#79: Willoughby Britton, Jared Lindahl -- Does Meditation Have a Dark Side?

Willoughby Britton & Jared Lindahl

Willoughby Britton & Jared Lindahl

 
 

“If you have something other than calm and relaxation in your meditation experience, you're not alone and it's not your fault.” This is the message that Dr. Willoughby Britton and her colleague at Brown University/fiancé, Dr. Jared R. Lindahl, hope people will take away from their latest publication in PLOS ONE, titled, “The varieties of contemplative experience: A mixed-methods study of meditation-related challenges in Western Buddhists.” Dan, Willoughby, and Jared go deep in the podcast, discussing many of the challenges observed in this new paper, then propose some ideas about how the meditation industry can better recognize and assist meditators who may experience difficulties in their practice. 

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Key Takeaways:

  • There are many areas of a person’s experience where meditation challenges can occur, according to this research, which documents 59 categories of experience in seven domains: perceptual, affective (emotional), somatic, cognitive, motivational, social, and sense of self.
  • While many of these experiences are more prevalent after a lengthy meditation retreat, they can be experienced by more casual meditators as well.
  • Challenges in meditation can be considered similarly to pain from exercise. The exercise and sports industries have developed robust methods to prevent, diagnose, and rehabilitate injuries. Perhaps the meditation industry can learn to treat meditation pains in a more well-supported way.
  • What may seem to be a distressing development in your meditation practice may, by some traditions, be considered a step along path to enlightenment. Some steps on the path may be uncomfortable, according to these traditions.
  • While this study is just the start of investigating meditation-based challenges, Willoughby and Jared make clear that they are meditation advocates. They’ve each been practicing for over 20 years. Take home message: Definitely do meditate if interested, but be an informed consumer. Choose a program that matches what you’re looking for.

Quotes

“One possible way forward is when people start meditating, it might be a good idea to think about why they're meditating. What do they want? What kind of goals are they trying to achieve? Even, what is well-being? What is happiness? What is suffering? Really think about that, and then make sure that the practice and the teacher and the tradition and the program that you choose really matches your goals… Getting a good fit is really the best way to optimize your results.” -Willoughby Britton
 “We were interviewing teachers, we were really hoping to get some consensus statement about what is a meditation difficulty and what do you do about it, but teachers really varied considerably based upon their background, their lineage, their teachers, their approach, whether they had some sort of psychological or psychiatric training in addition to their training as a Buddhist teacher.” -Jared Lindahl
 “I think that, unfortunately, there is no pat answer for why these things happen that applies to everyone, that everybody's experience is unique, and that it's a complex set of factors that creates the perfect storm for each person. I think that really honoring individual differences in diversity and complexity is the name of the game.” -Willoughby Britton 

Other Content Mentioned:

How to learn more about Willoughby and Jared:

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Conversation Transcript

Conversation with Willoughby, Jared, and Dan:

Dan Harris: This is as close as we get to breaking news in the meditation world. We are doing a special interview today with a pair of scientists and researchers at Brown University who have put out a fascinating new study being published today in PLOS ONE.

Here's the deal, most of us ... I would venture to say all of us get into meditation because we want the good stuff. We want to be more calm, we want to be more relaxed, we want to have less stress, we want to be less yanked around by our emotions. We see those tantalizing brain scans, the imagery from the fMRIs and we want our brains to be changing in that way. We see athletes and entertainers doing this stuff, and we want it, I think. Certainly that was the case for me.

But the truth is sometimes there are side effects, and you don't hear a lot about it. There hasn't been an enormous amount of scientific research into this subject, a controversial subject I might add, until now. Which brings us back to the aforementioned researchers at Brown University, Willoughby Britton and Jared Lindahl who have just put out this study that is being published, as I said, in the journal PLOS ONE.

Let me just say, I'm going to give a caveat that you've heard me give before which is that meditation is a very small world, so as is sometimes the case, these guys are my friends. That doesn't mean I won't be asking them tough questions, but just in the name of full disclosure and honesty, I just want to say that.

Jared and Willoughby, thanks for coming on!

Willoughby Britton: Thanks for having us!

Jared Lindahl: Yeah, thanks, Dan, a pleasure to be here.

Dan Harris: I know you've been working on this, I know just because we've been talking about it for years, I know you've been working on this really in a very, very dogged manner for a long time, so congratulations on finally seeing this work published, and I know it's just the beginning.

I want to, before we get to the meat of what you're reporting here on some of the side effects of meditation, I want to just get a little bit, so that people know who they're dealing with here, I want to get a little bit of background from both of you. So Willoughby, let me start with you. How did you get into meditation, and why this particular angle for your research?

Willoughby Britton: I started meditating 22 years ago, actually, after the death of a friend, a childhood friend. So, very much the same reasons other people get into it. Had a lot of grief and anxiety and wanted to learn ways to hold that better. That's how I started.

Most of the research that I've done on meditation has been around the health benefits, so particularly around depression and high states of negative affect has been my main approach.

Dan Harris: High states of negative affect. Can you say that in ... can you dumb that down for me?

Willoughby Britton: (laugh) Uh, feeling (bleep)y. Just feeling anxious, stressed, depressed, down, blue. Is that better?

Dan Harris: Yeah, yeah yeah yeah. So you were looking at mitigation of high states of negative affect.

Willoughby Britton: Yeah. So, I mean, that's been my main research is really the benefits, but really emotional benefits, and then looking at how does different types of meditation affect the brain and the body, and how do those changes in the brain and body, how do they relate to the emotional benefits? So that's been my main research.

I think that as the field of meditation has gained more traction and more ground, we've been able to ask broader questions. I think that it's in that larger context of many years of research on positive experiences that we're able to ask something ... a little bit more balanced questions.

Dan Harris: Yeah, I see it as a maturation of the field.

Willoughby Britton: Exactly.

Dan Harris: To be able to go beyond the health benefits. Did you, I'm just curious, from your personal experience, what drew you to looking at some of the side effects here, some of the darker aspects of meditative experience? Did you have some of these negative experiences? Did that pique your interest, personally?

Willoughby Britton: Sure, I've had plenty of really challenging experiences and a number of dharma friends have as well. I think we saw how meditation was being represented in the media as a sort of martini or a warm bath. It was sort of a joke. It's not quite that simple. But then we started to see that people actually believe that, that they think that it can be used for pretty much anything, across the board, without any downsides or challenges. Anyone who's been meditating for any period of time knows that that that's a little bit of a simplification.

