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Vol:.(1234567890)
Mindfulness (2024) 15:1162–1175
https://doi.org/10.1007/s12671-024-02356-z
ORIGINAL PAPER
Altered States ofConsciousness are Prevalent andInsufficiently
Supported Clinically: APopulation Survey
MalcolmJ.Wright1 · JulietaGalante2· JessicaS.Corneille3· AndreaGrabovac4· DanielM.Ingram3·
MatthewD.Sacchet5
Accepted: 12 April 2024 / Published online: 17 May 2024
© The Author(s) 2024
Abstract
Objectives Adoption of potentially consciousness-altering practices may be leading to a rise in emergent phenomena
(EP):sudden unusual mental or somatic experiences often interpreted as spiritual, mystical, energetic, or magical in nature.
It is unclear how frequently these altered states of consciousness occur and what the clinical implications may be. Anecdotal
accounts and prior literature suggest that EP may be common, under-reported, and followed by either positive or negative
changes to well-being. We sought to supplement prior evidence on the prevalence and effects of EP among general popula-
tions with large-scale quantitative measurements.
Method We measured the prevalence of EP, while not on mind-altering substances, through completion of online surveys
by representative samples from three international communities (n = 3135). The communities sampled were UK Qualtrics
online panelists, US-based MTurk workers, and the readers of a popular rationalist blog. Samples were broadly representa-
tive of underlying populations.
Results Forty-five percent of participants reported experiencing non-pharmacologically induced EP at least once in their
lives, including derealization (17%), unitive experiences (15%), ecstatic thrills (15%), vivid perceptions (11%), changes in
perceived size (10%), bodily heat or electricity (9%), out-of-body experiences (8%), and perception of non-physical lights
(5%). Respondents reported a mix of positive and negative well-being outcomes following EP, with 13% claiming moderate
or greater suffering and 1.1% claiming life-threatening suffering. Of those who experienced suffering, 63% did not seek help.
Conclusions EP are widespread among the studied populations with potential for both positive and negative outcomes, the
latter of which do not appear to be adequately addressed through recourse to clinical practice.
Keywords Altered states of consciousness· Contemplative practice· Emergent phenomena· Meditation· Mental health·
Mindfulness· Mystical experience
Contemplative practices such as yoga, meditation, and mind-
fulness-based interventions (MBIs) are gaining global popu-
larity for their potential to enhance well-being, productivity,
job performance, and pro-social behaviors (Masci & Hack-
ett, 2018). Buddhist-derived practices such as MBIs are
applied to promote mental and physical health (Galante
etal., 2021; Strohmaier, 2020), and utilized in therapeutic
and clinical settings for the management of stress (Garland
etal., 2017), anxiety (Goldberg etal., 2018), substance mis-
use (Garland etal., 2022; Li etal., 2017; Parisi etal., 2022),
mood and psychiatric disorders (Goldberg etal., 2018, 2019;
Kuyken etal., 2016; Wielgosz etal., 2019), and physical
ailments such as chronic pain (Brintz etal., 2020; Hilton
etal., 2017).
As mindfulness-based practices are thought to improve
resilience, cognitive ability, and emotional regulation (Gill
etal., 2020; Guendelman etal., 2017; Roeser etal., 2022),
they are applied in the education system (Dunning etal.,
* Malcolm J. Wright
M.J.Wright@massey.ac.nz
1 Massey University, Albany, Auckland, NewZealand
2 Contemplative Studies Centre, University ofMelbourne,
Melbourne, Australia
3 Emergence Benefactors, Huntsville, AL, USA
4 University ofBritish Columbia, Vancouver, BC, Canada
5 Meditation Research Program, Department ofPsychiatry,
Massachusetts General Hospital, Harvard Medical School,
Boston, MA, USA
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1163Mindfulness (2024) 15:1162–1175
2022; Tudor etal., 2022), prisons (Bouw etal., 2019), and
the military (Zanesco etal., 2019). They are also consid-
ered effective tools for corporate well-being (Van Dam
etal., 2018; Vonderlin etal., 2020), with one survey find-
ing that 52% of 163 evaluated companies offered mindful-
ness training that year (Lau, 2020). Mobile applications and
websites delivering mindfulness-based practices are popular
(Cavanagh etal., 2013; Sommers-Spijkerman etal., 2021),
with an estimated 52million meditation app downloads in
2019 and projected revenue of 6.7billion dollars by 2026
for mobile apps alone (Williams, 2020).
However, MBIs and other mindfulness-based practices
draw on contemplative traditions that seek to produce not
just enhanced well-being, but also altered states of con-
sciousness —including transformative experiences— to
trigger enduring changes in an individual’s sense of self and
the world around them (Taylor & Egeto-Szabo, 2017). These
transformations are often associated with a type of altered
state of consciousness we characterize as emergent phenom-
ena (EP): sudden unusual mental or somatic experiences
often interpreted as spiritual, mystical, energetic, or magi-
cal in nature. The cognitive and behavioral shifts associated
with EP may include a decreased fear of death, diminished
interest in dogma and traditional religion, and a rejection of
materialistic lifestyles (Griffiths etal., 2018; Johnson etal.,
2019; McClintock etal., 2016; McGee, 2020), as well as
a profound sense of connection; elevated mood; awe, rev-
erence, and wonder; deep states of peace and equanimity;
enhanced philosophical insight; creativity and problem-
solving; and appreciation of ineffability and paradoxicality
(Corneille & Luke, 2021; Hood, 1975; James, 1983 [1902];
Stace, 1960). These shifts are occasionally characterized by
a sense of dissolution of past conditioning including existing
beliefs and attitudes; a feeling of resetting the mind (some-
times interpreted as a “rebirth”); increased curiosity and
gratitude towards life; and a newfound sense of purpose or
calling to altruistically serve humanity. Such events are also
believed to enhance and promote pro-social and pro-environ-
mental behaviors such as empathy, compassion, gratitude,
and nature connection (Harrild & Luke, 2020; McClintock
etal., 2016), as well as healthier lifestyle choices, which in
turn have been shown to improve mental and physical health
(Woollacott etal., 2020). Endogenous mystical experiences
are also linked to sustained improvements in treatment-
resistant substance abuse (McGee, 2020). Transformative
experiences may be preceded by psychological turmoil and
trauma, sleep deprivation or starvation, or direct practice of
specific activities —although the effect may not always be
anticipated by the practitioner. They can also occur spon-
taneously, without any discernible trigger and so are not
restricted to meditative settings (Corneille & Luke, 2021).
