Mindfulness-based cognitive therapy does not increase the risk of depressive symptom worsening among patients in remission, according to a meta-analysis published in JAMA Network Open by researchers at the University of Wisconsin-Madison and a multi-university team, offering new clarity on the safety of the widely used psychological treatment.
Depression remains one of the world’s most widespread health conditions, affecting hundreds of millions of people worldwide and frequently returning even after an initial recovery. For individuals who have experienced repeated episodes, preventing relapse is just as critical as addressing acute symptoms. Mindfulness-based cognitive therapy, commonly known as MBCT, has long served as a cornerstone for this kind of long-term care, combining cognitive behavioral therapy with structured mindfulness practices such as meditation and mindful movement.
Yet, as the intervention gained traction across global healthcare systems following a seminal 2016 meta-analysis, questions regarding its safety began to surface. Limited studies suggested some patients experienced troubling or harmful effects during mindfulness interventions. However, those earlier warnings largely lacked a control group, making it difficult to determine whether symptom fluctuations stemmed from the therapy itself, the natural course of recurrent depression, or unrelated life events.
Reevaluating Trial Data at the University of Wisconsin-Madison
To settle the safety question, researchers at the University of Wisconsin-Madison’s Center for Healthy Minds joined forces with the UW-Madison Department of Educational Psychology and a broader multi-university team to reexamine the individual participant data behind the original 2016 findings.
The investigative team gathered de-identified individual participant data from nine randomized controlled trials evaluating MBCT for depression relapse prevention. These studies encompassed a total of 1,258 adult patients who were generally in partial or full remission when they entered the trials. By analyzing individual trajectories rather than relying solely on summary outcomes, the researchers could directly compare the odds of increased depressive symptoms post-treatment against control conditions.
The results provided clear reassurance. The data showed no evidence that MBCT increases the risk of depressive symptoms becoming worse relative to control groups. In fact, secondary analyses indicated that participants assigned to MBCT sometimes experienced a lower risk of worsening compared to alternative treatments, including antidepressant medications.
Clinical Significance and Expert Perspectives
The findings offer vital backing for clinicians and healthcare providers who recommend MBCT to help patients navigate the fragile period following depression recovery. Simon Goldberg, core faculty at the Center for Healthy Minds and associate professor in the UW-Madison Department of Counseling Psychology, underscored the necessity of addressing the safety concerns directly.
“Due to the pervasiveness of global depression, as well as the wide dissemination of MBCT across healthcare systems, it is crucial to investigate any possible risk factors.”
Simon Goldberg, Associate Professor at UW-Madison’s Department of Counseling Psychology
Goldberg noted that because the original 2016 meta-analysis proved so influential, collaborating to answer outstanding questions about symptom worsening was essential. While the current findings support the continued dissemination of the therapy, the research team emphasized a key boundary condition: because the analyzed trials focused on individuals in partial or full remission, the conclusions may not apply directly to patients experiencing acute depression or other clinical populations.
Future Clinical Trials and Patient Experience Assessments
Looking ahead, researchers hope to expand how patient experiences are measured in subsequent investigations. While randomized controlled trials remain the gold standard for clinical study, incorporating broader qualitative and experiential assessments will help paint a more granular picture of how individual patients interact with mindfulness-based programs.
“We hope that future randomized control trials will include a broader assessment of patient experiences, however, we are optimistic following these important findings that MBCT is both helpful and not harmful to the average patient,”
Simon Goldberg, Associate Professor at UW-Madison’s Department of Counseling Psychology
As research into mindfulness and mental health continues to expand, these findings help secure MBCT’s place as a dependable, evidence-based tool for preventing relapse, grounding its clinical utility in rigorous, controlled data.
