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Cited by 161Smoking Behavior and CessationMindfulness and Compassion InterventionsSubstance Abuse Treatment and Outcomes

Mindfulness training for smoking cessation: Moderation of the relationship between craving and cigarette use

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Elwafi, Hani M., Witkiewitz, Katie, Mallik, Sarah, IV, Thomas A. Thornhill, Brewer, Judson A.·2013·Drug and Alcohol Dependence
DOI 10.1016/j.drugalcdep.2012.11.015PMC PMC3619004
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Abstract

Background Smoking is the leading cause of preventable death in the US, while abstinence rates remain modest. Smoking has been shown to be perpetuated by operant conditioning, notably negative reinforcement (e.g., smoking to relieve negative affective states). Mindfulness training (MT) shows promise for smoking cessation, by potentially altering an individual's tendency to smoke in response to craving. The purpose of this study was to examine the effects of MT and mindfulness practice on the relationship between smoking and craving after receiving four weeks of MT.Methods 33 adults received MT as part of a randomized trial for smoking cessation. Individuals in the MT condition recorded formal and informal mindfulness practice during treatment using daily diaries.Results Analyses showed that strong correlations between craving and smoking at baseline (r=0.582) were attenuated at the end of treatment (r=0.126). Mindfulness home practice significantly predicted cigarette use (formal: B=-1.21, p=0.007; informal: B=-1.52, p<0.0001) and informal practice moderated the relationship between craving and smoking at the end of treatment (B=0.52, p=0.03).Conclusions These findings suggest that MT may be effective as a treatment for smoking cessation and that informal mindfulness practice predicts a decoupling of the association between craving and smoking.

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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 Elwafi, Witkiewitz, Mallik, Thornhill-IV, & Brewer, 2013

    The Results (§3.2; page unavailable) report that the craving–smoking correlation weakened after mindfulness training. The Introduction (§1; page unavailable) reports 31% versus 6% abstinence at four months in an earlier trial, consistent with an approximately fivefold difference. This paper does not report the claimed 40% reduction in craving-related eating, and its smoking findings do not establish that decoupling caused the higher cessation rate. (LLM, conf=0.88)

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  • In Elwafi et al. (2013), 33 smokers who completed an eight-session mindfulness treatment demonstrated the normative correlation between cravings and smoking frequency at baseline, but the correlation was no longer present at post treatment.

    “The 33 smokers who completed an eight-session mindfulness treatment (adapted from MBRP) demonstrated the normative correlation between cravings and smoking frequency at baseline, but the correlation was no longer present at the post treatment assessment.”

    From Decoupling as a Mechanism of Change in Mindfulness and Acceptance: A Literature Review (2015) · cites this paper as Elwafi et al., 2013

    Results §3.2 reports a positive craving–smoking correlation at baseline (r = 0.582) that was no longer statistically significant at the end of treatment (r = 0.126). Methods §2.3 describes an eight-session treatment adapted from a drug-relapse-prevention manual. However, Results §3.1 says 33 participants *initiated* treatment and attended an average of 6.7 of eight sessions; it does not say all 33 completed the treatment or attended every session. (LLM, conf=0.90)

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  • This review supports the traditional AMT account, with studies showing decoupling effects are related to improvements in self-compassion from treatment, improvements in decentering following mindful breathing, and amount of meditation practice.

    “This review supports the traditional AMT account, with studies showing decoupling effects are related to improvements in self-compassion from treatment (Kuyken et al., 2010), improvements in decentering following mindful breathing (Feldman et al., 2010) and amount of meditation practice (Elwafi et al., 2013).”

    From Decoupling as a Mechanism of Change in Mindfulness and Acceptance: A Literature Review (2015) · cites this paper as Elwafi et al., 2013

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  • Evidence indicates that mindfulness interventions work through reducing stress and craving and improving mindfulness and interoceptive awareness.

    “Evidence indicates that mindfulness interventions work through reducing stress and craving and improving mindfulness and interoceptive awareness [15,19,20,28–32].”

    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 [29]

    The Methods (2.4 Home practice; page unavailable) describe exercises that cultivate present-moment awareness and attention to bodily sensations. But the Discussion (section 4; page unavailable) says craving reduction lagged behind smoking cessation and that changes in craving did not predict immediate reductions in cigarette use. The paper does not establish reduced stress or improved mindfulness and interoceptive awareness as mechanisms of benefit. (LLM, conf=0.88)

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  • In Elwafi et al. (2013), frequency of informal meditation practice during the intervention period moderated the relationship between cravings and smoking frequency at post, such that there was a weaker relationship among those who practiced more; this moderation effect was not found with frequency of formal meditation practice.

    “Furthermore, the frequency of informal meditation practice during the intervention period moderated the relationship between cravings and smoking frequency at post, such that there was a weaker relationship between these internal experiences among those who practiced more (although this moderation effect was not found with frequency of formal meditation practice).”

    From Decoupling as a Mechanism of Change in Mindfulness and Acceptance: A Literature Review (2015) · cites this paper as Elwafi et al., 2013

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Authors
Elwafi, H. M., Witkiewitz, K., Mallik, S., IV, T. A. T., & Brewer, J. A.
Affiliations
  • Yale University (US)
  • University of New Mexico (US)
Corresponding author
Brewer, Judson A.
ORCID
Venue
Drug and Alcohol Dependence
Publisher
Elsevier BV
Published
2013-06
Volume
130
Issue
1-3
Pages
222-229
ISSN
0376-8716 (ISSN-L)
DOI
10.1016/j.drugalcdep.2012.11.015
PMC
PMC3619004
OpenAlex
W2157337754
Cited by
161
References
90
Citations by year
2026: 3 · 2025: 9 · 2024: 8 · 2023: 13 · 2022: 9 · 2021: 19 · 2020: 12 · 2019: 11 · 2018: 17 · 2017: 20 · 2016: 15 · 2015: 15 · 2014: 7 · 2013: 2 · 2012: 1
FWCI
5.36
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Drug and Alcohol Dependence (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Yale University
  • Centers for Disease Control and Prevention
  • National Institute on Drug Abuse (K12 DA00167, R03DA029163, K12DA000167)
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, craving, cigarette smoking, negative reinforcement, operant conditioning, moderation, daily diary, nicotine dependence
MeSH terms
Adult, Conditioning, Operant, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Middle Aged, Smoking, Smoking Cessation, Behavior, Addictive, Mind-Body Therapies

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