EP are also associated with challenging experiences,
including increased awareness of unpleasant sensations or
emotions, and difficulty dealing with disruption to estab-
lished modes of perception and thought. Individuals may
experience heightened sensitivity and porosity (Luhrmann
etal., 2021) making them prone to report paranormal phe-
nomena or perceived extra-sensory perception (ESP) occa-
sionally manifesting as the sudden onset of hearing voices
or feeling malicious non-sensory presences (Greyson, 2000;
Grof, 2019). Perceptual and emotional processing may
change drastically and thought processes may quicken or
slow-down (Ingram, 2018). Such intense cognitive shifts
may leave the experiencer in a state of disarray, confu-
sion, or overwhelm, due to their existing worldviews being
altered (Grof, 2019). EP can also be associated with power-
ful energetic or physical effects such as shaking, trembling,
involuntary positionings and contortions, electric sensations,
and temperature changes in the body (Lindahl etal., 2017;
Woollacott etal., 2020) and these occurrences sometimes
negatively impact the overall view of the experience. Con-
sequently, distress and impairment can arise during an EP
episode or afterwards as individuals attempt to cognitively
interpret their experiences (Grof & Grof, 1989, 2017; Lukoff
& Everest, 1985).
While contemplative traditions are often explicit about
the possibility of negative effects from EP, numerous stud-
ies examining the effects of contemplative practices have
been criticized for adopting methodologies prone to report
positively biased results (Lutkajtis, 2018; Van Dam etal.,
2018). However, in recent times, an increasing number of
studies have attempted to actively assess adverse side effects
from mindfulness-based interventions. Britton etal. (2021)
found meditation practice in mindfulness-based programs
was associated with transient distress and negative impacts
at similar rates to other psychological treatments. Francis
etal. (2022) found 19 (31%) of their participants responded
“yes” to the question on “unexpected, challenging, or dif-
ficult experiences that you associate with your practice of
meditation.” Recent systematic reviews have revealed the
total prevalence of adverse events in studies of meditation
practice to be 8.3% (Farias etal., 2020) and found that nearly
all studies of meditation interventions or mind-body prac-
tices report some form of mental distress and less commonly
somatic distress (Taylor etal., 2022).
Should the side effects of EP become distressing or impair
everyday functioning, they are referred to in transpersonal
psychology literature as spiritual emergencies or crises (Grof
& Grof, 1989). Activism from transpersonal psychologists
in the 1980s and 1990s sought to distinguish spiritual crises
from psychopathology, resulting in the introduction of the
Religious or Spiritual Problem diagnostic category in the
American Psychiatric Association’s Diagnostic and Statisti-
cal Manual of Mental Disorders in 1994 (DSM-IV; Ameri-
can Psychiatric Association, 1994; Lukoff, 1985). However,
modifications to the initial proposal excluded experiences
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1164 Mindfulness (2024) 15:1162–1175
outside a religious context (Turner etal., 1995). This exclu-
sion renders the category incomplete, given that negatively
valenced EP may occur more frequently in cases where the
experiencer does not have a religious or cultural structure
to assist in the interpretation of their experience (St Arnaud
& Cormier, 2017; Taylor, 2013). Despite studies addressing
the limitations of DSM categorization (Harris etal., 2019;
Menezes & Moreira-Almeida, 2010; Parnas & Henriksen,
2016; Rock & Clark, 2015), the Religious or Spiritual Prob-
lem diagnostic category remains virtually unchanged (DSM-
5; American Psychiatric Association, 2013). Further, while
the DSM-5 covers adverse side effects requiring immediate
treatment, such as dissociation and depersonalization, other
non-acute yet possibly equally distressing challenging effects
are omitted (Lindahl etal., 2017).
Accounts of individuals seeking help from established
healthcare systems suggest that, despite the updates to the
DSM, clinicians are not equipped with appropriate knowl-
edge and training to assist individuals who experience EP
(Grof & Grof, 2017). Although presentations of EP are
acknowledged in many contemplative, spiritual, religious,
and cultural traditions, and often regarded as goals, gifts, or
signposts of being on the “right path” (Buddhaghosa, 2010;
Sobhana, 1994; Wallace, 2011), mainstream psychology
and psychiatry typically view more extreme challenging EP
as symptomatic of mental disorder by default (Blom, 2013;
Menezes & Moreira-Almeida, 2010; Parnas & Henriksen,
2016). Although such a diagnosis may at times be accurate,
a lack of empirical data on the varieties and outcomes of EP,
and their overlaps with psychosis-inducing disorders such
as schizophrenia and bipolar disorder, makes it difficult to
identify the extent to which current diagnostic strategies are
appropriate.
Further, regardless of whether those experiencing EP
perceive them as positive or negative, fears of being mis-
understood, having one’s experiences invalidated, being
considered unstable, being diagnosed with a psychiatric
disorder, or being medicalized against one’s will, are not
uncommon (Cardeña etal., 2000). For these reasons, EP and
particularly negatively valenced EP are under-reported both
in clinical practice and in society more broadly (Lindahl
etal., 2017). Yet, early identification of potentially chal-
lenging effects from EP is important for the mitigation of
spiritual crisis (Shimokawa etal., 2010) and for the success-
ful cognitive interpretation and integration of the EP (Parker,
2018). Access to peer support and coherence between clini-
cal responses and the experiencer’s interpretive frameworks
may also play a role in successful integration of the EP (Van-
derKooi, 1997).
