Is Your Mindfulness Program Trauma-Sensitive? 3 reasons you need to know and 3 questions to ask.

It was a busy day in the week about 16 or 17  years ago. Emails were still clunky communication channels, which was good because the voicemail I was listening to carried all the emotions we miss in typescript. She was scared, she said. Having a hard time breathing. After a treatment program. Meditation. Mindfulness. Please call.

Back then, I wasn’t a fan of mindfulness-based programs – a seemingly new-fangled, somewhat New-Age-ish approach to treating mental health difficulties. There was little research to support it as a psychological treatment and, what seemed to me, a whole lot of blind enthusiasm for it. As a long-time meditator, I was also resistant to the idea of bringing something that was clearly a spiritual practice into a healthcare field with its clear rules against imposing religious or personal spiritual practices on our patients/clients.

When I met with the caller, I was ready for a story of incompetence and cult-like indoctrination by the people offering the program. It wasn’t that simple. The mindfulness program had been offered by someone with current training (training is very different now) and the meditations were within the range of what any professional trained in psychological approaches would use as relaxation response or calming breath strategies. And yet, the program had triggered something very distressing for her. From the first day of the program and until she left abruptly, she experienced panic attacks, a sense of being separate from the immediate environment, disembodied, and had nightmares. She didn’t inform the facilitator nor had there been any follow-up when she stopped attending the classes. When I asked, she described having been told in the second class, during a homework review when she disclosed her reaction to the Body Scan, that she simply had to “stay with it”. There were reassurances that “it will pass” and “just sitting with it” would resolve the feelings of anxiety.

This initial case became one of many over the years. Buddhist practitioners who had gone to silent retreats, mindfulness-seekers attending 8-week programs or short intense versions of the same, long-term meditators who suddenly found themselves in whirlpools of distressing emotional and physical experiences. They spoke of feeling like failures in their spiritual practices; angry and betrayed that something intended to relieve psychological distress had caused more suffering. They all had one question: Why were they not warned?

Why is knowing about adverse psychological experiences (APEs) important? Here are five reasons.

Reason 1: It’s not new.

That spiritual practices can lead to distress has been known for as long as spiritual practices have been around. My colleague, Jane Compson¹, discussed the different ways spiritual practitioners view these periods of intense distress.

(A) psychiatrist trained in Western allopathic medicine may judge that the distress is symptomatic of mental illness exacerbated by meditation, and suggest that the person stop meditating.  A Buddhist teacher, on the other hand, may understand the distress as a sign that the meditator is progressing through stages of insight towards liberation of suffering, and suggest more meditation or auxiliary practices as a way of moving through this stage.

She calls for a greater awareness of these APEs because their potential for harming the individual practitioner raises ethical issues of whether and how to offer meditation practices in any setting, spiritual or secular.

Reason 2: It can happen independently of experience or context.

Buddhist scholar/researcher Jared Lindahl, neuropsychologist Willoughby Britton and their colleagues² published what is likely the first in-depth examination of APEs among meditators. They reported that among Western Buddhist meditators

More than a quarter (29%) of practitioners first encountered challenges within their first year of practice, almost one half (45%) between 1±10 years of practice, and one quarter (25%) after more than 10 years of practice.

Challenges occurred during or immediately following a retreat for 43 practitioners (72%). The other 17 practitioners (28%) reported challenging experiences in the context of daily practice. About three-quarters (72%) of participants were regularly practicing within a meditation community or were working with a teacher (75%) when challenging experiences arose.

While we may think that spiritual practitioners experience a different context and intensity of meditation, Lindahl and colleagues point out that

…a number of participants also reported challenging or difficult experiences under similar conditions as MBIs, that is: in the context of daily practice; while meditating less than 1 hour per day, or within the first 50 hours of practice; and with an aim of health, well-being or stress-reduction. Some types of practice associated with challenging meditation experiences were in many cases not dissimilar from the primary components of MBIs.

