Part I: HSP Mental Health Research & Part II: When Meditation Becomes Hell

With my upcoming book, Spirituality Through a Highly Sensitive Lens: An Objective Look at Meditation Methods and Enlightenment (coming out this April), I’ll be sharing two parts in each blog post—the first will explore research, HSP news, and current insights, while the second will offer a more spiritual reflection and deeper inner perspective.  

Part I:

Research, A Major “Meta-analysis” of the Research about HSPs’ Mental Health, Plus a Study HS Mothers

Falkenstein, T., Sartori, L., Malanchini, M., Hadfield, K., & Pluess, M. (2025). The Relationship Between Environmental Sensitivity and Common Mental-Health Problems in Adolescents and Adults: A Systematic Review and Meta-Analysis. Clinical Psychological Science, 0(0). Read article here. 

There is an excellent description of this article for non-scientists—[make these dashes]written by its author, Tom Falkenstein–at the website Sensitivity Research. Yes, there are other authors listed, but this paper is one chapter in Tom’s upcoming doctoral dissertation on HSPs and mental health. The other authors are simply his dissertation supervisors (plus one helpful MA-level assistant). If you are interested in this subject, PLEASE FIRST READ TOM’S SUMMARY. And if you want, use the link above to look at the actual article. That way I do not need to repeat myself here, but rather can try to put the article in a larger context.  

More about Tom Falkenstein: He is a psychotherapist in private practice, licensed to practice in the U.K. and Germany, and the author of The Highly Sensitive Man, published in 2019.  Obviously he is also working on his doctoral dissertation, under Michael Pluess at Queen Mary University of London. And he is a member of the International Consultants on High Sensitivity (ICHS, a group of professionals I worked with so that they could speak in place of me!). 

What Is a Meta-Analysis?

Turning to Tom’s paper, just to review, as you will learn from reading his article, a meta-analysis has three steps. First, you identify all of the research on a subject, then second, reduce this research to the methodologically soundest studies, and finally, third, calculate the overall “effect” size—the strength of the relationship between two variables or groups, in this case mental health and environmental sensitivity, or high environmental sensitivity, as measured by the HSP Scale.  They began with 829 studies, reducing them to just 33, involving 12,697 participants (note: the average age was around 25 and 63% were female). The effect size for anxiety was a little higher than for depression, but both were “moderate” and there were strong relationships with other mental health problems as well.  To be clear, this means HSPs in general are moderately more likely to have mental health issues, but does not mean that every HSP has mental health problems or explain why the data indicates this relationship 

You may have noticed that Tom carefully avoided the term “mental illness” but stuck to “mental health” problems. However you term it, the press and internet (and AI) certainly picked up the finding, wrongly announcing this sort of thing: “A big study found that HSPs have more mental health problems.” But the good news is that the trait will now be taken even more seriously by mental health professionals, and maybe treatment will be better tailored to HSPs, although that is not guaranteed. Therapists may still treat an HSP’s depression, anxiety, or whatever as just another case of that, without considering the trait in greater depth. But it is Tom’s hope that by bringing it more to the attention of clinicians, through this meta-analysis and the rest of his research, they will develop greater wisdom about how HSPs specifically should be attended to in therapy.

The Bigger Picture—Problems with the HSP Scale

But before you go away with the simple conclusion that you belong to a group of people who are more likely than others to have, okay, mental health problems, let’s look at the bigger picture (always my favorite). None of this is meant as a criticism of Tom’s paper. It was very, very well done. Exactly right. But it has limited meaning, in part because obviously a meta-analysis can only be as good as what goes into it. That is why one narrows the studies down to the ones using the very best methods available.  But in this case, this meant only studies using the HSP Scale (which were almost all studies).  

I have already written extensively about the problems with that measure (read blog here). Above all, the items are mostly negative. If you are in a negative state generally or on the day you take the test (not feeling mentally healthy), for whatever reason, you might say yes to more of these items, regardless of your sensitivity. Hence it could be seen as a measure of high sensitivity AND, in addition, a measure of mental health, two things being measured by the same self-report. Not good. Hence the revision of it, which includes items not related to negative feelings, such as experiences of positive stimuli and feeling empathy. But for all those studies, the HSP Scale was the only good measure, and it has been a good-enough measure. It just has this slight bias.   

