Mindfulness based treatment for smoking cessation: How it works and future directions

Abstract

In 2015, over 1.1 billion people smoked tobacco worldwide [1]. The World Health Organization (WHO) has estimated that tobacco use (smoking and smokeless) is responsible for the death of about six million people across the world each year [1]. This total includes about 600,000 people who are also estimated to die from the effects of second-hand smoke [1]. In the United States, smoking costs more than $193 billion in health care costs and lost productivity per year [2]. Although over 70% of smokers want to quit, fewer than 5% achieve this goal annually [2]. Mainstay behavioral treatments for smoking have focused on teaching individuals to avoid cues, foster positive affective states, develop lifestyle changes that reduce stress, divert attention from cravings, substitute other activities for smoking, learn cognitive strategies that reduce negative mood, and develop social support mechanisms. These interventions and methods have shown modest success, with abstinence rates between only 20-30% holding steady over the past thirty years. This low rate of abstinence attainment and lack of improvement in outcomes is presumably due to the complex nature of the acquisition and maintenance of nicotine addiction, including associative learning mechanisms as well as positive and negative reinforcement.The complex learning mechanisms behind the acquisition of nicotine dependence is related to the fact that over time cues that are judged to be positive or negative can induce affective states, which can then trigger a craving to use [3,4]. Though the centrality of craving remains controversial, evidence suggests that craving is strongly associated with using, which, mainly through the physiological properties of nicotine, results in the maintenance or improvement of positive or reduction of negative affective states [4]. This sets up reinforcement loops by reinforcing memories between affect and smoking [3]. Thus, recent attention has been focused on additional strategies to help people tolerate negative affect and cravings rather than only avoiding cues or substituting activities.Recent research suggests that another psychological intervention called mindfulness training (MT) may decouple the association between craving and smoking, thus facilitating smoking cessation. Mindfulness means paying attention in the present moment, non-judgmentally, without commentary or decision-making. MT targets affective or craving states by teaching individuals to observe aversive body and mind states instead of responding to them with habitual reactions, thus allowing more adaptive, healthier responses [5]. MT has shown promise in reducing anxiety and depression and has recently been explored in the treatment of addictions. Davis et al. [6] conducted a pilot study to explore the effect of using Mindfulness Based Stress Reduction (MBSR) (with minor modifications) as a smoking intervention. MBSR was employed in its standard 8 weekly group session format. Subjects attempted smoking cessation during week seven without pharmacotherapy. The researche...