What NCCIH, NICE and Guidelines Say About Meditation

Public health bodies and guideline writers do not all say the same thing about meditation, and most say less than headlines suggest. This page sets out what each source I read actually says, for which conditions, and how strong the statement is. It is information only. Guidelines change, so check the current version and talk with a health professional about your own situation. Background: what meditation and mindfulness are.

NCCIH (United States)

The National Center for Complementary and Integrative Health describes meditation and mindfulness as usually considered to have few risks, while noting that few studies have looked for harm, so it is not possible to make definite statements about safety. [1] Its review of research is cautious: much of the research has been preliminary or not scientifically rigorous, and results may have been interpreted too optimistically. [1]

On specific uses, NCCIH describes:

• Anxiety and depression: mindfulness-based approaches were better than no treatment and worked as well as evidence-based therapies in a large 2018 analysis. [1] In a later analysis of anxiety disorders, some approaches matched cognitive behavioral therapy, but the risk of bias was unclear. [1]
• Pain: results are mixed. [1]
• Blood pressure: few high-quality studies exist. [1]
• ADHD: studies are not of high quality and evidence is not conclusive. [1]

Its practical tips: do not use meditation or mindfulness to replace conventional care or to postpone seeing a provider, and ask about the instructor's training and experience. [1]

NHS (United Kingdom)

The NHS says studies show mindfulness can help with stress, anxiety and depression, and that more research is needed for other mental health conditions. [2] It also says mindfulness is not right for everyone: some people find it does not help or can make them feel worse. [2]

NICE (England and Wales)

NICE is the United Kingdom's health guidance body. Its depression guideline (NG222, published June 2022) is the clearest case where mindfulness-based therapy is named.

• Treatment of a new episode of less severe depression: NICE lists group mindfulness and meditation among treatment options, describing a programme such as mindfulness-based cognitive therapy (MBCT), usually 8 regular sessions. [3] It notes the approach involves increasing awareness of thoughts and feelings rather than changing them, and does not directly help with relationship, employment or other stressors. [3] NICE says all listed treatments can be first-line, but to consider the least intrusive and least resource-intensive first, guided self-help. [3]
• Preventing relapse: for people who recovered on antidepressants alone and are at higher risk of relapse, NICE says to consider continuing medication, or a course of group CBT or MBCT for those who do not wish to continue on antidepressants. [3] The course usually consists of 8 sessions over 2 to 3 months. [3]

The NHS page also notes that NICE recommends mindfulness-based therapies for treating less severe depression. [2] See MBSR, MBCT and structured programs.

Where NICE is silent: in the recommendations text of NICE's chronic primary pain guideline (NG193), the word mindfulness does not appear; it advises considering acceptance and commitment therapy (ACT) or CBT for pain. [4] The same search of NICE's PTSD guideline (NG116) also found no mention of mindfulness; it advises offering individual trauma-focused CBT to adults with PTSD who presented more than 1 month after the event. [5] Silence is not a judgement that meditation is useless. It means the recommendation text read for this page did not name it; the committees' separate evidence reviews were not read.

American College of Physicians (United States)

In 2017, the ACP's low back pain guideline said that for chronic low back pain, clinicians and patients should initially select non-drug treatment, listing exercise, multidisciplinary rehabilitation, acupuncture and mindfulness-based stress reduction (moderate-quality evidence) among the choices. [6] Many other options were listed alongside, such as tai chi, yoga and cognitive behavioral therapy, mostly with low-quality evidence, and the recommendation was graded strong. [6]

American Heart Association (United States)

A 2017 scientific statement found studies of meditation suggest a possible benefit on cardiovascular risk, although the quality and quantity of data were modest. [7] It said meditation may be considered as an adjunct to guideline-directed cardiovascular risk reduction, with the understanding that the benefits remain to be better established. [7] NCCIH adds that few high-quality studies have examined blood pressure effects. [1]

At a glance

1. NICE NG222

   Established as an option

   Group MBCT-style programme is an option

   Condition: Depression (less severe; relapse prevention)

2. NHS

   Promising but limited to established, by condition

   Can help; not right for everyone

   Condition: Stress, anxiety, depression

3. ACP 2017

   Moderate-quality evidence

   MBSR among first-choice non-drug options

   Condition: Chronic low back pain

4. AHA 2017

   Promising but limited

   May be an adjunct; benefits to be better established

   Condition: Heart risk

5. NICE NG193 / NG116

   No guideline recommendation

   Mindfulness not named in recommendation text

   Condition: Chronic pain; PTSD

How to use this

Treat guidelines as a snapshot for specific conditions, not a blanket endorsement. For detailed evidence, see meditation for stress, sleep and anxiety and meditation for pain, attention and depression relapse. Meditation can be a complement to care, not a replacement for it. If you have thoughts of harming yourself, in the US call or text 988, or call 911 in an emergency.