I think that was the ... just our personal practice and talking to friends and teachers, knowing that there's more to the story, and then when I was doing my residency at Brown at a in-patient psychiatric hospital, there were two meditators that were hospitalized while I was there who had just come off a 10-day retreat. I sort of thought, you know, two in one year seems like something worthy of following up with. So that was really the beginning of, like, I should take this seriously in my research and make this into a research study.

Dan Harris: I failed, miserably, at giving your full title. So, you are Assistant Professor in the Department of Psychiatry and Human Behavior at Brown University. So you are a medical doctor, a psychiatrist? Am I saying that correctly?

Willoughby Britton: Actually, no, I'm not a psychiatrist.

Dan Harris: You're not.

Willoughby Britton: It's very confusing because my appointment is in the Department of Psychiatry, but I'm actually a Clinical Psychologist. So I have a Ph.D., not an M.D.

Dan Harris: Got ya. But you've done neuroscience research, correct?

Willoughby Britton: That's right, yep.

Dan Harris: That brings me to your fiance, Jared Lindahl, Visiting Assistant Professor in Brown's Cogut Center for the Humanities. Jared, how did you get into meditation, and why did you get interested in this particular angle, aside from just falling in love with Willoughby?

Jared Lindahl: (laugh) Yeah, that came much later. I've been involved with the practice of meditation for about 20 years. My interest really started very early in college where I was first, I guess, exposed to yoga and meditation classes. I think what interested me and what has for a long time interested me is questions around the nature of consciousness, the range of possible human experiences, how consciousness and subjective experience can be developed or regulated or wielded as a tool, and investigated, rather than something just sort of passively experienced.

As I was studying philosophy and anthropology and religion in college, I became particularly interested in the contemplative techniques that are really attempts to get better acquainted with the mind and the body and emotions and perception and to have a more active and maybe dynamic relationship with those.

So, questions around consciousness, range of human experiences and how those impact people has been, for a long time, what I've been interested in and eventually what I came to pursue academically in my undergraduate, and especially in my graduate training, which was in the academic study of religion. By the time I was finishing my Ph.D, more specifically in the cognitive science of religion, so using methodologies and existing scientific research and theories to attempt to provide some novel explanations for the relationship between religious practices and religious experiences.

So, I was researching, in particular, experiences described in metaphors of light and luminosity. It so happened that I was giving a conference paper on that at a cognitive science of religion conference here at Brown back in 2010, and Willoughby was paired to be my respondent to that paper, based upon some expertise she had. That's when I first became acquainted with the study that was really just beginning at that point in 2010.

Dan Harris: So she was already pushing ahead with what's known as the Varieties of Contemplative Experience study at that point?

Jared Lindahl: Yeah. It was just getting off the ground. There were probably around, I don't know, a dozen interviews or so that had been completed at that point.

And then I had a number of academic appointments after graduating that year and still kept in touch with her. We ended up running a number of research symposia, and then also writing the first paper based upon preliminary data from the study, which was really an attempt to unify my dissertation question with the reports of light experiences that she had already gathered in the first half of the study. So, our prior paper that has been published on those light related experiences was putting forth a model based upon my dissertation research on how sensory deprivation is a close analog to meditative practices, and we might have something to learn by looking at sensory deprivation research and explaining certain types of experiences associated with meditation.

So, that lead to our initial collaboration, and it's a hard project not to become immediately interested in and totally captivated and consumed by, so I eventually figured out how to get to Brown and really dove into directing the project, completing the interviews, and running a lot of the qualitative analysis that we did on the basis of the paper.

Dan Harris: I like the fact that I have a tiny walk-on role in your relationship because I happened to have been stopping by in Providence on my way to see my parents in Boston the day you moved in, Jared.

Willoughby Britton: Yep, that's right, I remember meeting you for the first time, and we had just gotten back from IKEA, and we were unloading Billy bookshelves. You got out of the cab in your suit, and that was our first half hour together was you helping us move bookshelves.

Dan Harris: (laugh)

Willoughby Britton: You made a big impression on me.

Dan Harris: Right, right, exactly. Well, definitely you guys made a big impression on me. I've been, as Jared said, when you hear about this study, you do become captivated by it.

So let's get to this study. Let me start with you here, Willoughby. What is the headline out of this study? And Jared mentioned interviews. We should say that you ... I'm probably going to mangle this, but the basis of the data is that you conducted, I believe, 100 interviews with meditators who had had challenging experiences, and that formed the basis of your study. And I'll let you describe what the conclusions are.

Willoughby Britton: Yeah, so the basic idea was to ... We already know all of the positive effects. They've been circulating for years now, and we wanted to see what's the other side of this story? What are the other kinds of effects?

So one of the best places to find that out is to ask meditation teachers, especially ones that run their own centers, have been teaching for decades and have seen hundreds and hundreds of students. So that's where we started was talking to really experienced teachers about what kinds of difficulties have you observed in your students? When we asked them those questions, a number of the teachers started to tell their own stories. "Oh, in my life, in my practice, here are some of the difficulties that I had."

So then we started making those teachers that we were interviewing as teachers, we did a separate interview as practitioners as well. So that's why about 60% of our sample ended up being meditation teachers themselves.

We have two sets of interviews, one of teachers talking about their students, and then one of meditators who have reported various kinds of challenges. That's the basis. And I think there were 92 altogether, yeah.

Dan Harris: What are the challenges you're finding? What are people encountering?

Willoughby Britton: Well, there's 59 categories of experiences, so quite a few to go over. We separated those out into seven different domains. So we have perceptual, affective (which is emotional), somatic, cognitive.

Dan Harris: Somatic meaning body-related.

Willoughby Britton: Yep, bodily-related, body function.

Dan Harris: Cognitive.

Willoughby Britton: Cognitive. Motivational and social. Oh yeah, and sense of self.

Dan Harris: Sense of self.

Willoughby Britton: A lot of different ones.

Dan Harris: All right, well let's just start unpacking these.

Willoughby Britton: Yep!

Dan Harris: Are we talking about ... so, sense of self, what do you mean by that?

Jared Lindahl: There are a number of different types of changes that we're associating with a sense of self. This ended up being classified as its own domain of related phenomena, for a couple of reasons that I think are worth understanding at the outset.

The first is that the processes around our sense of self are really quite complicated and cut across a number of aspects of human experience. So, there's bodily aspects that contribute to our sense of self. There's also narrative aspects that contribute to our sense of self. So already it's a complex phenomenon.

It's also a type of change that's really pretty central to Buddhist teachings and traditions. One of the central goals of Buddhism from the very beginning has been to introduce changes into one's sense of self. There are a number of key terms and debates around this, but often it entails coming to an understanding that certain aspects of one's self that one took to maybe be enduring or permanent or definitive are actually less so. They're more subject to change, revision, maybe even in some cases teachers would say they're illusory, they're not even real in an enduring sense.

