Mindfulness: what research says, its limits & combining it with therapy

Mindfulness-based stress reduction (MBSR) teaches mindful meditation, with discussion and ways to apply it to stress. Mindfulness-based cognitive therapy (MBCT) combines mindfulness with cognitive behavioral therapy.

Both are usually taught in groups over about eight weeks by trained instructors.

Right mindfulness is one part of the Noble Eightfold Path, alongside wise view, ethical speech and action, livelihood, effort and concentration (Samyutta Nikaya 56.11). Traditionally it is practiced together with ethics, community and a teacher.

Many Buddhist teachers see this wider setting as a source of support and safety. Others welcome secular programs as a helpful doorway. Both views exist with respect.

A 2018 analysis of 142 groups with more than 12,000 people found mindfulness worked better than no treatment for anxiety and depression, and about as well as other proven therapies such as CBT.

Across 9 trials, 38% of people who took MBCT had depression return within 60 weeks, compared with 49% of those who did not. Taking time into account, they were 31% less likely to relapse.

The researchers found no evidence of harm when MBCT was taught by well-trained teachers in a clinical setting.

Studies suggest MBSR may ease low-back pain in the short term, and that mindfulness may help some people tolerate pain better. A 2019 comparison found MBSR and CBT both worked better than no treatment for chronic pain.

A 2018 trial of 203 veterans found meditation was as effective as prolonged exposure therapy in reducing PTSD symptoms and depression.

The VA’s free Mindfulness Coach app teaches mindfulness to veterans, service members and anyone else. It can be used alone or alongside care, but is not a replacement for treatment.

A 2021 analysis of 23 studies found mixed results for anxiety and depression in the short term. Only some types of mindfulness matched CBT, and the few studies that followed people for more than two months found no long-term effects.

A 2019 analysis of 23 studies in college students found some benefit, but most of the studies were of poor quality.

The MYRIAD trial followed 8,376 students aged 11 to 14 in 85 UK schools. One year on, school mindfulness lessons did no better than usual social and emotional teaching for risk of depression or wellbeing.

This does not mean mindfulness never helps young people. It suggests one class for everyone may not be enough, and that some young people need other kinds of support.

The NHS notes that mindfulness is not suitable for everyone: “Some people find that it does not help them or that it can make them feel worse.”

NCCIH advises not to use meditation to replace care from a health professional, or as a reason to put off seeing one.

A study of nearly 100 meditators and teachers from Theravada, Zen and Tibetan traditions described experiences such as fear, anxiety and panic, losing feelings altogether, being very sensitive to light or sound, trouble sleeping and involuntary body movements.

These lasted anywhere from a few days to months, and in some cases more than a decade.

The Brown study found that asking an open question about bad experiences missed about 70% of them. A lack of complaints is often taken as proof that there is no harm, which is not always true.

In the study of Buddhist meditators, talking with someone familiar with challenging meditation experiences was one of the most common ways people found help.

Many people also find it helps to practice less, switch to gentler practices, and spend more time on ordinary, grounding activities. See “When meditation feels hard” in the Buddhist practices for hard times guide.

• Choose an anchor outside the body, like sounds or an object
• Keep sits short, and stop whenever you need to
• Keep your eyes open, with a soft gaze
• Practice with movement, like walking or gentle stretching
• Sit where you can see the door

Grounding skills turn attention to the present through the senses, such as naming things you can see, feeling your feet on the floor, or holding something cool.

If you have a trauma history, a trauma-informed therapist can help you decide whether, when and how to meditate. Some trauma therapies use mindfulness skills in a careful, step-by-step way.

See the Trauma: what it is & how it affects you and Healing from trauma guides.

The same report recommends mental health screening before retreats, practices tailored to each person, and access to professional mental health support.

Questions to ask

• Can I talk with a teacher privately?
• Do you ask about mental health before people join?
• Is someone with mental health training available?
• What happens if someone needs to leave early?

• You feel unreal, detached or far away and it does not pass
• You have not slept for a night or two
• Panic or fear will not settle
• You see or hear things others do not
• Your thinking feels strange, racing or out of control

• Do you check in privately about difficult experiences?
• How long have you been teaching, and where did you train?
• What do you do if a student struggles?
• Will you support me working with a therapist too?

Apps can be a good way to start. But they cannot notice if you are struggling. If an app practice makes you feel worse, stop, and talk with someone you trust.

Experienced monastics and lay teachers have often guided many students through difficult practice periods. It is okay to ask a teacher how they handle these experiences, and to seek a second opinion.

For choosing a teacher and community safely, see the Sangha, teachers & community guide.

MBCT combines mindfulness with cognitive behavioral therapy.

Dialectical behavior therapy (DBT) teaches mindfulness as one of its core skills, alongside handling distress, managing emotions and relationships.

Acceptance and commitment therapy (ACT) uses mindfulness and acceptance to help people live by their values.

Tell your therapist about your practice, including retreats and how long you sit. Tell your teacher, if you feel comfortable, that you are in therapy. This helps both of them support you safely.

You can ask a therapist directly: “Are you comfortable working with someone whose Buddhist practice matters to them?” A good therapist will be open and curious, not dismissive.

See the When faith and therapy meet guide.