Posted 06.26.2019 | by AMRA

Although most cigarette smokers want to quit, only 5% succeed in doing so each year. One reason for this low success rate is that smoking-related cues stimulate strong urges to smoke. Cues include observing someone else smoking, or engaging in activities previously associated with smoking (e.g., work breaks, meals, a cup of coffee, sex). Finding ways to reduce cue-induced urges may help more people quit.

Research shows that a brain area called the posterior cingulate cortex (PCC) becomes activated whenever cigarette smokers are exposed to smoking-related cues. Research also indicates that mindfulness meditation as an intervention reduces PCC activity. Janes et al. [Neuropsychopharmacology] tested whether a smartphone mindfulness app reduced smokers’ PCC reactivity to smoking-related cues and their smoking behavior.

The researchers recruited 83 adult smokers who were interested in quitting, 67 of whom completed the study and were included in the final data analysis (average age = 44; 67% female; 91% Caucasian). PCC-reactivity to smoking cues was assessed by functional magnetic resonance imaging (fMRI) and participants were then randomly assigned to either mindfulness training or a control condition. Both conditions used smartphone apps for 4 weeks to help quit smoking. Participants’ PCC reactivity to smoking-related cues was re-assessed via fMRI after the intervention.

The mindfulness app consisted of 22 modules that offered daily training videos and on-demand exercises to teach the core elements of mindfulness. The app also helped participants identity triggers, monitor smoking habits, increase awareness of urges, and use mindfulness as a coping mechanism.

The control group used the National Cancer Institute’s QuitGuide App to help monitor motivation and triggers, as well as offer inspirational messages and tips for dealing with cravings and moods without mindfulness training.

PCC reactivity was measured by having participants view smoking-related and neutral images while undergoing fMRI scanning. The fMRI scans were analyzed for differences in average PCC activation between smoking-related and neutral images.

Results showed that the mindfulness training group decreased average cigarette use by 11 cigarettes (d = 2.5) per day, and the control group decreased average use by 9 cigarettes (d = 1.28) per day. There was no significant difference in the amount of between-group change on this measure.

The mindfulness app group showed a significant correlation (r=.49) between cigarette reduction and the number of app modules completed, but the control group (r=.20) did not.

Both groups showed high levels of PCC reactivity to smoking-related cues on the fMRI scans at baseline. There were no significant group differences in PCC reactivity change scores over time. Within the mindfulness app group, there was a significant association between decreased PCC cue-related activation (r=.39) and decreased smoking. There was no such association between changes in PCC activation and smoking in the control group (r=.08).

On further examination, the correlation between PCC change scores and smoking change was significant for females in the mindfulness app group (r=.49) but not males (r=.08). Not all participants showed heightened PCC activation in response to smoking-related cues. Mindfulness participants who showed the greatest reduction in cue-related PCC activity also showed the greatest reduction in smoking (d=0.79), yet there was no such association in the control group.

At the end of the study, participants in the mindfulness app group were more likely to recommend their app to a friend (d=1.5) as compared to those in the control group.

This study suggests that a mindfulness app can reduce smoking through decreased cue sensitivity and decreased PCC reactivity. However, this effect was dependent on the number of app modules completed, and only significant for female smokers. While the National Cancer Institute’s QuitGuide App also reduced smoking, its effect wasn’t associated with changes in PCC reactivity. Some smokers may benefit more from a mindfulness app than others; specifically, women who show strong PCC activation in response to smoking-related cues.

Reference:

Janes, A. C., Datko, M., Roy, A., Barton, B., Druker, S., Neal, C., . . . Brewer, J. A. (2019). 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. Neuropsychopharmacology.

[Link to study]