Meditation

Meditation isn't one mechanism. Different styles work in different ways, and most practices combine several.

• Training attention. Noticing where your mind has gone and bringing it back, again and again. Over time this makes it easier to catch worry or rumination early, rather than an hour later.
• Changing your relationship with your thoughts. Rather than arguing with a thought or believing it outright, you start to see it as a thought passing through. The thought may not change, but its grip does.
• Settling the body. Many practices slow the breath and release held tension, which may calm the stress response. The mind tends to follow the body.
• Using imagery. Guided practices often invite you to picture a place that feels safe or peaceful. The mind responds to what you imagine, so this can be a way of feeling calm when your actual surroundings offer none.
• Shifting the tone of your inner voice. Loving-kindness and compassion practices deliberately practise warmth towards yourself. For people who are harsh with themselves, this is often the style that changes the most.
• Occupying the thinking mind. Repeating a word or phrase gives the busy, commentating part of the mind something simple to do, which can quieten it.
• Noticing the body. Body-based practices build awareness of physical sensation, which often means catching tension, exhaustion or a mood earlier than you otherwise would.
• Rest. Sometimes the value is simply having permission to stop, with nothing to achieve for ten minutes.

Meditation, particularly mindfulness-based programs, is one of the most researched practices in The Toolkit.

• For anxiety, it has matched a standard medication. A 2023 trial published in JAMA Psychiatry randomly assigned 276 adults with diagnosed anxiety disorders to either an eight-week mindfulness-based stress reduction course or escitalopram, a commonly prescribed antidepressant. Both groups improved by a similar amount, and mindfulness met the standard for being no less effective. Ten people stopped the medication because of side effects. Nobody stopped the mindfulness course for that reason.
• For depression, it helps prevent relapse. A 2016 analysis in JAMA Psychiatry pooled the individual records of 1,258 people with recurrent depression across nine randomised trials. Those who did mindfulness-based cognitive therapy were significantly less likely to relapse over the following 60 weeks, including when compared with active treatments such as staying on antidepressants. The benefit was largest for people with more severe remaining symptoms.
• Across the whole field, the picture is good but not uniform. A 2022 review examined 44 meta-analyses covering 336 randomised trials and more than 30,000 participants. Mindfulness programs consistently outperformed doing nothing, and were similar or better than some established treatments. Compared with other active treatments, the benefits were smaller and less often statistically significant. The authors also noted that unwanted effects are reported inconsistently across studies.
• For trauma, the evidence is thinner. Meta-analyses of mindfulness for PTSD exist, but they rest on a small number of trials, often in veterans. It shows promise, and it isn't yet on the same footing as the anxiety and depression research.
• It isn't risk-free. A 2020 review of 83 studies (6,703 people) found unwanted effects in about 8% of participants, most commonly anxiety, low mood and changes in thinking or perception, sometimes in people with no previous mental health history.

In short, meditation can be a helpful support for many people, but it isn't risk-free and it isn't a replacement for treatment.