Meditation and mindfulness: what the evidence shows, side effects and how to start

“Meditation” is not one method but a word for many practices. Some focus attention on one thing, such as the breath, a sound, an image or a repeated word or phrase (a mantra); others, such as mindfulness, keep attention on the present moment without judging (NCCIH, 2022). A column on Korea’s official mental health portal divides meditation into two broad kinds: focused meditation on one unchanging object, and awareness meditation, in which you attend to changing things such as the breath, sensations or pain and, when attention drifts, notice it and come back (National Mental Health Information Portal, 2020). The Korea Disease Control and Prevention Agency lists meditation, with belly breathing, yoga, progressive muscle relaxation and massage, as one of the relaxation methods that ease physical and mental tension (Korea Disease Control and Prevention Agency, 2026).

Mindfulness means paying attention to what is going on inside and outside ourselves, moment by moment. Gradually you train yourself to notice when your thoughts are taking over and to see them as mental events that do not have to control you (NHS, 2026a). Japan’s National Center of Neurology and Psychiatry describes mindfulness as “a way of noticing the experience of this moment and accepting it as it is”, practised through everyday attention, meditation and breathing (National Center of Neurology and Psychiatry, n.d.).

Much of the research is on structured programmes. Mindfulness-based stress reduction (MBSR) teaches mindfulness meditation alongside discussion and ways to apply it to stressful situations, and mindfulness-based cognitive therapy (MBCT) adds elements of cognitive behavioural therapy to mindfulness practice (NCCIH, 2022). In an analysis of meditation programme trials, MBSR usually involved 20 to 27.5 hours of training over 8 weeks, and there was no or insufficient evidence that mantra meditation programmes had an effect on stress and wellbeing measures (Goyal et al., 2014). Researchers also point out that “mindfulness” is an umbrella term for a large number of practices, processes and characteristics (Van Dam et al., 2018). So when weighing “the effects of meditation”, it helps to ask which method was used, by whom, and what it was compared with.

An analysis of randomised controlled trials that compared meditation programmes only with control activities matched for time and attention (47 trials, 3,515 people) found moderate evidence that mindfulness meditation programmes improved anxiety (effect size 0.38) and depression (0.30) at 8 weeks, and pain (0.33), and low evidence for stress and mental health-related quality of life. There was low evidence of no effect, or insufficient evidence, for positive mood, attention, sleep and weight, and no evidence that meditation programmes were better than drugs, exercise or other behavioural therapies. The authors concluded that meditation programmes can bring small to moderate reductions in several aspects of psychological stress (Goyal et al., 2014).

In an analysis of 142 samples (12,005 people) with diagnosed conditions, mindfulness-based interventions did better than no treatment (effect size 0.55), but the gap narrowed as the comparison became more active, to 0.23 against specific active treatments, and there was no difference from evidence-based treatments (Goldberg et al., 2018). In 30 head-to-head trials (2,750 people) comparing mindfulness-based therapy with cognitive behavioural therapy for depression, the two were equivalent (Sverre et al., 2023). In one trial of 276 adults with anxiety disorders, clinician-rated symptom severity in the 208 who completed it fell by 1.35 points with 8 weeks of MBSR and by 1.43 points with a commonly used antidepressant, so MBSR was not worse than the antidepressant (non-inferior; Hoge et al., 2023). These are results for structured, therapist-led programmes, though, and cannot simply be carried over to meditating on your own or using an app.

In a meta-analysis of 136 randomised controlled trials (11,605 people) in non-clinical settings, mindfulness programmes reduced anxiety (8 trials, effect size 0.56), depression (14 trials, 0.53) and distress (27 trials, 0.45), and improved wellbeing (9 trials, 0.33), compared with doing nothing. But there was no evidence that they were better than specific active comparison activities, only the effect on distress remained when trials at high risk of bias were left out, and the certainty of the evidence was moderate to very low (Galante et al., 2021). An analysis of individual data from 2,371 community adults who had chosen to join teacher-led group programmes also found a small to moderate reduction in distress one to six months later, compared with doing nothing (effect size 0.32; Galante et al., 2023).

A review of 44 meta-analyses (336 randomised controlled trials, 30,483 people) likewise found that mindfulness programmes generally did better than waiting lists or no intervention, but that effects were typically smaller and less often statistically significant against active comparison groups (Goldberg et al., 2022a).

