data.json

[
{
    "diagnosis": "Stimulant Use Disorder",
    "average_score": 0.7280424716178648,
    "items": [
        "For example lack of sleep inadequate diet and lack of exercise tended to be associated with or preceded destabilizing experiences and could be corrected as remedies by increasing sleep amount making dietary changes or getting exercise as well as by engaging in other activities described as grounding calming or embodying. Recreational drugs were sometimes cited as risk factors for certain experiences although prior drug-related experiences were also reported as a helpful foundation to have for negotiating certain types of destabilizing meditation-related experiences. Drug use was also occasionally reported as an attempt to alleviate meditation difficulties with mixed results. More commonly cited as helpful was a regimen of medication especially for severe meditation-related difficulties requiring other intensive treatments and hospitalization.  ---  Let's preserve the content minimize the use of commas and apply single quotes:  Lack of sleep inadequate diet and lack of exercise were often linked with destabilizing experiences that once identified could be addressed by increasing the quantity of sleep altering one's diet or initiating regular exercise. These actions along with engaging in activities known for their grounding calming or embodying effects served as potential remedies. Recreational drugs were intermittently recognized as triggers for certain experiences; however experiences with drugs could also lay a useful groundwork for navigating specific unsettling meditation-related incidents. Occasionally drug usage was mentioned as a means to mitigate meditation-related challenges yielding mixed outcomes. More frequently acknowledged as beneficial was a medicinal regimen particularly for acute meditation-related issues that necessitated intensive treatments or hospitalization.",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um...",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "Adverse events are either initial hurdles or challenges that ultimately contribute to personal growth according to references 3 9 88 93 and 105. Traditional meditation texts have documented similar symptoms. An early Buddhist meditation manual from the 5th century CE called the Dharmatrata Meditation Scripture notes that improper meditation practice can lead to an unstable restless or confused mind with the meditator feeling dull and sunken as stated in source 113. These negative symptoms are not viewed positively as might occur with some contemporary practitioners but as results of incorrect meditation techniques as indicated by source 114."
    ]
},
{
    "diagnosis": "Fetishistic Disorder",
    "average_score": 0.7392246765103881,
    "items": [
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um...",
        "Self-exploratory practice can surface distressing feelings or traumatic memories potentially triggering impairments with irreversible consequences. RD Springer delineates in 'When the Window Cracks: Transparency and the Fractured Self' the concept of altered self-awareness in Depersonalization Disorder. This condition is characterized by a detachment from one's self body and world. Specifically it examines self-detachment which signifies a 'divorce' or 'fracture' between the observing self and the observed self in the sixth conclusion of the paper."
    ]
},
{
    "diagnosis": "Other (or Unknown) Substance Use Disorder",
    "average_score": 0.7502851166155419,
    "items": [
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "For example lack of sleep inadequate diet and lack of exercise tended to be associated with or preceded destabilizing experiences and could be corrected as remedies by increasing sleep amount making dietary changes or getting exercise as well as by engaging in other activities described as grounding calming or embodying. Recreational drugs were sometimes cited as risk factors for certain experiences although prior drug-related experiences were also reported as a helpful foundation to have for negotiating certain types of destabilizing meditation-related experiences. Drug use was also occasionally reported as an attempt to alleviate meditation difficulties with mixed results. More commonly cited as helpful was a regimen of medication especially for severe meditation-related difficulties requiring other intensive treatments and hospitalization.  ---  Let's preserve the content minimize the use of commas and apply single quotes:  Lack of sleep inadequate diet and lack of exercise were often linked with destabilizing experiences that once identified could be addressed by increasing the quantity of sleep altering one's diet or initiating regular exercise. These actions along with engaging in activities known for their grounding calming or embodying effects served as potential remedies. Recreational drugs were intermittently recognized as triggers for certain experiences; however experiences with drugs could also lay a useful groundwork for navigating specific unsettling meditation-related incidents. Occasionally drug usage was mentioned as a means to mitigate meditation-related challenges yielding mixed outcomes. More frequently acknowledged as beneficial was a medicinal regimen particularly for acute meditation-related issues that necessitated intensive treatments or hospitalization.",
        "Being able to perceive more or possessing a highly sensitized attentional ability along with having a perceived ability of spiritual observation can also pose a challenge. In one instance as indicated by the practitioner it may have contributed to depression although this was compounded by other potent factors like overworking and illness. Another practitioner described challenges associated with a lack of acceptance for his perceived spiritual insights specifically because these insights were deemed highly valuable to others. When such insights found acceptance the experience of integration proved positive.",
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um...",
        "Self-exploratory practice can surface distressing feelings or traumatic memories potentially triggering impairments with irreversible consequences. RD Springer delineates in 'When the Window Cracks: Transparency and the Fractured Self' the concept of altered self-awareness in Depersonalization Disorder. This condition is characterized by a detachment from one's self body and world. Specifically it examines self-detachment which signifies a 'divorce' or 'fracture' between the observing self and the observed self in the sixth conclusion of the paper."
    ]
},
{
    "diagnosis": "Persistent Depressive Disorder",
    "average_score": 0.753050885110913,
    "items": [
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "The 1975 study featured detailed first-person accounts of personal experiences with subjects noting a state of openness and readiness for new growth and feelings of untapped mental potentials along with a belief that there must be more to life. Alongside these narratives the discourse included clinical descriptions of the observed phenomena where subjects' affect turned dysphoric and exhibited considerable use of intellectual processes. The research also incorporated psychological assessments such as the results from the Minnesota Multiphasic Personality Inventory profile.",
        "One key component in self-experiences related to time and the body is pivotal in these cases. Future work must investigate if feelings of being statically 'stuck' in the present 'trapped' in one\u2019s head or lacking a narrative 'flow' or 'plot' in life as reported by DPD patients even after more than 15 years of the condition (Ciaunica & Charlton 2018) are characteristic of meditation-induced forms of DPD. Noting the similarity between some aspects of meditation and DPD symptoms could be vital for developing therapies and interventions. Since a typical DPD sufferer feels 'trapped' in their mind disconnected from their body and the world the development of dynamic body-based therapies could offset this tendency towards excessive self-scrutiny and a self-objectifying stance.",
        "They are studying their prevalence duration impact on daily functioning and factors that tend to exacerbate their effects (Britton 2013). In the author's clinical practice multiple modalities such as pharmacotherapy modified meditation practice instructions and psychotherapy have been required to adequately address some of the psychological challenges that can arise during the stages of insight. While the majority of participants in a typical MBI group will not develop sufficient skill and concentration to begin to progress along the stages of insight a few participants may report experiences consistent with progress to the first or second stage. Personal interviews with senior MBI instructors as well as the experience of the author running MBCT groups \u00ae Springer indicate that there have been cases where participants appear to experience the Knowledge of the Three Characteristics sometimes as early as session 2 or 3 of the MBI group.  Here is your paragraph with the necessary adjustments:  They are studying their prevalence duration impact on daily functioning and factors that tend to exacerbate their effects (Britton 2013). In the author's clinical practice multiple modalities such as pharmacotherapy modified meditation practice instructions and psychotherapy have been required to adequately address some of the psychological challenges that can arise during the stages of insight. While the majority of participants in a typical MBI group will not develop sufficient skill and concentration to begin to progress along the stages of insight a few participants may report experiences consistent with progress to the first or second stage. Personal interviews with senior MBI instructors as well as the experience of the author running MBCT groups \u00ae Springer indicate that there have been cases where participants appear to experience the Knowledge of the Three Characteristics sometimes as early as session 2 or 3 of the MBI group.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011)."
    ]
},
{
    "diagnosis": "Substance_Medication_Induced Major or Mild Neurocognitive Disorder",
    "average_score": 0.7587499247574654,
    "items": [
        "Suicidal behavior gastrointestinal problems dissociation or depersonalization fear or terror trauma re-experience pain psychotic or delusional symptoms visual or auditory hallucinations stress or tension cognitive anomalies depression anxiety and adverse events in meditation were mostly assessed through self-report instruments. However some variables included various psychophysiological and biological measures - stress for instance was gauged via heart rate blood pressure skin conductance and cortisol levels alongside self-reports. Neurological or cognitive meditation adverse events (MAEs) featured in 17 studies accounting for 20%. The most prevalent MAEs were cognitive anomalies encountered in 14 studies. These included thought disorganization in three studies (3 89) amnesia (97) perceptual hypersensitivity (19) and impaired memory reliability (34 40). Additionally three studies noted involuntary bodily movements and muscle contractions during meditation.",
        "Given the variability of the acute effects and the potential for challenging emotional experiences both the context of the experience and the methods individuals use to process it afterward may significantly impact the long-term outcome. The experiences induced by both drugs and meditation suggest we require more refined measures that don't inherently link alterations in the sense of self with valence to comprehend how such transformations garner their immediate context and subsequent interpretation. In order to investigate how the sense of self is constructed and modified our framework must allow comparison of subjective experiences in real time irrespective of the setting or induction method. To grasp why phenomenologically similar changes can lead to diverse interpretations and outcomes it\u2019s imperative to monitor how individuals appraise and derive meaning from events as they occur and how these events are evaluated subsequently. For this we necessitate more nuanced metrics and enhanced methods for the analysis of first-person narratives.",
        "Although the clinical literature recognizes serious meditation-related difficulties that necessitate treatment there remains a dearth of systematic research into the challenges of meditation experiences their causes and methods for their prevention or management. Studies on reports from meditation practitioners are conducted within the context of anomalous experiences and typically involve lab-based experiments. These experiments induce state-based changes in meditators with the aim to investigate neural correlates referenced as sources '77-79'. Included in this category are studies on alterations in the sense of self '78-81' the sense of time and space '77 80 82' and perception changes '83'.",
        "The results challenge common causal assumptions such as the belief that meditation-related difficulties arise solely in individuals with pre-existing conditions (psychiatric or trauma history) who engage in long or intensive retreats are poorly supervised practice incorrectly or lack adequate preparation. However this does not imply that these and other factors are irrelevant. Indeed both experts and practitioners have identified various 'influencing factors' they believe affect the likelihood of facing meditation-related challenges including their duration and the degree of distress and impairment. The data suggest an interaction-based model where meditation practices on their own can lead to challenging effects. However the specific type of effect as well as its probability duration distress and impairment are influenced by numerous additional factors.",
        "The current study offers meditation instructors a detailed classification system of challenging experiences to aid in pinpointing students who might need extra support or corrective guidance. Early recognition is proven to enhance overall outcomes and lessen adverse effects as noted in source 163. This study provides an initial set of corrective strategies and management techniques from the insights of both specialists and practitioners and outlines potential contributing factors that warrant further examination in academic and practical domains. Refer to PLOS ONE at the provided link for more information as of May 24 2017 page 26 of 38. In the realm of contemplative experiences ongoing research starts to uncover practitioner-level influences like trauma history as documented in sources 61 and 164 or psychiatric conditions indicated in source 165. These factors may affect meditation-related results or necessitate changes in the design of teacher training programs including adjustments to the eligibility requirements referenced in source 166."
    ]
},
{
    "diagnosis": "Major or Mild Neurocognitive Disorder Due to Another Medical Condition",
    "average_score": 0.7601807459755915,
    "items": [
        "For example one early compendium of Buddhist meditation techniques from the 5th century CE\u2014the Dharmatrata Meditation Scripture\u2014reports that if the meditation is not carried out properly the mind can become unstable restless or confused and the meditator may feel dull confused and sunken (113). Such adverse symptoms are not viewed positively as might be the case with some modern meditators but are considered consequences of incorrect meditation practice (114). Other explanations presented in the medical and psychological literature pertain to the intensity of meditation practice (19 115) the skill of the teacher and participant vulnerabilities; however the latter have sometimes been observed to amplify the positive effects of meditation\u2014for instance in recurrently depressed individuals with a higher incidence of childhood trauma (48 110). Concerning participant vulnerability one factor suggested to precipitate MAEs (110) the examination of case studies has shown that the majority of individuals experiencing severe MAEs had no prior mental health record.   (Note: The text after the clean-up still contains commas as removing them would affect the clarity and meaning of the sentences. It also includes numbers in parentheses which appear to be references. The usage of singular quotes (') instead of double quotes (\") was not possible because there were no direct quotes in the paragraph provided. If those numbers are not meant to be references and the instruction was to eliminate all commas and replace double quotes with single quotes please provide further clarification.)",
        "The results challenge common causal assumptions such as the belief that meditation-related difficulties arise solely in individuals with pre-existing conditions (psychiatric or trauma history) who engage in long or intensive retreats are poorly supervised practice incorrectly or lack adequate preparation. However this does not imply that these and other factors are irrelevant. Indeed both experts and practitioners have identified various 'influencing factors' they believe affect the likelihood of facing meditation-related challenges including their duration and the degree of distress and impairment. The data suggest an interaction-based model where meditation practices on their own can lead to challenging effects. However the specific type of effect as well as its probability duration distress and impairment are influenced by numerous additional factors.",
        "Suicidal behavior gastrointestinal problems dissociation or depersonalization fear or terror trauma re-experience pain psychotic or delusional symptoms visual or auditory hallucinations stress or tension cognitive anomalies depression anxiety and adverse events in meditation were mostly assessed through self-report instruments. However some variables included various psychophysiological and biological measures - stress for instance was gauged via heart rate blood pressure skin conductance and cortisol levels alongside self-reports. Neurological or cognitive meditation adverse events (MAEs) featured in 17 studies accounting for 20%. The most prevalent MAEs were cognitive anomalies encountered in 14 studies. These included thought disorganization in three studies (3 89) amnesia (97) perceptual hypersensitivity (19) and impaired memory reliability (34 40). Additionally three studies noted involuntary bodily movements and muscle contractions during meditation.",
        "Another participant noted that the challenging nature of thinking\u2014certain concepts and mental exercises can be 'chewy' or tough\u2014might enhance self-awareness while still allowing space for others and different phenomena in one's thoughts. Memory is also impacted by meditation; it can either bolster or diminish recall capabilities. Improvement in memory can also result in de-repression meaning that previously suppressed traumatic experiences might surface in consciousness.",
        "Being able to perceive more or possessing a highly sensitized attentional ability along with having a perceived ability of spiritual observation can also pose a challenge. In one instance as indicated by the practitioner it may have contributed to depression although this was compounded by other potent factors like overworking and illness. Another practitioner described challenges associated with a lack of acceptance for his perceived spiritual insights specifically because these insights were deemed highly valuable to others. When such insights found acceptance the experience of integration proved positive."
    ]
},
{
    "diagnosis": "Antisocial Personality Disorder",
    "average_score": 0.7247476716397999,
    "items": [
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "Self-exploratory practice can surface distressing feelings or traumatic memories potentially triggering impairments with irreversible consequences. RD Springer delineates in 'When the Window Cracks: Transparency and the Fractured Self' the concept of altered self-awareness in Depersonalization Disorder. This condition is characterized by a detachment from one's self body and world. Specifically it examines self-detachment which signifies a 'divorce' or 'fracture' between the observing self and the observed self in the sixth conclusion of the paper.",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "We suggest disruptions in the transparent embodied and pre-reflective sense of self play a role in DPD impairing the capacity for navigation between the I- and body-as-subject and the I- and body-as-object of an experience. An increased emphasis on the latter over the former leads to a dominant presence of hyper-reflective mentalistic forms of self-awareness fostering self-opacity and sensations of 'living in a bubble' severed from one's self body and the external world. The concluding Section 5 touches on akin self-detachment experiences observed in certain Buddhist-derived meditative practices. We propose that alterations in self-experiences brought on by these contemplative methods might expose the intrinsic and implicit transparency marking embodied pre-reflective forms of self-consciousness.",
        "Mindfulness and related higher-order cognitive processes such as theory of mind perspective taking enable the observer of suffering to maintain a healthy differentiation between self and other. This enhances the ability to regulate one's instinctive threat-based reactions thereby providing a consistently compassionate presence. In CCT gradual and steady exposure to suffering imagery alongside a conscious decision to cultivate a compassionate motivation to alleviate that suffering\u2014rather than responding from a threat-based mentality characterized by avoidance denial or over-identification\u2014may elucidate the noteworthy increases in empathic concern and compassion and the reduction in empathic distress as indicated by the personal distress subscale detailed in Table 3."
    ]
},
{
    "diagnosis": "Delusional Disorder",
    "average_score": 0.7470037379775845,
    "items": [
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "The analysis indicates a discursive divide between two dominant framings: a biomedical discourse that constructs such experiences as psychiatric symptoms and an alternative discourse that perceives them as spiritual emergencies. Both approaches provide distinct therapeutic avenues. This divide aligns with the broader disciplinary divides within the mental health field potentially hindering a more nuanced understanding of these experiences. Nevertheless the two discourses are not necessarily mutually exclusive; authors of three articles opted to integrate them for their case reports.",
        "Some of these experiences can be very psychologically disturbing to meditators including symptoms consistent with psychiatric clinical syndromes such as depression mania psychosis and suicidality. As mentioned above these can persist during daily life outside of periods of formal practice. Based on questionnaires given to over 100 meditators during a series of 2 week and 3 month Vipassana retreats Kornfield (1979 p. 51) found that 'unusual experiences visual or auditory aberrations \"hallucinations\" unusual somatic experiences and so on are the norm among practiced meditation students.' More recently Kornfield (2011) describes the occurrence of frank psychotic breaks in meditation retreat participants usually in those with a history of psychiatric illness and occasionally the need for pharmacotherapy and hospitalization. Researchers in the Britton lab at Brown University are currently investigating these experiences with an emphasis on those that are psychologically challenging and usually occur in the Knowledges of Suffering."
    ]
},
{
    "diagnosis": "Catatonic Disorder Due to Another Medical Condition",
    "average_score": 0.7688742207487244,
    "items": [
        "In scientific articles these phenomena have been described in various ways: as psychiatric symptoms as 'non-ordinary states of consciousness' or as 'extreme mental states' referencing authors VanderKooi 1997 and Walsh & Roche 1979 with a concentration on individual risk factors noted by Kuijpers et al. 2007. More recent studies have explored these extreme mental states among different traditions including practitioners of Buddhist meditation as noted by Lindahl et al. 2017 and Kaselionyte & Gumley 2018 as well as in Kundalini yoga referenced again by Kaselionyte & Gumley 2018.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "Bodily affordances include cataplexy which is characterized by a loss of muscle control; an adrenaline surge resembling electricity shooting through the body; and an emotional surge often described as an intense overwhelming emotion. These physiological phenomena are not uncommon to the human body and are memorable enough for individuals to recall without specific terminology such as recalling the moment one experiences an intense rush of feelings upon opening a letter. While not as rare and striking as out-of-body experiences both Vineyard congregants and Thai Buddhists were familiar with the concepts when questioned. Vineyard congregants generally welcomed these experiences as evidence of something positive in contrast to the Thai Buddhists who did not share this perspective.",
        "These 'extreme mental states' may often prompt a response from meditation teachers or mental health services (VanderKooi 1997 p. 31). A discursive divide exists in reporting these experiences which have predominantly been constructed by the biomedical discourse as 'psychosis' requiring psychiatric interventions (Chan-Ob & Boonyanaruthee 1999; Kuijpers van der Heijden Tuinier & Verhoeven 2007; Sharma Singh Gnanavel & Kumar 2016) while the alternative discourse introduced other conceptualisations such as 'spiritual emergency' (Lukoff Lu & Turner 1998) and 'Kundalini awakening' (Ossoff 1993). It could be argued that these discursive constructions can to a greater or lesser degree obscure the nature and phenomenology of extreme mental states and hinder our understanding of these.   (Note: Single quotes have been used as requested and the content preserved. However due to the original request not to use any commas the in-text citations cannot have commas even though they would typically require them for proper APA citation format.)"
    ]
},
{
    "diagnosis": "Stereotypic Movement Disorder",
    "average_score": 0.7485426187601942,
    "items": [
        "Observation of the similarity between some aspects of meditation and DPD symptomatology holds significant implications for potential therapies and interventions. Indeed given that a typical DPD sufferer describes feelings of being 'trapped' in one's mind and disconnected from one's body and the world we may develop dynamic body-based therapies to counter this mentalistic overscrutiny and self-objectifying stance. Moreover while meditation-based interventions may help in regulating the anxiety commonly accompanying DPD experiences they lack the dynamic and embodied engagement component essential for patients to overcome the static feelings of 'living in a bubble' or in one's head. If our hypotheses presented here are accurate it is by moving one's body \u2014 and especially by moving with others \u2014 that we can potentially dissolve the 'experiential airbag' enveloping the fractured self in DPD which feels isolated from the world (Ciaunica & Fotopoulou 2017).",
        "Moreover while meditation-based interventions may prove useful in regulating the anxiety that typically accompanies DPD experiences they lack the dynamic and embodied engagement component necessary for patients to override the static feelings of 'living in a bubble' or being in one's head. If our hypotheses here are correct moving one's body\u2014especially in concert with others\u2014can potentially dissolve the 'experiential airbag' that surrounds the fractured self in DPD which feels isolated from the world (Ciaunica & Fotopoulou 2017). This recommendation is supported by anecdotal self-reports from DPD patients who often notice an improvement in their dissociation states after periods of intense physical training and social interactions; as one patient reported 'a constant source of interaction is the only thing that allows me to maintain a connection with the world. I'll also seek physical contact with whoever I'm with'.",
        "On a more subtle level the practitioner can become aware of the conditioned multidetermined nature of sensations. Intentions sensations and mental impressions may be experienced in a ratchet-like and almost mechanical sequence. This experience has been termed 'broken movements' by teachers in the Mahasi tradition (Chanmyay Sayadaw 2010 p. 113).  Note: The original instructions indicated to avoid the use of commas but due to the grammatical structure of the sentences omitting them would lead to reduced clarity and potentially lost meaning. If the goal is to strictly adhere to the avoidance of commas regardless of the impact on the text's readability we could attempt to restructure further but it would be a departure from conventional English syntax.",
        "One key component in self-experiences related to time and the body is pivotal in these cases. Future work must investigate if feelings of being statically 'stuck' in the present 'trapped' in one\u2019s head or lacking a narrative 'flow' or 'plot' in life as reported by DPD patients even after more than 15 years of the condition (Ciaunica & Charlton 2018) are characteristic of meditation-induced forms of DPD. Noting the similarity between some aspects of meditation and DPD symptoms could be vital for developing therapies and interventions. Since a typical DPD sufferer feels 'trapped' in their mind disconnected from their body and the world the development of dynamic body-based therapies could offset this tendency towards excessive self-scrutiny and a self-objectifying stance.",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world."
    ]
},
{
    "diagnosis": "Enuresis",
    "average_score": 0.750590358465745,
    "items": [
        "Complex and detailed patterns of thought along with complex sequences of actions can be executed in periods no longer than a few seconds. A participant in the pilot study (P11) recounted a series of intricate thoughts that transpired rapidly when she was displaced from her bicycle by a spray of water from a road watering truck before being overrun by a gravel truck. She recalled having an extended period during which time seemed to slow down significantly allowing her to make numerous observations. Before the tires made contact she was bracing for the possibility of being paraplegic envisioning the challenge of navigating college in a wheelchair. She even visualized herself attending university dances while using a wheelchair.",
        "It felt like a dream of sorts\u2014I didn't really understand what was happening to me. I needed a way to escape my thoughts as they made me feel as if I were going mad. Participant T2 also reflected on the distress that arises in those who have had spontaneous extreme experiences and begin to interpret them through the constructs of their own minds: 'The way people deal with the unknown\u2014it's a feeling of being out of control.",
        "Practitioners described boundaries between themselves and their surroundings becoming indistinct and experiencing a heightened sense of connection either with the environment or with other individuals. Some reported a sensation where their individual self seemed to extend beyond their physical form and blend with the world while others expressed the opposite feeling by noting the world seemed to integrate into their sense of self. Various emotional reactions were tied to this shift ranging from mere curiosity to profound joy and even to fear and panic. A prevalent experience was the diminishing sense of ownership over one's thoughts emotions and bodily sensations. The practitioners also spoke of reduced sense of control or the absence of the 'doer' in their actions including involuntary actions like weeping habitual movements such as walking and deliberate actions like talking.",
        "In scientific articles these phenomena have been described in various ways: as psychiatric symptoms as 'non-ordinary states of consciousness' or as 'extreme mental states' referencing authors VanderKooi 1997 and Walsh & Roche 1979 with a concentration on individual risk factors noted by Kuijpers et al. 2007. More recent studies have explored these extreme mental states among different traditions including practitioners of Buddhist meditation as noted by Lindahl et al. 2017 and Kaselionyte & Gumley 2018 as well as in Kundalini yoga referenced again by Kaselionyte & Gumley 2018.",
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um..."
    ]
},
{
    "diagnosis": "Major or Mild Frontotemporal Neurocognitive Disorder",
    "average_score": 0.7419746204218841,
    "items": [
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "Emotion regulation strategies moderate the relationship of fatigue with depersonalization and derealization symptoms as stated in the 'Journal of Affective Disorders' 227 pages 571-879. Tye M. in 1999 proposed 'Phenomenal consciousness: the explanatory gap as a cognitive illusion'.",
        "Complex and detailed patterns of thought along with complex sequences of actions can be executed in periods no longer than a few seconds. A participant in the pilot study (P11) recounted a series of intricate thoughts that transpired rapidly when she was displaced from her bicycle by a spray of water from a road watering truck before being overrun by a gravel truck. She recalled having an extended period during which time seemed to slow down significantly allowing her to make numerous observations. Before the tires made contact she was bracing for the possibility of being paraplegic envisioning the challenge of navigating college in a wheelchair. She even visualized herself attending university dances while using a wheelchair.",
        "Patients reported subjective experiences like changes in emotional states cognitive alterations shifts in consciousness sensory distortions paresthesias and other bodily sensations. Emotions described encompassed fear anxiety sadness apprehension threat and being chased; infrequently sensations of euphoria or feeling 'protected' were conveyed. Cognitive changes included experiences of d\u00e9j\u00e0 vu rapid thoughts indecipherable musings confusion repetitive single words in one's mind and flashbacks to early life. Other consciousness changes involved feelings of tiredness sleepiness being 'spacey' dazed fatigued wasteful inebriated descending into darkness and a lack of order.  Regarding sensory distortions individuals reported seeing flashes of light undulating lines insects geometric and colored shapes kaleidoscopic or monochromatic visions and visuals as if through a veil; hearing music throbbing sounds noises akin to Rice Krispies and muffled or decelerated voices; smelling sulfur burning watermelon ammonia and strong spices; tasting unpleasantness in the mouth. Paresthesias included sensations of light-headedness dizziness tingling electric shocks within the body stun-like effects akin to nerve blocks facial numbness a 'sugar rush' 'butterflies' energetic waves pulsating through the body and burning feelings.",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized."
    ]
},
{
    "diagnosis": "Tobacco Withdrawal",
    "average_score": 0.7393795197651577,
    "items": [
        "The sense of alertness similar to the sense of calmness was occasionally portrayed in spiritual terms despite being initiated by accidents or emergencies as evidenced by participants P31 and P36. Participant P9 upon receiving a diagnosis of cancer recounted: 'Just before my diagnosis of breast cancer while sitting in the waiting room I intuitively knew the outcome of the tests. As I sat there everything slowed down.",
        "Patients reported subjective experiences like changes in emotional states cognitive alterations shifts in consciousness sensory distortions paresthesias and other bodily sensations. Emotions described encompassed fear anxiety sadness apprehension threat and being chased; infrequently sensations of euphoria or feeling 'protected' were conveyed. Cognitive changes included experiences of d\u00e9j\u00e0 vu rapid thoughts indecipherable musings confusion repetitive single words in one's mind and flashbacks to early life. Other consciousness changes involved feelings of tiredness sleepiness being 'spacey' dazed fatigued wasteful inebriated descending into darkness and a lack of order.  Regarding sensory distortions individuals reported seeing flashes of light undulating lines insects geometric and colored shapes kaleidoscopic or monochromatic visions and visuals as if through a veil; hearing music throbbing sounds noises akin to Rice Krispies and muffled or decelerated voices; smelling sulfur burning watermelon ammonia and strong spices; tasting unpleasantness in the mouth. Paresthesias included sensations of light-headedness dizziness tingling electric shocks within the body stun-like effects akin to nerve blocks facial numbness a 'sugar rush' 'butterflies' energetic waves pulsating through the body and burning feelings.",
        "After inhaling my body became heavier and I felt more relaxed; soon after a sensation of floating emerged accompanied by numerous corporeal sensations. A sense of well-being pervaded my body characterized by calmness and a subtle warmth. There was a compulsion to close likely referring to the eyes coinciding with a strong high-energy surge that induced tingling in my neck and head. The intensity of the experience was palpable in my body and affected my mind and vision.",
        "Trauma-related memories might emerge and some of these symptoms could linger beyond the formal meditation period yet typically they subside as the practitioner progresses to the next insight stage. The simultaneous occurrence of rapidly observed sensations and abrupt physical pain usually signals entry into this stage as noted by Chanmyay Sayadaw (2010 p. 111) and Mahasi Sayadaw (2006 pp.).",
        "Suicidal behavior gastrointestinal problems dissociation or depersonalization fear or terror trauma re-experience pain psychotic or delusional symptoms visual or auditory hallucinations stress or tension cognitive anomalies depression anxiety and adverse events in meditation were mostly assessed through self-report instruments. However some variables included various psychophysiological and biological measures - stress for instance was gauged via heart rate blood pressure skin conductance and cortisol levels alongside self-reports. Neurological or cognitive meditation adverse events (MAEs) featured in 17 studies accounting for 20%. The most prevalent MAEs were cognitive anomalies encountered in 14 studies. These included thought disorganization in three studies (3 89) amnesia (97) perceptual hypersensitivity (19) and impaired memory reliability (34 40). Additionally three studies noted involuntary bodily movements and muscle contractions during meditation."
    ]
},
{
    "diagnosis": "Pica",
    "average_score": 0.7195852165194943,
    "items": [
        "In scientific articles these phenomena have been described in various ways: as psychiatric symptoms as 'non-ordinary states of consciousness' or as 'extreme mental states' referencing authors VanderKooi 1997 and Walsh & Roche 1979 with a concentration on individual risk factors noted by Kuijpers et al. 2007. More recent studies have explored these extreme mental states among different traditions including practitioners of Buddhist meditation as noted by Lindahl et al. 2017 and Kaselionyte & Gumley 2018 as well as in Kundalini yoga referenced again by Kaselionyte & Gumley 2018.",
        "Complex and detailed patterns of thought along with complex sequences of actions can be executed in periods no longer than a few seconds. A participant in the pilot study (P11) recounted a series of intricate thoughts that transpired rapidly when she was displaced from her bicycle by a spray of water from a road watering truck before being overrun by a gravel truck. She recalled having an extended period during which time seemed to slow down significantly allowing her to make numerous observations. Before the tires made contact she was bracing for the possibility of being paraplegic envisioning the challenge of navigating college in a wheelchair. She even visualized herself attending university dances while using a wheelchair.",
        "One participant recounted delving into subjects like the significance of pain and self-denial mentioning that these studies can often lead to a meditative state. The process might span years drawing upon everyday occurrences for enhancement until it culminates in a singular meditative moment. These instances can occur abruptly ushering in a flood of varied ideas and connections. Additionally some participants gained insights into human composition including the underlying mechanisms of day-to-day thought.",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized."
    ]
},
{
    "diagnosis": "Avoidant Personality Disorder",
    "average_score": 0.7447320486565139,
    "items": [
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Self-exploratory practice can surface distressing feelings or traumatic memories potentially triggering impairments with irreversible consequences. RD Springer delineates in 'When the Window Cracks: Transparency and the Fractured Self' the concept of altered self-awareness in Depersonalization Disorder. This condition is characterized by a detachment from one's self body and world. Specifically it examines self-detachment which signifies a 'divorce' or 'fracture' between the observing self and the observed self in the sixth conclusion of the paper.",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "Often the fear or anxiety was an additional response of negative affect that coincided with other unexpected or undesired changes. However in some cases fear was non-referential and reported as a phenomenological change unto itself. Increased emotionality also manifested as heightened affective lability sensitivity or reactivity in response to either people or other environmental stimuli. Emotional sensitivity to others often appeared as empathic and affiliative changes\u2014increased feelings of empathy or sharing others' emotions\u2014between the practitioner and other human beings. In contrast some practitioners reported experiencing fewer or less intense emotions or affective flattening sometimes even a complete absence of emotions. Positive affect including bliss and euphoria were also commonly reported but were sometimes followed by subsequent depression or agitation either within the context of a practice or transitioning from formal practice to daily life.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011)."
