Cited by 80Smoking Behavior and CessationMindfulness and Compassion InterventionsSubstance Abuse Treatment and Outcomes

Mechanisms underlying mindfulness-based addiction treatment versus cognitive behavioral therapy and usual care for smoking cessation.

Open access
Spears, Claire Adams, Hedeker, Donald, Li, Liang, Wu, Cai, Anderson, Natalie K., Houchins, Sean C., Vinci, Christine, Hoover, Diana Stewart +4 more·2017·Journal of Consulting and Clinical Psychology

Abstract

OBJECTIVE: To examine cognitive and affective mechanisms underlying mindfulness-based addiction treatment (MBAT) versus cognitive-behavioral therapy (CBT) and usual care (UC) for smoking cessation. METHOD: Participants in the parent study from which data were drawn (N = 412; 54.9% female; 48.2% African American, 41.5% non-Latino White, 5.4% Latino, 4.9% other; 57.6% annual income <$30,000) were randomized to MBAT (n = 154), CBT (n = 155), or UC (n = 103). From quit date through 26 weeks postquit, participants completed measures of emotions, craving, dependence, withdrawal, self-efficacy, and attentional bias. Biochemically confirmed 7-day smoking abstinence was assessed at 4 and 26 weeks postquit. Although the parent study did not find a significant treatment effect on abstinence, mixed-effects regression models were conducted to examine treatment effects on hypothesized mechanisms, and indirect effects of treatments on abstinence were tested. RESULTS: Participants receiving MBAT perceived greater volitional control over smoking and evidenced lower volatility of anger than participants in both other treatments. However, there were no other significant differences between MBAT and CBT. Compared with those receiving UC, MBAT participants reported lower anxiety, concentration difficulties, craving, and dependence, as well as higher self-efficacy for managing negative affect without smoking. Indirect effects of MBAT versus UC on abstinence occurred through each of these mechanisms. CONCLUSIONS: Whereas several differences emerged between MBAT and UC, MBAT and CBT had similar effects on several of the psychosocial mechanisms implicated in tobacco dependence. Results help to shed light on similarities and differences between mindfulness-based and other active smoking cessation treatments. (PsycINFO Database Record

Integrity signals

Registry

Crossref · 10.1037/ccp0000229

Cites

67 of 67 references verified0 citation errors · 0 not checkable

Statistics

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Claims the paper makes

0 of 43 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Compared to UC, MBAT participants reported lower anger (p < .05).

    “Compared to participants receiving UC, participants receiving MBAT reported lower levels of anger, anxiety, sadness, craving, concentration difficulties, craving, dependence motives (all subscales of the WISDM except social-environmental goads), subjective bias toward cigarettes, and higher self-efficacy for avoiding smoking when experiencing negative affect (ps < .05; see Table 1).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The missing data are missing at random for the full-likelihood analyses.
  • Findingown data

    Compared to UC, CBT participants reported lower anger (p < .05).

    “Compared to UC participants, those who received CBT reported lower negative affect, stress, anger, anxiety, sadness, concentration difficulties, dependence motives (most subscales), expectations of regulating affect by smoking, and higher self-efficacy for avoiding smoking when experiencing negative affect (ps < .05; see Table 1).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The missing data are missing at random for the full-likelihood analyses.
  • Findingown data

    Compared to UC, CBT participants reported lower negative affect (p < .05).

    “Compared to UC participants, those who received CBT reported lower negative affect, stress, anger, anxiety, sadness, concentration difficulties, dependence motives (most subscales), expectations of regulating affect by smoking, and higher self-efficacy for avoiding smoking when experiencing negative affect (ps < .05; see Table 1).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The missing data are missing at random for the full-likelihood analyses.
  • Findingown data

    Compared to UC, MBAT participants reported lower sadness (p < .05).

    “Compared to participants receiving UC, participants receiving MBAT reported lower levels of anger, anxiety, sadness, craving, concentration difficulties, craving, dependence motives (all subscales of the WISDM except social-environmental goads), subjective bias toward cigarettes, and higher self-efficacy for avoiding smoking when experiencing negative affect (ps < .05; see Table 1).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The missing data are missing at random for the full-likelihood analyses.
  • Findingown data

    Compared to UC, MBAT participants reported lower concentration difficulties (p < .05).