As I have written, when the scale was broken down into factors, aspects, or whatever you want to call them, two contained 18 of the 25 items, and all 18 were about negative aspects of the trait, mainly feeling overstimulated or not liking overstimulation.  The third factor contained 7 items, all of them positive or positively worded. In the three studies that were included that looked at the three factors, there was much less association, or none, between the 7-item positively worded factor and mental health problems. That does make the HSP Scale seem to be a mixed measure of mental health and HSPs.

More of the Bigger Picture—Measures of Mental Health

Measures of depression, anxiety, and the like are meant to apply to everyone. But do they apply equally to HSPs? Maybe not.  Consider a yard stick, meant to measure the height of horses. If you include ponies, the same yardstick will tell you that ponies are short horses. But ponies are not generally thought of as horses. They are different. Why think about the average height of ponies in the context of horses? By analogy, HSPs are also different. It is their nature to think about things more deeply, so they are going to think more about dangers. Hence they might score higher on a measure of anxiety because of this difference. If they have experienced trauma, they are going to think more about how the nature of their situation or of the world may be depressing, even hopeless. They may score higher on a measure of depression because of this difference. Applying my pony analogy to HSPs, because of their trait of depth of processing, their “shortness,” their differentness, they are going to measure “shorter” on a measure of anxiety or depression if those measures are based on the general population, which includes its “tall”–less reflective, more impulsive people. (If you did not follow all of that, just leave out the horses and ponies and read on.)

My point is that higher levels of anxiety may be “normal” for HSPs because of their depth of processing. And given differential susceptibility, that HSPs are more affected by both negative and positive experiences, another product of deep processing of one’s experiences would be that depression should be more common in HSPs than others given the same difficult environment, especially in childhood. What we need is a yard stick for measuring depth of processing! Or better, one for measuring helpful deep processing. 

In fact, when HSPs use their depth of processing to regulate their strong emotions, they do very well (see the study below about HS mothers and mindfulness as a personality trait). But research shows that HSPs have trouble regulating their feelings in these ways: accepting their feelings, not being ashamed of them, believing they can cope as well as others do, trusting bad feelings will not last forever, and assuming there’s hope–that they can do something about their bad feelings eventually. (See my article on this.) That is, they have trouble being “mindful.” We can assume that most of the HSPs in the 33 studies did not know much if anything about their trait and would have felt just these feelings about their intense emotions. With better understanding of their trait, they might have much better emotional regulation skills–be much better at accepting their feelings, dropping their shame, and so forth. And if they did have trouble, perhaps with more understanding of their trait, they would not hesitate to get the help they need for learning to handle their emotions. But such HSP-informed persons were probably not the participants in these studies.

Finally, as the authors noted, the studies in their meta-analysis used only self-report measures, which are subject to social-desirability bias (wanting to look good, probably true of non-HSPs) and to the participant’s level of introspection (affecting how much they think about each item, probably higher for HSPs). And I think it is safe to assume that on average HSPs are probably more honest and conscientious than others when reporting their mental health problems, possibly making them seem to have more of such problems. They might do the same with positive experiences, but these were not measured.

All in all, measures meant to compare HSPs and non-HSPs on their mental health can offer problems.

More of the Big Picture—The Details About the Participants in the Studies

Again, this is no fault of the authors of the meta-analysis but relates to the population of people in the 33 studies they had available. We saw they were young adults, the mean age being 25, who are known to have poor mental health in general, given a variety of pressures on them, and the majority were women. The mental health of women in that age range is known to be even worse than that of men of that age.  There is something about the environment, the pressures that people that age experience that makes life especially difficult. So, given differential susceptibility, we would expect HSPs in the same generational “environment” to have more mental health problems. We cannot assume that the results of these studies reflect the mental health of HSPs who are more mature or of populations including more men.

A Bigger Picture About Why HSPs are More Likely to have Mental Health Problems

After reaching their conclusions, the authors provide three reasons given by authors of some of the studies as to why HSPs might have more mental health problems. One, as I have said, is their depth of processing. Specifically, this was seen as leading to “rumination,” which is associated with depression. Another reason given is that since HSPs are more easily overstimulated, they must be more stressed by life in general. And finally, as I have noted, having more intense emotions requires better emotional regulation, and as I have said, HSPs have trouble in this area. 