    ]
},
{
    "diagnosis": "Trichotillomania (Hair_Pulling Disorder)",
    "average_score": 0.7265531938813191,
    "items": [
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um...",
        "One key component in self-experiences related to time and the body is pivotal in these cases. Future work must investigate if feelings of being statically 'stuck' in the present 'trapped' in one\u2019s head or lacking a narrative 'flow' or 'plot' in life as reported by DPD patients even after more than 15 years of the condition (Ciaunica & Charlton 2018) are characteristic of meditation-induced forms of DPD. Noting the similarity between some aspects of meditation and DPD symptoms could be vital for developing therapies and interventions. Since a typical DPD sufferer feels 'trapped' in their mind disconnected from their body and the world the development of dynamic body-based therapies could offset this tendency towards excessive self-scrutiny and a self-objectifying stance.",
        "One may argue that depersonalisation-like states are inevitable steps on the challenging path towards self-exploration leading to the ultimate no-self or 'pure subjectivity' state targeted by Buddhist-based meditative practices. This remains an open question and further examination is essential to provide a systematic comparison between meditation-induced forms of DPD and trauma drugs and anxiety-induced forms of DPD. For example a key component appears to be the temporal dimension of self-experiences and its relation to the body. In future work it will be crucial to examine if feelings of being statically 'stuck' in the present 'trapped' in one's head or lacking a narrative 'flow' or 'plot' in life as reported by DPD patients even after over 15 years of experiencing the condition are also characteristic of meditation-induced forms of DPD as highlighted in Ciaunica and Charlton 2018."
    ]
},
{
    "diagnosis": "Opioid Intoxication",
    "average_score": 0.7466995160853404,
    "items": [
        "Patients reported subjective experiences like changes in emotional states cognitive alterations shifts in consciousness sensory distortions paresthesias and other bodily sensations. Emotions described encompassed fear anxiety sadness apprehension threat and being chased; infrequently sensations of euphoria or feeling 'protected' were conveyed. Cognitive changes included experiences of d\u00e9j\u00e0 vu rapid thoughts indecipherable musings confusion repetitive single words in one's mind and flashbacks to early life. Other consciousness changes involved feelings of tiredness sleepiness being 'spacey' dazed fatigued wasteful inebriated descending into darkness and a lack of order.  Regarding sensory distortions individuals reported seeing flashes of light undulating lines insects geometric and colored shapes kaleidoscopic or monochromatic visions and visuals as if through a veil; hearing music throbbing sounds noises akin to Rice Krispies and muffled or decelerated voices; smelling sulfur burning watermelon ammonia and strong spices; tasting unpleasantness in the mouth. Paresthesias included sensations of light-headedness dizziness tingling electric shocks within the body stun-like effects akin to nerve blocks facial numbness a 'sugar rush' 'butterflies' energetic waves pulsating through the body and burning feelings.",
        "The current body of research often notes a typical occurrence of individuals re-experiencing past frequently challenging or traumatic memories while under the influence of ibogaine (Alper 2001; Heink et al. 2017). However this specific theme did not surface in the present investigation. Despite this a significant majority 80% of subjects reported encountering both unsettling and euphoric visual and emotional sensations. Emotional turmoil is a well-documented occurrence in similar studies (Heink et al.).",
        "In scientific articles these phenomena have been described in various ways: as psychiatric symptoms as 'non-ordinary states of consciousness' or as 'extreme mental states' referencing authors VanderKooi 1997 and Walsh & Roche 1979 with a concentration on individual risk factors noted by Kuijpers et al. 2007. More recent studies have explored these extreme mental states among different traditions including practitioners of Buddhist meditation as noted by Lindahl et al. 2017 and Kaselionyte & Gumley 2018 as well as in Kundalini yoga referenced again by Kaselionyte & Gumley 2018.",
        "After inhaling my body became heavier and I felt more relaxed; soon after a sensation of floating emerged accompanied by numerous corporeal sensations. A sense of well-being pervaded my body characterized by calmness and a subtle warmth. There was a compulsion to close likely referring to the eyes coinciding with a strong high-energy surge that induced tingling in my neck and head. The intensity of the experience was palpable in my body and affected my mind and vision.",
        "The sense of alertness similar to the sense of calmness was occasionally portrayed in spiritual terms despite being initiated by accidents or emergencies as evidenced by participants P31 and P36. Participant P9 upon receiving a diagnosis of cancer recounted: 'Just before my diagnosis of breast cancer while sitting in the waiting room I intuitively knew the outcome of the tests. As I sat there everything slowed down."
    ]
},
{
    "diagnosis": "Phencyclidine Intoxication",
    "average_score": 0.7588121456379466,
    "items": [
        "Patients reported subjective experiences like changes in emotional states cognitive alterations shifts in consciousness sensory distortions paresthesias and other bodily sensations. Emotions described encompassed fear anxiety sadness apprehension threat and being chased; infrequently sensations of euphoria or feeling 'protected' were conveyed. Cognitive changes included experiences of d\u00e9j\u00e0 vu rapid thoughts indecipherable musings confusion repetitive single words in one's mind and flashbacks to early life. Other consciousness changes involved feelings of tiredness sleepiness being 'spacey' dazed fatigued wasteful inebriated descending into darkness and a lack of order.  Regarding sensory distortions individuals reported seeing flashes of light undulating lines insects geometric and colored shapes kaleidoscopic or monochromatic visions and visuals as if through a veil; hearing music throbbing sounds noises akin to Rice Krispies and muffled or decelerated voices; smelling sulfur burning watermelon ammonia and strong spices; tasting unpleasantness in the mouth. Paresthesias included sensations of light-headedness dizziness tingling electric shocks within the body stun-like effects akin to nerve blocks facial numbness a 'sugar rush' 'butterflies' energetic waves pulsating through the body and burning feelings.",
        "The current body of research often notes a typical occurrence of individuals re-experiencing past frequently challenging or traumatic memories while under the influence of ibogaine (Alper 2001; Heink et al. 2017). However this specific theme did not surface in the present investigation. Despite this a significant majority 80% of subjects reported encountering both unsettling and euphoric visual and emotional sensations. Emotional turmoil is a well-documented occurrence in similar studies (Heink et al.).",
        "The triggers for these experiences were meditation and psychological turmoil which led to the dissolution of self-identity and an egoic self; this left individuals feeling liberated from life's challenges. He also notes that psychedelics may induce similar awakenings by creating a temporary dissolution of the normal self. Energetic awakenings often come with physiological experiences. Both historical texts and modern research agree that many individuals undergo physiological changes as part of the awakening and transformation process. MH Woollacott et al. document these phenomena.",
        "In scientific articles these phenomena have been described in various ways: as psychiatric symptoms as 'non-ordinary states of consciousness' or as 'extreme mental states' referencing authors VanderKooi 1997 and Walsh & Roche 1979 with a concentration on individual risk factors noted by Kuijpers et al. 2007. More recent studies have explored these extreme mental states among different traditions including practitioners of Buddhist meditation as noted by Lindahl et al. 2017 and Kaselionyte & Gumley 2018 as well as in Kundalini yoga referenced again by Kaselionyte & Gumley 2018.",
        "Bodily affordances include cataplexy which is characterized by a loss of muscle control; an adrenaline surge resembling electricity shooting through the body; and an emotional surge often described as an intense overwhelming emotion. These physiological phenomena are not uncommon to the human body and are memorable enough for individuals to recall without specific terminology such as recalling the moment one experiences an intense rush of feelings upon opening a letter. While not as rare and striking as out-of-body experiences both Vineyard congregants and Thai Buddhists were familiar with the concepts when questioned. Vineyard congregants generally welcomed these experiences as evidence of something positive in contrast to the Thai Buddhists who did not share this perspective."
    ]
},
{
    "diagnosis": "Bipolar I Disorder",
    "average_score": 0.749335325998112,
    "items": [
        "In contrast to heightened emotionality some practitioners experienced diminished or milder emotions or even affective flattening with occasional instances of total emotional absence. Positive feelings such as bliss and euphoria were frequently noted; however these were at times succeeded by depression or restlessness whether during a practice session or when transitioning to everyday activities. For some individuals the severity of depression led to thoughts of suicide. In other circumstances intense positive emotions did not lead to low energy states but rather intensified into destabilizing conditions akin to mania and psychosis frequently necessitating hospital admission.",
        "In scientific articles these phenomena have been described in various ways: as psychiatric symptoms as 'non-ordinary states of consciousness' or as 'extreme mental states' referencing authors VanderKooi 1997 and Walsh & Roche 1979 with a concentration on individual risk factors noted by Kuijpers et al. 2007. More recent studies have explored these extreme mental states among different traditions including practitioners of Buddhist meditation as noted by Lindahl et al. 2017 and Kaselionyte & Gumley 2018 as well as in Kundalini yoga referenced again by Kaselionyte & Gumley 2018.",
        "The 1975 study featured detailed first-person accounts of personal experiences with subjects noting a state of openness and readiness for new growth and feelings of untapped mental potentials along with a belief that there must be more to life. Alongside these narratives the discourse included clinical descriptions of the observed phenomena where subjects' affect turned dysphoric and exhibited considerable use of intellectual processes. The research also incorporated psychological assessments such as the results from the Minnesota Multiphasic Personality Inventory profile.",
        "Over the following eight weeks her mental state stabilized. She persisted in declining mood-stabilizing treatment and returned to the Buddhist retreat. Discussion: The triggering of mania by meditation has not previously been documented; however accounts of the altered states of consciousness associated with contemplative practices are plentiful in the mystical texts of various religions (Buckley 1981). Zen a Japanese branch of Buddhism takes its name from the Sanskrit 'dhyana' meaning meditation which is the core of Zen philosophy.",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing])."
    ]
},
{
    "diagnosis": "Cannabis Use Disorder",
    "average_score": 0.7342588139981704,
    "items": [
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "For example lack of sleep inadequate diet and lack of exercise tended to be associated with or preceded destabilizing experiences and could be corrected as remedies by increasing sleep amount making dietary changes or getting exercise as well as by engaging in other activities described as grounding calming or embodying. Recreational drugs were sometimes cited as risk factors for certain experiences although prior drug-related experiences were also reported as a helpful foundation to have for negotiating certain types of destabilizing meditation-related experiences. Drug use was also occasionally reported as an attempt to alleviate meditation difficulties with mixed results. More commonly cited as helpful was a regimen of medication especially for severe meditation-related difficulties requiring other intensive treatments and hospitalization.  ---  Let's preserve the content minimize the use of commas and apply single quotes:  Lack of sleep inadequate diet and lack of exercise were often linked with destabilizing experiences that once identified could be addressed by increasing the quantity of sleep altering one's diet or initiating regular exercise. These actions along with engaging in activities known for their grounding calming or embodying effects served as potential remedies. Recreational drugs were intermittently recognized as triggers for certain experiences; however experiences with drugs could also lay a useful groundwork for navigating specific unsettling meditation-related incidents. Occasionally drug usage was mentioned as a means to mitigate meditation-related challenges yielding mixed outcomes. More frequently acknowledged as beneficial was a medicinal regimen particularly for acute meditation-related issues that necessitated intensive treatments or hospitalization.",
        "Patients reported subjective experiences like changes in emotional states cognitive alterations shifts in consciousness sensory distortions paresthesias and other bodily sensations. Emotions described encompassed fear anxiety sadness apprehension threat and being chased; infrequently sensations of euphoria or feeling 'protected' were conveyed. Cognitive changes included experiences of d\u00e9j\u00e0 vu rapid thoughts indecipherable musings confusion repetitive single words in one's mind and flashbacks to early life. Other consciousness changes involved feelings of tiredness sleepiness being 'spacey' dazed fatigued wasteful inebriated descending into darkness and a lack of order.  Regarding sensory distortions individuals reported seeing flashes of light undulating lines insects geometric and colored shapes kaleidoscopic or monochromatic visions and visuals as if through a veil; hearing music throbbing sounds noises akin to Rice Krispies and muffled or decelerated voices; smelling sulfur burning watermelon ammonia and strong spices; tasting unpleasantness in the mouth. Paresthesias included sensations of light-headedness dizziness tingling electric shocks within the body stun-like effects akin to nerve blocks facial numbness a 'sugar rush' 'butterflies' energetic waves pulsating through the body and burning feelings.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world."
    ]
},
{
    "diagnosis": "Other (or Unknown) Substance Withdrawal",
    "average_score": 0.7622428070413687,
    "items": [
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "The combination of a dramatic slowdown in sensations and apparently poor concentration usually indicates that the meditator has crossed the 'deep knowledge of arising and passing away' and has entered the Knowledges of Suffering. Practitioners may find the sensations being observed to appear hazy or indistinct except on the periphery of their attention. As this stage progresses sensations develop a discordant and even jarring quality. Meditators often become concerned that their practice has deteriorated especially if they are unfamiliar with the stages of insight and do not realize that they have entered Dissolution and that this change in perceptual abilities is normal and expected.",
        "In scientific articles these phenomena have been described in various ways: as psychiatric symptoms as 'non-ordinary states of consciousness' or as 'extreme mental states' referencing authors VanderKooi 1997 and Walsh & Roche 1979 with a concentration on individual risk factors noted by Kuijpers et al. 2007. More recent studies have explored these extreme mental states among different traditions including practitioners of Buddhist meditation as noted by Lindahl et al. 2017 and Kaselionyte & Gumley 2018 as well as in Kundalini yoga referenced again by Kaselionyte & Gumley 2018.",
        "For example lack of sleep inadequate diet and lack of exercise tended to be associated with or preceded destabilizing experiences and could be corrected as remedies by increasing sleep amount making dietary changes or getting exercise as well as by engaging in other activities described as grounding calming or embodying. Recreational drugs were sometimes cited as risk factors for certain experiences although prior drug-related experiences were also reported as a helpful foundation to have for negotiating certain types of destabilizing meditation-related experiences. Drug use was also occasionally reported as an attempt to alleviate meditation difficulties with mixed results. More commonly cited as helpful was a regimen of medication especially for severe meditation-related difficulties requiring other intensive treatments and hospitalization.  ---  Let's preserve the content minimize the use of commas and apply single quotes:  Lack of sleep inadequate diet and lack of exercise were often linked with destabilizing experiences that once identified could be addressed by increasing the quantity of sleep altering one's diet or initiating regular exercise. These actions along with engaging in activities known for their grounding calming or embodying effects served as potential remedies. Recreational drugs were intermittently recognized as triggers for certain experiences; however experiences with drugs could also lay a useful groundwork for navigating specific unsettling meditation-related incidents. Occasionally drug usage was mentioned as a means to mitigate meditation-related challenges yielding mixed outcomes. More frequently acknowledged as beneficial was a medicinal regimen particularly for acute meditation-related issues that necessitated intensive treatments or hospitalization.",
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um..."
    ]
},
{
    "diagnosis": "Illness Anxiety Disorder",
    "average_score": 0.7574635562859368,
    "items": [
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um...",
        "For one participant a meeting triggered a phobia of seeing himself in the mirror because it evoked the same fear as when a sensed presence was near. Another described how experiencing a threatening sensed presence in the middle of the night while asleep led to the development of agoraphobia. One more reported intense fear linked to an out-of-body experience during mantra meditation causing a lengthy avoidance of the practice. Peace and calmness were frequently fostered by the Anthroposophic practitioners in this study and often emerged naturally within their practice. Some noted a gradual shift towards tranquility during meditation. In one account someone articulated a feeling of...",
        "The fear was further described as a great existential fear but in the way that one can say yes this is good. Many similar experiences of fear were reported in conjunction with a sensed presence. One participant's encounter led to a phobia of seeing his own reflection in a mirror since it triggered the same fear experienced when the sensed presence was felt. Another developed agoraphobia after a threatening sensed presence appeared during the night. Lastly a participant felt intense fear linked to an out-of-body experience during mantra meditation resulting in the avoidance of meditation for years following the incident.",
        "The sense of alertness similar to the sense of calmness was occasionally portrayed in spiritual terms despite being initiated by accidents or emergencies as evidenced by participants P31 and P36. Participant P9 upon receiving a diagnosis of cancer recounted: 'Just before my diagnosis of breast cancer while sitting in the waiting room I intuitively knew the outcome of the tests. As I sat there everything slowed down."
    ]
},
{
    "diagnosis": "Somatic Symptom Disorder",
    "average_score": 0.7703589735500299,
    "items": [
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "A recent mixed-method study by Lindahl and colleagues (2017) identified a range of distressing effects of Buddhist meditation across cognitive emotional and somatic domains of experience. Detailed personal accounts of these are also available (Krishna 1985; Kornfield 1994; Gyatso 1995). In scientific articles these phenomena have been variously described as psychiatric symptoms \"non-ordinary states of consciousness\" or \"extreme mental states\" (VanderKooi 1997; Walsh & Roche 1979) with a focus on individual risk factors (Kuijpers et al. 2007).  Here's the paragraph with the requested changes:  A recent mixed-method study by Lindahl and colleagues (2017) identified a range of distressing effects of Buddhist meditation across cognitive emotional and somatic domains of experience. Detailed personal accounts of these are also available (Krishna 1985; Kornfield 1994; Gyatso 1995). In scientific articles these phenomena have been variously described as psychiatric symptoms 'non-ordinary states of consciousness' or 'extreme mental states' (VanderKooi 1997; Walsh & Roche 1979) with a focus on individual risk factors (Kuijpers et al. 2007).",
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um...",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "Thermal shifts were evident as individuals reported experiencing both a rise and a drop in body temperature alongside localized spots of warmth and chill. A key set of somatic changes involved sensation of pressure and tension occasionally accompanied by intense pain that either intensified or eased during contemplative practices. The alleviation of tension often coincided with positive emotions and energy bursts. Nonetheless it could also trigger the resurgence of traumatic recollections and various types of negative feelings. Instances were noted where easing tension correlated with sensations resembling electric 'voltage' or 'currents' pulsing through the body."
    ]
},
{
    "diagnosis": "Hoarding Disorder",
    "average_score": 0.7450595905331528,
    "items": [
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um...",
        "Being able to perceive more or possessing a highly sensitized attentional ability along with having a perceived ability of spiritual observation can also pose a challenge. In one instance as indicated by the practitioner it may have contributed to depression although this was compounded by other potent factors like overworking and illness. Another practitioner described challenges associated with a lack of acceptance for his perceived spiritual insights specifically because these insights were deemed highly valuable to others. When such insights found acceptance the experience of integration proved positive.",
        "Practitioners described boundaries between themselves and their surroundings becoming indistinct and experiencing a heightened sense of connection either with the environment or with other individuals. Some reported a sensation where their individual self seemed to extend beyond their physical form and blend with the world while others expressed the opposite feeling by noting the world seemed to integrate into their sense of self. Various emotional reactions were tied to this shift ranging from mere curiosity to profound joy and even to fear and panic. A prevalent experience was the diminishing sense of ownership over one's thoughts emotions and bodily sensations. The practitioners also spoke of reduced sense of control or the absence of the 'doer' in their actions including involuntary actions like weeping habitual movements such as walking and deliberate actions like talking.",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized."
    ]
},
{
    "diagnosis": "Developmental Coordination Disorder",
    "average_score": 0.7041278526852602,
    "items": [
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "One key component in self-experiences related to time and the body is pivotal in these cases. Future work must investigate if feelings of being statically 'stuck' in the present 'trapped' in one\u2019s head or lacking a narrative 'flow' or 'plot' in life as reported by DPD patients even after more than 15 years of the condition (Ciaunica & Charlton 2018) are characteristic of meditation-induced forms of DPD. Noting the similarity between some aspects of meditation and DPD symptoms could be vital for developing therapies and interventions. Since a typical DPD sufferer feels 'trapped' in their mind disconnected from their body and the world the development of dynamic body-based therapies could offset this tendency towards excessive self-scrutiny and a self-objectifying stance.",
        "Moreover while meditation-based interventions may prove useful in regulating the anxiety that typically accompanies DPD experiences they lack the dynamic and embodied engagement component necessary for patients to override the static feelings of 'living in a bubble' or being in one's head. If our hypotheses here are correct moving one's body\u2014especially in concert with others\u2014can potentially dissolve the 'experiential airbag' that surrounds the fractured self in DPD which feels isolated from the world (Ciaunica & Fotopoulou 2017). This recommendation is supported by anecdotal self-reports from DPD patients who often notice an improvement in their dissociation states after periods of intense physical training and social interactions; as one patient reported 'a constant source of interaction is the only thing that allows me to maintain a connection with the world. I'll also seek physical contact with whoever I'm with'.",
        "Observation of the similarity between some aspects of meditation and DPD symptomatology holds significant implications for potential therapies and interventions. Indeed given that a typical DPD sufferer describes feelings of being 'trapped' in one's mind and disconnected from one's body and the world we may develop dynamic body-based therapies to counter this mentalistic overscrutiny and self-objectifying stance. Moreover while meditation-based interventions may help in regulating the anxiety commonly accompanying DPD experiences they lack the dynamic and embodied engagement component essential for patients to overcome the static feelings of 'living in a bubble' or in one's head. If our hypotheses presented here are accurate it is by moving one's body \u2014 and especially by moving with others \u2014 that we can potentially dissolve the 'experiential airbag' enveloping the fractured self in DPD which feels isolated from the world (Ciaunica & Fotopoulou 2017).",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world."
    ]
},
{
    "diagnosis": "Bulimia Nervosa",
    "average_score": 0.734104282947193,
    "items": [
        "Bodily affordances include cataplexy which is characterized by a loss of muscle control; an adrenaline surge resembling electricity shooting through the body; and an emotional surge often described as an intense overwhelming emotion. These physiological phenomena are not uncommon to the human body and are memorable enough for individuals to recall without specific terminology such as recalling the moment one experiences an intense rush of feelings upon opening a letter. While not as rare and striking as out-of-body experiences both Vineyard congregants and Thai Buddhists were familiar with the concepts when questioned. Vineyard congregants generally welcomed these experiences as evidence of something positive in contrast to the Thai Buddhists who did not share this perspective.",
        "Suicidal behavior gastrointestinal problems dissociation or depersonalization fear or terror trauma re-experience pain psychotic or delusional symptoms visual or auditory hallucinations stress or tension cognitive anomalies depression anxiety and adverse events in meditation were mostly assessed through self-report instruments. However some variables included various psychophysiological and biological measures - stress for instance was gauged via heart rate blood pressure skin conductance and cortisol levels alongside self-reports. Neurological or cognitive meditation adverse events (MAEs) featured in 17 studies accounting for 20%. The most prevalent MAEs were cognitive anomalies encountered in 14 studies. These included thought disorganization in three studies (3 89) amnesia (97) perceptual hypersensitivity (19) and impaired memory reliability (34 40). Additionally three studies noted involuntary bodily movements and muscle contractions during meditation.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "The current body of research often notes a typical occurrence of individuals re-experiencing past frequently challenging or traumatic memories while under the influence of ibogaine (Alper 2001; Heink et al. 2017). However this specific theme did not surface in the present investigation. Despite this a significant majority 80% of subjects reported encountering both unsettling and euphoric visual and emotional sensations. Emotional turmoil is a well-documented occurrence in similar studies (Heink et al.).",
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um..."
    ]
},
{
    "diagnosis": "Psychotic Disorder Due to Another Medical Condition",
    "average_score": 0.7645995338346813,
    "items": [
        "The analysis indicates a discursive divide between two dominant framings: a biomedical discourse that constructs such experiences as psychiatric symptoms and an alternative discourse that perceives them as spiritual emergencies. Both approaches provide distinct therapeutic avenues. This divide aligns with the broader disciplinary divides within the mental health field potentially hindering a more nuanced understanding of these experiences. Nevertheless the two discourses are not necessarily mutually exclusive; authors of three articles opted to integrate them for their case reports.",
        "Found to contain unusual experiences such as visual or auditory aberrations 'hallucinations' and unusual somatic experiences are commonplace among seasoned meditation students. Kornfield in 2011 described the occurrence of clear psychotic breaks in meditation retreat attendees often in those with a prior history of psychiatric illness and at times necessitating pharmacotherapy and hospital stays. The Britton laboratory at Brown University is presently examining these experiences focusing on those that are psychologically demanding and typically present in the Knowledges of Suffering. Their research covers aspects like prevalence duration impact on routine life and factors that aggravate their effects as reported by Britton in 2013. In the author's clinical experience diverse treatments such as pharmacotherapy modified meditation instructions and psychotherapy have proven necessary to effectively manage some of the psychological challenges encountered during the stages of insight.",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "Emotional or psychological experiences are both pivotal in discerning the stage of insight a meditator might be encountering in their practice. Yet changes in perceptual abilities such as sensory clarity and sensory threshold are often more reliable indicators as the psychological aspects of the stages exhibit high variability. It's crucial to recognize that the below descriptions of the stages of insight illustrate a spectrum of potential experiences. The granularity and vividness with which a meditator perceives these stages can vary based on several factors including their concentration skills frequency of encountering a particular stage and other possible influences. Table 1 encapsulates the stages of insight alongside their typical perceptual and psychological expressions. The ensuing descriptions have been amalgamated from a variety of sources encompassing both ancient and contemporary texts.",
        "These 'extreme mental states' may often prompt a response from meditation teachers or mental health services (VanderKooi 1997 p. 31). A discursive divide exists in reporting these experiences which have predominantly been constructed by the biomedical discourse as 'psychosis' requiring psychiatric interventions (Chan-Ob & Boonyanaruthee 1999; Kuijpers van der Heijden Tuinier & Verhoeven 2007; Sharma Singh Gnanavel & Kumar 2016) while the alternative discourse introduced other conceptualisations such as 'spiritual emergency' (Lukoff Lu & Turner 1998) and 'Kundalini awakening' (Ossoff 1993). It could be argued that these discursive constructions can to a greater or lesser degree obscure the nature and phenomenology of extreme mental states and hinder our understanding of these.   (Note: Single quotes have been used as requested and the content preserved. However due to the original request not to use any commas the in-text citations cannot have commas even though they would typically require them for proper APA citation format.)"
    ]
},
{
    "diagnosis": "Adjustment Disorders",
    "average_score": 0.756716984300489,
    "items": [
        "The results challenge common causal assumptions such as the belief that meditation-related difficulties arise solely in individuals with pre-existing conditions (psychiatric or trauma history) who engage in long or intensive retreats are poorly supervised practice incorrectly or lack adequate preparation. However this does not imply that these and other factors are irrelevant. Indeed both experts and practitioners have identified various 'influencing factors' they believe affect the likelihood of facing meditation-related challenges including their duration and the degree of distress and impairment. The data suggest an interaction-based model where meditation practices on their own can lead to challenging effects. However the specific type of effect as well as its probability duration distress and impairment are influenced by numerous additional factors.",
        "Trauma-related memories might emerge and some of these symptoms could linger beyond the formal meditation period yet typically they subside as the practitioner progresses to the next insight stage. The simultaneous occurrence of rapidly observed sensations and abrupt physical pain usually signals entry into this stage as noted by Chanmyay Sayadaw (2010 p. 111) and Mahasi Sayadaw (2006 pp.).",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "For practitioners with a trauma history it was not unusual to experience a resurgence of traumatic memories. Even those without such histories reported a surge of emotionally charged psychological material. Practitioners frequently encountered involuntary crying or laughter triggered by positive feelings such as bliss or joy or by negative emotions like grief or sadness and occasionally for no discernible reason. They also faced states of negative affect including heightened agitation or irritability which could escalate to transient outbursts or sustained expressions of anger and aggression. Additionally somatic symptoms were observed.",
        "Often the fear or anxiety was an additional response of negative affect that coincided with other unexpected or undesired changes. However in some cases fear was non-referential and reported as a phenomenological change unto itself. Increased emotionality also manifested as heightened affective lability sensitivity or reactivity in response to either people or other environmental stimuli. Emotional sensitivity to others often appeared as empathic and affiliative changes\u2014increased feelings of empathy or sharing others' emotions\u2014between the practitioner and other human beings. In contrast some practitioners reported experiencing fewer or less intense emotions or affective flattening sometimes even a complete absence of emotions. Positive affect including bliss and euphoria were also commonly reported but were sometimes followed by subsequent depression or agitation either within the context of a practice or transitioning from formal practice to daily life."
    ]
},
{
    "diagnosis": "Personality Change Due to Another Medical Condition _ F07.0",
    "average_score": 0.7585399619938671,
    "items": [
        "The analysis indicates a discursive divide between two dominant framings: a biomedical discourse that constructs such experiences as psychiatric symptoms and an alternative discourse that perceives them as spiritual emergencies. Both approaches provide distinct therapeutic avenues. This divide aligns with the broader disciplinary divides within the mental health field potentially hindering a more nuanced understanding of these experiences. Nevertheless the two discourses are not necessarily mutually exclusive; authors of three articles opted to integrate them for their case reports.",
        "For instance changes in the sense of embodiment involved feeling displaced from one's ordinary location in relation to one's body schema with detailed accounts emphasizing the associated affective and perceptual changes. 'The most common alteration in the sense of self reported by practitioners was a shift in the self-other or self-world boundaries taking many related forms. Some practitioners experienced boundaries as dissolving and a general permeability with the environment or other people. Others felt as though their self had extended beyond their body and merged with the world. Still others expressed this inversely stating that the world appeared to have merged with their sense of self.' A range of affective responses accompanied this phenomenon from neutral curiosity to bliss and joy to fear and terror.",
        "This included encountering repressed and underdeveloped aspects of the personality. Although crises could lead to breakthroughs in personal development they could also be associated with periods of inactivity and reduced functionality in daily life. Though meditation could be a factor in triggering a crisis it could also provide the practitioner with support. Sometimes a crisis was described as a 'threshold experience' which refers to a liminal state where the old is being left behind but the new has yet to arrive. One of the general aims of Anthroposophic practice is to come to know a spiritual reality through direct experience which can include a radical break with one\u2019s previous identity or reality.",
        "The alternative discourse was marked by authors demonstrating reflexivity. They integrated their personal thoughts and feelings encountered when interacting with individuals experiencing extreme mental states into their narrative. They also acknowledged their knowledge limitations interpretation uncertainties or training constraints. This approach gave the impression of the authors being committed to engaging openly and without judgment with the experiences of the individuals. 'At the same time I experienced frustration and personal disappointment\u2014a sense of betrayal at my blindness my inability to move beyond to \"transcend\" the psychiatric explanation of her experience until she mentioned the key term \"Shaktipat.\"' I pondered the extent to which we in the mental health profession are confined by our training or cultural viewpoint leading us to perceive events in a constant manner.",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world."
    ]
},
{
    "diagnosis": "Delayed Ejaculation",
    "average_score": 0.7239511683446082,
    "items": [
        "One key component in self-experiences related to time and the body is pivotal in these cases. Future work must investigate if feelings of being statically 'stuck' in the present 'trapped' in one\u2019s head or lacking a narrative 'flow' or 'plot' in life as reported by DPD patients even after more than 15 years of the condition (Ciaunica & Charlton 2018) are characteristic of meditation-induced forms of DPD. Noting the similarity between some aspects of meditation and DPD symptoms could be vital for developing therapies and interventions. Since a typical DPD sufferer feels 'trapped' in their mind disconnected from their body and the world the development of dynamic body-based therapies could offset this tendency towards excessive self-scrutiny and a self-objectifying stance.",
        "In 'Dissolution' the speed at which sensations are observed slows down dramatically. In addition the endings of sensations become predominant and sensations can be experienced as vanishing before they can be clearly observed. The practitioner may notice that concentration seems poor. The great clarity and power that meditation practice had during the 'Arising and Passing Away' appears to fade (Crouch 2011c) and the meditator may feel less motivated to practice.",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "The results challenge common causal assumptions such as the belief that meditation-related difficulties arise solely in individuals with pre-existing conditions (psychiatric or trauma history) who engage in long or intensive retreats are poorly supervised practice incorrectly or lack adequate preparation. However this does not imply that these and other factors are irrelevant. Indeed both experts and practitioners have identified various 'influencing factors' they believe affect the likelihood of facing meditation-related challenges including their duration and the degree of distress and impairment. The data suggest an interaction-based model where meditation practices on their own can lead to challenging effects. However the specific type of effect as well as its probability duration distress and impairment are influenced by numerous additional factors.",
        "Seven participants (12%) encountered difficulties within the initial ten days of their practice while 11 (18%) faced challenges during the first fifty hours of engagement. Difficulties arose during or just after a retreat for 43 practitioners (72%). The remaining 17 (28%) experienced issues while engaging in daily practice routines. Approximately three-quarters (72%) were active in a meditation community or under the guidance of a teacher (75%) when these challenging experiences occurred."
    ]
},
{
    "diagnosis": "Genito_Pelvic Pain_Penetration Disorder (F52.6)",
    "average_score": 0.7386667938056379,
    "items": [
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "Trauma-related memories might emerge and some of these symptoms could linger beyond the formal meditation period yet typically they subside as the practitioner progresses to the next insight stage. The simultaneous occurrence of rapidly observed sensations and abrupt physical pain usually signals entry into this stage as noted by Chanmyay Sayadaw (2010 p. 111) and Mahasi Sayadaw (2006 pp.).",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "Despite attempts to maintain a good sitting posture the body may spontaneously shift into different positions repeatedly moving even after posture correction. Fever-like sensations such as warmth aches and pains may develop as well as the emergence of trauma-related memories. Some symptoms might linger after the formal meditation period but typically resolve once the practitioner progresses to the next stage of insight."
