Mindfulness-Based Programs, CBT and ACT Compared

What each one is

NICE contrasts the two in depression care: group mindfulness work involves increasing awareness and recognition of thoughts and feelings rather than changing them. [2] CBT is a recommended treatment for many mental health problems. [4]

What trials and reviews found

• Overall: a 2013 meta-analysis found mindfulness-based therapy did not differ from traditional CBT or behavioral therapies, or from pharmacological treatments, though only 9 and 3 comparisons were available. [5] A 2018 analysis of 142 samples (12,005 participants) found mindfulness conditions did not differ from evidence-based treatments. [6]
• Anxiety: a meta-analysis of 11 trials found no difference between mindfulness-based approaches and CBT on anxiety, depression and sleep quality after treatment. [7] NCCIH, summarizing a 2021 analysis, says only some mindfulness approaches were as effective as CBT, and the few studies that followed people for more than 2 months found no long-term effects. [1]
• Social anxiety: in 108 unmedicated adults randomized to CBT group therapy, MBSR or waitlist, the two treatments did not differ in reducing negative emotion. [8]
• Chronic low back pain: in 342 adults, MBSR and CBT both beat usual care and did not differ significantly from each other. [9]
• Depression relapse: MBCT reduced relapse risk compared with active treatments in an individual-patient analysis. [10] NICE lists group CBT or MBCT as psychological options for people who do not wish to continue antidepressants. [2]

And ACT?

No recent direct ACT-versus-CBT review could be read for this page. An older review judged that there were not enough well-controlled studies to conclude ACT is generally more effective than other active treatments, though the data were promising, and suggested it may work through different processes. [11] Evidence label: promising but limited for a general verdict; Proper evidence not found here for a current head-to-head summary.

Why no winner

• Most comparisons are small, and reviews of mindfulness note that power may be lacking against active comparators. [12]
• Adverse effects were inconsistently reported. [12]
• Participants cannot be blinded to therapy type.
• Effects differ by condition: relaxation therapy seemed less effective than CBT for post-traumatic stress disorder and obsessive-compulsive disorder in one review. [13]

Fit and practicalities

• Homework: group MBCT needs willingness to do home practice with recordings; group CBT also uses homework. [2]
• Hard for some: mindfulness-based groups may be difficult for people with intense or highly distressing thoughts, or who find focusing on the body difficult. [2]
• Access: in England, many people can self-refer to NHS talking therapies for CBT; some conditions need a GP referral. [4]
• Qualifications: NICE says group work is delivered preferably by two practitioners, at least one with therapy-specific training. [2] See choosing a qualified practitioner.

Related reading: MBSR, MBCT and structured programs, meditation for pain, attention and depression relapse and mindfulness and meditation for stress.