| 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.
QUIZ EXERCISE 10:
a) extremely rare b) best treated with meditation training c) a risk with a substantial minority of patients. d) none of the above
Record your answers for later insertion into the Quiz. |
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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