    “Compared to participants receiving UC, participants receiving MBAT reported lower levels of anger, anxiety, sadness, craving, concentration difficulties, craving, dependence motives (all subscales of the WISDM except social-environmental goads), subjective bias toward cigarettes, and higher self-efficacy for avoiding smoking when experiencing negative affect (ps < .05; see Table 1).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The missing data are missing at random for the full-likelihood analyses.
  • May combine two claims. 18
  • Classified as probably not a substantial claim. 12
  • May combine two claims.

    Findingown data

    Effects of MBAT vs CBT on WISDM - Craving trended as expected, with MBAT participants indicating less craving than CBT (β = .19, p = .066).

    “The effects of MBAT vs. CBT on WISDM – Primary Dependence (β = .19, p = .059), WISDM – Craving (β = .19, p = .066), and WISDM – Tolerance (β = .19, p = .059) each trended as expected, with MBAT participants indicating less primary dependence, craving, and tolerance than those receiving CBT.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The missing data are missing at random for the full-likelihood analyses.
  • May combine two claims.

    Findingown data

    MBAT did not differ significantly from CBT (p = .349) or UC (p = .109) on volatility of craving.

    “However, MBAT did not differ significantly from CBT (p = .349) or UC (p = .109).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The missing data are missing at random for the full-likelihood analyses.
  • May combine two claims.

    Findingown data

    Compared to UC, MBAT predicted lower anxiety and higher self-efficacy for managing negative affect, which predicted higher odds of abstinence at week 4.

    “Compared to UC, MBAT predicted lower anxiety and higher self-efficacy for managing negative affect, which predicted higher odds of abstinence at week 4.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The missing data are missing at random for the full-likelihood analyses.
  • May combine two claims.

    Findingown data

    Compared to UC, MBAT predicted lower concentration difficulties, craving, and dependence, which predicted higher odds of abstinence at 26 weeks post-quit.

    “Compared to UC, MBAT predicted lower concentration difficulties, craving, and dependence, which predicted higher odds of abstinence at 26 weeks post-quit.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The missing data are missing at random for the full-likelihood analyses.
  • May combine two claims.

    Findingown data

    The ANCOVA predicting volatility of craving trended as expected (p = .056), with MBAT participants evidencing the lowest volatility.

    “The ANCOVA predicting volatility of craving trended as expected (p = .056), with MBAT participants evidencing the lowest volatility.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The missing data are missing at random for the full-likelihood analyses.
  • May combine two claims.

    Findingown data

    Overall effect sizes for MBAT versus UC and CBT versus UC were similar, with some notable exceptions.

    “Effect sizes for the MBAT vs. UC and CBT vs. UC comparisons are similar overall, with a few notable differences.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    Goyal et al.'s meta-analysis indicated that mindfulness meditation programs reduced anxiety and depression, but did not affect positive emotions when compared to nonspecific active controls.

    “Goyal et al.’s (2014) meta-analysis in adult clinical populations indicated that mindfulness meditation programs reduced anxiety and depression, but did not affect positive emotions when compared to nonspecific active controls.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Goyal et al., 2014

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    Premisecitation

    Quitting smoking is associated with increased negative affect, and negative affect and stress are strong predictors of difficulty quitting.

    “Quitting smoking is associated with increased negative affect (Leventhal, Waters, Moolchan, Heishman, & Pickworth, 2010), and negative affect and stress are strong predictors of difficulty quitting (Baker, Piper, McCarthy, Majeskie, & Fiore, 2004).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Leventhal et al., 2010

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    • cites Baker et al., 2004

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    Premisecitation

    Mindfulness-based programs have produced significantly higher abstinence rates than standard treatment and quitline-delivered treatment.

