Stay Abstinent from Smoking Mindfully

Stay Abstinent from Smoking Mindfully

 

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.” (Centers for Disease Control and Prevention). So, treating nicotine addiction and producing smoking cessation could greatly improve health. But, smoking has proved devilishly difficult to treat. 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.

 

In today’s Research News article “Dispositional Mindfulness Predicts Enhanced Smoking Cessation and Smoking Lapse Recovery.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4867253/, Heppner and colleagues recruited African American smokers who smoked at least 5 cigarettes per day for at least one year and enrolled in a smoking cessation treatment program. They were measured 19 and 5 days before quitting smoking and 3 days, 31 days, and 26 weeks after quitting for cigarettes smoked per day, smoking abstinence, mindfulness, positive and negative emotions, dependence and withdrawal symptoms, self-efficacy, and social support.

 

They found that the number of participants remaining abstinent dropped precipitously over 26 weeks but mindfulness mattered. Abstinence dropped to around 7% of participants who were low in mindfulness but to only 14% of participants who were high in mindfulness. Of those participants who relapsed at day 3 after treatment high mindfulness participants were significantly more likely to recover abstinence by day 31 and week 26. They also found that the improvement in abstinence at day 3 produced by mindfulness occurred primarily as a result of mindfulness producing lower levels of sadness, anger, and depression, lower use of smoking to control emotions, and more social support which in turn were associated with better abstinence rates.

 

These results are interesting but correlational, so causation cannot be determined. But, prior research has shown that mindfulness training improves treatment for nicotine addiction. So, it is likely that the relationships between mindfulness and smoking cessation observed in the present study were due to mindfulness causing the improved abstinence. Mindfulness acted through intermediaries of improved emotion regulation and improved social support to support abstinence. These results suggest that mindfulness is very helpful in remaining abstinent after quitting smoking and should become a component of all smoking cessation treatment packages.

 

So, stay abstinent from smoking mindfully.

 

“each time the individual does not succumb to the craving, the craving becomes weaker until eventually it no longer gets triggered. Moreover, with each moment of mindfulness, the smoker regains a sense of control and understanding regarding their mind and body, which can be empowering.”Azadeh Aalai

 

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Heppner, W. L., Spears, C. A., Correa-Fernández, V., Castro, Y., Li, Y., Guo, B., … Wetter, D. W. (2016). Dispositional Mindfulness Predicts Enhanced Smoking Cessation and Smoking Lapse Recovery. Annals of Behavioral Medicine : A Publication of the Society of Behavioral Medicine, 50(3), 337–347. http://doi.org/10.1007/s12160-015-9759-3

 

Abstract

Background

Although mindfulness has been hypothesized to promote health behaviors, no research has examined how dispositional mindfulness might influence the process of smoking cessation.

Purpose

The current study investigated dispositional mindfulness, smoking abstinence, and recovery from a lapse among African American smokers.

Methods

Participants were 399 African Americans seeking smoking cessation treatment (treatments did not include any components related to mindfulness). Dispositional mindfulness and other psychosocial measures were obtained pre-quit; smoking abstinence was assessed 3 days, 31 days, and 26 weeks post-quit.

Results

Individuals higher in dispositional mindfulness were more likely to quit smoking both initially and over time. Moreover, among individuals who had lapsed at day 3, those higher in mindfulness were more likely to recover abstinence by the later time points. The mindfulness-early abstinence association was mediated by lower negative affect, lower expectancies to regulate affect via smoking, and higher perceived social support.

Conclusions

Results suggest that mindfulness might enhance smoking cessation among African American smokers by operating on mechanisms posited by prominent models of addiction.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4867253/

Reduce Cigarette Smoking and Cravings with Mindfulness

Image may contain: 1 person, closeup

 

By John M. de Castro, Ph.D.

 

“Mindfulness, which is commonly described as present-moment, nonjudgmental awareness, can be an effective tool for riding out cravings and “sitting with” the distress associated with the quitting process. Furthermore, mindfulness can help foster an attitude of acceptance of present-moment challenges and thoughts (such as, “Quitting feels extremely difficult, and sometimes I worry I can’t do this.”). Acceptance can help one to ride out these moments, understanding them as temporary, rather than being overwhelmed by them.” – Traci Stein

 

“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).

