Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive Therapy and How Programs Are Structured

A structured mindfulness program is a set course with a trained teacher, a fixed number of sessions, group discussion and daily home practice. It is different from picking up a meditation recording on your own. This page is the overview of the programs that have been tested in trials, with a short guide to each one and links to the full pages. It is information only and does not replace care from a health professional.

The main programs at a glance

MBSR

Mindfulness-based stress reduction (MBSR) teaches mindful meditation and also includes discussion sessions. [5] It grew out of a 10-week stress reduction program for people with chronic pain, described in a 1982 report on 51 patients. [6] In a recent US trial the course was described as 8 weekly classes of 2.5 hours, a day-long retreat in week five or six, and 45 minutes of home practice a day. [1]

In a 2014 review of 47 trials with active comparison groups, mindfulness meditation programs had moderate evidence of easing anxiety, depression and pain. [7] A meta-analysis of MBSR in healthy adults (29 studies, 2,668 people) found large effects on stress and moderate effects on anxiety, but high variation between studies. [8] In a trial of 276 adults with anxiety disorders, an 8-week MBSR course was not worse than the antidepressant escitalopram on a clinician rating. [9] That trial excluded people with bipolar disorder, psychotic disorders, obsessive compulsive disorder, PTSD, substance use disorders or significant active suicidal ideation, so it says little about them. [1]

For a 342-person back pain trial, see meditation for pain, attention and depression relapse. For the course itself, see MBSR in detail.

MBCT

Mindfulness-based cognitive therapy (MBCT) combines mindfulness practice with parts of cognitive behavioral therapy. [5] NICE (England) describes a group of 8 to 15 people, usually 8 sessions, with homework that includes mindfulness recordings. [2]

An analysis of individual patient data from 9 trials (1,258 people in remission) found lower relapse risk over 60 weeks than in people who did not receive MBCT. [10] In the PREVENT trial of 424 people with three or more past episodes, MBCT with support to taper antidepressants was not shown to be better than staying on antidepressants over 24 months. [11] Label: established for relapse prevention in recurrent depression, not for everyone with low mood. Details are on the MBCT for depression page.

Self-compassion, ACT, DBT and relapse prevention

• Mindful self-compassion and compassion-focused programs: a meta-analysis of 21 trials found effects on self-reported depression and anxiety, but most trials were small. [12] See compassion-focused and self-compassion programs.
• ACT and DBT: these are psychological therapies that include mindfulness skills. A meta-analysis of 39 trials found ACT outperformed control conditions, with no clear difference from CBT. [13] See ACT and DBT mindfulness skills.
• Mindfulness-based relapse prevention: a trial of 286 people after substance use treatment found fewer days of substance use and less heavy drinking at 12 months than relapse prevention or usual aftercare, yet a Cochrane review of 40 trials found the evidence uncertain on most outcomes. [4][14] See mindfulness-based relapse prevention.

Across 142 samples (12,005 people) in a review of mindfulness-based programs for psychiatric conditions, the programs beat no treatment and did not differ from evidence-based treatments. [15] Because trials of these programs cannot hide who got what, and many use waitlist comparisons, expectation can inflate results.

Programs versus apps

A program has a trained teacher, a group, set weekly sessions and homework. An app usually offers recordings on your own. In a 2021 meta-analysis of 97 online mindfulness trials, effects on depression and stress were moderate and on anxiety small, stress effects were larger with guidance, and adherence ranged from 35% to 92%. [16] Proper evidence not found, in the sources read, for a direct trial of a popular app against MBSR or MBCT. See online and in-person courses.

Checking a teacher

• United States: Proper evidence not found for a state or federal license for mindfulness teachers. NCCIH advises asking about the instructor's training and experience. [5]
• England: NICE says group mindfulness should preferably be led by 2 practitioners, at least one with therapy-specific training and competence. [2]
• Teaching competence: authors from mindfulness training centers describe assessing teaching competence as a way to set shared standards, while noting the science behind it is not yet robust enough for wide use. [17] Universities such as Brown list MBSR and MBCT teacher training pathways. [18] Read more at standards for mindfulness teachers.