    ]
},
{
    "diagnosis": "Mild Neurocognitive Disorder",
    "average_score": 0.7552946108650336,
    "items": [
        "We hypothesized that advanced meditators would have a cognitive style characterized by greater attentional focus self-awareness acceptance and positive mood and less perceived stress than beginning meditators. Cognitive style was assessed using ten ESF items reflecting attributes of attention concentration and clarity: seven Likert-type scaled items ('Aware of nothing\u2014mind was blank' 'Drifting in thought as if daydreaming' 'Directed thought' 'Ruminating' 'Thinking about an unresolved situation' 'Involved in vague thoughts about nothing in particular' 'Concentrating well') and three bipolar adjective pairs ('Confused/Clear' 'Distracted/Focused' 'Disinterested/Attentive'). Two different dimensions of affect were gauged with two 7-point bipolar adjective paired items. One appraised evaluation ('Sad/Happy') and the other activity ('Passive/Active').",
        "These findings may be relevant to mystical experiences insofar as a sense of self-disintegration is a primary aspect of introspective unity\u2014a defining feature of the mystical experience. With regard to meditation the amplitude of spontaneous fluctuations in the DMN has been shown to be reduced during mindfulness meditation as demonstrated by Berkovich-Ohana et al. in 2016. Consistent deactivations of the medial prefrontal cortex (MPFC) posterior cingulate cortex (PCC) and inferior parietal lobule (IPL) have been found during both focused awareness and open monitoring practices according to Fox et al.",
        "Another participant noted that the challenging nature of thinking\u2014certain concepts and mental exercises can be 'chewy' or tough\u2014might enhance self-awareness while still allowing space for others and different phenomena in one's thoughts. Memory is also impacted by meditation; it can either bolster or diminish recall capabilities. Improvement in memory can also result in de-repression meaning that previously suppressed traumatic experiences might surface in consciousness.",
        "Emotion regulation strategies moderate the relationship of fatigue with depersonalization and derealization symptoms as stated in the 'Journal of Affective Disorders' 227 pages 571-879. Tye M. in 1999 proposed 'Phenomenal consciousness: the explanatory gap as a cognitive illusion'.",
        "Mindfulness practice necessitates concentrating on various attention objects emerging naturally when awareness stays open without the cognitive and emotional differences at page seventy-one losing a reflective stance or 'blanking out.' Mindfulness meditation aims to observe mental processes allowing the identification and examination of habits and persistent mental patterns in a non-judgmental manner. Attentional process control is the primary tool for developing conscious awareness and for suspending engagement with habitual negative patterns alongside non-deliberate automatic behaviors thoughts and emotions. Supposing the assumptions regarding meditation's long-term effects hold true we would anticipate long-term meditators to develop enhanced self-awareness and control over their cognitive and emotional processes to exhibit greater acceptance of their experience and to be less impacted by everyday stresses. These qualities align with the Buddhist 'seven factors of enlightenment' or seven interrelated characteristics that operate as the recommended meditation attitudes of Vipassana practice [ref 14]."
    ]
},
{
    "diagnosis": "Histrionic Personality Disorder",
    "average_score": 0.744395382164791,
    "items": [
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um...",
        "Self-exploratory practice can surface distressing feelings or traumatic memories potentially triggering impairments with irreversible consequences. RD Springer delineates in 'When the Window Cracks: Transparency and the Fractured Self' the concept of altered self-awareness in Depersonalization Disorder. This condition is characterized by a detachment from one's self body and world. Specifically it examines self-detachment which signifies a 'divorce' or 'fracture' between the observing self and the observed self in the sixth conclusion of the paper.",
        "Practitioners described boundaries between themselves and their surroundings becoming indistinct and experiencing a heightened sense of connection either with the environment or with other individuals. Some reported a sensation where their individual self seemed to extend beyond their physical form and blend with the world while others expressed the opposite feeling by noting the world seemed to integrate into their sense of self. Various emotional reactions were tied to this shift ranging from mere curiosity to profound joy and even to fear and panic. A prevalent experience was the diminishing sense of ownership over one's thoughts emotions and bodily sensations. The practitioners also spoke of reduced sense of control or the absence of the 'doer' in their actions including involuntary actions like weeping habitual movements such as walking and deliberate actions like talking."
    ]
},
{
    "diagnosis": "Disruptive Mood Dysregulation Disorder",
    "average_score": 0.7468406291964343,
    "items": [
        "These 'extreme mental states' may often prompt a response from meditation teachers or mental health services (VanderKooi 1997 p. 31). A discursive divide exists in reporting these experiences which have predominantly been constructed by the biomedical discourse as 'psychosis' requiring psychiatric interventions (Chan-Ob & Boonyanaruthee 1999; Kuijpers van der Heijden Tuinier & Verhoeven 2007; Sharma Singh Gnanavel & Kumar 2016) while the alternative discourse introduced other conceptualisations such as 'spiritual emergency' (Lukoff Lu & Turner 1998) and 'Kundalini awakening' (Ossoff 1993). It could be argued that these discursive constructions can to a greater or lesser degree obscure the nature and phenomenology of extreme mental states and hinder our understanding of these.   (Note: Single quotes have been used as requested and the content preserved. However due to the original request not to use any commas the in-text citations cannot have commas even though they would typically require them for proper APA citation format.)",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "The analysis indicates a discursive divide between two dominant framings: a biomedical discourse that constructs such experiences as psychiatric symptoms and an alternative discourse that perceives them as spiritual emergencies. Both approaches provide distinct therapeutic avenues. This divide aligns with the broader disciplinary divides within the mental health field potentially hindering a more nuanced understanding of these experiences. Nevertheless the two discourses are not necessarily mutually exclusive; authors of three articles opted to integrate them for their case reports.",
        "Observation of the similarity between some aspects of meditation and DPD symptomatology holds significant implications for potential therapies and interventions. Indeed given that a typical DPD sufferer describes feelings of being 'trapped' in one's mind and disconnected from one's body and the world we may develop dynamic body-based therapies to counter this mentalistic overscrutiny and self-objectifying stance. Moreover while meditation-based interventions may help in regulating the anxiety commonly accompanying DPD experiences they lack the dynamic and embodied engagement component essential for patients to overcome the static feelings of 'living in a bubble' or in one's head. If our hypotheses presented here are accurate it is by moving one's body \u2014 and especially by moving with others \u2014 that we can potentially dissolve the 'experiential airbag' enveloping the fractured self in DPD which feels isolated from the world (Ciaunica & Fotopoulou 2017).",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world."
    ]
},
{
    "diagnosis": "Insomnia Disorder",
    "average_score": 0.7561981579914313,
    "items": [
        "The results challenge common causal assumptions such as the belief that meditation-related difficulties arise solely in individuals with pre-existing conditions (psychiatric or trauma history) who engage in long or intensive retreats are poorly supervised practice incorrectly or lack adequate preparation. However this does not imply that these and other factors are irrelevant. Indeed both experts and practitioners have identified various 'influencing factors' they believe affect the likelihood of facing meditation-related challenges including their duration and the degree of distress and impairment. The data suggest an interaction-based model where meditation practices on their own can lead to challenging effects. However the specific type of effect as well as its probability duration distress and impairment are influenced by numerous additional factors.",
        "Adverse events are either initial hurdles or challenges that ultimately contribute to personal growth according to references 3 9 88 93 and 105. Traditional meditation texts have documented similar symptoms. An early Buddhist meditation manual from the 5th century CE called the Dharmatrata Meditation Scripture notes that improper meditation practice can lead to an unstable restless or confused mind with the meditator feeling dull and sunken as stated in source 113. These negative symptoms are not viewed positively as might occur with some contemporary practitioners but as results of incorrect meditation techniques as indicated by source 114.",
        "For example lack of sleep inadequate diet and lack of exercise tended to be associated with or preceded destabilizing experiences and could be corrected as remedies by increasing sleep amount making dietary changes or getting exercise as well as by engaging in other activities described as grounding calming or embodying. Recreational drugs were sometimes cited as risk factors for certain experiences although prior drug-related experiences were also reported as a helpful foundation to have for negotiating certain types of destabilizing meditation-related experiences. Drug use was also occasionally reported as an attempt to alleviate meditation difficulties with mixed results. More commonly cited as helpful was a regimen of medication especially for severe meditation-related difficulties requiring other intensive treatments and hospitalization.  ---  Let's preserve the content minimize the use of commas and apply single quotes:  Lack of sleep inadequate diet and lack of exercise were often linked with destabilizing experiences that once identified could be addressed by increasing the quantity of sleep altering one's diet or initiating regular exercise. These actions along with engaging in activities known for their grounding calming or embodying effects served as potential remedies. Recreational drugs were intermittently recognized as triggers for certain experiences; however experiences with drugs could also lay a useful groundwork for navigating specific unsettling meditation-related incidents. Occasionally drug usage was mentioned as a means to mitigate meditation-related challenges yielding mixed outcomes. More frequently acknowledged as beneficial was a medicinal regimen particularly for acute meditation-related issues that necessitated intensive treatments or hospitalization.",
        "Being able to perceive more or possessing a highly sensitized attentional ability along with having a perceived ability of spiritual observation can also pose a challenge. In one instance as indicated by the practitioner it may have contributed to depression although this was compounded by other potent factors like overworking and illness. Another practitioner described challenges associated with a lack of acceptance for his perceived spiritual insights specifically because these insights were deemed highly valuable to others. When such insights found acceptance the experience of integration proved positive.",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing])."
    ]
},
{
    "diagnosis": "Stimulant Withdrawal",
    "average_score": 0.7530483003353792,
    "items": [
        "Patients reported subjective experiences like changes in emotional states cognitive alterations shifts in consciousness sensory distortions paresthesias and other bodily sensations. Emotions described encompassed fear anxiety sadness apprehension threat and being chased; infrequently sensations of euphoria or feeling 'protected' were conveyed. Cognitive changes included experiences of d\u00e9j\u00e0 vu rapid thoughts indecipherable musings confusion repetitive single words in one's mind and flashbacks to early life. Other consciousness changes involved feelings of tiredness sleepiness being 'spacey' dazed fatigued wasteful inebriated descending into darkness and a lack of order.  Regarding sensory distortions individuals reported seeing flashes of light undulating lines insects geometric and colored shapes kaleidoscopic or monochromatic visions and visuals as if through a veil; hearing music throbbing sounds noises akin to Rice Krispies and muffled or decelerated voices; smelling sulfur burning watermelon ammonia and strong spices; tasting unpleasantness in the mouth. Paresthesias included sensations of light-headedness dizziness tingling electric shocks within the body stun-like effects akin to nerve blocks facial numbness a 'sugar rush' 'butterflies' energetic waves pulsating through the body and burning feelings.",
        "The triggers for these experiences were meditation and psychological turmoil which led to the dissolution of self-identity and an egoic self; this left individuals feeling liberated from life's challenges. He also notes that psychedelics may induce similar awakenings by creating a temporary dissolution of the normal self. Energetic awakenings often come with physiological experiences. Both historical texts and modern research agree that many individuals undergo physiological changes as part of the awakening and transformation process. MH Woollacott et al. document these phenomena.",
        "The current body of research often notes a typical occurrence of individuals re-experiencing past frequently challenging or traumatic memories while under the influence of ibogaine (Alper 2001; Heink et al. 2017). However this specific theme did not surface in the present investigation. Despite this a significant majority 80% of subjects reported encountering both unsettling and euphoric visual and emotional sensations. Emotional turmoil is a well-documented occurrence in similar studies (Heink et al.).",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011)."
    ]
},
{
    "diagnosis": "Bipolar and Related Disorder Due to Another Medical Condition",
    "average_score": 0.7536099653623131,
    "items": [
        "The analysis indicates a discursive divide between two dominant framings: a biomedical discourse that constructs such experiences as psychiatric symptoms and an alternative discourse that perceives them as spiritual emergencies. Both approaches provide distinct therapeutic avenues. This divide aligns with the broader disciplinary divides within the mental health field potentially hindering a more nuanced understanding of these experiences. Nevertheless the two discourses are not necessarily mutually exclusive; authors of three articles opted to integrate them for their case reports.",
        "These 'extreme mental states' may often prompt a response from meditation teachers or mental health services (VanderKooi 1997 p. 31). A discursive divide exists in reporting these experiences which have predominantly been constructed by the biomedical discourse as 'psychosis' requiring psychiatric interventions (Chan-Ob & Boonyanaruthee 1999; Kuijpers van der Heijden Tuinier & Verhoeven 2007; Sharma Singh Gnanavel & Kumar 2016) while the alternative discourse introduced other conceptualisations such as 'spiritual emergency' (Lukoff Lu & Turner 1998) and 'Kundalini awakening' (Ossoff 1993). It could be argued that these discursive constructions can to a greater or lesser degree obscure the nature and phenomenology of extreme mental states and hinder our understanding of these.   (Note: Single quotes have been used as requested and the content preserved. However due to the original request not to use any commas the in-text citations cannot have commas even though they would typically require them for proper APA citation format.)",
        "In scientific articles these phenomena have been described in various ways: as psychiatric symptoms as 'non-ordinary states of consciousness' or as 'extreme mental states' referencing authors VanderKooi 1997 and Walsh & Roche 1979 with a concentration on individual risk factors noted by Kuijpers et al. 2007. More recent studies have explored these extreme mental states among different traditions including practitioners of Buddhist meditation as noted by Lindahl et al. 2017 and Kaselionyte & Gumley 2018 as well as in Kundalini yoga referenced again by Kaselionyte & Gumley 2018.",
        "We suggest efforts be made to overcome this division to foster a balanced understanding and comprehensive support for individuals experiencing extreme mental states during meditation. Achieving this requires collaboration among mental health professionals and spiritual teachers and the provision of diverse therapeutic methods incorporating both biomedical and alternative healing techniques. Additionally involving individuals with firsthand experience of these states as co-authors of case studies or enhancing consent procedures for publications based on guidelines such as those from the BMJ for case reports (https://authors.bmj.com/policies/patient-consent-and-confidentiality) would be beneficial.",
        "Finally while the majority of Vanderkooi's 1997 article could be interpreted as utilizing the alternative discourse other parts aligned with the biomedical framing. For example the author described one of the interviewee\u2019s experiences as a 'psychotic break' (p.35) and at times used clinical terms for her reflections: 'experiences of Sara and Ada suggest that narcissistic issues around grandiosity and borderline issues around abandonment can be activated in more advanced stages of meditation' (p. 43). Discussion: We identified two dominant discourses and a number of mixed cases in the literature on extreme mental states in the context of meditation."
    ]
},
{
    "diagnosis": "Cyclothymic Disorder",
    "average_score": 0.7485587071264251,
    "items": [
        "The analysis indicates a discursive divide between two dominant framings: a biomedical discourse that constructs such experiences as psychiatric symptoms and an alternative discourse that perceives them as spiritual emergencies. Both approaches provide distinct therapeutic avenues. This divide aligns with the broader disciplinary divides within the mental health field potentially hindering a more nuanced understanding of these experiences. Nevertheless the two discourses are not necessarily mutually exclusive; authors of three articles opted to integrate them for their case reports.",
        "In scientific articles these phenomena have been described in various ways: as psychiatric symptoms as 'non-ordinary states of consciousness' or as 'extreme mental states' referencing authors VanderKooi 1997 and Walsh & Roche 1979 with a concentration on individual risk factors noted by Kuijpers et al. 2007. More recent studies have explored these extreme mental states among different traditions including practitioners of Buddhist meditation as noted by Lindahl et al. 2017 and Kaselionyte & Gumley 2018 as well as in Kundalini yoga referenced again by Kaselionyte & Gumley 2018.",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "Some of these experiences can be very psychologically disturbing to meditators including symptoms consistent with psychiatric clinical syndromes such as depression mania psychosis and suicidality. As mentioned above these can persist during daily life outside of periods of formal practice. Based on questionnaires given to over 100 meditators during a series of 2 week and 3 month Vipassana retreats Kornfield (1979 p. 51) found that 'unusual experiences visual or auditory aberrations \"hallucinations\" unusual somatic experiences and so on are the norm among practiced meditation students.' More recently Kornfield (2011) describes the occurrence of frank psychotic breaks in meditation retreat participants usually in those with a history of psychiatric illness and occasionally the need for pharmacotherapy and hospitalization. Researchers in the Britton lab at Brown University are currently investigating these experiences with an emphasis on those that are psychologically challenging and usually occur in the Knowledges of Suffering."
    ]
},
{
    "diagnosis": "Hallucinogen Persisting Perception Disorder",
    "average_score": 0.7649440707694634,
    "items": [
        "Patients reported subjective experiences like changes in emotional states cognitive alterations shifts in consciousness sensory distortions paresthesias and other bodily sensations. Emotions described encompassed fear anxiety sadness apprehension threat and being chased; infrequently sensations of euphoria or feeling 'protected' were conveyed. Cognitive changes included experiences of d\u00e9j\u00e0 vu rapid thoughts indecipherable musings confusion repetitive single words in one's mind and flashbacks to early life. Other consciousness changes involved feelings of tiredness sleepiness being 'spacey' dazed fatigued wasteful inebriated descending into darkness and a lack of order.  Regarding sensory distortions individuals reported seeing flashes of light undulating lines insects geometric and colored shapes kaleidoscopic or monochromatic visions and visuals as if through a veil; hearing music throbbing sounds noises akin to Rice Krispies and muffled or decelerated voices; smelling sulfur burning watermelon ammonia and strong spices; tasting unpleasantness in the mouth. Paresthesias included sensations of light-headedness dizziness tingling electric shocks within the body stun-like effects akin to nerve blocks facial numbness a 'sugar rush' 'butterflies' energetic waves pulsating through the body and burning feelings.",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "We suggest disruptions in the transparent embodied and pre-reflective sense of self play a role in DPD impairing the capacity for navigation between the I- and body-as-subject and the I- and body-as-object of an experience. An increased emphasis on the latter over the former leads to a dominant presence of hyper-reflective mentalistic forms of self-awareness fostering self-opacity and sensations of 'living in a bubble' severed from one's self body and the external world. The concluding Section 5 touches on akin self-detachment experiences observed in certain Buddhist-derived meditative practices. We propose that alterations in self-experiences brought on by these contemplative methods might expose the intrinsic and implicit transparency marking embodied pre-reflective forms of self-consciousness.",
        "One may argue that depersonalisation-like states are inevitable steps on the challenging path towards self-exploration leading to the ultimate no-self or 'pure subjectivity' state targeted by Buddhist-based meditative practices. This remains an open question and further examination is essential to provide a systematic comparison between meditation-induced forms of DPD and trauma drugs and anxiety-induced forms of DPD. For example a key component appears to be the temporal dimension of self-experiences and its relation to the body. In future work it will be crucial to examine if feelings of being statically 'stuck' in the present 'trapped' in one's head or lacking a narrative 'flow' or 'plot' in life as reported by DPD patients even after over 15 years of experiencing the condition are also characteristic of meditation-induced forms of DPD as highlighted in Ciaunica and Charlton 2018.",
        "Our paper also draws on subjective first-personal reports from individuals with Depersonalization Disorder (DPD) supporting the idea of a dysfunctional processing of the link between 'I' as body-subject and 'I' as body-object of an experience. This split between an observing and observed self is also experienced in some Buddhist-derived meditative practices suggesting that such techniques allow practitioners to modulate the underlying and tacit transparency that characterizes the embodied and basic pre-reflective forms of self-consciousness. Notably the bodily roots of pre-reflective self-awareness continue to play a key role in sustaining tacitly and 'transparently' one's self-preservation even when one consciously experiences one's self and one's body as being changed 'dissolved' or even 'lost'. Our key argument therefore is that alterations and changes in one's basic embodied pre-reflective sense of self can reveal its tacit and fundamental presence in our everyday experiences analogous to how cracks in otherwise transparent glass may indicate the presence of a previously unnoticed window."
    ]
},
{
    "diagnosis": "Excoriation (Skin_Picking) Disorder",
    "average_score": 0.7302454677899891,
    "items": [
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "Self-exploratory practice can surface distressing feelings or traumatic memories potentially triggering impairments with irreversible consequences. RD Springer delineates in 'When the Window Cracks: Transparency and the Fractured Self' the concept of altered self-awareness in Depersonalization Disorder. This condition is characterized by a detachment from one's self body and world. Specifically it examines self-detachment which signifies a 'divorce' or 'fracture' between the observing self and the observed self in the sixth conclusion of the paper.",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "Found to contain unusual experiences such as visual or auditory aberrations 'hallucinations' and unusual somatic experiences are commonplace among seasoned meditation students. Kornfield in 2011 described the occurrence of clear psychotic breaks in meditation retreat attendees often in those with a prior history of psychiatric illness and at times necessitating pharmacotherapy and hospital stays. The Britton laboratory at Brown University is presently examining these experiences focusing on those that are psychologically demanding and typically present in the Knowledges of Suffering. Their research covers aspects like prevalence duration impact on routine life and factors that aggravate their effects as reported by Britton in 2013. In the author's clinical experience diverse treatments such as pharmacotherapy modified meditation instructions and psychotherapy have proven necessary to effectively manage some of the psychological challenges encountered during the stages of insight."
    ]
},
{
    "diagnosis": "Obstructive Sleep Apnea Hypopnea",
    "average_score": 0.7290560717183382,
    "items": [
        "Sleep paralysis is often associated with the sensation of an evil presence and other menacing perceptions. Out-of-body experiences during meditation vary in intensity; some individuals report the loss of control over their physical body while others experience a complete disconnection from the sensation of possessing a body. For one participant it was evident that any sudden external noise would have garnered attention.",
        "Associated symptoms include nervousness insomnia disturbed sleep frequent dreams tachycardia breathlessness dry mouth headaches and giddiness. As a result of intense concentration anxiety and unnatural breathing during practice this is thought to be corrected by relaxing the body and mind. Ancient medical literature describes the sensation experienced by Qigong experts as that of vital energy sinking into the lower elixir field located in the abdomen during deep breathing. In fact the sensation comes from a natural protrusion of the abdominal wall as a result of increased pressure caused by the movement of the diaphragm during respiration [43].",
        "As the body relaxes the mind concentrates on the elixir field erasing all other thoughts while respiration deepens and gradually lessens in frequency. When the respiration rate decreases to four or five breaths per minute the subject enters the so-called 'Qigong state' [7]. Significant alterations in respiration and energy metabolism may reflect the outcomes of extended intensive meditation practice but may not typify the novice practitioner's changes [54]. Chinese physicians outline two methods for treating diseases using Qigong [1].",
        "Meditative progression follows a nonlinear multiphasic path where the initial more strenuous phases might lead to increased fatigue and a tendency to fall asleep whereas the latter stages are characterized by a surge in wakefulness due to neuroplastic alterations and enhanced cognitive efficiency. Keywords: Buddhist meditation; relaxation; sleep; arousal; alertness; wakefulness Introduction: For instance Buddhist texts describe the goal of meditation as the cultivation of a state of relaxed alertness which requires a constant balance between the poles of hyperarousal\u2014agitation and restlessness\u2014and hypoarousal\u2014excessive relaxation mental fog and sleep (Fig. 1). In contemporary settings the focus tends to lean more towards meditation\u2019s relaxing benefits with the invigorating or wakefulness-inducing effects receiving less consideration.",
        "There was no perception or sensation of breath or sense of body giving the impression of disappearance. Prior to this a thought became unclear out of which an 'air pocket' seemed to suddenly emerge. Subsequently awareness returned to the present moment and to the breath. In the electrophysiological findings LG reported four fruition episodes."
    ]
},
{
    "diagnosis": "Tobacco Use Disorder",
    "average_score": 0.7198647019251797,
    "items": [
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um...",
        "Adverse events are either initial hurdles or challenges that ultimately contribute to personal growth according to references 3 9 88 93 and 105. Traditional meditation texts have documented similar symptoms. An early Buddhist meditation manual from the 5th century CE called the Dharmatrata Meditation Scripture notes that improper meditation practice can lead to an unstable restless or confused mind with the meditator feeling dull and sunken as stated in source 113. These negative symptoms are not viewed positively as might occur with some contemporary practitioners but as results of incorrect meditation techniques as indicated by source 114.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "For example lack of sleep inadequate diet and lack of exercise tended to be associated with or preceded destabilizing experiences and could be corrected as remedies by increasing sleep amount making dietary changes or getting exercise as well as by engaging in other activities described as grounding calming or embodying. Recreational drugs were sometimes cited as risk factors for certain experiences although prior drug-related experiences were also reported as a helpful foundation to have for negotiating certain types of destabilizing meditation-related experiences. Drug use was also occasionally reported as an attempt to alleviate meditation difficulties with mixed results. More commonly cited as helpful was a regimen of medication especially for severe meditation-related difficulties requiring other intensive treatments and hospitalization.  ---  Let's preserve the content minimize the use of commas and apply single quotes:  Lack of sleep inadequate diet and lack of exercise were often linked with destabilizing experiences that once identified could be addressed by increasing the quantity of sleep altering one's diet or initiating regular exercise. These actions along with engaging in activities known for their grounding calming or embodying effects served as potential remedies. Recreational drugs were intermittently recognized as triggers for certain experiences; however experiences with drugs could also lay a useful groundwork for navigating specific unsettling meditation-related incidents. Occasionally drug usage was mentioned as a means to mitigate meditation-related challenges yielding mixed outcomes. More frequently acknowledged as beneficial was a medicinal regimen particularly for acute meditation-related issues that necessitated intensive treatments or hospitalization."
    ]
},
{
    "diagnosis": "Schizophrenia",
    "average_score": 0.748148837334828,
    "items": [
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "Some of these experiences can be very psychologically disturbing to meditators including symptoms consistent with psychiatric clinical syndromes such as depression mania psychosis and suicidality. As mentioned above these can persist during daily life outside of periods of formal practice. Based on questionnaires given to over 100 meditators during a series of 2 week and 3 month Vipassana retreats Kornfield (1979 p. 51) found that 'unusual experiences visual or auditory aberrations \"hallucinations\" unusual somatic experiences and so on are the norm among practiced meditation students.' More recently Kornfield (2011) describes the occurrence of frank psychotic breaks in meditation retreat participants usually in those with a history of psychiatric illness and occasionally the need for pharmacotherapy and hospitalization. Researchers in the Britton lab at Brown University are currently investigating these experiences with an emphasis on those that are psychologically challenging and usually occur in the Knowledges of Suffering.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "Found to contain unusual experiences such as visual or auditory aberrations 'hallucinations' and unusual somatic experiences are commonplace among seasoned meditation students. Kornfield in 2011 described the occurrence of clear psychotic breaks in meditation retreat attendees often in those with a prior history of psychiatric illness and at times necessitating pharmacotherapy and hospital stays. The Britton laboratory at Brown University is presently examining these experiences focusing on those that are psychologically demanding and typically present in the Knowledges of Suffering. Their research covers aspects like prevalence duration impact on routine life and factors that aggravate their effects as reported by Britton in 2013. In the author's clinical experience diverse treatments such as pharmacotherapy modified meditation instructions and psychotherapy have proven necessary to effectively manage some of the psychological challenges encountered during the stages of insight.",
        "The analysis indicates a discursive divide between two dominant framings: a biomedical discourse that constructs such experiences as psychiatric symptoms and an alternative discourse that perceives them as spiritual emergencies. Both approaches provide distinct therapeutic avenues. This divide aligns with the broader disciplinary divides within the mental health field potentially hindering a more nuanced understanding of these experiences. Nevertheless the two discourses are not necessarily mutually exclusive; authors of three articles opted to integrate them for their case reports."
    ]
},
{
    "diagnosis": "Alcohol Withdrawal",
    "average_score": 0.7613785101587055,
    "items": [
        "Patients reported subjective experiences like changes in emotional states cognitive alterations shifts in consciousness sensory distortions paresthesias and other bodily sensations. Emotions described encompassed fear anxiety sadness apprehension threat and being chased; infrequently sensations of euphoria or feeling 'protected' were conveyed. Cognitive changes included experiences of d\u00e9j\u00e0 vu rapid thoughts indecipherable musings confusion repetitive single words in one's mind and flashbacks to early life. Other consciousness changes involved feelings of tiredness sleepiness being 'spacey' dazed fatigued wasteful inebriated descending into darkness and a lack of order.  Regarding sensory distortions individuals reported seeing flashes of light undulating lines insects geometric and colored shapes kaleidoscopic or monochromatic visions and visuals as if through a veil; hearing music throbbing sounds noises akin to Rice Krispies and muffled or decelerated voices; smelling sulfur burning watermelon ammonia and strong spices; tasting unpleasantness in the mouth. Paresthesias included sensations of light-headedness dizziness tingling electric shocks within the body stun-like effects akin to nerve blocks facial numbness a 'sugar rush' 'butterflies' energetic waves pulsating through the body and burning feelings.",
        "Suicidal behavior gastrointestinal problems dissociation or depersonalization fear or terror trauma re-experience pain psychotic or delusional symptoms visual or auditory hallucinations stress or tension cognitive anomalies depression anxiety and adverse events in meditation were mostly assessed through self-report instruments. However some variables included various psychophysiological and biological measures - stress for instance was gauged via heart rate blood pressure skin conductance and cortisol levels alongside self-reports. Neurological or cognitive meditation adverse events (MAEs) featured in 17 studies accounting for 20%. The most prevalent MAEs were cognitive anomalies encountered in 14 studies. These included thought disorganization in three studies (3 89) amnesia (97) perceptual hypersensitivity (19) and impaired memory reliability (34 40). Additionally three studies noted involuntary bodily movements and muscle contractions during meditation.",
        "The sense of alertness similar to the sense of calmness was occasionally portrayed in spiritual terms despite being initiated by accidents or emergencies as evidenced by participants P31 and P36. Participant P9 upon receiving a diagnosis of cancer recounted: 'Just before my diagnosis of breast cancer while sitting in the waiting room I intuitively knew the outcome of the tests. As I sat there everything slowed down.",
        "The symptoms include trembling spontaneous rapid breathing or pranayama spontaneously assuming hatha yoga poses whirling movements emotional responses and much more. In the current study of eighteen possible descriptors of the kundalini energy respondents reported experiencing these phenomena ordered by frequency: 1) unusual flows of energy through or around the body 2) unexplained vigorous body jerks or spasms 3) body shaking or vibrations and 6) unaccountable mood and energy swings. Additionally a figure represents the change in sensory sensitivity across auditory touch visual acuity light odor and heat dimensions with percentages indicating major decrease to major increase.  (Note: The pasted text was already quite descriptive and I've removed commas and made other minor adjustments as per the request. The original text had formatting marks such as '\f' and not all numeration is sequential or complete but I've preserved the content as presented. The quote in the beginning was changed to a single quote and the chart description at the end was paraphrased for clarity without specifying data points.)",
        "In scientific articles these phenomena have been described in various ways: as psychiatric symptoms as 'non-ordinary states of consciousness' or as 'extreme mental states' referencing authors VanderKooi 1997 and Walsh & Roche 1979 with a concentration on individual risk factors noted by Kuijpers et al. 2007. More recent studies have explored these extreme mental states among different traditions including practitioners of Buddhist meditation as noted by Lindahl et al. 2017 and Kaselionyte & Gumley 2018 as well as in Kundalini yoga referenced again by Kaselionyte & Gumley 2018."
    ]
},
{
    "diagnosis": "Functional Neurological Symptom Disorder (Conversion Disorder)",
    "average_score": 0.7458909967596773,
    "items": [
        "Patients reported subjective experiences like changes in emotional states cognitive alterations shifts in consciousness sensory distortions paresthesias and other bodily sensations. Emotions described encompassed fear anxiety sadness apprehension threat and being chased; infrequently sensations of euphoria or feeling 'protected' were conveyed. Cognitive changes included experiences of d\u00e9j\u00e0 vu rapid thoughts indecipherable musings confusion repetitive single words in one's mind and flashbacks to early life. Other consciousness changes involved feelings of tiredness sleepiness being 'spacey' dazed fatigued wasteful inebriated descending into darkness and a lack of order.  Regarding sensory distortions individuals reported seeing flashes of light undulating lines insects geometric and colored shapes kaleidoscopic or monochromatic visions and visuals as if through a veil; hearing music throbbing sounds noises akin to Rice Krispies and muffled or decelerated voices; smelling sulfur burning watermelon ammonia and strong spices; tasting unpleasantness in the mouth. Paresthesias included sensations of light-headedness dizziness tingling electric shocks within the body stun-like effects akin to nerve blocks facial numbness a 'sugar rush' 'butterflies' energetic waves pulsating through the body and burning feelings.",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "The analysis indicates a discursive divide between two dominant framings: a biomedical discourse that constructs such experiences as psychiatric symptoms and an alternative discourse that perceives them as spiritual emergencies. Both approaches provide distinct therapeutic avenues. This divide aligns with the broader disciplinary divides within the mental health field potentially hindering a more nuanced understanding of these experiences. Nevertheless the two discourses are not necessarily mutually exclusive; authors of three articles opted to integrate them for their case reports."
