Meditation In Mental Health

LESSON 6
Contraindications

Contraindications

There are conditions and situations when meditation is contra-indicated. A useful rule of thumb is that meditation should be used with caution whenever there are concerns regarding reality testing, ego boundaries, lack of empathy, or rigid over-control. For example, when treating a schizophrenic patient with active psychotic symptoms, it may be inadvisable to include meditation as a component of treatment, as reality testing may be impaired.

Walsh R, Roche L. Precipitation of acute psychotic episodes by intensive meditation in individuals with a history of schizophrenia. Am J Psychiatry. 1979 Aug;136(8):1085-6

Similarly, meditation may be inadvisable in treating some personality disorders (DSM-IV cluster B - antisocial, borderline, histrionic, or narcissistic) which involve lack of empathy, as it could reinforce further preoccupation with the self that characterizes those disorders.

Use with Clinical Populations

However, an experienced therapist who has developed personal skills with meditation and other mind-body techniques can incorporate meditation into most treatment protocols, given appropriate attention to preparation of the patient. For example, the course author developed a multimodal holistic health program for schizophrenic patients at a state psychiatric hospital which incorporated meditation without any adverse effects.

Lukoff D, Wallace CJ, Liberman RP, Burke K. A holistic program for chronic schizophrenic patients. Schizophr Bull. 1986;12(2):274-82.

Since meditation can be a powerful tool for self-reflection, it can occasionally produce an opening to the inner dimensions of experience that could be overwhelming to psychologically fragile individuals. In addition, relaxation-induced anxiety, where an individual unaccustomed to deep relaxation that often accompanies meditation and finds the resulting physiological release and attention to internal sensations, perceptions, and images, to be a source of fearful anxiety-producing apprehension, can occur in meditation as well as in other relaxation techniques used in therapy.

Therefore, it is prudent to begin a meditation intervention slowly, allowing the patient to become comfortable with the sensations and thoughts that arise. It is also prudent to have some personal experience with meditation prior to utilizing it with a patient.

Besides the contra-indications and cautions mentioned above (i.e., those resulting from deficient reality testing, porous (fragile) ego boundaries, pathological deficiency in empathy, rigid self-control), there is no published scientific literature describing negative side effects of meditation.

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