So, this is particularly important because this is related to some of the goals of meditation in a more traditional context. You'll see some of this show up even in some of the more applied aspects of meditation in, say, contemporary psychology, where maybe one of the problems that one would address with meditation would be an enduring negative self-image, or rumination about oneself that leads to these sort of states of negative emotions that Dr. Britton was talking about moments ago.

Dan Harris: What about a feeling that you don't exist?

Jared Lindahl: Yeah. So that's an interesting one. That's a little bit more on the deep end of the pool than simply the changes around narrative and self-image. Maybe even before we get to there, as a bridge to that, a lot of practice instructions, not across the board, but certainly in some traditions will ask that you take a stance of distancing oneself from, or maybe even de-identifying with one's transient thoughts, emotions, and body sensations. So, as these things arise and pass away in the duration of your meditation session, they're some distance from identifying with those thoughts, emotions, and body sensations as me. That can be really helpful for people who are maybe overly identifying with certain things and getting into, again, maybe states of distress or states of undesirable negative emotions on account of that.

But, just as there are benefits to that, if you keep doing that, or if you do that in a really intensive and prolonged process, a number of other types of changes could happen that are maybe no longer quite under your control anymore. So, thoughts arise, but they don't feel like they're you at all. Or body sensations arise, or actions arise, but you feel like there's no agent who is in control of those actions.

Dan Harris: So you're walking across the room and you don't know who's driving the ship?

Jared Lindahl: Yeah. Maybe walking across the road would be another scenario where that would be of a little bit more concern.

Dan Harris: Yeah, that sounds dangerous! Like maybe we're talking about psychosis here.

Jared Lindahl: That's a tough one. I think we do have some ... There are some other symptoms that we can discuss to get at that end of the spectrum, which is also something we saw in the study. But, you know, with regard to the changes of sense of self, maybe just to conclude on this point, I think one of the key points that we want to make here is that certain things that in certain contexts, like a retreat, are maybe novel insights, even. Maybe really helpful in the context of a retreat. If they are enduring, and especially if they're no longer in your control as that retreat or practice session ends, and as the practitioner is trying to integrate into his or her daily life, those things that were interesting, novel, maybe even insightful changes, those can become difficult to reintegrate, and even a source of impairment and distress if they're no longer something that you can manage well. So, if you can't sort of have your sense of agency and sense of self come back online when you need it to, because you spent a lot of time deconstructing it, that can be a problem.

I think a lot of the issues we're seeing and dealing with are often arising in this context of integration following a practice session, or integration following a retreat. That can be a particular context in which some difficulties arise.

Dan Harris: Okay, but let me press you on this, guys because it sounds like ... And we've only gotten into .. we're in one of the seven domains here. There are lots of domains. What you're describing here sounds like, "If you meditate enough, you could lose your damn mind.

Willoughby Britton: That sounds a little bit like a scare tactic.

Dan Harris: No, I'm not trying to be a ... I'm just saying this is what people are going to conclude. Or worry about when they hear this. So just talk me, as a proxy for the listener, off that ledge.

Willoughby Britton: Yeah, I mean, I think that the way that meditation has been marketed has been similar to a warm bath, very benign and harmless, and I think that maybe the take home message is to have a little bit more respect for the power of these practices. I don't think that we want to scare people away from trying it or induce some kind of mass paranoia, but I think that the range of different experiences beyond calm and relaxation, and even ones that are distressing or impairing to functioning have been documented before. We just documented that they are still happening in modern day Buddhist meditators, and that that might be something that we want to consider as the meditation industry keeps going.

Dan Harris: Well said. You say this quite eloquently in your paper and in the accompanying press release, that meditation has been around for millennia, and in the literature from way, way back, they talk about difficulties in the varying schools. You're looking at Buddhism and the three main schools of Buddhism - Zen, Tibetan, and Theravada, they talk about the kind of difficulties meditators will encounter. In Theravada, for example, there's a stage of the path known as Fear.

This is, as you say in your own paper, this is not new, but it hasn't been looked at in this new batch of science and excitement that we're seeing around meditation.

But I just want to drill a little bit deeper on that scary question I asked before. What would you say to somebody who's hearing this and is like, "Oh, well, should I not meditate now?

Jared Lindahl: Well it'd be sad. I don't think that the conclusion that should be derived from our research is that this isn't worth doing at all. It's worth keeping in mind that because this is an interview-based study, where really what we have are 60 or 92 different stories. But let's just stick with the practitioners for a minute. We have 60 different practitioner narratives that had a wide range of experiences, and in some cases experiences quite similar to each other.

What makes a particular experience even feel negative, let alone distressing or impairing, that, I think, another major part of our paper, is to attempt to identify what we call the "influencing factors." These are perhaps some of the variables, probably not even all of them, that impact whether a practitioner is going to feel distress or have a negatively valenced experience, whether they're going to be impaired, how they're going to resolve this experience, how long the experience is going to last. So, when we interviewed these practitioners, in addition to them talking about, usually, a couple of dozen different types of experience that they had. Not all of which, by any means, were negative. But at least some were.

They also identified, usually, around a dozen of these influencing factors. That can range from things like their early life history, some of their medical or psychiatric history. It can range from what types of practices they were doing, the degree of social support, their relationship with their teachers in their communities, and a whole list of what we called, "Health behaviors," which were different types of responses, usually. So things like psychotherapy, presence or absence of medication, changes in diet and exercise, these sorts of things. Really depending on the particular type of phenomena that we're talking about.

So, certain phenomena tended to be maybe either transient or fairly easy to resolve or integrate, whereas other definitely required a lot more support, and often support going beyond what a meditation teacher, or center, or practice, or conception of the path could provide.

Just to come back and comment a little bit on what you were mentioning earlier, about the presence of these phenomena in Buddhist texts and traditions, I think you're right about that for a lot of these phenomena are there. What's interesting, we found, is that despite recognition or acknowledgment of a lot of these things, and I certainly wouldn't say all of them, there's also often some disagreement about what they mean and what their value is. So, as we were interviewing teachers, we were really hoping to get some consensus statement about what is a meditation difficulty and what do you do about it, but teachers really varied considerably based upon their background, their lineage, their teachers, their approach, whether they had some sort of psychological or psychiatric training in addition to their training as a Buddhist teacher.

A lot of these things could really influence what they considered to be part of the path, versus what they considered to be, as you were using the word earlier, a side effect, or let's say an unwanted effect and one that maybe required some sort of intervention beyond just practicing differently or some sort of easy fix through practice technique.