Reason 3: Awareness of psychological and trauma history is important

More relevant to our discussion here, in Lindahl’s study 32% had a psychiatric history and 43% had a trauma history. They are careful to indicate that prior histories are not necessarily predictive or considered risk factors. At the same time, we know enough about the way psychological challenges, in particular, trauma, are processed that some caution is advisable.

This is where things get really complicated. Many of us may not know that or don’t see ourselves as having experienced trauma. While I do get irritated when some authors equate the “trauma” of burnt toast to the level of aversive childhood experiences (ACEs) that lead to significant debilitation in adulthood, trauma is an historic reality for many of us. The challenge is when we are so functional that we, ourselves, no longer view our history as “traumatic”. We may well have rebounded from it in healthy ways and feel it is something in our past.

But the body knows the trauma differently.

This is where being trauma-informed as a mindfulness therapist and as a mindfulness consumer is very important. The following three questions may help to be trauma-informed and know if the program you are considering is trauma-sensitive.

Question 1: Is the program trauma-sensitive?

This is actually a pre-program question. Ask the facilitators if they are informed of the potential challenges someone with trauma may encounter. Practices such as the Body Scan can evoke reactions if the participant has a history of physical or sexual abuse. Meditations that drop into deep relaxation and open the field of awareness can be anxiety-provoking. What are the facilitators’ approaches should this happen – in the classroom or between classes?

Question 2: What do certain terms mean?

“Just sit with it” or “turn towards the distress” are typical suggestions when participants are feeling distressing sensations or emotions. For the most part, they are acceptable suggestions or invitations to develop distress tolerance. However, if the distress escalates quickly or becomes too intense, these are not the best first line of practice. Ask for clarity and expect responses that are in everyday language.

Question 3: What practices are being taught to help when APEs occur?

Every program is different however there should be a component of grounding practices, resetting the physiology (using the breath), and/or adaptations to typical approaches in meditation. Can you open your eyes if things get activating internally? Can you stand, step out of the room and return, or care for yourself in some way that respects your needs and those of other participants? Can you meet with the facilitator after the class or, if you need to, during the week?

Mindfulness programs can be very helpful and life-changing. Our role as facilitators is to ensure that these practices can change your life in the right direction. Our role as participant is to feel safe and supported as we go along this path of practice.

Recommended Book: Trauma-Sensitive Mindfulness: Practices for safe and transformative healing by David Treleaven, W.W. Norton & Company


  1. Compson, J.C. (2018). Adverse Meditation Experiences: Navigating Buddhist and Secular Frameworks for Addressing Them. Mindfulness, http://link.springer.com/article/10.1007/s12671-017-0878-8
  2. Lindahl et al., (2017). The varieties of contemplative experience: A mixed-methods study of meditation-related challenges in Western Buddhists. PLoS ONE 12(5): e0176239. https://doi.org/10.1371/journal.pone.0176239

Before you close your eyes: things to know about meditation

“Do you meditate?”

It’s a common question these days. Almost everyone I speak to has taken a mindfulness program or is looking for a place to learn how to meditate. It’s an exciting time as well because, as healthcare professionals, we’re finding ways to help people that seem to be making a difference in their lives. So, how can there be a problem with that?

None, if meditation is taken up with an understanding of what it is and how it works. And, more important, how it doesn’t work.

What we think meditation is

Most people want to feel free of the stresses in their lives and it’s a realistic desire. Jobs are demanding or lost; relationships are frayed; the world seems fragile with disasters and destruction; chronic illnesses are affecting so many people. Who wouldn’t want something for these turbulent moments that gives a few moments of peace? When we approach meditation with the agenda of feeling better,  it can feel good and for many of us, it may be enough to get us through the tough times.

But, is meditation just a practice of feel-good sayings or moments of by-passing reality?

What is meditation, really?

A Zen teacher said, “If all it takes to be enlightened is sitting, then frogs would be enlightened.”

If you’ve been meditating and still find yourself getting angry, frustrated, sad, or reactive, welcome to being human. The one thing meditation will not change is the natural responses we have to upsetting events in our life. Of course, the Catch-22 is that the more upset we feel in our lives, the harder it is to meditate because it’s all the same mind and mental habits.

