Symptom Worsening in Mindfulness-Based Cognitive Therapy (Goldberg et al., 2026)
Any treatment that asks people to turn toward difficult thoughts and feelings invites a fair question: could it make some people feel worse? Mindfulness-based cognitive therapy, or MBCT, is an eight-week group program recommended in clinical guidelines to help people with recurrent depression stay well, yet questions about the safety of mindfulness-based programs have been growing. Two earlier studies documented patient-reported harm, but neither had a control group, so they could not show whether MBCT made such experiences more likely. A research letter in JAMA Network Open, from Simon Goldberg of the University of Wisconsin–Madison, Willem Kuyken of the University of Oxford and colleagues, tackled the question with a control comparison.
The preregistered analysis reused participant-level data from nine randomized trials of MBCT for preventing depressive relapse, first gathered for a 2016 meta-analysis. The 1,258 adults (596 in MBCT and 662 in control groups, average age 47, three-quarters of them women) all had recurrent major depression and were in full or partial remission when they joined. Working from each person’s own scores allowed the team to define symptom worsening as a rise on the Beck Depression Inventory, a standard questionnaire, of about a quarter of a standard deviation or more between the start of the trial and the end of treatment, and then compare the odds of that happening with and without MBCT. Some trials compared MBCT with active treatments such as antidepressants or cognitive psychoeducation.
Across the analyses, there was no evidence that MBCT increased the odds of symptom worsening. At the end of treatment, about 22 percent of people who received MBCT had worsened, compared with about 33 percent of controls. In the main statistical model, which combined results study by study, that difference was not statistically significant. Interestingly, a second approach that analyzed all participants together suggested that MBCT lowered the odds of worsening, including relative to antidepressants, but the main model did not, and results varied noticeably between trials. These apparent advantages are best treated as possibilities rather than established findings.
The authors note several limits. All of the trials involved people in remission or partial remission, so the findings may not apply to people who are acutely depressed or have other conditions. Worsening on a depression questionnaire is a useful signal of possible harm, but it does not capture the full range of adverse experiences that mindfulness training can bring, and some people do face significant challenges along the way.
The authors conclude that randomized trials have not shown MBCT to cause symptom worsening, which supports continuing to offer it as an evidence-based treatment for recurrent depression. Future trials will need to assess a broader set of possible adverse experiences so that benefits and harms can be weighed on the same scale.
Reference and link: https://doi.org/10.1001/jamanetworkopen.2026.29946