This, I think is, again, another really key point from our study, that the experiences themselves don't necessarily have intrinsic meaning, and they're not all intrinsically adverse. Maybe there are a couple of exceptions to this where intense fear, suicidal ideation, these types of things were pretty universally treated as things that need some sort of remedy, and it's not something that a practitioner should stay in for a prolonged period of time.

But as you pointed out, even fear can be a tricky one, because there are particular conceptions of the path, as you've pointed out, in Theravada Buddhism, where that's considered as expected stage, and even perhaps a sign of progress, and even though a difficult one, could be read as moving on to something that is ultimately of benefit to the practitioners.

This ends up really always being negotiated socially with the teachers, with the communities. In cases where practitioners don't have that type of support or framework, these things can be even more disorienting.

Dan Harris: You said so many interesting things there Jared. In particular, and I've heard Willoughby talk about this before in our private conversations, that people who get into meditation for the martini/warm bath, they may not know that these difficult stages are considered signs of progress in some of these schools. But they're not signing up for that.

There seems to be some sort of cultural misunderstanding here, almost.

Willoughby Britton: Yeah, I would say sort of a mismatch. One possible way forward is when people start meditating, it might be a good idea to think about why they're meditating. What do they want? What kind of goals are they trying to achieve? Even, what is well-being? What is happiness? What is suffering? Really think about that, and then make sure that the practice and the teacher and the tradition and the program that you choose really matches your goals because there are so many different kinds of practices and teachers and approaches and reasons to do these practices. That getting a good fit is really the best way to optimize your results.

Dan Harris: How common do you think difficulties are?

Willoughby Britton: That's the million dollar question, and unfortunately, the way that we did the study, our methodology is really not set up to answer that question. So it's just going to have to be stay tuned for future research kind of answer.

Dan Harris: Do you think ... an analog that I use, I mean, I haven't talked about this publicly, but just in my own head, is with exercise. With exercise, we all know it's possible you could get hurt. That's why your gym makes you sign a waiver. I get hurt once in awhile, but it's not happening to me every day, and there are things that I can do to mitigate the chances, reduce the chances that I would get hurt. Would you say that's a fair analogy?

Willoughby Britton: Yeah. I'm always looking for really good metaphors and analogies. I haven't found a perfect one, but I think exercise has a lot to offer. In the exercise, you also hear, like, "No Pain No Gain" kind of instructions sometimes. That sounds really great until you injure yourself, then your coach is like, "Oh no, I didn't mean no pain no gain in that sense!" So, obviously, they scale back those instructions. So there are some nuances there.

But within an exercise, there are also people who are trained to identify that types of behaviors or postures or intensities are likely to lead to injury, and there are entire books written about it that are, you know, too many.

I think with that analogy, we want to build something comparable in the meditation community. That doesn't really exist now.

Dan Harris: Yeah, so talk about what you want to see built.

Willoughby Britton: Well, I think ... just to have a general awareness. SO when you get the paper, there's also a code book with the 59 categories, really detailed descriptions of these experiences. This is like 101 for a meditation teacher. Any teacher should be very well-versed in any of these experiences. Just be able to identify them when they come up. And they may have different views on what should be done about them or how to manage them, but they should at least be very familiar with what they are.

I think, generally speaking, someone who goes into meditation should have a sense of what they are as well. Just a basic type of awareness. That's kind of the basic level. I think as the research continues and other people are also doing research on this, we'll have a better sense of what kind of options are the most helpful. I think we have some ideas of what can be tested at this point, but we don't really have a real answer. So i think that's where we're going, to build a really informed and adequate support structure for when these experiences come up.

Dan Harris: I go to the Insight Meditation Society, don't they have ... If I recall correctly, they have somebody on staff to deal with people who are experiencing challenges and have for a while.

Willoughby Britton: Yeah, there have been support staff, and they are awesome, and they help a lot of people, but there are often only one or two people, and they're not always available after the retreat ends. The person needs more long-term or sometimes even 24-hour care. That's a really good start, but I think we need more, and I think there are lots of clinicians now that have training in mindfulness and meditation-based interventions, and they would be really great people to be taking on some of the people that are having more enduring difficulties.

Dan Harris: You spoke before about the cultural misunderstanding that can happen who are looking for a bubble bath and find that their sense of self is dissolving and that's not what they wanted.

But there's another potential culture clash here, which is you could walk out of meditation retreat having some specific meditation-related challenges, like (to list some of the things that you include), like hypersensitivity to light or sound, insomnia, involuntary body movements, a heightened sense of fear and anxiety, or a loss of emotions altogether. These are some of the things that you've found in your research that if you go to a clinician who has no training or background in meditation, you might get medicated or treated in a way that actually doesn't meet your specific needs, because they're going to see it through the lens of psychopathology, right?

Willoughby Britton: Yes, and I think that we have to be really aware that there are multiple frameworks at play here, and there really always have been. So I think it's important to really understand where the meditator is coming from, which framework or frameworks they're using, and to have that decide where they're seeking help.

Jared Lindahl: Yeah, and I think that this can really cut both ways, too. So to come back to the no pain, no gain analogy that you two were discussing in the context of exercise, a lot of practitioners in our study, and even some teachers invoked something akin to that framework for meditation. It's supposed to be difficult, and that's part of the process, and that's part of how one gains benefits from it.

I think the challenge becomes that it's really not always clear where to draw the line between something that's difficult but can be held in the context of practice, worked through, and then benefited from, from something that can't be, and from something that needs some sort of additional support. And I think that's something that needs to be negotiated between the practitioners and the teachers, which is why we're hoping this study will inform both of them.

One of the challenges in the current meditation world in America, at least, is that a lot of people go away for these retreats that may even be quite geographically distance from where they live and reside, and as Willoughby mentioned, you might have some good resources while you're on the retreat, we hope, but that may not also see you through the process of integration, or if these things are enduring, are they come back up in your daily practice? A lot people in our study had difficulties, even in the context of daily practice. So this is not just limited to retreat context. But then those resources might not be available.

It's also the case that given a lot of these, the transiency of some students coming on retreat, while there are some good attempts to understand the practitioner's background, most teachers aren't going to know a lot about the people they are working with unless they develop a close relationship with them. I think, in this case, this is also why it's really important for the practitioners to be informed that some aspects of their life history, or their personal medical or psychiatric or traumatic history, that these things could be at play, and that they could be beyond the scope of what they should expect a meditation teacher to be able to hold and help them process.

Again, this is all really a process of negotiation. It really highlights the importance of communities in relationships in both appraising and responding to what's happening during meditation.