Thus, with the growth of the multibillion-dollar meditation
industry, increases in engagement with meditation practices
worldwide (Wieczner, 2016), and growing interest in advanced
meditation including meditative development and meditative
endpoints (Galante etal., 2023; Sparby & Sacchet, 2022;
Wright etal., 2023), EP are likely to become more widely expe-
rienced and consequently more frequently encountered in clini-
cal settings. An understanding of the prevalence and outcomes
of EP among both meditating and non-meditating members of
the general population is becoming an increasingly important
matter. The potential benefits of EP, coupled with potential dan-
gers, highlight the necessity for a sophisticated, detailed, and
more complete understanding of such phenomena. From both
ethical and medical standpoints, it is thereby crucial to address
(a) whether such phenomena are widespread; (b) which are
most common; (c) the balance of positive versus negative con-
sequences; and (d) whether and where those struggling with EP
seek help. These questions and expectations were assessed in
the present, exploratory, study of the occurrence of EP among
general populations.
Our expectation was that EP would be present both
among meditators and non-meditators in the general popula-
tion, that it would be of the types described in contemplative
practice manuals, that EP would have the potential to lead to
both positive and negative changes to well-being, including
the types of suffering described in Buddhist traditions (e.g.,
the Dukkha nanas; Ingram, 2018).
Method
Participants
Participants were recruited from two commercial survey
panels (US MTurk and UK Qualtrics ) and one online com-
munity (subscribers to a popular Rationalist blog). MTurk
provided a convenience sampling approach to evaluate per-
formance of the instrument developed for this study. Qual-
trics is a reputable commercial survey panel known to offer
a large pool of respondents representative of the UK popu-
lation. Access to the Rationalist blog readers presented an
opportunity to gather additional data from a more homog-
enous population known to take a skeptical approach to
meditative experiences. Purposive selection of three diverse
populations across two countries ensured main results would
be robust to sampling frame bias.
Permissions to recruit participants were sought and
granted prior to the commencement of the study. All par-
ticipants were over 18 years of age. Participation was vol-
untary. A total of 3135 participants provided valid responses
to the survey (UK Qualtrics: n = 1130; US MTurk: n = 351;
Rationalist blog: n = 1654). The UK Qualtrics and US
MTurk samples were reasonably representative of the age
groups, genders, and ethnicities of the sampled populations.
The MTurk data oversampled the 35–54 group compared to
the 55 + age group, and undersampled Hispanic/Latino eth-
nicities compared to the White ethnicity. There is otherwise
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1165Mindfulness (2024) 15:1162–1175
no indication of response bias from these demographic data.
Although the Rationalist blog readers had distinctive demo-
graphic skews compared to the other two populations, these
closely reflected the underlying blog readership demograph-
ics (Table1).
UK Qualtrics and US MTurk data included geospatial
locations for response completion. Plots of these locations
(Supplementary InformationFigureS1) demonstrate the
samples are geographically distributed as would be expected
from representative surveys. There is therefore no indication
of response bias from survey location.
Past diagnoses of mental illness were relatively com-
mon within our samples, having been received by 36% of
respondents across all three samples. This proportion is
consistent with other estimates of the lifetime prevalence
of mental disorders. For example, while 47% of individu-
als in the USA are reported to experience mental illness
during their lifetime (Kessler etal., 2009), for 25% of these
people, onset of mental illness occurs after the age of 24
(National Alliance on Mental Illness, n.d.). Combined, these
results suggest the proportion of our sample who have had
a diagnosis of mental illness is a reasonable approximation
of population averages, and there is no evidence of dispro-
portionate responding from those with a past diagnosis of
mental illness.
Procedures
Qualtrics panelists were invited to participate with the
message: “Congratulations! You have been selected, you
have x surveys available, you can earn up to $x.” MTurk
workers were invited to participate in a survey that would
ask whether they had a spiritual or meditative practice and
also about their well-being. Recruitment of Qualtrics pan-
elists and MTurk workers followed the standard practice
of issuing invitations and accepting responses until demo-
graphic quotas and sample size requirements were met.
The Rationalist blog readers were invited to participate in
25 surveys of which the 7th was “Meditative Experiences.”
The “Meditative Experiences” survey was completed as an
independent task that did not include questions from any of
the other 24 surveys, thereby minimizing context effects.
All invitations required adult participants and responses
were screened to ensure this criterion was met.An infor-
mation sheet was used to address ethical requirements and
introduce the survey topic.
Although the study was not expected to involve any
obvious risks, helplines were provided for participants
who continued to be affected by past related unpleasant
experiences. Participants were informed that participa-
tion was voluntary and anonymous, that they could omit
answering any question, and were given the option to with-
draw from participation prior to submission of the ques-
tionnaire. Anonymity was maintained throughout the study
and raw data stored on a password-secured computer. The
information sheet also sought to reduce selection bias for
all three surveys by stating:
Many people report unusual mental phenomena that
have a spiritual or mystical component. Almost half
of US adults (49%) report having had a ‘sudden reli-
gious insight or moment of awakening’. A similar
number (46%) experience mental health challenges
during their lifetime. Very little is known about the
relationship between unusual mental phenomena,
mental health, and well-being. To find out more, we
are asking a range of people about their spiritual or
meditative practices and their experience of unusual
mental phenomena. We hope you will answer the sur-
vey to help us better understand these widespread
human experiences.
The same survey was applied to all three populations
subject to minor variations in survey logic and question
stem wording to reflect unique characteristics of each pop-
ulation and apply lessons learned from prior implementa-
tion. For the commercial panels, the survey was imple-
mented using Qualtrics survey software with pre-testing
followed by the main survey. For the Rationalist blog, the
survey was implemented by the blog host (including all
ethical requirements).