 

Nicotine is one of the most addictive substances known. But, its addictiveness is not just due to its pharmacological properties. Addiction to smoking also involves learned or conditioned factors, genetics, and social and environmental factors. This makes it easy to become addicted and very difficult to stop. To some extent this is why there still are high rates of smoking even though mostly everyone understands that it has very negative effects on health and longevity.

 

There are a wide variety of methods and strategies to quit smoking which are to some 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 after quitting if a single cigarette is smoked, going back to regular smoking is almost assured. As John Polito wrote “nicotine dependency recovery is one of the few challenges in life where being 99% successful all but assures 100% defeat.”

 

So, better methods to quit are badly needed. Mindfulness training has been shown to be helpful in treatment for addiction and prevention of relapse after recovery. In today’s Research News article “Effect of Brief Mindfulness Practice on Self-Reported Affect, Craving, and Smoking: A Pilot Randomized Controlled Trial Using Ecological Momentary Assessment.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1425084614182127/?type=3&theater

or see summary below, Ruscio and colleagues test the effectiveness of brief meditation in real life situations to assist in reducing smoking. They recruited a community sample of adult cigarette smokers and randomly assigned them to either a brief (2 week) meditation or sham meditation condition. Meditation group participants were instructed in meditation and required to meditate once per day for at least 20 minutes at a time and place of their choosing with pre-recorded guided meditations. The control group also “sham meditated” once a day with a recording that guided them to let their minds wander and judge experience. Both groups were given a Personal Digital Assistant (PDA) that was programmed to prompt them at four random times during each day to complete assessments of smoking, craving, and positive and negative feelings.

 

They found that the meditation group reported significantly lower cravings after meditation and fewer negative emotions. Importantly, the meditation group significantly and progressively decreased the number of cigarettes smoked per day over the 2 weeks while the sham meditation group did not. These findings are particularly striking because real-world smoking was followed and assessed and there was a truly comparable control condition. Hence, the findings are not due to experimental contamination and are applicable to the kinds of situations where smoking normally occurs. The importance of this should not be underestimated. The lab or the clinic is not the real world. Smoking is prompted by many situations and signals present in the everyday environment that are not present in the lab. So, it is particularly important to test potential therapies against real world smoking behavior.

 

These are interesting and potentially important findings. A brief daily meditation is capable of reducing craving to smoke and the number of cigarettes smoked per day. If this could be maintained for longer periods it might lead to complete cessation of smoking and possibly prevention of relapse. It will require future research to examine these possibilities. Regardless meditation appears to reduce smoking over the short-term.

 

So, reduce cigarette smoking and cravings with mindfulness.

 

“With mindful awareness, patients are no longer at the mercy of their cravings. Instead, they can build awareness for their cravings and choose how to respond.. . mindfulness may also allow patients to build healthier behaviors. . .  everyone knows smoking and eating too much is bad for them, but mere knowledge doesn’t change behavior. It’s when they actually begin to pay attention to how smoking tastes, they want to change on a visceral level.” – Jamie Zimmerman

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

 

Study Summary

Ruscio AC, Muench C, Brede E, Waters AJ. Effect of Brief Mindfulness Practice on Self-Reported Affect, Craving, and Smoking: A Pilot Randomized Controlled Trial Using Ecological Momentary Assessment. Nicotine Tob Res. 2016 Jan;18(1):64-73. doi: 10.1093/ntr/ntv074.

 

Abstract

Introduction: Despite efficacious pharmacological and behavioral treatments, most smokers attempt to quit without assistance and fail to quit. Mindfulness practice may be useful in smoking cessation.

Methods: This ecological momentary assessment (EMA) study was a pilot parallel group randomized controlled trial of a brief mindfulness practice (Brief-MP) intervention on self-reported smoking behavior delivered to smokers on a Personal Digital Assistant (PDA) in the field. Adult community smokers (N = 44) were randomly assigned to a Brief-MP (n = 24) or Control (sham meditation; n = 20) group. Participants were instructed to smoke as much or as little as they liked. Participants carried a PDA for 2 weeks and were instructed to initiate 20 minutes of meditation (or control) training on the PDA daily, completing an assessment of cognitive and affective processes immediately afterwards. Additionally, they completed assessments at random times up to four times per day. Primary outcome variables were negative affect, craving, and cigarettes smoked per day, all self-reported.