But what about the role of an HSP’s childhood? Childhood adversities are significantly related to mental health problems, and we know this is more common for HSPs because they are more affected by both bad and good childhood environments, but this contribution was not examined in these studies, or at least not reported in the metanalysis. Further, whatever other adversity HSPs may have faced, most of those in the populations studied grew up in families and went to schools where their trait was not understood. Surely this is another reason the studies’ participants might have felt there was something wrong with them, something they should be anxious or depressed about, contributing to their answers on the self-report measures in these studies.

Bottom Line(s):  There is no doubt that HSPs are somewhat more likely to have mental health problems when measuring them against non-HSPs on the usual measures of mental health, just as ponies become nothing but short horses if you only look at numbers on a yardstick! But given HSPs’ depth of processing, they are their own thing, just as ponies are more than just small horses. We do not want HSPs to be viewed as simply more troubled versions of people without the trait. Their depth of processing of their experiences also leads to their doing better than others in many ways. But in a meta-analysis of the existing studies, the yardsticks, the measures used, treated HSPs and non-HSPs as the same. The limitations in the population age and gender also raise questions about the conclusion regarding the size of the relationship between mental health problems and HSPs. Plus there are the possible reasons for this relationship, still not well explored, which can drastically change how we view the association. Nevertheless, it is an excellent study of its type, highlighting just how much research has been done and summarizing it quite beautifully. As Tom told me, “My hope is that our findings will help to highlight the role of sensitivity in mental health and that mental health professionals will take the trait more seriously.” And that is a lovely goal, certain to benefit HSPs in the long run. 

Highly Sensitive Mothers who are More Mindful Find it Easier Parenting Preschoolers

Passaquindici, I., Sperati, A., Lionetti, F., Fasolo, M., & Spinelli, M. (2025). Maternal mindfulness buffers parenting in highly sensitive mothers. Current Psychology, 1-4.

This study gave four self-report measures to mothers of young children: the HSP Scale, a measure of parent’s emotional regulation, of the mother’s perception of the bond between mother and child, and of mindfulness as a trait (not as a meditation practice). That measure has five subscales: how much one observes one’s momentary inner and outer environment, being able to describe this, acting with awareness of what one has observed, not judging your inner experience and accepting it or not reacting to it. 

Reading the list of subscales in the measure of mindfulness would lead you to think that being mindful sounds just like being an HSP, but we know from other research that many HSPs struggle with some of this, the parts about accepting their inner experience, that is their feelings–not judging and not reacting. See my blog on this, which contains the research. As I said in the article above and will repeat here, heir emotional regulation abilities may fall short in five specific ways: Trouble accepting feelings, being ashamed of them, not thinking they can cope as well as others do, feeling like what they experience as bad feelings will last forever, and not feeling hope that they can do something about these feelings.

These specific problems with emotional regulation may not be true of you, but they are for many HSPs, and if this is true of you, you can work on it. But you can see that measuring mindfulness is almost another way of measuring emotional regulation.  And not surprisingly, HS mothers high in mindfulness also reported being high in their emotional regulation as a parent and having a better bond with their preschool child than other HS mothers. (This was not found for mothers of toddlers, so younger children may make it hard for anyone to stay “mindful”!)

While practicing meditation might help, it was not a part of the study. To me, this study was really about HSPs’ attitudes about their intense emotions, attitudes that HSPs can and must develop for a happier personal and family life. So, again, do not judge your strong “bad” feelings, but accept them. They are normal for you, an HSP. For example, your child is having a tantrum.  Don’t like your child right now? Wish you had never become a parent? That is okay. Normal. Accept it. Then, being less stressed about yourself and your feelings, you will be able to see what you know needs to be done to improve the situation. Don’t know for sure how to do better? Read some parenting books or take some parenting courses. Get some advice from an expert. You can do it! 

Bottom Line:  HSPs, including parents and maybe especially parents, need to accept their feelings and trust that they know, or can learn, what to do to make things better.

Part II: 

When “Meditation is hell.”

Again, the second part of my blog is about something sort of “spiritual.” In May I wrote about meditation as, specifically, a valuable path to enlightenment when consistently practiced. Then I wrote about why some people stop. There were many comments, but one stood out that I wanted to answer. What follows in italics is only part of this person’s comment, but I do want to address the issue she raised—what to do when meditation feels hard or even feels like hell. Here is what she wrote.