    “Mindfulness-based programs have produced significantly higher abstinence rates than standard treatment (Brewer et al., 2011) and quitline-delivered treatment (Davis, Goldberg, et al., 2014).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Brewer et al., 2011

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    • cites Davis, Goldberg, et al., 2014

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    Premisecitation

    Adams et al. found that dispositional mindfulness predicted lower volatility of negative emotions and depressive symptoms among smokers attempting to quit, indicating higher stability in negative but not positive emotions.

    “Adams et al. (2014) found that dispositional mindfulness predicted lower volatility of negative emotions and depressive symptoms among smokers attempting to quit, indicating higher stability in negative (but not positive) emotions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Adams et al., 2014

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Hill and Updegraff found that among college students, dispositional mindfulness predicted lower volatility of both negative and positive emotions.

    “Hill and Updegraff (2012) found that among college students, dispositional mindfulness predicted lower volatility of both negative and positive emotions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Hill and Updegraff, 2012

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    Premisecitation

    Among smokers, abstinence increases attentional bias toward smoking-related cues, and attentional bias is associated with higher risk for early lapses to smoking.

    “Among smokers, abstinence increases attentional bias toward smoking-related cues (Leventhal et al., 2010), and attentional bias is associated with higher risk for early lapses to smoking (Waters et al., 2003).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Leventhal et al., 2010

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    • cites Waters et al., 2003

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    Premisecitation

    Vidrine et al. found that smokers with greater dispositional mindfulness indicated greater self-efficacy for abstaining from smoking and stronger expectations that they could regulate their emotions without smoking.

    “Indeed, Vidrine et al. (2009) found that smokers with greater dispositional mindfulness indicated greater self-efficacy for abstaining from smoking and stronger expectations that they could regulate their emotions without smoking.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Vidrine et al., 2009

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  • Classified as probably not a substantial claim.

    Study design and conductown data

    Indirect effects analyses controlled for baseline demographics, number of cigarettes per day, and time to first cigarette.

    “Potential mechanisms that were identified in the first phase of analyses as significantly differing between treatments were tested, controlling for baseline demographics, number of cigarettes per day, and time to first cigarette.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The missing data are missing at random for the full-likelihood analyses.
  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Seven-day point prevalence abstinence was biochemically confirmed with CO level < 6 ppm.

    “Seven-day point prevalence abstinence from smoking was assessed at 4 and 26 weeks post-quit and biochemically confirmed with CO level < 6 ppm (Vidrine et al., 2016).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Vidrine et al., 2016

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    Study design and conductown data

    Mixed-effects regression models controlled for demographics, baseline smoking, and abstinence at each time point.

    “Analyses controlled for demographics, baseline smoking, and abstinence at each time point.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The missing data are missing at random for the full-likelihood analyses.
  • Classified as probably not a substantial claim.

    Study design and conductown data

    Participants were randomized to MBAT (n=154), CBT (n=155), or UC (n=103) using adaptive minimization.

    “Participants were randomized to MBAT (n = 154), CBT (n = 155), or UC (n = 103) using adaptive minimization.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Sensitivity analyses examined robustness under different missing data assumptions.

    “For indirect effects analyses, sensitivity analyses were conducted to examine the robustness of effects under different assumptions regarding missing data.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The missing data are missing at random for the full-likelihood analyses.
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    ANCOVAs controlled for baseline demographic variables, baseline smoking, and abstinence at each time point.

    “Analyses of covariance (ANCOVAs) were conducted to examine group effects on volatility surrounding the quit date and through follow-up, controlling for baseline demographic variables, baseline smoking, and abstinence at each time point.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The missing data are missing at random for the full-likelihood analyses.
  • May combine two claims.

    Premisecitation

    Khoury et al.'s (2013) meta-analysis found mindfulness-based therapy outperformed some active treatments such as supportive therapy, but not CBT.

    “Similarly, Khoury et al.’s (2013) meta-analysis concluded that mindfulness-based therapy was superior to some other active treatments (e.g., supportive therapy) but not CBT.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Khoury et al.’s (2013)

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Many analyses were run to test multiple possible mechanisms.

