Mindfulness for OCD, Bipolar Disorder and Psychosis: Evidence and Cautions

Urgent help first

If you or someone else is thinking about suicide or self-harm, call or text 988 (the 988 Suicide & Crisis Lifeline, free, 24 hours a day) or call 911 in the US if there is immediate danger. [1] Call 911 too if someone is severely confused, cannot stay safe, or is acting on frightening beliefs or voices. If meditation seems to be making thoughts, sleep or mood worse, stop practicing and contact your clinician the same day.

Where mindfulness fits

These conditions are treated mainly with talking therapy and medicine. The NHS describes OCD treatment as therapy with exposure and response prevention and/or an SSRI medicine [2], and psychosis treatment as antipsychotic medicines, talking therapies and social support [3]. NIMH says bipolar disorder usually requires lifelong treatment. [4] Mindfulness has been tested as an addition to this care. Never stop or change medicine because of meditation, and NCCIH advises against using it to replace conventional care. [5]

Labels used: promising but limited, mixed, insufficient evidence.

Obsessive-compulsive disorder (OCD)

• A 2025 review of 46 trials (2,221 patients) of mindfulness- and acceptance-based programs found large reductions in OCD severity compared with controls overall. [6]
• Compared with cognitive behavioral therapy (CBT) and exposure and response prevention, there was no difference. Compared with medication it did better (5 comparisons) and compared with waitlists much better, but waitlist comparisons flatter any treatment. [6]
• A 2026 review limited to 6 trials with active comparison groups (499 people) found mindfulness did not differ significantly from cognitive-behavioral techniques on OCD symptoms or dropout. [7]
• Label: promising but limited. The authors call for longer, higher-quality trials. [6] Exposure and response prevention remains the therapy the NHS names first. [2]

Bipolar disorder

• A 2020 review of 10 studies (only 3 controlled) found depression and anxiety scores fell after mindfulness-based cognitive therapy (MBCT), mania symptoms did not, and the gains were gone at 12 months. [8]
• A 2023 trial of 144 people with bipolar I or II found MBCT added to usual care was not more effective for depressive symptoms than usual care alone; exploratory analysis suggested those with more depression and functional impairment benefited more. [9]
• In that trial, 29 of the 72 people monitored during MBCT reported adverse experiences (7 were later judged not due to MBCT), mostly in the first 3 weeks. They were not serious or lasting, and more than half later saw them as part of a therapeutic process; higher baseline anxiety raised the risk. [10]
• Label: mixed. Whether meditation can trigger mania is unclear: the only mania-specific item we found was a single case letter with no abstract available to read, so proper evidence on this risk was not found.

Psychosis and schizophrenia

• A 2020 review of 10 trials (1,094 people) found mindfulness added to standard care improved overall symptoms and functioning, but the authors urged caution because trials differed and had weaknesses. [11]
• A 2024 analysis of 18 trials found better psychosocial function and insight. [12]
• A 2024 safety review of 39 trials (2,684 people) found hospitalization and crisis service use were higher in control groups, and no significant difference in adverse events, but no trial reported side effects of therapy and harm reporting was inconsistent. [13]
• Case reports describe psychosis linked to intensive, unguided meditation. They cannot show how common this is, and the authors advise tailoring practice after assessing mental state. [14]
• Label: promising but limited, for clinician-led, adapted programs only. This is different from intensive retreats or unguided long sessions. See Meditation and Psychosis or Mania.

Borderline personality disorder

A 2022 review of 5 trials (294 people) reported improvements in impulsivity, emotion regulation and attention skills after mindfulness training, and said larger, longer trials were needed. [15] Mindfulness skills are part of some structured therapies such as DBT; see ACT and DBT Mindfulness Skills. Label: promising but limited.

Related pages

• Who Should Check With a Clinician Before Meditating
• When to Stop or Pause Meditating
• Meditation Compared With Medication and Therapy