Mindfulness training for smoking cessation: Results from a randomized controlled trial
Open accessAbstract
Background Cigarette smoking is the leading cause of preventable death in the world, and long-term abstinence rates remain modest. Mindfulness training (MT) has begun to show benefits in a number of psychiatric disorders, including depression, anxiety and more recently, in addictions. However, MT has not been evaluated for smoking cessation through randomized clinical trials.Methods 88 treatment-seeking, nicotine-dependent adults who were smoking an average of 20cigarettes/day were randomly assigned to receive MT or the American Lung Association's freedom from smoking (FFS) treatment. Both treatments were delivered twice weekly over 4 weeks (eight sessions total) in a group format. The primary outcomes were expired-air carbon monoxide-confirmed 7-day point prevalence abstinence and number of cigarettes/day at the end of the 4-week treatment and at a follow-up interview at week 17.Results 88% of individuals received MT and 84% of individuals received FFS completed treatment. Compared to those randomized to the FFS intervention, individuals who received MT showed a greater rate of reduction in cigarette use during treatment and maintained these gains during follow-up (F=11.11, p=.001). They also exhibited a trend toward greater point prevalence abstinence rate at the end of treatment (36% vs. 15%, p=.063), which was significant at the 17-week follow-up (31% vs. 6%, p=.012).Conclusions This initial trial of mindfulness training may confer benefits greater than those associated with current standard treatments for smoking cessation.
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In smoking and emotional eating studies, mindfulness training decoupled craving from behavior, with a fivefold increase in smoking cessation and a 40% reduction in craving-related eating.
“in studies of cigarette smoking and emotional eating, mindfulness training was found to mechanistically decouple cigarette or food craving from smoking or eating, with a subsequent fivefold increase in smoking cessation rates, and a 40% reduction in craving-related eating, respectively (Brewer et al., 2011; Elwafi, Witkiewitz, Mallik, Thornhill-IV, & Brewer, 2013; Ashley E. Mason, Jhaveri, Cohn, &”
From Can Mindfulness Mechanistically Target Worry to Improve Sleep Disturbances? Theory and Study Protocol for App-Based Anxiety Program. (2020) · cites this paper as Brewer et al., 2011
The Results (§3.2; page not provided) report 31% point-prevalence abstinence with mindfulness training versus 6% with the comparison treatment at 17 weeks—approximately fivefold. The Introduction (§1) proposes that mindfulness may help people experience cravings without smoking, but this trial does not establish mechanistic decoupling. It does not study emotional eating or report a 40% reduction in craving-related eating. (LLM, conf=0.88)
Experimental — accuracy not yet measuredContextual CBTs such as mindfulness-based therapy and Acceptance and Commitment Therapy appear to succeed in treating nicotine addiction and promoting smoking cessation with minimal or no reported increased suicidality risk.
“contextual CBTs such as mindfulness-based therapy and ACT appear to demonstrate success in treating nicotine addiction and promoting smoking cessation with minimal or no reported increased risk of suicidality.76,78,88”
From Are smoking cessation treatments associated with suicidality risk? An overview (2016) · cites this paper as [78]
The Results (§3.2; page unavailable) report higher smoking-abstinence rates after mindfulness training than after the comparison treatment, and the Introduction (§1; page unavailable) describes preliminary evidence for ACT in smoking cessation. The paper does not report suicidality outcomes or establish that either treatment carries minimal or no increased suicidality risk. (LLM, conf=0.88)
Experimental — accuracy not yet measuredBrewer et al. concluded that mindfulness training is an effective method to help people quit smoking.
“Brewer et al.78 concluded that mindfulness training is an effective method to help people quit smoking.”
From Are smoking cessation treatments associated with suicidality risk? An overview (2016) · cites this paper as [78]
The Results (section 3.2) report higher smoking abstinence with mindfulness training than with the comparison treatment at 17 weeks. But the paper’s Conclusions describe this as an initial trial whose findings suggest mindfulness training *may* confer benefits; the claim presents its effectiveness as a settled conclusion. (LLM, conf=0.86)
Experimental — accuracy not yet measuredBrewer et al. reported a 17-week point prevalence odds ratio of 6.75 in the mindfulness group, significantly larger than the average odds ratio of behavioral therapies in current clinical practice guidelines.
“These authors further promote that the 17-week point prevalence odds ratio of 6.75 in their mindfulness-based intervention group was significantly larger than the average odds ratio of behavioral therapies as reported in the current clinical practice guidelines”
From Are smoking cessation treatments associated with suicidality risk? An overview (2016) · cites this paper as [78]
The Discussion (section 4) reports a 17-week point-prevalence odds ratio of 6.75. It calls this significantly larger than the average odds ratio of 1.76 in a meta-analysis of group counseling, and separately says it was larger than odds ratios for therapies in clinical practice guidelines. It does not say the comparison with the guideline figures was statistically significant. (LLM, conf=0.87)
Experimental — accuracy not yet measuredRecent reviews indicate that mindfulness-based therapies are efficacious for promoting abstinence and reducing cravings.