Dan Harris: How do you know that meditation is the cause of the things you're finding in your study? Because a lot of them, you found some pretty ... a whole range of things, but some of them are pretty daunting. The suicidal ideation, for example. How do you know that that isn't the result of some sort of pre-existing psychological or psychiatric condition?

Willoughby Britton: Yeah so this was one of the most challenging questions, to assess causality. What we did was we used the methods that regulatory agencies like the FDA or the World Health Organization use to assess the safety of medical devices or medical treatments. They typically use 13 different criteria, and we were able to use 11 of those criteria.

I can go through them one at a time. I go through them ad nauseum in the paper, so if you want to know more about it ... But, you know, subjective attribution is one. Does the teacher or the practitioner think that meditation was the cause? The basic, they thought it was, counts for at least one point.

Then the temporal proximity, which is also called challenge, where the experience happened during meditation or shortly after. Then we have consistency, and there's three different kinds of consistency where it happened on more than one occasion. So they say, "Every time I meditate, X happens." So there's the temporal proximity is repeated over time. Then you have the interpersonal intersubjective consistency, where this happens across different people. So, in the context of meditation, the same experience is arising across different people.

Then you have cross-modal consistency, where both teachers and meditators are saying that this is caused by meditations. Then you have due challenge, which means that the effect goes away when you stop meditating, so people back off for a while, and then their headaches go away or they start sleeping again.

Then re-challenge is when you start again, you start meditating again, and then you stop sleeping again, or your headaches come back. So those are some of the ones that are related to the timeframe, the temporal proximity.

Then you also have expert judgment. So the fact that there were 32 meditation teachers who said, "These effects are caused by meditation." And then we also have prior published reports. So we found more than 40 published reports in the medical literature describing these same kinds of experiences, and being attributed to meditation. So, we made an effort to address the causality as best we could with the design that we had.

Dan Harris: You summarized that with admiral concision, I have to say. Let me ask a related question, which Jared touched on a little bit earlier. The dosage questions. So, you guys have talked a lot about retreats, but what about those of us who practice only five to 10 minutes a day, we use an app, or we read a Jon Kabat-Zinn or Sharon Salzberg book, and we're just kind of bopping along with our own five to 10 minutes, or whatever. Are these people likely to bump into hypersensitivity to light and somatic changes such as insomnia, involuntary body movements, this sort of litany of challenges that you lay out in your study?

Jared Lindahl: Yeah, I think I want to shy away from commenting on the term "likely," because as Willoughby mentioned earlier, we really can't say anything conclusive about that. What I can say is that I think it's worth keeping in mind that with those various modes of causality assessment that were just summarized, we're also looking at those in relationship to a lot of these other variables that are maybe practitioner specific or practice specific, or relationship specific. I think, in this case, there are some ways in which we're getting some indication that certain practitioner level variables, so say, for instance, prior trauma history, the presence or absence of that, those are two different populations that we can't just lump them together and say, "Well, if these two people are doing 30 minutes a day or two hours a day, that they're necessarily going to have comparable experiences. Because it's not just about the amount of practice. The amount of practice definitely can be a variable, but there are a lot of other variables that we also looked at.

For instance, to stick with that example, there is an indication in our study and in other prior studies on meditation that re-experiencing of traumatic memories is something that can happen, and it doesn't necessarily need a lot of practice. There were a lot of people, maybe not a lot, but there were enough people in our study who were working at the lower end of practice amount and intensity that I think we should take seriously the possibility that some of these things could start to emerge, could start to show up. They might not end up being as intense as for other people in different contexts or with different backgrounds.

But this is really a question that we think needs a lot further research. We had a mixed pool of practitioners, they were doing a lot of different things at a lot of different amounts, so we can't really conclusively answer the question of whether there's a safe amount to do it, for instance, but I think people should generally be aware of what some of these phenomena are, maybe even be aware of how some of them are even closely related to things that are good.

To give an example of that, regulating your emotions and maybe decreasing your emotional range or intensity can be something that people are really trying out meditation for, and it can be a really big benefit for them to do that. But at the other end of that range, or at the other end of that same trajectory could be the loss of emotional range altogether. We've had a number of stories of people coming off, say, of an intensive retreat and practice, and not feeling any emotional connection with their family and loved ones, and having that be a real source of distress, that what was once a positive aspect of gaining more equanimity, gaining less emotional range, when emotions disappear altogether, that's maybe no longer desirable.

Dan Harris: Did those ... Sorry to just interrupt you, Jared, I know I've interrupted you a couple of time, but I just want to make sure I follow up on that. Did those people say that that lack of affection for their family, was that a permanent thing or was it a temporary shift?

Jared Lindahl: Yeah, thankfully, that tended to be temporary. I don't think anybody is still going through that, at least I hope not.

Willoughby Britton: Temporary meaning, like, one of those I remember lasted a year.

Dan Harris: Oh.

Willoughby Britton: So yeah, temporary, but long enough.

Jared Lindahl: And it's really the enduring nature of it, and again, the loss of control over that that can be part of why that's distressing. So, this complicates matters further, to also bear in mind that in these practices, coming out of often a very monastic context, or coming out of a tradition that at least in certain historical and geographical contexts was about renunciation of worldly concerns. So, one could even suggest that this is, again, one of those things that might be a sign of some sort of progress, that maybe one is to continue on the path, and that's actually considered a goal. Not all Buddhist traditions would agree with that, but there are definitely some for whom this sort of intense equanimity could be construed as valuable.

The challenge then becomes what are the dominant motivations of people who are picking up this practice in 21st century America, and is that really what they're wanting or expecting? Regardless of whether that's considered to be the goal in some other place or time. That's where, again, this cultural negotiation is a big part of what we think we're grappling with here.

Dan Harris: So let me see if I can state your bottom line, in terms of, and then I'll probably/almost certainly will mass this up, and then you guys can just correct me. But is your bottom line, to rank and file meditators, and I'm not talking about folks who are avidly attending retreats, I'm talking about, basically, doing five to ten minutes a couple days a week, et cetera. Is your bottom line, like, "Yes, this is a good thing to do. Just know that there's a range of potential outcomes, some of which may not be positive. It's not happening ... You don't know the frequency, but ... I'm kind of at a loss. What should we be telling people to have their eyes open for if they're continuing or looking to establish a meditation practice?

Willoughby Britton: I mean, obviously, meditation practice has been profoundly beneficial for many, many people. If you're interested in meditation, you should try it. But also know that there are many different versions and different types of practices and different programs and apps and teachers that have different orientations with different goals. So, I think, be an informed consumer. Do your homework, and choose wisely. Choose a program ... It's similar to choosing a doctor. Choose one that matches what you're looking for. So I think that may be one take home message.

