Efficacy of mindfulness meditation for smoking cessation: A systematic review and meta-analysis
Introduction
The most recent U.S. Public Health Service guidelines for smoking cessation interventions focus on counseling and medications, including nicotine replacement (U.S. Department of Health and Human Services, 2008). Individual, group, and telephone counseling are all effective, and effectiveness increases with intensity (Patnode et al., 2015). Nicotine replacement, bupropion SR (sustained release), and varenicline are recommended as first-line medications. Each of these interventions has consistently been found effective in many high-quality randomized controlled trials (RCTs), resulting in the highest rating for strength of evidence (U.S. Department of Health and Human Services, 2008). Since the publication of those guidelines, smoking cessation programs have increasingly incorporated complementary and alternative medicine modalities (Carim-Todd, Mitchell, & Oken, 2013). One such modality is mindfulness meditation, derived from a 2500-year-old Buddhist practice called Vipassana, or insight meditation. Mindfulness has been defined as “paying attention on purpose, in the present moment, and non-judgmentally, to the unfolding of experience moment to moment.” (Kabat-Zinn, 1990) Individuals of any background can be trained to incorporate the practice systematically into daily life (UCLA Health, 2015). Clinical applications of mindfulness include stress reduction (Goyal, Singh, Sibinga, et al., 2014), treatment of substance abuse (Chiesa & Serretti, 2014), and chronic pain (Cramer et al., 2012, Kozasa et al., 2012, Reiner et al., 2013).
A 2013 systematic review on yoga and meditation for smoking cessation (Carim-Todd et al., 2013) included three RCTs of mindfulness-based interventions; (Bowen and Marlatt, 2009, Brewer et al., 2011, Rogojanski et al., 2011) two of these found significant differences favoring the mindfulness interventions. A more recent review de Souza, de Barros, Gomide, et al. (2015) reported promising results; the authors did not conduct meta-analysis. That review included several studies that did not meet our definition of mindfulness meditation; we believe they also double counted two studies. Therefore, this review was undertaken to reassess the efficacy and safety of mindfulness meditation, as an adjunctive or monotherapeutic treatment for smoking cessation. Abstinence from smoking was the primary outcome; secondary outcomes included reduction in use, and cravings. The systematic review protocol is registered in PROSPERO, an international registry for systematic reviews.
Section snippets
Inclusion criteria
This systematic review was limited to RCTs of adults. Interventions that used mindfulness meditation, such as mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT), or brief mindfulness training, either as an adjunctive or monotherapy, were included. Studies evaluating other meditation interventions, such as yoga, tai chi, qigong, and transcendental meditation techniques, without reference to mindfulness meditation, were excluded. Inclusion was not limited by
Search results
We identified 190 citations through the electronic database searches and reference-mining of included studies and previous systematic reviews related to tobacco use. The literature flow is displayed in Fig. 1 below. Full-text articles were obtained for 30 citations identified as potentially eligible. Twenty of these articles were excluded for the following reasons: three did not study tobacco use, one had no relevant outcomes (e.g., reporting only intention to quit), two employed an
Discussion
This review has several strengths: an a priori research design, duplicate study selection and data abstraction of study information, a comprehensive search of electronic databases, risk of bias assessments, and comprehensive quality of evidence assessments used to formulate review conclusions. The effects of mindfulness meditation on smoking cessation did not differ significantly from those of comparator interventions. The comparators were often active interventions such as the American Lung
Role of funding sources
Funding for this study was provided by the U.S. Defense Center of Excellence (DCoE) for Psychological Health and Traumatic Brain Injury (W91WAW-12-C-0030). The funder had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.
Contributors
Margaret A. Maglione designed the study, wrote the protocol, directed the screening and abstraction of data, oversaw the analysis, interpreted the findings and wrote the first draft of the manuscript. Alicia Ruelaz Maher, Benjamin Colaiaco, Sydne Newberry, and Ryan Kandrack screened the literature search results, abstracted data, and assisted in interpreting the findings. Brett Ewing conducted the statistical analyses. Roberta M. Shanman conducted the electronic literature searches. Melony E.
Conflict of interest
All authors declare that they have no conflicts of interest.
Acknowledgements
We gratefully acknowledge Kristie Gore of RAND for her support and guidance throughout the project. We thank Aneesa Motala and Barbara Hennessey of RAND for research assistance and administrative support in preparing the report. We also would like to thank our project officers and points of contact at the Defense Center of Excellence (DCoE) for Psychological Health and Traumatic Brain Injury -Marina Khusid, Chris Crowe, and Michael Freed—for their support of our work.
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