premisecitation

    Even virtues and positive traits such as curiosity and optimism are non-monotonic, having an optimum level above or below which returns are minimal or effects undesirable.

    “Grant and Schwartz [1] demonstrate that even virtues and positive traits like curiosity and optimism are non-monotonic; they have an optimum level above or below which are minimal returns or undesirable effects.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Grant AM, Schwartz B: Too Much of a Good Thing: The Challenge and Opportunity of the Inverted U. Perspect Psychol Sci 2011, 6: 61– 76. 26162116 source

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    Premisecitation

    Long-term meditators have poorer sleep than non-meditators, with cortical arousal linearly correlated with lifetime meditation practice amount.

    “Long-term meditators have also been found to have poorer sleep than non-meditators, with cortical arousal that is linearly correlated with lifetime meditation practice amount [52].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [52] Ferrarelli F, Smith R, Dentico D, Riedner BA, Zennig C, Benca RM, Lutz A, Davidson RJ, Tononi G: Experienced mindfulness meditators exhibit higher parietal-occipital EEG gamma activity during NREM sleep. PLoS One 2013, 8: e73417. 24015304 PMC3756031 source

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    Interpretationcitation

    High levels of a specific MRP may produce negative effects on its own, but can be counterbalanced by supplementing with other MRPs.

    “High levels of a specific MRP may produce negative effects on its own, but can be counterbalanced by supplementing with other MRPs.”
    Quote in the paperSubstantial claim

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    Premisecitation

    Avoidant individuals benefit from exposure (attending to threat), while those with bias toward threat benefit most from cognitive bias modification (training attention away from threat).

    “Avoidant individuals have been shown to benefit from exposure (attending to threat), while those with bias toward threat benefit most from cognitive bias modification (CBM), or training attention away from threat [41,42].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [41] Barry TJ, Vervliet B, Hermans D: An integrative review of attention biases and their contribution to treatment for anxiety disorders. Front Psychol 2015, 6: 968. 26217284 PMC4495309 source

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    • cites [42] McNally RJ: Attentional bias for threat: Crisis or opportunity? Clin Psychol Rev 2018. 29853421

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  • Probably not a substantial claim: may not pass S1 (asserted).

    Premisecitation

    Mindfulness training recruits the inferior parietal lobe's dissociative functions (out-of-body experiences and depersonalization) to create mindfulness's detached or objective mode of self-focus.

    “Farb et al. [39] hypothesizes that mindfulness training recruits the IPL’s dissociative functions (out-of-body experiences and depersonalization) to create mindfulness’s “detached or objective mode of self-focus” or the ability to switch from a 1st to 3rd person perspective.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Farb NA, Segal ZV, Mayberg H, Bean J, McKeon D, Fatima Z, Anderson AK: Attending to the present: mindfulness meditation reveals distinct neural modes of self-reference. Soc Cogn Affect Neurosci 2007, 2: 313– 322. 18985137 PMC2566754 source

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    Premisecitation

    Re-appraising or accepting a situation can ease distress when there are no other options, but failing to take corrective action in a situation one could have changed can cause depression.

    “For example, re-appraising or accepting a situation can ease distress when there are no other options, but failing to take corrective action in a situation one could have changed can cause depression [47].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [47] Troy AS, Shallcross AJ, Mauss IB: A person-by-situation approach to emotion regulation: cognitive reappraisal can either help or hurt, depending on the context. Psychol Sci 2013, 24: 2505– 2514. 24145331 source

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    Premisecitation

    Anxiety and other disorders can be caused and maintained not only by attentional bias away from threat but also by attentional bias toward threat.

    “However, anxiety and other disorders can be caused and maintained not only by attentional bias away from (avoidance of) threat, but also by attentional bias toward threat [41,42].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [41] Barry TJ, Vervliet B, Hermans D: An integrative review of attention biases and their contribution to treatment for anxiety disorders. Front Psychol 2015, 6: 968. 26217284 PMC4495309 source

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    • cites [42] McNally RJ: Attentional bias for threat: Crisis or opportunity? Clin Psychol Rev 2018. 29853421

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    Premisecitation

    Exposure theory predicts and has verified that those who benefit most reduce high levels of experiential avoidance by deliberately attending to threat.

    “Drawing from empirical evidence that many disorders are caused and maintained by high levels of experiential avoidance, exposure theory predicts and has verified that those who benefit the most reduce high levels of experiential avoidance by deliberately attending to threat [41].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] Barry TJ, Vervliet B, Hermans D: An integrative review of attention biases and their contribution to treatment for anxiety disorders. Front Psychol 2015, 6: 968. 26217284 PMC4495309 source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Present-moment awareness constitutes the "what" of mindfulness, while mindfulness qualities constitute the "how".

