Can Mindfulness Make Depression Worse?

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Summary: In general, mindfulness does not make depression worse, when utilized in a treatment context with expert facilitators supported by qualified, experienced mental health professionals.

Key Points:

Every treatment experience can have positive or negative outcomes, from standard psychotherapy, to the use of pharmacological medication, to lifestyle changes, to peer support with minimal counseling or professional therapy.
Positive outcomes generally refer to improved symptoms and quality of life, while negative outcomes most often refer to worsening symptoms of decreased overall quality of life.
Mindfulness is a component in many treatment plans for depression, sometimes as a first-line treatment with mindfulness-based cognitive therapy (MBCBT), or as a supporting, complementary approach in the form of mindful meditation and practices like mindful breathing or walking.
New research examines whether the potential negative outcomes associated with mindfulness may outweigh the positive outcomes, as compared to other forms of treatment for depression.

Mindfulness in Depression Treatment: Help or Harm?

In August 2026, a group of researchers published a review called “Symptom Worsening in Mindfulness-Based Cognitive Therapy.” They conducted the review because mindfulness-based cognitive therapy (MBCBT) and other mindfulness modalities are now common components of depression treatment, but some research indicates that using mindfulness techniques during depression treatment may promote adverse events or worsening symptoms of depression.

In their words:

“Two recent studies examined the occurrence of meditation-related harm in the context of MBCT”

These are the studies in question:

The researchers continue their analysis:

“Although definitions and rates of harm differed across these studies, both documented cases defined as reflecting patient-reported harm. Importantly, neither study included a control condition, making it impossible to evaluate the degree to which MBCT increased the likelihood of these experiences occurring.”

To add to the scholarship on mindfulness in depression treatment, and establish whether mindfulness can make depression worse, the authors reviewed a study that used a control group and allows for an accurate assessment of MBCT and mindfulness, as compared to other forms of treatment for depression.

The authors of the study they reviewed – “Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse: An Individual Patient Data Meta-Analysis From Randomized Trials” – defined this research objective:

“To conduct a meta-analysis on individual patient data to examine the efficacy of mindfulness-based cognitive therapy (MBCT) compared with usual care and other active treatments, including antidepressants, in treating those with recurrent depression.”

We’ll share the top-line data from that study and from first review we cite above. Before we do that, though, let’s define mindfulness, using the words of the world’s foremost and most well-known mindfulness advocate, the late Thich Nhat Hanh, a Vietnamese monk who helped introduce mindfulness to people across the U.S. Here’s how he defines mindfulness:

“…our ability to be aware of what is going on both inside us and around us. It is the continuous awareness of our bodies, emotions, and thoughts.”

With that idea in mind, let’s take a look at the results of those studies.

Depression Treatment: Outcomes Depend on a Variety of Factors

We’ll reiterate something we say in the introduction of this article:

In mental health treatment, not every treatment attempt is one hundred percent successful. On the road to remission and recovery, there may be improvements, drawbacks, and everything in between.

For some people, antidepressants are all they need. For others, it may be once a week CBT with minor changes to daily habits. And for still others, successful depression treatment may require residential treatment and intensive dialectical behavior therapy (DBT) to help people manage overwhelming emotions and develop effective stress management and distress tolerance skills.

Therefore, it would be naïve to suppose that mindfulness or MBCT leads to improvement in every instance, and it would be realistic to suppose that during treatment with mindfulness or MBCBT, some patients may experience a worsening of symptoms or adverse events.

Why?

Because this can happen with any form of treatment: there is no perfect modality that works for everyone in all situations. That’s why a more helpful way to think about mindfulness is to compare it to other common modes of treatment and assess whether – with respect to the well-documented benefits of mindfulness – the harms and adverse events during mindfulness treatment exceed those reported during treatment with modalities that don’t involve mindfulness.

That’s exactly what the researchers did: assessed a study that had adequate controls, involved multiple modalities, and enabled an evidence-based based comparison of the relative harms and/or adverse events associated with each form of treatment.

Let’s take a look at what they found.

