Using Mindfulness as a Technique to Quit Smoking

You’ve heard of mindfully meditating, but what about mindfully smoking?

By: Rhiannon Ueberholz

(Hyson, 2020)

If you google “ways to improve your mental health” it’s likely that any results that pop up will contain some information on mindfulness. In our tech-dominated world, mindfulness has become a saving grace, as it allows us to shift away from our busy minds. Though often conflated with meditation, any activity can be done mindfully, including walking, eating, or making a pot of coffee – being mindful is simply:

  • paying attention to what you are doing on purpose
  • with an attitude of openness and curiosity (Kabat-Zinn, 2003). 

Mindfulness meditation is a specific type of meditation that involves sitting comfortably while paying attention to any thoughts or sensations in the body, accepting them, and allowing them to pass without judgment (Kabat-Zinn, 2003). You can even try it right now: stop what you’re doing, close your eyes or lower your gaze to the floor and take five deep breaths, in through the nose and out through the mouth. Your mind isn’t going to be completely blank, so just try to notice the thoughts that pop into your head without judgment, and then redirect your attention back to your breath. That’s mindfulness! Don’t worry if you found it difficult (most people do); luckily, it gets a lot easier with practice. 

While this may sound like a new-age wellness fad, as often associated with hippie-culture, the research has shown that practicing mindfulness can lead to improvements in stress, depression, insomnia, chronic pain, and anxiety (Grossman et al., 2014; Goldberg et al., 2018; Goyal et al., 2014). 

More recently, Psychologists have broadened mindfulness practice to treating nicotine addiction. Mindfulness treatments are different from other therapies because they target nicotine addiction by having patients accept their cravings (ie. the intense urge to smoke) and work through them, rather than avoiding or substituting nicotine with something else (Brewer et al., 2011). This can be compared to behavioural treatments, where a common technique would be to avoid places and items that trigger cravings, for example, someone avoiding the store where they buy their cigarettes (Larimer et al., 1999). In order to understand how mindfulness-based treatment works, it’s important that we have a clear understanding of nicotine addiction and why people continue to smoke when they know cigarettes are bad for them. 

(Venture Academy, 2020)

Why do people get addicted to cigarettes in the first place?

The Incentive Salience Model describes addiction as a progression; people start smoking because it’s enjoyable until they eventually come to dislike it, but strong cravings make it difficult to quit (Robinson et al., 2016). 

A typical case might look like this: Bill smokes for the first time in a social setting; he enjoys the nicotine-induced head rush and looks cool for smoking in front of his peers. The next time Bill is at a party with his friends and sees a cigarette, the reward system in his brain will light up, reminding him of how much he enjoyed smoking last time he was at a party, and he will be motivated to smoke again (Robinson et al., 2016). This may also happen when Bill experiences negative events, for example stress from work or sadness from a breakup (Brewer et al., 2011). His brain will remember that smoking makes him feel good and will motivate him to smoke a cigarette to make himself feel better. Eventually, this turns into a habit and Bill develops stronger nicotine cravings whenever he experiences a stressful event, is out with friends or sees something that reminds him of smoking. Over time, Bill no longer experiences the same rewards from smoking; by now he’s developed a tolerance for nicotine, so he no longer experiences a head rush and his peers disapprove. Bill might try to quit by distracting himself or using sheer willpower, but whenever he gets tired or stressed, he may not have the mental resources to exert such willpower and end up smoking again (Brewer et al., 2011).

How does Mindfulness Treat Nicotine Addiction?

Mindfulness works to treat nicotine addiction in two ways (1) by allowing people to develop a natural disliking for smoking and (2) helping them cope with cravings (Brewer et al., 2011). In Dr. Brewer’s lab, he actually encourages people to smoke a cigarette while mindfully paying attention to how smoking makes them feel. His research shows that when people actually pay attention to the experience of smoking, for example noticing how the cigarette burns their throat, makes their breath taste bad, and gets smoke in their eyes, they are able to develop a natural dislike for it (Brewer et al., 2011). When people understand on a deeper level that they dislike smoking, they have a much easier time quitting as opposed to simply having the knowledge that smoking is bad for them.

