Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive Therapy and How Programs Differ From Apps

MBSR

Mindfulness-based stress reduction (MBSR) teaches mindful meditation and also includes discussion sessions and other strategies to apply what participants learn to stressful experiences. [1] In a 342-person trial in Washington State, MBSR (training in mindfulness meditation and yoga) was delivered in 8 weekly 2-hour groups. [2]

Evidence: a meta-analysis of 29 studies in healthy adults found MBSR moderately effective for stress and anxiety (Hedges g about 0.5), with high variation between studies. [3] Label: promising but limited to mixed. For back pain results see meditation for pain, attention and depression relapse.

MBCT

Mindfulness-based cognitive therapy (MBCT) integrates mindfulness practice with parts of cognitive behavioral therapy. [1] NICE (England) describes a group course designed for people with depression, usually 8 sessions of 8 to 15 people, with homework using mindfulness recordings. [4]

Evidence: for people who have recovered from recurrent depression, an analysis of 9 trials (1,258 patients) found a lower relapse risk over 60 weeks than with usual care or other treatments. [5] NICE says to consider MBCT or group cognitive behavioral therapy for people at higher risk of relapse. [4] Label: established for this specific use, in appropriate clinical contexts. This is not a general claim for everyone.

Programs vs 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%. [6]

I did not find a trial in the sources read that directly compares one popular app with MBSR or MBCT, so treat them as different things. Apps may suit general stress and practice between sessions. Anyone with depression, trauma or other serious symptoms should talk to a clinician first. See meditation for beginners.

Teacher Qualifications and Program Structure

• England: NICE says group mindfulness should preferably be led by 2 practitioners, at least one with therapy-specific training and competence. [4]
• United States: Proper evidence not found for a licensing body for mindfulness teachers. NCCIH advises asking about an instructor's training and experience. [1]
• UK teacher bodies: the British Association of Mindfulness-Based Approaches page could not be read (access blocked), so no claims are made here about its listings.

Questions to ask any teacher: what training did you complete, who supervises you, what happens if practice becomes distressing, and what is the program format. See meditation difficulties and distressing experiences.

Safety and who should take extra care

In community MBSR classes (2,155 people) and three trials, MBSR did not lead to higher harm rates than waitlist. [7] NICE says group mindfulness may be difficult for people with intense or highly distressing thoughts. [4] A small share of participants still experience harm. [7] A trial of MBCT variants measured meditation-related side effects, and lasting bad effects occurred in 6 to 14% of 96 participants. [8]