Posted 07.29.2020 | by AMRA

Cigarette smoking remains the leading cause of preventable mortality in the world. While smoking cessation programs are often initially effective, they tend to lose efficacy over time with 40%-70% of former smokers eventually relapsing. Smoking cessation maintenance programs aim to address the problems of urges to smoke and a decreased capacity for experiencing pleasure after quitting.

Mindfulness-based approaches focused on relapse prevention use meditation practices to help users experience urges without reaction and increase attentiveness to pleasurable experiences. Weiss de Souza et al. [Nicotine and Tobacco Research] tested whether an add-on Mindfulness-Based Relapse Prevention (MBRP) program increases the efficacy of a standard relapse prevention program in preventing smoking relapse.

The researchers randomized 86 Brazilian smokers (80% female; average age = 50 years) to standard relapse prevention treatment plus MBRP, or to the standard treatment alone. Both groups received four weeks of standard treatment, then half the group went on to receive an additional 8 weeks of MBRP. Standard treatment consisted of four 90-minute weekly group sessions and six maintenance sessions in weeks 6, 8, 10, 12, and 24. MBRP groups were conducted concurrently with the standard treatment maintenance groups.

Standard treatment focused on cognitive-behavioral strategies for coping with thoughts and situations that trigger relapse. Medication to reduce cravings (nicotine patches or gum, bupropion) was also provided. The 8-week MBRP program met for 2-hour weekly group sessions that included guided meditations, discussion, homework review, and encouragement for daily home practice.

Participants were assessed at baseline and at 1-month (after standard treatment), 3-month (after MBSR), and 6-month follow-ups for smoking abstinence assessed by exhaled carbon monoxide as well as self-report of cravings, mood, anxiety, depression, and mindfulness (Five Facet Mindfulness Questionnaire).

Both groups experienced high attrition rates as is often common in smoking cessation studies. Thirty-six percent of the standard treatment group did not complete the 1-month standard treatment program, and a total of 79% of the starting standard treatment cohort did not make it through to 6-month follow-up. Forty-five percent of MBRP participants did not complete the standard treatment program, another 23% did not complete the MBRP program, and an additional 7% did not show for 6-month follow-up. As a result, the researchers provided results for the both the intention-to-treat cohort (all 86 participants initially enrolled in the study) and the completers (the 9 standard treatment and 11 MBRP participants who completed the study).

Among standard treatment completers, 84% of the standard group and 67% of the MBRP group were abstinent from smoking immediately following the 4-week standard program. After the MBRP program at 3-month follow-up, 90% of the standard group and 86% of the MBRP group were abstinent.

At 6-month follow-up, 67% of the standard group and 82% of the MBRP group were abstinent. In the intention-to-treat cohort, 14% of standard and 20% of MBRP participants were abstinent at 6-month follow-up.

MBRP members reported a significant increase in mindfulness and a significant decrease in cravings by 6-month follow-up. There were no significant improvements on these measures for the standard group. There were no other significant within or between-group differences on self-report measures. All 14 of the participants who completed the MBRP program rated it a “10” on a 10-point scale of importance.

The study suggests that appending mindfulness-based relapse prevention to the end of standard relapse prevention program can slightly improve smoking cessation. Trends toward significant differences in long-term abstinence rates were observed for both completers and the intent-to-treat cohort.

The study has major limitations due to high attrition rates, unequal time and attention given to each treatment group, and differing lengths of follow-up time after intensive interventions for each group.


Weiss de Souza, I. C., Kozasa, E. H., Bowen, S., Richter, K. P., Sartes, L. M. A., Colugnati, F. A. B., & Noto, A. R. (2020). Effectiveness of Mindfulness-based Relapse Prevention Program as an Adjunct to the Standard Treatment for Smoking: A Pragmatic Design Pilot Study. Nicotine & Tobacco Research.

[Link to study]