Once people have this deeper sense of how smoking makes them feel, they can start to detach the feeling of craving from the actual behaviour of smoking a cigarette (Brewer & Kabat-Zinn, 2017). Someone adopting a mindfulness technique would be able to (1) notice when a craving occurs, (2) take inventory of the sensations in their body and their surrounding environment, and (3) reflect on their experience of mindfully smoking (ie. remember that they don’t actually enjoy it), rather than impulsively reaching for a cigarette (Klein & Brewer, 2021). They can now recognize the craving as simply a combination of different body sensations that are being triggered by their internal state or environment, which may help them to resist the urge to smoke. Repeatedly experiencing craving without smoking will eventually break the habit (Klein & Brewer, 2021). 

Since mindfulness is linked to improved emotion regulation, using mindfulness to quit may have secondary, positive effects for stress – which is often a trigger for smoking! (Penberthy et al., 2017) Bill, who is now trying to quit smoking using mindfulness, might notice that he always smokes a cigarette to calm down after getting in a fight with his spouse. If he replaces this habit with taking ten minutes to practice mindfulness, not only will he reduce the chances of reaching for a cigarette, but he may also be able to better cope with the stress of the fight (Guendelman et al., 2017).

(Alphaspirit.it, 2020)

Is Mindfulness Effective?

Mindfulness is a skill and can be quite challenging to develop; however, practicing it regularly has actually been shown to reduce the overall level of activity in an area of the brain linked to craving, the posterior cingulate cortex (Brewer et al., 2013). Mindfulness works by quieting down the “Default Mode Network”, which is a series of brain structures that are responsible for remembering the past and thinking about the future; the posterior cingulate cortex makes up part of this network (Garrison et al., 2015). One study by Dr. Westbrook and colleagues showed that when people with nicotine addictions practiced mindfulness while looking at photos of cigarettes, they rated their craving as lower and had less activity in this area of the brain, compared to participants who didn’t practice mindfulness while looking at the images (Westbrook et al., 2013). Observing the sensations of craving with mindful curiosity actually makes the brain less reactive to the smoking cues that might cause someone to smoke!

Recent studies have shown that mindfulness treatments can be more effective than other popular treatments in reducing the likelihood of relapse (Davis et al., 2014). In these studies, a mindfulness-based addiction treatment program is compared with a treatment program that uses common behavioural techniques for quitting smoking, like avoiding triggers. In one study Dr. Brewer, a top neuroscientist in the field of addiction, and his colleagues compared a four-week mindfulness program to the American Lung Association’s “Freedom from Smoking program”, cited as “America’s Gold Standard” for smoking cessation (American Lung Association, 2021). This program combines group support, behavioural techniques, and the option for nicotine replacement therapy (ie. nicotine patches) or smoking cessation medication (ie. Bupropion). They found that participants in the mindfulness group had greater success in quitting without relapse seventeen weeks after both programs ended (Brewer et al., 2011). One participant in a mindfulness treatment program reported that they had smoked twenty cigarettes a day for 35 years, but after using a mindfulness-based app for smoking cessation, they were able to quit after just 6 days (Craving to Quit, 2021).

The most important takeaway from this research is that mindfulness is a new tool that can be incorporated into personalized treatment for addiction, not that it’s the best and only treatment. Mindfulness treatments may be effective on their own or often, treatment programs will combine mindfulness with other techniques depending on the needs of the individual. For example, the combination of mindfulness training and taking smoking cessation medication has shown to be more effective than taking medication alone. In a study by Dr. Gifford and colleagues, 32% of the participants who did a combination of therapy that incorporated mindfulness, and bupropion were successful in quitting smoking at a one-year follow-up, compared to 18% who just took medication (Gifford, 2011). An example of one program that uses multiple approaches is “Mindfulness Training for Smokers”, offering medication, mindfulness training, cognitive behavioural therapy, and skills training to combat nicotine addiction (Davis, 2021).

What are the Limitations?

It’s important to note, that while mindfulness has shown promise, it can be quite difficult and may not work for everyone depending on their circumstances. Developing a mindfulness practice takes time and effort, and therefore it would be important for the individual to be highly motivated. Additionally, since using mindfulness-based treatment requires that the person comes to an understanding that they don’t actually enjoy smoking, people who don’t consider their addiction to be that severe and subjectively enjoy cigarettes may not be as invested in a mindfulness approach. This was found in Davis’s and colleagues’ study; people who smoked fewer cigarettes per day were more likely to drop out of the mindfulness program compared to people who smoked more frequently (Davis et al., 2014). 