We're absolutely not trying to dissuade people from meditating. There's obviously a huge benefit for many people. But that's not the whole story. I think one of the motivations for the study is to really give voice to a group of people that have felt incredibly ashamed and very isolated because they had had a less than optimal meditation experience. We're trying to give them a little bit of voice that, like, this also happens. If you have something other than calm and relaxation in your meditation experience, you're not alone and it's not your fault. These are well-documented experiences, and they happen.

A lot of it is reaching out to that group that has really been marginalized up until this point.

Dan Harris: And we should say-

Jared Lindahl: Can I just add something to that.

Dan Harris: Absolutely, go ahead.

Jared Lindahl: I think in order to reach that community and also help them, that we hope that raising awareness about the range of possible experiences, the range of possible variables that impact those, and how they land on someone, and the range of responses for what to do with them ... While we don't have conclusive data on any of those things, what we have is our summary of what people told us, practitioners and teachers told us. We hope that that can not only help practitioners be more informed consumers, but the people who are responsible for guiding those practitioners, whether that's meditation teachers and centers, whether that's increasingly clinicians as well, that their increased awareness about the range of possible phenomena, and the range of responses to them, that in time we can help provide some resources that will help them figure out how to, again, negotiate what are often some really challenging decisions about how to interpret something, what is the best response? Is it to keep practicing and get through it? Is it to stop practicing and seek something else? What should we do here?

We're not really in a position here to, yet, make those types of recommendations. This study started and emerged from a collaboration with teachers and practitioners and clinicians, and we think the implementation of any best practices is also going to be a collaborative project.

Dan Harris: But inevitably people listening to this podcast, some percentage will have had these experiences, or may be dealing with it right now. Are there resources out there for people?

Willoughby Britton: I mean, there are a number of teachers that are very knowledgeable and available. There are also clinicians that are knowledgeable and available. What we're hoping to do is actually create a referral list as part of our website. We've had a number of teachers and clinicians volunteer to be a resource. We just haven't had an opportunity to put that together yet. But that's what we're hoping.

Dan Harris: Can people contact you?

Willoughby Britton: People do contact me. I've had more than 300 people contact me. I do my best to talk to people as much as I can, but it's a lot of volume, and more than I can handle well. So, I'm hoping that this ... That we can have other people help out with that.

Dan Harris: You, for a while, were running something called Cheetah House in your house, the one where I helped you move in the IKEA furniture. Tell us a little bit ... you basically had people who were having meditation difficulties living with you for a while. Can you talk a little bit about that?

Willoughby Britton: Yeah, so a number of people that called us in response to the study or some of the media coverage of the study, they were well enough to not be in the hospital, but they were not well enough to be working, and they really just needed a place to be in community with other people that understood what was happening to them and support them through this. Because, again, a lot of times the conflicting frameworks of being told that you're sick, or this is pathological, that wasn't helping them. They needed a little bit of space and community.

So, I have a big Victorian home, and I have a third floor with a couple extra rooms in it. So, people stayed there and healed and talked to each other, and it was ... I hope that something like that can be resurrected in the future. It was financially not really that feasible, to be sort of taking care of this many people with having a full-time job doing something else. I mean, I think it's a great idea, and I think that there have been other places like that. I believe there was one in California for a while, where meditation communities where people can be supported in a more long-term way by their peers.

But yeah, Cheetah House as a residential facility is no longer. It's just an apartment now. But we are trying to make the resources available on the website, and we also have started just the beginning of some support groups. I think one of the things that we're finding that people find really helpful is to reach across that feeling of isolation and shame. When people share their stories with each other it's just so supportive and comforting. So, the support group idea, I think, is a really great one. But we just started that.

Dan Harris: You mentioned before, the fact that you've been studying this has been out in the public for a while. Releasing the results on May 24th, but we've known for a while that the study has been ongoing and that has attracted a lot of people to you who have had questions. What has the reaction been in the meditation industrial complex? The people like me who have apps and other scientists who have been touting the benefits of meditation, how do people respond to the fact that you're doing this?

Willoughby Britton: I mean, I'm not surprised I think it's been a mix. I think there has been a lot of really encouraging responses, so the centers for mindfulness, the U-Mass Center, the Oxford Center, the Bangor Center, the big centers that are interested or involved in doing mindfulness instructor training have been very open and supportive of the research. They've written support letters when I apply for grants. We're trying to make our book into a questionnaire that can be used in clinical trials and meditation centers and a number of the directors of those mindfulness centers wrote letters of support and how important this was and how much it was needed. So that was really encouraging.

They've also invited me to come share the data in some of their mindfulness instructor programs this summer in the U.K. So I think that's all really positive development. A number of Dharma centers have asked Jared and I to come and give an overview of the different experiences that we're seeing our data to different Dharma teachers, and also just the support staff at the centers. So hopefully that will continue.

Then there are other people that are just not really ready to hear it. I think that the dominant narrative of this being all good, all positive panacea is a very powerful one, and one that people want that to be true, then they don't really want to hear that there's another side to the story. So I think that inevitably there's going to be some backlash, but I think that's just the way it is.

Dan Harris: I mentioned before, I'm part of this meditation industrial complex. I made that term up, I mean, I'm sure I'm not the first person to use it. But it's not a thing really.

But what responsibility does somebody in my position have? I have a podcast, I write books, or I wrote one book and I'm going to do another, I have an app. What responsibility do I have when talking about this to present it in the right light? And I guess the second part of that question, you know, we at the 10% Happier app, we have coaches who anybody who uses our app has access to an experienced meditator that they can communicate with directly through the app. These people have 10 to 15 years experience. We've done a lot of talking about how to know if somebody has an issue. What are the answers to their questions? When is the right point for a referral to an in-person clinical setting? Is that enough?

Jared Lindahl: I think that's a terrific start, no doubt about it. I think that that probably goes above and beyond what you can find in some of the other more barebones apps. So certainly applaud you for making those efforts.

I think that the main thing is to have a mechanism where you can really be tracking what's going on with people, or they can be able to report back some of the difficulties or challenges or just uncertainties that they're having and implementing their practice of meditation via an app. This is a new experiment that has never been done before in the history of meditation, and it's a product of our current contemporary highly technologized culture. I think it has some real implications for what types of experiences people are going to have through this impersonal medium.

Certainly, one of the things that we're finding from our study that I think should be a concern to anybody who is implementing or delivering meditation through this medium is that degree of social support and perceived social support was really, really important. For people who didn't really have a community or were geographically distant from their community, or could only have access to a teacher very irregularly, that could be a real difficulty for them. Somebody who could really track them carefully, who knew what to look for, that could really ease them through a challenging experience, and maybe even keep it from being one that ended up being distressing or harmful for them and could really make it be something that was ultimately positive.

