Mindful attention reduces neural and self-reported cue-induced craving in smokers

Abstract

An emerging body of research suggests that mindfulness-based interventions may be beneficial for smoking cessation and the treatment of other addictive disorders. One way that mindfulness may facilitate smoking cessation is through the reduction of craving to smoking cues. The present work considers whether mindful attention can reduce self-reported and neural markers of cue-induced craving in treatment seeking smokers. Forty-seven (n = 47) meditation-naïve treatment-seeking smokers (12-h abstinent from smoking) viewed and made ratings of smoking and neutral images while undergoing functional magnetic resonance imaging (fMRI). Participants were trained and instructed to view these images passively or with mindful attention. Results indicated that mindful attention reduced self-reported craving to smoking images, and reduced neural activity in a craving-related region of subgenual anterior cingulate cortex (sgACC). Moreover, a psychophysiological interaction analysis revealed that mindful attention reduced functional connectivity between sgACC and other craving-related regions compared to passively viewing smoking images, suggesting that mindfulness may decouple craving neurocircuitry when viewing smoking cues. These results provide an initial indication that mindful attention may describe a 'bottom-up' attention to one's present moment experience in ways that can help reduce subjective and neural reactivity to smoking cues in smokers.

Figures

Fig. 1

Scanning task design. Schematic illustration of a single trial. Each trial began with a 2500-ms long instruction (LOOK or MINDFULLY ATTEND or REAPPRAISE), followed by a jittered interval. A photo was then presented onscreen for 8000 ms (neutral, negative or smoking). Subsequently, participants were asked to rate the strength of their craving and negative affect. Trials were separated by a 2000-ms intertrial interval.

Fig. 2

Differences in self-reported craving. Mean cue-induced craving reported by condition for the fMRI sample.

Fig. 3

Activations during MindfulSmoking > LookSmoking. Regions modulated by mindful attention. Sagittal (x = 14), coronal (y = 38) and axial slices (z = −4) views of sgACC, which was significantly less activated during mindful attention to smoking pictures, compared to passive viewing.

Fig. 4

Region of overlap between MindfulSmoking > LookSmoking contrast and LookSmoking > LookNeutral contrast (BA 32/10, 8, 46, −8, k = 53).

Fig. 5

Functional connectivity in MindfulSmoking > LookSmoking. Regions that were functionally connected to sgACC seed during mindful attention to smoking stimuli compared to passive viewing. Highlighted regions are part of a network previously associated with craving, including the VS and insula.

Fig. 6

Representative single-subject plots of functional connectivity in VS and insula. Activity in VS and insula from two different subjects compared to ACC activity in MindfulSmoking and LookSmoking conditions. Functional coupling between ACC and insula (A) and VS (B) was greater in the LookSmoking condition than in the MindfulSmoking condition.