JMIR Publications

ABSTRACT

Background:

Digital meditation-based interventions (MBIs) reach vast global audiences with millions of active users, yet concerns persist about the frequency, nature, and interpretation of adverse experiences (AExs) occuring during meditation training. Some prior studies argued that they reflect iatrogenic harm caused by meditation and are substantially underdetected. Others contend that, apart from rare severe adverse events, these experiences largely reflect common life stressors that participants retrospectively misattribute to meditation. These competing perspectives underscore the need for further research, particularly in the context of digital MBIs, the most widely used form of meditation training.

Objective:

This study examined the prevalence, predictors, and subjective evaluations of AExs during a digital MBI, and tested whether reported experiences could be caused by meditation practice.

Methods:

Data were drawn from two trials of the Healthy Minds Program (HMP), a freely available digital MBI. Exploratory Study 1 (n = 315) used a sample of distressed U.S. undergraduate students to estimate the prevalence of AExs and identify baseline predictors. Preregistered confirmatory Study 2 (n = 594) sampled distressed U.S. adults from all 50 states to replicate findings from Study 1 and to examine participants’ subjective evaluations of AExs. Study 2 additionally compared AEx rates between participants who did and did not complete guided meditations to assess whether AExs could be caused by meditation exposure. Study 3 (n = 87) used qualitative methods to analyze Study 1 participants’ responses to an open-ended question regarding their strategies for coping with AExs.

Results:

In Studies 1 and 2, 27.94% and 10.10% of participants, respectively, reported at least one AEx during the study period, with 5.72% and 3.03% reporting functional impairment. Critically, in Study 2, rates of AExs did not significantly differ between participants who did and did not complete guided meditations, suggesting that these experiences were not caused by meditation practice. Higher baseline depression, anxiety, loneliness, experiential avoidance, and perceived barriers to meditation predicted more frequent AExs. In Study 1 and Study 2, 89.77% and 90.00% of participants who reported AExs, respectively, indicated that they were glad to have learned to meditate. Qualitative analyses showed that participants employed diverse AEx coping strategies, often using skills learned through HMP.

Conclusions:

Adverse experiences were relatively common but occurred at comparable rates among participants who did and did not engage in meditation, challenging claims that such experiences were caused by meditation practice. Although a subset of participants reported functional impairment, most evaluated their AExs as tolerable and described their overall MBI experience as positive. Together, these findings highlight the importance of distinguishing AExs that likely reflect epiphenomena of pre-existing distress or symptoms from iatrogenic harm attributable to MBIs. Clinical Trial: Parent Study 1 trial: ClinicalTrials.gov NCT04741529; https://www.ClinicalTrials.gov/study/NCT04741529 Open Science Framework (OSF) Registries; https://osf.io/fmvw4 and https://osf.io/rvhsb Parent Study 2 trial: ClinicalTrials.gov NCT06282523; https://ClinicalTrials.gov/study/NCT06282523 OSF Registries; https://osf.io/27w3h?view_only=f0d113ec784c4c74b785ae322ae56889 Study 2 hypotheses and data analyses: OSF Registries; https://osf.io/6y47x