The Contemplative Lineage
2,500 years of practice on the nature of mind — and the 40-year experiment of bringing it into the therapy room
Clinical and evidence statements in this lineage remain under review. The source checks below apply only to their stated treatment, population and outcome.
Guideline sources for approaches in this lineage
Buddhist Psychology / Contemplative Psychotherapy
Guidelines and official sources (2)
2 clinical guideline checks
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Management of Major Depressive Disorder
Discussed in the source
VA/DoD finds insufficient evidence for or against adjunctive meditation. The reviewed meditation programmes do not establish a recommendation for this broad contemplative psychotherapy approach.
Scope: Adults with MDD; adjunctive meditation.
- Management of Bipolar Disorder
Discussed in the source
VA/DoD finds insufficient evidence for or against adjunctive meditation. This does not establish a recommendation for a specific contemplative psychotherapy or for bipolar I.
Scope: Adults with bipolar II; adjunctive treatment of depressive episodes or symptoms.
MBSR
Guidelines and official sources (12)
12 clinical guideline checks
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Clinical Practice Guideline for Management of PTSD and Acute Stress Disorder
Recommendation for the stated population
VA/DoD suggests MBSR with a weak recommendation. This PTSD recommendation does not establish support for every other condition linked to MBSR.
Scope: Adults with PTSD; MBSR as a complementary/integrative intervention.
- Management of First-Episode Psychosis and Schizophrenia
Discussed in the source
VA/DoD suggests the acceptance/mindfulness therapy category (weak for) and explicitly includes MBSR in its evidence discussion. It does not assign MBSR a separate recommendation grade.
Scope: Adults with schizophrenia; psychotherapy combined with medication.
- Clinical Practice Guideline for the Management of Chronic Multisymptom Illness
Discussed in the source
VA/DoD weakly recommends the mindfulness-based therapy family and discusses MBSR in fibromyalgia. It does not separately grade MBSR or establish its benefit for every syndrome covered by the guideline.
Scope: MBSR studied in fibromyalgia within the chronic multisymptom illness guideline.
- Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea
Discussed in the source
VA/DoD finds insufficient evidence for or against mindfulness meditation for insomnia. This is a category-level statement, not a separate grade for MBSR; evidence was not newly reviewed for this recommendation.
Scope: Mindfulness meditation as a primary treatment for adult chronic insomnia disorder.
- Diagnosis and Treatment of Low Back Pain
Insufficient evidence for or against
The current guideline finds insufficient evidence for or against MBSR. Its appendix also reproduces the older positive recommendation; that historical wording is not the 2022 recommendation.
Scope: Adults with chronic low back pain.
- Management of Headache
Discussed in the source
The recommendation is neutral for the mindfulness-based therapy category; the discussion includes MBSR. It does not assign MBSR a separate recommendation grade.
Scope: Mindfulness-based interventions for headache treatment or prevention.
- Tinnitus
Insufficient evidence for or against
VA/DoD names MBSR among the interventions for which evidence is insufficient to recommend for or against treatment. The list is explicitly unranked.
Scope: Adults with bothersome tinnitus receiving MBSR from a trained provider.
- Management of Type 2 Diabetes Mellitus
Recommendation for the stated population
VA/DoD suggests a mindfulness-based stress reduction programme (weak for). The reviewed programmes vary; this does not establish lasting benefit or treatment of every anxiety or depressive disorder.
Scope: Adults with distress related to type 2 diabetes; short-term improvement.
- Clinical Practice Guideline for Management of Stroke Rehabilitation
Discussed in the source
VA/DoD weakly recommends mindfulness-based therapies and specifically reviews MBSR and MBCT. The recommendation is for the therapy family in this post-stroke population.
Scope: Depression following stroke.
- Clinical Practice Guideline for Psychological and Other Nonpharmacological Treatment of Chronic Musculoskeletal Pain in Adults
Recommendation for the stated population
APA conditionally suggests MBSR, considering patient preferences.
Scope: Adults with chronic low-back pain; MBSR versus usual care, attention control, or another intervention.
- Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder in Adults
Insufficient evidence for or against
APA finds insufficient evidence to recommend for or against MBSR in this comparison.