Mindfulness programs for smoking have just recently become more common and are still being tested (Spears et al., 2019). While there have been studies that found mindfulness treatments to be more effective than standard treatments, there have also been studies that found no difference when comparing treatment approaches (Goldberg et al., 2018). This is quite common when developing new treatments, but doing more research will help to find the most effective ways to implement mindfulness for nicotine addiction. 

Getting Help During the Pandemic

Amidst the COVID-19 pandemic, studies have found that people who had low levels of nicotine addiction before the pandemic are more likely to experience moderate or high levels of addiction, potentially due to increased stress (Fidanci et al., 2021). Interestingly, it has been found that during the pandemic more people are quitting smoking, rather than starting, which may be the result of anxiety surrounding the increased risk of COVID-19 complications for smokers (Yang & Ma, 2021).

 If you or someone you know is having a hard time quitting, mindfulness might be the perfect tool! There are some mindfulness-based apps that can offer support while face-to-face treatment programs are unavailable.  One mindfulness program for nicotine addiction is Dr. Brewer’s mindfulness-based app, Craving to Quit. This virtual program teaches mindfulness-based exercises to manage cravings, provides personal coaching, and connects users to an online peer community. The program is designed to be 21 days; however, it’s designed to offer support for as long as the client needs. 

All things considered, we are living in very stressful times. Developing a mindfulness practice can be a useful tool to reduce stress, depression, and anxiety, whether you’re struggling with a nicotine addiction or not. Try to focus on the things you can manage in the present moment and everything else will fall into place. 

References

American Lung Association. (2021). Freedom From Smoking. Retrieved from https://www.lung.org/quit-smoking/join-freedom-from-smoking

Brewer, J. A., Mallik, S., Babuscio, T. A., Nich, C., Johnson, H. E., Deleone, C. M., Minnix-Cotton, C. A., Byrne, S. A., Kober, H., Weinstein, A. J., Carroll, K. M., & Rounsaville, B. J. (2011). Mindfulness training for smoking cessation: Results from a randomized controlled trial. Drug and Alcohol Dependence, 119(1–2), 72–80. https://doi.org/10.1016/j.drugalcdep.2011.05.027

Brewer, J. A., Worhunsky, P. D., Gray, J. R., Tang, Y.-Y., Weber, J., & Kober, H. (2011). Meditation experience is associated with differences in default mode network activity and connectivity. Proceedings of the National Academy of Sciences, 108(50), 20254–20259. https://doi.org/10.1073/pnas.1112029108

Brewer, J. A., Elwafi, H. M., & Davis, J. H. (2013). Craving to quit: Psychological models and neurobiological mechanisms of mindfulness training as treatment for addictions. Psychology of Addictive Behaviors, 27(2), 366–379. https://doi.org/10.1037/a0028490

Brewer, J., & Kabat-Zinn, J. (2017). The craving mind: From cigarettes to smartphones to love – why we get hooked and how we can break bad habits. Yale University Press.

Davis, J. M., Goldberg, S. B., Anderson, M. C., Manley, A. R., Smith, S. S., & Baker, T. B. (2014). Randomized Trial on Mindfulness Training for Smokers Targeted to a Disadvantaged Population. Substance Use & Misuse, 49(5), 571–585. https://doi.org/10.3109/10826084.2013.770025

Davis, J. (2021). Quit resources. Retrieved from https://www.quitresources.com/

Garrison, K. A., Zeffiro, T. A., Scheinost, D., Constable, R. T., & Brewer, J. A. (2015). Meditation leads to reduced default mode network activity beyond an active task. Cognitive, Affective, & Behavioral Neuroscience, 15(3), 712–720. https://doi.org/10.3758/s13415-015-0358-3

Gifford, E. V., Kohlenberg, B. S., Hayes, S. C., Pierson, H. M., Piasecki, M. P., Antonuccio, D. O., & Palm, K. M. (2011). Does Acceptance and Relationship Focused Behavior Therapy Contribute to Bupropion Outcomes? A Randomized Controlled Trial of Functional Analytic Psychotherapy and Acceptance and Commitment Therapy for Smoking Cessation. Behavior Therapy, 42(4), 700–715. https://doi.org/10.1016/j.beth.2011.03.002