What about sleep? In an analysis of 18 trials (1,654 people), sleep quality improved more than with general comparison activities such as sleep education (effect size 0.33), but there was low-strength evidence of no difference compared with other evidence-based treatments (Rusch et al., 2019). If insomnia persists, the treatment recommended first is covered in insomnia: what helps. For chronic pain, pain decreased slightly more than with all kinds of control conditions in 30 trials, but the quality of the evidence was low (Hilton et al., 2017).

And apps? In an analysis of 45 randomised controlled trials, mindfulness apps reduced depression (effect size 0.24) and anxiety (0.28) slightly more than control groups, but few studies compared them with other active approaches, and those found no difference (Linardon et al., 2024). Another analysis of 34 app trials (7,566 people) found lower stress than in control groups at the end of use (0.46), but warned that the results should be read with care because there were few studies and the risk of bias was unclear (Gál et al., 2021).

The UK guideline (NICE) lists group mindfulness and meditation as one of 11 options that can be used as a first treatment for less severe depression; it comes seventh in the committee’s order, and the guideline says to consider the least intensive option, guided self-help, first. These groups use a programme such as MBCT designed for depression, usually run for 8 sessions with 8 to 15 people, and involve practising at home with recordings between sessions (NICE, 2022).

MBCT is a set 8-week (8-session) treatment course used to prevent depression from coming back. In an analysis of individual data from 9 randomised controlled trials (1,258 people) that compared MBCT with other treatments in people with recurrent depression in full or partial remission, the risk of relapse over 60 weeks was lower than without MBCT (hazard ratio 0.69), and also lower than with other active treatments (hazard ratio 0.79). There was some evidence that the effect, compared with other treatments, was larger in people with more severe depressive symptoms before treatment, and the effect tended to shrink as follow-up went on (Kuyken et al., 2016). A hazard ratio compares the risk of relapse; it is not the share of people who relapsed.

In a trial of 424 UK adults who had had three or more episodes of depression and were on maintenance medication, relapse over 2 years did not clearly differ between people who reduced their medication with their doctor’s support while doing MBCT and people who stayed on medication (Kuyken et al., 2015). That does not mean you can stop medication because you do MBCT. Reduce or stop medication gradually, in consultation with your prescriber; see antidepressants and psychiatric medication for more. These results are for set group courses, not for meditating alone or using an app.

For people who improved on antidepressants alone but are at higher risk of relapse, the UK guideline says to consider continuing the medication, group CBT or MBCT for those who do not want to continue it, or continuing the medication together with such therapy. These courses focus on relapse-prevention skills and usually consist of 8 sessions over 2 to 3 months, with the option of further sessions within the next 12 months (NICE, 2022). The French health authority likewise describes mindfulness therapy as a form of CBT used when depressive episodes recur (HAS, 2017).

Japan’s depression guideline notes that the UK guideline lists group mindfulness and meditation among non-drug options for mild depression, but adds that in Japan mindfulness-based cognitive therapy is not a psychotherapy covered by health insurance and that its techniques are not in the treatment manuals recommended by the health ministry (Japanese Society of Mood Disorders, 2025). The Korean portal column explains that meditation programmes with the religious framing removed have been used for stress and chronic pain, and that psychiatry sees meditation as a kind of emotion and attention training to ease symptoms such as anxiety, depression and insomnia (National Mental Health Information Portal, 2020). Treatment for depression in general is covered in depression: what helps.

There is a lot of hype in meditation research. Researchers who critically reviewed the field warned that misinformation and poor methods in past studies may lead the public to be harmed, misled and disappointed, and said that much more research is needed before we know for which problems, and in which people, these programmes are definitively helpful (Van Dam et al., 2018). The US National Center for Complementary and Integrative Health also says that much of the research has been preliminary or not rigorous, and that results may have been interpreted too optimistically (NCCIH, 2022).

Positive results also tend to stand out. A 2016 analysis found that 108 of 124 published trials of mindfulness-based therapy (87%) reported at least one positive result in the abstract, 1.6 times the number expected from the effect size, and that 13 of 21 registered trials (62%) were still unpublished 30 months after they ended (Coronado-Montoya et al., 2016). On the other hand, a review of 44 meta-analyses found the results generally robust to publication bias, though other important sources of bias were present and adverse effects were reported inconsistently (Goldberg et al., 2022a).

