Group Therapy for Nicotine Dependence: Mindfulness and Smoking

This 3-group randomized clinical trial will develop and evaluate a Mindfulness-Based Addiction Treatment (MBAT) for nicotine dependence. Mindfulness reflects a purposeful control of attention and can be learned through training in attentional control procedures.

Current cigarette smokers (N=550; 400 in formal study; up to 80-150 pilot) will be randomly assigned to Usual Care (UC), Standard Treatment (ST) or MBAT. UC will be four 5-10 minute counseling sessions following the problem-solving approach in the Treating Tobacco Use and Dependence Clinical Practice Guideline (Guideline). ST is a standard smoking cessation group program using a problem-solving/coping skills approach. MBAT is a group smoking cessation program derived from Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy. MBAT will not alter the basic mindfulness approach used in MBCT and MBSR, but will replace depression-related material with smoking cessation strategies from the Guideline. All participants will receive nicotine patches and self-help materials. MBAT mechanisms and effects will be assessed using "implicit" cognitive psychological measures and computer-administered questionnaires. Participants will be tracked from baseline through 4 (UC) or 8 (ST and MBAT) treatment visits and follow-up visits 1 and 23 weeks post-treatment.

The overarching goals are to evaluate MBAT's efficacy for nicotine dependence and the mechanisms and effects posited to mediate MBAT's impact on abstinence.

Primary specific aims are to:

• Examine the effects of MBAT on abstinence rates
• Examine the effects of MBAT on mindfulness/metacognitive awareness, attentional control, smoking automaticity, smoking associations in memory, negative affect, depression, stress, affect regulation expectancies, self-efficacy, withdrawal, and coping across the pre- and post-cessation period, and whether these variables mediate MBAT effects on abstinence.

Inclusion criteria

• Age 18 or above
• Current smoker with a history of at least five cigarettes/day for the past year
• Motivated to quit within the next 30 days (preparation stage)
• Participants must provide a viable home address and a functioning home telephone number
• Can read and write in English
• Register "8" or more on a carbon monoxide breath test
• Provide viable collateral contact information

Exclusion criteria

• Contraindication for nicotine patch use
• Regular use of tobacco products other than cigarettes (cigars, pipes, smokeless tobacco)
• Use of bupropion or nicotine patch replacement products other than the study patches
• Pregnancy or lactation
• Another household member enrolled in the study
• Active substance dependence (exclusive of nicotine dependence)
• Current psychiatric disorder; current use of psychotropic medication
• Participation in a smoking cessation program or study during the past 90 days