Scope: Adults with PTSD; MBSR versus no intervention or usual care.
- Clinical Practice Guideline for Tobacco Use Treatment
Discussed in the source
VA/DoD weakly recommends against standalone mindfulness for this cessation goal. This is category-level guidance; MBSR is not separately graded, and the statement does not address adjunctive use or other conditions.
Scope: Mindfulness used as a standalone treatment for abstinence from tobacco or nicotine.
MBCT
Guidelines and official sources (14)
13 clinical guideline checks · 1 evidence registry check
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Depression in adults: treatment and management (NG222)
Recommendation for the stated population
NICE lists group MBCT as a relapse-prevention option, with or without continuing antidepressants according to preference.
Scope: People remitted on antidepressants alone and at higher relapse risk
- Mindfulness-based cognitive therapy
Discussed in the source
The archive lists Strong under 1998 criteria and pending 2015 re-evaluation.
Scope: MBCT; depression/relapse prevention evidence
- Depression in adults: treatment and management (NG222)
Recommendation for the stated population
NICE includes group mindfulness and meditation using a programme such as MBCT among treatment options. This is separate from its relapse-prevention recommendations.
Scope: Adults with a new episode of less severe depression; depression-specific group programme.
- Clinical Practice Guideline for Management of PTSD and Acute Stress Disorder
Insufficient evidence for or against
VA/DoD finds insufficient evidence for or against MBCT for PTSD.
Scope: Adults with PTSD; mind-body interventions.
- Management of Major Depressive Disorder
Recommendation for the stated population
VA/DoD suggests mindfulness-based cognitive therapy among seven unranked psychotherapy options (weak for). Treatment strategy also depends on severity, chronicity, prior response and preference.
Scope: Adults with uncomplicated MDD choosing psychotherapy.
- Management of Major Depressive Disorder
Discussed in the source
VA/DoD strongly recommends first-line evidence-based psychotherapy, referring to the list that includes mindfulness-based cognitive therapy. This is a class-level recommendation, with no preferred individual approach.
Scope: Pregnant or breastfeeding adults with mild-to-moderate MDD.
- Management of Major Depressive Disorder
Recommendation for the stated population
VA/DoD suggests MBCT during continuation treatment to reduce relapse or recurrence (weak for). CBT, IPT and MBCT are not ranked against one another.
Scope: Remitted MDD with high risk of relapse or recurrence.
- Clinical Practice Guideline for the Management of Chronic Multisymptom Illness
Discussed in the source
The guideline discusses an IBS adaptation of MBCT within a weak recommendation for mindfulness-based therapies. This is not a separate recommendation for standard MBCT across all chronic multisymptom illnesses.
Scope: MBCT adapted for IBS within the chronic multisymptom illness guideline.
- Management of Headache
Discussed in the source
The recommendation is neutral for the mindfulness-based therapy category; the discussion includes MBCT. It does not assign MBCT a separate recommendation grade.
Scope: Mindfulness-based interventions for headache treatment or prevention.
- Tinnitus
Discussed in the source
The guideline is neutral for mindfulness-based therapies. MBCT appears in the evidence discussion, without a separate MBCT recommendation grade.
Scope: Mindfulness-based therapies for adults with bothersome tinnitus.
- Management of Type 2 Diabetes Mellitus
Discussed in the source
The review includes MBCT within mindfulness/acceptance interventions. The graded recommendation concerns a stress-reduction programme category, without a separate MBCT grade or established long-term benefit.
Scope: Adults with stress related to type 2 diabetes.
- Clinical Practice Guideline for Management of Stroke Rehabilitation
Discussed in the source
VA/DoD weakly recommends mindfulness-based therapies and specifically reviews MBSR and MBCT. The recommendation is for the therapy family in this post-stroke population.
Scope: Depression following stroke.
- Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts
Discussed in the source
APA includes MBCT among broadly comparable models; it cannot recommend a superior monotherapy.
Scope: Adults with depressive disorders, excluding psychotic depression; initial monotherapy selection.
- Clinical Practice Guideline for Tobacco Use Treatment
Discussed in the source
VA/DoD weakly recommends against standalone mindfulness for this cessation goal. This is category-level guidance; MBCT is not separately graded, and the statement does not address adjunctive use or other conditions.