    “While present-moment awareness may constitute the “what” of mindfulness, mindfulness qualities constitute the “how” [16] by balancing that awareness with qualities of nonjudgment, acceptance, curiosity, open-mindedness, optimism, self-efficacy, courage, trust, patience, persistence, kindness, empathy, generosity, gratitude, social intelligence, freedom, autonomy and choice.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Eisenlohr-Moul TA, Walsh EC, Charnigo RJ Jr., Lynam DR, Baer RA: The “what” and the “how” of dispositional mindfulness: using interactions among subscales of the five-facet mindfulness questionnaire to understand its relation to substance use. Assessment 2012, 19: 276– 286. 22589412 PMC3715554 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Mindfulness qualities are attitudinal factors considered an essential foundation for mindfulness practice.

    “Mindfulness qualities are attitudinal factors that are considered an essential foundation for mindfulness practice [31].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Kabat-Zinn J: Full catastrophe living Using the wisdom of your body and mind to face stress, pain, and illness: Delta; 1990.

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    Premisecitation

    Decentering is the ability to step back or have psychological distance from one's experience, especially thoughts and emotions.

    “An essential part of mindful emotion regulation is decentering—the ability to “step back” or to have psychological distance from instead of fusion with one’s experience, especially one’s thought and emotions [13,37].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [13] Holzel BK, Lazar SW, Gard T, Schuman-Olivier Z, Vago DR, Ott U: How Does Mindfulness Meditation Work? Proposing Mechanisms of Action From a Conceptual and Neural Perspective. Perspect Psychol Sci 2011, 6: 537– 559. 26168376 source

      Not checked in the free run.

    • cites [37] Crane RS, Brewer J, Feldman C, Kabat-Zinn J, Santorelli S, Williams JM, Kuyken W: What defines mindfulness-based programs? The warp and the weft. Psychol Med 2017, 47: 990– 999. 28031068 source

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  • May combine two claims.

    Premisecitation

    Low practice amounts in MBCT participants increased sleep duration, but as practice amount approached 30 minutes per day, sleep duration and depth began to decrease and cortical arousal began to increase.

    “Low practice amounts in MBCT participants increased sleep duration, but as practice amount approached 30 minutes per day, sleep duration and depth began to decrease and cortical arousal (awakenings and microarousals) began to increase.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [50] Britton WB, Lindahl JR, Cahn BR, Davis JH, Goldman RE: Awakening is not a metaphor: the effects of Buddhist meditation practices on basic wakefulness. Ann N Y Acad Sci 2014, 1307: 64– 81. 24372471 PMC4054695 source

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    • cites [51] Britton WB, Haynes PL, Fridel KW, Bootzin RR: Polysomnographic and subjective profiles of sleep continuity before and after mindfulness-based cognitive therapy in partially remitted depression. Psychosom Med 2010, 72: 539– 548. 20467003 source

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  • May combine two claims.

    Premisecitation

    All usually beneficial mindfulness qualities are non-monotonic, or can have undesirable costs in certain situations, for certain people, or when taken too far.

    “While it’s hard to imagine ever having too much of any of these qualities, Grant and Schwartz [1] demonstrate that all of these usually beneficial qualities are non-monotonic, or can have undesirable costs in certain situations, for certain people or when taken too far.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Grant AM, Schwartz B: Too Much of a Good Thing: The Challenge and Opportunity of the Inverted U. Perspect Psychol Sci 2011, 6: 61– 76. 26162116 source

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    Interpretationreasoning

    The non-monotonicity model predicts that positive effects are most likely in practitioners with low baseline levels (deficits) in MRPs, while negative effects are most likely in those with high baseline levels of MRPs.

    “The non-monotonicity model also predicts that both positive and negative effects will be more likely to occur in practitioners with particular baseline conditions: Positive effects would be most likely to occur in those with low levels (deficits) in MRPs, while negative effects would be most likely to occur in those with high baseline levels of MRPs.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Mindfulness is thought to exert transdiagnostic benefits by facilitating extinction of distress in response to strong emotions, leading to reduced emotional avoidance and disorder symptoms.

    “By intentionally and consistently using an “approach orientation” [37], “turning towards the difficult,” and experiencing one’s negative emotions fully, mindfulness is thought to exert transdiagnostic benefits by “facilitating extinction of distress in response to strong emotions, leading to reduced emotional avoidance and, consequently, disorder symptoms” [40].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] Brake CA, Sauer-Zavala S, Boswell JF, Gallagher MW, Farchione TJ, Barlow DH: Mindfulness-Based Exposure Strategies as a Transdiagnostic Mechanism of Change: An Exploratory Alternating Treatment Design. Behav Ther 2016, 47: 225– 238. 26956654 PMC8177505 source

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  • May combine two claims.

