MORE Mindfulness for Stopping Smoking
By John M. de Castro, Ph.D.
“I liken it to having weeds in your garden. Standard treatments—for example, avoiding triggers such as ashtrays and lighters or using substitutes such as eating carrot sticks and chewing on your pen—just pull the heads off the weeds, so they grow back. These treatments don’t uproot the craving itself. In contrast, mindfulness really gets in there and pulls up the roots.” – Judson Brewer
“Tobacco use remains the single largest preventable cause of death and disease in the United States. Cigarette smoking kills more than 480,000 Americans each year, with more than 41,000 of these deaths from exposure to secondhand smoke. In addition, smoking-related illness in the United States costs more than $300 billion a year. In 2013, an estimated 17.8% (42.1 million) U.S. adults were current cigarette smokers.” (Centers for Disease Control and Prevention).
There are a wide variety of methods and strategies to quit smoking which are to only a very limited extent effective. According to the National Institutes of Health, about 40% of smokers who want to quit make a serious attempt to do so each year, but fewer than 5% actually succeed. Most people require three or four failed attempts before being successful. One problem is that nicotine is one of the most addictive substances known and withdrawal from nicotine is very stressful, producing many physical and psychological problems, including negative emotional states and depression. In essence the addict feels miserable without the nicotine. This promotes relapse to relieve the discomfort.
Better methods to quit which can not only promote quitting but also prevent relapse are badly needed. Mindfulness practices have been found to be helpful in treating addictions, including nicotine addiction, and reducing the risk of relapse. But, it is not known how mindfulness produces these beneficial effects. One possibility is that mindfulness training helps to alter how rewarding smoking is, called restructuring reward processes.
In today’s Research News article “Restructuring Reward Mechanisms in Nicotine Addiction: A Pilot fMRI Study of Mindfulness-Oriented Recovery Enhancement for Cigarette Smokers.” See summary below or view the full text of the study at:
Froeliger and colleagues examine whether restructuring reward processes is involved in mindfulness training’s effectiveness in aiding smoking cessation. They recruited nicotine-dependent adult smokers who reported smoking more than 10 cigarettes/day for a minimum of 2 years. They separated them into a mindfulness training group and a matched no-treatment control group. Mindfulness training, called Mindfulness-Oriented Recovery Enhancement (MORE) involved 8 weekly sessions, including mindful breathing and body scan meditations, cognitive reappraisal to decrease negative emotions and craving, and savoring to augment natural reward processing and positive emotion. They were also encouraged to practice at home for 15 minutes per day. The groups were measured for smoking by self-report and breath CO2 measurement, craving to smoke, positive and negative emotions, and mindfulness. Both groups underwent functional Magnetic Resonance Imaging (fMRI) before and after the 8-week training. During scanning they were instructed to imagine feeling positive emotions in response to a picture or to simply look at neutral or smoking related images.
They found that MORE mindfulness training significantly reduced cigarette consumption and improved positive emotions following treatment. The fMRI scans revealed significant changes in brain structure and connectivity in the MORE mindfulness training group. While imagining positive reactions to pictures, after, but not before training, the MORE mindfulness trained group evidenced a significantly greater response than the control group in the rostral anterior cingulate cortex and ventral striatum. Conversely, while viewing smoking related images, the MORE mindfulness trained group evidenced a significantly lower response than the control group in the rostral anterior cingulate cortex and ventral striatum. Hence, MORE mindfulness training appeared to restructure the brain increasing brain responses to positive thoughts while decreasing them to smoking stimuli. So, treatment appeared to change the brain making it react more positively to everyday stimuli and more negatively to smoking images, reducing the emotional rewards of smoking.
They also found that the larger the brain response to imagining positive emotions to everyday stimuli in the rostral anterior cingulate cortex and ventral striatum the greater the positive emotions and the smaller the craving for cigarettes and the greater the reduction in cigarettes smoked. So, mindfulness training increased the response of these structures resulting in greater positive mood and a lowering of cigarette craving and consumption. This suggests that MORE mindfulness training reduces craving and smoking by changing the brain to produce less positive emotional responses to smoking.
These are fascinating results and encourage further, better controlled work than this pilot study that did not have an active control condition. But, the results clearly suggest that mindfulness training is effective in helping nicotine addicts stop smoking and does so by altering the brain to be more positive normally and less positive to smoking. The mindfulness training appeared to restructure the brain making smoking less rewarding and the rest of life more so, leading to reduced smoking.
So, MORE mindfulness for stopping smoking.
“Early evidence suggests that exercises aimed at increasing self-control, such as mindfulness meditation, can decrease the unconscious influences that motivate a person to smoke,” – Nora Volkow
CMCS – Center for Mindfulness and Contemplative Studies
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Froeliger, B., Mathew, A. R., McConnell, P. A., Eichberg, C., Saladin, M. E., Carpenter, M. J., & Garland, E. L. (2017). Restructuring Reward Mechanisms in Nicotine Addiction: A Pilot fMRI Study of Mindfulness-Oriented Recovery Enhancement for Cigarette Smokers. Evidence-Based Complementary and Alternative Medicine : eCAM, 2017, 7018014. http://doi.org/10.1155/2017/7018014
The primary goal of this pilot feasibility study was to examine the effects of Mindfulness-Oriented Recovery Enhancement (MORE), a behavioral treatment grounded in dual-process models derived from cognitive science, on frontostriatal reward processes among cigarette smokers. Healthy adult (N = 13; mean (SD) age 49 ± 12.2) smokers provided informed consent to participate in a 10-week study testing MORE versus a comparison group (CG). All participants underwent two fMRI scans: pre-tx and after 8-weeks of MORE. Emotion regulation (ER), smoking cue reactivity (CR), and resting-state functional connectivity (rsFC) were assessed at each fMRI visit; smoking and mood were assessed throughout. As compared to the CG, MORE significantly reduced smoking (d = 2.06) and increased positive affect (d = 2.02). MORE participants evidenced decreased CR-BOLD response in ventral striatum (VS; d = 1.57) and ventral prefrontal cortex (vPFC; d = 1.7) and increased positive ER-BOLD in VS (dVS = 2.13) and vPFC (dvmPFC = 2.66). Importantly, ER was correlated with smoking reduction (r’s = .68 to .91) and increased positive affect (r’s = .52 to .61). These findings provide preliminary evidence that MORE may facilitate the restructuring of reward processes and play a role in treating the pathophysiology of nicotine addiction.