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Giving up smoking? Put your mind to it

By Cecilia Westbrook

Everybody knows that smoking is bad for you. Yet quitting smoking is a challenging endeavour – insurmountable for some. Even smokers who get the best help available still have a 50% chance of relapsing. Clearly, the more options we have to help with cessation, the better. Recent research suggests that meditation and mindfulness may be beneficial for smokers looking to extinguish the habit.

Mindfulness is a concept stemming from ancient Buddhist philosophy, comprising nonjudgmental attention to present-moment emotions and experiences. Mindfulness and meditation-based practices have shown remarkable benefit for a variety of ailments, from depression to chronic pain. This year, the first randomised, controlled trial of a mindfulness-based smoking cessation program found that it worked better than a standard behavioral paradigm in helping smokers quit and avoid relapse.

Mindfulness seems to be beneficial by helping smokers cope with craving. Cigarette craving can be a powerful motivator, and one of the major reasons for relapse. But mindfulness is effective at helping people cope with strong emotions, such as those experienced with depression, anxiety, and pain. A small handful of studies have examined the relationship between mindfulness, craving, and smoking, and have lent some support to this hypothesis. However, the findings from those studies are inconsistent, and not terribly conclusive.

Wanting to examine this link further, we conducted research using functional magnetic resonance imaging (fMRI). We trained smokers in mindful attention and had them deploy it while looking at smoking-related images, which are known to induce strong craving in smokers. While they did so, we scanned their brains to learn more about what mechanisms might underlie the effects of mindful attention on cigarette craving.

We wanted our training to be quick and easy, so it would mimic what a smoking counselor might really teach her clients. The training took about fifteen minutes, and was based around a simple principle: focus your attention on whatever feelings or sensations arise, and then accept those without judgment. Secondly, we had them rate their craving right after viewing a picture. We didn’t tell them that mindful attention was supposed to make them crave less, so they didn’t have any expectations about what would happen. For all they knew, their craving might increase. Finally, we also included a control condition, where we asked them just to ‘passively view’ pictures—in other words, to view them as they normally would.

Our findings had some interesting implications for mindfulness in general, and for its application to smoking cessation.

First, we found that mindfully attending to smoking images caused people’s self-reported craving to decrease. In other words, when people ‘passively viewed’ a smoking-related image, their craving increased, but if they practiced mindful attention, they craved less. Their cravings weren’t completely eliminated, but were significantly decreased.

Second, we found that mindful attention affected a specific part of the brain, the subgenual anterior cingulate cortex (sgACC). SgACC is known to be important in regulation of emotions, and it is overactive in depression and other mood disorders. During passive viewing of smoking pictures, when participants were craving, they had increased activation in this region. However, mindful viewing decreased activation in this region back to levels seen for neutral pictures. In addition, we found a decrease in functional connectivity between various brain regions known to underlie the sensation of craving, including insula, premotor cortex, and ventral striatum. This suggests that during mindful attention, the network underlying cigarette craving may not be as strongly coupled.

In addition to the findings themselves, there was one surprising aspect. Prior research suggested that mindful attention was associated with prefrontal cortex—areas involved in cognitive control and skills like attention and working memory. However, we didn’t find activation in that region. This suggests that mindful attention works through a more ‘bottom-up’ mechanism, where instead of directly suppressing craving, you instead mentally disengage from it. This may seem like a fine point, but it suggests that mindful attention works differently from the kinds of cognitive skills we usually teach smokers, which involve things like re-thinking a craving, distracting yourself, or actively suppressing it. Therefore, mindful attention might be a new kind of skill, useful for different people or different situations in which cognitive strategies don’t work as well.

Overall, our work has some implications for how mindfulness relates to cigarette craving. Based on our work, we think mindful attention can be taught relatively quickly, and is effective at decreasing a cigarette craving in the moment—when it’s most important to a smoker. Therefore, we think this approach has clinical usefulness in the real world, and this is part of why it seems to help smokers quit. And finally, since it seems to work in a manner differently from the types of cognitive skills currently taught by counselors, it could represent a new kind of tool to add to the tool-kit. And of course the more tools we have to help people quit, the better.

So if you’re trying to quit, consider learning mindfulness techniques to help you cope when you’re craving. It might be just the tool you need!

Cecilia Westbrook is an MD/PhD student at the University of Wisconsin—Madison. Her interests include affective neuroscience, behavioral regulation, and mindfulness. Her paper has been made publicly available by the journal Social Cognitive and Affective Neuroscience (SCAN). You can read it in full and for free here.

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