1. Not effective for everyone

While MBCT is helpful for many, it doesn’t work equally well for all types of depression.

• • It’s most effective for people with recurrent depression who’ve had three or more episodes.
  • People experiencing current, severe depressive episodes (notably with high suicidality) might struggle to engage with MBCT.

Their symptoms can make it hard to focus, sit with their thoughts, or commit to mindfulness practice.

2. Requires active participation

MBCT isn’t a passive therapy and demands consistent practice, both during sessions and at home.

• • Daily meditation (often around 30–45 minutes) is expected.
  • This can feel like an additional burden rather than a help for people who are very fatigued or unmotivated.

3. Mindfulness can generate difficult emotions
   
   

People might come into direct contact with painful thoughts and feelings they usually avoid when practicing mindfulness.

• • For some, this can initially worsen anxiety, sadness, or distress.
  • A 2021 review pointed out that around 87% of mindfulness practitioners report at least one momentary adverse effect during meditation.

4. Not a substitute for crisis treatment

MBCT is not designed for acute crises like severe depression with active suicidal ideation, psychosis, or manic episodes.

• • It’s preventative rather than emergency
  • More intensive interventions like hospitalization, medication adjustments, or immediate psychotherapy are necessary in crises.

5. Cultural and accessibility issues
   
   

Mindfulness practices have roots in Eastern traditions, but MBCT is a Westernized, clinical version.

• • For some, it might feel inauthentic, misaligned with their beliefs, or forced.
  • MBCT programs can be expensive, time-consuming, and not available everywhere.

Online versions are growing, but accessibility is still an issue for marginalized or rural populations.

6. Therapist quality matters

The efficiency of MBCT heavily depends on the skill and training of the instructor.

• • Poorly delivered MBCT can fail to engage clients, miss key therapeutic components, or even harm people by mishandling emotional reactions.

7. Limited research for certain groups
   
   

While MBCT is well-studied for recurrent depression, less is known about its effects in:

• • Adolescents.
  • People with bipolar depression.
  • Those with complex PTSD.
  • Diverse racial and ethnic groups.

Research is expanding, but for now, the evidence base is narrower outside of adult, recurrent unipolar depression.