Claims that “meditation changes your brain” also need care. Pooled brain-imaging studies suggest modest changes in brain structure, but similar changes appear when people learn other skills, such as a musical instrument, so they may not be specific to meditation, and their practical meaning is still unclear (Van Dam et al., 2018). In two combined trials that randomly assigned 218 people new to meditation to a waiting list, 8 weeks of MBSR or a matched comparison activity, there was no evidence that MBSR changed brain structure compared with either comparison group (Kral et al., 2022).

Mindfulness lessons for every pupil at school also fell short of expectations. In a trial covering 8,376 pupils at 84 UK schools, 10 mindfulness lessons showed no evidence of benefit to mental health after one year compared with usual social-emotional teaching, and no lesson-related adverse events were observed (Kuyken et al., 2022).

Meditation and mindfulness are usually thought to carry few risks, but few studies have looked at harmful effects, so it is not possible to say for certain that they are safe (NCCIH, 2022). The NHS also says mindfulness is not right for everyone: some people find it does not help them, or that it makes them feel worse (NHS, 2026a).

In a review of 83 studies (6,703 people), meditation-related adverse effects came to about 8% (8.3%) overall, but varied greatly with the study design: 3.7% in experimental studies and 33.2% in observational ones. The most common were anxiety and depression, and they could also occur in people with no history of mental health problems (Farias et al., 2020). In a study in which an independent assessor interviewed 96 people after an 8-week MBCT course, 37% had at least one reaction that affected their daily functioning, and 6 to 14% had lasting bad effects, which were linked with signs of hyperarousal and dissociation. The researchers considered the transient distress and negative effects to be at rates similar to other psychological treatments (Britton et al., 2021).

Surveys of people who have meditated give very different rates depending on how they ask. In a survey of 434 US adults, 32.3% reported an adverse effect from meditation, 10.6% some degree of impairment in daily life, and 1.2% impairment lasting a month or more. The most common were anxiety, re-experiencing traumatic memories and emotional sensitivity, and they were more common in people who had faced adversity in childhood. Those who reported adverse effects were as glad to have meditated as those who did not (Goldberg et al., 2022b). In a survey of 886 US adults, 31.4% reported a challenging or distressing experience and 9.1% impaired daily functioning as a result; this was linked with greater psychological distress, psychotic-like traits and attending a meditation retreat (Van Dam et al., 2025). Of 1,232 regular meditators, 25.6% reported a particularly unpleasant experience, more often among those who had ever been on a meditation retreat (Schlosser et al., 2019).

Common mindfulness courses often list substance dependence, suicidal thoughts, psychosis, post-traumatic stress disorder, severe depression, severe social anxiety and a recent major crisis such as a bereavement or divorce among their exclusion criteria. But programmes adapted for some of these conditions have shown promising results, so exclusion criteria should be applied flexibly (Baer et al., 2019). The UK guideline also says these programmes may be difficult for people experiencing intense or highly distressing thoughts, or who find focusing on the body difficult (NICE, 2022). If any of this applies to you, talk to the doctor or therapist treating you before starting on your own. In the review of adverse effects, a few studies also reported suicidal behaviour (Farias et al., 2020). If you have thoughts of dying during or after meditation, do not carry them alone: call or text 988 in the US and Canada, or call Samaritans on 116 123 in the UK and Ireland, right away.

There are also case reports of severe symptoms, such as psychosis, mania, depersonalisation and derealisation, or traumatic memories, set off by meditation. They involved several kinds of meditation, often during intensive retreats, and none involved an evidence-based mindfulness programme (Baer et al., 2019). Case reports do not show how often such things happen. Depersonalisation and derealisation during meditation are covered in depersonalisation or derealisation.

A French public mental health information site warns that meditation can, at times and in some people, cause adverse effects such as euphoria, visions, intense physical pain, paranoia, anger or fear, and advises watching for signs of distress, especially if you live with a mental disorder; if they appear, stop the sessions and, if needed, see a mental health professional (Psycom, 2026).

You do not need any special equipment. Sit somewhere comfortable and warm, upright and at ease (NHS, 2026b). Rest your attention on the breath coming in and going out; when your attention drifts and a thought, feeling or sensation comes up, notice it without judging or pushing it away (“ah, I had that thought”) and come back to the breath. It is hard to concentrate for long at first, so start with a few minutes and build up as you get used to it (National Mental Health Information Portal, 2020).

