Randomized Trial of Mindfulness- and Reappraisal-Based Regulation of Craving Training Among Daily Cigarette Smokers

Objective: Craving predicts smoking, yet existing interventions may not adequately target regulation of craving. We evaluated two versions of regulation of craving-training (ROC-T), a computerized intervention with intensive practice of strategies when exposed to smoking-related images. Method: Ninety-two nicotine-dependent daily smokers were randomized to mindfulness-based therapy (MBT) ROC-T focusing on mindful acceptance, and cognitive behavioral therapy (CBT) ROC-T focusing on reappraisal or no intervention control. The ROC task was administered pre- and postintervention to assess changes in cue-induced craving and mindfulness- and reappraisal-based regulation of craving. Results: MBT and CBT-versus control-showed significantly greater reductions in smoking during the intervention phase (baseline to Week 4), corresponding to large (d = −1.08, 95% CI [−1.64, −0.52]) and medium-to-large effect sizes (d = −0.69, 95% CI [−1.22, −0.15]), respectively. During follow-up (Week 4-16), CBT showed significant increases in smoking, whereas MBT and control did not. For the entire study (baseline to Week 16), MBT showed significantly greater reductions in smoking compared to control (d = −1.6, 95% CI [−2.56, −0.66]) but CBT was not significantly different than control (d = −0.82, 95% CI [−1.77, 0.13]). There were no effects on smoking when directly comparing MBT and CBT. Quit rates were low across the sample, with no difference among conditions. MBT and CBT-versus control-significantly reduced cue-induced craving. CBT (but not MBT)-versus control-significantly improved reappraisal-based regulation of craving. Both MBT and CBT-versus control-significantly improved mindfulness-based regulation of craving. Conclusions: MBT- and CBT-ROC-T may reduce cue-induced craving and smoking, and MBT may be more durable than CBT. Public Health Significance Statement Innovative behavioral interventions for cigarette smoking are needed to reduce relapse rates. We evaluated brief, computerized, mechanism-focused interventions targeting craving, a core mechanism underlying smoking. Findings are promising and suggest that such interventions may play an important role in improving smoking reduction treatment outcomes.