Comparing Mindfulness to Other Treatment: Does Mindfulness Make Depression Worse?

To address this question, researchers collected data from 1,258 individual patient records, dividing them into an experimental group, i.e. patients receiving MBCBT, and two active control groups, one receiving antidepressants and one receiving antidepressants + cognitive psychoeducation. Researchers assessed worsening symptoms by comparing baseline scores on the Beck Depression Inventory (BDI) recorded before and after treatment with MBCBT and the two control groups.

Here’s what they found.

Mindfulness vs. Control Groups: Risk of Worsening Symptoms/Adverse Events

First Outcome:

Mindfulness (MBCBT) vs. All Control Groups:
Mindfulness showed 41% decreased risk of worsening symptoms
Risk not identified as significantly different than risk of worsening symptoms in all control groups

Second Outcome:

Mindfulness (MBCBT) vs. Antidepressants + Cognitive Psychoeducation:
Mindfulness showed 33% decreased risk of worsening symptoms
Risk not identified as significantly different than risk of worsening symptoms in antidepressant + cognitive psychoeducation control group

Third Outcome:

Mindfulness (MBCBT) vs. Antidepressants only:
Mindfulness showed 28% decreased risk of worsening symptoms
Risk not identified as significantly different than risk of worsening symptoms in the antidepressant group

We’ll elaborate on these results below.

Do Negative Emotions or Feelings Qualify as Adverse Events or Harms Associated With Treatment?

Let’s be clear that every depression treatment includes a risk of worsening symptoms.

We can expand that – without exaggeration – and say that any treatment for any medical and/or mental health condition/problem/disorder has a risk of not working and therefore a risk of resulting in a worsening of symptoms.

Even drinking a big glass of water for a headache might make your stomach feel worse before your headache begins to improve.

We say that not to trivialize adverse events or negative emotions that arise during treatment, but to offer simple perspective on the topic.

In addition, we should observe that mental health treatment – including depression treatment – can involve psychological, physical, and emotional discomfort. When we discuss adverse events in mental health treatment, we may not always include:

Sadness experienced during treatment sessions for depression
Agitation or restlessness experienced during treatment sessions for anxiety
Mania or hypomania during treatment sessions for bipolar disorder

We may not always include them because those experiences are often an essential part of the healing process, accurately described by the saying, the only way out is through. However, we do always note them and always include them when symptoms do not improve and/or when symptoms worsen. That’s how we know a treatment isn’t appropriate for that individual, and that we need to change that component of the treatment plan.

Do Negative Experiences During Mindfulness Qualify as Harms?

When we discuss feelings that arise during mindfulness practices, we can apply the same template. It’s possible to experience negative emotions or feel adverse physical sensations during mindfulness exercises within a greater treatment context that ultimately leads to improvement. But when the big picture doesn’t improve, i.e. the overall treatment goals are not met, and/or when symptoms worsen, we recognize that mindfulness may be part of the reason for the lack of/absence of progress, and we may remove mindfulness from the treatment plan.

What this study tells us is this:

The adverse events and/or negative emotions experienced during mindfulness practices do not increase risk of worsening symptoms in depression treatment more than standard depression treatments such as treatment with antidepressants or treatment with antidepressants + cognitive psychoeducation.

Here’s how the study authors summarize their findings:

“Across models, we found no evidence that MBCT increased odds of depressive symptom worsening relative to controls…Some individuals experience significant challenges over the course of mindfulness training. However, randomized trials have not demonstrated a causal association with mindfulness interventions when harm is defined as symptom worsening.”

What this means is that mindfulness interventions like MBCBT – despite some studies that document negative experiences during treatment – are nevertheless safe and effective evidence-based treatments for depression, particularly hard-to-treat depression in individuals with a history of relapse.

We understand that a mindfulness approach may not work for everyone, and if it doesn’t, we’ll change the treatment plan. That’s what we mean by a patient-first, integrated approach to treatment. We collaborate with our patients to learn what works best, what resonates most with them, and adjust their plan accordingly across all phase of treatment, from intake to discharge and their return home.