Mindfulness therapy session notes: what to write, a template and an example

Why the note is different in mindfulness work

In standard psychotherapy, the note mainly sums up what was said and how you understand it. In mindfulness work, much of the work is done by practising, in the session and then at home between appointments. So the note has to keep track of what was practised, what the patient experienced and what they do at home. Without this, it becomes hard to tell, three months later, where progress came from or which practice does not suit the patient.

For the general framework of a psychologist's notes (content, status, retention), see our article Psychologists' session notes: framework, content and template.

Individual sessions or group programmes

Mindfulness within individual therapy

Many practitioners bring mindfulness exercises into individual therapy, whatever their approach. There is no set programme. You choose the practices according to the patient and the stage of therapy, and the note keeps track of what was offered and what helped. If you work in acceptance and commitment therapy, see also our ACT session notes.

Group programmes: MBSR and MBCT

• MBSR (mindfulness-based stress reduction) was developed in the late 1970s at the University of Massachusetts Medical Center by Jon Kabat-Zinn. The programme described by Penn State University includes an orientation session, eight weekly sessions of two and a half to three hours and a seven-hour silent retreat day between the sixth and seventh sessions.
• MBCT (mindfulness-based cognitive therapy) is an adaptation of MBSR by Zindel Segal, Mark Williams and John Teasdale, for people who have had repeated episodes of depression. According to NICE, it usually has 8 sessions over 2 to 3 months, with 8 to 15 participants. An NHS service in Oxford describes it as eight weekly two-hour sessions, with daily practice at home.

What to write after each session

Practices offered in the session

Write the name of the practice, its length and whether it was guided. For example, "body scan lying down, 30 min, guided". Add any adaptations, such as keeping the eyes open, shortening the practice or staying seated.

What the patient experienced

Write down what they noticed in their own words, in quotation marks when a sentence says a lot. Separate bodily sensations, the thoughts that came up and how the patient related to them. "I saw I was drifting into my scenarios and I managed to come back to the breath" tells you a lot about how therapy is going.

Home practice and how regular it is

This is often the most useful section for tracking change. Write the number of days of practice since the last session, which practices, roughly how long, and what helped or got in the way. Write the figures as the patient gives them, without judging. "Twice, and I felt guilty the rest of the time" is clinical information, not a failure.

NICE points out that group participants must be willing to do this work at home, including using guided meditation audio. It is worth checking before referring a patient to a programme.

Difficulties

Boredom, drowsiness, restlessness, the feeling of "doing it wrong", lack of time, practice dropped after an event. These obstacles are common. Writing them down shows whether they come back and what was suggested.

Link with the therapy goals

End with one or two lines linking the session to the goals of therapy. In relapse prevention for depression, for example, note whether the patient is better at spotting the first signs of low mood and what they plan to do. Then write the practice suggested before the next session.

Adverse effects: what the literature says and what to write

This is the section templates most often leave out. Two studies help to get a sense of it.

• Farias and colleagues (2020) pooled 83 studies and 6,703 people who had practised meditation. The overall prevalence of adverse effects was 8.3%, with wide differences by study type (3.7% in experimental studies, 33.2% in observational studies). The most often reported were anxiety, depression and cognitive anomalies, including in people with no history of mental health problems.
• Britton and colleagues (2021) questioned 96 people after an eight-week mindfulness programme. 58% reported at least one meditation-related adverse effect, 37% an effect that affected their functioning and 6% effects lasting more than a month. Harmful effects were linked to poorly regulated arousal (anxiety, hyperstimulation or emotional blunting). Waiting for spontaneous complaints was not enough, and specific questions asked in private brought more effects to light.

NICE also notes that group mindfulness may be difficult for people with intense or highly distressing thoughts, or who find it hard to focus on the body. For the note, this leads to a few habits.

• Regularly ask a specific question ("Has any practice made you anxious or brought back painful memories?") and write down the answer, even if it is no.
• If an effect appears, note what it is (anxiety, memories coming back, a sense of unreality, sleep, lower mood), the practice involved, how long it lasted and its impact.
• Note what you adapted. A shorter practice, eyes open, attention on sounds or points of contact rather than the breath, a pause or a change of direction.
• Note how the effect evolved at the next session.

Tracking change from one session to the next

You see whether therapy is moving forward by reading several notes in a row. A few items, written the same way each session, make this easy.

• Regular practice. The number of practice days per week can be compared at a glance over several weeks.
• Relationship to thoughts. The patient's own sentences show the ground covered, for example moving from "I'm useless" to "I'm having the thought that I'm useless again".
• Early signs of relapse. Keep the list of signs the patient has learned to recognise and what they plan to do, and update it.
• Questionnaires. If you use one (mood, anxiety, mindfulness), note its name, the score and the date, always at the same points in therapy.

At the end of therapy, these items let you write an end-of-therapy summary quickly.

What guidelines say about MBCT

In the UK, NICE

NICE guideline NG222 on depression in adults (June 2022) mentions MBCT in two places. For less severe depression, "group mindfulness and meditation" is listed among possible first-line treatments, using a programme such as MBCT.

For relapse prevention, recommendation 1.8.5 covers people in remission after antidepressant treatment alone who are assessed as being at higher risk. It suggests considering continuing the antidepressant, a course of group CBT or MBCT for those who do not wish to continue medication, or both together. Recommendation 1.8.6 asks for this course to focus explicitly on relapse prevention skills, usually over 8 sessions across 2 to 3 months, with possible follow-up sessions over the next 12 months.

