Mindful smoking cessation: a promising and effective strategy

Mindfulness interventions have shown great promise in addressing the core component of smoking addiction: craving. Craving, defined as an intense and conscious desire to consume a specific drug or food, is strongly associated with subsequent smoking, particularly among daily smokers^[6]. Also, intense and unremitting craving often precedes the initial lapse following a cessation attempt, and studies have shown that increases in the intensity of craving can accurately predict lapse and relapse risk. Therefore, craving is often considered an appropriate target for intervention, and the effectiveness of mindfulness interventions may largely lie in their impact on cravings. Empirical studies have shown that both long-term and short-term training, or even the use of mindfulness strategies alone can impact craving^[7]. Various models explain how mindfulness reduces craving, and based on these models, researchers have proposed that three core strategies of mindfulness—awareness, acceptance, and decentering—can reduce craving by: (1) Interrupting craving-related elaboration by reducing self-referential processing; and (2) decoupling the relationship between craving and craving-related behavior, facilitating an extinction process where the individual inhibits craving-related behavior.

Repeated smoking can lead to addictive behaviors that become automated or habitual, resulting in cue-induced actions that are largely unconscious and outside of intentional control^[8]. Mindfulness, which increases awareness of present experiences, effectively interrupts these automatic responses triggered by cues^[9].

For addiction, the motivation for reward-seeking behavior initially stems from positive reinforcement, such as the pleasurable effects of smoking. Over time, however, the behavior may shift from seeking pleasure to avoiding the discomfort or anxiety caused by withdrawal. This shift significantly increases the risk of relapse, as negative emotional states are most pronounced during withdrawal. Negative affects, such as stress and anxiety, is directly linked to heightened brain reactivity to stressors, making it harder for individuals to cope with cravings and negative emotions, further complicating the quitting process. Mindfulness can be an effective strategy for addressing this issue by alleviating negative emotions. Numerous studies have shown that practicing mindfulness can reduce distress, with this effect being mediated by a decrease in rumination, which then decouples from negative affects and smoking urge^[10]. Mindfulness training can also effectively treat pain, anxiety disorders, and depression, which can further alleviate cravings.

Mindfulness-based interventions, such as Mindfulness-Based Relapse Prevention (MBRP) and Mindfulness-Oriented Recovery Enhancement (MORE), have been specifically designed for addictive disorders. These interventions, along with other short-term mindfulness training programs, have shown promising results in reducing smoking and improving emotional regulation. Overall, mindfulness appears to be a valuable tool for helping individuals quit smoking by addressing both the psychological and physiological aspects of addiction.

Despite its potential, mindfulness-based smoking cessation programs face several challenges. Mindfulness interventions typically require consistent practice, often over the course of 8 weeks, which may be difficult for some individuals to maintain. Recently, there has been a rise in online mindfulness programs, making it easier for individuals to access smoking cessation resources. However, such programs have been less commonly used. Additionally, mindfulness-based smoking cessation programs remain relatively scarce in certain regions, including China, limiting their accessibility. To address these challenges, it is crucial to integrate mindfulness-based approaches into existing smoking cessation programs. Government support and community-based resources, including hospitals and public health initiatives, can play a pivotal role in increasing accessibility and encouraging the widespread adoption of mindfulness techniques for smoking cessation.

Mindfulness-based interventions offer promising approaches to enhancing smoking cessation programs and developing more personalized and adaptive treatments. However, further research and broader implementation are needed to fully realize their potential. The Journal of Smoking Cessation serves as a key platform for sharing innovative research and evidence-based strategies to help individuals overcome nicotine addiction. Through the dedication of the editorial community, authors, reviewers, and readers, we invite your contributions to advance this critical work. Together, we strive to promote better health outcomes through promising scientific findings.