Depression is one of the world’s most widespread health conditions, affecting hundreds of millions of people and often returning after an initial recovery. For patients who have experienced repeated episodes, preventing relapse can be as important as treating symptoms in the first place. A new analysis from researchers at the University of Wisconsin–Madison’s Center for Healthy Minds, the Department of Educational Psychology and a wider multi-university collaboration now offers reassurance about one of the most widely used psychological approaches for this purpose: mindfulness-based cognitive therapy, or MBCT. The study found no evidence that MBCT increases the risk of depressive symptoms becoming worse when compared with control conditions.
Published in JAMA Network Open, the research revisits evidence from nine randomized controlled trials involving 1,258 adults with recurrent depression. The participants were generally in partial or full remission when they entered the original studies, meaning they were not experiencing the most severe phase of an acute depressive episode. The researchers used individual participant data rather than relying only on summary results reported in earlier publications. This approach allowed them to examine changes in symptoms for each participant and compare the likelihood of worsening between people assigned to MBCT and those receiving control treatments.
MBCT combines techniques from cognitive behavioral therapy with structured mindfulness practices. Cognitive behavioral therapy helps patients identify patterns of thinking that can intensify emotional distress and teaches strategies for responding to those patterns differently. Mindfulness training, meanwhile, encourages people to observe thoughts, feelings and bodily sensations without immediately judging or reacting to them. In clinical programs, participants typically practice meditation and mindful movement while learning how to recognize early warning signs of relapse. The aim is not to eliminate difficult thoughts, but to reduce the automatic cycles of rumination and avoidance that can contribute to depression.
The treatment became a major focus of depression research after a landmark 2016 meta-analysis combined results from nine studies and supported MBCT as an effective strategy for preventing relapse. A meta-analysis statistically integrates findings from multiple investigations, increasing the amount of evidence available and making it possible to estimate an overall treatment effect. Those earlier findings helped establish MBCT as a recommended option for people with recurrent depression. But the treatment’s growing popularity also prompted a difficult safety question: could intensive attention to distressing thoughts and emotions make some patients feel worse?
That concern was fueled by limited studies in which patients reported harmful or troubling experiences during mindfulness-based interventions. Such reports deserve attention, particularly when an intervention is delivered across healthcare systems and to large populations. However, the earlier studies generally lacked a control group. Without a comparison group, researchers cannot determine whether symptom worsening was caused by the treatment, by the natural course of depression, by unrelated life events or by the difficulties faced by people receiving other forms of care. Depression symptoms can fluctuate even when no intervention is introduced, making controlled comparisons essential for assessing risk.
The new analysis was designed to address that limitation. The researchers reevaluated the original trial data and defined symptom worsening by examining whether participants showed increased depressive symptoms after treatment relative to their starting point and assigned control condition. They then calculated the odds of worsening in the MBCT groups compared with participants who received alternative interventions or control care. Some control groups included people taking antidepressant medication, allowing the investigators to make additional comparisons with a commonly used medical treatment. Because the analysis used data from randomized trials, assignment to MBCT or control conditions was not determined by patients’ preferences or clinicians’ expectations alone, reducing several sources of bias.
The central result was clear: the data provided no evidence that MBCT increased the odds of depressive symptom worsening compared with control conditions. In some secondary analyses, participants assigned to MBCT appeared to have a lower risk of worsening than those receiving other treatments, including antidepressants. These additional findings should be interpreted cautiously because secondary analyses can be affected by differences among the original trials, treatment formats and comparison groups. Nevertheless, the overall pattern did not support the idea that MBCT carries a general risk of worsening depression for the average patient participating in relapse-prevention treatment.
The findings do not mean that every person will benefit from mindfulness practice or that unwanted experiences are impossible. Psychological treatments can affect patients differently, and some people may find meditation uncomfortable, emotionally demanding or difficult to practice without expert guidance. The trials included in this analysis also focused mainly on adults who had recurrent depression but were in partial or full remission. Their results may therefore not apply directly to people experiencing acute, severe depression, individuals with other psychiatric conditions or patients whose symptoms are changing rapidly. Clinicians still need to monitor patients carefully, discuss possible reactions to treatment and provide alternative care when necessary.
Researchers say the next generation of randomized trials should collect a broader range of information about patient experiences, including both benefits and harms. Standard measures of depressive symptoms are important, but they may not capture feelings such as emotional disconnection, heightened anxiety, distress during meditation or changes in day-to-day functioning. More detailed safety monitoring could help identify whether particular patients, practices or delivery settings are associated with different outcomes. It could also distinguish temporary discomfort that resolves with support from clinically meaningful deterioration requiring a change in treatment.
For now, the study strengthens the evidence supporting MBCT as a relapse-prevention option for recurrent depression. Its importance lies not in showing that mindfulness is universally effective, but in testing a specific safety concern with controlled data from more than a thousand participants. As MBCT continues to spread through hospitals, mental health services and community programs, the analysis offers a measured message: available trial evidence does not show that the therapy makes depressive symptoms worse relative to control care, while future research should continue to examine who benefits most, who may struggle and how psychological treatments can be delivered as safely as possible.
Subject of Research: People
Article Title: Symptom Worsening in Mindfulness-Based Cognitive Therapy
News Publication Date: 20-Aug-2026
Web References: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2026.29946 ; https://doi.org/10.1001/jamanetworkopen.2026.29946
References: JAMA Network Open; 2016 meta-analysis indexed at https://pubmed.ncbi.nlm.nih.gov/27119968/; World Health Organization depression fact sheet at https://www.who.int/news-room/fact-sheets/detail/depression
Keywords: Mindfulness-based cognitive therapy, depression, relapse prevention, mental health, meta-analysis, symptom worsening, psychotherapy
Tags: depression relapse preventiondepression symptom managementefficacy of MBCTindividual participant data analysisJAMA Network Open depression studiesmental health interventions comparisonmental health researchMindfulness-Based Cognitive Therapypreventing depressive relapsepsychological approaches for depressionrandomized controlled trials in psychologyrecurrent depression treatment
