The Examen is a 500-year-old Jesuit introspective prayer and reflection. Recent research has indicated that it has utility in psychotherapy. This study implemented the Examen as a secular cognitive–behavioral tool in the first longitudinal clinical trial of the intervention with an addiction treatment population, comparing it directly to a treatment-as-usual mindfulness intervention. The study found that Examen and mindfulness are equivalent in outcomes on depression, anxiety, stress, and substance craving. Further research should continue to investigate the Examen as an alternative to mindfulness for religious and secular populations and the factors responsible for the success of these practices