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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
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.
In the citing paper
“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
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.
In the citing paper
“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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In the citing paper
“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
In the citing paper
“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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Citations
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Cited by
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Contemplating Mindfulness at Work: An Integrative Review
Good, D. J., Lyddy, C. J., Glomb, T. M., Bono, J. E., Brown, K. W., Duffy, M. K., Baer, R. A., Brewer, J. A., & Lazar, S. W. (2016) · Journal of Management · doi:10.1177/0149206315617003 · Cited by 1,043
Self-citationReconstructing and deconstructing the self: cognitive mechanisms in meditation practice
Dahl, C. J., Lutz, A., & Davidson, R. J. (2015) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2015.07.001 · Cited by 809
Food cue reactivity and craving predict eating and weight gain: A meta-analytic review
Boswell, R. G., & Kober, H. (2016) · Obesity Reviews · doi:10.1111/obr.12354 · Cited by 703
“In drug addiction, MBTs reduce craving and use of drugs (215–217), and reductions in craving reportedly mediate reductions in drug use (215,217).”
Mindfulness and Behavior Change
Schuman-Olivier, Z., Trombka, M., Lovas, D. A., Brewer, J. A., Vago, D. R., Gawande, R., Dunne, J. P., Lazar, S. W., Loucks, E. B., & Fulwiler, C. (2020) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000277 · Cited by 435
Self-citationBrewer, J. A., Elwafi, H. M., & Davis, J. H. (2013) · Psychology of Addictive Behaviors · doi:10.1037/a0028490 · Cited by 303
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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