Mindfulness practice

The best-evidenced option for holding your gains once the acute work is done.

How it works

An eight-week structured programme — MBSR or MBCT — rather than an app streak. Its strongest role in this plan is relapse prevention in Phase 4, once you have already changed how you handle worry.

How good is the evidence

Moderate evidence

Hoge et al. (JAMA Psychiatry, 2023; TAME trial, n=276) found 8 weeks of MBSR statistically non-inferior to escitalopram (CGI-S improvement 1.35 vs. 1.43; difference −0.07, 95% CI −0.38 to 0.23), with far fewer adverse events (15.4% vs. 78.6%). Kuyken et al. (2016) found MBCT reduced depression relapse, HR 0.69 (95% CI 0.58–0.82).

Caveat: Against active comparators the effects shrink substantially — in one student population g fell from ~0.42 to ~0.13. Adverse effects occur in roughly 8.3% of meditators and fewer than one trial in five monitors them. Approach intensive practice cautiously, especially with a trauma history.

Related techniques

• Worry triage — Sort each worry into one you can act on today and one you cannot. They need opposite treatment.
• Worry postponement — Capture worries as they arrive, and deal with them only in a fixed daily slot.
• Detached mindfulness — Notice a thought arrive, and take no action on it whatsoever — including not arguing with it.
• Decatastrophising — Realistic worst case, most likely case, and — the part people skip — how you would actually cope.