Promising Role of Mindfulness Meditation in Treatment for Smoking

Written by on December 1, 2014 in Research & Technology - No comments

Tobacco use is the number one cause of preventable death in the United States, affecting nearly every organ of the body.1 Despite the well-known health consequences of tobacco use and increases in tobacco prevention policies, still about 20% of adults in the United States are current smokers. Furthermore, use of alternative nicotine products such as e-cigarettes is on the rise. These alternatives remain potentially addictive and are not currently regulated by the Food and Drug Administration.

The good news is that most tobacco users are interested in quitting. In 2010, 69% of adult smokers said they want to quit, and 52% had tried to quit during the preceding year. 1 Quitting has benefits regardless of age or smoking history. Even among those who have used tobacco for several decades, cessation is associated with significant improvements in health.

7792297_xxWEBIn spite of their interest in quitting, many tobacco users find it hard to permanently quit. Not only is nicotine highly addictive, but quitting may also be difficult because most smokers in the US who try to quit using tobacco do so without taking advantage of empirically tested, effective methods.1 There are numerous successful tobacco dependence treatments and medications, which are generally categorized into behavioral therapies, nicotine replacement products, and non-nicotine medications such as bupropion SR (Zyban®) and varenicline tartrate (Chantix®). Standard behavioral therapy programs, whether delivered in group or individual format, often include the following components: increasing self-awareness of tobacco use, enhancing motivation to quit, preparing for quitting, and providing strategies to maintain abstinence and prevent relapse. More effective than employing either counseling or medication alone, however, is the utilization of both together.1

Even among “gold standard” approaches, relapse remains a problem. When interviewed, only about 4–6% of smokers succeeded in quitting in the past year.1 To address the problem of relapse, novel practices such as acupuncture, “workplace challenges,” text messaging and cell phone “app” support, and others are beginning to be included in cessation programs in order to increase chances of long-term success. Mindfulness meditation is one adjunctive practice that is beginning to show promise in treatment of tobacco use disorders.

With roots in Buddhism, mindfulness is an active process, which involves paying attention in the present moment, non-judgmentally, without commentary or decision-making. Mindfulness is about being compassionate with yourself. Further, mindfulness is not a religion, does not take a lot of time, and is not complicated, making it a skill that is feasible to include in tobacco cessation programs.

All mindfulness techniques are considered forms of meditation, and there is more than one way to practice mindfulness. Here we describe one example of a mindfulness exercise, which involves sitting quietly and focusing on your breathing. Notice all the sensations in the abdomen as the breath moves in and out of the body. If you notice your mind wandering while you do this, simply notice where it went, and then gently escort it to the present moment and back to the breath. Mind-wandering will happen often, and there is no need to judge yourself. When you register that your mind has wandered, just bring your attention back to the breath. This technique can be practiced twice daily for 10-15 minutes.

Mindfulness training has been shown to significantly aid in improvement of physical health, mental health, and overall well-being. For example, it has been successfully applied to treatment of psychological disorders including anxiety and depression. The practice of mindfulness meditation is also associated with improved immune system functioning, enhanced learning and memory, increased psychological hardiness, and reduced pain. Mindfulness is thought to work by reducing anxiety and negative affect, decreasing rumination, improving coping strategies, assisting in the development of self-observation, and improving attention. Indeed, participants undergoing mindfulness training exhibit increased levels of activity in areas of the brain associated with attentional deployment, learning and memory, and self-control.2

