Source
Lindahl, Fisher, Cooper, Rosen & Britton (2017), PLOS ONE 12(5), e0176239, LIT-066, the Varieties of Contemplative Experience study, read in full in NOTE-036. The supporting files S1–S5 (interview protocols, codebooks) were not read, so category definitions are as the article gives them.
What was actually shown
The sample (Table 1). Recruitment was purposive “deviant case” sampling: a challenging, difficult or impairing meditation-related experience was the condition of entry (p. 7). Of 73 interviewed, 13 were excluded, leaving 60 practitioners from Theravāda, Zen and Tibetan traditions, plus 32 teachers and clinicians, 11 of whom were also practitioners. The sample is 94% White and 85% US, and 60% were meditation teachers.
The taxonomy (Table 4). Thematic coding gave 59 phenomenology categories in seven domains: cognitive, perceptual, affective, somatic, conative, sense of self and social. A practitioner reported a mean of 19.6 categories (SD 7.2) across 6.1 domains. The commonest were fear/anxiety/panic/paranoia (82%), changes in motivation or goal (78%), positive affect (75%), somatic energy (63%), sleep changes (62%), depression/dysphoria/grief (57%) and changes in self–other boundaries (53%). Experts reported 56 of the 59. A double-coded 15% subset gave weighted κ = .70.
Where onset occurred (Table 3). 72% had onset on or right after a retreat, and 28% in daily practice. 25% were practising under an hour a day at onset. 12% reported challenges within their first ten days of practice, and 18% within their first 50 hours.
Impact (p. 21). Median duration was 1–3 years. 73% reported moderate-to-severe impairment in at least one domain, 17% suicidality and 17% inpatient hospitalisation.
What could have come out otherwise. Every onset could have fallen on long retreat, or after years of practice. It did not: a minority of cases in each of the three conditions (daily practice, low dose, first days) is enough to falsify “only on retreat” and “only after long practice”. The taxonomy could also have failed to saturate, or the experts’ reports could have diverged from the practitioners’. Saturation was judged at 30 and 60 interviews, and experts reported nearly every category.
What this does not say
- Not a prevalence or incidence. The 82%, 73% and 17% are proportions within people recruited for having had difficulty. The authors call the 100% rate of challenge “an artifact of sampling” (p. 27). Nothing here says how often an unselected meditator, or a participant in a mindfulness-based intervention, has any of these experiences, and the Limitations say the results “cannot be generalized” to such interventions.
- Not that meditation caused them. Each practitioner scored six self-reported causality criteria, and a score of two or more was an inclusion condition, so “100% met causality criteria” is guaranteed by the design (NOTE-036, Corrections). There is no control group and no base rate. The cut-off is also stated inconsistently (“>2” on p. 13, “two or greater” on p. 10).
- Not a list of risk factors. The 26 influencing-factor categories (teacher relationship, worldview, practice intensity) are participants’ views. The authors disclaim them as “a theory or hypothesis about risk factors” of their own (p. 22).
- Not that the experiences are adverse. The taxonomy is valence-neutral by design, and the paper reports that phenomenologically similar experiences were appraised from very positive to very negative. That appraisal claim is qualitative; no valence data are given.
- Not that the predisposed are unaffected. The exclusion criterion was a history of unusual experiences closely resembling the reported ones, not psychiatric history. 32% of the retained sample had a psychiatric history and 43% a trauma history (Table 3). The rebuttal is of “only people with pre-existing conditions”, not of any difference in risk.
Connections
- THEORY-051 (the self as context in acceptance and commitment therapy) cites this study for the “loss of basic self” and self–other boundary categories. The sense-of-self domain (loss of agency 25%, loss of basic self 25%, self–other boundaries 53%) is the part of the taxonomy that bears on the minimal-self accounts, THEORY-458 among them.
- NOTE-036 notes a phenomenological parallel with the entropic-brain frame for psychedelic states (LIT-080). Neither paper cites the other, and the link is the reader’s.