Mindfulness-based stress reduction (MBSR): the course, the evidence and possible downsides

The US National Center for Complementary and Integrative Health describes MBSR as a programme that teaches mindful meditation but also includes discussion sessions and other strategies to help people apply what they learn to stress. It is usually taught to a group by a trained teacher.

The NCCIH summary does not give the number of weeks or the weekly time commitment, so confirm the length, session times and expected home practice with any course you are considering. The NHS lists mindfulness meditation, yoga and tai chi among formal mindfulness practices.

A related programme, mindfulness-based cognitive therapy, is covered in its own guide on this site and is the mindfulness-based approach used for depression.

The NHS describes everyday mindfulness as paying attention to what is going on inside and outside ourselves, moment by moment. NHS inform adds that mindfulness is easy to practise, needing no special training, equipment or money. A formal course is a more structured route for those who want teaching and group support.

NCCIH reports strong evidence that mindfulness approaches performed as well as cognitive behavioural therapy and antidepressant medication for anxiety and depression. It also describes strong evidence for chronic pain, improved sleep quality comparable to cognitive behavioural therapy, and reduced cravings in substance use disorders.

Evidence is moderate for post-traumatic stress symptoms, cancer-related distress and fatigue, and blood pressure. It is limited or mixed for acute pain, where there was no evidence of reduced pain severity though pain tolerance may improve, for attention deficit hyperactivity disorder, and for weight loss, where mindfulness was less effective at helping people lose weight despite benefits for eating behaviours.

Mindfulness is not harmless for everyone. A 2020 review found that about 8 per cent of participants had a negative effect from practising meditation, with anxiety and depression the most common. NCCIH adds that few studies have examined potentially harmful effects.

The NHS is similarly careful: many people find mindfulness helpful, but it is not right for everyone, and some people find it does not help or can make them feel worse. Sitting quietly with difficult thoughts can be uncomfortable, particularly during a depressive episode or after trauma.

• If a practice increases distress, you can stop it, shorten it or switch to an eyes-open, movement-based version.

• Tell the teacher beforehand about depression, anxiety, trauma or other mental health conditions.

• Raise persistent worsening of mood with your GP rather than pushing through.

NCCIH advises asking about the training and experience of the instructor, and gives no single credential. Because mindfulness teaching is not a statutorily regulated profession in the UK, questions about training, supervision and experience with your health condition are the practical safeguard.

Some NHS services, workplaces and community organisations run mindfulness courses, and the NHS notes that NICE suggests employers consider providing access to mindfulness to support employee wellbeing. Ask your GP or local talking therapies service what is commissioned in your area, and treat any claim of guaranteed results with caution.