کارآزمایی تصادفی در مقایسه آموزش ذهن آگاهی برای سیگاری ها برای گروه کنترل

Smoking continues to take an enormous toll on society, and although most smokers would like to quit, most are unsuccessful using existing therapies. These findings call on researchers to develop and test therapies that provide higher rates of long-term smoking abstinence. We report results of a randomized controlled trial comparing a novel smoking cessation treatment using mindfulness training to a matched control based on the American Lung Association's Freedom From Smoking program. Data were collected on 175 low socioeconomic status smokers in 2011–2012 in a medium sized midwestern city. A significant difference was not found in the primary outcome; intent-to-treat biochemically confirmed 6-month smoking abstinence rates were mindfulness = 25.0%, control = 17.9% (p = 0.35). Differences favoring the mindfulness condition were found on measures of urges and changes in mindfulness, perceived stress, and experiential avoidance. While no significant differences were found in quit rates, the mindfulness intervention resulted in positive outcomes.

Mindfulness is a cognitive skill of paying attention to internal phenomena (e.g., thoughts, emotions) or external phenomena (e.g., walking, talking) in a way that is intentional rather than automatic, non-reactive rather than reactive, and accepting rather than critical (Kabat-Zinn, 1990, Kabat-Zinn, 1994 and Segal et al., 2002). Studies have shown that mindfulness training is associated with decreased smoking urges (Westbrook et al., 2011), decreased stress (Grossman, Niemann, Schmidt, & Walach, 2004), increased distress tolerance (Grossman et al., 2004 and Shapiro et al., 2008), decreased anxiety (Creswell et al., 2007, Hofmann et al., 2010 and Koszycki et al., 2007), decreased depression (Teasdale, Segal, & Williams, 1995), and improved emotion regulation (Deckersbach et al., 2012, Farb et al., 2012, Hill and Updegraff, 2012, Hofmann et al., 2010, Kemeny et al., 2012 and Mars and Abbey, 2010). Mindfulness training as therapy for smokers has shown some promise. A pilot study of MBSR (with modifications for smokers) yielded smoking abstinence at 6 weeks post-cessation of 56% (Davis, Fleming, Bonus, & Baker, 2007). A follow up study showed that mindfulness training, compared to telephonic quit line, yielded significantly higher biochemically confirmed abstinence rates at 4-weeks and 24-weeks post-quit in treatment initiators (Davis et al., 2014). A study showed “urge surfing” (a mindfulness technique) led to fewer cigarettes smoked per day (Bowen & Marlatt, 2009), and another study found that ACT (including mindfulness training) led to increased rates of smoking abstinence 1-year post-quit (Gifford et al., 2011). While the initial reports have been promising, more stringently controlled study designs are needed to better isolate the effect of mindfulness in smokers (Baardseth et al., 2013, Chiesa and Serretti, 2009, Maccoon et al., 2012, Wampold, 2001 and Wampold et al., 1997). A recent study by Brewer et al. (2011) compared mindfulness training for smoking cessation to the American Lung Association's Freedom from Smoking (FFS; American Lung Association, 2013). FFS is one of the most widely used intensive (2 months) smoking cessation intervention available in the US (Thieleke, McMahon, Meyer, & Yun, 2005). It provides cognitive behavioral modification, skills training and group support, and has demonstrated 1-year post-quit biochemically confirmed abstinence rates of 16% (Thieleke et al., 2005). The Brewer, Mallik, et al. (2011) trial showed that mindfulness training compared to FFS produced non-significantly higher abstinence post-treatment and significantly higher abstinence rates 13-weeks post-quit. The study provided the FFS intervention in a way that was faithful to its clinical implementation, but made few alterations in FFS to time/intensity match the mindfulness intervention. In this paper we describe an intervention providing mindfulness training for smokers (MTS) compared to FFS. Ours study differs from Brewer, Mallik, et al. (2011) in that substantial “enhancements” were made to FFS (referred to here as FFS-E) in order to more closely match the two interventions, and better isolate and test the effect of mindfulness training. Additionally, recruitment in the present study was carried out with a low socioeconomic status (SES) population. We were unable to find published studies on mindfulness training for low SES smokers or the effect of SES on outcomes in mindfulness training. Low SES smokers were targeted because smoking occurs disproportionately among low-SES individuals (David et al., 2010, Hiscock et al., 2012 and Kunst et al., 2004), and it seemed important to understand whether training in mindfulness – a conceptually abstract cognitive skill - would be well received within a low SES population. It was our supposition that mindfulness training could be provided using concrete language and accessible examples such that it would be well-received and effective in this population. Furthermore, it was felt that if mindfulness training could be provided in a way that was effective in this challenging population, we would have a promising model for use in the wider population of smokers. The purpose of this study was to compare MTS to FFS-E on measures of class attendance, attrition, practice compliance, smoking abstinence, urge intensity, mindfulness acquisition, and psychological outcomes.