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Mindfulness training for smoking cessation: Moderation of the relationship between craving and cigarette use
Open accessAbstract
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 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
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“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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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 (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 [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]
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“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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“The most direct demonstration of decoupling effects come from laboratory-based experiments and treatment outcome studies in which AMT interventions reduce or eliminate the relationship between internal experiences and internal/overt behavior (e.g., urges to smoke are no longer predictive of smoking behavior after a mindfulness intervention; e.g., 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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“A mindfulness-based smoking cessation intervention derived from MBRP significantly reduced the association between craving and cigarette smoking [57].”
From Mindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research (2018) · cites this paper as [57]
In the citing paper
“In contrast, the PFM predicts a reduction in smoking independently of reductions in craving or negative affect (Brewer et al. 2013; Elwafi et al. 2013).”
From Mindfulness, Acceptance and Defusion Strategies in Smokers: A Systematic Review of Laboratory Studies (2018) · cites this paper as Elwafi et al. 2013
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Taylor, V. A., Moseley, I. H., Sun, S., Smith, R. S., Roy, A., Ludwig, V. U., & Brewer, J. A. (2021) · Journal of Behavioral Addictions · doi:10.1556/2006.2021.00020 · Cited by 14
Self-citationThe Emerging Science of Mindfulness as a Treatment for Addiction
Houlihan, S. D., & Brewer, J. A. (2015) · Springer eBooks · doi:10.1007/978-3-319-22255-4_9 · Cited by 14
Self-citationHaugg, A., Manoliu, A., Sladky, R., Hulka, L. M., Kirschner, M., Brühl, A. B., Seifritz, E., Quednow, B. B., Herdener, M., & Scharnowski, F. (2021) · Addiction Biology · doi:10.1111/adb.13083 · Cited by 13
Rosen, R. K., Thind, H. K., Jennings, E., Guthrie, K. M., Williams, D. M., & Bock, B. C. (2016) · International Journal of Yoga Therapy · doi:10.17761/1531-2054-26.1.33 · Cited by 14
Serfaty, S., Gale, G., Beadman, M., Froeliger, B., & Kamboj, S. K. (2018) · Mindfulness · doi:10.1007/s12671-017-0767-1 · Cited by 12
“In contrast, the PFM predicts a reduction in smoking independently of reductions in craving or negative affect (Brewer et al. 2013; Elwafi et al. 2013).”
BackgroundBarrows, P. D., & Gordon, W. V. (2021) · Religions · doi:10.3390/rel12080586 · Cited by 12
A Network Analysis of Cigarette Craving
Aslan, M., Sala, M., Gueorguieva, R. V., & Garrison, K. A. (2023) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntad021 · Cited by 14
Vidrine, J. I., Businelle, M. S., Reitzel, L. R., Cao, Y., Cinciripini, P. M., Marcus, M. T., Li, Y., & Wetter, D. W. (2014) · Mindfulness · doi:10.1007/s12671-014-0276-4 · Cited by 11
“The results of four of these studies indicated that mindfulness-based treatments were generally associated with enhanced cessation outcomes (Bowen and Marlatt 2009; Brewer et al. 2011; Davis et al. 2007; Elwafi et al. 2013).”
ResultHemenway, M., Witkiewitz, K. A., Unrod, M., Brandon, K. O., Brandon, T. H., Wetter, D. W., Sutton, S. K., & Vinci, C. (2020) · Contemporary Clinical Trials · doi:10.1016/j.cct.2020.106218 · Cited by 10
Self-citationUnresolved Issues in the Application of Mindfulness-Based Interventions for Substance Use Disorders
Witkiewitz, K. A., & Black, D. S. (2014) · Substance Use & Misuse · doi:10.3109/10826084.2014.852797 · Cited by 12
“A few studies have identified that changing the association between craving and substance use could be a promising mechanism of change following mindfulness-based treatment (Elwafi et al., 2013; Witkiewitz & Bowen, 2010), while changes in mindful awareness, nonjudgment, and acceptance may be a promising mechanism for…”
BackgroundSelf-citationMhende, J., Bell, S. A., Cottrell‐Daniels, C., Luong, J., Streiff, M., Dannenfelser, M., Hayat, M. J., & Spears, C. A. (2021) · JMIR Formative Research · doi:10.2196/25926 · Cited by 9
Horváth, M., Grutman, A. J., O’Malley, S. S., Gueorguieva, R. V., Khan, N., Brewer, J. A., & Garrison, K. A. (2021) · JMIR Research Protocols · doi:10.2196/32521 · Cited by 9
“Last, a “RAIN” (recognize, allow, investigate, nonidentification [21]) mindfulness exercise is targeted to predicted smoking events according to individualized smoking profiles to help smokers work mindfully with cravings rather than to react by smoking [27,32].”
BackgroundSelf-citationMindfulness, Emotions and Leadership
Ayoko, O. B. (2023) · Journal of Management & Organization · doi:10.1017/jmo.2023.26 · Cited by 7
“In this regard, mindfulness has been shown to help individuals quit smoking (a behaviour that is deeply ingrained and often automatised) by reducing cigarette cravings (Westbrook et al., 2013) and by breaking the connection between craving and smoking (Elwafi et al., 2013).”