    “Finally, because this is the first known study to examine mechanisms underlying mindfulness-based versus cognitive-behavioral and usual care treatments for smoking cessation, a relatively large number of analyses were conducted to examine multiple potential mechanisms.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Study design and conductnone given

    UC was less intensive than MBAT and CBT, used individual rather than group counseling, and was not matched for time or attention.

    “In addition, UC was less intensive than both MBAT and CBT, involved individual rather than group counseling, and was not balanced for time/attention; differences between UC and MBAT/CBT could be partially due to dose effects.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    Mindfulness-based relapse prevention led to fewer substance-use days than cognitive-behavioral relapse prevention, particularly at 12 months.

    “For example, mindfulness-based relapse prevention predicted fewer days of substance use than cognitive-behavioral relapse prevention (Witkiewitz, Warner, et al., 2014), especially at 12-month follow-up (Bowen et al., 2014).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Witkiewitz, Warner, et al., 2014

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    • cites Bowen et al., 2014

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    Premisecitation

    CBT attempts to alter irrational thinking, while mindfulness emphasizes observing thoughts without evaluation.

    “However, whereas CBT involves efforts to change irrational thinking, mindfulness involves non-evaluative observation of thoughts (i.e., changing the way one relates to his/her thoughts rather than directly attempting to change the content of thoughts; Baer, 2003; Teasdale et al., 2002).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Baer, 2003

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    • cites Teasdale et al., 2002

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    This higher early abstinence may have reduced statistical power for later time-point analyses.

    “In addition, abstinence rates were higher at 4-weeks post-quit than at 26-weeks post-quit, which could have limited statistical power for analyses predicting the later time point.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Mindfulness training should lower scores on the Automaticity, Loss of Control, Cue Exposure-Associative Processes, and Negative Reinforcement subscales.

    “Thus, it makes sense that mindfulness training would reduce the following particular subscales: Automaticity (smoking without awareness or purposeful choice), Loss of Control (the feeling that cigarettes control one’s life, rather than the sense of personal control over smoking), Cue Exposure-Associative Processes (strong links between external cues and smoking behavior), and Negative Reinforcemen”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Informal mindfulness practices were not measured.

    “Furthermore, adherence to between-session formal meditation practice recommendations in this study was low (Vidrine et al., 2016), and more informal mindfulness practices (e.g., urge surfing) were not assessed.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Goldin et al. (2016) found mindfulness training and CBT had equal efficacy for social anxiety disorder and more similarities than differences in mechanisms.

    “Recently, Goldin et al. (2016) reported that mindfulness training and CBT were equally efficacious for treating social anxiety disorder and that there were more similarities than differences in terms of underlying mechanisms.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Goldin et al. (2016)

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28 of 28
  • The paper relies on this without support.

    The mechanisms underlying mindfulness-based interventions versus more traditional smoking cessation approaches are unclear.

    “However, the mechanisms underlying mindfulness-based interventions versus more traditional approaches for smoking cessation are unclear.”
  • The paper relies on this without support.

    No study has examined the effect of mindfulness-based treatment or CBT on affective volatility.

    “No study, to our knowledge, has examined the effect of mindfulness-based treatment (or CBT) on affective volatility.”
  • The authors state this as an assumption.

    The missing data are missing at random for the full-likelihood analyses.

    “The statistical analyses using the available data are based on full-likelihood estimation, and hence are valid under the missing at random assumption (Laird, 1988).”
  • The paper relies on this without support.

    No prior study has directly compared mechanisms underlying MBAT versus CBT and usual care for smoking cessation.

    “This is the first known study to directly compare mechanisms underlying the effects of mindfulness-based versus cognitive-behavioral and usual care treatments for smoking cessation.”
  • The paper relies on this without support.

    No known research has examined the effects of mindfulness treatment on volatility of anger.

    “Although no known research has examined the effects of mindfulness treatment on volatility, dispositional mindfulness predicts lower volatility of negative affect (Adams et al., 2014), and mindfulness training shows promise for reducing anger (e.g., Amutio et al., 2014).”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Rigorous RCTs comparing mindfulness-based interventions and CBT have failed to show differential treatment effects on a whole range of mechanisms, including dispositional mindfulness, reappraisal, self-efficacy, acceptance, catastrophizing, and positive and negative affect.

