Mindful attention reduces neural and self-reported cue-induced craving in smokers

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Social Cognitive and Affective Neuroscience (Impact Factor: 7.37). 11/2011; 8(1). DOI: 10.1093/scan/nsr076
Source: PubMed


An emerging body of research suggests that mindfulness-based interventions may be beneficial for smoking cessation and the treatment of other addictive disorders. One way that mindfulness may facilitate smoking cessation is through the reduction of craving to smoking cues. The present work considers whether mindful attention can reduce self-reported and neural markers of cue-induced craving in treatment seeking smokers. Forty-seven (n = 47) meditation-naïve treatment-seeking smokers (12-h abstinent from smoking) viewed and made ratings of smoking and neutral images while undergoing functional magnetic resonance imaging (fMRI). Participants were trained and instructed to view these images passively or with mindful attention. Results indicated that mindful attention reduced self-reported craving to smoking images, and reduced neural activity in a craving-related region of subgenual anterior cingulate cortex (sgACC). Moreover, a psychophysiological interaction analysis revealed that mindful attention reduced functional connectivity between sgACC and other craving-related regions compared to passively viewing smoking images, suggesting that mindfulness may decouple craving neurocircuitry when viewing smoking cues. These results provide an initial indication that mindful attention may describe a 'bottom-up' attention to one's present moment experience in ways that can help reduce subjective and neural reactivity to smoking cues in smokers.

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Available from: Golnaz Tabibnia
    • "This reduction in sgACC activation levels likely reflects the reported reduction in craving, as sgACC has been generally implicated in increased craving in smokers (Engelmann et al., 2012;Kober et al., 2010). There was no evidence for an involvement of prefrontal control regions during mindful attention (Westbrook et al., 2013), suggesting that mindfulness may act through a different mechanism than other cognitive interventions. Importantly, brain imaging also demonstrated that mindful attention to drug cues led to a reduced correlation between activation levels in the sgACC and striatum, a core region implicated in reward processing. "
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    ABSTRACT: Neuroimaging provides a tool for investigating the neurobiological mechanisms of cognitive interventions in addiction. The aim of this review was to describe the brain circuits that are recruited during cognitive interventions, examining differences between various treatment modalities while highlighting core mechanisms, in drug addicted individuals. Based on a systematic Medline search we reviewed neuroimaging studies on cognitive behavioral therapy, cognitive inhibition of craving, motivational interventions, emotion regulation, mindfulness, and neurofeedback training in addiction. Across intervention modalities, common results included the normalization of aberrant activity in the brain's reward circuitry, and the recruitment and strengthening of the brain's inhibitory control network. Results suggest that different cognitive interventions act, at least partly, through recruitment of a common inhibitory control network as a core mechanism. This implies potential transfer effects between training modalities. Overall, results confirm that chronically hypoactive prefrontal regions implicated in cognitive control in addiction can be normalized through cognitive means.
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    • "First, smokers who show attentional bias towards smoking related cues could show more active participation during exposure sessions (Baker, Piper, McCarthy, Majeskie, & Fiore, 2004) and also have fewer problems with reducing and coping with cigarette craving (Brewer et al., 2011;Westbrook et al., 2013). Second, there is evidence that active attention decreased activity and functional connectivity between cravingrelated regions and these reductions in brain regions also showed reductions in the subjective experience of craving (Brewer et al., 2011;Gray & Critchley, 2007;Westbrook et al., 2013). Third, it is possible that prolonged exposure to smoking-related cues without being allowed to smoke produces some degree of reversal of processing bias towards smoking cues and hence reduction in craving (Munafò et al., 2003). "
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    ABSTRACT: Although extensive research has demonstrated that cigarette craving can be effectively attenuated, very few studies have explored associations between individual variables and craving reduction. This study explored whether individual characteristics predict craving decreases during virtual reality cue exposure treatment (VR-CET). Participants were 41 treatment-seeking smokers (73% women) with a mean age of 39.4 (SD=13.2), who had been smoking 15.0 (SD=7.1) cigarettes per day for 20.0 (SD=10.7) years. Their mean score on the Fagerström Test of Nicotine Dependence (FTND) was 4.8 (SD=2.3). Participants completed five cue exposure sessions using virtual reality for smoking cessation over a five-week period. The percentage of reduction in craving was calculated by comparing self-reported craving after the first and last exposure sessions. Sociodemographic characteristics (gender, age, years of education and marital status), tobacco-related [duration of daily smoking, cigarettes per day, FTND and Nicotine Dependence Syndrome Scale (NDSS)] and psychological characteristics [depressive symptoms (Beck's Depression Inventory-Second Edition, BDI-II), impulsiveness (delay discounting) and anxiety (State-Trait Anxiety Inventory, STAI)] were examined as possible predictors for craving reductions. Multiple regression revealed that greater decreases in craving were associated with younger age (β=-.30, p=.043), cigarettes smoked per day (β=.30, p=.042), higher values on delay discounting (β=.34, p=.020) and higher BDI-II scores (β=.30, p=.035). These findings suggest that smokers with certain individual characteristics may benefit most from interventions aimed at reducing craving through VR-CET. Copyright © 2015 Elsevier Ltd. All rights reserved.
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    • "Furthermore, high-arousal situations impair adolescent decision-making abilities much more than those in adults (Steinberg, 2005). These contingencies suggest that practices like mindfulness, which enhance executive functioning (Oberle, Schonert-Reichl, Lawlor, & Thomson, 2012; Westbrook et al., 2013), could support prefrontal brain structure development in adolescents. Arguably, such training could also enable adolescents to manage excessive levels of negative emotions like anxiety, which interfere with working memory and attention (Shackman et al., 2006; Shackman, Maxwell, McMenamin, Greischar, & Davidson, 2011) and impact on well-being and academic performance (Kaplan, Liu, & Kaplan, 2005). "
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