Mindfulness may have risks as well as benefits

Kirby ¹ lists a large number of benefits of mindfulness, including citing evidence suggesting that it is useful in the treatment of anxiety, stress and depression. However, the article has no discussion of disbenefits and nor does the word ‘risk’ appear even once. This is concordant with under-reporting of harms of psychological interventions in the literature, ² but nonetheless undermines the ability of physicians to use the article to decide whether they would like to practise mindfulness.

While no systematic reviews of the safety of mindfulness interventions appear to have been published, this is not evidence of absence of harm. Indeed, a cursory search of the literature finds a number of adverse effects reported in individual papers including physical pain, ³ disorientation, ³ addiction to meditation, ³ suicidal ideation ⁴ and destructive behaviour. ⁴ In those with pre-existing mental health problems, mindfulness practices have been associated with effects including psychotic episodes. ⁵ These side-effects could be particularly troublesome if, as Kirby advises, mindfulness is practised while in control of a motor vehicle, ‘driving home from work after a stressful day’.

Beyond the specific harms of the practice, it is reasonable to suppose that self-prescribed mindfulness interventions may also delay presentation for assessment of clinical psychiatric problems among physicians, and hence potentially put patients at risk.

As Kirby rightly suggests, many doctors may benefit from mindfulness practices. However, as with any intervention, it is important to be fully aware of the benefits and risks and to make an informed choice before ‘getting started’.