“recent reviews of the evidence indicate its efficacy for promoting abstinence and reducing cravings.51,78–80,95”
From Are smoking cessation treatments associated with suicidality risk? An overview (2016) · cites this paper as [78]
The Results (section 3.2; page unavailable) report higher smoking abstinence with mindfulness training than with the comparison treatment at 17 weeks. But this paper is a randomized trial, not a review, and its stated outcomes were abstinence and cigarettes smoked per day; it does not establish that the therapy reduced cravings. (LLM, conf=0.87)
Experimental — accuracy not yet measured
MBIs (e.g., MTS) showed significant improvements on self-reported measures of attentional control, emotion regulation, and mindfulness, and these measures were significantly correlated with meditation time and smoking abstinence versus Quit Line intervention or FFS.
“MBIs (e.g., MTS) showed significant improvements on self-reported measures of attentional control, emotion regulation, and mindfulness. Post-treatment, these measures were significantly correlated with meditation time and smoking abstinence versus Quit Line intervention or FFS (55, 73, 74).”
From Mindfulness-Based Interventions for the Treatment of Substance and Behavioral Addictions: A Systematic Review (2018) · cites this paper as [73]
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredMindfulness-based interventions have demonstrated promise for supporting recovery and improving mental health for persons with substance use conditions.
“Mindfulness-based interventions have demonstrated promise for supporting recovery and improving mental health for persons with substance use conditions (e.g. Refs. [11–21]).”
From Mindful moms: acceptability and impact of co-designed and digitally delivered video meditations for pregnant and parenting women with opioid use disorder (2025) · cites this paper as [13]
The Results (section 3.2) report higher smoking abstinence with mindfulness training at 17 weeks, supporting its promise for cessation. The Introduction says mindfulness treatments have shown promise for anxiety and depression, but the Discussion (section 4.1) says benefit for people with both addiction and psychiatric disorders remains a possibility to assess, not a demonstrated mental-health outcome in that population. Page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredBrewer 2011 accounts for the difference between the conclusions of Oikonomou 2017's review and this review, because Brewer 2011 indicated a strong benefit of mindfulness training with high imprecision (RR 4.97, 95% CI 1.52 to 16.22; 88 participants).
“Brewer 2011 accounts for the difference between the conclusions of Oikonomou 2017's review and our review. Brewer 2011's results indicated a strong benefit of mindfulness training, albeit with high levels of imprecision (RR 4.97, 95% CI 1.52 to 16.22; 88 participants).”
From Mindfulness for smoking cessation (2022) · cites this paper as Brewer 2011
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredMindfulness training has been found to mechanistically break key links in the reinforcement pathway for other habitual behaviors such as smoking and emotional eating, with concomitant changes in related brain regions predicting clinical outcomes.
“MT has been found to mechanistically break key links in the reinforcement pathway for other habitual behaviors such as smoking and emotional eating [29,30], with concomitant changes in related brain regions predicting clinical outcomes [31].”
From Clinical Efficacy and Psychological Mechanisms of an App-Based Digital Therapeutic for Generalized Anxiety Disorder: Randomized Controlled Trial (2021) · cites this paper as [29]
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredBrewer et al. found 36% abstinence in mindfulness training participants versus 15% in the alternative treatment group, and after 17 weeks 31% versus 6% remained abstinent.
“These researchers found that 36% of participants receiving mindfulness training achieved abstinence compared to 15% of participants in the alternative treatment group. After a 17-week follow-up, 31% of the mindfulness cohort remained abstinent compared to just 6% of participants receiving the alternative.”
From Are smoking cessation treatments associated with suicidality risk? An overview (2016) · cites this paper as [78]
Similar to Oikonomou 2017, Goldberg 2018 differs from this review's results because it included Brewer 2011, which showed a strong benefit of mindfulness on abstinence rates.
“Similar to Oikonomou 2017, this differs from our results because it included Brewer 2011, which showed a strong benefit of mindfulness on abstinence rates.”
From Mindfulness for smoking cessation (2022) · cites this paper as Brewer 2011
Several studies reported positive associations between the degree to which participants engaged in mindfulness homework exercises and changes in cigarette, marijuana, and alcohol use posttreatment.
“Several studies reported positive associations between the degree to which participants engaged in mindfulness homework exercises and changes in cigarette, marijuana, and alcohol use posttreatment (e.g., [68–70]).”
From Mindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research (2018) · cites this paper as [68]
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An exploratory study of Mindfulness Based Stress Reduction for emotional eating
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- Authors
- 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.
- Affiliations
- Yale University (US)
- Corresponding author
- Brewer, Judson A.
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2011-12
- Volume
- 119
- Issue
- 1-2
- Pages
- 72-80
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC3191261
- OpenAlex
- W2089965180
- Cited by
- 383
- References
- 92
- Citations by year
- 2026: 11 · 2025: 16 · 2024: 14 · 2023: 23 · 2022: 27 · 2021: 21 · 2020: 35 · 2019: 34 · 2018: 39 · 2017: 20 · 2016: 31 · 2015: 33 · 2014: 37 · 2013: 27 · 2012: 13
- FWCI
- 17.23
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Yale University
- National Institute on Drug Abuse (K05-DA00457, K05DA000089, K05DA00089, P50DA009241, K05DA000457, K12 DA00167, R03DA029163, P50-DA-0-9241, K12DA000167)
- National Institute of Dental and Craniofacial Research (UL1DE019586)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- mindfulness training, smoking cessation, nicotine dependence, smoking abstinence, group intervention, addiction treatment
- MeSH terms
- Adult, Carbon Monoxide, Female, Follow-Up Studies, Humans, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Nicotine, Smoking, Tobacco Use Disorder, Smoking Cessation, Treatment Outcome, Nicotinic Agonists, Young Adult
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