Protocol
MBSR (Mindfulness-Based Stress Reduction) 8-week program
Pooled randomized trials find small to moderate reductions in self-reported anxiety, depression and distress: Goyal 2014 (PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 24395196) pooled 47 trials of mindfulness meditation programs generally, not MBSR alone, against active controls; Khoury 2015 (PMID 25818837) pooled 29 MBSR studies in healthy adults; Galante 2021 (PMID 33428616) pooled 136 trials in nonclinical settings and found benefit against no intervention but no superiority over specific active treatments.
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How this letter has changedLatest: October 2026 · Corrected.
The record carried a not-replicated flag while its B rested on a pooled analysis of randomized trials (Goyal et al., JAMA Intern Med, 2014; PMID 24395196). The flag describes a single trial nobody has repeated; a meta-analysis A study that pools the numbers from several trials into one combined estimate. of independent randomized trials is replication The same finding reproduced by a separate research group. A result seen once can be chance or bias; a replicated one is harder to explain away. by definition, and what caps this letter at B is the endpoint The outcome a trial measures to decide whether the treatment worked, such as heart attacks, blood pressure or a symptom score., not the absence of a second trial. Flag removed, letter unchanged. Applied the written grade definition under the editor's standing instruction of October 2026 (Arnold Sandlow, D.C.).PMID 24395196
The description said a 32-trial meta-analysis; Goyal et al. (JAMA Intern Med, 2014; PMID 24395196) pooled 47 trials of mindfulness meditation programs generally, not MBSR alone, found only low-strength evidence for stress, did not assess rumination or emotional regulation, and found no superiority over active treatments, none of which the record said. The uncited claim that apps have smaller effects than instructor-led MBSR is removed. Added: Khoury et al. (J Psychosom Res, 2015; PMID 25818837), 29 MBSR studies in healthy adults; Galante et al. (PLoS Med, 2021; PMID 33428616), 136 trials, with its null against specific active controls; and the TAME trial (Hoge et al., JAMA Psychiatry, 2023; PMID 36350591), MBSR noninferior to escitalopram on a blinded clinician scale. Replicated pooled self-report evidence is B, unchanged. Applied the written grade definition under the editor's standing instruction of October 2026 (Arnold Sandlow, D.C.).PMID 24395196 PMID 25818837 PMID 33428616 PMID 36350591
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MBSR is an eight-week group program that teaches mindfulness, with 2.5 hours of class a week and daily home practice. Three pooled reviews from separate teams found small to moderate drops in anxiety, depression and stress, as reported by the people themselves. In one study of people with anxiety disorders, rated by experts who did not know the groups, it did about as well as a common anxiety drug. It has not been shown to beat talk therapy, exercise or medicine. Physical health and sleep were not covered.
Pooled randomized trials find small to moderate reductions in self-reported anxiety, depression and distress: Goyal 2014 (PMID 24395196) pooled 47 trials of mindfulness meditation programs generally, not MBSR alone, against active controls; Khoury 2015 (PMID 25818837) pooled 29 MBSR studies in healthy adults; Galante 2021 (PMID 33428616) pooled 136 trials in nonclinical settings and found benefit against no intervention but no superiority over specific active treatments. The one trial with a blinded clinician scale found MBSR noninferior to escitalopram in anxiety disorders (Hoge 2023; PMID 36350591). An 8-week structured program, 2.5 hours a week plus daily home practice. Self-reported outcomes cap the letter at B.
Why this gradeThe reasoning, and what the grade does not cover.
Grade B on self-reported anxiety, depression and distress. Three independent pooled analyses of randomized trials agree on small to moderate benefit against no intervention or active controls: Goyal et al. (2014; PMID 24395196; 47 trials of mindfulness programs generally), Khoury et al. (2015; PMID 25818837; 29 MBSR studies in healthy adults) and Galante et al. (2021; PMID 33428616; 136 trials in nonclinical settings).
WHY NOT Athe outcomes are questionnaires; the one trial with a blinded clinician scale (Hoge et al., 2023; PMID 36350591) is a single noninferiority comparison with escitalopram and no placebo An inactive substitute made to look like the real treatment, so participants cannot tell which one they received. arm, which cannot lift the letter.
WHY NOT Cthe pooled results replicate across groups.
WHAT THIS GRADE DOES NOT COVERsuperiority over specific active treatments such as cognitive behavioral therapy, exercise or medication, which no pooled analysis shows; app-based programs, which the cited reviews did not grade and for which this record makes no comparative claim; rumination and emotional regulation, which the 2014 pooled analysis (PMID 24395196) did not assess; physical health outcomes such as blood pressure or heart disease; and sleep.
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The evidence, in fullFour papers, each linked to its PubMed record.
Goyal et al. (JAMA Intern Med, 2014; PMID 24395196): meta-analysis of 47 randomized trials, 3,515 participants, of mindfulness meditation programs generally (MBSR, MBCT and others); moderate evidence of improved anxiety, depression and pain against active controls, low evidence for stress and distress, and no evidence that the programs beat active treatments such as drugs, exercise or other behavioral therapies. Khoury et al. (J Psychosom Res, 2015; PMID 25818837): meta-analysis of 29 MBSR studies in healthy adults, 2,668 participants; moderate between-group effects (Hedges g 0.53), large on stress and moderate on anxiety and depression, maintained at about 19 weeks. Galante et al. (PLoS Med, 2021; PMID 33428616): meta-analysis of 136 randomized trials of mindfulness-based programs in nonclinical settings, 11,605 participants; against no intervention, anxiety (SMD -0.56), depression (-0.53) and distress (-0.45) improved, with prediction intervals crossing zero; against nonspecific active controls only depression improved, against specific active controls no superiority, and only the distress effect survived removal of higher-risk trials. Hoge et al. (JAMA Psychiatry, 2023; PMID 36350591), the TAME trial: 276 adults with anxiety disorders randomized to 8 weeks of MBSR or escitalopram; MBSR noninferior on the blinded clinician-rated Clinical Global Impression of Severity, a noninferiority design with no placebo arm. Grade B: replicated pooled randomized evidence on self-reported outcomes, the ceiling for self-report.
The PSS-10 (Perceived Stress Scale) or a validated anxiety or depression questionnaire at baseline, week 4 and program end, which is what the pooled trials measured. Session attendance is the process measure.
Evidence notes: meta-analysis
Endpoint graded: Self-reported anxiety, depression and pain (self_report)
Last reviewed: July 2026
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