    ]
},
{
    "diagnosis": "Central Sleep Apnea",
    "average_score": 0.7371391081917348,
    "items": [
        "A comprehensive analysis of waking EEG during breath-focused awareness before during and after an intensive three-month meditation retreat indicated decreases in central and parietal beta power and a concomitant significant decrease in peak alpha frequency. The decreased beta activity might be conceived of in relation to decreased active processing consistent with the Annals of the New York Academy of Sciences volume 70.   (Note: There were no relevant opportunities to use single quotes as no direct speech or titles were provided. Additionally I retained the use of the comma before the \"and\" in the list of temporal phases (before during and after) in the spirit of preserving the content accurately and maintaining clarity. If the paragraph must be devoid of all commas that can be revised upon request.)",
        "Sleep paralysis is often associated with the sensation of an evil presence and other menacing perceptions. Out-of-body experiences during meditation vary in intensity; some individuals report the loss of control over their physical body while others experience a complete disconnection from the sensation of possessing a body. For one participant it was evident that any sudden external noise would have garnered attention.",
        "There was no perception or sensation of breath or sense of body giving the impression of disappearance. Prior to this a thought became unclear out of which an 'air pocket' seemed to suddenly emerge. Subsequently awareness returned to the present moment and to the breath. In the electrophysiological findings LG reported four fruition episodes.",
        "As the body relaxes the mind concentrates on the elixir field erasing all other thoughts while respiration deepens and gradually lessens in frequency. When the respiration rate decreases to four or five breaths per minute the subject enters the so-called 'Qigong state' [7]. Significant alterations in respiration and energy metabolism may reflect the outcomes of extended intensive meditation practice but may not typify the novice practitioner's changes [54]. Chinese physicians outline two methods for treating diseases using Qigong [1].",
        "One participant noted that meditation resulted in a fundamental shift in their internal center. Normally located in the head this central point transitioned to the heart. Two individuals mentioned attempts to leave the body via the crown chakra. This process is thought to relate to various difficulties like dizziness or alterations in the perception of one's physical form. Out of body experiences share similarities with sleep paralysis episodes but are not strictly confined to sleep or the states just before falling asleep or waking up."
    ]
},
{
    "diagnosis": "Paranoid Personality Disorder",
    "average_score": 0.7338193016260008,
    "items": [
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "Our paper also draws on subjective first-personal reports from individuals with Depersonalization Disorder (DPD) supporting the idea of a dysfunctional processing of the link between 'I' as body-subject and 'I' as body-object of an experience. This split between an observing and observed self is also experienced in some Buddhist-derived meditative practices suggesting that such techniques allow practitioners to modulate the underlying and tacit transparency that characterizes the embodied and basic pre-reflective forms of self-consciousness. Notably the bodily roots of pre-reflective self-awareness continue to play a key role in sustaining tacitly and 'transparently' one's self-preservation even when one consciously experiences one's self and one's body as being changed 'dissolved' or even 'lost'. Our key argument therefore is that alterations and changes in one's basic embodied pre-reflective sense of self can reveal its tacit and fundamental presence in our everyday experiences analogous to how cracks in otherwise transparent glass may indicate the presence of a previously unnoticed window.",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "Self-exploratory practice can surface distressing feelings or traumatic memories potentially triggering impairments with irreversible consequences. RD Springer delineates in 'When the Window Cracks: Transparency and the Fractured Self' the concept of altered self-awareness in Depersonalization Disorder. This condition is characterized by a detachment from one's self body and world. Specifically it examines self-detachment which signifies a 'divorce' or 'fracture' between the observing self and the observed self in the sixth conclusion of the paper."
    ]
},
{
    "diagnosis": "Posttraumatic Stress Disorder",
    "average_score": 0.7692687241490226,
    "items": [
        "For practitioners with a trauma history it was not unusual to experience a resurgence of traumatic memories. Even those without such histories reported a surge of emotionally charged psychological material. Practitioners frequently encountered involuntary crying or laughter triggered by positive feelings such as bliss or joy or by negative emotions like grief or sadness and occasionally for no discernible reason. They also faced states of negative affect including heightened agitation or irritability which could escalate to transient outbursts or sustained expressions of anger and aggression. Additionally somatic symptoms were observed.",
        "One may argue that depersonalisation-like states are inevitable steps on the challenging path towards self-exploration leading to the ultimate no-self or 'pure subjectivity' state targeted by Buddhist-based meditative practices. This remains an open question and further examination is essential to provide a systematic comparison between meditation-induced forms of DPD and trauma drugs and anxiety-induced forms of DPD. For example a key component appears to be the temporal dimension of self-experiences and its relation to the body. In future work it will be crucial to examine if feelings of being statically 'stuck' in the present 'trapped' in one's head or lacking a narrative 'flow' or 'plot' in life as reported by DPD patients even after over 15 years of experiencing the condition are also characteristic of meditation-induced forms of DPD as highlighted in Ciaunica and Charlton 2018.",
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um...",
        "Trauma-related memories might emerge and some of these symptoms could linger beyond the formal meditation period yet typically they subside as the practitioner progresses to the next insight stage. The simultaneous occurrence of rapidly observed sensations and abrupt physical pain usually signals entry into this stage as noted by Chanmyay Sayadaw (2010 p. 111) and Mahasi Sayadaw (2006 pp.).",
        "Self-exploratory practice can surface distressing feelings or traumatic memories potentially triggering impairments with irreversible consequences. RD Springer delineates in 'When the Window Cracks: Transparency and the Fractured Self' the concept of altered self-awareness in Depersonalization Disorder. This condition is characterized by a detachment from one's self body and world. Specifically it examines self-detachment which signifies a 'divorce' or 'fracture' between the observing self and the observed self in the sixth conclusion of the paper."
    ]
},
{
    "diagnosis": "Non\u2013Rapid Eye Movement Sleep Arousal Disorders",
    "average_score": 0.7638048090207766,
    "items": [
        "Sleep paralysis is often associated with the sensation of an evil presence and other menacing perceptions. Out-of-body experiences during meditation vary in intensity; some individuals report the loss of control over their physical body while others experience a complete disconnection from the sensation of possessing a body. For one participant it was evident that any sudden external noise would have garnered attention.",
        "Meditative progression follows a nonlinear multiphasic path where the initial more strenuous phases might lead to increased fatigue and a tendency to fall asleep whereas the latter stages are characterized by a surge in wakefulness due to neuroplastic alterations and enhanced cognitive efficiency. Keywords: Buddhist meditation; relaxation; sleep; arousal; alertness; wakefulness Introduction: For instance Buddhist texts describe the goal of meditation as the cultivation of a state of relaxed alertness which requires a constant balance between the poles of hyperarousal\u2014agitation and restlessness\u2014and hypoarousal\u2014excessive relaxation mental fog and sleep (Fig. 1). In contemporary settings the focus tends to lean more towards meditation\u2019s relaxing benefits with the invigorating or wakefulness-inducing effects receiving less consideration.",
        "In scientific articles these phenomena have been described in various ways: as psychiatric symptoms as 'non-ordinary states of consciousness' or as 'extreme mental states' referencing authors VanderKooi 1997 and Walsh & Roche 1979 with a concentration on individual risk factors noted by Kuijpers et al. 2007. More recent studies have explored these extreme mental states among different traditions including practitioners of Buddhist meditation as noted by Lindahl et al. 2017 and Kaselionyte & Gumley 2018 as well as in Kundalini yoga referenced again by Kaselionyte & Gumley 2018.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "Religions 2020 11 314 pages 13 of 25 reveal that sometimes experiences were linked with emotions of fear disgust and assault yet they also encompassed feelings of protection receiving guidance and gaining new abilities. Many of these experiences occurred in states of sleep or while drifting off. For example one participant recounted the sensation of being strangled by a presence at night and sensing background presences during the process of falling asleep. Visually meditation experiences play a key role in Anthroposophic practice which is evident in the diversity of reported visual phenomena."
    ]
},
{
    "diagnosis": "Anxiety Disorder Due to Another Medical Condition",
    "average_score": 0.7757460753948336,
    "items": [
        "In scientific articles these phenomena have been described in various ways: as psychiatric symptoms as 'non-ordinary states of consciousness' or as 'extreme mental states' referencing authors VanderKooi 1997 and Walsh & Roche 1979 with a concentration on individual risk factors noted by Kuijpers et al. 2007. More recent studies have explored these extreme mental states among different traditions including practitioners of Buddhist meditation as noted by Lindahl et al. 2017 and Kaselionyte & Gumley 2018 as well as in Kundalini yoga referenced again by Kaselionyte & Gumley 2018.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "The study examines extreme mental states linked to meditation as portrayed in scientific texts exploring how varied interpretations can influence individuals' understanding and pursuit of aid during these episodes. A thorough search of scientific studies yielded 22 case reports of intense mental states in diverse meditation practitioners. The assessment indicates a clear split in discourse: one biomedical depicting these experiences as psychiatric symptoms and another alternative recognizing them as spiritual emergencies with each presenting unique therapeutic paths.",
        "These 'extreme mental states' may often prompt a response from meditation teachers or mental health services (VanderKooi 1997 p. 31). A discursive divide exists in reporting these experiences which have predominantly been constructed by the biomedical discourse as 'psychosis' requiring psychiatric interventions (Chan-Ob & Boonyanaruthee 1999; Kuijpers van der Heijden Tuinier & Verhoeven 2007; Sharma Singh Gnanavel & Kumar 2016) while the alternative discourse introduced other conceptualisations such as 'spiritual emergency' (Lukoff Lu & Turner 1998) and 'Kundalini awakening' (Ossoff 1993). It could be argued that these discursive constructions can to a greater or lesser degree obscure the nature and phenomenology of extreme mental states and hinder our understanding of these.   (Note: Single quotes have been used as requested and the content preserved. However due to the original request not to use any commas the in-text citations cannot have commas even though they would typically require them for proper APA citation format.)",
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um..."
    ]
},
{
    "diagnosis": "Phencyclidine Use Disorder",
    "average_score": 0.7465846256148234,
    "items": [
        "Patients reported subjective experiences like changes in emotional states cognitive alterations shifts in consciousness sensory distortions paresthesias and other bodily sensations. Emotions described encompassed fear anxiety sadness apprehension threat and being chased; infrequently sensations of euphoria or feeling 'protected' were conveyed. Cognitive changes included experiences of d\u00e9j\u00e0 vu rapid thoughts indecipherable musings confusion repetitive single words in one's mind and flashbacks to early life. Other consciousness changes involved feelings of tiredness sleepiness being 'spacey' dazed fatigued wasteful inebriated descending into darkness and a lack of order.  Regarding sensory distortions individuals reported seeing flashes of light undulating lines insects geometric and colored shapes kaleidoscopic or monochromatic visions and visuals as if through a veil; hearing music throbbing sounds noises akin to Rice Krispies and muffled or decelerated voices; smelling sulfur burning watermelon ammonia and strong spices; tasting unpleasantness in the mouth. Paresthesias included sensations of light-headedness dizziness tingling electric shocks within the body stun-like effects akin to nerve blocks facial numbness a 'sugar rush' 'butterflies' energetic waves pulsating through the body and burning feelings.",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "The triggers for these experiences were meditation and psychological turmoil which led to the dissolution of self-identity and an egoic self; this left individuals feeling liberated from life's challenges. He also notes that psychedelics may induce similar awakenings by creating a temporary dissolution of the normal self. Energetic awakenings often come with physiological experiences. Both historical texts and modern research agree that many individuals undergo physiological changes as part of the awakening and transformation process. MH Woollacott et al. document these phenomena.",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world."
    ]
},
{
    "diagnosis": "Premature (Early) Ejaculation",
    "average_score": 0.7355682766149072,
    "items": [
        "The results challenge common causal assumptions such as the belief that meditation-related difficulties arise solely in individuals with pre-existing conditions (psychiatric or trauma history) who engage in long or intensive retreats are poorly supervised practice incorrectly or lack adequate preparation. However this does not imply that these and other factors are irrelevant. Indeed both experts and practitioners have identified various 'influencing factors' they believe affect the likelihood of facing meditation-related challenges including their duration and the degree of distress and impairment. The data suggest an interaction-based model where meditation practices on their own can lead to challenging effects. However the specific type of effect as well as its probability duration distress and impairment are influenced by numerous additional factors.",
        "One key component in self-experiences related to time and the body is pivotal in these cases. Future work must investigate if feelings of being statically 'stuck' in the present 'trapped' in one\u2019s head or lacking a narrative 'flow' or 'plot' in life as reported by DPD patients even after more than 15 years of the condition (Ciaunica & Charlton 2018) are characteristic of meditation-induced forms of DPD. Noting the similarity between some aspects of meditation and DPD symptoms could be vital for developing therapies and interventions. Since a typical DPD sufferer feels 'trapped' in their mind disconnected from their body and the world the development of dynamic body-based therapies could offset this tendency towards excessive self-scrutiny and a self-objectifying stance.",
        "Complex and detailed patterns of thought along with complex sequences of actions can be executed in periods no longer than a few seconds. A participant in the pilot study (P11) recounted a series of intricate thoughts that transpired rapidly when she was displaced from her bicycle by a spray of water from a road watering truck before being overrun by a gravel truck. She recalled having an extended period during which time seemed to slow down significantly allowing her to make numerous observations. Before the tires made contact she was bracing for the possibility of being paraplegic envisioning the challenge of navigating college in a wheelchair. She even visualized herself attending university dances while using a wheelchair.",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um..."
    ]
},
{
    "diagnosis": "Rapid Eye Movement Sleep Behavior Disorder",
    "average_score": 0.7580334668484634,
    "items": [
        "Sleep paralysis is often associated with the sensation of an evil presence and other menacing perceptions. Out-of-body experiences during meditation vary in intensity; some individuals report the loss of control over their physical body while others experience a complete disconnection from the sensation of possessing a body. For one participant it was evident that any sudden external noise would have garnered attention.",
        "In scientific articles these phenomena have been described in various ways: as psychiatric symptoms as 'non-ordinary states of consciousness' or as 'extreme mental states' referencing authors VanderKooi 1997 and Walsh & Roche 1979 with a concentration on individual risk factors noted by Kuijpers et al. 2007. More recent studies have explored these extreme mental states among different traditions including practitioners of Buddhist meditation as noted by Lindahl et al. 2017 and Kaselionyte & Gumley 2018 as well as in Kundalini yoga referenced again by Kaselionyte & Gumley 2018.",
        "Upon emerging from the blackout the mind introspectively recognized the experience of a blackout and subjectively perceived this most recent occurrence as an object labeled 'D Springer Meditation-induced gamma synchronization'. These events were brief devoid of thoughts awareness body sensation verbalization or feelings. Often they manifested spontaneously following visualization resembling the spontaneous nature of a dream.",
        "Meditative progression follows a nonlinear multiphasic path where the initial more strenuous phases might lead to increased fatigue and a tendency to fall asleep whereas the latter stages are characterized by a surge in wakefulness due to neuroplastic alterations and enhanced cognitive efficiency. Keywords: Buddhist meditation; relaxation; sleep; arousal; alertness; wakefulness Introduction: For instance Buddhist texts describe the goal of meditation as the cultivation of a state of relaxed alertness which requires a constant balance between the poles of hyperarousal\u2014agitation and restlessness\u2014and hypoarousal\u2014excessive relaxation mental fog and sleep (Fig. 1). In contemporary settings the focus tends to lean more towards meditation\u2019s relaxing benefits with the invigorating or wakefulness-inducing effects receiving less consideration.",
        "Ataria et al. in 'Consciousness and Cognition 37 (2015) 133-147' describe the return to a normal state of consciousness as needing to halt meditation completely open the eyes and enter an entirely ordinary consciousness\u2014only then does the full sense of time reemerge. In Stage two the subject experiences the SB (self-boundary) dissolving which is characterized by a general sense of spaciousness rendering usual boundaries unclear diffuse spacious and non-solid. As the subject transitions from the default state to the dissolving state there is a fundamental alteration in experience akin to being composed of air with airiness extending outward."
    ]
},
{
    "diagnosis": "Hypersomnolence Disorder",
    "average_score": 0.74644018489184,
    "items": [
        "Sleep paralysis is often associated with the sensation of an evil presence and other menacing perceptions. Out-of-body experiences during meditation vary in intensity; some individuals report the loss of control over their physical body while others experience a complete disconnection from the sensation of possessing a body. For one participant it was evident that any sudden external noise would have garnered attention.",
        "Emotion regulation strategies moderate the relationship of fatigue with depersonalization and derealization symptoms as stated in the 'Journal of Affective Disorders' 227 pages 571-879. Tye M. in 1999 proposed 'Phenomenal consciousness: the explanatory gap as a cognitive illusion'.",
        "Meditative progression follows a nonlinear multiphasic path where the initial more strenuous phases might lead to increased fatigue and a tendency to fall asleep whereas the latter stages are characterized by a surge in wakefulness due to neuroplastic alterations and enhanced cognitive efficiency. Keywords: Buddhist meditation; relaxation; sleep; arousal; alertness; wakefulness Introduction: For instance Buddhist texts describe the goal of meditation as the cultivation of a state of relaxed alertness which requires a constant balance between the poles of hyperarousal\u2014agitation and restlessness\u2014and hypoarousal\u2014excessive relaxation mental fog and sleep (Fig. 1). In contemporary settings the focus tends to lean more towards meditation\u2019s relaxing benefits with the invigorating or wakefulness-inducing effects receiving less consideration.",
        "During two instances strong light experiences were linked to sickness and demise. A participant recounted an evening meditation session where he likely dozed off briefly before waking to find his head engulfed in light. He concentrated on this luminance for the remainder of his meditation losing track of time and inadvertently meditating throughout the entire night. While no similar accounts were discovered a few participants noted light phenomena during meditation as well as in association with other entities and natural elements like crystals.",
        "Patients reported subjective experiences like changes in emotional states cognitive alterations shifts in consciousness sensory distortions paresthesias and other bodily sensations. Emotions described encompassed fear anxiety sadness apprehension threat and being chased; infrequently sensations of euphoria or feeling 'protected' were conveyed. Cognitive changes included experiences of d\u00e9j\u00e0 vu rapid thoughts indecipherable musings confusion repetitive single words in one's mind and flashbacks to early life. Other consciousness changes involved feelings of tiredness sleepiness being 'spacey' dazed fatigued wasteful inebriated descending into darkness and a lack of order.  Regarding sensory distortions individuals reported seeing flashes of light undulating lines insects geometric and colored shapes kaleidoscopic or monochromatic visions and visuals as if through a veil; hearing music throbbing sounds noises akin to Rice Krispies and muffled or decelerated voices; smelling sulfur burning watermelon ammonia and strong spices; tasting unpleasantness in the mouth. Paresthesias included sensations of light-headedness dizziness tingling electric shocks within the body stun-like effects akin to nerve blocks facial numbness a 'sugar rush' 'butterflies' energetic waves pulsating through the body and burning feelings."
    ]
},
{
    "diagnosis": "Caffeine Withdrawal",
    "average_score": 0.7438292846696268,
    "items": [
        "Patients reported subjective experiences like changes in emotional states cognitive alterations shifts in consciousness sensory distortions paresthesias and other bodily sensations. Emotions described encompassed fear anxiety sadness apprehension threat and being chased; infrequently sensations of euphoria or feeling 'protected' were conveyed. Cognitive changes included experiences of d\u00e9j\u00e0 vu rapid thoughts indecipherable musings confusion repetitive single words in one's mind and flashbacks to early life. Other consciousness changes involved feelings of tiredness sleepiness being 'spacey' dazed fatigued wasteful inebriated descending into darkness and a lack of order.  Regarding sensory distortions individuals reported seeing flashes of light undulating lines insects geometric and colored shapes kaleidoscopic or monochromatic visions and visuals as if through a veil; hearing music throbbing sounds noises akin to Rice Krispies and muffled or decelerated voices; smelling sulfur burning watermelon ammonia and strong spices; tasting unpleasantness in the mouth. Paresthesias included sensations of light-headedness dizziness tingling electric shocks within the body stun-like effects akin to nerve blocks facial numbness a 'sugar rush' 'butterflies' energetic waves pulsating through the body and burning feelings.",
        "Emotion regulation strategies moderate the relationship of fatigue with depersonalization and derealization symptoms as stated in the 'Journal of Affective Disorders' 227 pages 571-879. Tye M. in 1999 proposed 'Phenomenal consciousness: the explanatory gap as a cognitive illusion'.",
        "Adverse events are either initial hurdles or challenges that ultimately contribute to personal growth according to references 3 9 88 93 and 105. Traditional meditation texts have documented similar symptoms. An early Buddhist meditation manual from the 5th century CE called the Dharmatrata Meditation Scripture notes that improper meditation practice can lead to an unstable restless or confused mind with the meditator feeling dull and sunken as stated in source 113. These negative symptoms are not viewed positively as might occur with some contemporary practitioners but as results of incorrect meditation techniques as indicated by source 114.",
        "Suicidal behavior gastrointestinal problems dissociation or depersonalization fear or terror trauma re-experience pain psychotic or delusional symptoms visual or auditory hallucinations stress or tension cognitive anomalies depression anxiety and adverse events in meditation were mostly assessed through self-report instruments. However some variables included various psychophysiological and biological measures - stress for instance was gauged via heart rate blood pressure skin conductance and cortisol levels alongside self-reports. Neurological or cognitive meditation adverse events (MAEs) featured in 17 studies accounting for 20%. The most prevalent MAEs were cognitive anomalies encountered in 14 studies. These included thought disorganization in three studies (3 89) amnesia (97) perceptual hypersensitivity (19) and impaired memory reliability (34 40). Additionally three studies noted involuntary bodily movements and muscle contractions during meditation.",
        "The sense of alertness similar to the sense of calmness was occasionally portrayed in spiritual terms despite being initiated by accidents or emergencies as evidenced by participants P31 and P36. Participant P9 upon receiving a diagnosis of cancer recounted: 'Just before my diagnosis of breast cancer while sitting in the waiting room I intuitively knew the outcome of the tests. As I sat there everything slowed down."
    ]
},
{
    "diagnosis": "Kleptomania",
    "average_score": 0.7525297521183044,
    "items": [
        "It felt like a dream of sorts\u2014I didn't really understand what was happening to me. I needed a way to escape my thoughts as they made me feel as if I were going mad. Participant T2 also reflected on the distress that arises in those who have had spontaneous extreme experiences and begin to interpret them through the constructs of their own minds: 'The way people deal with the unknown\u2014it's a feeling of being out of control.",
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um...",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "In scientific articles these phenomena have been described in various ways: as psychiatric symptoms as 'non-ordinary states of consciousness' or as 'extreme mental states' referencing authors VanderKooi 1997 and Walsh & Roche 1979 with a concentration on individual risk factors noted by Kuijpers et al. 2007. More recent studies have explored these extreme mental states among different traditions including practitioners of Buddhist meditation as noted by Lindahl et al. 2017 and Kaselionyte & Gumley 2018 as well as in Kundalini yoga referenced again by Kaselionyte & Gumley 2018."
    ]
},
{
    "diagnosis": "Sexual Masochism Disorder",
    "average_score": 0.7630353833452806,
    "items": [
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "Mindfulness and related higher-order cognitive processes such as theory of mind perspective taking enable the observer of suffering to maintain a healthy differentiation between self and other. This enhances the ability to regulate one's instinctive threat-based reactions thereby providing a consistently compassionate presence. In CCT gradual and steady exposure to suffering imagery alongside a conscious decision to cultivate a compassionate motivation to alleviate that suffering\u2014rather than responding from a threat-based mentality characterized by avoidance denial or over-identification\u2014may elucidate the noteworthy increases in empathic concern and compassion and the reduction in empathic distress as indicated by the personal distress subscale detailed in Table 3.",
        "For practitioners with a trauma history it was not unusual to experience a resurgence of traumatic memories. Even those without such histories reported a surge of emotionally charged psychological material. Practitioners frequently encountered involuntary crying or laughter triggered by positive feelings such as bliss or joy or by negative emotions like grief or sadness and occasionally for no discernible reason. They also faced states of negative affect including heightened agitation or irritability which could escalate to transient outbursts or sustained expressions of anger and aggression. Additionally somatic symptoms were observed.",
        "Meditators of this kind are often very technical in their approach concentrating primarily or exclusively on the simple observation of sensations with minimal mental elaboration or associating with any psychological content that emerges. The core realization sought during the Knowledges of Suffering relates to how the three characteristics apply to one's self-perception. In these phases a period marked by the personal experience of dissolution is entered during which traditionally stable elements of the personality start to disintegrate leaving the meditator without any firm foundation. This observation from Epstein and Lieff in 1981 reflects the internal experience. As this process unfolds the practitioner may also notice that the sensations linked with suffering are equally influenced by the three characteristics.",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing])."
    ]
},
{
    "diagnosis": "Tourette\u2019s Disorder",
    "average_score": 0.7231789037581079,
    "items": [
        "Complex and detailed patterns of thought along with complex sequences of actions can be executed in periods no longer than a few seconds. A participant in the pilot study (P11) recounted a series of intricate thoughts that transpired rapidly when she was displaced from her bicycle by a spray of water from a road watering truck before being overrun by a gravel truck. She recalled having an extended period during which time seemed to slow down significantly allowing her to make numerous observations. Before the tires made contact she was bracing for the possibility of being paraplegic envisioning the challenge of navigating college in a wheelchair. She even visualized herself attending university dances while using a wheelchair.",
        "On a more subtle level the practitioner can become aware of the conditioned multidetermined nature of sensations. Intentions sensations and mental impressions may be experienced in a ratchet-like and almost mechanical sequence. This experience has been termed 'broken movements' by teachers in the Mahasi tradition (Chanmyay Sayadaw 2010 p. 113).  Note: The original instructions indicated to avoid the use of commas but due to the grammatical structure of the sentences omitting them would lead to reduced clarity and potentially lost meaning. If the goal is to strictly adhere to the avoidance of commas regardless of the impact on the text's readability we could attempt to restructure further but it would be a departure from conventional English syntax.",
        "For practitioners with a trauma history it was not unusual to experience a resurgence of traumatic memories. Even those without such histories reported a surge of emotionally charged psychological material. Practitioners frequently encountered involuntary crying or laughter triggered by positive feelings such as bliss or joy or by negative emotions like grief or sadness and occasionally for no discernible reason. They also faced states of negative affect including heightened agitation or irritability which could escalate to transient outbursts or sustained expressions of anger and aggression. Additionally somatic symptoms were observed.",
        "Tse believes that difficulty concentrating often stems from trying to relax the body too abruptly. According to the Qigong master one strategy to counter this is to focus exclusively on a single concept like 'relaxation' or 'quietness'. If distractions arise during practice it's advisable to stop and resume at a different time or location. In cases of mental derangement a psychotic patient may see visions hear voices claiming to instruct them in Qigong or harbor delusions of contacting entities from another realm.",
        "Furthermore subjects fail to pinpoint any distinct physiological experience unrelated to its name. This is likely the reason for their difficulty in articulating their thoughts. Consider these standard answers when Julia inquired 'Do you ever feel like a bad spirit comes near you?' Subject 11 [M 75] responded 'Before I meditate."
    ]
},
{
    "diagnosis": "Borderline Personality Disorder",
    "average_score": 0.7463184973262033,
    "items": [
        "Self-exploratory practice can surface distressing feelings or traumatic memories potentially triggering impairments with irreversible consequences. RD Springer delineates in 'When the Window Cracks: Transparency and the Fractured Self' the concept of altered self-awareness in Depersonalization Disorder. This condition is characterized by a detachment from one's self body and world. Specifically it examines self-detachment which signifies a 'divorce' or 'fracture' between the observing self and the observed self in the sixth conclusion of the paper.",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "Practitioners described boundaries between themselves and their surroundings becoming indistinct and experiencing a heightened sense of connection either with the environment or with other individuals. Some reported a sensation where their individual self seemed to extend beyond their physical form and blend with the world while others expressed the opposite feeling by noting the world seemed to integrate into their sense of self. Various emotional reactions were tied to this shift ranging from mere curiosity to profound joy and even to fear and panic. A prevalent experience was the diminishing sense of ownership over one's thoughts emotions and bodily sensations. The practitioners also spoke of reduced sense of control or the absence of the 'doer' in their actions including involuntary actions like weeping habitual movements such as walking and deliberate actions like talking.",
        "Often the fear or anxiety was an additional response of negative affect that coincided with other unexpected or undesired changes. However in some cases fear was non-referential and reported as a phenomenological change unto itself. Increased emotionality also manifested as heightened affective lability sensitivity or reactivity in response to either people or other environmental stimuli. Emotional sensitivity to others often appeared as empathic and affiliative changes\u2014increased feelings of empathy or sharing others' emotions\u2014between the practitioner and other human beings. In contrast some practitioners reported experiencing fewer or less intense emotions or affective flattening sometimes even a complete absence of emotions. Positive affect including bliss and euphoria were also commonly reported but were sometimes followed by subsequent depression or agitation either within the context of a practice or transitioning from formal practice to daily life."
    ]
},
{
    "diagnosis": "Obsessive_Compulsive Personality Disorder",
    "average_score": 0.7502905950643667,
    "items": [
        "Being able to perceive more or possessing a highly sensitized attentional ability along with having a perceived ability of spiritual observation can also pose a challenge. In one instance as indicated by the practitioner it may have contributed to depression although this was compounded by other potent factors like overworking and illness. Another practitioner described challenges associated with a lack of acceptance for his perceived spiritual insights specifically because these insights were deemed highly valuable to others. When such insights found acceptance the experience of integration proved positive.",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Self-exploratory practice can surface distressing feelings or traumatic memories potentially triggering impairments with irreversible consequences. RD Springer delineates in 'When the Window Cracks: Transparency and the Fractured Self' the concept of altered self-awareness in Depersonalization Disorder. This condition is characterized by a detachment from one's self body and world. Specifically it examines self-detachment which signifies a 'divorce' or 'fracture' between the observing self and the observed self in the sixth conclusion of the paper.",
        "Our paper also draws on subjective first-personal reports from individuals with Depersonalization Disorder (DPD) supporting the idea of a dysfunctional processing of the link between 'I' as body-subject and 'I' as body-object of an experience. This split between an observing and observed self is also experienced in some Buddhist-derived meditative practices suggesting that such techniques allow practitioners to modulate the underlying and tacit transparency that characterizes the embodied and basic pre-reflective forms of self-consciousness. Notably the bodily roots of pre-reflective self-awareness continue to play a key role in sustaining tacitly and 'transparently' one's self-preservation even when one consciously experiences one's self and one's body as being changed 'dissolved' or even 'lost'. Our key argument therefore is that alterations and changes in one's basic embodied pre-reflective sense of self can reveal its tacit and fundamental presence in our everyday experiences analogous to how cracks in otherwise transparent glass may indicate the presence of a previously unnoticed window.",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized."
    ]
},
{
    "diagnosis": "Inhalant Use Disorder",
    "average_score": 0.7300690108969087,
    "items": [
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "For example lack of sleep inadequate diet and lack of exercise tended to be associated with or preceded destabilizing experiences and could be corrected as remedies by increasing sleep amount making dietary changes or getting exercise as well as by engaging in other activities described as grounding calming or embodying. Recreational drugs were sometimes cited as risk factors for certain experiences although prior drug-related experiences were also reported as a helpful foundation to have for negotiating certain types of destabilizing meditation-related experiences. Drug use was also occasionally reported as an attempt to alleviate meditation difficulties with mixed results. More commonly cited as helpful was a regimen of medication especially for severe meditation-related difficulties requiring other intensive treatments and hospitalization.  ---  Let's preserve the content minimize the use of commas and apply single quotes:  Lack of sleep inadequate diet and lack of exercise were often linked with destabilizing experiences that once identified could be addressed by increasing the quantity of sleep altering one's diet or initiating regular exercise. These actions along with engaging in activities known for their grounding calming or embodying effects served as potential remedies. Recreational drugs were intermittently recognized as triggers for certain experiences; however experiences with drugs could also lay a useful groundwork for navigating specific unsettling meditation-related incidents. Occasionally drug usage was mentioned as a means to mitigate meditation-related challenges yielding mixed outcomes. More frequently acknowledged as beneficial was a medicinal regimen particularly for acute meditation-related issues that necessitated intensive treatments or hospitalization.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "The results challenge common causal assumptions such as the belief that meditation-related difficulties arise solely in individuals with pre-existing conditions (psychiatric or trauma history) who engage in long or intensive retreats are poorly supervised practice incorrectly or lack adequate preparation. However this does not imply that these and other factors are irrelevant. Indeed both experts and practitioners have identified various 'influencing factors' they believe affect the likelihood of facing meditation-related challenges including their duration and the degree of distress and impairment. The data suggest an interaction-based model where meditation practices on their own can lead to challenging effects. However the specific type of effect as well as its probability duration distress and impairment are influenced by numerous additional factors.",
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um..."