BackgroundVinci, C., Sutton, S. K., Yang, M.-J., Jones, S. R., Kumar, S., & Wetter, D. W. (2025) · JMIR mhealth and uhealth · doi:10.2196/55379 · Cited by 9
“…delivery of a strategy (vs none) participants would report higher positive affect (PA [43,46-48]), mindfulness [15,49-51], abstinence self-efficacy [44,45,52,53], and motivation to quit [54,55], and report lower NA [3,44,48,56-59], craving [9,11,44,51,60,61], and smoking expectancies [49,62,63].”
Mindfulness and smoking frequency: An investigation with Australian students
Chan, E. Y. (2021) · Addictive Behaviors Reports · doi:10.1016/j.abrep.2021.100342 · Cited by 8
Effectiveness of Mindfulness-Based Stress Reduction in a Community Sample over 2 Years
Madson, L., Klug, B., Madson, L., Stimatze, T., Eness-Potter, K., & MacDonald, J. A. (2018) · Annals of Clinical Psychiatry · doi:10.1177/154733251803000108 · Cited by 8
Grounding Motivation for Behaviour ChangePreprint
Papies, E. K., Barsalou, L. W., Claassen, M. A., Davis, T., Farrar, S. T., Gauthier, E., Rodger, A., Tatar, B., Wehbe, L. H., & Werner, J. (2022) · doi:10.31234/osf.io/j94vb · Cited by 8
Effects of mindfulness meditation on human impulsivity: a systematic review and meta-analysis
Tsang, E. W., Gao, J., Lo, C. N., Trapp, N. T., Boes, A. D., & Sik, H. (2025) · Academia Mental Health and Well-Being · doi:10.20935/mhealthwellb7477 · Cited by 8
Smoking Detection and Cessation: An Updated Scoping Review of Digital and Mobile Health Technologies
Casu, M., Guarnera, F., Rosa, G. R. M. L., Battiato, S., Caponnetto, P., Polosa, R., & Emma, R. (2025) · IEEE Journal of Biomedical and Health Informatics · doi:10.1109/jbhi.2025.3549255 · Cited by 7
Current Smoking: An Independent Predictor of Elevated A1C in Persons With Type 2 Diabetes
DiNardo, M. M., Sereika, S. M., Korytkowski, M. T., Baniak, L. M., Weinzierl, V., Hoenstine, A. L., & Chasens, E. R. (2019) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721719829068 · Cited by 7
Smoking Cessation Using Wearable Sensors: Protocol for a Microrandomized Trial
Hernandez, L. M., Wetter, D. W., Kumar, S., Sutton, S. K., & Vinci, C. (2021) · JMIR Research Protocols · doi:10.2196/22877 · Cited by 7
“Most importantly, mindfulness is linked to underlying mechanisms associated with abstinence, such as decreasing negative affect [19-23], increasing positive affect [20,23,24], increasing self-efficacy [25-28], and lowering craving [29-32].”
BackgroundMindfulness and the Addictive Process: Psychological Models and Neurobiological Mechanisms
Brewer, J. A., Dam, N. T. V., & Davis, J. H. (2015) · Springer eBooks · doi:10.1007/978-1-4939-2263-5_14 · Cited by 7
Self-citationWeakness of Will and the Measurement of Freedom
Côté, N. (2020) · Ethics · doi:10.1086/707214 · Cited by 7
An assessment of mindfulness intervention as a regular subject in Ecuadorian higher education
Prado, S. M. M., & Anastacio, J. A. R. (2018) · International Journal of Adolescence and Youth · doi:10.1080/02673843.2018.1450273 · Cited by 6
The Relationship between Mindfulness and Readiness to Change in Alcohol Drinkers
Hamza, E. A., Yoon, A., Liu, L., Garg, A., Richard, Y., Frydecka, D., Helal, A. A., & Moustafa, A. A. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20095690 · Cited by 9
“Finally, Elwafi, Witkiewitz, Mallik, Thornhill, and Brewer [51] suggested that through Non-Judging of Inner Experience and Acting with Awareness facets, individuals become aware of and tolerate situations where drinkers are likely to engage in automatic reactive behaviours.”
BackgroundResultObservational Study on a Mindfulness Training for Smokers within a Smoking Cessation Program
Davis, J. M., Goldberg, S. B., Angel, K. S., Silver, R. H., Kragel, E. A., & Lagrew, D. J. (2017) · Mindfulness · doi:10.1007/s12671-017-0744-8 · Cited by 6
“Neuroimaging and cognitive processing studies have led to two compellingmodels for howmindfulness may function therapeutically within an addiction (Brewer et al. 2013; Elwafi et al. 2013; Garland et al. 2013).”
Stone, D. I. G., DuBois, R. H., DeJesus, B., Rodgers, R. F., & Rizzo, C. J. (2017) · Journal of Adolescence · doi:10.1016/j.adolescence.2017.09.002 · Cited by 6
Brewer, J. A. (2018) · Contemporary Buddhism · doi:10.1080/14639947.2018.1443553 · Cited by 6
Self-citationVinci, C., Cambron, C., Lam, C. Y., & Wetter, D. W. (2021) · Health Psychology · doi:10.1037/hea0001093 · Cited by 7
Cioe, P. A., Sokolovsky, A. W., Brewer, J. A., & Kahler, C. W. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20064826 · Cited by 7
Self-citation
Metadata
- 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.
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2013-06
- Volume
- 130
- Issue
- 1-3
- Pages
- 222-229
- ISSN
- 0376-8716 (ISSN-L)
- 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
- FWCI
- 5.36
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- 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 › Public Health, Environmental and Occupational Health › 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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