A wandering mind is a natural part of meditation, not a failure, and it happens to experienced people too. A blank mind is not the goal either. If your mind wanders off 10 times, bring it back to the breath 10 times, and when you finish, do not stop too suddenly. There is no rule about how long a session should last, but the NHS suggests about 20 minutes as a good guide (NHS, 2026b). There is also walking meditation, paying attention to the feeling of your feet touching the ground (National Mental Health Information Portal, 2020).

If setting aside time is hard, pick a regular moment in the day, such as the journey to work or a walk at lunchtime, to notice the sensations around you, or try silently naming the thoughts and feelings that come up (NHS, 2026a).

The 8-week courses used in research usually involve a weekly class of 2 to 2.5 hours, one all-day session and about 45 minutes of home practice, 6 days a week. In an analysis of 43 studies (1,427 people), participants did 64% of that, about 30 minutes a day. In the 28 studies (898 people) that looked at it, more self-reported practice went with slightly better results (correlation 0.26). This is only an association, not proof that practising longer makes you better (Parsons et al., 2017).

When choosing a course or teacher, ask about the teacher’s training and experience (NCCIH, 2022). You can start with an app, but as shown above, the effects were small.

Do not use meditation to replace conventional care or as a reason to put off seeing a doctor (NCCIH, 2022). The Korean portal column also says meditation is not a cure-all, and that other treatments, including medication, may matter more (National Mental Health Information Portal, 2020). Many mindfulness centres try to make clear that mindfulness is not meant to replace standard psychiatric care (Van Dam et al., 2018).

If low mood or anxiety has gone on for more than 2 weeks and is disrupting daily life, look back over the past 2 weeks with the depression check-in (PHQ-9) or the anxiety check-in (GAD-7), and see depression: what helps or seeing a psychiatrist for the first time about getting care. If you want to ease everyday stress, other options with evidence, such as exercise, sleep and slow breathing, are covered in how to relieve stress.

Where to learn depends on the country. In Korea, ask your local public health centre or mental health welfare centre whether it runs a mindfulness programme. In Japan, mindfulness-based cognitive therapy is not a psychotherapy covered by health insurance (Japanese Society of Mood Disorders, 2025), so if you need treatment, it is best to talk to your doctor first. Mindful self-compassion, a programme that adds practice in being kind to yourself, is covered in how to build self-compassion.

Q. Do I have to empty my mind when I meditate? A. No. Having a totally blank mind is not the goal of meditation; if a thought intrudes, just gently shift your focus back to your breath (NHS, 2026b). Mindfulness is not about making thoughts go away but about seeing them as mental events that come and go. This can be very hard at first, but with gentle persistence it is possible (NHS, 2026a).

Q. Is meditation a religion? A. Many meditation techniques began as practices in various religions, but meditation programmes with the religious framing removed have been used for stress and chronic pain (National Mental Health Information Portal, 2020). The NHS says meditation is not mystical but simply a way to stop for a moment and be calm (NHS, 2026b), and the Japanese Association of Mindfulness describes research and practice in many fields, including psychology, medicine, education, religion and industry (Japanese Association of Mindfulness, n.d.).

Q. Will meditation always make me feel calmer? A. Not necessarily. The effects seen in trials were small to moderate on average (Goyal et al., 2014), and some people find it does not help them or makes them feel worse (NHS, 2026a). If a difficult reaction comes up, stop and, if needed, talk to a mental health professional (Psycom, 2026).

Q. Is longer always better? A. Not necessarily. In 8-week courses, practising more was linked with slightly better results (Parsons et al., 2017), but attending meditation retreats was also linked with difficult experiences (Van Dam et al., 2025). There is no set rule about how long a session should last (NHS, 2026b).

Q. Can meditation replace treatment? A. No. Do not use meditation to replace conventional care or as a reason to put off seeing a doctor (NCCIH, 2022). Approaches with evidence, such as MBCT to prevent depressive relapse, are set treatment courses, and even in that trial medication was reduced with the doctor’s support (Kuyken et al., 2015). Talk to your prescriber before reducing or stopping any medication.

Q. I have thoughts of wanting to die during or after meditation. A. Stop meditating and please do not carry this alone. Reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you are in immediate danger, contact your local emergency services.

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