    “Rigorous RCTs comparing mindfulness-based interventions and CBT have failed to show differential treatment effects on a whole range of mechanisms, including dispositional mindfulness, reappraisal, self-efficacy, acceptance, catastrophizing, and positive and negative affect [11,73,74].”

    From Testing the mindfulness-to-meaning theory: Evidence for mindful positive emotion regulation from a reanalysis of longitudinal data (2017) · cites this paper as [74]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured
  • In a full-scale clinical trial, mindfulness-based addiction treatment significantly improved smoking abstinence by decreasing concentration difficulties.

    “in a full-scale clinical trial, mindfulness-based addiction treatment significantly improved smoking abstinence by decreasing concentration difficulties [37].”
  • In a large clinical trial, the effects of mindfulness-based addiction treatment on smoking abstinence were mediated by decreased craving.

    “in a large clinical trial, the effects of mindfulness-based addiction treatment on smoking abstinence were mediated by decreased craving [37].”
  • In individual studies, MBIs produced significant decreases in attentional bias, addictive automaticity, dysphoric affect, and pain severity and related functional interference in patients with chronic pain.

    “as well as decreases in attentional bias [52, 66, 67], addictive automaticity [66], dysphoric affect [40, 66], and pain severity and related functional interference in patients with chronic pain [41].”
  • In individual studies, MBIs produced significant increases in emotion regulation, substance-related self-efficacy, and positive emotions.

    “In individual studies, MBIs produced a host of other significant salutary effects including increases in emotion regulation [41, 54], substance-related self-efficacy [65, 66], and positive emotions [33]”

Cites

1 retracted

Flagged first, then by citations

Research works printed but not linked: 2

  1. Marlatt GA Gordon JR 1985 Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors New York Guilford Press
  2. USDHHS 2014 The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General Atlanta (GA) Centers for Disease Control and Prevention (US) 24455788

Cited by

Sorted by citations

Authors
Spears, C. A., Hedeker, D., Li, L., Wu, C., Anderson, N. K., Houchins, S. C., Vinci, C., Hoover, D. S., Vidrine, J. I., Cinciripini, P. M., Waters, A. J., & Wetter, D. W.
Affiliations
  • Georgia State University (US)
  • University of Chicago (US)
  • The University of Texas MD Anderson Cancer Center (US)
  • Catholic University of America (US)
  • Moffitt Cancer Center (US)
  • OU Health Stephenson Cancer Center (US)
  • Uniformed Services University of the Health Sciences (US)
  • University of Utah (US)
Venue
Journal of Consulting and Clinical Psychology
Published
2017-11
Volume
85
Issue
11
Pages
1029-1040
ISSN
  • 0022-006X (ISSN-L)
  • 1939-2117
OpenAlex
W2645344634
Cited by
80
References
66
Citations by year
2026: 2 · 2025: 3 · 2024: 7 · 2023: 16 · 2022: 11 · 2021: 15 · 2020: 9 · 2019: 7 · 2018: 8 · 2017: 2
FWCI
5.26
Type
journal article
Language
en
Open access
Locations
  • Journal of Consulting and Clinical Psychology (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute on Drug Abuse (R01DA018875)
  • National Center for Complementary and Integrative Health (K23AT008442)
  • National Cancer Institute (P30CA016672)
  • National Institute on Minority Health and Health Disparities (K99MD010468)
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
cognitive behavioral therapy, smoking cessation, tobacco dependence, smoking abstinence, therapeutic mechanisms, craving, withdrawal symptoms, self-efficacy, attentional bias, volitional control, anxiety, usual care
MeSH terms
Adult, Emotions, Female, Humans, Male, Smoking, Tobacco Use Disorder, Cognitive Behavioral Therapy, Smoking Cessation, Behavior, Addictive, Treatment Outcome, Self Efficacy, Mindfulness, Craving

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