Most of the clinical evidence for mindfulness comes from a small number of structured programmes with defined curricula. Knowing what is in them explains why app-based practice performs differently.
The structure
Typically eight weekly sessions of a couple of hours in a group, with daily home practice between, and generally a longer silent day near the end.
That is a substantial commitment, which is worth noting, since it is considerably more than most people assume mindfulness involves.
The components
A body scan, moving attention systematically through the body, which is generally the first practice introduced.
Sitting practice with attention to breath, then expanding to sounds, sensations and thoughts.
Mindful movement, generally gentle stretching with attention to sensation.
And informal practice — bringing the same attention to routine activities.
The parts that are not meditation
The frequently overlooked half.
Group discussion of experience, which provides normalisation and the discovery that others find it equally difficult.
Psychoeducation about stress, mood and the specific mechanisms the programme targets.
In the depression-focused variant, explicit cognitive content about the relationship between mood and thinking, and relapse prevention planning.
Which means these are structured psychological interventions containing meditation, not meditation courses, and evaluating them as evidence for meditation alone overstates what they show.
The relapse prevention finding
The strongest result in the field and worth stating precisely.
The depression-focused programme, delivered to people with a history of recurrent depression who are currently well, reduces relapse rates.
Effects have been comparable to maintenance antidepressant medication in some trials.
Which is why it appears in clinical guidelines in several countries for that specific population.
The finding does not extend to people currently in an episode, where the evidence is weaker and the practice may be harder to engage with.
The proposed mechanism
Decentering — relating to thoughts as mental events rather than as facts.
The model is that depressive relapse involves low mood reactivating patterns of negative thinking, which then amplify the mood.
Recognising the pattern as it starts, without engaging with the content, interrupts the cycle.
Measures of decentering do mediate outcomes in some studies, which supports the model.
The teacher question
Programme developers are explicit that teachers should have substantial personal practice and specific training.
The stated reasoning is that responding to participants' difficulties requires having encountered them, and that some participants raise material requiring careful handling.
Teacher training pathways exist with defined requirements, and adherence to them varies enormously in what is offered commercially.
Which means a course described using the same terminology may bear little relation to what was studied.
Adverse experiences
Structured programmes generally screen participants and include guidance on managing difficulty.
Which is one of the clearer differences from unsupported app-based practice, where nobody is screening anyone.
People with trauma histories, current severe depression, or psychotic conditions are generally advised toward modified approaches or against certain practices, and that judgement requires someone competent to make it.
What to look for
If considering a course, asking about the teacher's training, whether there is a screening conversation, and whether the curriculum follows an established programme will separate most of the offering.
And for anyone with a history of recurrent depression, this is worth raising with a doctor, since in some systems it is available through health services rather than commercially.
Cost and access
Structured programmes are available through health services in some countries for specific indications, and privately elsewhere at substantial cost.
Which creates an obvious access problem and explains the appeal of applications despite their weaker evidence.
Some programmes are delivered in groups at lower cost, and community and workplace provision has expanded, with quality varying considerably.
What the practice feels like
Worth setting expectations, since disappointment drives dropout.
Most people find it dull, uncomfortable and frustrating initially, and programme materials generally say so.
The body scan in particular is commonly disliked in early weeks, and participants frequently fall asleep during it.
Which is normal, is addressed in the group discussion, and is one of the things that solitary app practice provides no context for.
Maintenance
Follow-up studies find that continued practice after the programme predicts maintained benefit in some studies and not others.
Which leaves open whether the programme produces a durable change or whether ongoing practice is required, and the answer probably differs by person and by outcome.
The silent day
Most programmes include a longer session, generally around six hours, near the end.
It is where difficulty most often surfaces, and where the teacher's competence matters most.
Anyone with concerns about extended practice should raise them beforehand rather than during.
Group versus individual
These programmes are designed as group interventions, and the group is part of the mechanism rather than a delivery convenience.
Hearing others describe the same difficulties normalises them, which is the component solitary practice cannot provide.
Individual delivery exists and is less studied, and it loses that element entirely.