Childhood trauma linked to worse outcomes in mindfulness therapy for depression

New research published in PLOS One finds that childhood trauma may worsen outcomes and increase risks in mindfulness meditation programs designed for managing depression.

Mindfulness-Based Cognitive Therapy (MBCT) was originally developed to prevent relapse in people who had recovered from depression. It combines meditation practices with cognitive therapy techniques. Over time, MBCT and similar mindfulness-based programs have been offered to people experiencing active depression. While many participants report improvements, researchers have begun to notice that not everyone responds in the same way.

Previous studies hinted that childhood trauma might influence how well mindfulness programs work. In some cases, trauma survivors benefited more from MBCT when it was used to prevent relapse. But when treating active depression, the picture was less clear. Some participants with trauma histories struggled to improve, and reports of meditation-related adverse effects – such as anxiety, panic, or traumatic memories resurfacing – raised concerns.

A research team at Brown University in Rhode Island set out to explore this gap. Led by Nicholas K. Canby, they conducted two clinical trials. The first involved 52 participants (average age 47 yrs, 79% female), while the second included 104 (average age 40 yrs, 74% female). All participants had symptoms of depression, and some had past or subclinical post-traumatic stress disorder (PTSD).

In the first study, participants were randomized to an MBCT program or a waitlist control group. In the second study, participants were assigned to standard MBCT, focused attention meditation, or open monitoring practices

“The MBCT module followed the standard session-by-session manual, while the [focused attention meditation] and [open monitoring practices] curriculums emphasized specific forms of meditation that are both present in standard MBCT,” Canby and colleagues explained.

Researchers measured depression symptoms before and after treatment, tracked dropout rates, and asked participants about any unexpected or unpleasant experiences during meditation.

Across both studies, childhood trauma predicted worse depression outcomes. In particular, childhood sexual abuse consistently emerged as a strong predictor of poor depression outcomes across both studies, and was significantly linked to higher dropout rates in the larger second study.

Emotional neglect and emotional abuse were also linked to less improvement in depression symptoms. Participants with trauma histories were more likely to report meditation-related side effects, ranging from vivid imagery and heightened anxiety to dissociation and emotional blunting. Some described feeling trapped or overwhelmed during body-focused meditation practices, which triggered memories of past abuse.

The authors concluded, “childhood trauma predicts poorer outcomes in MBCT treatment for active depression yet better outcomes when MBCT is used as a relapse prevention program in remitted individuals who are not currently depressed.”

Canby and colleagues emphasize that meditation is not inherently harmful, but that trauma survivors may need additional support or modifications to standard programs. For example, shorter meditation sessions, smaller group sizes, or trauma-informed guidance could help reduce risks.

The study does have limitations. The participants were mostly female, white, and highly educated, meaning the findings may not apply to all groups. Additionally, one of the trials lacked a non-meditation control group, making it harder to determine whether the negative outcomes were specific to mindfulness or part of a broader treatment challenge.

The study, “Childhood trauma and subclinical PTSD symptoms predict adverse effects and worse outcomes across two mindfulness-based programs for active depression,” was authored by Nicholas K. Canby, Elizabeth A. Cosby, Roman Palitsky, Deanna M. Kaplan, Josie Lee, Golnoosh Mahdavi, Adrian A. Lopez, Roberta E. Goldman, Kristina Eichel, Jared R. Lindahl, and Willoughby B. Britton.