Craving to Quit: A Randomized Controlled Trial of Smartphone App-Based Mindfulness Training for Smoking Cessation

Abstract

Introduction: Mindfulness training may reduce smoking rates and lessen the association between craving and smoking. This trial tested the efficacy of mindfulness training via smartphone app to reduce smoking. Experience sampling (ES) was used to measure real-time craving, smoking, and mindfulness.

Methods: A researcher-blind, parallel randomized controlled trial compared the efficacy of mobile mindfulness training with experience sampling (MMT-ES; Craving to Quit) versus experience sampling only (ES) to (1) increase 1-week point-prevalence abstinence rates at 6 months, and (2) lessen the association between craving and smoking. A modified intent-to-treat approach was used for treatment starters (MMT-ES n = 143; ES n = 182; 72% female, 81% white, age 41 ± 12 year).

Results: No group difference was found in smoking abstinence at 6 months (overall, 11.1%; MMT-ES, 9.8%; ES, 12.1%; χ2(1) = 0.43, p = .51). From baseline to 6 months, both groups showed a reduction in cigarettes per day (p < .0001), craving strength (p < .0001) and frequency (p < .0001), and an increase in mindfulness (p < .05). Using ES data, a craving by group interaction was observed (F(1,3785) = 3.71, p = .05) driven by a stronger positive association between craving and cigarettes per day for ES (t = 4.96, p < .0001) versus MMT-ES (t = 2.03, p = .04). Within MMT-ES, the relationship between craving and cigarettes per day decreased as treatment completion increased (F(1,104) = 4.44, p = .04).

Conclusions: Although mindfulness training via smartphone app did not lead to reduced smoking rates compared with control, our findings provide preliminary evidence that mindfulness training via smartphone app may help lessen the association between craving and smoking, an effect that may be meaningful to support quitting in the longer term.

Implications: This is the first reported full-scale randomized controlled trial of any smartphone app for smoking cessation. Findings provide preliminary evidence that smartphone app-based MMT-ES may lessen the association between craving and smoking.

Trial registration: Clinicaltrials.gov NCT02134509.

© The Author(s) 2018. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Figures

Figure 1.

Change in smoking, craving and mindfulness: (a) cigarettes per day; (b) craving frequency; (c) craving strength; and (d) mindfulness, at baseline (0) and 6 months (6) for mobile mindfulness training with experience sampling (MMT-ES) (solid) and experience sampling-only (ES) (dashed).

Figure 2.

The relationship between change in cigarettes per day (CPD) and change in craving strength grouped by low (0–14 modules), medium (15–41 modules), and high (42+ modules) rates of completion of mobile mindfulness training with experience sampling (MMT-ES) training modules (of 58 modules). The relationship between CPD and craving strength decreased as the number of MMT-ES treatment modules completed increased (p = .04).

Figure 3.

Regression lines for the prediction of total daily smoking (cigarettes per day) by average daily craving across treatment days for each group. This prediction differed between groups (p = .05), with a weaker association between craving and smoking for mobile mindfulness training with experience sampling (MMT-ES) (t = 2.03, p = .04; solid line) as compared with experience sampling-only (ES) (t = 4.96, p < .0001; dashed line).