I think it's great to have experienced meditators or teachers who people can talk to. One thing I would just caution about that is that there are people who can meditate for a long time and themselves not have gone through some of these difficulties. So, come back to the example of trauma history, if your coaches haven't had traumatic memories resurfacing in their practice because they don't have a trauma history, they might not necessarily know how to draw upon their own experience in order to respond to somebody like that. And there are lots of other types of examples where individual differences are really important, and naturally, teachers who have had the widest range of challenging experiences and managed them are often the best equipped to know how to respond and help people through that.

But, for better or worse, those teachers are not always that common or accessible or able to really help everybody who's just getting their feet with this.

Dan Harris: Yeah. We've developed standards of care in conjunction with some very, very experienced meditation teachers so that our coaches, who are pretty experienced themselves, know when to refer people for qualified in-person support. But this is something we take very seriously and we want to continue to work on, and that's why I personally and we as a company find the work you're doing to be really valuable.

Willoughby Britton: I mean, I think one of the things that I learned about monitoring for adverse effects is that negative effects of treatment are a very different kind of thing than positive effects, and so people are not going to voluntarily tell you when they're having negative effects. It's very likely that they'll just not tell you, especially the teacher. So there needs to be a kind of program or monitoring system where it's actually not even enough to ask people, "Have you had any unusual or unpleasant effects? Because these open-ended questions also don't generate the kind of accurate accounts. That's why we have this specific code book, so you have really, really specific information about what to ask about.

Then when you start asking specific questions, like, "Do you feel like you don't exist?" Or, "Do you feel like you're existing outside your body? Or that movements happen on their own and they're not made by you." "Oh yeah, oh yeah, I have that." So, people, it needs to be a very specific question.

There is a real science to monitoring correctly. So that's another thing that I think that the entire field of meditation, including apps, will eventually get good at that. I think that that's probably coming down the line.

Dan Harris: Yeah, with your help. Sorry, go ahead.

Willoughby Britton: And then one other thought that I had, you know, how do we know that the support systems that we've created are enough? I would say that when my phone stops ringing, then that means that the support systems that are in place are enough.

But right now, the fact that people ... I mean, I get so many emails every week and calls every week. More than I can handle. That's an indication, to me, that we're missing something, that there's something else that needs to happen.

Dan Harris: Let me just read to you, because we've gotten some questions from our users that are interesting along these lines. I just want to read one. I'm not going to use the name here, but this is a quote. And when I say users, I mean app users. "I've been listening to Joseph on the Insight Hour. These are ultimate teachings, for me, and also with Sam Harris," Sam Harris is an old friend of Joseph's and mine, "discussing higher stages of realization. But these discussions of reaching a new level of perception, shedding the conventional notion of 'self,' a maturation of the spiritual practice, is one of the ultimate truths or true wisdom or something like that, and how this can be painful and disorienting and disturbing. This is what I want to be ignorant of. Am I alone in this? Am I the only one who wants to abandon the practice when it reaches these higher stages."

How would you respond to this user?

Jared Lindahl: Yeah, this is an interesting issue that I was thinking about as Willoughby was talking about monitoring. So, so you're monitoring for someone who's having ... And someone reports a loss of sense of agency over their actions. It's not just an issue of identifying a particular experience. It's then an issue of what does that mean, and is that an insight? Is that part of the goal? Or is that something that is going to be concerning? So, this is, again, where I think the practitioner's goals and expectations, also their context, are they doing this in the context of an app that is primarily advertising better emotional regulation, calm, and enhanced functioning in daily life. If that's the experience that's happening in that context, perhaps there's a mismatch there, and they might want to have some sort of guidance back towards the types of things that they were more expecting.

It's, of course, quite different if you are on a meditation retreat at a monastery in a traditional Buddhist context. You've done a lot of scriptural study and you're interested in having these insights into changes and sense of self and seeing if Buddhist teachings around the reduction of suffering that are thought to accompany those can really play out for you.

Then I think the experience may be described in identical words could mean something different for that person, who has that motivation, is in that context, and is oriented towards that goal. This is, for me, one of the interesting questions as meditation comes out of the monasteries and into the marketplace. How is this impacting what these different experiences mean? It really makes the study much more complicated. It makes it complicated amidst our sample of Buddhists, and it makes it even more complicated attempting to apply what we've found to other meditation applications, your own apps, in the field of mindfulness-based interventions, which are often really situated in different cultural contexts with different narrative about what's supposed to happen, what is the goal here.

So, in response, I think that the context is really important, the motivation is really important, and that makes it very difficult to say what any of these things mean, in any intrinsic sense.

Dan Harris: So what do you guys think are the next ... There are so many open questions, which you guys openly acknowledge. What are you most excited about looking at next? What are the big questions you want to tackle going forward?

Willoughby Britton: Well, we have a long list, but I think, for me, I'm really interested in understanding the mechanism. Because I'm a neuroscientist, the neurobiological mechanisms, which I actually think are extremely low hanging fruit because we have a pretty good knowledge of a lot of the effects on the brain that different meditation practices have.

These difficulties, I don't think they're going to be radically different than those. They're probably going to be the same, but just sort of an exaggeration. So, for example, a lot my earlier research, and even my TEDtalk goes on and on about how good meditation is, it strengthens the prefrontal cortex and controlling the limbic system and the amygdala and how that results in improved emotional reactivity, or decreased emotional reactivity.

We already know that. That's the positive side. But having a really strong prefrontal cortex that shuts down your limbic system and your autonomic nervous system is also the neurobiology of dissociation and blunted affect and kind of a zombie-like state that if you keep going could result in that. So it's not that different. And like I said, it's low-hanging fruit, which is always a good thing in research, not to have to reinvent the world.

I think I am excited to see whether other people would also take that on. I think there have been a number of other people who are looking into ... are already working on a number of the mechanisms that we're thinking about.

Jared Lindahl: Yeah, and I'll just, from my own perspective, those of you who read the paper, which I hope you will attempt to do, you'll see that the study that we're reporting on, as we've mentioned is an interview-based qualitative study, and you might be surprised to find that, it being a qualitative study, does not feature qualitative data. This is really because this first paper is an attempt to summarize what we did, our methodology, what we found in our overall summary of our results.

But where we can go from here is working with the many thousands of pages of transcripts that we have, the really rich and interesting and compelling narratives that both practitioners and teachers gave us. We can look at ... undertake specific questions. Whether that's looking at how people in a particular tradition or sub-tradition think about certain issues. We can look at clusters of related experiences and think about how and why those might be emerging together. We can do all sorts of, I think, creative and interesting analyses that will allow us to slowly get some of these voices and stories out there as well, and have it not just be this admittedly more abstract summary that we're offering in this first paper.