Table 1 Participant demographics. All values indicate percentage of
the given cohort. Figures in parenthesis are comparators drawn from
census.gov, gov.uk, and scotlandcensus.gov.uk for Qualtrics; data.
census.gov for MTurk; and subscriber base demographics for the
Rationalist blog. Age comparators are percentages of those 18+. US
ethnicity data is calculated as % of all reported ethnicities
*Not measured
Qualtrics
n = 1130
%
MTurk
n = 351
%
Rtnl. blog
n = 1654
%
Age 18–34 32 (28) 22 (29) 57 (59)
35–54 33 (32) 56 (32) 36 (33)
55+ 35 (40) 22 (38) 7 (7)
Gender Male 47 (50) 50 (50) 83 (85)
Female 52 (50) 50 (50) 11 (11)
GNB/other 0.4 (*) 0.3 (*) 6 (5)
Ethnicity White 82 (83) 79 (66) 91 (86)
Asian 9 (9) 7 (7) 6 (5)
Black 6 (4) 8 (13) 1 (0.03)
Hispanic/Latino * 3 (14) 2 (2)
Other 3 (5) 3 (1) 4 (6)
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1166 Mindfulness (2024) 15:1162–1175
Measures
To investigate the prevalence and effects of EPin gen-
eralpopulations,we assembled an interdisciplinary team
to develop a suitablesurveyinstrument using a quantita-
tive self-report questioning approach. The team included
professional expertise in emergency medicine, psychiatry,
public health, epidemiology, neuroscience, advanced medi-
tative research and practice, and survey research. We judged
extant multi-item scales in the domain of EP unsuitable for
this study and so developed a new questioning strategy to
elicit reports of the occurrence of EP, well-being outcomes,
assistance sought for negatively valenced EP, and potential
covariates to be investigated in future research.
Instrument development employed a process similar to
the Delphi method, modified to suit the context of our study.
The interdisciplinary team acted as a panel of experts who
iteratively contributed their insights through multiple rounds
of refinement. Unlike the traditional Delphi method, our pro-
cess did not maintain anonymity of panel members, focusing
instead on collaborative discussion to achieve consensus on
the design of the instrument.
Within the instrument, the questioning approach was to
obtain direct recall of personally experienced events. This
was informed by advanced questionnaire design principles
(Labaw, 1982; Gendall, 1998; Holdershaw etal., 2003),
including asking questions that respondents could answer
with sincerity, and Rossiter’s (2011) advocacy for single-
item measures when both object and attribute under question
are concrete to respondents. To facilitate unambiguous recall
and reporting, we avoided abstract terminology in favor of
questions that were grounded in the specific, describable
aspects of meditative experiences. We also employed onto-
logically neutral language able to accommodate a wide
range of contemplative, spiritual, religious, and existential
perspectives.
Survey questions typically began with a stem introducing the
personal characteristic or experience, followed by a pre-deter-
mined list of single-item measures of alternative outcomes or
events that may have been experienced, from which respondents
could select as many as applied. An "other" category and free
text box were provided to capture responses that fell outside the
pre-determined options. Specific details of individual question
wording are presented throughout the Results section.
The final instrument underwent multiple rounds of
pre-testing, including evaluations by the authorship team,
local postgraduate students, a sample of 30 MTurk workers
(excluded from the final study sample), and through techni-
cal pretests on the MTurk and Qualtrics platforms to ensure
survey functionality. Continuous minor emendations were
made between studies to reflect lessons learned from each
implementation and to tailor question wording to suit target
populations more effectively.
Data Analyses
Data was cleaned to remove duplicate, incomplete, and
inattentive responses, and to harmonize skip logic between
implementations. Cleaning and analysis were undertaken
using Microsoft Excel and IBM SPSS software packages.
Given the exploratory nature of this work, analysis was
restricted to reporting and comparisons of population esti-
mates, with uncertainty quantified through summarized
reporting of the standard errors present in each table. Chi-
square analysis is also employed in one instance to deter-
mine the significance of the association between suffering
and mental illness.
More extensive reporting of statistical tests for all ques-
tions across all surveys would run a significant risk of type
1 errors. This risk could be addressed by making a Bon-
ferroni correction to critical values for the statistical tests;
however, determining the numerator of the Bonferroni
correction would require assumptions about which tests to
include to determine the quantum of correction. Thus, unlike
the reporting of standard errors, more extensive statistical
testing would in this case would not be independent of the
assumptions of the analyst.
Results
“Supernatural” and“Miraculous” Events
Contemplative practice manuals record many types of EP
and describe their phenomenology in some detail. However,
for those unfamiliar with contemplative traditions, EP are
sometimes interpreted as “supernatural” or “miraculous”
events. We therefore first asked: “Have you ever, while
not on mind-altering substances, had supernatural experi-
ences that you believe ordinary science could not explain,
appearing to be ‘miraculous,’ ‘magical,’ or ‘psychic’.” (UK
Qualtrics and US MTurk), and “Have you ever, while not
on mind-altering substances, had any supernatural experi-
ences such that you believe the ordinary laws of physics
could not explain, so they appear to be ‘miraculous,’ ‘magi-
cal,’ or ‘psychic’?” (Rationalist blog). The question stem
was slightly altered between surveys to reflect wording most
likely to be used by the sampled population.
Twenty-six percent of all respondents reported such experi-
ences. The UK Qualtrics group displayed a higher prevalence
of reports (39%), compared to the US MTurk group (26%) and
Rationalist blog group (18%) –— with 13% of the UK Qualtrics
group reporting precognitive experiences (“inexplicable knowl-
edge of something that had not yet happened”), 11% reporting
having had visions of other beings (“… such as angels, demons,
djinni, spirits or ghosts”), and 6% reporting out-of-body experi-
ences (“the experience of leaving my body behind to travel to
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1167Mindfulness (2024) 15:1162–1175
some other place”). The most common reports overall across
the three cohorts were forms of precognitive knowledge (10%),
followed by visions of other beings (7%), knowledge of distant
events (6%), and knowledge of others’ thoughts (6%). The least
commonly reported experience was the ability to move objects
without touching them (1%). Detailed results are provided in
Supplementary InformationTableS1.