Goldberg, S. B., Tucker, R. P., Greene, P. A., Davidson, R. J., Wampold, B. E., Kearney, D. J., & Simpson, T. L. (2018). Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis. Clinical Psychology Review, 59, 52–60. https://doi.org/10.1016/j.cpr.2017.10.011

Goyal, M., Singh, S., Sibinga, E. M. S., Gould, N. F., Rowland-Seymour, A., Sharma, R., Berger, Z., Sleicher, D., Maron, D. D., Shihab, H. M., Ranasinghe, P. D., Linn, S., Saha, S., Bass, E. B., & Haythornthwaite, J. A. (2014). Meditation Programs for Psychological Stress and Well-being: A Systematic Review and Meta-analysis. JAMA Internal Medicine, 174(3), 357. https://doi.org/10.1001/jamainternmed.2013.13018

Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits. Journal of Psychosomatic Research, 57(1), 35–43. https://doi.org/10.1016/S0022-3999(03)00573-7

Guendelman, S., Medeiros, S., & Rampes, H. (2017). Mindfulness and Emotion Regulation: Insights from Neurobiological, Psychological, and Clinical Studies. Frontiers in Psychology, 8. https://doi.org/10.3389/fpsyg.2017.00220

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Klein E., Brewer J. (2021). Ezra Klein Interviews Judson Brewer [Audio Podcast]. Retrieved from https://www.nytimes.com/2021/04/20/podcasts/ezra-klein-podcast-judson-brewer-transcript.html 

Larimer, M. E., Palmer, R. S., & Marlatt, G. A. (1999). Relapse prevention. An overview of Marlatt’s cognitive-behavioral model. Alcohol Research & Health: The Journal of the National Institute on Alcohol Abuse and Alcoholism, 23(2), 151–160.

MindSciences. (2021). Craving to quit. Retrieved from https://www.cravingtoquit.com/

Penberthy, J. K., Penberthy, J. M., Lynch, M., & Chhabra, D. (2017). Mindfulness based treatment for smoking cessation: How it works and future directions. Contemporary Behavioral Health Care, 2(1). https://doi.org/10.15761/CBHC.1000119 

Robinson, M. et al. (2016). Roles of “Wanting” and “Liking” in Motivating Behaviour: Gambling, Food and Drug Addictions. In E.H Simpson & P.D. Balsam (EDS) Behavioural Neuroscience of Motivation (pp. 2015-136), Berlin, Germany: Springer.

Spears, C. A., Abroms, L. C., Glass, C. R., Hedeker, D., Eriksen, M. P., Cottrell-Daniels, C., Tran, B. Q., & Wetter, D. W. (2019). Mindfulness-Based Smoking Cessation Enhanced With Mobile Technology (iQuit Mindfully): Pilot Randomized Controlled Trial. JMIR MHealth and UHealth, 7(6), e13059. https://doi.org/10.2196/13059

Westbrook, C., Creswell, J. D., Tabibnia, G., Julson, E., Kober, H., & Tindle, H. A. (2013). Mindful attention reduces neural and self-reported cue-induced craving in smokers. Social Cognitive and Affective Neuroscience, 8(1), 73–84. https://doi.org/10.1093/scan/nsr076

Yang, H., & Ma, J. (2021). How the COVID-19 pandemic impacts tobacco addiction: Changes in smoking behavior and associations with well-being. Addictive Behaviors, 119, 106917. https://doi.org/10.1016/j.addbeh.2021.106917

Images

Alphaspirit.it. (2020). Stressed Businessman with Broken Mechanism Head Screams [Photograph found in Stock Images]. Retrieved from https://www.shutterstock.com/image-photo/stressed-businessman-broken-mechanism-head-screams-346270295 

Hyson. (2020). Balancing Stones [Photograph found in The Ultimate Morning Meditation for Relaxation]. Retrieved from https://www.onnit.com/academy/morning-meditation/ 

Venture Academy. (2019). Teen Smoking [Photograph found in Teen Behavioural Treatment]. Retrieved from https://www.ventureacademy.ca/troubled-teen-blog/teen-smoking/

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