Meditation-related psychological adverse effects, challenging, unpleasant, and negative experiences: Toward the safe dissemination and practice of advanced meditation

Meditation research is increasingly moving beyond the study of health-related benefits toward the investigation of non-ordinary states of consciousness and ways of being that may arise through advanced meditative practice. Alongside potential benefits, however, intensive or advanced meditation has been associated with a higher incidence of meditation-related psychological adverse effects, challenging, unpleasant, and negative experiences (MRPAEs). Although a growing body of empirical work indicates that MRPAEs are relatively prevalent, substantial heterogeneity in terminology, definitions, and assessment criteria has contributed to wide variation in reported prevalence estimates and has complicated efforts to characterize the nature, severity, and significance of these experiences. This review synthesizes the literature on MRPAEs, with particular attention to advanced and intensive meditation contexts. We examine proposed theoretical and interpretive frameworks; practitioner-, practice-, relationship-, and environmental/health-related factors associated with MRPAEs; potential risk and protective factors; considerations related to normal meditative development versus psychopathology; and key directions for future research. Overall, this review aims to provide a foundation for a more comprehensive and systematic understanding of MRPAEs and to inform approaches to advanced meditation that support both safety and effectiveness.