Is Mindfulness Safe for Trauma Survivors?
by David Treleaven
David Treleaven
Over the past decade, I’ve researched the relationship between mindfulness meditation and trauma. Placed beside one another, mindfulness and trauma can seem like natural, even inevitable, allies. Both are concerned with the nature of suffering. Both are grounded in sensory experience. And while trauma creates stress, mindfulness has been shown to reduce it. In theory it seems that anyone who has experienced trauma could benefit from practicing mindfulness meditation. What could go wrong?
Plenty, it turns out. For people who’ve experienced trauma, mindfulness meditation can actually end up exacerbating symptoms of traumatic stress. When asked to pay focused, sustained attention to their internal experience, trauma survivors can find themselves overwhelmed by flashbacks and heightened emotional arousal. I’ve met survivors who, despite their best intentions, have ended up feeling disoriented, distressed and humiliated for somehow making things worse. The power of meditation thrusts survivors directly into the heart of wounds that often require more than mindful awareness to heal.
Yet mindfulness is also a valuable asset for trauma survivors. Mindfulness can enhance present-moment awareness, increase self-compassion, and strengthen a person’s ability to self-regulate—all important skills that support trauma recovery. The question for those of us who teach and utilize mindfulness is thus how we can help minimize the potential dangers of meditation to trauma survivors while simultaneously leveraging its potential benefits.
To be “trauma-sensitive” means having a basic understanding of trauma in the context of one’s work.
The answer I came to in my own work was a trauma-informed approach to mindfulness meditation. Mindfulness doesn’t cause trauma—rather, it may uncover it—but the practice by which mindfulness is pursued can land trauma survivors in difficulty. To be “trauma-sensitive” means having a basic understanding of trauma in the context of one’s work. A trauma-informed physician will ask for permission before touching a patient, for example; and a trauma-informed school counselor might ask a student whether they want the door open or closed during a session, and inquire about a comfortable sitting distance. With trauma-informed mindfulness, we apply this concept to mindfulness instruction. We can give people options about how they practice mindfulness, encouraging breaks and utilizing various anchors of attention. We can ensure we’re trained in recognizing trauma symptoms, responding to them skillfully, and taking preemptive steps to ensure that people aren’t re-traumatizing themselves under our guidance.
The potential risks of meditation, including for trauma survivors, have become increasingly well-known. At Brown University, a clinical neuroscientist by the name of Willoughby Britton started a project named the “The Varieties of Contemplative Experience” (https://www.brown.edu/research/labs/britton/research/varieties-contemplative-experience), which, over several years, has examined the range of challenging experiences that can arise in the context of Buddhist meditation—experiences that can resemble psychological dissociation, depersonalization, and the re-experiencing of traumatic memories (Lindahl, Fisher, Cooper, Rosen, & Britton, 2017).
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Many who suffer under the weight of traumatic stress respond favorably to mindfulness meditation. But others may have a different experience, where the practice unintentionally lands them in more pain. Mindfulness practice doesn’t need to work for everyone, but I’ve become convinced that certain modifications to meditation can support survivors, at the very least ensuring that they are not re-traumatizing themselves in practice. Mindfulness meditation isn’t bad: it’s powerful. And those of us offering it to others benefit when we continue exploring its risks and rewards.
Ultimately, the need for trauma-sensitive mindfulness is a reflection of both odds and statistics. As many readers will know, the practice of mindfulness has exploded in popularity over the past decade and is now encouraged in a wide range of secular environments, including elementary and high schools, businesses, and hospitals. Yet, at the same time, the prevalence of trauma is extraordinarily high. The majority of us will be exposed to at least some type of traumatic event in our lifetime, and some of us will develop debilitating symptoms in its aftermath. What this means is that in any environment where mindfulness is being practiced, there’s a high likelihood that someone will be struggling with traumatic stress.