    Interpretationreasoning

    The non-monotonic model predicts that negative effects could occur with correct practice and would be more likely at higher doses of practice or MRP.

    “This model would predict that negative effects could occur with correct practice, and would be more likely at higher doses of practice or MRP.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Mindfulness training increases prefrontal control over the limbic system and amygdala, which is associated with improved emotion regulation, anxiety, depression, and emotional reactivity.

    “Mindfulness training has been found to increase prefrontal control over the limbic system and amygdala, which is associated with improved emotion regulation, anxiety, depression and emotional reactivity [22,32].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [22] Gotink RA, Meijboom R, Vernooij MW, Smits M, Hunink MG: 8-week Mindfulness Based Stress Reduction induces brain changes similar to traditional long-term meditation practice -A systematic review. Brain Cogn 2016, 108: 32– 41. 27429096 source

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    • cites [32] Tang YY, Holzel BK, Posner MI: The neuroscience of mindfulness meditation. Nat Rev Neurosci 2015, 16: 213– 225. 25783612 source

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  • May combine two claims.

    Premisecitation

    Mindful emotion regulation seeks to increase adaptive approach-related strategies like acceptance and reappraisal, and seeks to decrease maladaptive, avoidant strategies like distraction and suppression.

    “Mindful emotion regulation seeks to increase adaptive approach-related strategies like acceptance and reappraisal, and seeks to decrease maladaptive, avoidant strategies like distraction and suppression [13,37].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [13] Holzel BK, Lazar SW, Gard T, Schuman-Olivier Z, Vago DR, Ott U: How Does Mindfulness Meditation Work? Proposing Mechanisms of Action From a Conceptual and Neural Perspective. Perspect Psychol Sci 2011, 6: 537– 559. 26168376 source

      Not checked in the free run.

    • cites [37] Crane RS, Brewer J, Feldman C, Kabat-Zinn J, Santorelli S, Williams JM, Kuyken W: What defines mindfulness-based programs? The warp and the weft. Psychol Med 2017, 47: 990– 999. 28031068 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The benefits and/or harms of exposure depend on the initial baseline level of the targeted problem (bias toward or away from threat), and can become ineffective or iatrogenic when applied to people with levels different than the targeted one.

    “Thus, the benefits and/or harms of exposure depend on the initial baseline level of the targeted problem (bias toward or away from threat), and can become either ineffective or iatrogenic when applied to people with levels different than the targeted one [29].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [29] Treleaven DA: Trauma-Sensitive Mindfulness: Practices for safe and transformative healing New York: Norton; 2018.

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    Premisecitation

    Treating any one emotion regulation strategy as either consistently adaptive or maladaptive has been called "the fallacy of uniform efficacy".

    “However, treating any one strategy as either consistently adaptive or maladaptive has been called “the fallacy of uniform efficacy” [45].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [45] Bonanno GA, Burton CL: Regulatory Flexibility: An Individual Differences Perspective on Coping and Emotion Regulation. Perspect Psychol Sci 2013, 8: 591– 612. 26173226 source

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    Premisecitation

    Depending on the context and the person, favored strategies like acceptance and reappraisal may be superior, inferior, or equal to disfavored strategies like suppression and distraction, and are sometimes associated with adverse effects.

    “Depending on the context and the person, favored strategies like acceptance and reappraisal may be superior, inferior, or equal to disfavored strategies like suppression and distraction [46] and are sometimes associated with adverse effects [47,48].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [46] Kohl A, Rief W, Glombiewski JA: How effective are acceptance strategies? A meta-analytic review of experimental results. J Behav Ther Exp Psychiatry 2012, 43: 988– 1001. 22561050 source

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    • cites [47] Troy AS, Shallcross AJ, Mauss IB: A person-by-situation approach to emotion regulation: cognitive reappraisal can either help or hurt, depending on the context. Psychol Sci 2013, 24: 2505– 2514. 24145331 source

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    • cites [48] Dunn BD, Billotti D, Murphy V, Dalgleish T: The consequences of effortful emotion regulation when processing distressing material: a comparison of suppression and acceptance. Behav Res Ther 2009, 47: 761– 773. 19559401 PMC2764381 source

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    Premisecitation

    Most MBI studies use data only from treatment completers and lack data from long-term follow-ups and dropouts-the groups most likely to have negative effects.

