Automatic Processes Critical Role in Addictive Behavior
Given that automatic processes are
thought to play a critical role in addictive behavior (Tiffany, 1990), mindfulness could be a
useful strategy for reducing dependence. Mindfulness training might also help to attenuate
craving (Davis, Manley, et al., 2014; Ruscio, Muench, Brede, & Waters, 2015) and lessen
the negative emotional experience of withdrawal. Although the differential effects of
mindfulness vs. CBT are unclear, CBT might also reduce tobacco dependence (Raja et al.,
In terms of quitting smoking, a sense of “agency” can include self-efficacy for refraining
from smoking in high-risk situations as well as expectations about one’s ability to regulate
emotions without smoking (Vidrine et al., 2009). Smokers with greater agency are more
likely to successfully quit (Businelle et al., 2010). By increasing awareness of present-
moment experience, mindfulness interventions may help smokers to broaden their perceived
array of possible coping strategies and resources, which could increase agency. Indeed,
Vidrine et al. (2009) found that smokers with greater dispositional mindfulness indicated
greater self-efficacy for abstaining from smoking and stronger expectations that they could
regulate their emotions without smoking. Self-efficacy may also be a key mechanism
through which CBT influences smoking cessation (Hendricks, Delucchi, & Hall, 2010).
Among smokers, abstinence increases attentional bias toward smoking-related cues
(Leventhal et al., 2010), and attentional bias is associated with higher risk for early lapses to
smoking (Waters et al., 2003). Greater ability to focus and redirect attention is hypothesized
to be a key mechanism of mindfulness interventions (and has even been termed “attentional
control training” in some early work; Teasdale, Segal, & Williams, 1995). Mindfulness
meditation involves continual redirecting of attention to present-moment experience. In daily
life, mindfulness practice can involve noticing when one’s attention is captured by
problematic stimuli (e.g., smoking triggers) and disengaging from these cues. Through this
practice over time, smokers might experience greater purposeful control over their attention
and find that their attention is less automatically captured by smoking-related cues.
Although no known research has examined the effect of mindfulness training on attentional
bias specifically toward cigarettes, Davis, Goldberg, et al. (2014) found that a mindfulness-
based smoking cessation intervention led to greater self-reported attentional control.
Data were collected as part of a randomized controlled trial (Vidrine et al., 2016) comparing
the efficacy of MBAT to CBT and UC for smoking cessation. In this parent trial, 7-day
abstinence rates at 4 weeks post-quit were 34.4% in MBAT, 32.3% in CBT, and 24.3% in
- At 26 weeks post-quit, rates were 13.0% in MBAT, 15.5% in CBT, and 11.7% in UC.
There were no significant differences between treatment groups on overall abstinence rates
over time. However, among participants who were smoking at the end of treatment, those in
MBAT were more likely to recover abstinence by the following week (26.8%) and 26 weeks
Spears et al. Page 4
J Consult Clin Psychol. Author manuscript; available in PMC 2018 November 01.