Quitting starts in the brain: a randomized controlled trial of app-based mindfulness shows decreases in neural responses to smoking cues that predict reductions in smoking
Open accessAbstract
Current treatments for smoking yield suboptimal outcomes, partly because of an inability to reduce cue-induced smoking. Mindfulness training (MT) has shown preliminary efficacy for smoking cessation, yet its neurobiological target remains unknown. Our prior work with nonsmokers indicates that MT reduces posterior cingulate cortex (PCC) activity. In individuals who smoke, the PCC, consistently a main hub of the "default mode network," activates in response to smoking cues. In this randomized controlled trial, we tested the effects of app-delivered MT on PCC reactivity to smoking cues and whether individual differences in MT-mediated PCC changes predicted smoking outcomes. Smoking cue-induced PCC reactivity was measured using functional magnetic resonance imaging at baseline and 1 month after receiving smartphone app-based MT (n = 33) vs. an active control (National Cancer Institute's QuitGuide, n = 34). Whether individual differences in treatment-related changes in PCC activity predicted smoking behavior was assessed. The MT group demonstrated a significant correlation between a reduction in PCC reactivity to smoking cues and a decline in cigarette consumption (r = 0.39, p = 0.02). No association was found in the control group (r = 0.08, p = 0.65). No effects of group alone were found in PCC or cigarette reduction. Post hoc analysis revealed this association is sex specific (women, r = 0.49, p = 0.03; men: r = -0.08, p = 0.79). This initial report indicates that MT specifically reduces smoking cue-induced PCC activity in a subject-specific manner, and the reduction in PCC activity predicts a concurrent decline in smoking. These findings link the hypothesized behavioral effects of MT for smoking to neural mechanisms particularly in women. This lays the groundwork for identifying individuals who may benefit from targeted digital therapeutic treatments such as smartphone-based MT, yielding improved clinical outcomes.
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Increased mindfulness is proposed to alleviate cue-induced craving, increase top-down control, help emotional regulation, and reduce distress among individuals who use substances.
“Increased mindfulness is proposed to alleviate cue-induced craving, increase top-down control, help emotional regulation, and reduce distress among individuals who use substances [43,44].”
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 [43]
The Introduction (page unavailable) proposes that mindfulness training helps smokers work with cue-induced affective states and avoid getting caught up in cravings; it also reports a decoupling of craving from smoking. This supports the claim’s general account of responding to cues, but the paper does not say that mindfulness increases top-down control or reduces distress, and its evidence centers on smokers rather than substance users generally. (LLM, conf=0.87)
Experimental — accuracy not yet measuredIn developing more mindful awareness to these processes, people can learn to be and work with unpleasant states, rather than avoid or react to them and perpetuate the habitual cycle of worry.
“In developing more mindful awareness to these processes, people can learn to be and work with unpleasant states18,21,22, rather than avoid or react to them and perpetuate the habitual cycle of worry15,16.”
From Cluster-based psychological phenotyping and differences in anxiety treatment outcomes (2023) · cites this paper as [21]
Mindfulness 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 [31]
Human neuroscience documents restoration of functioning after abstinence and reveals predictors of clinical success.
“Human neuroscience documents restoration of functioning after abstinence [40,41] and reveals predictors of clinical success [42].”
From Addiction as a brain disease revised: why it still matters, and the need for consilience (2021) · cites this paper as [42]
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- Authors
- Janes, A. C., Datko, M., Roy, A., Barton, B., Druker, S., Neal, C., Ohashi, K., Benoit, H., van Lutterveld, R., & Brewer, J. A.
- Affiliations
- Harvard University (US)
- Cambridge Health Alliance (US)
- Brown University (US)
- University of Massachusetts Chan Medical School (US)
- University of Oklahoma - Tulsa (US)
- Corresponding author
- Brewer, Judson A.
- ORCID
- Venue
- Neuropsychopharmacology
- Published
- 2019-04-30
- Volume
- 44
- Issue
- 9
- Pages
- 1631-1638
- ISSN
- 0893-133X (ISSN-L)
- 1740-634X
- PMC
- PMC6785102
- OpenAlex
- W2943648060
- Cited by
- 55
- References
- 62
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 9 · 2023: 8 · 2022: 11 · 2021: 12 · 2020: 2 · 2019: 2
- FWCI
- 4.63
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Neuropsychopharmacology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship@UMassChan (submittedVersion)
- Funders
- U.S. Department of Health & Human Services | NIH | National Institute on Drug Abuse (K02DA042987)
- U.S. Department of Health & Human Services | NIH | National Center for Complementary and Integrative Health (1R61AT009337-02S)
- 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, smoking cues, posterior cingulate cortex, default mode network, cue reactivity, sex differences, digital therapeutics, individual differences in treatment response, cigarette consumption
- MeSH terms
- Cigarette Smoking, Adult, Brain, Cues, Female, Gyrus Cinguli, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Smoking Cessation, Functional Neuroimaging, Mobile Applications, Mindfulness
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