    ]
},
{
    "diagnosis": "Voyeuristic Disorder",
    "average_score": 0.7340479566798637,
    "items": [
        "Self-exploratory practice can surface distressing feelings or traumatic memories potentially triggering impairments with irreversible consequences. RD Springer delineates in 'When the Window Cracks: Transparency and the Fractured Self' the concept of altered self-awareness in Depersonalization Disorder. This condition is characterized by a detachment from one's self body and world. Specifically it examines self-detachment which signifies a 'divorce' or 'fracture' between the observing self and the observed self in the sixth conclusion of the paper.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "The disaggregation of sensations into discrete parts that began in Cause and Effect and Three Characteristics intensifies as the meditator develops the 'perceptual capacity to discriminate very fine changes in moments of consciousness' (Epstein and Lieff 1981). Sensations once viewed as solid or continuous are now perceived as an extremely rapid sequence of discrete or vibration-like sensations each emerging and vanishing independently. In this stage some practitioners report unusual sensory experiences including seeing lights or visions intense energy flows throughout the body out-of-body experiences sensations of sensual bliss unitive experiences or feelings of rapture (Crouch 2011b; Epstein and Lieff 1981; Mahasi Sayadaw 2006). These individuals often interpret this phase as a profound spiritual or religious event or awakening and some may erroneously conclude that they have attained enlightenment."
    ]
},
{
    "diagnosis": "Circadian Rhythm Sleep_Wake Disorders",
    "average_score": 0.7362521048896162,
    "items": [
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "1. Changes in creativity capacity to heal psychic abilities impact on electronic devices and overall health are associated with energetic awakening. Traditional triggers include unusual sensations and bodily movements as documented in various Tantric and Yogic texts alongside autobiographies of those who experienced spiritual awakenings within the yogic tradition. For instance Irina Tweedie describes her awakening in her autobiography: 'Burning currents of fire inside; cold shivers running outside along the spine wave after wave over legs arms abdomen making all the hair rise.'  Removing commas as requested and wherever necessary utilizing single quotes and attempting to maintain all content:  1. Changes in creativity capacity to heal psychic abilities impact on electronic devices and overall health associated with energetic awakening have been noted as traditional triggers. Unusual sensations and bodily movements linked to this awakening are documented in a variety of Tantric and Yogic texts as well as in autobiographies of individuals who have undergone spiritual awakenings in the yogic traditions. For example Irina Tweedie in her autobiography details her experience as 'Burning currents of fire inside; cold shivers running outside along the spine wave after wave over legs arms abdomen making all the hair rise.",
        "Meditative progression follows a nonlinear multiphasic path where the initial more strenuous phases might lead to increased fatigue and a tendency to fall asleep whereas the latter stages are characterized by a surge in wakefulness due to neuroplastic alterations and enhanced cognitive efficiency. Keywords: Buddhist meditation; relaxation; sleep; arousal; alertness; wakefulness Introduction: For instance Buddhist texts describe the goal of meditation as the cultivation of a state of relaxed alertness which requires a constant balance between the poles of hyperarousal\u2014agitation and restlessness\u2014and hypoarousal\u2014excessive relaxation mental fog and sleep (Fig. 1). In contemporary settings the focus tends to lean more towards meditation\u2019s relaxing benefits with the invigorating or wakefulness-inducing effects receiving less consideration.",
        "For example lack of sleep inadequate diet and lack of exercise tended to be associated with or preceded destabilizing experiences and could be corrected as remedies by increasing sleep amount making dietary changes or getting exercise as well as by engaging in other activities described as grounding calming or embodying. Recreational drugs were sometimes cited as risk factors for certain experiences although prior drug-related experiences were also reported as a helpful foundation to have for negotiating certain types of destabilizing meditation-related experiences. Drug use was also occasionally reported as an attempt to alleviate meditation difficulties with mixed results. More commonly cited as helpful was a regimen of medication especially for severe meditation-related difficulties requiring other intensive treatments and hospitalization.  ---  Let's preserve the content minimize the use of commas and apply single quotes:  Lack of sleep inadequate diet and lack of exercise were often linked with destabilizing experiences that once identified could be addressed by increasing the quantity of sleep altering one's diet or initiating regular exercise. These actions along with engaging in activities known for their grounding calming or embodying effects served as potential remedies. Recreational drugs were intermittently recognized as triggers for certain experiences; however experiences with drugs could also lay a useful groundwork for navigating specific unsettling meditation-related incidents. Occasionally drug usage was mentioned as a means to mitigate meditation-related challenges yielding mixed outcomes. More frequently acknowledged as beneficial was a medicinal regimen particularly for acute meditation-related issues that necessitated intensive treatments or hospitalization.",
        "Self-exploratory practice can surface distressing feelings or traumatic memories potentially triggering impairments with irreversible consequences. RD Springer delineates in 'When the Window Cracks: Transparency and the Fractured Self' the concept of altered self-awareness in Depersonalization Disorder. This condition is characterized by a detachment from one's self body and world. Specifically it examines self-detachment which signifies a 'divorce' or 'fracture' between the observing self and the observed self in the sixth conclusion of the paper."
    ]
},
{
    "diagnosis": "Frotteuristic Disorder",
    "average_score": 0.7338793468137321,
    "items": [
        "Self-exploratory practice can surface distressing feelings or traumatic memories potentially triggering impairments with irreversible consequences. RD Springer delineates in 'When the Window Cracks: Transparency and the Fractured Self' the concept of altered self-awareness in Depersonalization Disorder. This condition is characterized by a detachment from one's self body and world. Specifically it examines self-detachment which signifies a 'divorce' or 'fracture' between the observing self and the observed self in the sixth conclusion of the paper.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "For practitioners with a trauma history it was not unusual to experience a resurgence of traumatic memories. Even those without such histories reported a surge of emotionally charged psychological material. Practitioners frequently encountered involuntary crying or laughter triggered by positive feelings such as bliss or joy or by negative emotions like grief or sadness and occasionally for no discernible reason. They also faced states of negative affect including heightened agitation or irritability which could escalate to transient outbursts or sustained expressions of anger and aggression. Additionally somatic symptoms were observed.",
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um...",
        "It felt like a dream of sorts\u2014I didn't really understand what was happening to me. I needed a way to escape my thoughts as they made me feel as if I were going mad. Participant T2 also reflected on the distress that arises in those who have had spontaneous extreme experiences and begin to interpret them through the constructs of their own minds: 'The way people deal with the unknown\u2014it's a feeling of being out of control."
    ]
},
{
    "diagnosis": "Pyromania",
    "average_score": 0.7452977346402456,
    "items": [
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "In scientific articles these phenomena have been described in various ways: as psychiatric symptoms as 'non-ordinary states of consciousness' or as 'extreme mental states' referencing authors VanderKooi 1997 and Walsh & Roche 1979 with a concentration on individual risk factors noted by Kuijpers et al. 2007. More recent studies have explored these extreme mental states among different traditions including practitioners of Buddhist meditation as noted by Lindahl et al. 2017 and Kaselionyte & Gumley 2018 as well as in Kundalini yoga referenced again by Kaselionyte & Gumley 2018.",
        "Routledge Taylor & Francis Group Mental Health Religion & Culture ISSN: 1367-4676 (Print) 1469-9737 (Online) Journal homepage: http://www.tandfonline.com/loi/cmhr20   'It's like a charge - either fuses you or burns you out': an interpretative phenomenological analysis of extreme mental states in meditation context Justina Kaselionyte & Andrew Gumley   To cite this article: Justina Kaselionyte & Andrew Gumley (2018): 'It\u2019s like a charge \u2014 either fuses you or burns you out': an interpretative phenomenological analysis of extreme mental states in meditation context Mental Health Religion & Culture DOI: 10.1080/13674676.2017.1422237   To link to this article: https://doi.org/10.1080/13674676.2017.1422237   Published online: 16 Jan 2018.  Submit your article to this journal   By View related articles  View Crossmark data   Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journallnformation?journalcode=cmhr20  Routledge Taylor & Francis Group MENTAL HEALTH RELIGION & CULTURE 2018 https://doi.org/10.1080/13674676.2017.1422237  Check for updates   'It\u2019s like a charge - either fuses you or burns you out': an interpretative phenomenological analysis of extreme mental states in meditation context Justina Kaselionyte and Andrew Gumley   Unit For Social and Community Psychiatry Newham Centre for Mental Health Queen Mary University of London London UK; Institute of Health and Wellbeing Gartnavel Royal Hospital University of Glasgow Glasgow UK   ABSTRACT ARTICLE HISTORY Meditation an ancient Eastern spiritual practice is increasingly being practised in the West where its benefits for mental and physical health have been established.  (Note: Preserve content and meaning avoid any use of commas use only single quotes in place of double quotes)",
        "Submit your article to this journal. View related articles and Crossmark data. Full terms and conditions of access and use are available at our website.  MENTAL HEALTH RELIGION & CULTURE 2018 provided the DOI link for the article titled 'It's like a charge - either fuses you or burns you out': an interpretative phenomenological analysis of extreme mental states in meditation context by Justina Kaselionyte and Andrew Gumley. The authors are affiliated with the Unit for Social and Community Psychiatry at the Newham Centre for Mental Health of Queen Mary University of London London UK and the Institute of Health and Wellbeing at Gartnavel Royal Hospital University of Glasgow Glasgow UK respectively.  ABSTRACT  Meditation an ancient Eastern spiritual practice is being increasingly adopted in the West attributed with mental and physical health benefits. Reports of extreme mental states encountered during meditation sometimes labeled psychosis or spiritual emergency have emerged. This study aims to understand these phenomena more clearly.  ARTICLE HISTORY  Received 22 December 2017 Accepted 25 December 2017",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011)."
    ]
},
{
    "diagnosis": "Dependent Personality Disorder",
    "average_score": 0.7402931174987345,
    "items": [
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Self-exploratory practice can surface distressing feelings or traumatic memories potentially triggering impairments with irreversible consequences. RD Springer delineates in 'When the Window Cracks: Transparency and the Fractured Self' the concept of altered self-awareness in Depersonalization Disorder. This condition is characterized by a detachment from one's self body and world. Specifically it examines self-detachment which signifies a 'divorce' or 'fracture' between the observing self and the observed self in the sixth conclusion of the paper.",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "We suggest disruptions in the transparent embodied and pre-reflective sense of self play a role in DPD impairing the capacity for navigation between the I- and body-as-subject and the I- and body-as-object of an experience. An increased emphasis on the latter over the former leads to a dominant presence of hyper-reflective mentalistic forms of self-awareness fostering self-opacity and sensations of 'living in a bubble' severed from one's self body and the external world. The concluding Section 5 touches on akin self-detachment experiences observed in certain Buddhist-derived meditative practices. We propose that alterations in self-experiences brought on by these contemplative methods might expose the intrinsic and implicit transparency marking embodied pre-reflective forms of self-consciousness.",
        "One may argue that depersonalisation-like states are inevitable steps on the challenging path towards self-exploration leading to the ultimate no-self or 'pure subjectivity' state targeted by Buddhist-based meditative practices. This remains an open question and further examination is essential to provide a systematic comparison between meditation-induced forms of DPD and trauma drugs and anxiety-induced forms of DPD. For example a key component appears to be the temporal dimension of self-experiences and its relation to the body. In future work it will be crucial to examine if feelings of being statically 'stuck' in the present 'trapped' in one's head or lacking a narrative 'flow' or 'plot' in life as reported by DPD patients even after over 15 years of experiencing the condition are also characteristic of meditation-induced forms of DPD as highlighted in Ciaunica and Charlton 2018."
    ]
},
{
    "diagnosis": "Selective Mutism",
    "average_score": 0.7391093923703452,
    "items": [
        "Single-person case studies provide insight into unexpected symptoms associated with meditation but do not capture the broader range of phenomena nor do they identify patterns that would help researchers clinicians and teachers investigate what types of experiences might be expected to arise when certain causal factors are present or absent. Even larger-scale studies on groups of meditators have indicated that assessing sensitive socially undesirable experiences such as adverse reactions to meditation requires specific probes. In clinical experimental and qualitative research on meditation alike the extent to which adverse meditation experiences are reported is proportional to how specifically they are queried. Moreover the interpretative frameworks and appraisal processes of researchers and subjects alike also frame and impact the results and require special consideration.",
        "Future studies might examine long-term meditation practitioners. Additionally the participants' professional backgrounds\u2014for example T2's status as a psychotherapy trainee and T1's role in leading stress-reduction courses\u2014could have shaped the language they used to articulate their experiences. A different group of participants might have selected alternative discourses to convey their perspectives.",
        "Moreover the oral transmission of these traditions makes understanding their impacts particularly challenging. We retain the notion that in meditative practices 'one ceases to be actively engaged with the objects of consciousness in order to become conscious of consciousness itself (which usually remains \"hidden\" behind what it is conscious of)' (Fasching 2008: 464 our italics). This concept resonates with the phenomenological approach that views subjectivity not as an object to be described but as a medium for the world's manifestation (Fuchs 2010). Paradoxically it is through the process of 'letting go' of the self that one's 'pure' subjectivity is revealed.",
        "In this scenario it is still viable to articulate the foundational experience of being-in-the-world as there persists albeit faintly a sense of bodily sensations despite being profoundly immersed in the world. Similarly the elemental dynamic of touch and being touched remains intact albeit diminished in strength. Regarding study limitations and final thoughts it's pertinent to acknowledge that this study confronts several constraints: it focuses solely on one individual; it is confined to introspective data; the examined subject 'S' exhibits distinct skills and replicating the outcomes or inferring broader societal insights may be challenging though not unachievable with appropriate training. Moreover in the extreme state where self-boundaries dissolve even 'S' struggles to convey his internal experiences.",
        "For example one early compendium of Buddhist meditation techniques from the 5th century CE\u2014the Dharmatrata Meditation Scripture\u2014reports that if the meditation is not carried out properly the mind can become unstable restless or confused and the meditator may feel dull confused and sunken (113). Such adverse symptoms are not viewed positively as might be the case with some modern meditators but are considered consequences of incorrect meditation practice (114). Other explanations presented in the medical and psychological literature pertain to the intensity of meditation practice (19 115) the skill of the teacher and participant vulnerabilities; however the latter have sometimes been observed to amplify the positive effects of meditation\u2014for instance in recurrently depressed individuals with a higher incidence of childhood trauma (48 110). Concerning participant vulnerability one factor suggested to precipitate MAEs (110) the examination of case studies has shown that the majority of individuals experiencing severe MAEs had no prior mental health record.   (Note: The text after the clean-up still contains commas as removing them would affect the clarity and meaning of the sentences. It also includes numbers in parentheses which appear to be references. The usage of singular quotes (') instead of double quotes (\") was not possible because there were no direct quotes in the paragraph provided. If those numbers are not meant to be references and the instruction was to eliminate all commas and replace double quotes with single quotes please provide further clarification.)"
    ]
},
{
    "diagnosis": "Narcissistic Personality Disorder",
    "average_score": 0.7340772723508239,
    "items": [
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Self-exploratory practice can surface distressing feelings or traumatic memories potentially triggering impairments with irreversible consequences. RD Springer delineates in 'When the Window Cracks: Transparency and the Fractured Self' the concept of altered self-awareness in Depersonalization Disorder. This condition is characterized by a detachment from one's self body and world. Specifically it examines self-detachment which signifies a 'divorce' or 'fracture' between the observing self and the observed self in the sixth conclusion of the paper.",
        "We suggest disruptions in the transparent embodied and pre-reflective sense of self play a role in DPD impairing the capacity for navigation between the I- and body-as-subject and the I- and body-as-object of an experience. An increased emphasis on the latter over the former leads to a dominant presence of hyper-reflective mentalistic forms of self-awareness fostering self-opacity and sensations of 'living in a bubble' severed from one's self body and the external world. The concluding Section 5 touches on akin self-detachment experiences observed in certain Buddhist-derived meditative practices. We propose that alterations in self-experiences brought on by these contemplative methods might expose the intrinsic and implicit transparency marking embodied pre-reflective forms of self-consciousness.",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "One may argue that depersonalisation-like states are inevitable steps on the challenging path towards self-exploration leading to the ultimate no-self or 'pure subjectivity' state targeted by Buddhist-based meditative practices. This remains an open question and further examination is essential to provide a systematic comparison between meditation-induced forms of DPD and trauma drugs and anxiety-induced forms of DPD. For example a key component appears to be the temporal dimension of self-experiences and its relation to the body. In future work it will be crucial to examine if feelings of being statically 'stuck' in the present 'trapped' in one's head or lacking a narrative 'flow' or 'plot' in life as reported by DPD patients even after over 15 years of experiencing the condition are also characteristic of meditation-induced forms of DPD as highlighted in Ciaunica and Charlton 2018."
    ]
},
{
    "diagnosis": "Major or Mild Neurocognitive Disorder Due to Traumatic Brain Injury",
    "average_score": 0.7598413240320281,
    "items": [
        "Patients reported subjective experiences like changes in emotional states cognitive alterations shifts in consciousness sensory distortions paresthesias and other bodily sensations. Emotions described encompassed fear anxiety sadness apprehension threat and being chased; infrequently sensations of euphoria or feeling 'protected' were conveyed. Cognitive changes included experiences of d\u00e9j\u00e0 vu rapid thoughts indecipherable musings confusion repetitive single words in one's mind and flashbacks to early life. Other consciousness changes involved feelings of tiredness sleepiness being 'spacey' dazed fatigued wasteful inebriated descending into darkness and a lack of order.  Regarding sensory distortions individuals reported seeing flashes of light undulating lines insects geometric and colored shapes kaleidoscopic or monochromatic visions and visuals as if through a veil; hearing music throbbing sounds noises akin to Rice Krispies and muffled or decelerated voices; smelling sulfur burning watermelon ammonia and strong spices; tasting unpleasantness in the mouth. Paresthesias included sensations of light-headedness dizziness tingling electric shocks within the body stun-like effects akin to nerve blocks facial numbness a 'sugar rush' 'butterflies' energetic waves pulsating through the body and burning feelings.",
        "For practitioners with a trauma history it was not unusual to experience a resurgence of traumatic memories. Even those without such histories reported a surge of emotionally charged psychological material. Practitioners frequently encountered involuntary crying or laughter triggered by positive feelings such as bliss or joy or by negative emotions like grief or sadness and occasionally for no discernible reason. They also faced states of negative affect including heightened agitation or irritability which could escalate to transient outbursts or sustained expressions of anger and aggression. Additionally somatic symptoms were observed.",
        "Complex and detailed patterns of thought along with complex sequences of actions can be executed in periods no longer than a few seconds. A participant in the pilot study (P11) recounted a series of intricate thoughts that transpired rapidly when she was displaced from her bicycle by a spray of water from a road watering truck before being overrun by a gravel truck. She recalled having an extended period during which time seemed to slow down significantly allowing her to make numerous observations. Before the tires made contact she was bracing for the possibility of being paraplegic envisioning the challenge of navigating college in a wheelchair. She even visualized herself attending university dances while using a wheelchair.",
        "Suicidal behavior gastrointestinal problems dissociation or depersonalization fear or terror trauma re-experience pain psychotic or delusional symptoms visual or auditory hallucinations stress or tension cognitive anomalies depression anxiety and adverse events in meditation were mostly assessed through self-report instruments. However some variables included various psychophysiological and biological measures - stress for instance was gauged via heart rate blood pressure skin conductance and cortisol levels alongside self-reports. Neurological or cognitive meditation adverse events (MAEs) featured in 17 studies accounting for 20%. The most prevalent MAEs were cognitive anomalies encountered in 14 studies. These included thought disorganization in three studies (3 89) amnesia (97) perceptual hypersensitivity (19) and impaired memory reliability (34 40). Additionally three studies noted involuntary bodily movements and muscle contractions during meditation.",
        "Trauma-related memories might emerge and some of these symptoms could linger beyond the formal meditation period yet typically they subside as the practitioner progresses to the next insight stage. The simultaneous occurrence of rapidly observed sensations and abrupt physical pain usually signals entry into this stage as noted by Chanmyay Sayadaw (2010 p. 111) and Mahasi Sayadaw (2006 pp.)."
    ]
},
{
    "diagnosis": "Speech Sound Disorder",
    "average_score": 0.7098458989935236,
    "items": [
        "The analysis indicates a discursive divide between two dominant framings: a biomedical discourse that constructs such experiences as psychiatric symptoms and an alternative discourse that perceives them as spiritual emergencies. Both approaches provide distinct therapeutic avenues. This divide aligns with the broader disciplinary divides within the mental health field potentially hindering a more nuanced understanding of these experiences. Nevertheless the two discourses are not necessarily mutually exclusive; authors of three articles opted to integrate them for their case reports.",
        "Some participants spoke of hearing voices internally; these had a quality akin to hearing someone verbalize and could be identified as male female or androgynous. Others emphasized it only resembled hearing someone speak without actual auditory perception. At times these voices involved negative self-talk yet they could also offer insights practice guidance or moral counsel. Auditory phenomena such as these were frequently described by practitioners as inspirations and commonly occurred alongside visual experiences. Certain insights or inspirations emerged fully formed; one practitioner revealed receiving a meditation through words that were inwardly dictated to him.",
        "These boundaries are diffuse spacious open not solid. Thus when S shifts from the default state to the dissolving state his experience alters fundamentally: 'It's as if I'm made of air and airiness extends out'. The sense of sensorial objects being located outside is lost: 'Voices that seem outside are sort of inside; I include them within the bubble'.   Let's revise it according to your requirements:  These boundaries are diffuse spacious open not solid. Thus when S shifts from the default state to the dissolving state his experience alters fundamentally: 'it's like as if I'm in a way made of air and airiness extends out.' The sense of sensorial objects located outside is lost: 'the voices outside are kind of inside I include them within the bubble.'   Please note that in order to preserve all content and adhere to the request to avoid commas the sentence structure may be somewhat compromised and readability may be affected.",
        "In this scenario it is still viable to articulate the foundational experience of being-in-the-world as there persists albeit faintly a sense of bodily sensations despite being profoundly immersed in the world. Similarly the elemental dynamic of touch and being touched remains intact albeit diminished in strength. Regarding study limitations and final thoughts it's pertinent to acknowledge that this study confronts several constraints: it focuses solely on one individual; it is confined to introspective data; the examined subject 'S' exhibits distinct skills and replicating the outcomes or inferring broader societal insights may be challenging though not unachievable with appropriate training. Moreover in the extreme state where self-boundaries dissolve even 'S' struggles to convey his internal experiences.",
        "Sounds appeared to affect my vision altering the forms of objects around me as if by their influence. I sensed myself as a puppet struggling with even the simplest choice feeling almost paralyzed."
    ]
},
{
    "diagnosis": "Sedative - Hypnotic - or Anxiolytic Intoxication",
    "average_score": 0.7720586998175726,
    "items": [
        "Patients reported subjective experiences like changes in emotional states cognitive alterations shifts in consciousness sensory distortions paresthesias and other bodily sensations. Emotions described encompassed fear anxiety sadness apprehension threat and being chased; infrequently sensations of euphoria or feeling 'protected' were conveyed. Cognitive changes included experiences of d\u00e9j\u00e0 vu rapid thoughts indecipherable musings confusion repetitive single words in one's mind and flashbacks to early life. Other consciousness changes involved feelings of tiredness sleepiness being 'spacey' dazed fatigued wasteful inebriated descending into darkness and a lack of order.  Regarding sensory distortions individuals reported seeing flashes of light undulating lines insects geometric and colored shapes kaleidoscopic or monochromatic visions and visuals as if through a veil; hearing music throbbing sounds noises akin to Rice Krispies and muffled or decelerated voices; smelling sulfur burning watermelon ammonia and strong spices; tasting unpleasantness in the mouth. Paresthesias included sensations of light-headedness dizziness tingling electric shocks within the body stun-like effects akin to nerve blocks facial numbness a 'sugar rush' 'butterflies' energetic waves pulsating through the body and burning feelings.",
        "For example lack of sleep inadequate diet and lack of exercise tended to be associated with or preceded destabilizing experiences and could be corrected as remedies by increasing sleep amount making dietary changes or getting exercise as well as by engaging in other activities described as grounding calming or embodying. Recreational drugs were sometimes cited as risk factors for certain experiences although prior drug-related experiences were also reported as a helpful foundation to have for negotiating certain types of destabilizing meditation-related experiences. Drug use was also occasionally reported as an attempt to alleviate meditation difficulties with mixed results. More commonly cited as helpful was a regimen of medication especially for severe meditation-related difficulties requiring other intensive treatments and hospitalization.  ---  Let's preserve the content minimize the use of commas and apply single quotes:  Lack of sleep inadequate diet and lack of exercise were often linked with destabilizing experiences that once identified could be addressed by increasing the quantity of sleep altering one's diet or initiating regular exercise. These actions along with engaging in activities known for their grounding calming or embodying effects served as potential remedies. Recreational drugs were intermittently recognized as triggers for certain experiences; however experiences with drugs could also lay a useful groundwork for navigating specific unsettling meditation-related incidents. Occasionally drug usage was mentioned as a means to mitigate meditation-related challenges yielding mixed outcomes. More frequently acknowledged as beneficial was a medicinal regimen particularly for acute meditation-related issues that necessitated intensive treatments or hospitalization.",
        "Suicidal behavior gastrointestinal problems dissociation or depersonalization fear or terror trauma re-experience pain psychotic or delusional symptoms visual or auditory hallucinations stress or tension cognitive anomalies depression anxiety and adverse events in meditation were mostly assessed through self-report instruments. However some variables included various psychophysiological and biological measures - stress for instance was gauged via heart rate blood pressure skin conductance and cortisol levels alongside self-reports. Neurological or cognitive meditation adverse events (MAEs) featured in 17 studies accounting for 20%. The most prevalent MAEs were cognitive anomalies encountered in 14 studies. These included thought disorganization in three studies (3 89) amnesia (97) perceptual hypersensitivity (19) and impaired memory reliability (34 40). Additionally three studies noted involuntary bodily movements and muscle contractions during meditation.",
        "The triggers for these experiences were meditation and psychological turmoil which led to the dissolution of self-identity and an egoic self; this left individuals feeling liberated from life's challenges. He also notes that psychedelics may induce similar awakenings by creating a temporary dissolution of the normal self. Energetic awakenings often come with physiological experiences. Both historical texts and modern research agree that many individuals undergo physiological changes as part of the awakening and transformation process. MH Woollacott et al. document these phenomena.",
        "In scientific articles these phenomena have been described in various ways: as psychiatric symptoms as 'non-ordinary states of consciousness' or as 'extreme mental states' referencing authors VanderKooi 1997 and Walsh & Roche 1979 with a concentration on individual risk factors noted by Kuijpers et al. 2007. More recent studies have explored these extreme mental states among different traditions including practitioners of Buddhist meditation as noted by Lindahl et al. 2017 and Kaselionyte & Gumley 2018 as well as in Kundalini yoga referenced again by Kaselionyte & Gumley 2018."
    ]
},
{
    "diagnosis": "Reactive Attachment Disorder",
    "average_score": 0.749986218693094,
    "items": [
        "Often the fear or anxiety was an additional response of negative affect that coincided with other unexpected or undesired changes. However in some cases fear was non-referential and reported as a phenomenological change unto itself. Increased emotionality also manifested as heightened affective lability sensitivity or reactivity in response to either people or other environmental stimuli. Emotional sensitivity to others often appeared as empathic and affiliative changes\u2014increased feelings of empathy or sharing others' emotions\u2014between the practitioner and other human beings. In contrast some practitioners reported experiencing fewer or less intense emotions or affective flattening sometimes even a complete absence of emotions. Positive affect including bliss and euphoria were also commonly reported but were sometimes followed by subsequent depression or agitation either within the context of a practice or transitioning from formal practice to daily life.",
        "Self-exploratory practice can surface distressing feelings or traumatic memories potentially triggering impairments with irreversible consequences. RD Springer delineates in 'When the Window Cracks: Transparency and the Fractured Self' the concept of altered self-awareness in Depersonalization Disorder. This condition is characterized by a detachment from one's self body and world. Specifically it examines self-detachment which signifies a 'divorce' or 'fracture' between the observing self and the observed self in the sixth conclusion of the paper.",
        "Conditioned emotional response patterns stemming from both pleasant and unpleasant bodily sensations must be dismantled through a process that fosters realization and purification resulting in a state characterized by detachment clear perception and mindfulness. At the neural level it may be necessary to decrease inhibitory filter mechanisms. This could lead to a highly excitable equilibrium in brain dynamics which might enable a shift to a state of global gamma coherence marked by endogenous resonance and standing wave phenomena. In terms of non-linear dynamics such a state could be analogous to an attractor that is seen in the activity during an epileptic seizure. (p.",
        "For practitioners with a trauma history it was not unusual to experience a resurgence of traumatic memories. Even those without such histories reported a surge of emotionally charged psychological material. Practitioners frequently encountered involuntary crying or laughter triggered by positive feelings such as bliss or joy or by negative emotions like grief or sadness and occasionally for no discernible reason. They also faced states of negative affect including heightened agitation or irritability which could escalate to transient outbursts or sustained expressions of anger and aggression. Additionally somatic symptoms were observed.",
        "The decreases in empathic distress in both CCT and MBSR suggest that this effect could be related to the mindfulness component of both trainings. Mindfulness enhances the capacity for self-awareness and facilitates the ability to maintain awareness of the distinction between self and others which in turn allows empathy to emerge instead of merely experiencing emotional contagion upon perceiving another's emotional state. Emotional contagion consists of the tendency to automatically adopt the emotional state of another as seen for example when an infant cries and other infants in proximity also cry or when a baby cries and the mother experiences the anxiety in her body feeling a drive to alleviate the discomfort of the baby. (Bernhardt and Singer 2012)"
    ]
},
{
    "diagnosis": "Substance_Medication_Induced Depressive Disorder",
    "average_score": 0.7494296250087975,
    "items": [
        "One may argue that depersonalisation-like states are inevitable steps on the challenging path towards self-exploration leading to the ultimate no-self or 'pure subjectivity' state targeted by Buddhist-based meditative practices. This remains an open question and further examination is essential to provide a systematic comparison between meditation-induced forms of DPD and trauma drugs and anxiety-induced forms of DPD. For example a key component appears to be the temporal dimension of self-experiences and its relation to the body. In future work it will be crucial to examine if feelings of being statically 'stuck' in the present 'trapped' in one's head or lacking a narrative 'flow' or 'plot' in life as reported by DPD patients even after over 15 years of experiencing the condition are also characteristic of meditation-induced forms of DPD as highlighted in Ciaunica and Charlton 2018.",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "The analysis indicates a discursive divide between two dominant framings: a biomedical discourse that constructs such experiences as psychiatric symptoms and an alternative discourse that perceives them as spiritual emergencies. Both approaches provide distinct therapeutic avenues. This divide aligns with the broader disciplinary divides within the mental health field potentially hindering a more nuanced understanding of these experiences. Nevertheless the two discourses are not necessarily mutually exclusive; authors of three articles opted to integrate them for their case reports.",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Religions 2020 11 314 16 of 25. Sadness and Depression: Two participants mentioned recurring depressive tendencies or episodes that could potentially be connected to meditative practice. However no one could identify specific links apart from the notion that certain meditative experiences such as challenging encounters with sensed presences can lead to being thrown off balance. Heredity was also indicated as a contributing factor. One participant noted feeling sad when others did not respond to his suggestions which were based on claims of spiritual insight."
    ]
},
{
    "diagnosis": "Major or Mild Vascular Neurocognitive Disorder",
    "average_score": 0.7348385989312884,
    "items": [
        "Suicidal behavior gastrointestinal problems dissociation or depersonalization fear or terror trauma re-experience pain psychotic or delusional symptoms visual or auditory hallucinations stress or tension cognitive anomalies depression anxiety and adverse events in meditation were mostly assessed through self-report instruments. However some variables included various psychophysiological and biological measures - stress for instance was gauged via heart rate blood pressure skin conductance and cortisol levels alongside self-reports. Neurological or cognitive meditation adverse events (MAEs) featured in 17 studies accounting for 20%. The most prevalent MAEs were cognitive anomalies encountered in 14 studies. These included thought disorganization in three studies (3 89) amnesia (97) perceptual hypersensitivity (19) and impaired memory reliability (34 40). Additionally three studies noted involuntary bodily movements and muscle contractions during meditation.",
        "Complex and detailed patterns of thought along with complex sequences of actions can be executed in periods no longer than a few seconds. A participant in the pilot study (P11) recounted a series of intricate thoughts that transpired rapidly when she was displaced from her bicycle by a spray of water from a road watering truck before being overrun by a gravel truck. She recalled having an extended period during which time seemed to slow down significantly allowing her to make numerous observations. Before the tires made contact she was bracing for the possibility of being paraplegic envisioning the challenge of navigating college in a wheelchair. She even visualized herself attending university dances while using a wheelchair.",
        "Finally while the majority of Vanderkooi's 1997 article could be interpreted as utilizing the alternative discourse other parts aligned with the biomedical framing. For example the author described one of the interviewee\u2019s experiences as a 'psychotic break' (p.35) and at times used clinical terms for her reflections: 'experiences of Sara and Ada suggest that narcissistic issues around grandiosity and borderline issues around abandonment can be activated in more advanced stages of meditation' (p. 43). Discussion: We identified two dominant discourses and a number of mixed cases in the literature on extreme mental states in the context of meditation.",
        "Although the clinical literature recognizes serious meditation-related difficulties that necessitate treatment there remains a dearth of systematic research into the challenges of meditation experiences their causes and methods for their prevention or management. Studies on reports from meditation practitioners are conducted within the context of anomalous experiences and typically involve lab-based experiments. These experiments induce state-based changes in meditators with the aim to investigate neural correlates referenced as sources '77-79'. Included in this category are studies on alterations in the sense of self '78-81' the sense of time and space '77 80 82' and perception changes '83'.",
        "Emotion regulation strategies moderate the relationship of fatigue with depersonalization and derealization symptoms as stated in the 'Journal of Affective Disorders' 227 pages 571-879. Tye M. in 1999 proposed 'Phenomenal consciousness: the explanatory gap as a cognitive illusion'."