The intent of meditation is to become aware of three patterns of reactivity:

Anger – I don’t want what I have
Clinging – I want what I don’t have
Confusion – I don’t know why things are going the way they are

If it’s happening in our everyday lives, it’s going to pop up in on the cushion as well. And, when it does, we start to feel meditation “isn’t working”. That’s when we may start avoiding or only sitting if it gives us good feelings like relaxation.

What keeps us from going back to the cushion?

In Buddhist psychology, there are five habit patterns that get in the way of changing our reactivities (and why we need to “meditate” throughout the day):

Desire for things that please us
It’s easy to see that if we really want to sleep in because the bed is so warm and cozy, we’re less likely to get out and get our butt on the cushion. that’s a low-level example, but I think we can see that many activities appear more desirable than sitting still – especially if sitting still brings up unpleasant thoughts and emotions!

Anger
It’s the same with feelings of anger; whether in the everyday activities of our lives or when we sit and the gates open, anger is a tough emotion to be a comfortable feeling. The problem is, if we’re practising anger throughout the day, it’s more likely to show up when we sit down and relax our mental control. So, watch for those moments of irritation when you’re off the cushion!

Sloth & torpor
I admit these are my favourite obstacles! Most days, by the time I get home, I’m wiped out – lethargy and laziness are my BFFs. If I try to sit when I feel this way, I just end up drifting off to sleep, which I rationalize as being one with the cosmic vastness. I also know that moment-by-moment, I’m likely practising sloth & torpor in my day as well. That means I need to pay attention to my procrastination and avoidance patterns.

Worry & agitation
These buddies are linked to needing an outcome that reassures us we’re doing the right thing. The problem is that there’s no “right thing” in most activities and our perfectionism pushes us to set unrealistic standards. Do a reality check: is what you’re aiming for really what’s needed.

Doubt
This obstacle is the foundation of the previous four. And, it’s a sneaky one! It shows up as perfectionist tendencies, reverse praise (You did so well the last time!), cautious behaviour and procrastination, and so much more. Learn what you go-to excuses are for not getting to something that needs doing. See which of the previous four obstacles are partnering up with doubt to bring you to a grinding halt.

Am I getting enlightened?

Let’s hope so! Be careful of the hype around meditation. It doesn’t cure everything (or anything, actually). However, it can become possible to develop a level of steadiness that makes things more understandable. It can become the pause in our interactions that allow us to make a better choice, or see how we get in our own way. The catch is that it takes practice – and avoiding the desire for and addiction to the quick-fix of relaxation is the first step.

If you want to practice, try our meditations here (in French here) or on Insight Timer.

Self-Compassion Practices for Emotional Distress: It’s not just about being kind

leavesSelf-Compassion practices and programs are gaining momentum in psychological treatments and look like they might well become the next wave of transforming our painful feelings. Mindful Self-Compassion (1), developed by Drs. Christopher Germer and Kristen Neff, is an approach that can be both an adjunct to conventional therapies as well as a stand-alone treatment model. The interesting and very useful aspects of this approach are its applicability to our multilayered experiences of suffering. First, let’s look at what they define as Self-Compassion.

Neff (2) describes it as a three-fold system that are antidotes to the experiences that cause us suffering. (A sidebar note: Suffering is typically described as Pain multiplied by our Resistance to the reality of that pain (3)). Here’s a table that summarizes Neff’s definition of self-compassion. Continue reading

Building Safeness: How to get intimate with our inner critic

chive heart

We all want to feel safe. It’s important. When we feel safe, we feel confident and more willingly open ourselves to new experiences. In fact, feeling safe leads to the willingness to take risks – to risk being known, being seen, loving and feeling loved. As we encounter the world in all its various ways of showing us what being safe means, we learn to open and close our hearts (and minds) when we feel respected or rejected. Paul Gilbert¹, the developer of Compassion Focused Therapy, uses the term “safeness” to describe the experience of being safe. It’s different from “safety” or “safety-seeking” which tend to be what we do when we are engaged in the threat evaluation/response processes.