Scope: Mindfulness used as a standalone treatment for abstinence from tobacco or nicotine.
ACT
Guidelines and official sources (18)
16 clinical guideline checks · 2 evidence registry checks
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Acceptance and commitment therapy for depression
Discussed in the source
The archive lists Modest under 1998 criteria, with 2015 re-evaluation pending. A registry entry does not establish a depression guideline recommendation.
Scope: ACT for depression
- Acceptance and commitment therapy for chronic pain
Discussed in the source
The archive lists Strong under 1998 criteria, with 2015 re-evaluation pending.
Scope: ACT for chronic pain
- Chronic pain (primary and secondary) in over 16s (NG193)
Recommendation for the stated population
NICE says to consider ACT or CBT for pain, delivered by appropriately trained professionals.
Scope: People aged 16 and over with chronic primary pain
- Clinical Practice Guideline for Management of PTSD and Acute Stress Disorder
Insufficient evidence for or against
VA/DoD finds insufficient evidence for or against ACT for PTSD. This assessment does not determine its status for other conditions.
Scope: Individual psychotherapy for adults with PTSD.
- Clinical Practice Guideline for the Non-Surgical Management of Hip and Knee Osteoarthritis
Discussed in the source
The appendix names ACT as an optional psychosocial or behavioral intervention, guided by availability and patient preference. This is ungraded implementation guidance, not a separately graded osteoarthritis recommendation.
Scope: Conceptual approach to chronic primary (nociplastic) pain when self-management strategies are insufficient.
- Management of Major Depressive Disorder
Recommendation for the stated population
VA/DoD suggests acceptance and commitment therapy among seven unranked psychotherapy options (weak for). Treatment strategy also depends on severity, chronicity, prior response and preference.
Scope: Adults with uncomplicated MDD choosing psychotherapy.
- Management of Major Depressive Disorder
Discussed in the source
VA/DoD strongly recommends first-line evidence-based psychotherapy, referring to the list that includes acceptance and commitment therapy. This is a class-level recommendation, with no preferred individual approach.
Scope: Pregnant or breastfeeding adults with mild-to-moderate MDD.
- Management of First-Episode Psychosis and Schizophrenia
Discussed in the source
VA/DoD suggests the acceptance/mindfulness therapy category (weak for) and explicitly includes ACT in its evidence discussion. It does not assign ACT a separate recommendation grade.
Scope: Adults with schizophrenia; psychotherapy combined with medication.
- Clinical Practice Guideline for the Management of Substance Use Disorders
Insufficient evidence for or against
The guideline reviews ACT studies and finds insufficient evidence for or against the broader mindfulness-based treatment category. This is a neutral finding for this substance-use scope.
Scope: ACT within the review of mindfulness-based treatments for substance-use disorders.
- Clinical Practice Guideline for Tobacco Use Treatment
Insufficient evidence for or against
The guideline discusses ACT and finds insufficient evidence to recommend a specific behavioral counseling approach over standard CBT. Its description of ACT is not a separate positive recommendation.
Scope: ACT compared with standard CBT for adult tobacco cessation.
- Diagnosis and Treatment of Low Back Pain
Discussed in the source
The review found no eligible ACT studies and identifies comparative ACT research as a priority. The CBT recommendation should not be presented as a separate ACT endorsement.
Scope: ACT evidence considered in the chronic low back pain review.
- Management of Headache
Discussed in the source
The recommendation is neutral for the mindfulness-based therapy category; the discussion includes ACT. It does not assign ACT a separate recommendation grade.
Scope: Mindfulness-based interventions for headache treatment or prevention.
- Tinnitus
Insufficient evidence for or against
VA/DoD names ACT among the interventions for which evidence is insufficient to recommend for or against treatment. The list is explicitly unranked.
Scope: Adults with bothersome tinnitus receiving ACT from a trained provider.
- Management of Adult Overweight and Obesity
Discussed in the source
ACT studies inform the weak recommendation for the cognitive behavioral intervention category. ACT receives no separate grade here; this is not an eating-disorder treatment recommendation.
Scope: Internalized weight bias and stigma in adult overweight/obesity care.