I believe that finally seeing the reality of the lifelong-held trauma ended up calming my mind. Now that the anxiety and confusion that would keep shouting “See me! Hold me!” have been heard, I could come back to meditation without “sitting in fire”, as I would sometimes describe it. Meditating could be SO hard.

So here is my suggestion.

Keeping in mind that HSP can be hit really hard by ACE-trauma and often left deprived of a minimally balanced future, it would really be comforting that its impact on meditation would be addressed more often when talking about its benefits. You know, for people severely traumatized early in life, meditation can also feel like hell sometimes.

And when one is deeply spiritually inclined, one can’t help asking “what’s wrong with me if even meditation can’t help my troubled soul?” Hope doesn’t come by easily then.

Let me be clear at the start:  Meditation should not feel like hell. If it does, stop and consult a good meditation teacher.( I am not addressing the different types of meditation. That is another topic, a long one requiring two chapters in my book coming out April 1, Spirituality Through a Highly Sensitive Lens: An Objective Look at Meditation Methods and Enlightenment.) What I am saying here applies to all types of meditation, although finding help may differ according to where, how, and what you learned. If trauma is rearing up also, as it did for this person, consult a good, HS-informed therapist.

 Meditation and therapy can work well together, but it is also fine to stop meditating until you resolve the reasons for the hellish feeling. There is nothing wrong with needing to stop or modify your meditation practice. But always get help. It is not okay for meditation to feel like hell, ever.

What does the Research Say?

If you have had or are having negative experiences in meditation, you are not alone. Here is a summary of what I wrote in my book on the subject of whether meditation can be harmful or lead to negative experiences. This is a complicated topic, since one must define harm (feeling a little down, very depressed, a little anxious, very anxious, etc.), and over how long (an hour, a day, months, years). . Indeed, something that seems adverse one day may seem like the beginning of something good the next day. But the negative stuff should not persist. Meditation teachers expect some negative experiences, such as feeling more anxiety, and are trained in handling them, and then they are over

Still, a survey might find those same meditators who had their issues resolved would have admitted in a survey to having had at one time or other some negative experiences in meditation, boosting the number of negative experiences reported.  Again, research on this is complicated by the question of how to report the amount of harm and for how long.  

A systematic review of studies of harmful effects of meditation found that as of 2020 roughly 8.3% of meditators reported having had adverse experiences that felt harmful or undesirable and lasted more than a few hours. These were highly varied, including increased depression, anxiety, a sense of dissociation, trouble focusing, reliving of traumas, and panic One of thestudies in the review found it was closer to 10%, although the same study found 88% were happy with their meditation practice and this was unrelated to reporting harmful events.

Another study estimated that the incidence of bad effects lasting over a month was around 5%, about the same as for any other psychological treatment, although one study found it to be closer to 10%. But again, in that same study,  85% were happy with their meditation practice, and that did not differ whether meditators had had adverse effects.

The research is clear, however, that you are far more likely to have negative experiences that persist if you learn on your own, or, once you learn, do not seek any further guidance as your experiences change. After all, until very recently, meditation was always taught face-to-face by an experienced teacher who could tailor the practice to the individual and hear immediately how it went, adjusting the method as needed. Obviously, the risk of going without guidance is greater if you are already struggling in your life, especially with repressed material, such as experiences of abuse or other forms of PTSD. 

Again, professional, competent teachers of meditation expect meditators to have some “adverse” experiences as part of the learning process, but competent teachers can usually help with these. If a person stops meditating without discussing it with a teacher, feeling meditation harms them, there is no doubt some truth to it. But as a therapist, I can attest that some people come for help right when they are about to fall apart, and then the help is too late or not what they really needed or they even blame the help as the cause, when trouble was just waiting to erupt. I cannot know in any particular case, but meditation seems very safe or maybe totally safe as long as you turn to a knowledgeable teacher if a problem arises.  And stop if it feels like hell! If you have been a victim of abuse, do not let meditation abuse you too.  And definitely do not blame yourself.  There are many paths, and one may be closed to you now, rightly, yet open up later. Try to trust your process.