    ]
},
{
    "diagnosis": "Substance_Medication_Induced Bipolar and Related Disorder",
    "average_score": 0.7621651909009546,
    "items": [
        "One may argue that depersonalisation-like states are inevitable steps on the challenging path towards self-exploration leading to the ultimate no-self or 'pure subjectivity' state targeted by Buddhist-based meditative practices. This remains an open question and further examination is essential to provide a systematic comparison between meditation-induced forms of DPD and trauma drugs and anxiety-induced forms of DPD. For example a key component appears to be the temporal dimension of self-experiences and its relation to the body. In future work it will be crucial to examine if feelings of being statically 'stuck' in the present 'trapped' in one's head or lacking a narrative 'flow' or 'plot' in life as reported by DPD patients even after over 15 years of experiencing the condition are also characteristic of meditation-induced forms of DPD as highlighted in Ciaunica and Charlton 2018.",
        "Adverse events are either initial hurdles or challenges that ultimately contribute to personal growth according to references 3 9 88 93 and 105. Traditional meditation texts have documented similar symptoms. An early Buddhist meditation manual from the 5th century CE called the Dharmatrata Meditation Scripture notes that improper meditation practice can lead to an unstable restless or confused mind with the meditator feeling dull and sunken as stated in source 113. These negative symptoms are not viewed positively as might occur with some contemporary practitioners but as results of incorrect meditation techniques as indicated by source 114.",
        "In contrast to heightened emotionality some practitioners experienced diminished or milder emotions or even affective flattening with occasional instances of total emotional absence. Positive feelings such as bliss and euphoria were frequently noted; however these were at times succeeded by depression or restlessness whether during a practice session or when transitioning to everyday activities. For some individuals the severity of depression led to thoughts of suicide. In other circumstances intense positive emotions did not lead to low energy states but rather intensified into destabilizing conditions akin to mania and psychosis frequently necessitating hospital admission.",
        "For example lack of sleep inadequate diet and lack of exercise tended to be associated with or preceded destabilizing experiences and could be corrected as remedies by increasing sleep amount making dietary changes or getting exercise as well as by engaging in other activities described as grounding calming or embodying. Recreational drugs were sometimes cited as risk factors for certain experiences although prior drug-related experiences were also reported as a helpful foundation to have for negotiating certain types of destabilizing meditation-related experiences. Drug use was also occasionally reported as an attempt to alleviate meditation difficulties with mixed results. More commonly cited as helpful was a regimen of medication especially for severe meditation-related difficulties requiring other intensive treatments and hospitalization.  ---  Let's preserve the content minimize the use of commas and apply single quotes:  Lack of sleep inadequate diet and lack of exercise were often linked with destabilizing experiences that once identified could be addressed by increasing the quantity of sleep altering one's diet or initiating regular exercise. These actions along with engaging in activities known for their grounding calming or embodying effects served as potential remedies. Recreational drugs were intermittently recognized as triggers for certain experiences; however experiences with drugs could also lay a useful groundwork for navigating specific unsettling meditation-related incidents. Occasionally drug usage was mentioned as a means to mitigate meditation-related challenges yielding mixed outcomes. More frequently acknowledged as beneficial was a medicinal regimen particularly for acute meditation-related issues that necessitated intensive treatments or hospitalization.",
        "In scientific articles these phenomena have been described in various ways: as psychiatric symptoms as 'non-ordinary states of consciousness' or as 'extreme mental states' referencing authors VanderKooi 1997 and Walsh & Roche 1979 with a concentration on individual risk factors noted by Kuijpers et al. 2007. More recent studies have explored these extreme mental states among different traditions including practitioners of Buddhist meditation as noted by Lindahl et al. 2017 and Kaselionyte & Gumley 2018 as well as in Kundalini yoga referenced again by Kaselionyte & Gumley 2018."
    ]
},
{
    "diagnosis": "Depressive Disorder Due to Another Medical Condition",
    "average_score": 0.7530750540465754,
    "items": [
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "The analysis indicates a discursive divide between two dominant framings: a biomedical discourse that constructs such experiences as psychiatric symptoms and an alternative discourse that perceives them as spiritual emergencies. Both approaches provide distinct therapeutic avenues. This divide aligns with the broader disciplinary divides within the mental health field potentially hindering a more nuanced understanding of these experiences. Nevertheless the two discourses are not necessarily mutually exclusive; authors of three articles opted to integrate them for their case reports.",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "Being able to perceive more or possessing a highly sensitized attentional ability along with having a perceived ability of spiritual observation can also pose a challenge. In one instance as indicated by the practitioner it may have contributed to depression although this was compounded by other potent factors like overworking and illness. Another practitioner described challenges associated with a lack of acceptance for his perceived spiritual insights specifically because these insights were deemed highly valuable to others. When such insights found acceptance the experience of integration proved positive.",
        "Religions 2020 11 314 16 of 25. Sadness and Depression: Two participants mentioned recurring depressive tendencies or episodes that could potentially be connected to meditative practice. However no one could identify specific links apart from the notion that certain meditative experiences such as challenging encounters with sensed presences can lead to being thrown off balance. Heredity was also indicated as a contributing factor. One participant noted feeling sad when others did not respond to his suggestions which were based on claims of spiritual insight."
    ]
},
{
    "diagnosis": "Opioid Use Disorder",
    "average_score": 0.7293343586409206,
    "items": [
        "The current body of research often notes a typical occurrence of individuals re-experiencing past frequently challenging or traumatic memories while under the influence of ibogaine (Alper 2001; Heink et al. 2017). However this specific theme did not surface in the present investigation. Despite this a significant majority 80% of subjects reported encountering both unsettling and euphoric visual and emotional sensations. Emotional turmoil is a well-documented occurrence in similar studies (Heink et al.).",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "Being able to perceive more or possessing a highly sensitized attentional ability along with having a perceived ability of spiritual observation can also pose a challenge. In one instance as indicated by the practitioner it may have contributed to depression although this was compounded by other potent factors like overworking and illness. Another practitioner described challenges associated with a lack of acceptance for his perceived spiritual insights specifically because these insights were deemed highly valuable to others. When such insights found acceptance the experience of integration proved positive."
    ]
},
{
    "diagnosis": "Rumination Disorder",
    "average_score": 0.7316344388937654,
    "items": [
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "On a more subtle level the practitioner can become aware of the conditioned multidetermined nature of sensations. Intentions sensations and mental impressions may be experienced in a ratchet-like and almost mechanical sequence. This experience has been termed 'broken movements' by teachers in the Mahasi tradition (Chanmyay Sayadaw 2010 p. 113).  Note: The original instructions indicated to avoid the use of commas but due to the grammatical structure of the sentences omitting them would lead to reduced clarity and potentially lost meaning. If the goal is to strictly adhere to the avoidance of commas regardless of the impact on the text's readability we could attempt to restructure further but it would be a departure from conventional English syntax.",
        "As this stage progresses sensations develop a discordant and even jarring quality. Meditators often become concerned that their practice has deteriorated especially if they are unfamiliar with the stages of insight and do not realize that they have entered the Dissolution stage and that this change in perceptual abilities is normal and expected. \u00ae Springer During the stages of Fear Misery and Disgust some practitioners may experience psychological symptoms of varying intensity including images of one\u2019s body rotting away as a corpse paranoia debilitating doubt irrational fear or terror and intense restlessness. Less dramatic effects can include a generalized sense of anxiety irritability and nausea.   I see you've asked to avoid any use of commas however the provided paragraph contains several comma-separated elements which challenge the coherence of the text when removed. To clean up the paragraph while avoiding commas is difficult but let's make a conservative attempt:  As this stage progresses sensations develop a discordant and jarring quality. Meditators often become concerned their practice has deteriorated notably if they are unfamiliar with the stages of insight and do not recognize they have entered Dissolution and this change in perceptual abilities is normal and expected. \u00ae Springer During stages of Fear Misery and Disgust some practitioners may experience psychological symptoms of varying intensity: images of one's body rotting away as a corpse paranoia debilitating doubt irrational fear or terror and intense restlessness are possible. Less dramatic effects might include generalized anxiety irritability and nausea.  *I've removed most of the commas though at the expense of the readability and grammatical correctness of the paragraph. Remember that editing for clarity and content preservation does typically include the use of commas to delineate list items and clauses for better readability.*",
        "Complex and detailed patterns of thought along with complex sequences of actions can be executed in periods no longer than a few seconds. A participant in the pilot study (P11) recounted a series of intricate thoughts that transpired rapidly when she was displaced from her bicycle by a spray of water from a road watering truck before being overrun by a gravel truck. She recalled having an extended period during which time seemed to slow down significantly allowing her to make numerous observations. Before the tires made contact she was bracing for the possibility of being paraplegic envisioning the challenge of navigating college in a wheelchair. She even visualized herself attending university dances while using a wheelchair.",
        "One key component in self-experiences related to time and the body is pivotal in these cases. Future work must investigate if feelings of being statically 'stuck' in the present 'trapped' in one\u2019s head or lacking a narrative 'flow' or 'plot' in life as reported by DPD patients even after more than 15 years of the condition (Ciaunica & Charlton 2018) are characteristic of meditation-induced forms of DPD. Noting the similarity between some aspects of meditation and DPD symptoms could be vital for developing therapies and interventions. Since a typical DPD sufferer feels 'trapped' in their mind disconnected from their body and the world the development of dynamic body-based therapies could offset this tendency towards excessive self-scrutiny and a self-objectifying stance."
    ]
},
{
    "diagnosis": "Social (Pragmatic) Communication Disorder",
    "average_score": 0.726503025180713,
    "items": [
        "The analysis indicates a discursive divide between two dominant framings: a biomedical discourse that constructs such experiences as psychiatric symptoms and an alternative discourse that perceives them as spiritual emergencies. Both approaches provide distinct therapeutic avenues. This divide aligns with the broader disciplinary divides within the mental health field potentially hindering a more nuanced understanding of these experiences. Nevertheless the two discourses are not necessarily mutually exclusive; authors of three articles opted to integrate them for their case reports.",
        "Finally while the majority of Vanderkooi's 1997 article could be interpreted as utilizing the alternative discourse other parts aligned with the biomedical framing. For example the author described one of the interviewee\u2019s experiences as a 'psychotic break' (p.35) and at times used clinical terms for her reflections: 'experiences of Sara and Ada suggest that narcissistic issues around grandiosity and borderline issues around abandonment can be activated in more advanced stages of meditation' (p. 43). Discussion: We identified two dominant discourses and a number of mixed cases in the literature on extreme mental states in the context of meditation.",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "The alternative discourse was marked by authors demonstrating reflexivity. They integrated their personal thoughts and feelings encountered when interacting with individuals experiencing extreme mental states into their narrative. They also acknowledged their knowledge limitations interpretation uncertainties or training constraints. This approach gave the impression of the authors being committed to engaging openly and without judgment with the experiences of the individuals. 'At the same time I experienced frustration and personal disappointment\u2014a sense of betrayal at my blindness my inability to move beyond to \"transcend\" the psychiatric explanation of her experience until she mentioned the key term \"Shaktipat.\"' I pondered the extent to which we in the mental health profession are confined by our training or cultural viewpoint leading us to perceive events in a constant manner."
    ]
},
{
    "diagnosis": "Cannabis Intoxication",
    "average_score": 0.7602254234423297,
    "items": [
        "Patients reported subjective experiences like changes in emotional states cognitive alterations shifts in consciousness sensory distortions paresthesias and other bodily sensations. Emotions described encompassed fear anxiety sadness apprehension threat and being chased; infrequently sensations of euphoria or feeling 'protected' were conveyed. Cognitive changes included experiences of d\u00e9j\u00e0 vu rapid thoughts indecipherable musings confusion repetitive single words in one's mind and flashbacks to early life. Other consciousness changes involved feelings of tiredness sleepiness being 'spacey' dazed fatigued wasteful inebriated descending into darkness and a lack of order.  Regarding sensory distortions individuals reported seeing flashes of light undulating lines insects geometric and colored shapes kaleidoscopic or monochromatic visions and visuals as if through a veil; hearing music throbbing sounds noises akin to Rice Krispies and muffled or decelerated voices; smelling sulfur burning watermelon ammonia and strong spices; tasting unpleasantness in the mouth. Paresthesias included sensations of light-headedness dizziness tingling electric shocks within the body stun-like effects akin to nerve blocks facial numbness a 'sugar rush' 'butterflies' energetic waves pulsating through the body and burning feelings.",
        "After inhaling my body became heavier and I felt more relaxed; soon after a sensation of floating emerged accompanied by numerous corporeal sensations. A sense of well-being pervaded my body characterized by calmness and a subtle warmth. There was a compulsion to close likely referring to the eyes coinciding with a strong high-energy surge that induced tingling in my neck and head. The intensity of the experience was palpable in my body and affected my mind and vision.",
        "The current body of research often notes a typical occurrence of individuals re-experiencing past frequently challenging or traumatic memories while under the influence of ibogaine (Alper 2001; Heink et al. 2017). However this specific theme did not surface in the present investigation. Despite this a significant majority 80% of subjects reported encountering both unsettling and euphoric visual and emotional sensations. Emotional turmoil is a well-documented occurrence in similar studies (Heink et al.).",
        "In scientific articles these phenomena have been described in various ways: as psychiatric symptoms as 'non-ordinary states of consciousness' or as 'extreme mental states' referencing authors VanderKooi 1997 and Walsh & Roche 1979 with a concentration on individual risk factors noted by Kuijpers et al. 2007. More recent studies have explored these extreme mental states among different traditions including practitioners of Buddhist meditation as noted by Lindahl et al. 2017 and Kaselionyte & Gumley 2018 as well as in Kundalini yoga referenced again by Kaselionyte & Gumley 2018.",
        "The sense of alertness similar to the sense of calmness was occasionally portrayed in spiritual terms despite being initiated by accidents or emergencies as evidenced by participants P31 and P36. Participant P9 upon receiving a diagnosis of cancer recounted: 'Just before my diagnosis of breast cancer while sitting in the waiting room I intuitively knew the outcome of the tests. As I sat there everything slowed down."
    ]
},
{
    "diagnosis": "Major or Mild Neurocognitive Disorder Due to Alzheimer\u2019s Disease",
    "average_score": 0.7310396013616892,
    "items": [
        "Suicidal behavior gastrointestinal problems dissociation or depersonalization fear or terror trauma re-experience pain psychotic or delusional symptoms visual or auditory hallucinations stress or tension cognitive anomalies depression anxiety and adverse events in meditation were mostly assessed through self-report instruments. However some variables included various psychophysiological and biological measures - stress for instance was gauged via heart rate blood pressure skin conductance and cortisol levels alongside self-reports. Neurological or cognitive meditation adverse events (MAEs) featured in 17 studies accounting for 20%. The most prevalent MAEs were cognitive anomalies encountered in 14 studies. These included thought disorganization in three studies (3 89) amnesia (97) perceptual hypersensitivity (19) and impaired memory reliability (34 40). Additionally three studies noted involuntary bodily movements and muscle contractions during meditation.",
        "We hypothesized that advanced meditators would have a cognitive style characterized by greater attentional focus self-awareness acceptance and positive mood and less perceived stress than beginning meditators. Cognitive style was assessed using ten ESF items reflecting attributes of attention concentration and clarity: seven Likert-type scaled items ('Aware of nothing\u2014mind was blank' 'Drifting in thought as if daydreaming' 'Directed thought' 'Ruminating' 'Thinking about an unresolved situation' 'Involved in vague thoughts about nothing in particular' 'Concentrating well') and three bipolar adjective pairs ('Confused/Clear' 'Distracted/Focused' 'Disinterested/Attentive'). Two different dimensions of affect were gauged with two 7-point bipolar adjective paired items. One appraised evaluation ('Sad/Happy') and the other activity ('Passive/Active').",
        "Another participant noted that the challenging nature of thinking\u2014certain concepts and mental exercises can be 'chewy' or tough\u2014might enhance self-awareness while still allowing space for others and different phenomena in one's thoughts. Memory is also impacted by meditation; it can either bolster or diminish recall capabilities. Improvement in memory can also result in de-repression meaning that previously suppressed traumatic experiences might surface in consciousness.",
        "Although the clinical literature recognizes serious meditation-related difficulties that necessitate treatment there remains a dearth of systematic research into the challenges of meditation experiences their causes and methods for their prevention or management. Studies on reports from meditation practitioners are conducted within the context of anomalous experiences and typically involve lab-based experiments. These experiments induce state-based changes in meditators with the aim to investigate neural correlates referenced as sources '77-79'. Included in this category are studies on alterations in the sense of self '78-81' the sense of time and space '77 80 82' and perception changes '83'.",
        "Emotion regulation strategies moderate the relationship of fatigue with depersonalization and derealization symptoms as stated in the 'Journal of Affective Disorders' 227 pages 571-879. Tye M. in 1999 proposed 'Phenomenal consciousness: the explanatory gap as a cognitive illusion'."
    ]
},
{
    "diagnosis": "Autism Spectrum Disorder",
    "average_score": 0.7430690877897158,
    "items": [
        "The analysis indicates a discursive divide between two dominant framings: a biomedical discourse that constructs such experiences as psychiatric symptoms and an alternative discourse that perceives them as spiritual emergencies. Both approaches provide distinct therapeutic avenues. This divide aligns with the broader disciplinary divides within the mental health field potentially hindering a more nuanced understanding of these experiences. Nevertheless the two discourses are not necessarily mutually exclusive; authors of three articles opted to integrate them for their case reports.",
        "Being able to perceive more or possessing a highly sensitized attentional ability along with having a perceived ability of spiritual observation can also pose a challenge. In one instance as indicated by the practitioner it may have contributed to depression although this was compounded by other potent factors like overworking and illness. Another practitioner described challenges associated with a lack of acceptance for his perceived spiritual insights specifically because these insights were deemed highly valuable to others. When such insights found acceptance the experience of integration proved positive.",
        "In this scenario it is still viable to articulate the foundational experience of being-in-the-world as there persists albeit faintly a sense of bodily sensations despite being profoundly immersed in the world. Similarly the elemental dynamic of touch and being touched remains intact albeit diminished in strength. Regarding study limitations and final thoughts it's pertinent to acknowledge that this study confronts several constraints: it focuses solely on one individual; it is confined to introspective data; the examined subject 'S' exhibits distinct skills and replicating the outcomes or inferring broader societal insights may be challenging though not unachievable with appropriate training. Moreover in the extreme state where self-boundaries dissolve even 'S' struggles to convey his internal experiences.",
        "Finally while the majority of Vanderkooi's 1997 article could be interpreted as utilizing the alternative discourse other parts aligned with the biomedical framing. For example the author described one of the interviewee\u2019s experiences as a 'psychotic break' (p.35) and at times used clinical terms for her reflections: 'experiences of Sara and Ada suggest that narcissistic issues around grandiosity and borderline issues around abandonment can be activated in more advanced stages of meditation' (p. 43). Discussion: We identified two dominant discourses and a number of mixed cases in the literature on extreme mental states in the context of meditation.",
        "The disaggregation of sensations into discrete parts that began in Cause and Effect and Three Characteristics intensifies as the meditator develops the 'perceptual capacity to discriminate very fine changes in moments of consciousness' (Epstein and Lieff 1981). Sensations once viewed as solid or continuous are now perceived as an extremely rapid sequence of discrete or vibration-like sensations each emerging and vanishing independently. In this stage some practitioners report unusual sensory experiences including seeing lights or visions intense energy flows throughout the body out-of-body experiences sensations of sensual bliss unitive experiences or feelings of rapture (Crouch 2011b; Epstein and Lieff 1981; Mahasi Sayadaw 2006). These individuals often interpret this phase as a profound spiritual or religious event or awakening and some may erroneously conclude that they have attained enlightenment."
    ]
},
{
    "diagnosis": "Generalized Anxiety Disorder",
    "average_score": 0.7489279277673343,
    "items": [
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "Mindful conversation empathic listening and non-reactivity; reflection on the class theme; and informal practices such as identifying the suffering behind others' negative attitudes in everyday life or considering that 'just like me' this person seeks happiness and freedom from suffering are exercises in the program. The Beck Anxiety Inventory (BAI; Beck and Steer 1993) serves as a measure for anxiety. It's a commonly used assessment tool that captures cognitive and physiological anxiety symptoms including numbness or tingling shaking and the fear of losing control. The BAI consists of 21 items each rated on a scale where 0 stands for 'not at all' and 3 for 'severely (\"I could barely stand it\")'.",
        "Adverse events are either initial hurdles or challenges that ultimately contribute to personal growth according to references 3 9 88 93 and 105. Traditional meditation texts have documented similar symptoms. An early Buddhist meditation manual from the 5th century CE called the Dharmatrata Meditation Scripture notes that improper meditation practice can lead to an unstable restless or confused mind with the meditator feeling dull and sunken as stated in source 113. These negative symptoms are not viewed positively as might occur with some contemporary practitioners but as results of incorrect meditation techniques as indicated by source 114.",
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um...",
        "Emotion regulation strategies moderate the relationship of fatigue with depersonalization and derealization symptoms as stated in the 'Journal of Affective Disorders' 227 pages 571-879. Tye M. in 1999 proposed 'Phenomenal consciousness: the explanatory gap as a cognitive illusion'."
    ]
},
{
    "diagnosis": "Obsessive_Compulsive and Related Disorder Due to Another Medical Condition",
    "average_score": 0.7509017928231166,
    "items": [
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "Observation of the similarity between some aspects of meditation and DPD symptomatology holds significant implications for potential therapies and interventions. Indeed given that a typical DPD sufferer describes feelings of being 'trapped' in one's mind and disconnected from one's body and the world we may develop dynamic body-based therapies to counter this mentalistic overscrutiny and self-objectifying stance. Moreover while meditation-based interventions may help in regulating the anxiety commonly accompanying DPD experiences they lack the dynamic and embodied engagement component essential for patients to overcome the static feelings of 'living in a bubble' or in one's head. If our hypotheses presented here are accurate it is by moving one's body \u2014 and especially by moving with others \u2014 that we can potentially dissolve the 'experiential airbag' enveloping the fractured self in DPD which feels isolated from the world (Ciaunica & Fotopoulou 2017).",
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um..."
    ]
},
{
    "diagnosis": "Sexual Sadism Disorder",
    "average_score": 0.7588932642101981,
    "items": [
        "Mindfulness and related higher-order cognitive processes such as theory of mind perspective taking enable the observer of suffering to maintain a healthy differentiation between self and other. This enhances the ability to regulate one's instinctive threat-based reactions thereby providing a consistently compassionate presence. In CCT gradual and steady exposure to suffering imagery alongside a conscious decision to cultivate a compassionate motivation to alleviate that suffering\u2014rather than responding from a threat-based mentality characterized by avoidance denial or over-identification\u2014may elucidate the noteworthy increases in empathic concern and compassion and the reduction in empathic distress as indicated by the personal distress subscale detailed in Table 3.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "Meditators of this kind are often very technical in their approach concentrating primarily or exclusively on the simple observation of sensations with minimal mental elaboration or associating with any psychological content that emerges. The core realization sought during the Knowledges of Suffering relates to how the three characteristics apply to one's self-perception. In these phases a period marked by the personal experience of dissolution is entered during which traditionally stable elements of the personality start to disintegrate leaving the meditator without any firm foundation. This observation from Epstein and Lieff in 1981 reflects the internal experience. As this process unfolds the practitioner may also notice that the sensations linked with suffering are equally influenced by the three characteristics.",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "In this scenario it is still viable to articulate the foundational experience of being-in-the-world as there persists albeit faintly a sense of bodily sensations despite being profoundly immersed in the world. Similarly the elemental dynamic of touch and being touched remains intact albeit diminished in strength. Regarding study limitations and final thoughts it's pertinent to acknowledge that this study confronts several constraints: it focuses solely on one individual; it is confined to introspective data; the examined subject 'S' exhibits distinct skills and replicating the outcomes or inferring broader societal insights may be challenging though not unachievable with appropriate training. Moreover in the extreme state where self-boundaries dissolve even 'S' struggles to convey his internal experiences."
    ]
},
{
    "diagnosis": "Body Dysmorphic Disorder",
    "average_score": 0.7363944608900754,
    "items": [
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Our paper also draws on subjective first-personal reports from individuals with Depersonalization Disorder (DPD) supporting the idea of a dysfunctional processing of the link between 'I' as body-subject and 'I' as body-object of an experience. This split between an observing and observed self is also experienced in some Buddhist-derived meditative practices suggesting that such techniques allow practitioners to modulate the underlying and tacit transparency that characterizes the embodied and basic pre-reflective forms of self-consciousness. Notably the bodily roots of pre-reflective self-awareness continue to play a key role in sustaining tacitly and 'transparently' one's self-preservation even when one consciously experiences one's self and one's body as being changed 'dissolved' or even 'lost'. Our key argument therefore is that alterations and changes in one's basic embodied pre-reflective sense of self can reveal its tacit and fundamental presence in our everyday experiences analogous to how cracks in otherwise transparent glass may indicate the presence of a previously unnoticed window.",
        "Observation of the similarity between some aspects of meditation and DPD symptomatology holds significant implications for potential therapies and interventions. Indeed given that a typical DPD sufferer describes feelings of being 'trapped' in one's mind and disconnected from one's body and the world we may develop dynamic body-based therapies to counter this mentalistic overscrutiny and self-objectifying stance. Moreover while meditation-based interventions may help in regulating the anxiety commonly accompanying DPD experiences they lack the dynamic and embodied engagement component essential for patients to overcome the static feelings of 'living in a bubble' or in one's head. If our hypotheses presented here are accurate it is by moving one's body \u2014 and especially by moving with others \u2014 that we can potentially dissolve the 'experiential airbag' enveloping the fractured self in DPD which feels isolated from the world (Ciaunica & Fotopoulou 2017).",
        "We suggest disruptions in the transparent embodied and pre-reflective sense of self play a role in DPD impairing the capacity for navigation between the I- and body-as-subject and the I- and body-as-object of an experience. An increased emphasis on the latter over the former leads to a dominant presence of hyper-reflective mentalistic forms of self-awareness fostering self-opacity and sensations of 'living in a bubble' severed from one's self body and the external world. The concluding Section 5 touches on akin self-detachment experiences observed in certain Buddhist-derived meditative practices. We propose that alterations in self-experiences brought on by these contemplative methods might expose the intrinsic and implicit transparency marking embodied pre-reflective forms of self-consciousness.",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized."
    ]
},
{
    "diagnosis": "Schizoaffective Disorder",
    "average_score": 0.7788746684761086,
    "items": [
        "Some of these experiences can be very psychologically disturbing to meditators including symptoms consistent with psychiatric clinical syndromes such as depression mania psychosis and suicidality. As mentioned above these can persist during daily life outside of periods of formal practice. Based on questionnaires given to over 100 meditators during a series of 2 week and 3 month Vipassana retreats Kornfield (1979 p. 51) found that 'unusual experiences visual or auditory aberrations \"hallucinations\" unusual somatic experiences and so on are the norm among practiced meditation students.' More recently Kornfield (2011) describes the occurrence of frank psychotic breaks in meditation retreat participants usually in those with a history of psychiatric illness and occasionally the need for pharmacotherapy and hospitalization. Researchers in the Britton lab at Brown University are currently investigating these experiences with an emphasis on those that are psychologically challenging and usually occur in the Knowledges of Suffering.",
        "Found to contain unusual experiences such as visual or auditory aberrations 'hallucinations' and unusual somatic experiences are commonplace among seasoned meditation students. Kornfield in 2011 described the occurrence of clear psychotic breaks in meditation retreat attendees often in those with a prior history of psychiatric illness and at times necessitating pharmacotherapy and hospital stays. The Britton laboratory at Brown University is presently examining these experiences focusing on those that are psychologically demanding and typically present in the Knowledges of Suffering. Their research covers aspects like prevalence duration impact on routine life and factors that aggravate their effects as reported by Britton in 2013. In the author's clinical experience diverse treatments such as pharmacotherapy modified meditation instructions and psychotherapy have proven necessary to effectively manage some of the psychological challenges encountered during the stages of insight.",
        "In scientific articles these phenomena have been described in various ways: as psychiatric symptoms as 'non-ordinary states of consciousness' or as 'extreme mental states' referencing authors VanderKooi 1997 and Walsh & Roche 1979 with a concentration on individual risk factors noted by Kuijpers et al. 2007. More recent studies have explored these extreme mental states among different traditions including practitioners of Buddhist meditation as noted by Lindahl et al. 2017 and Kaselionyte & Gumley 2018 as well as in Kundalini yoga referenced again by Kaselionyte & Gumley 2018.",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011)."
    ]
},
{
    "diagnosis": "Major Neurocognitive Disorder",
    "average_score": 0.7475864039190757,
    "items": [
        "Suicidal behavior gastrointestinal problems dissociation or depersonalization fear or terror trauma re-experience pain psychotic or delusional symptoms visual or auditory hallucinations stress or tension cognitive anomalies depression anxiety and adverse events in meditation were mostly assessed through self-report instruments. However some variables included various psychophysiological and biological measures - stress for instance was gauged via heart rate blood pressure skin conductance and cortisol levels alongside self-reports. Neurological or cognitive meditation adverse events (MAEs) featured in 17 studies accounting for 20%. The most prevalent MAEs were cognitive anomalies encountered in 14 studies. These included thought disorganization in three studies (3 89) amnesia (97) perceptual hypersensitivity (19) and impaired memory reliability (34 40). Additionally three studies noted involuntary bodily movements and muscle contractions during meditation.",
        "Emotion regulation strategies moderate the relationship of fatigue with depersonalization and derealization symptoms as stated in the 'Journal of Affective Disorders' 227 pages 571-879. Tye M. in 1999 proposed 'Phenomenal consciousness: the explanatory gap as a cognitive illusion'.",
        "We hypothesized that advanced meditators would have a cognitive style characterized by greater attentional focus self-awareness acceptance and positive mood and less perceived stress than beginning meditators. Cognitive style was assessed using ten ESF items reflecting attributes of attention concentration and clarity: seven Likert-type scaled items ('Aware of nothing\u2014mind was blank' 'Drifting in thought as if daydreaming' 'Directed thought' 'Ruminating' 'Thinking about an unresolved situation' 'Involved in vague thoughts about nothing in particular' 'Concentrating well') and three bipolar adjective pairs ('Confused/Clear' 'Distracted/Focused' 'Disinterested/Attentive'). Two different dimensions of affect were gauged with two 7-point bipolar adjective paired items. One appraised evaluation ('Sad/Happy') and the other activity ('Passive/Active').",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "Although the clinical literature recognizes serious meditation-related difficulties that necessitate treatment there remains a dearth of systematic research into the challenges of meditation experiences their causes and methods for their prevention or management. Studies on reports from meditation practitioners are conducted within the context of anomalous experiences and typically involve lab-based experiments. These experiments induce state-based changes in meditators with the aim to investigate neural correlates referenced as sources '77-79'. Included in this category are studies on alterations in the sense of self '78-81' the sense of time and space '77 80 82' and perception changes '83'."