In France, the HAS

In its 2017 guideline on major depressive episodes in adults in primary care, the HAS (Haute Autorité de Santé, the French national health authority) states in a footnote that « la thérapie de pleine conscience (« mindfulness ») est une TCC indiquée dans la prise en charge de la récidive (récurrence) d'un EDC » (mindfulness therapy is a CBT indicated for managing recurrence of a major depressive episode). We did not find a HAS guideline dedicated to MBCT.

What the evidence shows

A meta-analysis published in 2016 in JAMA Psychiatry (Kuyken and colleagues, 9 trials, 1,258 patients) found a lower risk of depressive relapse over 60 weeks after MBCT than without MBCT (hazard ratio 0.69), and also compared with active treatments (0.79). If therapy aims to prevent relapse, say so in the note and write down what relates to it at each session.

Ready-to-use session note template

This template suits an individual session. In a group, use it for each participant's note with lighter sections.

• Session. Date, number, length, in person or video. For a programme, the programme session (for example 4 of 8).
• State on arrival. Mood and events since the last session, in two or three lines. Questionnaire score if you use one.
• Home practice. Number of days out of 7, practices done, rough length, what helped or got in the way.
• Practices in session. Name, length, guided or not, adaptations.
• Reported experience. Sensations, thoughts, emotions, and how the patient related to them. One or two quotations.
• Difficulties. Obstacles in the session or at home and what was suggested.
• Adverse effects. Question asked and answer. If an effect is present, what it is, practice involved, length, impact, adaptation.
• Link with goals. What the session adds to the goals, for example early signs of relapse identified.
• Next time. Practice suggested, date of the next appointment, point to come back to.

These sections also fit a SOAP, DAP or BIRP format, as our article SOAP, DAP, BIRP session notes shows. For other approaches, see our clinical document templates.

Completed example (fictional case)

Mr R., 46, has had three depressive episodes. He has been in remission for four months, does not want to restart an antidepressant and comes to therapy to avoid a relapse. Therapy is individual and includes practices inspired by MBCT.

• Session. Session 6, 50 min, in person.
• State on arrival. Busy week, a tense meeting on Tuesday. Sleeping well. "Less rumination in the evening than last month."
• Home practice. Body scan 4 days out of 7 (about 20 min, in the morning). Three-minute breathing space used twice, once after the meeting. Two days skipped "for lack of time".
• Practices in session. Sitting meditation, breath then sounds, 15 min, guided. Three-minute breathing space at the end of the session.
• Reported experience. Thoughts about the meeting came back several times. "I saw I was replaying the meeting in my head, and I managed to come back to the sounds." Tension in the shoulders noticed without trying to make it go away.
• Difficulties. Drowsiness when he practises in the evening. Suggested keeping practice in the morning.
• Adverse effects. Asked about discomfort or painful memories during practices. Answers no.
• Link with goals. Identifies two signs that came before his episodes, social withdrawal and waking around 4 am. List updated. Plans to tell his partner and get back in touch if these signs last more than a week.
• Next time. Sitting meditation 20 min, 6 days out of 7, in the morning. Breathing space after tense situations. Next session in 2 weeks.

In a group: one note per participant

A single note for the session is not enough, because each participant has their own file and their own progress. A simple set-up works well.

• One group note per session. Date, programme session, practices offered, theme, who attended and who did not.
• One short note per participant. Their home practice, what they shared about their experience, their difficulties, any adverse effect and what to follow up with them. Three to six lines are often enough.
• No other participant's name in an individual note. If an exchange matters, describe it without naming the person ("in response to another participant"). This protects the group's confidentiality.
• Absences. Note them in the participant's note, with what was offered to catch up.

How Delta works

Delta is an AI assistant for mental health and allied health practitioners. During the session, Delta transcribes what is said, then prepares a session report that you review. You can also dictate your observations just after the session. The report takes your specialty and your therapeutic approach into account. It is added to the patient's file, which brings out the change specific to that approach over the sessions. Delta also drafts your assessment reports, letters and certificates.

Data is hosted in France, with a host certified for health data (HDS). AI processing, transcription included, takes place on servers located in France. The patient's name and identifying information are pseudonymised before going through the AI, no audio file is kept, data is never used to train models and it is encrypted in transit and at rest. On informing patients, see our article on consent and AI note-taking.

Frequently asked questions

Sources

• NICE, Depression in adults: treatment and management (NG222), 2022
• NICE, NG222, PDF version (recommendations 1.8.5 and 1.8.6, table 1)
• HAS, Épisode dépressif caractérisé de l'adulte : prise en charge en soins de premier recours, 2017
• Oxford Health NHS Foundation Trust, Mindfulness Based Cognitive Therapy Class
• MBCT.com, About MBCT
• Penn State College of Medicine, Mindfulness-Based Stress Reduction (MBSR)
• Kuyken W. et al., JAMA Psychiatry, 2016;73(6):565-574
• Farias M. et al., "Adverse Events in Meditation Practices and Meditation-Based Therapies: A Systematic Review", Acta Psychiatrica Scandinavica, 2020
• Brown University, on the study by Britton W.B. et al., Clinical Psychological Science, 2021