There are many things in our environment that we have learned are safe and many we have learned are unsafe. Hot stoves, fast-moving traffic, dark alleys and the like are easy to discern in terms of their safety. Emotion-cued environments are harder to figure out. Our childhood experiences are a fruitful ground where we learn many of our lessons about safeness and safety. Angry voices, certain words, patterns of relationships and other features of interpersonal relationships can become cues for safeness. We typically know the degree of safeness from the language and tone of the person speaking to or interacting with us. Safeness with respect to our inner dialogue is no different from our external experience.

Most people, when asked about their inner voice, smile sheepishly and confess it’s not a pleasant one. But almost immediately, they will begin to defend their not-so-silent partner. “It’s how I motivate myself.” “I’d never know how to avoid mistakes I make if I didn’t remind myself that I can screw up.” While all this is true, the sad fact is, our inner critical voice is often what keeps us from engaging with life. More than that, the inner critic leaves us feeling threatened rather than safe.

Like all relationships, our relationship with our inner critic is complicated. We suspect it’s trying to help but it sure doesn’t feel like it at times. We’d like to turn it off but we’re afraid without it we’d become a lazy lump on the couch. We want it gone forever but it’s a hard-wired part of who we are. We’d like to make peace with it but we’re not ready for that inner group hug. We think it just wants us to be careful and wise but it sounds like it’s telling us can’t do anything right, ever! And to add insult to injury, no one knows us better than that inner critic. It knows all the buttons to push to get us to start or stop. It knows our vulnerabilities and strengths, often over-emphasizing the former and diminishing the latter. It is like being inseparable from an unruly, impolite friend who has really good intentions to keep us safe but can’t create safeness. It is intimate with every aspect of who we are and that also makes it primed for self-compassion²‚³.

However, befriending a person like that is a challenge at the best of times; befriending ourselves in the worst of our times can be daunting. That’s why we need to take slow, quiet steps towards engaging with the inner critic.

Step 1. Mindfulness. It’s hard to be in the presence of harshness, so mindfulness practice helps us stay grounded and aware when the inner critic begins its monologue of dire warnings. Mindfulness of our emotions helps us stay connected with the impact of the words. It also tells us when we’ve had enough and need to get off that nasty train of thoughts.

Step 2. Acknowledge we heard its message. This sounds strange because it may feel like we’re agreeing with it. Notice we are saying, “I hear you,” and not “You’re right.” Everyone has a perspective and the point of view of the inner critic is just one perspective on our life. As we become more comfortable with acknowledging its voice, we can try to acknowledge its attempt to help. Eventually with practice, we may get to say “Thanks for alerting me. I’ve got this!” Remember we can’t fight the inner critic with brute strength; we have to soften around it.

Step 3. Strong back, soft front: respect the partnership. The inner critic is really our attempt at feeling solid in our life; that’s the strong back. We have opinions, ideas, feelings and a reality that is meaningful. We are also of a softer nature that is attentive and giving, accommodating and caring. We feel our vulnerability and openness in relationships. The balance between the strong back and soft front helps us be flexible and available emotionally.

Meditation practices you can try:

1. Lovingkindness and compassion meditations help us develop less fear of being wounded. The inner critic tries to toughen us up against external criticisms and that subtly makes these criticisms seem more threatening than they are and the wounds deeper than they might be.

2. Giving and receiving compassion meditations can help to create space and calm between ourselves and our inner critic. Although the meditations are intended to give compassion to another person in our life who needs it, we could see the inner critic as an aspect of ourselves that needs compassion too.

3. Compassion Breaks and “Soften-Soothe-Allow” meditations help to develop presence in the face of the monologue we heard internally.

———–

With notes from Glynn, Brittany, Mindful Self-Compassion 8-week program, Ottawa Mindfulness Clinic

¹Gilbert, Paul (2009). The Compassionate Mind: A new approach to life’s challenges. New Harbinger Publications: CA

²Germer, Christopher (2009). The Mindful Path to Self-Compassion:Freeing yourself from destructive thoughts and emotions. Guilford Press: NY

³Neff, Kristin (2011). Self-Compassion: Stop beating yourself up and leave insecurity behind. William Morrow: NY