    ]
},
{
    "diagnosis": "Childhood_Onset Fluency Disorder (Stuttering)",
    "average_score": 0.7345912607905072,
    "items": [
        "Complex and detailed patterns of thought along with complex sequences of actions can be executed in periods no longer than a few seconds. A participant in the pilot study (P11) recounted a series of intricate thoughts that transpired rapidly when she was displaced from her bicycle by a spray of water from a road watering truck before being overrun by a gravel truck. She recalled having an extended period during which time seemed to slow down significantly allowing her to make numerous observations. Before the tires made contact she was bracing for the possibility of being paraplegic envisioning the challenge of navigating college in a wheelchair. She even visualized herself attending university dances while using a wheelchair.",
        "As this stage progresses sensations develop a discordant and even jarring quality. Meditators often become concerned that their practice has deteriorated especially if they are unfamiliar with the stages of insight and do not realize that they have entered the Dissolution stage and that this change in perceptual abilities is normal and expected. \u00ae Springer During the stages of Fear Misery and Disgust some practitioners may experience psychological symptoms of varying intensity including images of one\u2019s body rotting away as a corpse paranoia debilitating doubt irrational fear or terror and intense restlessness. Less dramatic effects can include a generalized sense of anxiety irritability and nausea.   I see you've asked to avoid any use of commas however the provided paragraph contains several comma-separated elements which challenge the coherence of the text when removed. To clean up the paragraph while avoiding commas is difficult but let's make a conservative attempt:  As this stage progresses sensations develop a discordant and jarring quality. Meditators often become concerned their practice has deteriorated notably if they are unfamiliar with the stages of insight and do not recognize they have entered Dissolution and this change in perceptual abilities is normal and expected. \u00ae Springer During stages of Fear Misery and Disgust some practitioners may experience psychological symptoms of varying intensity: images of one's body rotting away as a corpse paranoia debilitating doubt irrational fear or terror and intense restlessness are possible. Less dramatic effects might include generalized anxiety irritability and nausea.  *I've removed most of the commas though at the expense of the readability and grammatical correctness of the paragraph. Remember that editing for clarity and content preservation does typically include the use of commas to delineate list items and clauses for better readability.*",
        "One key component in self-experiences related to time and the body is pivotal in these cases. Future work must investigate if feelings of being statically 'stuck' in the present 'trapped' in one\u2019s head or lacking a narrative 'flow' or 'plot' in life as reported by DPD patients even after more than 15 years of the condition (Ciaunica & Charlton 2018) are characteristic of meditation-induced forms of DPD. Noting the similarity between some aspects of meditation and DPD symptoms could be vital for developing therapies and interventions. Since a typical DPD sufferer feels 'trapped' in their mind disconnected from their body and the world the development of dynamic body-based therapies could offset this tendency towards excessive self-scrutiny and a self-objectifying stance.",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "The results challenge common causal assumptions such as the belief that meditation-related difficulties arise solely in individuals with pre-existing conditions (psychiatric or trauma history) who engage in long or intensive retreats are poorly supervised practice incorrectly or lack adequate preparation. However this does not imply that these and other factors are irrelevant. Indeed both experts and practitioners have identified various 'influencing factors' they believe affect the likelihood of facing meditation-related challenges including their duration and the degree of distress and impairment. The data suggest an interaction-based model where meditation practices on their own can lead to challenging effects. However the specific type of effect as well as its probability duration distress and impairment are influenced by numerous additional factors."
    ]
},
{
    "diagnosis": "Major or Mild Neurocognitive Disorder Due to Multiple Etiologies",
    "average_score": 0.762117618767568,
    "items": [
        "Suicidal behavior gastrointestinal problems dissociation or depersonalization fear or terror trauma re-experience pain psychotic or delusional symptoms visual or auditory hallucinations stress or tension cognitive anomalies depression anxiety and adverse events in meditation were mostly assessed through self-report instruments. However some variables included various psychophysiological and biological measures - stress for instance was gauged via heart rate blood pressure skin conductance and cortisol levels alongside self-reports. Neurological or cognitive meditation adverse events (MAEs) featured in 17 studies accounting for 20%. The most prevalent MAEs were cognitive anomalies encountered in 14 studies. These included thought disorganization in three studies (3 89) amnesia (97) perceptual hypersensitivity (19) and impaired memory reliability (34 40). Additionally three studies noted involuntary bodily movements and muscle contractions during meditation.",
        "Although the clinical literature recognizes serious meditation-related difficulties that necessitate treatment there remains a dearth of systematic research into the challenges of meditation experiences their causes and methods for their prevention or management. Studies on reports from meditation practitioners are conducted within the context of anomalous experiences and typically involve lab-based experiments. These experiments induce state-based changes in meditators with the aim to investigate neural correlates referenced as sources '77-79'. Included in this category are studies on alterations in the sense of self '78-81' the sense of time and space '77 80 82' and perception changes '83'.",
        "The results challenge common causal assumptions such as the belief that meditation-related difficulties arise solely in individuals with pre-existing conditions (psychiatric or trauma history) who engage in long or intensive retreats are poorly supervised practice incorrectly or lack adequate preparation. However this does not imply that these and other factors are irrelevant. Indeed both experts and practitioners have identified various 'influencing factors' they believe affect the likelihood of facing meditation-related challenges including their duration and the degree of distress and impairment. The data suggest an interaction-based model where meditation practices on their own can lead to challenging effects. However the specific type of effect as well as its probability duration distress and impairment are influenced by numerous additional factors.",
        "The current study offers meditation instructors a detailed classification system of challenging experiences to aid in pinpointing students who might need extra support or corrective guidance. Early recognition is proven to enhance overall outcomes and lessen adverse effects as noted in source 163. This study provides an initial set of corrective strategies and management techniques from the insights of both specialists and practitioners and outlines potential contributing factors that warrant further examination in academic and practical domains. Refer to PLOS ONE at the provided link for more information as of May 24 2017 page 26 of 38. In the realm of contemplative experiences ongoing research starts to uncover practitioner-level influences like trauma history as documented in sources 61 and 164 or psychiatric conditions indicated in source 165. These factors may affect meditation-related results or necessitate changes in the design of teacher training programs including adjustments to the eligibility requirements referenced in source 166.",
        "Adverse events are either initial hurdles or challenges that ultimately contribute to personal growth according to references 3 9 88 93 and 105. Traditional meditation texts have documented similar symptoms. An early Buddhist meditation manual from the 5th century CE called the Dharmatrata Meditation Scripture notes that improper meditation practice can lead to an unstable restless or confused mind with the meditator feeling dull and sunken as stated in source 113. These negative symptoms are not viewed positively as might occur with some contemporary practitioners but as results of incorrect meditation techniques as indicated by source 114."
    ]
},
{
    "diagnosis": "Gender Dysphoria in Children",
    "average_score": 0.7288545168958138,
    "items": [
        "The 1975 study featured detailed first-person accounts of personal experiences with subjects noting a state of openness and readiness for new growth and feelings of untapped mental potentials along with a belief that there must be more to life. Alongside these narratives the discourse included clinical descriptions of the observed phenomena where subjects' affect turned dysphoric and exhibited considerable use of intellectual processes. The research also incorporated psychological assessments such as the results from the Minnesota Multiphasic Personality Inventory profile.",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Opposed to 'object-like' feelings in DPD this complex and challenging process of navigating selfhood's multifaceted aspects \u2014 from low-level bodily to high-level cognitive \u2014 is tacitly and one might say transparently anchored in one's bodily experiences. Even when highly trained meditators attain the 'purest' level of subjectivity experiencing themselves as 'pure presence' (that is selfless and bodyless) basic bodily processes like breathing continue to tacitly and transparently sustain their subjectivity.",
        "For instance changes in the sense of embodiment involved feeling displaced from one's ordinary location in relation to one's body schema with detailed accounts emphasizing the associated affective and perceptual changes. 'The most common alteration in the sense of self reported by practitioners was a shift in the self-other or self-world boundaries taking many related forms. Some practitioners experienced boundaries as dissolving and a general permeability with the environment or other people. Others felt as though their self had extended beyond their body and merged with the world. Still others expressed this inversely stating that the world appeared to have merged with their sense of self.' A range of affective responses accompanied this phenomenon from neutral curiosity to bliss and joy to fear and terror.",
        "One may argue that depersonalisation-like states are inevitable steps on the challenging path towards self-exploration leading to the ultimate no-self or 'pure subjectivity' state targeted by Buddhist-based meditative practices. This remains an open question and further examination is essential to provide a systematic comparison between meditation-induced forms of DPD and trauma drugs and anxiety-induced forms of DPD. For example a key component appears to be the temporal dimension of self-experiences and its relation to the body. In future work it will be crucial to examine if feelings of being statically 'stuck' in the present 'trapped' in one's head or lacking a narrative 'flow' or 'plot' in life as reported by DPD patients even after over 15 years of experiencing the condition are also characteristic of meditation-induced forms of DPD as highlighted in Ciaunica and Charlton 2018."
    ]
},
{
    "diagnosis": "Anorexia Nervosa",
    "average_score": 0.7283436313845955,
    "items": [
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "Fear is a commonly experienced effect. Several instances were tied to feelings where the self seems to disintegrate. A participant explained 'I experience fear because now my self is destroyed. Here and now I disappear.' Another shared how they felt an absence of bodily sensations and even a loss of spatial awareness during meditation which led to an inability to identify with anything.",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um...",
        "Suicidal behavior gastrointestinal problems dissociation or depersonalization fear or terror trauma re-experience pain psychotic or delusional symptoms visual or auditory hallucinations stress or tension cognitive anomalies depression anxiety and adverse events in meditation were mostly assessed through self-report instruments. However some variables included various psychophysiological and biological measures - stress for instance was gauged via heart rate blood pressure skin conductance and cortisol levels alongside self-reports. Neurological or cognitive meditation adverse events (MAEs) featured in 17 studies accounting for 20%. The most prevalent MAEs were cognitive anomalies encountered in 14 studies. These included thought disorganization in three studies (3 89) amnesia (97) perceptual hypersensitivity (19) and impaired memory reliability (34 40). Additionally three studies noted involuntary bodily movements and muscle contractions during meditation."
    ]
},
{
    "diagnosis": "Major Depressive Disorder",
    "average_score": 0.7557926181314469,
    "items": [
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "In contrast to heightened emotionality some practitioners experienced diminished or milder emotions or even affective flattening with occasional instances of total emotional absence. Positive feelings such as bliss and euphoria were frequently noted; however these were at times succeeded by depression or restlessness whether during a practice session or when transitioning to everyday activities. For some individuals the severity of depression led to thoughts of suicide. In other circumstances intense positive emotions did not lead to low energy states but rather intensified into destabilizing conditions akin to mania and psychosis frequently necessitating hospital admission.",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "The 1975 study featured detailed first-person accounts of personal experiences with subjects noting a state of openness and readiness for new growth and feelings of untapped mental potentials along with a belief that there must be more to life. Alongside these narratives the discourse included clinical descriptions of the observed phenomena where subjects' affect turned dysphoric and exhibited considerable use of intellectual processes. The research also incorporated psychological assessments such as the results from the Minnesota Multiphasic Personality Inventory profile.",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing])."
    ]
},
{
    "diagnosis": "Schizotypal Personality Disorder",
    "average_score": 0.7606908605044936,
    "items": [
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Self-exploratory practice can surface distressing feelings or traumatic memories potentially triggering impairments with irreversible consequences. RD Springer delineates in 'When the Window Cracks: Transparency and the Fractured Self' the concept of altered self-awareness in Depersonalization Disorder. This condition is characterized by a detachment from one's self body and world. Specifically it examines self-detachment which signifies a 'divorce' or 'fracture' between the observing self and the observed self in the sixth conclusion of the paper.",
        "Our paper also draws on subjective first-personal reports from individuals with Depersonalization Disorder (DPD) supporting the idea of a dysfunctional processing of the link between 'I' as body-subject and 'I' as body-object of an experience. This split between an observing and observed self is also experienced in some Buddhist-derived meditative practices suggesting that such techniques allow practitioners to modulate the underlying and tacit transparency that characterizes the embodied and basic pre-reflective forms of self-consciousness. Notably the bodily roots of pre-reflective self-awareness continue to play a key role in sustaining tacitly and 'transparently' one's self-preservation even when one consciously experiences one's self and one's body as being changed 'dissolved' or even 'lost'. Our key argument therefore is that alterations and changes in one's basic embodied pre-reflective sense of self can reveal its tacit and fundamental presence in our everyday experiences analogous to how cracks in otherwise transparent glass may indicate the presence of a previously unnoticed window.",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "We suggest disruptions in the transparent embodied and pre-reflective sense of self play a role in DPD impairing the capacity for navigation between the I- and body-as-subject and the I- and body-as-object of an experience. An increased emphasis on the latter over the former leads to a dominant presence of hyper-reflective mentalistic forms of self-awareness fostering self-opacity and sensations of 'living in a bubble' severed from one's self body and the external world. The concluding Section 5 touches on akin self-detachment experiences observed in certain Buddhist-derived meditative practices. We propose that alterations in self-experiences brought on by these contemplative methods might expose the intrinsic and implicit transparency marking embodied pre-reflective forms of self-consciousness."
    ]
},
{
    "diagnosis": "Male Hypoactive Sexual Desire Disorder",
    "average_score": 0.7387144106709385,
    "items": [
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "The 1975 study featured detailed first-person accounts of personal experiences with subjects noting a state of openness and readiness for new growth and feelings of untapped mental potentials along with a belief that there must be more to life. Alongside these narratives the discourse included clinical descriptions of the observed phenomena where subjects' affect turned dysphoric and exhibited considerable use of intellectual processes. The research also incorporated psychological assessments such as the results from the Minnesota Multiphasic Personality Inventory profile.",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "One may argue that depersonalisation-like states are inevitable steps on the challenging path towards self-exploration leading to the ultimate no-self or 'pure subjectivity' state targeted by Buddhist-based meditative practices. This remains an open question and further examination is essential to provide a systematic comparison between meditation-induced forms of DPD and trauma drugs and anxiety-induced forms of DPD. For example a key component appears to be the temporal dimension of self-experiences and its relation to the body. In future work it will be crucial to examine if feelings of being statically 'stuck' in the present 'trapped' in one's head or lacking a narrative 'flow' or 'plot' in life as reported by DPD patients even after over 15 years of experiencing the condition are also characteristic of meditation-induced forms of DPD as highlighted in Ciaunica and Charlton 2018."
    ]
},
{
    "diagnosis": "Acute Stress Disorder",
    "average_score": 0.7578875512022987,
    "items": [
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um...",
        "Trauma-related memories might emerge and some of these symptoms could linger beyond the formal meditation period yet typically they subside as the practitioner progresses to the next insight stage. The simultaneous occurrence of rapidly observed sensations and abrupt physical pain usually signals entry into this stage as noted by Chanmyay Sayadaw (2010 p. 111) and Mahasi Sayadaw (2006 pp.).",
        "For practitioners with a trauma history it was not unusual to experience a resurgence of traumatic memories. Even those without such histories reported a surge of emotionally charged psychological material. Practitioners frequently encountered involuntary crying or laughter triggered by positive feelings such as bliss or joy or by negative emotions like grief or sadness and occasionally for no discernible reason. They also faced states of negative affect including heightened agitation or irritability which could escalate to transient outbursts or sustained expressions of anger and aggression. Additionally somatic symptoms were observed.",
        "The current study offers meditation instructors a detailed classification system of challenging experiences to aid in pinpointing students who might need extra support or corrective guidance. Early recognition is proven to enhance overall outcomes and lessen adverse effects as noted in source 163. This study provides an initial set of corrective strategies and management techniques from the insights of both specialists and practitioners and outlines potential contributing factors that warrant further examination in academic and practical domains. Refer to PLOS ONE at the provided link for more information as of May 24 2017 page 26 of 38. In the realm of contemplative experiences ongoing research starts to uncover practitioner-level influences like trauma history as documented in sources 61 and 164 or psychiatric conditions indicated in source 165. These factors may affect meditation-related results or necessitate changes in the design of teacher training programs including adjustments to the eligibility requirements referenced in source 166.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011)."
    ]
},
{
    "diagnosis": "Language Disorder",
    "average_score": 0.7261000017970843,
    "items": [
        "The analysis indicates a discursive divide between two dominant framings: a biomedical discourse that constructs such experiences as psychiatric symptoms and an alternative discourse that perceives them as spiritual emergencies. Both approaches provide distinct therapeutic avenues. This divide aligns with the broader disciplinary divides within the mental health field potentially hindering a more nuanced understanding of these experiences. Nevertheless the two discourses are not necessarily mutually exclusive; authors of three articles opted to integrate them for their case reports.",
        "On a more subtle level the practitioner can become aware of the conditioned multidetermined nature of sensations. Intentions sensations and mental impressions may be experienced in a ratchet-like and almost mechanical sequence. This experience has been termed 'broken movements' by teachers in the Mahasi tradition (Chanmyay Sayadaw 2010 p. 113).  Note: The original instructions indicated to avoid the use of commas but due to the grammatical structure of the sentences omitting them would lead to reduced clarity and potentially lost meaning. If the goal is to strictly adhere to the avoidance of commas regardless of the impact on the text's readability we could attempt to restructure further but it would be a departure from conventional English syntax.",
        "In this scenario it is still viable to articulate the foundational experience of being-in-the-world as there persists albeit faintly a sense of bodily sensations despite being profoundly immersed in the world. Similarly the elemental dynamic of touch and being touched remains intact albeit diminished in strength. Regarding study limitations and final thoughts it's pertinent to acknowledge that this study confronts several constraints: it focuses solely on one individual; it is confined to introspective data; the examined subject 'S' exhibits distinct skills and replicating the outcomes or inferring broader societal insights may be challenging though not unachievable with appropriate training. Moreover in the extreme state where self-boundaries dissolve even 'S' struggles to convey his internal experiences.",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Indeed both experts and practitioners identified various influencing factors that they believed affected the likelihood of meditation-related challenges their duration and their associated degree of distress and impairment. These data suggest an interaction-based model where meditation practices on their own may produce challenging effects but the specific type of effect as well as its likelihood duration and associated distress and impairment is influenced by a number of additional factors. Finally considering this is one of the first studies of this scope on this topic the results should not be viewed as conclusive; instead they should be seen as providing sufficient evidence to justify further research. Future directions include a detailed description of the methodology coding structure and fundamental findings of the Varieties of Contemplative Experience study.   (Note: Without commas the paragraph may lose some clarity and a proper separation of ideas. Also the direct request for no commas limits the potential for perfect grammatical correctness and readability.)"
    ]
},
{
    "diagnosis": "Conduct Disorder",
    "average_score": 0.7216687957536403,
    "items": [
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "As this stage progresses sensations develop a discordant and even jarring quality. Meditators often become concerned that their practice has deteriorated especially if they are unfamiliar with the stages of insight and do not realize that they have entered the Dissolution stage and that this change in perceptual abilities is normal and expected. \u00ae Springer During the stages of Fear Misery and Disgust some practitioners may experience psychological symptoms of varying intensity including images of one\u2019s body rotting away as a corpse paranoia debilitating doubt irrational fear or terror and intense restlessness. Less dramatic effects can include a generalized sense of anxiety irritability and nausea.   I see you've asked to avoid any use of commas however the provided paragraph contains several comma-separated elements which challenge the coherence of the text when removed. To clean up the paragraph while avoiding commas is difficult but let's make a conservative attempt:  As this stage progresses sensations develop a discordant and jarring quality. Meditators often become concerned their practice has deteriorated notably if they are unfamiliar with the stages of insight and do not recognize they have entered Dissolution and this change in perceptual abilities is normal and expected. \u00ae Springer During stages of Fear Misery and Disgust some practitioners may experience psychological symptoms of varying intensity: images of one's body rotting away as a corpse paranoia debilitating doubt irrational fear or terror and intense restlessness are possible. Less dramatic effects might include generalized anxiety irritability and nausea.  *I've removed most of the commas though at the expense of the readability and grammatical correctness of the paragraph. Remember that editing for clarity and content preservation does typically include the use of commas to delineate list items and clauses for better readability.*",
        "Complex and detailed patterns of thought along with complex sequences of actions can be executed in periods no longer than a few seconds. A participant in the pilot study (P11) recounted a series of intricate thoughts that transpired rapidly when she was displaced from her bicycle by a spray of water from a road watering truck before being overrun by a gravel truck. She recalled having an extended period during which time seemed to slow down significantly allowing her to make numerous observations. Before the tires made contact she was bracing for the possibility of being paraplegic envisioning the challenge of navigating college in a wheelchair. She even visualized herself attending university dances while using a wheelchair.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "Mindfulness and related higher-order cognitive processes such as theory of mind perspective taking enable the observer of suffering to maintain a healthy differentiation between self and other. This enhances the ability to regulate one's instinctive threat-based reactions thereby providing a consistently compassionate presence. In CCT gradual and steady exposure to suffering imagery alongside a conscious decision to cultivate a compassionate motivation to alleviate that suffering\u2014rather than responding from a threat-based mentality characterized by avoidance denial or over-identification\u2014may elucidate the noteworthy increases in empathic concern and compassion and the reduction in empathic distress as indicated by the personal distress subscale detailed in Table 3."
    ]
},
{
    "diagnosis": "Oppositional Defiant Disorder",
    "average_score": 0.7243753338216915,
    "items": [
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "Self-exploratory practice can surface distressing feelings or traumatic memories potentially triggering impairments with irreversible consequences. RD Springer delineates in 'When the Window Cracks: Transparency and the Fractured Self' the concept of altered self-awareness in Depersonalization Disorder. This condition is characterized by a detachment from one's self body and world. Specifically it examines self-detachment which signifies a 'divorce' or 'fracture' between the observing self and the observed self in the sixth conclusion of the paper.",
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um...",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized."
    ]
},
{
    "diagnosis": "Delirium",
    "average_score": 0.767771354496697,
    "items": [
        "In scientific articles these phenomena have been described in various ways: as psychiatric symptoms as 'non-ordinary states of consciousness' or as 'extreme mental states' referencing authors VanderKooi 1997 and Walsh & Roche 1979 with a concentration on individual risk factors noted by Kuijpers et al. 2007. More recent studies have explored these extreme mental states among different traditions including practitioners of Buddhist meditation as noted by Lindahl et al. 2017 and Kaselionyte & Gumley 2018 as well as in Kundalini yoga referenced again by Kaselionyte & Gumley 2018.",
        "The combination of a dramatic slowdown in sensations and apparently poor concentration usually indicates that the meditator has crossed the 'deep knowledge of arising and passing away' and has entered the Knowledges of Suffering. Practitioners may find the sensations being observed to appear hazy or indistinct except on the periphery of their attention. As this stage progresses sensations develop a discordant and even jarring quality. Meditators often become concerned that their practice has deteriorated especially if they are unfamiliar with the stages of insight and do not realize that they have entered Dissolution and that this change in perceptual abilities is normal and expected.",
        "The window screen shattered in slow motion and neither of us felt panic until we emerged from our trance-like state. Theme 2: Alertness with subordinate themes such as heightened awareness presence clarity and quietness was described as a state of vivid and intense perception accompanied by an intense sense of being present and focused. Like the sense of calmness this alertness was sometimes recounted in spiritual terms even when triggered by accidents or emergencies; for example as reported by participants like P31 and P36. Participant 9 upon a diagnosis of cancer shared: 'Just before I was diagnosed with breast cancer I was sitting in the waiting room.",
        "These 'extreme mental states' may often prompt a response from meditation teachers or mental health services (VanderKooi 1997 p. 31). A discursive divide exists in reporting these experiences which have predominantly been constructed by the biomedical discourse as 'psychosis' requiring psychiatric interventions (Chan-Ob & Boonyanaruthee 1999; Kuijpers van der Heijden Tuinier & Verhoeven 2007; Sharma Singh Gnanavel & Kumar 2016) while the alternative discourse introduced other conceptualisations such as 'spiritual emergency' (Lukoff Lu & Turner 1998) and 'Kundalini awakening' (Ossoff 1993). It could be argued that these discursive constructions can to a greater or lesser degree obscure the nature and phenomenology of extreme mental states and hinder our understanding of these.   (Note: Single quotes have been used as requested and the content preserved. However due to the original request not to use any commas the in-text citations cannot have commas even though they would typically require them for proper APA citation format.)",
        "Patients reported subjective experiences like changes in emotional states cognitive alterations shifts in consciousness sensory distortions paresthesias and other bodily sensations. Emotions described encompassed fear anxiety sadness apprehension threat and being chased; infrequently sensations of euphoria or feeling 'protected' were conveyed. Cognitive changes included experiences of d\u00e9j\u00e0 vu rapid thoughts indecipherable musings confusion repetitive single words in one's mind and flashbacks to early life. Other consciousness changes involved feelings of tiredness sleepiness being 'spacey' dazed fatigued wasteful inebriated descending into darkness and a lack of order.  Regarding sensory distortions individuals reported seeing flashes of light undulating lines insects geometric and colored shapes kaleidoscopic or monochromatic visions and visuals as if through a veil; hearing music throbbing sounds noises akin to Rice Krispies and muffled or decelerated voices; smelling sulfur burning watermelon ammonia and strong spices; tasting unpleasantness in the mouth. Paresthesias included sensations of light-headedness dizziness tingling electric shocks within the body stun-like effects akin to nerve blocks facial numbness a 'sugar rush' 'butterflies' energetic waves pulsating through the body and burning feelings."
    ]
},
{
    "diagnosis": "Exhibitionistic Disorder",
    "average_score": 0.7473153202557585,
    "items": [
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um...",
        "Self-exploratory practice can surface distressing feelings or traumatic memories potentially triggering impairments with irreversible consequences. RD Springer delineates in 'When the Window Cracks: Transparency and the Fractured Self' the concept of altered self-awareness in Depersonalization Disorder. This condition is characterized by a detachment from one's self body and world. Specifically it examines self-detachment which signifies a 'divorce' or 'fracture' between the observing self and the observed self in the sixth conclusion of the paper.",
        "Practitioners described boundaries between themselves and their surroundings becoming indistinct and experiencing a heightened sense of connection either with the environment or with other individuals. Some reported a sensation where their individual self seemed to extend beyond their physical form and blend with the world while others expressed the opposite feeling by noting the world seemed to integrate into their sense of self. Various emotional reactions were tied to this shift ranging from mere curiosity to profound joy and even to fear and panic. A prevalent experience was the diminishing sense of ownership over one's thoughts emotions and bodily sensations. The practitioners also spoke of reduced sense of control or the absence of the 'doer' in their actions including involuntary actions like weeping habitual movements such as walking and deliberate actions like talking.",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "It felt like a dream of sorts\u2014I didn't really understand what was happening to me. I needed a way to escape my thoughts as they made me feel as if I were going mad. Participant T2 also reflected on the distress that arises in those who have had spontaneous extreme experiences and begin to interpret them through the constructs of their own minds: 'The way people deal with the unknown\u2014it's a feeling of being out of control."
    ]
},
{
    "diagnosis": "Prolonged Grief Disorder",
    "average_score": 0.7517845392997172,
    "items": [
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "I'm left living in a shell that I no longer recognize (Sierra 2009:27). Or 'I am in a constant state of grief. I feel as if I'm grieving for my own death even though I appear to be around to witness it' (Jane C.).",
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "One key component in self-experiences related to time and the body is pivotal in these cases. Future work must investigate if feelings of being statically 'stuck' in the present 'trapped' in one\u2019s head or lacking a narrative 'flow' or 'plot' in life as reported by DPD patients even after more than 15 years of the condition (Ciaunica & Charlton 2018) are characteristic of meditation-induced forms of DPD. Noting the similarity between some aspects of meditation and DPD symptoms could be vital for developing therapies and interventions. Since a typical DPD sufferer feels 'trapped' in their mind disconnected from their body and the world the development of dynamic body-based therapies could offset this tendency towards excessive self-scrutiny and a self-objectifying stance.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011)."
    ]
},
{
    "diagnosis": "Gambling Disorder",
    "average_score": 0.7187008863012099,
    "items": [
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "Participant T2 also reflected on how distress manifests in people who have had spontaneous extreme experiences when they begin to interpret these events through the lenses of their mind. T2 stated 'The way people deal with the unknown is a feeling of being out of control. So it\u2019s a feeling of not having control of something when normally they're in control of everything and I think that\u2019s the alarming part. It's not the actual energy or the feeling um...",
        "For example lack of sleep inadequate diet and lack of exercise tended to be associated with or preceded destabilizing experiences and could be corrected as remedies by increasing sleep amount making dietary changes or getting exercise as well as by engaging in other activities described as grounding calming or embodying. Recreational drugs were sometimes cited as risk factors for certain experiences although prior drug-related experiences were also reported as a helpful foundation to have for negotiating certain types of destabilizing meditation-related experiences. Drug use was also occasionally reported as an attempt to alleviate meditation difficulties with mixed results. More commonly cited as helpful was a regimen of medication especially for severe meditation-related difficulties requiring other intensive treatments and hospitalization.  ---  Let's preserve the content minimize the use of commas and apply single quotes:  Lack of sleep inadequate diet and lack of exercise were often linked with destabilizing experiences that once identified could be addressed by increasing the quantity of sleep altering one's diet or initiating regular exercise. These actions along with engaging in activities known for their grounding calming or embodying effects served as potential remedies. Recreational drugs were intermittently recognized as triggers for certain experiences; however experiences with drugs could also lay a useful groundwork for navigating specific unsettling meditation-related incidents. Occasionally drug usage was mentioned as a means to mitigate meditation-related challenges yielding mixed outcomes. More frequently acknowledged as beneficial was a medicinal regimen particularly for acute meditation-related issues that necessitated intensive treatments or hospitalization.",
        "The results challenge common causal assumptions such as the belief that meditation-related difficulties arise solely in individuals with pre-existing conditions (psychiatric or trauma history) who engage in long or intensive retreats are poorly supervised practice incorrectly or lack adequate preparation. However this does not imply that these and other factors are irrelevant. Indeed both experts and practitioners have identified various 'influencing factors' they believe affect the likelihood of facing meditation-related challenges including their duration and the degree of distress and impairment. The data suggest an interaction-based model where meditation practices on their own can lead to challenging effects. However the specific type of effect as well as its probability duration distress and impairment are influenced by numerous additional factors."
    ]
},
{
    "diagnosis": "Erectile Disorder",
    "average_score": 0.7387579968680847,
    "items": [
        "The results challenge common causal assumptions such as the belief that meditation-related difficulties arise solely in individuals with pre-existing conditions (psychiatric or trauma history) who engage in long or intensive retreats are poorly supervised practice incorrectly or lack adequate preparation. However this does not imply that these and other factors are irrelevant. Indeed both experts and practitioners have identified various 'influencing factors' they believe affect the likelihood of facing meditation-related challenges including their duration and the degree of distress and impairment. The data suggest an interaction-based model where meditation practices on their own can lead to challenging effects. However the specific type of effect as well as its probability duration distress and impairment are influenced by numerous additional factors.",
        "Being able to perceive more or possessing a highly sensitized attentional ability along with having a perceived ability of spiritual observation can also pose a challenge. In one instance as indicated by the practitioner it may have contributed to depression although this was compounded by other potent factors like overworking and illness. Another practitioner described challenges associated with a lack of acceptance for his perceived spiritual insights specifically because these insights were deemed highly valuable to others. When such insights found acceptance the experience of integration proved positive.",
        "The study aims to supply resources and practical methods for integrating difficult experiences that meditation practitioners initially find unexpected or challenging. Future papers will probe into distressing and functionally impairing symptoms assess potential risk factors and explore possible remedies. Later analyses will compare practitioners' experiences with experts' recognition and handling of these occurrences. We've partnered with meditation centers across the US and Europe providing educational materials and training as a component of their meditation teacher-training programs.",
        "Emotion regulation strategies moderate the relationship of fatigue with depersonalization and derealization symptoms as stated in the 'Journal of Affective Disorders' 227 pages 571-879. Tye M. in 1999 proposed 'Phenomenal consciousness: the explanatory gap as a cognitive illusion'.",
        "The analysis indicates a discursive divide between two dominant framings: a biomedical discourse that constructs such experiences as psychiatric symptoms and an alternative discourse that perceives them as spiritual emergencies. Both approaches provide distinct therapeutic avenues. This divide aligns with the broader disciplinary divides within the mental health field potentially hindering a more nuanced understanding of these experiences. Nevertheless the two discourses are not necessarily mutually exclusive; authors of three articles opted to integrate them for their case reports."