Sudden Unusual Mental Events
We next asked about EP using the descriptions developed by the
expert panel. The question stem was: “Have you ever, while not
on any mind-altering substances, had sudden unusual mental
events that involved strange changes in perception, or ecstatic
pleasurable feelings?” This was followed by presentation of a
range of pre-determined answer categories. Forty-five percent of
all participants reported of all participants reported experienc-
ing such sudden unusual mental events. Symptoms of dereali-
zation (“had the sense that everything was unreal, like a dream
or a cartoon”) were most reported, closely followed by both
“unexpectedly experienced a strong sense of oneness with the
world, or with God” and “unexpectedly felt strong ecstatic thrills
running through my body”, and then “unexpectedly experienced
a strong sense of vivid brightness and clarity in sensation.” Least
commonly reported was the experience of “lost consciousness in
the midst of a meditative or spiritual experience.” Although the
rationalist blog group had reported fewer supernatural experi-
ences, they reported more sudden unusual mental events (52%)
compared to both other groups (UK Qualtrics: 38%; US MTurk:
33%) (Table2:see the table legend for standard errors).
Respondent Perception ofLong‑Term Changes
toWell‑Being
The expectations of the expert panel were that positively per-
ceived events would be more likely to have positive impacts on
well-being and negatively perceived events would be more likely
to have negative impacts, but that impacts on well-being may
occasionally have the opposite valence to EP due to complexi-
ties in integrating the experience. The relationship between EP,
perceived valence of the experience, and longer-term changes
to well-being is therefore complex, so we adopted a multi-part
questioning strategy to investigate these effects. First, partici-
pants were asked about their experience with sudden unusual
mental events, as reported above. Then, they were asked whether
some of the events they had experienced (if any) were perceived
positively, for which they were instructed to select from a list
of positive terms used by a variety of traditions to describe EP.
The question was as follows: “Sometimes these unusual mental
events are seen in positive or transformative terms, even if they
weren’t all that pleasant at the time - Which of these positive
terms (or their very near equivalents) have you ever thought
might reasonably apply to what was going on with you?”. The
outcomes were measured through the question: “If you have
experienced any of these unusual positive mental events, did you
notice any longer-term change to your wellbeing afterwards?”
Table 2 Participants who had experienced sudden unusual mental
events. All values indicate percentage of the given cohort. Maximum
standard error is 1 percentage point for the UK Qualtrics and Ration-
alist blog respondents (0.014/0.012, respectively), and 3 percent-
agepoints for the US MTurk respondents (0.025)
*Not measured
Qualtrics
n = 1130
%
MTurk
n = 351
%
Rtnl. blog
n = 1654
%
All
n = 3135
%
I have never had such experiences 62 67 48 55
Had the sense that everything was unreal, like a dream or a cartoon 11 11 22 17
Unexpectedly experienced a strong sense of oneness with the world, or with
God 7 13 21 15
Unexpectedly felt strong ecstatic thrills running through my body 7 7 22 15
Unexpectedly experienced a strong sense of vivid brightness and clarity in
sensation 6 7 16 11
Felt that everything else was very small, or that I was very big 6 6 13 10
Felt heat or electricity rise in my body 8 7 10 9
Had my point of view suddenly shift out of my body to different perspective 6 5 9 8
Saw bright lights that were not physically present 6 6 5 5
Had some of my sensory input turn into discrete rapidly strobing frames 3 1 4 3
Lost consciousness in the midst of a meditative or spiritual experience 3 2 2 2
Yes, something else 4 3 6 5
Saw sacred geometric patterns that were not physically present * * 4 *
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1168 Mindfulness (2024) 15:1162–1175
with options to select varying degrees of positivity and nega-
tivity. A nearly identical series of questions followed, adapted
for negatively perceived events. In both cases, respondents who
had experienced multiple such events were invited to select all
answer categories that applied. The results therefore report num-
bers of event outcomes rather than the number of respondents
(Table3: see the table legend for standard errors).
Over all types of outcomes reported across all three
surveys, in 30% of cases respondent did not notice any
changes after the sudden unusual mental event, in 28% of
cases respondents noticed negative outcomes, and in 40%
of cases respondents noted positive outcomes. Those who
experienced positive events mostly associated these with
positive outcomes (55%) and those who experienced nega-
tive events mostly associated these with negative outcomes
(48%). Some from each group reported that they did not
notice any changes (27% and 36%, respectively). However,
a smaller proportion associated events with oppositely
valenced outcomes, namely negative outcomes for 15% of
positively valenced events and positive outcomes for 14% of
negatively valenced events (Table3).
The results suggest that positively perceived events are
more likely to lead to positive changes to well-being, while
negatively perceived events are more likely to lead to nega-
tive changes to well-being (Table3). However, this rela-
tionship is not determinative; that is, either type of event
(positive or negative) could lead to either type of outcome
(positive or negative).
Types ofNegative Experiences
Respondents were asked “If you suffered from unpleasant
emotions, thinking or physical pain after an unusual men-
tal event, what kind of experiences were associated with
your suffering. Please select all that apply.” Responses were
invited according to an inventory of nine common forms of
suffering derived from contemplative practice manuals and
the expertise of the expert panel.
