Mindfulness training for smoking cessation: moderation of the relationship between craving and cigarette use

Abstract

Background: Smoking is the leading cause of preventable death in the US, while abstinence rates remain modest. Smoking has been shown to be perpetuated by operant conditioning, notably negative reinforcement (e.g., smoking to relieve negative affective states). Mindfulness training (MT) shows promise for smoking cessation, by potentially altering an individual's tendency to smoke in response to craving. The purpose of this study was to examine the effects of MT and mindfulness practice on the relationship between smoking and craving after receiving four weeks of MT.

Methods: 33 adults received MT as part of a randomized trial for smoking cessation. Individuals in the MT condition recorded formal and informal mindfulness practice during treatment using daily diaries.

Results: Analyses showed that strong correlations between craving and smoking at baseline (r=0.582) were attenuated at the end of treatment (r=0.126). Mindfulness home practice significantly predicted cigarette use (formal: B=-1.21, p=0.007; informal: B=-1.52, p<0.0001) and informal practice moderated the relationship between craving and smoking at the end of treatment (B=0.52, p=0.03).

Conclusions: These findings suggest that MT may be effective as a treatment for smoking cessation and that informal mindfulness practice predicts a decoupling of the association between craving and smoking.

Conflict of interest statement

Conflict of Interest.

None.

Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Figures

Figure 1. Associative learning “addictive loop” for nicotine dependence

a) Smoking becomes associated with positive (green) and negative (red) affective states through positive and negative reinforcement. Cues that lead to these states (gray arrows) can also trigger cue-induced craving, and subsequent smoking, which becomes habitual after multiple rounds of reinforcement. b) Strategies that teach avoidance of cues or substitute behaviors may not directly dismantle the core addictive loop (black arrows). Avoidance of cues dampens input into the addictive loop, while substitute behaviors (blue arrows) circumvent the targeted addictive behavior (e.g. smoking). Copyright 2011 Judson Brewer. Reprinted with permission of author.

Figure 2. Decreases in craving scores lag behind abstinence with mindfulness training

Abstainers = individuals with biochemically-verified one-week point prevalence abstinence at the end of treatment and at their 4-month follow up interview. QSU = Questionnaire of Smoking Urges. * indicates a significant difference in craving scores at the 4-month primary endpoint, p = 0.03.