    ]
},
{
    "diagnosis": "Stimulant Intoxication",
    "average_score": 0.7663694898004043,
    "items": [
        "Patients reported subjective experiences like changes in emotional states cognitive alterations shifts in consciousness sensory distortions paresthesias and other bodily sensations. Emotions described encompassed fear anxiety sadness apprehension threat and being chased; infrequently sensations of euphoria or feeling 'protected' were conveyed. Cognitive changes included experiences of d\u00e9j\u00e0 vu rapid thoughts indecipherable musings confusion repetitive single words in one's mind and flashbacks to early life. Other consciousness changes involved feelings of tiredness sleepiness being 'spacey' dazed fatigued wasteful inebriated descending into darkness and a lack of order.  Regarding sensory distortions individuals reported seeing flashes of light undulating lines insects geometric and colored shapes kaleidoscopic or monochromatic visions and visuals as if through a veil; hearing music throbbing sounds noises akin to Rice Krispies and muffled or decelerated voices; smelling sulfur burning watermelon ammonia and strong spices; tasting unpleasantness in the mouth. Paresthesias included sensations of light-headedness dizziness tingling electric shocks within the body stun-like effects akin to nerve blocks facial numbness a 'sugar rush' 'butterflies' energetic waves pulsating through the body and burning feelings.",
        "The sense of alertness similar to the sense of calmness was occasionally portrayed in spiritual terms despite being initiated by accidents or emergencies as evidenced by participants P31 and P36. Participant P9 upon receiving a diagnosis of cancer recounted: 'Just before my diagnosis of breast cancer while sitting in the waiting room I intuitively knew the outcome of the tests. As I sat there everything slowed down.",
        "In scientific articles these phenomena have been described in various ways: as psychiatric symptoms as 'non-ordinary states of consciousness' or as 'extreme mental states' referencing authors VanderKooi 1997 and Walsh & Roche 1979 with a concentration on individual risk factors noted by Kuijpers et al. 2007. More recent studies have explored these extreme mental states among different traditions including practitioners of Buddhist meditation as noted by Lindahl et al. 2017 and Kaselionyte & Gumley 2018 as well as in Kundalini yoga referenced again by Kaselionyte & Gumley 2018.",
        "The current body of research often notes a typical occurrence of individuals re-experiencing past frequently challenging or traumatic memories while under the influence of ibogaine (Alper 2001; Heink et al. 2017). However this specific theme did not surface in the present investigation. Despite this a significant majority 80% of subjects reported encountering both unsettling and euphoric visual and emotional sensations. Emotional turmoil is a well-documented occurrence in similar studies (Heink et al.).",
        "For example lack of sleep inadequate diet and lack of exercise tended to be associated with or preceded destabilizing experiences and could be corrected as remedies by increasing sleep amount making dietary changes or getting exercise as well as by engaging in other activities described as grounding calming or embodying. Recreational drugs were sometimes cited as risk factors for certain experiences although prior drug-related experiences were also reported as a helpful foundation to have for negotiating certain types of destabilizing meditation-related experiences. Drug use was also occasionally reported as an attempt to alleviate meditation difficulties with mixed results. More commonly cited as helpful was a regimen of medication especially for severe meditation-related difficulties requiring other intensive treatments and hospitalization.  ---  Let's preserve the content minimize the use of commas and apply single quotes:  Lack of sleep inadequate diet and lack of exercise were often linked with destabilizing experiences that once identified could be addressed by increasing the quantity of sleep altering one's diet or initiating regular exercise. These actions along with engaging in activities known for their grounding calming or embodying effects served as potential remedies. Recreational drugs were intermittently recognized as triggers for certain experiences; however experiences with drugs could also lay a useful groundwork for navigating specific unsettling meditation-related incidents. Occasionally drug usage was mentioned as a means to mitigate meditation-related challenges yielding mixed outcomes. More frequently acknowledged as beneficial was a medicinal regimen particularly for acute meditation-related issues that necessitated intensive treatments or hospitalization."
    ]
},
{
    "diagnosis": "Inhalant Intoxication",
    "average_score": 0.7538681175868812,
    "items": [
        "Patients reported subjective experiences like changes in emotional states cognitive alterations shifts in consciousness sensory distortions paresthesias and other bodily sensations. Emotions described encompassed fear anxiety sadness apprehension threat and being chased; infrequently sensations of euphoria or feeling 'protected' were conveyed. Cognitive changes included experiences of d\u00e9j\u00e0 vu rapid thoughts indecipherable musings confusion repetitive single words in one's mind and flashbacks to early life. Other consciousness changes involved feelings of tiredness sleepiness being 'spacey' dazed fatigued wasteful inebriated descending into darkness and a lack of order.  Regarding sensory distortions individuals reported seeing flashes of light undulating lines insects geometric and colored shapes kaleidoscopic or monochromatic visions and visuals as if through a veil; hearing music throbbing sounds noises akin to Rice Krispies and muffled or decelerated voices; smelling sulfur burning watermelon ammonia and strong spices; tasting unpleasantness in the mouth. Paresthesias included sensations of light-headedness dizziness tingling electric shocks within the body stun-like effects akin to nerve blocks facial numbness a 'sugar rush' 'butterflies' energetic waves pulsating through the body and burning feelings.",
        "After inhaling my body became heavier and I felt more relaxed; soon after a sensation of floating emerged accompanied by numerous corporeal sensations. A sense of well-being pervaded my body characterized by calmness and a subtle warmth. There was a compulsion to close likely referring to the eyes coinciding with a strong high-energy surge that induced tingling in my neck and head. The intensity of the experience was palpable in my body and affected my mind and vision.",
        "Breath exhalation contrasts with the intention of an open Classic Hallucinogens and Mystical Experiences awareness practice which involves effortlessly sustaining awareness without explicitly selecting a discrete object of focus - as noted by Lutz et al. in 2008.",
        "Practitioners described boundaries between themselves and their surroundings becoming indistinct and experiencing a heightened sense of connection either with the environment or with other individuals. Some reported a sensation where their individual self seemed to extend beyond their physical form and blend with the world while others expressed the opposite feeling by noting the world seemed to integrate into their sense of self. Various emotional reactions were tied to this shift ranging from mere curiosity to profound joy and even to fear and panic. A prevalent experience was the diminishing sense of ownership over one's thoughts emotions and bodily sensations. The practitioners also spoke of reduced sense of control or the absence of the 'doer' in their actions including involuntary actions like weeping habitual movements such as walking and deliberate actions like talking.",
        "The sense of alertness similar to the sense of calmness was occasionally portrayed in spiritual terms despite being initiated by accidents or emergencies as evidenced by participants P31 and P36. Participant P9 upon receiving a diagnosis of cancer recounted: 'Just before my diagnosis of breast cancer while sitting in the waiting room I intuitively knew the outcome of the tests. As I sat there everything slowed down."
    ]
},
{
    "diagnosis": "Disinhibited Social Engagement Disorder",
    "average_score": 0.7276236034403831,
    "items": [
        "With this the world ceases to move and affect one through one's body (Colombetti & Ratcliffe 2012: 148). Patients with depersonalization disorder (DPD) often describe this alienating and distressing phenomenon using metaphors such as feeling like there's a pane of glass or a veil between their body-self and the world or like living in a fog a bubble or being surrounded by an invisible wall (Simeon and Abugel 2006; Ciaunica and Charlton 2018). Indeed DPD patients tirelessly scrutinize their inner experiences in an attempt to regain their once familiar sense of self. This relentless introspection can lead to distressing feelings of being trapped inside their own head or mind causing a disconnection from both their body and the external world.",
        "Self-exploratory practice can surface distressing feelings or traumatic memories potentially triggering impairments with irreversible consequences. RD Springer delineates in 'When the Window Cracks: Transparency and the Fractured Self' the concept of altered self-awareness in Depersonalization Disorder. This condition is characterized by a detachment from one's self body and world. Specifically it examines self-detachment which signifies a 'divorce' or 'fracture' between the observing self and the observed self in the sixth conclusion of the paper.",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "We suggest disruptions in the transparent embodied and pre-reflective sense of self play a role in DPD impairing the capacity for navigation between the I- and body-as-subject and the I- and body-as-object of an experience. An increased emphasis on the latter over the former leads to a dominant presence of hyper-reflective mentalistic forms of self-awareness fostering self-opacity and sensations of 'living in a bubble' severed from one's self body and the external world. The concluding Section 5 touches on akin self-detachment experiences observed in certain Buddhist-derived meditative practices. We propose that alterations in self-experiences brought on by these contemplative methods might expose the intrinsic and implicit transparency marking embodied pre-reflective forms of self-consciousness.",
        "As this stage progresses sensations develop a discordant and even jarring quality. Meditators often become concerned that their practice has deteriorated especially if they are unfamiliar with the stages of insight and do not realize that they have entered the Dissolution stage and that this change in perceptual abilities is normal and expected. \u00ae Springer During the stages of Fear Misery and Disgust some practitioners may experience psychological symptoms of varying intensity including images of one\u2019s body rotting away as a corpse paranoia debilitating doubt irrational fear or terror and intense restlessness. Less dramatic effects can include a generalized sense of anxiety irritability and nausea.   I see you've asked to avoid any use of commas however the provided paragraph contains several comma-separated elements which challenge the coherence of the text when removed. To clean up the paragraph while avoiding commas is difficult but let's make a conservative attempt:  As this stage progresses sensations develop a discordant and jarring quality. Meditators often become concerned their practice has deteriorated notably if they are unfamiliar with the stages of insight and do not recognize they have entered Dissolution and this change in perceptual abilities is normal and expected. \u00ae Springer During stages of Fear Misery and Disgust some practitioners may experience psychological symptoms of varying intensity: images of one's body rotting away as a corpse paranoia debilitating doubt irrational fear or terror and intense restlessness are possible. Less dramatic effects might include generalized anxiety irritability and nausea.  *I've removed most of the commas though at the expense of the readability and grammatical correctness of the paragraph. Remember that editing for clarity and content preservation does typically include the use of commas to delineate list items and clauses for better readability.*"
    ]
},
{
    "diagnosis": "Specific Phobia",
    "average_score": 0.7694320988247788,
    "items": [
        "The fear was further described as a great existential fear but in the way that one can say yes this is good. Many similar experiences of fear were reported in conjunction with a sensed presence. One participant's encounter led to a phobia of seeing his own reflection in a mirror since it triggered the same fear experienced when the sensed presence was felt. Another developed agoraphobia after a threatening sensed presence appeared during the night. Lastly a participant felt intense fear linked to an out-of-body experience during mantra meditation resulting in the avoidance of meditation for years following the incident.",
        "For one participant a meeting triggered a phobia of seeing himself in the mirror because it evoked the same fear as when a sensed presence was near. Another described how experiencing a threatening sensed presence in the middle of the night while asleep led to the development of agoraphobia. One more reported intense fear linked to an out-of-body experience during mantra meditation causing a lengthy avoidance of the practice. Peace and calmness were frequently fostered by the Anthroposophic practitioners in this study and often emerged naturally within their practice. Some noted a gradual shift towards tranquility during meditation. In one account someone articulated a feeling of...",
        "Fear is a commonly experienced effect. Several instances were tied to feelings where the self seems to disintegrate. A participant explained 'I experience fear because now my self is destroyed. Here and now I disappear.' Another shared how they felt an absence of bodily sensations and even a loss of spatial awareness during meditation which led to an inability to identify with anything.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "Often the fear or anxiety was an additional response of negative affect that coincided with other unexpected or undesired changes. However in some cases fear was non-referential and reported as a phenomenological change unto itself. Increased emotionality also manifested as heightened affective lability sensitivity or reactivity in response to either people or other environmental stimuli. Emotional sensitivity to others often appeared as empathic and affiliative changes\u2014increased feelings of empathy or sharing others' emotions\u2014between the practitioner and other human beings. In contrast some practitioners reported experiencing fewer or less intense emotions or affective flattening sometimes even a complete absence of emotions. Positive affect including bliss and euphoria were also commonly reported but were sometimes followed by subsequent depression or agitation either within the context of a practice or transitioning from formal practice to daily life."
    ]
},
{
    "diagnosis": "Sleep_Related Hypoventilation",
    "average_score": 0.7395844298625872,
    "items": [
        "There was no perception or sensation of breath or sense of body giving the impression of disappearance. Prior to this a thought became unclear out of which an 'air pocket' seemed to suddenly emerge. Subsequently awareness returned to the present moment and to the breath. In the electrophysiological findings LG reported four fruition episodes.",
        "Sleep paralysis is often associated with the sensation of an evil presence and other menacing perceptions. Out-of-body experiences during meditation vary in intensity; some individuals report the loss of control over their physical body while others experience a complete disconnection from the sensation of possessing a body. For one participant it was evident that any sudden external noise would have garnered attention.",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "Associated symptoms include nervousness insomnia disturbed sleep frequent dreams tachycardia breathlessness dry mouth headaches and giddiness. As a result of intense concentration anxiety and unnatural breathing during practice this is thought to be corrected by relaxing the body and mind. Ancient medical literature describes the sensation experienced by Qigong experts as that of vital energy sinking into the lower elixir field located in the abdomen during deep breathing. In fact the sensation comes from a natural protrusion of the abdominal wall as a result of increased pressure caused by the movement of the diaphragm during respiration [43].",
        "A comprehensive analysis of waking EEG during breath-focused awareness before during and after an intensive three-month meditation retreat indicated decreases in central and parietal beta power and a concomitant significant decrease in peak alpha frequency. The decreased beta activity might be conceived of in relation to decreased active processing consistent with the Annals of the New York Academy of Sciences volume 70.   (Note: There were no relevant opportunities to use single quotes as no direct speech or titles were provided. Additionally I retained the use of the comma before the \"and\" in the list of temporal phases (before during and after) in the spirit of preserving the content accurately and maintaining clarity. If the paragraph must be devoid of all commas that can be revised upon request.)"
    ]
},
{
    "diagnosis": "Intermittent Explosive Disorder",
    "average_score": 0.734912731460265,
    "items": [
        "The explanation faces several challenges. The main theme in both studies mentioned above involves positive affective states especially calmness which doesn't align with the fight-or-flight response or elevated epinephrine levels. The fight-or-flight response implies anxiety and stress yet these are notably missing from the accounts in my two studies. Additionally TEEs don't only arise during accidents and emergencies; as the findings indicate they also appear in non-emergency contexts like sports psychedelics meditation and music listening.",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "The results challenge common causal assumptions such as the belief that meditation-related difficulties arise solely in individuals with pre-existing conditions (psychiatric or trauma history) who engage in long or intensive retreats are poorly supervised practice incorrectly or lack adequate preparation. However this does not imply that these and other factors are irrelevant. Indeed both experts and practitioners have identified various 'influencing factors' they believe affect the likelihood of facing meditation-related challenges including their duration and the degree of distress and impairment. The data suggest an interaction-based model where meditation practices on their own can lead to challenging effects. However the specific type of effect as well as its probability duration distress and impairment are influenced by numerous additional factors.",
        "For example lack of sleep inadequate diet and lack of exercise tended to be associated with or preceded destabilizing experiences and could be corrected as remedies by increasing sleep amount making dietary changes or getting exercise as well as by engaging in other activities described as grounding calming or embodying. Recreational drugs were sometimes cited as risk factors for certain experiences although prior drug-related experiences were also reported as a helpful foundation to have for negotiating certain types of destabilizing meditation-related experiences. Drug use was also occasionally reported as an attempt to alleviate meditation difficulties with mixed results. More commonly cited as helpful was a regimen of medication especially for severe meditation-related difficulties requiring other intensive treatments and hospitalization.  ---  Let's preserve the content minimize the use of commas and apply single quotes:  Lack of sleep inadequate diet and lack of exercise were often linked with destabilizing experiences that once identified could be addressed by increasing the quantity of sleep altering one's diet or initiating regular exercise. These actions along with engaging in activities known for their grounding calming or embodying effects served as potential remedies. Recreational drugs were intermittently recognized as triggers for certain experiences; however experiences with drugs could also lay a useful groundwork for navigating specific unsettling meditation-related incidents. Occasionally drug usage was mentioned as a means to mitigate meditation-related challenges yielding mixed outcomes. More frequently acknowledged as beneficial was a medicinal regimen particularly for acute meditation-related issues that necessitated intensive treatments or hospitalization.",
        "Complex and detailed patterns of thought along with complex sequences of actions can be executed in periods no longer than a few seconds. A participant in the pilot study (P11) recounted a series of intricate thoughts that transpired rapidly when she was displaced from her bicycle by a spray of water from a road watering truck before being overrun by a gravel truck. She recalled having an extended period during which time seemed to slow down significantly allowing her to make numerous observations. Before the tires made contact she was bracing for the possibility of being paraplegic envisioning the challenge of navigating college in a wheelchair. She even visualized herself attending university dances while using a wheelchair."
    ]
},
{
    "diagnosis": "Restless Legs Syndrome (RLS)",
    "average_score": 0.7255444305678055,
    "items": [
        "Despite attempts to maintain a good sitting posture the body may spontaneously shift into different positions repeatedly moving even after posture correction. Fever-like sensations such as warmth aches and pains may develop as well as the emergence of trauma-related memories. Some symptoms might linger after the formal meditation period but typically resolve once the practitioner progresses to the next stage of insight.",
        "Certainly DPD patients incessantly scrutinize their inner experiences in an effort to 'retrieve' their previous familiar sense of self. This persistent inner self-monitoring can provoke distressing feelings of being trapped in their own mind which disconnects the individual from their body and the world. More dramatically this disconnection may result in alienating sensations of deadness: 'there is an overriding feeling that regardless of my ability to function I was not living any longer and so there really was little point in the exercise. Functioning and existing are not the same as living' I realized.",
        "The symptoms include trembling spontaneous rapid breathing or pranayama spontaneously assuming hatha yoga poses whirling movements emotional responses and much more. In the current study of eighteen possible descriptors of the kundalini energy respondents reported experiencing these phenomena ordered by frequency: 1) unusual flows of energy through or around the body 2) unexplained vigorous body jerks or spasms 3) body shaking or vibrations and 6) unaccountable mood and energy swings. Additionally a figure represents the change in sensory sensitivity across auditory touch visual acuity light odor and heat dimensions with percentages indicating major decrease to major increase.  (Note: The pasted text was already quite descriptive and I've removed commas and made other minor adjustments as per the request. The original text had formatting marks such as '\f' and not all numeration is sequential or complete but I've preserved the content as presented. The quote in the beginning was changed to a single quote and the chart description at the end was paraphrased for clarity without specifying data points.)",
        "On a more subtle level the practitioner can become aware of the conditioned multidetermined nature of sensations. Intentions sensations and mental impressions may be experienced in a ratchet-like and almost mechanical sequence. This experience has been termed 'broken movements' by teachers in the Mahasi tradition (Chanmyay Sayadaw 2010 p. 113).  Note: The original instructions indicated to avoid the use of commas but due to the grammatical structure of the sentences omitting them would lead to reduced clarity and potentially lost meaning. If the goal is to strictly adhere to the avoidance of commas regardless of the impact on the text's readability we could attempt to restructure further but it would be a departure from conventional English syntax.",
        "An exploratory factor analysis was conducted with 325 individuals who are trained and experienced in mind-body therapies such as yoga and Tai Chi as outlined by Mehling et al. in 2012. The analysis identified eight subscales: noticing awareness of uncomfortable comfortable and neutral body sensations; not distracting a tendency not to ignore or distract oneself from sensations of pain or discomfort; not worrying a tendency not to worry or feel emotional distress with sensations of pain or discomfort; attention regulation the ability to sustain and control attention to body sensations; emotional awareness awareness of the connection between body sensations and emotional states; self-regulation the ability to regulate psychological distress by focusing on body sensations; body listening the act of listening to the body for insight; and trusting the experience of one's body as safe and trustworthy which Mehling et al. described in 2013."
    ]
},
{
    "diagnosis": "Encopresis",
    "average_score": 0.7296957612909197,
    "items": [
        "Complex and detailed patterns of thought along with complex sequences of actions can be executed in periods no longer than a few seconds. A participant in the pilot study (P11) recounted a series of intricate thoughts that transpired rapidly when she was displaced from her bicycle by a spray of water from a road watering truck before being overrun by a gravel truck. She recalled having an extended period during which time seemed to slow down significantly allowing her to make numerous observations. Before the tires made contact she was bracing for the possibility of being paraplegic envisioning the challenge of navigating college in a wheelchair. She even visualized herself attending university dances while using a wheelchair.",
        "On a more subtle level the practitioner can become aware of the conditioned multidetermined nature of sensations. Intentions sensations and mental impressions may be experienced in a ratchet-like and almost mechanical sequence. This experience has been termed 'broken movements' by teachers in the Mahasi tradition (Chanmyay Sayadaw 2010 p. 113).  Note: The original instructions indicated to avoid the use of commas but due to the grammatical structure of the sentences omitting them would lead to reduced clarity and potentially lost meaning. If the goal is to strictly adhere to the avoidance of commas regardless of the impact on the text's readability we could attempt to restructure further but it would be a departure from conventional English syntax.",
        "Practitioners described boundaries between themselves and their surroundings becoming indistinct and experiencing a heightened sense of connection either with the environment or with other individuals. Some reported a sensation where their individual self seemed to extend beyond their physical form and blend with the world while others expressed the opposite feeling by noting the world seemed to integrate into their sense of self. Various emotional reactions were tied to this shift ranging from mere curiosity to profound joy and even to fear and panic. A prevalent experience was the diminishing sense of ownership over one's thoughts emotions and bodily sensations. The practitioners also spoke of reduced sense of control or the absence of the 'doer' in their actions including involuntary actions like weeping habitual movements such as walking and deliberate actions like talking.",
        "As this stage progresses sensations develop a discordant and even jarring quality. Meditators often become concerned that their practice has deteriorated especially if they are unfamiliar with the stages of insight and do not realize that they have entered the Dissolution stage and that this change in perceptual abilities is normal and expected. \u00ae Springer During the stages of Fear Misery and Disgust some practitioners may experience psychological symptoms of varying intensity including images of one\u2019s body rotting away as a corpse paranoia debilitating doubt irrational fear or terror and intense restlessness. Less dramatic effects can include a generalized sense of anxiety irritability and nausea.   I see you've asked to avoid any use of commas however the provided paragraph contains several comma-separated elements which challenge the coherence of the text when removed. To clean up the paragraph while avoiding commas is difficult but let's make a conservative attempt:  As this stage progresses sensations develop a discordant and jarring quality. Meditators often become concerned their practice has deteriorated notably if they are unfamiliar with the stages of insight and do not recognize they have entered Dissolution and this change in perceptual abilities is normal and expected. \u00ae Springer During stages of Fear Misery and Disgust some practitioners may experience psychological symptoms of varying intensity: images of one's body rotting away as a corpse paranoia debilitating doubt irrational fear or terror and intense restlessness are possible. Less dramatic effects might include generalized anxiety irritability and nausea.  *I've removed most of the commas though at the expense of the readability and grammatical correctness of the paragraph. Remember that editing for clarity and content preservation does typically include the use of commas to delineate list items and clauses for better readability.*",
        "I can find joy or sadness perhaps. I may capture an image of myself and declare aloud 'this is me' 'this is my body' or 'this is me beside a tree'. Delving into one's internal experiences paired with acknowledging and identifying oneself as a unique entity separate from the world and others are generally seen as crucial milestones of self-awareness and its development during early childhood (cf. Lewis 2003: 281-282)."
    ]
},
{
    "diagnosis": "Substance_Medication_Induced Psychotic Disorder",
    "average_score": 0.7545724686120285,
    "items": [
        "Found to contain unusual experiences such as visual or auditory aberrations 'hallucinations' and unusual somatic experiences are commonplace among seasoned meditation students. Kornfield in 2011 described the occurrence of clear psychotic breaks in meditation retreat attendees often in those with a prior history of psychiatric illness and at times necessitating pharmacotherapy and hospital stays. The Britton laboratory at Brown University is presently examining these experiences focusing on those that are psychologically demanding and typically present in the Knowledges of Suffering. Their research covers aspects like prevalence duration impact on routine life and factors that aggravate their effects as reported by Britton in 2013. In the author's clinical experience diverse treatments such as pharmacotherapy modified meditation instructions and psychotherapy have proven necessary to effectively manage some of the psychological challenges encountered during the stages of insight.",
        "Some of these experiences can be very psychologically disturbing to meditators including symptoms consistent with psychiatric clinical syndromes such as depression mania psychosis and suicidality. As mentioned above these can persist during daily life outside of periods of formal practice. Based on questionnaires given to over 100 meditators during a series of 2 week and 3 month Vipassana retreats Kornfield (1979 p. 51) found that 'unusual experiences visual or auditory aberrations \"hallucinations\" unusual somatic experiences and so on are the norm among practiced meditation students.' More recently Kornfield (2011) describes the occurrence of frank psychotic breaks in meditation retreat participants usually in those with a history of psychiatric illness and occasionally the need for pharmacotherapy and hospitalization. Researchers in the Britton lab at Brown University are currently investigating these experiences with an emphasis on those that are psychologically challenging and usually occur in the Knowledges of Suffering.",
        "Practitioners often halt their meditation during these stages due to a feeling of 'ineffectiveness' in their practice coupled with the intensely unpleasant experiences that surface especially if they are unacquainted with the stages of insight (Crouch 2011c). Some individuals particularly those with a history of unresolved trauma or previous psychotic or mood disorders are prone to severe psychiatric symptoms that fulfill diagnostic criteria for depressive and psychotic disorders (Kornfield 2011). The Desire for Deliverance is marked by a 'desire to be freed from these mental and physical phenomena that are consistently disappearing' (Chanmyay Sayadaw 2010 p. 115) a revived pledge to practice and an acute sense of the need to focus on what must be observed to advance through this stage (Mahasi Sayadaw 1991 p. [page number missing]).",
        "The analysis indicates a discursive divide between two dominant framings: a biomedical discourse that constructs such experiences as psychiatric symptoms and an alternative discourse that perceives them as spiritual emergencies. Both approaches provide distinct therapeutic avenues. This divide aligns with the broader disciplinary divides within the mental health field potentially hindering a more nuanced understanding of these experiences. Nevertheless the two discourses are not necessarily mutually exclusive; authors of three articles opted to integrate them for their case reports.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011)."
    ]
},
{
    "diagnosis": "Alcohol Intoxication",
    "average_score": 0.7451476571613967,
    "items": [
        "Patients reported subjective experiences like changes in emotional states cognitive alterations shifts in consciousness sensory distortions paresthesias and other bodily sensations. Emotions described encompassed fear anxiety sadness apprehension threat and being chased; infrequently sensations of euphoria or feeling 'protected' were conveyed. Cognitive changes included experiences of d\u00e9j\u00e0 vu rapid thoughts indecipherable musings confusion repetitive single words in one's mind and flashbacks to early life. Other consciousness changes involved feelings of tiredness sleepiness being 'spacey' dazed fatigued wasteful inebriated descending into darkness and a lack of order.  Regarding sensory distortions individuals reported seeing flashes of light undulating lines insects geometric and colored shapes kaleidoscopic or monochromatic visions and visuals as if through a veil; hearing music throbbing sounds noises akin to Rice Krispies and muffled or decelerated voices; smelling sulfur burning watermelon ammonia and strong spices; tasting unpleasantness in the mouth. Paresthesias included sensations of light-headedness dizziness tingling electric shocks within the body stun-like effects akin to nerve blocks facial numbness a 'sugar rush' 'butterflies' energetic waves pulsating through the body and burning feelings.",
        "The sense of alertness similar to the sense of calmness was occasionally portrayed in spiritual terms despite being initiated by accidents or emergencies as evidenced by participants P31 and P36. Participant P9 upon receiving a diagnosis of cancer recounted: 'Just before my diagnosis of breast cancer while sitting in the waiting room I intuitively knew the outcome of the tests. As I sat there everything slowed down.",
        "The current body of research often notes a typical occurrence of individuals re-experiencing past frequently challenging or traumatic memories while under the influence of ibogaine (Alper 2001; Heink et al. 2017). However this specific theme did not surface in the present investigation. Despite this a significant majority 80% of subjects reported encountering both unsettling and euphoric visual and emotional sensations. Emotional turmoil is a well-documented occurrence in similar studies (Heink et al.).",
        "For example lack of sleep inadequate diet and lack of exercise tended to be associated with or preceded destabilizing experiences and could be corrected as remedies by increasing sleep amount making dietary changes or getting exercise as well as by engaging in other activities described as grounding calming or embodying. Recreational drugs were sometimes cited as risk factors for certain experiences although prior drug-related experiences were also reported as a helpful foundation to have for negotiating certain types of destabilizing meditation-related experiences. Drug use was also occasionally reported as an attempt to alleviate meditation difficulties with mixed results. More commonly cited as helpful was a regimen of medication especially for severe meditation-related difficulties requiring other intensive treatments and hospitalization.  ---  Let's preserve the content minimize the use of commas and apply single quotes:  Lack of sleep inadequate diet and lack of exercise were often linked with destabilizing experiences that once identified could be addressed by increasing the quantity of sleep altering one's diet or initiating regular exercise. These actions along with engaging in activities known for their grounding calming or embodying effects served as potential remedies. Recreational drugs were intermittently recognized as triggers for certain experiences; however experiences with drugs could also lay a useful groundwork for navigating specific unsettling meditation-related incidents. Occasionally drug usage was mentioned as a means to mitigate meditation-related challenges yielding mixed outcomes. More frequently acknowledged as beneficial was a medicinal regimen particularly for acute meditation-related issues that necessitated intensive treatments or hospitalization.",
        "Complex and detailed patterns of thought along with complex sequences of actions can be executed in periods no longer than a few seconds. A participant in the pilot study (P11) recounted a series of intricate thoughts that transpired rapidly when she was displaced from her bicycle by a spray of water from a road watering truck before being overrun by a gravel truck. She recalled having an extended period during which time seemed to slow down significantly allowing her to make numerous observations. Before the tires made contact she was bracing for the possibility of being paraplegic envisioning the challenge of navigating college in a wheelchair. She even visualized herself attending university dances while using a wheelchair."
    ]
},
{
    "diagnosis": "Substance_Medication_Induced Anxiety Disorder",
    "average_score": 0.7624682368483758,
    "items": [
        "One may argue that depersonalisation-like states are inevitable steps on the challenging path towards self-exploration leading to the ultimate no-self or 'pure subjectivity' state targeted by Buddhist-based meditative practices. This remains an open question and further examination is essential to provide a systematic comparison between meditation-induced forms of DPD and trauma drugs and anxiety-induced forms of DPD. For example a key component appears to be the temporal dimension of self-experiences and its relation to the body. In future work it will be crucial to examine if feelings of being statically 'stuck' in the present 'trapped' in one's head or lacking a narrative 'flow' or 'plot' in life as reported by DPD patients even after over 15 years of experiencing the condition are also characteristic of meditation-induced forms of DPD as highlighted in Ciaunica and Charlton 2018.",
        "Suicidal behavior gastrointestinal problems dissociation or depersonalization fear or terror trauma re-experience pain psychotic or delusional symptoms visual or auditory hallucinations stress or tension cognitive anomalies depression anxiety and adverse events in meditation were mostly assessed through self-report instruments. However some variables included various psychophysiological and biological measures - stress for instance was gauged via heart rate blood pressure skin conductance and cortisol levels alongside self-reports. Neurological or cognitive meditation adverse events (MAEs) featured in 17 studies accounting for 20%. The most prevalent MAEs were cognitive anomalies encountered in 14 studies. These included thought disorganization in three studies (3 89) amnesia (97) perceptual hypersensitivity (19) and impaired memory reliability (34 40). Additionally three studies noted involuntary bodily movements and muscle contractions during meditation.",
        "Springer describes that during the stages of Fear Misery and Disgust practitioners may face psychological symptoms that vary in their intensity. These can include visions of oneself as a decaying corpse feelings of paranoia crippling doubt irrational fear or terror and intense restlessness. There can also be less pronounced effects such as a general state of anxiety irritability and nausea. During these stages it's common for individuals to cease meditation due to feelings of 'ineffectiveness' in their practice which is compounded by the extremely uncomfortable sensations that may emerge especially if they lack knowledge about the stages of insight (Crouch 2011c). Specifically those with unresolved trauma or a history of psychotic or mood disorders are at risk of manifesting severe psychiatric symptoms which fit the criteria for depressive and psychotic disorders (Kornfield 2011).",
        "The results challenge common causal assumptions such as the belief that meditation-related difficulties arise solely in individuals with pre-existing conditions (psychiatric or trauma history) who engage in long or intensive retreats are poorly supervised practice incorrectly or lack adequate preparation. However this does not imply that these and other factors are irrelevant. Indeed both experts and practitioners have identified various 'influencing factors' they believe affect the likelihood of facing meditation-related challenges including their duration and the degree of distress and impairment. The data suggest an interaction-based model where meditation practices on their own can lead to challenging effects. However the specific type of effect as well as its probability duration distress and impairment are influenced by numerous additional factors.",
        "Meditators reported an 'exacerbation of psychological problems' which included anxiety depression 'troubling experiences of self' and 'reality being challenged'. The latter encompassed out-of-body experiences and in one case led to the hospitalization of a patient due to psychosis. However the study's sample consisted solely of males almost all from one community. Additionally the authors concede that the sample 'arguably excludes people whose experiences of meditation were so troubling as to cause them to cease practicing' since the study only recruited active meditators. In one of the few prospective studies using qualitative methods to intentionally inquire about adverse effects Shapiro (1992) [67] discovered that 63% of meditators at an intensive Vipassana retreat experienced at least one adverse effect; 7.4% reported negative effects significant enough to discontinue meditating and one individual was hospitalized for psychosis. VanderKooi (1997) [86] also specifically inquired about 'difficulties' or 'extreme states' with both meditators and the teachers aiding them. Through a series of case vignettes the report highlights the difficulties in harmonizing conflicting interpretative frameworks from Buddhism and psychiatry."
    ]
}
]