Of all responses, most reported were “Feelings of mis-
ery, sadness, or disgust with mylife”, followed by “A dis-
turbing sense that the world is nothing but a dream or
cartoon”. Least commonly reported were “Painful sensa-
tions of pins and needles in the body, head, or face”.One
percent of all respondents selected “Something else”
(Rationalist blog) or “Some other type of experience”
(Qualtrics and MTurk) indicating the accuracy of the
standard descriptions of suffering drawn from contempla-
tive practice manuals (Table4:see the table legend for
standard errors).
Intensity ofWorst Suffering
Respondents were asked, “How intense was the worst
of these experiences?” In total, 18% of the total sample
(n = 3135) reported some degree of intensity of suffering
with 6% reporting mildly intense suffering, 8% reporting
moderately intense suffering, and 4% reporting severely
intense suffering. A further 34 respondents (1.1% of the
combined sample) reported that the suffering was life-
threateningly intense.
Association withMental Illness
Respondents were asked “Has a physician or mental health
professional ever diagnosed you as having any type of men-
tal illness, such as an anxiety disorder, depression, bipolar
disorder, psychosis, schizophrenia or similar, or prescribed
you medication for any type of mental illness?” For those
who experienced moderately intense, severely intense, or
life-threateningly intense suffering, 57% reported a diagnosis
of mental illness and 43% did not. The association between
Table 3 Long-term changes to
well-being. All values indicate
percentage of the given cohort.
Maximum standard error is 1
percentage point (0.01) across
all cell entries
After events perceived as
positive
n = 1453
%
After events perceived as
negative
n = 901
%
After both
types of
events
n = 2354
%
Did not notice any changes 27 36 30
Temporary minor negativity 9 25 15
Temporary major negativity 3 14 8
Enduring negativity 3 9 5
Temporary minor positivity 24 5 17
Temporary major positivity 14 4 10
Enduring positivity 18 5 13
Some other change 2 2 1
Total for negativity 15 48 28
Total for positivity 55 14 40
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1169Mindfulness (2024) 15:1162–1175
a diagnosis of mental illness and greater suffering was sig-
nificant (χ2(4, n = 617) = 22, p < 0.001).
Seeking Help After Negative Experiences
Respondents were asked if they sought help for their nega-
tively perceived events. A majority of those who reported
any degree of suffering did not seek help (63%). Of those
who had negatively perceived events, 15% sought help from
generalist healthcare providers, 13% from family or friends,
12% from experts in meditation or spiritual practices, and
8% from specialist healthcare providers. Note this answer
category allows multiple answer responses.
Despite widespread prevalence of suffering after unusual
mental events, only 47% of all respondents (32% UK Qual-
trics, 25% US MTurk, 62% Rationalist blog) had heard of
the “risks of challenging negative emotional, cognitive or
physical outcomes from meditation or spiritual practice”
(rationalist blog) or “unpleasant emotions or thinking, or
physical pain, arising from spiritual or meditative practice”
(US MTurk and UK Qualtrics) prior to the completion of the
survey. For the group who experienced suffering following
EP, 29% still reported that they had not heard of these risks
prior to completion of the survey (29% for those experienc-
ing moderately intense suffering, 29% for those experiencing
severely intense suffering, and 26% for those experiencing
life-threateningly intense suffering).
Discussion
We were concerned to know whether EP were widespread,
which were most common, the balance between positive ver-
sus negative consequences; and whether and where those
struggling with EP sought help. We found 45% of partici-
pants reported experiencing non-pharmacologically induced
EP at least once in their lives, including derealization (17%),
unitive experiences (15%), ecstatic thrills (15%), vivid per-
ceptions (11%), changes in perceived size (10%), bodily heat
or electricity (9%), out-of-body experiences (8%), and per-
ception of non-physical lights (5%). Respondents reported
a mix of positive and negative well-being outcomes follow-
ing EP, with 13% claiming moderate or greater suffering
and 1.1% claiming life-threatening suffering. Of those who
experienced suffering, 63% did not seek help.
Experts working with meditation and its modern deriva-
tives may already recognize the potential for EP to emerge
from certain specialized contemplative practices (or from
psychedelic use). Nonetheless, EP continue to be under-
reported in clinical settings (Lindahl etal., 2017) with evi-
dence suggesting clinicians are not adequately prepared to
assist individuals who experience EP (Grof & Grof, 2017),
with deeply unsettling experiences of EP tending to be
pathologized by default (Parnas & Henriksen, 2016). These
issues are reflected in the content of the DSM-5, and in the
general expectation that adverse side effects of EP will only
rarely present in modern mental and medical healthcare
systems, and that they are more likely to occur in a small
minority of individuals with significant comorbidities such
as psychosis, schizophrenia, bipolar, or schizotypal personal-
ity disorder, or because of psychosis-mimicking substance
abuse.
Contrary to these views, our expectation was that unwanted
EP would constitute a risk for those engaging in modern mind-
fulness-based practices drawn from contemplative traditions,
and that this risk may be reflected in some occurrence of EP
among the general population. The use of mindfulness has
increased from 2.5% of adults in the United States in 2012 to
5% of adults in 2017 (Simonsson etal., 2020a) and has been
estimated to be 15% of adults in the United Kingdom (Simons-
son etal., 2020b). We were surprised to find evidence that EP
was in fact even more widespread than mindfulness practices.
Table 4 Types of negative experiences. All values indicate percentage of the given cohort. Maximum standard error is 1 percentage point across
all cell entries (0.012)
Qualtrics
n = 1130
%
MTurk
n = 351
%
Rtnl. blog
n = 1654
%
All
n = 3135
%
Feelings of misery, sadness or disgust with my life 8 4 11 9
Obsessive thinking about problems and how they might be solved, or corrected 7 5 7 7
Feelings of nausea, fear or terror about physical or supernatural surroundings 5 3 6 5
Disenchantment, irritability or desire to change things I previously enjoyed 4 2 7 5
A disturbing sense that the world is nothing but a dream or a cartoon 5 3 6 5
A disturbing sense that I no longer exist as a person 5 1 4 4
Rapid cycling between negative and positive emotions and thoughts 4 4 3 4
Painful sensations or pins and needles, or burning, in the body, head or face 4 2 2 3
Something else/ Some other type of experience 1 1 2 1
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1170 Mindfulness (2024) 15:1162–1175
Of all the participants who took part in this study, nearly half
reported experiencing sudden unusual mental events at some
point in their lives while not under the influence of mind-altering
substances. Further, over one-quarter of the total number of par-
ticipants additionally reported non-pharmacologically induced
supernatural experiences.