- Primary Care Management of Chronic Kidney Disease
Discussed in the source
The appendix names ACT among behavioral pain-management options, selected by availability and preference. This is ungraded guidance; much supporting evidence comes from people without kidney disease.
Scope: Adults with chronic kidney disease and chronic pain; self-management insufficient.
- Management of Type 2 Diabetes Mellitus
Discussed in the source
The review includes ACT within mindfulness/acceptance interventions. The graded recommendation concerns a stress-reduction programme category, without a separate ACT grade or established long-term benefit.
Scope: Adults with stress related to type 2 diabetes.
- Clinical Practice Guideline for Psychological and Other Nonpharmacological Treatment of Chronic Musculoskeletal Pain in Adults
Insufficient evidence for or against
APA finds the evidence insufficient for a recommendation in these comparisons. This is not a finding of ineffectiveness.
Scope: Adults with chronic musculoskeletal pain; ACT versus active control or usual care.
- Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders
Discussed in the source
ACT is named in the reviewed third-wave therapy category. WHO recommends that category alongside other structured therapies; it does not give ACT a separate recommendation or separate certainty rating here.
Scope: Adults with moderate-to-severe depression, within the mhGAP non-specialist-care context.
Morita Therapy
Guidelines and official sources (1)
1 professional reference check
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Psychotherapy: explanation from the psychotherapy committee
Discussed in the source
The society describes Morita therapy among approaches developed in Japan. This educational account does not establish a national standard-of-care recommendation.
Scope: Professional information on Morita therapy and its historical clinical uses.
Mindfulness-Based Relapse Prevention
Guidelines and official sources (3)
3 clinical guideline checks
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Clinical Practice Guideline for the Management of Substance Use Disorders
Insufficient evidence for or against
VA/DoD finds insufficient evidence for or against mindfulness-based therapies. It discusses MBRP directly, but does not make a positive recommendation for it.
Scope: Mindfulness-based therapies, including MBRP, for substance-use disorders.
- Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders
Discussed in the source
Mindfulness-based relapse prevention is discussed within the reviewed psychosocial interventions. WHO conditionally recommends structured psychosocial treatment as a group, with low-certainty evidence, while noting uncertainty about individual therapy types versus usual care.
Scope: Adults with alcohol dependence.
- Clinical Practice Guideline for Tobacco Use Treatment
Discussed in the source
VA/DoD weakly recommends against standalone mindfulness for this cessation goal. This is category-level guidance; MBRP is not separately graded, and the statement does not address adjunctive use or other conditions.
Scope: Mindfulness used as a standalone treatment for abstinence from tobacco or nicotine.
DBT
Guidelines and official sources (9)
8 clinical guideline checks · 1 evidence registry check
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Borderline personality disorder: recognition and management (CG78)
Recommendation for the stated population
NICE says to consider a comprehensive DBT programme for this specified population. This does not establish a recommendation for every personality disorder or every presentation.
Scope: Women with BPD for whom reducing recurrent self-harm is a priority.
- Assessment and Management of Patients at Risk for Suicide
Insufficient evidence for or against
The 2024 guideline finds insufficient evidence for or against DBT for these outcomes. This recommendation is separate from NICE’s BPD recommendation.
Scope: Adults aged 18 and over at risk of suicide; DBT for reducing suicidal ideation, suicide attempts or suicide.
- Psychotherapie bij persoonlijkheidsstoornissen
Recommendation for the stated population
DBT is named among recommended specialist BPD treatments.
Scope: BPD; treatment delivered as described and studied
- Dialectical behavior therapy for BPD
Discussed in the source
The archive lists Strong under 1998 criteria, with 2015 re-evaluation pending; this is an evidence listing.
Scope: DBT for BPD
- Self-harm: assessment, management and preventing recurrence (NG225)
Discussed in the source
NICE says to consider the adolescent adaptation, DBT-A, for this specified self-harm population. This does not grade every DBT programme or suicide-related outcome.
Scope: Children and young people with significant emotional dysregulation and frequent self-harm
- Clinical Practice Guideline for Management of PTSD and Acute Stress Disorder
Insufficient evidence for or against
VA/DoD finds insufficient evidence for or against DBT for PTSD. This assessment does not determine its status for other conditions.