    “Most MBI studies use data only from the treatment completers and lack data from long-term follow-ups and dropouts—the groups most likely to have negative effects [56,60].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [56] Coronado-Montoya S, Levis AW, Kwakkenbos L, Steele RJ, Turner EH, Thombs BD: Reporting of Positive Results in Randomized Controlled Trials of Mindfulness-Based Mental Health Interventions. PLoS One 2016, 11: e0153220. 27058355 PMC4825994 This review of mindfulness-based intervention RCTs found that nearly 90% of the trials reviewed reported positive results in favor of mindfulness, which the authors concluded is suggestive of reporting bias. Only 25% of studies that found negative results reported them in a straightforward way. Instead, 75% of studies “spun” negative findings to appear equivoc source

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    • cites [60] Ioannidis JP, Evans SJ, Gotzsche PC, O’Neill RT, Altman DG, Schulz K, Moher D: Better reporting of harms in randomized trials: an extension of the CONSORT statement. Ann Intern Med 2004, 141: 781– 788. 15545678 source

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    Premisecitation

    Very few MBI trials actively measure adverse effects, relying instead on passive monitoring, which can underestimate the actual frequency by more than 20-fold.

    “In addition, very few MBI trials actively measure adverse effects [58], relying instead on passive monitoring, which can underestimate the actual frequency by more than 20-fold [59,60].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [58] Wong S, Chan J, Zhang D, Lee E, Tsoi K: The Safety of Mindfulness-Based Interventions: a Systematic Review of Randomized Controlled Trials. Mindfulness 2018. In a review of 231 RCTs of mindfulness-based interventions (MBSR or MBCT), the vast majority (84.4%) did not contain any information about measuring or monitoring adverse effects. In the remaining 15.6%, fewer adverse effects in the MBI arm were more likely to be reported when MBIs failed to outperformed controls, or when authors reported conflicts of interest. Current MBI trial harms reporting is not adequate to produce an accurate estim source

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    • cites [59] Bent S, Padula A, Avins AL: Brief communication: Better ways to question patients about adverse medical events: a randomized, controlled trial. Ann Intern Med 2006, 144: 257– 261. 16490911 source

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    • cites [60] Ioannidis JP, Evans SJ, Gotzsche PC, O’Neill RT, Altman DG, Schulz K, Moher D: Better reporting of harms in randomized trials: an extension of the CONSORT statement. Ann Intern Med 2004, 141: 781– 788. 15545678 source

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  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Mindfulness researchers and program developers have recognized that reversal of deficiencies in MRPs enhances wellbeing, but have paid less attention to how excesses in these processes could also undermine wellbeing.

    “Mindfulness researchers and program developers have recognized that reversal of deficiencies in MRPs enhance wellbeing, but have paid less attention to how excesses in these processes could also undermine wellbeing.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Null and negative effects signify boundary condition violations or inflection points, and provide information about optimal versus ineffective or harmful doses of MRPs under different conditions or for different people.

    “The framework values null and negative effects because they signify boundary condition violations or inflection points. These are important because they provide otherwise unavailable information about optimal versus ineffective or harmful doses of MRPs under different conditions or for different people.”
    Quote in the paperSubstantial claim

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    Premisecitation

    Mindfulness studies tend to over-represent positive results, while negative findings are either not published or obscured by post-hoc subgroup analyses or creative reinterpretations.

    “Mindfulness studies tend to over-represent positive results, while negative findings are either not published or obscured by post-hoc subgroup analyses or creative reinterpretations [55–57].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [55] Dimidjian S, Segal ZV: Prospects for a clinical science of mindfulness-based intervention. Am Psychol 2015, 70: 593– 620. 26436311 PMC5853107 source

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    • cites [56] Coronado-Montoya S, Levis AW, Kwakkenbos L, Steele RJ, Turner EH, Thombs BD: Reporting of Positive Results in Randomized Controlled Trials of Mindfulness-Based Mental Health Interventions. PLoS One 2016, 11: e0153220. 27058355 PMC4825994 This review of mindfulness-based intervention RCTs found that nearly 90% of the trials reviewed reported positive results in favor of mindfulness, which the authors concluded is suggestive of reporting bias. Only 25% of studies that found negative results reported them in a straightforward way. Instead, 75% of studies “spun” negative findings to appear equivoc source

      Not checked in the free run.

    • cites [57] Morone NE, Moore CG, Greco CM: Characteristics of Adults Who Used Mindfulness Meditation: United States, 2012. J Altern Complement Med 2017, 23: 545– 550. 28084788 Querying more than 100,000 adults as part of the 2012 U.S. National Health survey, this study represents the largest cross-sectional study to date that compares mindfulness meditators to non-meditators. The study found that mindfulness meditators had worse physical and mental health than non-meditators, including higher levels of pain, headaches, stress, depression, anxiety, insomnia and acute illness. Although cross-sectional studi source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Expert meditators with mental health issues are typically excluded from research, resulting in a selective representation of the effects from long-term practice.