Results: Thirty-seven participants provided EMA data totaling 1874 assessments. Linear Mixed Model analyses on EMA data revealed that Brief-MP (vs. Control) reduced overall negative affect, F(1, 1798) = 13.8, P= .0002; reduced craving immediately post-meditation, (Group × Assessment Type interaction, F(2, 1796) = 12.3, P = .0001); and reduced cigarettes smoked per day over time (Group × Day interaction, F(1, 436) = 5.50, P = .01).

Conclusions: Brief-MP administered in the field reduced negative affect, craving, and cigarette use, suggesting it may be a useful treatment.

 

Kick the Smoking Habit with Mindfulness

Kick the Smoking Habit with Mindfulness

 

By John M. de Castro, Ph.D.

 

“There’s lots of self-judgment that goes on when you’re trying to do something difficult, like trying to quit smoking. Also if we judge others, that can get us riled up, which can lead to smoking. We teach it as a way to learn to concentrate more but also to let go of judgment. When people have a craving, they can notice if they’re resisting or beating themselves up.” – 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).

 

Nicotine is one of the most addictive substances known. But, its addictiveness is not just due to its pharmacological properties. Addiction to smoking also involves learned or conditioned factors, genetics, and social and environmental factors. This makes it easy to become addicted and very difficult to stop. To some extent this is why there still are high rates of smoking even though mostly everyone understands that it has very negative effects on health and longevity.

 

There are a wide variety of methods and strategies to quit smoking which are to some 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 after quitting if a single cigarette is smoked, going back to regular smoking is almost assured. As John Polito wrote “nicotine dependency recovery is one of the few challenges in life where being 99% successful all but assures 100% defeat.”

 

So, better methods to quit which can not only promote quitting but also prevent relapse are badly needed. Mindfulness training has been shown to be helpful in treatment for addiction and prevention of relapse after recovery. In today’s Research News article “Mindfulness training for smoking cessation: A meta-analysis of randomized-controlled trials.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1224395630917694/?type=3&theater

or below

Oikonomou and colleagues review the published randomized controlled trials on the use of mindfulness training as a treatment for quitting cigarette smoking. They found, not surprising, that the training was successful in increasing mindfulness. More importantly, they found that although mindfulness training did not produce significantly different cigarette abstinence rates at 4 to 6 weeks following training, it did at 17 to 24 weeks, where 25.2% of mindfulness trained participants were abstinent while only 13.6% of usual treatment participants were.

 

These results are encouraging as the reviewed studies were high quality, well controlled, and designed trials. They suggest that mindfulness training is effective in promoting the long-term cessation of cigarette smoking. It is not known exactly what it is about mindfulness training that assists with cessation of smoking. But, it can be speculated that since quitting smoking is very stressful, mindfulness training might help because it reduces the psychological and physical responses to stress, thus making it easier for the individual to withstand the stress of nicotine withdrawal. The fact, however, that mindfulness training did not improve cessation rates at 4 weeks after treatment and it is during this time that nicotine withdrawal effects are present, that it is unlikely that this is the mechanism of action.

 

Staying abstinent from smoking over the long-term requires that the individual be able to refrain from responding to the myriad of social, environmental, and physical triggers that signal cigarette smoking. By increasing mindfulness, the training may make it easier for the individual to be aware of these triggers and thus be better able to prevent responding to them. Regardless of the mechanism, it is clear that mindfulness training is effective in promoting abstinence from cigarette smoking following successful quitting. This is an important advance in the fight against this major threat to health.

 

So, kick the smoking habit with mindfulness.

 

“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

 

 

Study Summary

Oikonomou MT, Arvanitis M, Sokolove RL. Mindfulness training for smoking cessation: A meta-analysis of randomized-controlled trials. J Health Psychol. 2016 Apr 4. pii: 1359105316637667. [Epub ahead of print]

 

Abstract

Recent studies have shown that mindfulness training has a promising potential for smoking treatment. In order to examine the efficacy of mindfulness training in smoking cessation, we performed a systematic review of the literature and meta-analysis of randomized controlled trials. Four randomized controlled trials with 474 patients were included in our analysis. The results showed that 25.2 percent of participants remained abstinent for more than 4 months in the mindfulness group compared to 13.6 percent of those who received usual care therapy (relative risk, 1.88; 95 percent confidence interval, 1.04–3.40). Our results suggest that mindfulness training may have an important role to play in efforts to lower cigarette smoking rates.