Scope: Individual psychotherapy for adults with PTSD.
- Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder in Adults
Insufficient evidence for or against
APA finds insufficient evidence to recommend one of these treatment arrangements over the other. This does not assess DBT for BPD.
Scope: Adults with PTSD; DBT plus PE versus DBT alone.
- Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders
Discussed in the source
DBT is named in the reviewed third-wave therapy category. WHO recommends that category alongside other structured therapies; it does not give DBT a separate recommendation or separate certainty rating here.
Scope: Adults with moderate-to-severe depression, within the mhGAP non-specialist-care context.
- Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders
Discussed in the source
WHO conditionally supports digital interventions based on approaches including DBT, with low-certainty evidence. This is not a recommendation for every full DBT program, and the reviewed trials did not establish benefit for attempts or deaths and were underpowered for those outcomes.
Scope: Digital support for people with suicidal thoughts.
Contemplative traditions have been investigating the mind for millennia. Buddhist psychology offered a sophisticated phenomenology of suffering, impermanence, and non-self long before Western psychology existed. The entry point into Western psychotherapy came through three doors: Kabat-Zinn\u2019s MBSR (1979), which secularized mindfulness for medical settings; the "third wave" of CBT (MBCT, ACT), which integrated mindfulness into behavioral frameworks; and contemplative psychotherapy programs like Naropa\u2019s, which brought the full depth of Buddhist psychology into clinical training. Meanwhile, Japanese therapeutic traditions like Morita and Naikan developed independently from Zen. The tension at the heart of this lineage: does extracting mindfulness from its ethical and philosophical context preserve what matters, or does it produce a shallow imitation?
Full Contents
Read all 8 entries as a single page
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The Buddha
The Four Noble Truths describe suffering, its origin, cessation, and path. The Eightfold Path includes Right Mindfulness (sati). The Abhidharma developed a systematic phenomenological psychology of mental states.
Concepts: Four Noble Truths · Eightfold Path · Sati (mindfulness) · Dukkha · Anatta (non-self) · Anicca (impermanence)
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Shoma Morita
Japanese psychiatrist who developed Morita Therapy (1919) from Zen. Key insight: the problem is not anxiety but fixation on eliminating it (toraware). Accept feelings as they are (arugamama) while engaging in purposeful action.
Concepts: Arugamama · Toraware · Fumon · Accept feelings, change behavior
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Ishin Yoshimoto
Developed Naikan therapy from Jōdo Shinshū Buddhist self-examination. Three questions: What did I receive? What did I give? What trouble did I cause? The radical omission: "What was done to me?"
Concepts: Three Naikan questions · Gratitude · Interdependence · Self-reflection over self-advocacy
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Chögyam Trungpa
Founded Naropa University (1974), home to the most developed contemplative psychotherapy training. Introduced "brilliant sanity" and warned against "spiritual materialism."
Concepts: Brilliant sanity · Spiritual materialism · Maitri · Contemplative psychotherapy
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Jon Kabat-Zinn
Created MBSR at UMass Medical School (1979). Deliberately secularized Vipassana and Zen for medical settings. The 8-week group program launched an entire research field.
Concepts: MBSR · Non-judgmental awareness · Beginner’s mind · Full catastrophe living · Body scan
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Segal, Williams & Teasdale
Created MBCT (2002) by integrating MBSR with cognitive therapy’s understanding of depressive relapse. Mindfulness teaches decentering — observing thoughts as mental events rather than truths.
Concepts: MBCT · Decentering · Thoughts are not facts · Cognitive reactivity · Relapse prevention
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Steven Hayes
Created ACT from contextual behavioral science, but the parallels with Buddhist psychology are striking: defusion echoes non-attachment, acceptance maps to equanimity, values-based living resembles Right Action.
Concepts: Psychological flexibility · Cognitive defusion · Acceptance · Values · Self-as-context
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Paul Gilbert
Created CFT (2005) integrating evolutionary psychology, attachment theory, and Buddhist compassion practices. Three emotion systems explain why shame-prone clients struggle.
Concepts: Three emotion systems · Compassionate mind · Self-compassion · Evolutionary mismatch