Given the widespread occurrence of EP, it is important to
understand the subsequent impact on well-being. Previous
studies observing endogenously occurring mystical experi-
ences (a subset of EP focused on positive events) have reported
predominantly positive long-term increases in overall physi-
cal and mental well-being following an event (Corneille &
Luke, 2021; Taylor & Egeto-Szabo, 2017). Other studies have
reported adverse effects among meditators (e.g., Farias etal.,
2020; Goldberg etal., 2022) but did not examine the variety
of EP-related events among the general population uncovered
by our surveys. In our research, when participants were asked
whether EP was followed by longer-term changes to well-being,
most reported positive changes, followed next in frequency by
no perceived longer-term impact; however, a substantial propor-
tion of respondents reported negative effects. Strikingly, over the
whole sample, almost one-fifth of respondents reported experi-
ences of suffering following EP, and almost one-eighth of the
whole sample reported suffering that was moderately intense or
worse. Despite it being the least reported intensity of suffering, 1
in 100 people believed they had survived a life-threatening expe-
rience of suffering following EP. While well-being outcomes
were largely aligned with the initial valence of the EP event, a
minority of participants reported an oppositely valenced effect,
consistent with the expectations of the expert panel. These find-
ings suggest that suffering following the occurrence of EP, of
the types recorded in contemplative traditions, is already a sig-
nificant public health issue, despite the relative lack of clinical
attention to these effects.
The results also raise the question of what makes EP out-
comes vary so greatly. The vast spectrum of types of EP
makes it challenging to accurately determine which practices
are more conducive to positive or negative results and why
such a variety of outcomes do occur. To document all the
different types of EP and their possible outcomes is beyond
the scope of the present study; however, as EP has the poten-
tial to catalyze important transformation (whether negative
or positive), the mental and medical health community ought
to seriously consider the best and most appropriate ways to
support individuals through all types of EP, to ensure the
best possible outcomes for well-being.
In considering the response of participants to EP, we
found that of those who had experienced negative mental
events 63% did not seek help. A significant implication is
that those suffering from EP-related negative effects do not
perceive clinicians as an appropriate source of assistance.
The reluctance to seek help from those experiencing a nega-
tive consequence of EP may partly be due to uncertainty
about what effective help may be available; however, it may
also be partly due to the perceived potential for a controlling
or repressive response (Grof & Grof, 2017). This perception
may be substantiated. There are a lack of widely available
diagnostic tools and treatment plans to support clinicians
presented with adverse effects from EP (Lukoff etal., 1998),
and indeed current emergency medicine textbooks contain
minimal guidelines on treating EP (Tintinalli etal., 2016;
Walls etal., 2021). Given the widespread and occasionally
severe nature of negative effects related to EP, addressing
this apparent neglect is crucial. Substantial work is needed
to develop a body of research to support diagnosis and treat-
ment of EP-related negative effects in clinical settings, as
well as to communicate the results through relevant clini-
cal textbooks, training programs, diagnostic manuals, and
professional development. Properly understanding the long-
term effects of EP and their role in meditative development
will help ensure the best possible outcomes for individual
and societal health.
With the use of EP-inducing practices and EP-inducing
psychedelics increasing, the prevalence of clinical presenta-
tion of EP might be expected to increase, so there is poten-
tial for an increasing burden on clinicians and healthcare
systems from these practices. Also, more positively, there
is potential to move beyond use of contemplative practices
and psychedelics simply for emotional regulation, to instead
embrace achieving genuinely transformative experiences.
Clinicians and emergency physicians, as well as holistic and
well-being practitioners, should therefore become familiar
with the spectrum and scale of EP and the associated effects.
Without an appropriate and clear understanding of the high
prevalence of these experiences, they are unlikely to be con-
sidered a clinical priority and will continue to be bracketed
and treated within the pathological frame by default, even
where other treatments may be more effective.
For those providing or promoting contemplative prac-
tices, whether through traditional retreats, personal instruc-
tion, mindfulness-based intervention, commercial apps, or
informal groups, the principle of informed consent suggests
that participants should receive information on the range of
potential side effects of practice, along with advice for han-
dling any negative or disorienting effects (Grabovac, 2015).
Even positive experiences may cause significant personal-
ity, relationship, and life changes that may impact individu-
als in addition to the person who may have experienced EP
(Ingram, 2018). Some organizations already offer services
to address meditation-related negative effects, demonstrating
both the need and the possibility of providing counselling
to integrate challenging meditative experiences (American
Center for the Integration of Spiritually Transformative
Experiences; Cheetah House; Integrative Mental Health
University; International Spiritual Emergence Network;
Spiritual Crisis Network). Meditation providers should take
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1171Mindfulness (2024) 15:1162–1175
account of how to minimize negative effects that may arise
from meditation programs, as failure to do so may not only
cause harm for their clients, but open the door to potential
legal concerns, jeopardize their social license to operate,
and over time increase the risk of regulation. Research is
also required into the causes and conditions of negative or
disoriented effects, so that participant advice and support
can be appropriately tailored to the techniques selected for
practice (Galante etal., 2023).
Limitations andFuture Research
A general limitation of the current study includes the reli-
ance on self-recall, a method which is vulnerable to error.
However, Griffiths etal. (2006) conducted a study on the
reliability of recall of mystical experiences and found retro-
spective recall in this context is not as prone to error as in
other contexts, perhaps due to the general subjective signifi-
cance of these experiences.
