Table 6.
Study | Design & Indication |
Subjects | Intervention | Outcome measures | Results | MQS |
---|---|---|---|---|---|---|
Study 1. Gifford et al., 2008, submitted (59) |
2-arm RCT: smoking cessation, community settings |
303 (10 F), mean age 46.0 (18–75 yrs); PSR 2; tobacco dependent, community- recruited adults; on average, 24 cigarettes/day, 2.2 prior quit attempts in the past 2 yrs, with a median abstinence of 21 days. |
• MM intervention, 10 wks: ACT + Functional Analytic Psychotherapy (therapist-led, weekly 120 min group and 50 min individual sessions) + bupropion. • Control group: bupropion only (medical management, one 60 min educational meeting, handouts) |
• Collected at 0, 10, 26, 52 wks; • smoking (7-day point prevalence; self-report, exhaled CO); • withdrawal severity, psychological health; • Working Alliance, Tx satisfaction. |
• Retention: 45.2%; PP: • quit rate was higher at the MM than control group (31.6% vs. 17.5%, p<0.05, ES 0.3 [ARR 14.1, NNT 7]). • during 52 wks, MM was more effective in reducing smoking than control Tx (OR 2.2, p<0.05). • acceptance- based responding and the therapeutic relationship mediated effects of MinM on Tx outcomes; • MM group reported higher Tx satisfaction than controls at all time points (p<0.05, ES 0.7 at 52 wks). |
MQS: 10/17 CBS: N/A per ITT (+2 PP) Manualized MM intervention. |
Study 2. Brown et al., 2008*, submitted (58) |
Case series: smoking cessation, community settings |
16 (12 F), mean age 41.9 (18–65 yrs); PSR 2; tobacco dependent, community- recruited adults; on average, 20.4 cigarettes/day, smoked for 26.3 yrs, unable to abstain for longer than 3 days in the past 10 yrs. |
• MM intervention, 10 wks, therapist-led: ACT + Cognitive Behavioral Therapy (wks 4–10) + NRT (wks 6–14). |
•Collected at 0, 10, 14, 19, 32 wks (quit date: week 6); • smoking (self-reported, exhaled CO); • withdrawal and depressive symptom severity. |
• Retention: 75%; • quit rates at 10, 14, 19, 32 wks: 31%, 25%, 19%, and 0%. • during the study, the longest continuous abstinence was median 24 days (mean 41.6), number of days abstinent was median 40.5 (mean 58.8, out of 180 study days), time to relapse (7 consecutive smoking days) was median 45.5 days (mean 49.9), and number of quit-smoking attempts was median 2.5 times (mean 4.1). • 82% reported that the learned skills were “very” or “extremely useful” in helping quit smoking. |
MQS: 5/17 CBS: N/A* *No statistical assessment of the significance of pre-post change was provided; only descriptive statistics were used. Follow-up psychological outcomes were not reported. Manualized intervention. |
Study 3. Bowen 2008, PhD dissertation (60) |
2-arm RCT, laboratory study: smoking, and related craving and negative affect; community settings |
123 (34 F), mean age 20.3 (18–46 yrs); PSR 2; undergraduate psychology students; on average, low dependence scores, smoked 5.3 cigarettes/day in the past week, had 8.4 quit attempts of minimum 24 hrs in the past year. |
Subjects did not smoke for 12 hrs prior, then underwent 4 brief cue (cigarette) exposures in a 90-min long laboratory session, during which they were asked to cope with arising thoughts, sensations and emotions using: • MM intervention (n=61): guided, audio- recorded, mindfulness- based coping strategies; • Controls (n=62): their "usual" coping strategies. |
• Collected post-exposure (4 in-person assessments), at 1 and 7 days; • smoking (self-reported); • smoking urges, affect; • brief written description of used coping strategies. |
• Retention: 90.2%; PP: • during the follow-up week, MM group smoked fewer cigarettes/day than controls (p<0.05, ES 0.6) – compared to baseline, MM decreased smoking by 26%, while controls increased it by 11%; • no significant differences between groups were found in latency to the first cigarette, negative affect and smoking urges; • during cue exposures, to cope with cravings and urges, MM group used MM strategies, while controls used primarily distraction-based techniques. |
MQS: 9/17 CBS: N/A per ITT (+2 PP) Manualized intervention. |
After completion of this manuscript, a report from this study has been published.(61)
Values (presented in [square brackets]) calculated for the systematic review: ARR: Absolute Risk Reduction; CBS: Clinical Benefit Score; CES: Cumulative Evidence Score; ES: Effect Size (Cohen's d); MQS: Methodological Quality Score; NNT: Number Needed to Treat; PSS: Population Severity Score.
ACT: Acceptance Commitment Therapy; CO: carbon monoxide; MM: mindfulness meditation; ITT: intention to treat analysis; min: minutes; mos: months; NRT: Nicotine Replacement Therapy; PP: per protocol analysis; Tx: treatment; UTox: urine toxicology test; wks: weeks; yrs: years.