Many who suffer under the weight of traumatic stress respond favorably to mindfulness meditation. But others may have a different experience, where the practice unintentionally lands them in more pain. Mindfulness practice doesn’t need to work for everyone, but I’ve become convinced that certain modifications to meditation can support survivors, at the very least ensuring that they are not re-traumatizing themselves in practice. Mindfulness meditation isn’t bad: it’s powerful. And those of us offering it to others benefit when we continue exploring its risks and rewards.
Reference
Lindahl, J. R., Fisher, N. E., Cooper, D. J., Rosen, R. K., & Britton, W. B. (2017). The varieties of contemplative experience: A mixed-methods study of meditation-related challenges in Western Buddhists. PLoS One, 12(5), e0176239. doi:10.1371/journal.pone.0176239
David A. Treleaven, PhD, is an educator and psychotherapist whose work focuses on the intersection of trauma, mindfulness, and social justice. Trained in Counseling Psychology at the University of British Columbia, he received his Doctorate in Psychology from the California Institute of Integral Studies. He has been studying mindfulness for twenty years, has a private practice in the San Francisco Bay area, and is the author of Trauma-Sensitive Mindfulness: Practices for Safe and Transformative Healing (in press, W. W. Norton & Co).
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About The Author:
I teach emotional regulation groups for people with PTSD and trauma/attachment disorders. I have found that trauma survivors often have a limited tolerance for mindfulness exercises at first, and I always encourage group members to use distraction or self-soothing techniques as needed so they don’t have to dissociate or get overwhelmed by their memories. People have to start where they are, and gradually build up their tolerance, whether it is by a few minutes at a time, or even a few seconds.
Dear David,
Thank you for your interesting article. While it is true that meditation and mindfulness practices can be anxiety provoking for trauma survivors, it is the quality of the facilitator (ie the therapist or professional) that determines how helpful mindfulness is to trauma survivors.I am a registered psychologist in Australia for more than 23 years. I am also a trained mindfulness and MBSR teacher and have used mindfulness with trauma patients for a number of years. I have found it helpful as a way to help the client to get in touch with deep emotions surrounding their trauma. But first it is important to ensure the emotional safety of the client. So I help them to do some simple meditation practices, then I encourage them to get in touch with the events/feelings/thoughts that caused the trauma, if I feel that they are emotionally ready to get in touch with their deep emotions. It is important that the client is encouraged to do so in the presence of the therapist and in the safety of the therapy room, rather than outside office hours. I encourage the client to verbalise the trauma which they often have difficulty to do so. Because the meditation practice soothes their mind, it will be less anxiety provoking for the client.
Finally, I ask the client to select a piece of music, usually a soothing piece and without words to listen through while they recall the trauma in their own words. This exercise is often repeated several times over several sessions. The idea is to help the client “to cleanse” their negative thoughts, feelings, emotions through the soothing music and replace them with more neutral and positive affects. I have found this to be helpful for many trauma survivors. The most important thing is that the therapist/facilitator has to be well trained in meditation and mindfulness practices, and know for themselves whether they are skilful enough to ensure the emotional and physical safety of the client when they are helping the client to access these emotions. If the therapist is not sure, don’t attempt it. I have written about this in my article below. For readers who are interested in the article, please see the reference below
Khong, B.S.L. (2011). Mindfulness: A Way of Cultivating Deep Respect for Emotions. Mindfulness, 2(1), 27-32.
In summary, the caveats for using mindfulness practices with trauma survivors include the following:1) if as a professional, you are not sure of your skills to help the client, don’t do it 2) if you are not sure that the client is ready to use this exercise, don’t use this practice 3) always ensure that you allow time after such an exercise, to give the client sufficient time and emotional space to process what comes up, ideally in the therapy room, and 4) also consider informing family members (with the client’s consent) that you are planning to use this practice with the client. It is imperative that the professionals know their own limitations. So to answer your question, is mindfulness safe for trauma survivors? Yes, with the above caveats.
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