Importantly, mindfulness training has shown early effectiveness in treating addictions, including nicotine dependence. It is thought to work by addressing common barriers to successful long-term cessation, namely cravings, also called smoking urges, and stress. Studies have shown that suppression of thoughts related to substance abuse may increase unwanted thoughts and even counteract attempts in smoking cessation, activating brain networks related to craving. Mindfulness meditation practice emphasizes acknowledgement and acceptance, rather than suppression, of unwanted thoughts. Therefore, it does not force participants to resist craving, but instead, allows tobacco users to identify and understand cues, improve self-control and increase capacity to handle craving, thereby reducing the likelihood of relapse. Some have suggested the training may help to bring automatic reactions and habits under more conscious, cognitive control. In this regard, mindfulness meditation may help tobacco users engage in “urge surfing,” or coping with cravings and allowing them to pass without returning to smoking. One mindfulness technique now taught as part of tobacco use interventions is to recognize a craving is arising, accept this moment, notice how your body feels as the craving enters and to replace the wish for the craving to go away with the knowledge that it will subside. In essence, smokers try to “ride out” the uncomfortable sensations without acting on them. In a study of smokers trained to practice mindfulness meditation, brain scans show altered activity in areas related to self-awareness and self-control.3

Stress and resulting negative emotions are also predictors of relapse that may be addressed through mindfulness practice. In fact, many tobacco users report that they smoke to alleviate stress and to regulate their mood. Thus, when encountering anxiety and irritability, which are common symptoms of nicotine withdrawal, tobacco users may be likely to relapse. The rehearsal of present-focused attention, rather than past or future-oriented attention, may address these barriers by allowing the individual to observe negative states, but not react to them, thus aiding in stress reduction and improving mood. Mindfulness may also work by allowing individuals to better adhere to tobacco cessation treatment in the moment and use coping skills when faced with triggers.

With regards to smoking, mindfulness training has shown preliminary utility in reducing negative emotions, craving, withdrawal symptoms, number of cigarettes smoked, and nicotine dependence. For example, in a study comparing the American Lung Association’s Freedom from Smoking treatment and mindfulness training over 8 weeks, participants randomized to the mindfulness condition smoked fewer cigarettes and were more likely to be abstinent from smoking four months after the treatment ended.4 In a second study comparing these two behavioral treatments, smokers in the mindfulness condition showed decreases in intensity of cravings and stress.5

Based on the research findings to date, mindfulness meditation shows promise as a strategy for reducing cravings and negative emotions which tend to accompany smoking cessation and predict relapse. Adjunctive mindfulness exercises that are quick and straightforward are now being included alongside standard interventions or used in conjunction with tobacco replacements with promising results. With additional research, mindfulness meditation may be considered a cost-effective method to enhance treatment-as-usual in addressing tobacco use disorders.

References

  1. U.S. Department of Health and Human Services [DHHS]. (2014). The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
  2. Brewer, J. A., Elwafi, H. M., & Davis, J. H.  (2013). Craving to quit: Psychological models and neurobiological mechanisms of mindfulness training as treatments for addictions. Psychology of Addictive Behaviors, 27, 366-379.
  3. Tang, Y.-Y., Tang, R. Posner M. I. (2013). Brief meditation training induces smoking reduction. Proceedings of the National Academy of Sciences, 110, 13971–13975.
  4. Brewer, J. A., Mallik, S., Babuscio, T. A., Nich, C. Johnson, H. E., Deleone, C. M…, Rounsaville, B. J. (2011). Mindfulness training for smoking cessation: Results from a randomized controlled trial. Drug and Alcohol dependence, 119, 72-80.
  5. Davis, J. M., Manley, A. R., Goldberg, S. B., Smith, S. S., Jorenby, D. E. (2014). Randomized trial comparing mindfulness training for smokers to a matched control. Journal of Substance Abuse Treatment, 47, 213-221.

“This material is based upon work supported by the Department of Veterans Affairs. This reflects the authors’ personal views and in no way represents the official view of the Department of Veterans Affairs of the U.S. Government.”

Author Biography
The authors comprise a research team which includes a licensed psychologist, two pre-doctoral psychology interns, and two undergraduate psychology students at the Gulf Coast Veterans Health Care System in Biloxi, MS. They are currently conducting a longitudinal study examining the effectiveness of a tobacco cessation intervention for Veterans.

By Nicole C. Rushing, Ph.D. Lauren M. Smith, Ph.D. Emily L. Smith, Taylor Anne D’Ilio, & Scott A. Cardin, Ph.D.

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