    “Expert meditators with mental health issues are typically excluded from research, resulting in a selective representation of the effects from long-term practice [52].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [52] Ferrarelli F, Smith R, Dentico D, Riedner BA, Zennig C, Benca RM, Lutz A, Davidson RJ, Tononi G: Experienced mindfulness meditators exhibit higher parietal-occipital EEG gamma activity during NREM sleep. PLoS One 2013, 8: e73417. 24015304 PMC3756031 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Because the MAAS measures mindfulness in the deficiency-reversal phase but not the excess phase of the inverted U-shaped curve, it is more likely to be highly and linearly associated with gains in wellbeing or functioning and show few negative effects.

    “Because it is measuring mindfulness in the deficiency-reversal phase (Figure 1, Panel 1), but not in the excess phase of the inverted U-shaped curve, it is more likely to be highly and linearly associated with gains in wellbeing or functioning and show few negative effects.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    A non-monotonic framework will help maximize effectiveness and minimize harms in mindfulness-based applications by providing a model that can chart a middle way between "not enough" and "too much of a good thing."

    “A non-monotonic framework will help to maximize effectiveness and minimize harms in mindfulness-based applications by providing a model that can chart a “middle way” between “not enough” and “too much of a good thing.””
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    The field of mindfulness has been primarily focused on the upward slope of the inverted U-shaped curve, with insufficient attention to the downward slope.

    “In other words, the field of mindfulness has been primarily focused on the upward slope of the inverted U-shaped curve, with insufficient attention to the downward slope of the curve.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    A mindfulness research agenda that employs a non-monotonic framework may be better positioned to make sense of positive, null, and contradictory findings, differential outcomes for different subgroups, and negative effects.

    “A mindfulness research agenda that employs a non-monotonic framework—one that includes the entirety of the inverted U-shaped curve—may be better positioned to make sense of positive, null, and contradictory findings, differential outcomes for different subgroups, and negative effects.”
    Quote in the paperNot a substantial claim
34 of 34

  • The paper relies on this without support.

    Mindfulness-related programs and products are popular and rapidly proliferating.

    “Given the popularity and rapid proliferation of mindfulness-related programs and products, the investigation of optimal levels of mindfulness— which also entails identifying its boundary conditions and negative effects—would benefit not only the end-users, but also researchers, program developers and providers.”

  • The paper relies on this without support.

    Negative effects observed in meditation studies are caused by the mindfulness-related processes themselves rather than by confounding factors.

    “and all of these effects have been reported in the context of mindfulness meditation training [7,9,11,12,28,29].”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Lomas, 2014, A qualitative summary of experiential challenges associated with meditation practice, Mindfulness, 1

Cited by

Sorted by citations

Related

Authors
Britton, W. B.
Affiliations
Brown University (US)
Corresponding author
Britton, Willoughby B
ORCID
Britton, Willoughby B
Venue
Current Opinion in Psychology
Publisher
Elsevier BV
Published
2019-08
Volume
28
Pages
159-165
ISSN
2352-250X (ISSN-L)
DOI
10.1016/j.copsyc.2018.12.011
PMC
PMC6612475
OpenAlex
W2910579481
Semantic Scholar
9bb1b1d9b7c875f59bee971ecae7ef24926faa59
Cited by
267
References
63
Citations by year
2026: 33 · 2025: 56 · 2024: 37 · 2023: 52 · 2022: 37 · 2021: 36 · 2020: 13 · 2019: 3
FWCI
3.52
Type
journal article
Language
en
Open access
Licence
Locations
  • Current Opinion in Psychology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • MindRxiv (OSF Preprints) (submittedVersion, cc-by)
  • MindRxiv (OSF Preprints) (submittedVersion)
Funders
  • National Institutes of Health (K23-AT006328-01A1)
  • National Center for Complementary and Integrative Health (UH2AT009145)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Psychology › Social Psychology › Psychological Well-being and Life Satisfaction
  • Social Sciences › Health › Religion, Spirituality, and Psychology
Keywords
mindfulness, non-monotonic effects, inverted U-shaped relationship, mindful attention, interoception, decentering, acceptance, meditation practice, boundary conditions, mindfulness-based interventions
MeSH terms
Emotional Regulation, Attention, Awareness, Humans, Meditation, Mindfulness, Interoception

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-07.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-07.

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