Most yoga and meditation teachers are not licensed mental health professionals, but many students who come to these practices may view them as an alternative to therapy or clinical treatment for mental health issues. But mindfulness is not always enough on its own—and a new comprehensive report from the University of Cambridge recently confirmed this.
A large review and meta-analysis published in PLOS Medicine found that while mindfulness can be effective for improving mental health, it may be no more effective than other practices geared toward improving well-being.
The researchers reviewed 136 randomized controlled trials (RTCs) that tested the effects of mindfulness training on mental health in various community settings. The trials included 11,605 participants aged 18–73 years from 29 different countries; 77 percent of the subjects were women. An analysis of this scale allows for more robust conclusions, since most mindfulness studies are often small in size and lack rigor. The review determined that mindfulness, when compared to doing nothing at all, effectively reduced anxiety, depression, and stress in most community settings. But the data also suggested that in more than 1 in 20 trials, mindfulness did not improve mental well-being at all. The findings indicate that while mindfulness can be beneficial for many people, its effectiveness may depend on how it is used and the individual’s needs.
Julieta Galante, PhD, a research associate at the Department of Psychiatry at Cambridge and the lead author of the study said in a statement that when it comes to mental health, particularly depression, anxiety, and psychological distress, it shouldn’t be assumed that mindfulness works for everyone. “Community mindfulness courses should be just one option among others, and the range of effects should be researched as courses are implemented in new settings,” she said.
Other practices that promote mental well-being, such as cardiovascular exercise, may be more effective for those who do not benefit from mindfulness, adds Peter Jones, PhD, a professor of psychiatry at Cambridge and co-author of the review. “In many cases, these may prove to be more suitable alternatives if they are more effective, culturally more acceptable, or are more feasible or cost effective to implement,” he said. “The good news is that there are now more options.”
The researchers acknowledge that the success rates of mindfulness-based programs included in the review may depend on variables such as how they were implemented and by whom, as well as the individual circumstances of the subjects who were included. They note that mindfulness techniques are vastly diverse and range from Buddhist psychology and meditation to cognitive neuroscience, which can have different effects on outcome.
In addition, the meta-analysis only examined in-person mindfulness trainings and researchers have not yet looked at the effects of online offerings. The COVID-19 pandemic has of course exacerbated the volume of online mindfulness courses, and researchers have expressed concern about their efficacy. “If the effects of online mindfulness courses vary as widely according to the setting as their offline counterparts, then the lack of human support they offer could cause potential problems,” Galente said. “We need more research before we can be confident about their effectiveness and safety.”
When Mindfulness Backfires
Mindfulness-based interventions like yoga and meditation are touted as a universal tool for stress reduction and improved well-being. While many people may seek out mindfulness as an alternative to therapy, self-treatment does not always resolve underlying long-term stress and residual trauma. As a consequence, mindfulness can become more of a coping mechanism, which can be an effective strategy for managing emotions but may not resolve underlying psychological issues. In some cases, mindfulness can even spike anxiety.
A 2019 study published in PLOS One showed that at least one quarter of regular meditators experienced adverse effects like anxiety, depression, panic attacks, and dissociation. The researchers wanted to learn more about “a growing number of reports” citing psychologically unpleasant experiences occurring within the context of a meditation practice.
David Treleaven, PhD, author of Trauma-Sensitive Mindfulness: Practices for Safe and Transformative Healing, specializes in the intersection of mindfulness, trauma, and social justice at his private practice in the Bay Area. He says that if a person becomes distressed during meditation because of an underlying psychological issue, the practice could backfire.
The Link Between Trauma and Mindfulness
Treleaven says that for those who’ve endured trauma, anxiety and other symptoms can arise at any time in a yoga or meditation setting, particularly as someone is asked to become aware of their present state of mind. He explains that a pose like Savasana, which is supposed to be restful, restorative, and meditative, may be problematic for some students. Laying on the floor in stillness in a room full of strangers can be an uncomfortable experience for someone with a history of trauma and cause their anxiety to spike. As a teacher guides the student to relax and release their tension, Treleavan says this may only heighten their attention and ramp up anxiety. “More is not always better with meditation when it comes to trauma and mental illness,” he said.
Alexandria Crow, an educator on ethical and sustainable yoga and founder of Yoga Physics, says that in group vinyasa classes, some people may not yet possess the skills to make the best choices for their body and mind. Depending on an individual’s circumstance and whether past trauma is involved, they may employ maladaptive survival techniques such as perfectionism or a no-pain-no-gain mentality, which could further perpetuate the same patterns they came in with. “They are surrendering their personal agency to the person who’s leading the class and are impacted by the people around them in a group, which can make it difficult to create their own experience and make their own choices,” she says.
According to the Adverse Childhood Experiences (ACEs) study, more than 50 percent of the population experiences at least one trauma in their lifetimes and upwards of 80 percent will endure another. Many people who make up this large demographic may find their way into the yoga and/or meditation setting. For those who’ve experienced trauma, doubling down on their mindfulness practices can be especially precarious.
“One common symptom of posttraumatic stress is dysregulated arousal,” Treleavan explains. “This is when the accelerator (sympathetic arousal) and brakes (parasympathetic arousal) of our nervous system fall out of balance. We might suddenly become hypervigilant and extremely anxious, or dissociated and numb.” These symptoms, according to Treleavan, indicate that a person might need to modify their practice in order to receive the full benefits. “While mindfulness meditation can help us navigate these experiences, many people will need specific self-regulation strategies beyond the scope of meditation to stay balanced in practice,” he says. “Think of trauma as an injury and meditation as an exercise—you wouldn’t ask someone with a shoulder injury, for example, to do a bunch of pushups. They’d need modifications to build their strength over time.”
In a vinyasa setting, Crow says that many poses require the practitioner to move their joints beyond a functional range of motion, which can stimulate the nervous system. There is some evidence to suggest that joint mobilization may upregulate the sympathetic nervous system, or fight-or-flight stress response, but further research is still needed.
See also: Learn About Trauma-Informed Yoga
For yoga teachers who’ve ever wondered why a student suddenly got up and left the room during Savasana, it’s possible they were feeling anxious, confused, and even ashamed, and not necessarily because they didn’t like the class or had somewhere to be. Treleaven says these students often leave class feeling frustrated and more distressed than they were before they began. “Asking someone to pay attention to their inner world is a big ask if what they’ll find is profound dysregulating sensations, thoughts and emotions,” he says.
What Does This Mean for You?
If mindfulness alone doesn’t seem to help you, that doesn’t mean you should completely discount it. Within the context of yoga and meditation, self-regulation practices such as breath awareness or focused concentration, can be integral to avoiding adverse experiences, according to Treleaven. It’s important for an individual to know how to self-regulate, or monitor and manage their emotions and behavior in response to certain situations. Self-regulation skills, combined with one-to-one professional counseling, can be very helpful for many people with trauma-related psychological conditions.
Indeed, research supports yoga as a potential complementary treatment for anxiety, depression, and PTSD. But it’s also important for yoga teachers to be extra mindful of the language they employ in their instruction in group settings. While it’s true that Savasana can be the most difficult pose, no student should ever feel that they’re obligated to stay in the pose for the full duration. “It’s a big deal to ask anyone to pay attention to their inner world, and having a bit of extra support can help people gain the full benefits from practice,” Treleaven says.