So, there's already a number of works in process, and basically almost under review for some of our forthcoming papers, and I think people can expect that we'll be thinking carefully about and writing and publishing on this for many years to come.

Dan Harris: As we wrap up here, is there something that I should have asked but didn't?

Willoughby Britton: I think one of the ... we said this in the press release, and we say it in the paper, but I think it's important to sort of counteract a lot of the predominant assumptions that we often get in response to this research. That meditation difficulties only happen to people on intensive retreats, only happen to people who have prior psychiatric vulnerabilities, like a psychiatric disorder or a trauma history, only happen to people who are not adequately prepared, or have adequately supervision, or don't have a teacher. While those may play a role, we found exceptions to all of those.

So I think that, unfortunately, there is no pat answer for why these things happen that applies to everyone, that everybody's experience is unique, and that it's a complex set of factors that creates the perfect storm for each person. I think that really honoring individual differences in diversity and complexity is the name of the game. I know that's not the media's forte, but I'm going to ask for it anyway.

Dan Harris: You have, ever since the first time I met you, Willoughby, at a Buddhist geeks conference in Boulder, Colorado back in 2010 or something like that, you've had some sort of wariness about the media. I'm not saying it's unjustified. But this study that you've been conducting for many years now, conducting it somewhat involuntarily in public, because people have known that you were working on this. It's generated controversy every step of the way. Well, now it's finally out. What are you worried about?

Willoughby Britton: It's funny, you know, I think that journalists and scientists have these stereotypes of each other, which are kind of true. So, journalists think that we can't give a straight answer, that we caveat everything to death, we split hairs, we have these long-winded answers that don't anything. I'm sure people think that who have been listening to this podcast so far.

Scientists are frustrated with the media. We think they'll do anything to sell a story, they don't care about accuracy or the truth, and they want to sensationalize. So there's this really unfortunate relationship. I think that that really needs to change, experience now with alternative facts and fake news. There's definitely desire to want to go hide and not deal with the media at all, but I also am thinking about the people who are alone and feeling ashamed of what happened to them in meditation. They need someone to reach out to them. I'm sort of ... It's my practice right now is to deal with the media.

Dan Harris: It's your meditation practice.

Willoughby Britton: It's my meditation practice. I've had a lot of ... And this is not just making up stories in my mind, this is based on experience. I've been misquoted, I've been ... I really only gave one interview so far, and that interview has been cut up and repackaged and circulated in different places where I was never invited to give commentary. So I haven't had good experiences before. But I think this is important, and I think that there are a lot of people that are suffering needlessly that I can actually help.

So I'm making an effort, but it's definitely not high on my list. It's challenging for me, for sure.

Dan Harris: What is the twist that you're worried about? What is the way in which this research could get twisted that you don't want it to get twisted?

Willoughby Britton: I think one of the things that are most concerning to me is that there are a number of people, these are major stakeholders in the meditation industry. These are dharma teachers, long-term meditators, people that have written books, and they were brave enough to talk about their experiences, and some of them were really harrowing and heartbreaking. They told us their stories, and some of the responses that I've seen have been various kinds of victim blaming, that somehow this experience that they had was their fault, that they didn't know what they were getting into, they meditated too much, they didn't have the right teacher, they did it wrong. Just some kind of way that it's their fault.

We know from attribution psychology that that's called the fundamental attribution error, when you make dispositional attributions to something, especially if you don't like it.

So we know that's going to happen, but it just pains me to see that people who have already been through so much by being in this research study are being blamed again. It sort of reminds me of the Vietnam vets, or World War II vets, who were blamed for having PTSD, when in fact war causes trauma and not some kind of personality weakness. I see that pattern happening again, and it makes me really sad.

Dan Harris: What about the flip side, that people would write articles that say, "Meditation drives you crazy."

Jared Lindahl: Well that's kind of a version of that though because I think that just as there are ... we want to say that just as the individual factors are not the whole story, and you can't just blame the person or their approach, and that somehow meditation is not culpable or there's no role that the practice itself played ... There is a role that the practice played, but again, it's not the only role. So that, I think, to misconstrue it that way is to assume that the practice is inherently dangerous. That's certainly not the case either, and that's very much not what we're saying.

As we write in the paper, what we're really looking at here is what we call an interaction-based model, where there are instances in which the practice is playing a role, and our causality assessments were, in large part, a way of making sure of that, and keeping people out of the study for who this experience was just happening anyway due to other life circumstances, and that they don't think meditation played a roll, it just happened to be concurrent. We did our best to try to not have that be part of what we were studying.

So that's to say that, again, there are multiple things going on here. It's not all practitioner, and it's not all practice. Exactly how much of each is responsible in these cases is really individual, and I think to really get a handle on this is going to require a lot more research, and research that's designed differently than what we did, which was primarily to document the range of these effects, but not really address issues of frequency, and certainly not address in a kind of fundamental and conclusive way issues of causality.

Dan Harris: A little bit of housekeeping here. If people want to read the study, which I recommend, because it's a good read, or also to find out more about you guys and your work, where would you send them?

Willoughby Britton: We made an effort to make sure that the study and all of the accompanying supplementary files are free and accessible to the public. So we chose and open access journal, PLOS ONE, P-L-O-S one, like the number. So you can just go to their website and find it. You can also just follow the link that will be part of our press release.

Dan Harris: So what I'm about to say is probably colored by my personal affection for you guys, but I do really think that this is an incredibly valuable contribution you're making. And as I said before, I see it as part of the maturation of this still new field. I think we shouldn't be afraid of the truth here. We should talk about what the difficulties are and let people know so they can be informed, consumers. So, I thank you.

Willoughby Britton: Thank you.

Jared Lindahl: Thanks, Dan.

Dan Harris: And I also just want to thank a few other people. I want to thank your folks up at Brown University. I'm in New York City, you're up in Providence, Rhode Island, and there was a certain amount of hustle that needed to take place on your end to make this technically possible, to get you into a radio studio on campus. So big thanks to those guys. And I want to thank the folks on my end, Josh Cohan, and Lauren Ephron who produce this podcast who also had to do a certain amount of hustle and also are going to more hustle to do to get this posted in time. So, big thanks to everybody involved here, and thanks again to both of you, Willoughby and Jared, and congratulations again on getting this study out after so many years of hard work.

Willoughby Britton: Thanks Dan.

Jared Lindahl: It's a pleasure to be here.

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