While the single-item direct questioning approach
adopted in this study is sufficient for obtaining population
estimates of biographical events that can be concretely
recalled, it may not be sufficient for clinical work. Here,
multi-item scales might be necessary to enhance diagnostic
confidence for individuals presenting with potential negative
effects related to EP. We recognize the method adopted here
as a limitation for clinical applications and propose this as
an area for future development.
To better understand the extent and impact of EP, rep-
resentative surveys should be conducted across additional
countries and diverse ethnic communities. There also
remains substantial potential to use survey data to examine
EP and their outcomes in more detail, including differences
in effects between specific contemplative techniques, as well
as investigating how the experience of positively or nega-
tively valenced EP affects the development of well-being
over time.
As the proportion of the population who have under-
taken MBI is increasing, it would be useful to include par-
ticipation in MBI as a potential risk factor or moderator
for EP, together with participants’ broader contemplative
practice history. However, given widespread occurrence of
EP among the populations studied, contemplative practice
histories alone are unlikely to be a sufficient explanandum
of the effects observed. More comprehensive studies of epi-
demiologicalrisk factors for EP are also required and could
include consideration of associations with different types of
mental illness, past trauma, psychedelic or other drug use,
and other personal characteristics.
Using samples from opt-in internet panels may raise
concerns about data quality. Studies have found that such
panels are less accurate than probability samples obtained
through random digit dialing, but more accurate than the
convenience samples otherwise widely used in social sci-
ence research (Berinsky etal., 2012). While concerns about
data quality are increasing, particularly for MTurk (Douglas
etal., 2023), evidence suggests that these panels continue to
offer a useful resource for social science researchers and that
some perceived disadvantages such as the presence of non-
naive respondents may be overstated (Chandler & Shapiro,
2016; Goodman & Paolacci, 2017). It remains important
to ensure sample diversity, perform unobtrusive attention
checks, remove duplicate and inattentive responses, and to
carefully evaluate data quality as has been done in the pre-
sent study; however, given adherence to these disciplines,
it is possible to have reasonable confidence in the resulting
data. Nonetheless, data quality continues to improve with
the emergence of newer providers, and evidence suggests the
Prolific panel currentlyperforms best (Douglas etal., 2023).
Further replications of the present work could usefully draw
data from that platform.
While our resultsdemonstrate that respondents com-
monly attribute changes in well-being to the experience
of EP, the use of self-reports nonetheless precludes rigor-
ous consideration of the direction of causation. Prospec-
tive longitudinal studies of sufficient size and design are
recommended to further explore questions of incidence,
predisposing factors, causality, developmental trajectories,
clinical patterns, and well-being implications. Importantly,
we cannot at present rule out the possibility that both EP
and health outcomes are commonly caused by some other
unobserved factors.
Finally, further research could also contribute to better
understanding of inter-population differences of the preva-
lence of EP, how EP is likely to be perceived, how EP affects
well-being, and how the individual experience of EP may be
integrated over time. As noted, religious or cultural struc-
tures may assist in the interpretation and integration of EP
(St Arnaud & Cormier, 2017; Taylor, 2013). Further, cer-
tain indigenous communities may retain cultural traditions
of the experience of EP that are unlike expectations to be
found in other populations. Research into culturally-located
traditions of EPmay require qualitative or anthropological
methods capable of more nuanced interpretation of the stud-
ied contexts than is achievable with a quantitative survey
instrument.
While replication and extension of these initial findings
is essential, we hope the results to date will provide guid-
ance on the prevalence of EP as a “variant of normal”, and
encourage clinicians, physicians, and holistic and well-being
practitioners to become aware of EP and tobetter consider
how best to support those undergoing such experiences. We
also hope to inspire experiencers to disclose their EP with
more ease; however, this in turn relies on an open acknowl-
edgement and understanding of EP in clinical practice.
Such open acknowledgement is the first step to promoting
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1172 Mindfulness (2024) 15:1162–1175
successful integration and well-being as outcomes of these
consciousness-altering experiences.
Supplementary Information The online version contains supplemen-
tary material available at https:// doi. org/ 10. 1007/ s12671- 024- 02356-z.
Acknowledgements Thanks to Massey University and Emergence
Benefactors for supporting fieldwork and research assistance costs.
Author Contribution MJW — conceptualization, data curation, for-
mal analysis, funding acquisition, investigation, methodology, project
administration, supervision, writing — original draft, review and
editing.
JG — conceptualization, methodology, writing — review and
editing.
JSC — conceptualization, writing — original draft, writing —
review and editing.
AG — conceptualization, methodology, writing — review and
editing.
DI — conceptualization, data curation, funding acquisition, meth-
odology, writing — review and editing.
MDS — conceptualization, methodology, supervision, writing —
original draft, review and editing.
Funding Open Access funding enabled and organized by CAUL and
its Member Institutions
Data Availability De-identified data will be made available once addi-
tional manuscripts, currently under preparation, are complete; in the
interim, please contact the first author for data access. AI tools were
not utilized in this study.
Declarations
Ethics Approval Approved by Massey University Human Ethics Com-
mittee (NOR 21/05).
Informed Consent Participants were briefed with an information sheet,
informed that participation was voluntary and anonymous, that con-
tinuing the survey would indicate consent, that they could omit answer-
ing any question, and that they could withdraw from participation any
time prior to submission of the questionnaire.
Conflict of Interest The authors declare no competing interests.
Open Access This article is licensed under a Creative Commons Attri-
bution 4.0 International License, which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long
as you give appropriate credit to the original author(s) and the source,
provide a link to the Creative Commons licence, and indicate if changes
were made. The images or other third party material in this article are
included in the article's Creative Commons licence, unless indicated
otherwise in a credit line to the material. If material is not included in
the article's Creative Commons licence and your intended use is not
permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a
copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/.
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