Craving to Quit: A Randomized Controlled Trial of Smartphone App-Based Mindfulness Training for Smoking Cessation

INTRODUCTION

Mindfulness training may reduce smoking rates and lessen the association between craving and smoking. This trial tested the efficacy of mindfulness training via smartphone app to reduce smoking. Experience sampling (ES) was used to measure real-time craving, smoking, and mindfulness.

METHODS

A researcher-blind, parallel randomized controlled trial compared the efficacy of mobile mindfulness training with experience sampling (MMT-ES; Craving to Quit) versus experience sampling only (ES) to (1) increase 1-week point-prevalence abstinence rates at 6 months, and (2) lessen the association between craving and smoking. A modified intent-to-treat approach was used for treatment starters (MMT-ES n = 143; ES n = 182; 72% female, 81% white, age 41 ± 12 year).

RESULTS

No group difference was found in smoking abstinence at 6 months (overall, 11.1%; MMT-ES, 9.8%; ES, 12.1%; χ2(1) = 0.43, p = .51). From baseline to 6 months, both groups showed a reduction in cigarettes per day (p < .0001), craving strength (p < .0001) and frequency (p < .0001), and an increase in mindfulness (p < .05). Using ES data, a craving by group interaction was observed (F(1,3785) = 3.71, p = .05) driven by a stronger positive association between craving and cigarettes per day for ES (t = 4.96, p < .0001) versus MMT-ES (t = 2.03, p = .04). Within MMT-ES, the relationship between craving and cigarettes per day decreased as treatment completion increased (F(1,104) = 4.44, p = .04).

CONCLUSIONS

Although mindfulness training via smartphone app did not lead to reduced smoking rates compared with control, our findings provide preliminary evidence that mindfulness training via smartphone app may help lessen the association between craving and smoking, an effect that may be meaningful to support quitting in the longer term.

IMPLICATIONS

This is the first reported full-scale randomized controlled trial of any smartphone app for smoking cessation. Findings provide preliminary evidence that smartphone app-based MMT-ES may lessen the association between craving and smoking.

TRIAL REGISTRATION

Clinicaltrials.gov NCT02134509.

Improving community well-being through collaborative initiatives at a medical library

Background

In an increasingly digital age, the role of the library is changing to better serve its community. The authors' library serves health care professionals who experience high levels of stress due to everyday demands of work or study, which can have negative impacts on physical and mental health. Our library is committed to serving the needs of our community by identifying opportunities to improve their well-being.

Case Presentation

Librarians at the Harvey Cushing/John Hay Whitney Medical Library at Yale University developed a group mindfulness program and a space for self-defined personal care to assist health care professionals in alleviating stress. Surveys were used to evaluate the mindfulness program and self-care space.

Conclusions

We successfully implemented two collaborative wellness and self-care initiatives with students and other stakeholders, as demonstrated by program attendance, diverse space use, and positive survey responses for both initiatives. While these endeavors do not replace the need to challenge structural problems at the root of stress in the health care professions, this case report offers a blueprint for other medical libraries to support the well-being of their communities.

Communication of emotion via drumming: dual-brain imaging with functional near-infrared spectroscopy

Nonverbal communication of emotion is essential to human interaction and relevant to many clinical applications, yet it is an understudied topic in social neuroscience. Drumming is an ancient nonverbal communication modality for expression of emotion that has not been previously investigated in this context. We investigate the neural response to live, natural communication of emotion via drumming using a novel dual-brain neuroimaging paradigm. Hemodynamic signals were acquired using whole-head functional near-infrared spectroscopy (fNIRS). Dyads of 36 subjects participated in two conditions, drumming and talking, alternating between 'sending' (drumming or talking to partner) and 'receiving' (listening to partner) in response to emotionally salient images from the International Affective Picture System. Increased frequency and amplitude of drum strikes was behaviorally correlated with higher arousal and lower valence measures and neurally correlated with temporoparietal junction (TPJ) activation in the listener. Contrast comparisons of drumming greater than talking also revealed neural activity in right TPJ. Together, findings suggest that emotional content communicated by drumming engages right TPJ mechanisms in an emotionally and behaviorally sensitive fashion. Drumming may provide novel, effective clinical approaches for treating social-emotional psychopathology.

Women Benefit More Than Men in Response to College-based Meditation Training

Objectives: While recent literature has shown that mindfulness training has positive effects on treating anxiety and depression, there has been virtually no research investigating whether effects differ across genders-despite the fact that men and women differ in clinically significant ways. The current study investigated whether college-based meditation training had different effects on negative affect for men and women. Methods: Seventy-seven university students (36 women, age = 20.7 ± 3.0 years) participated in 12-week courses with meditation training components. They completed self-report questionnaires of affect, mindfulness, and self-compassion before and after the course. Results: Compared to men, women showed greater decreases in negative affect and greater increases on scales measuring mindfulness and self-compassion. Women's improvements in negative affect were correlated to improvements in measures of both mindfulness skills and self-compassion. In contrast, men showed non-significant increases in negative affect, and changes in affect were only correlated with ability to describe emotions, not any measures of experiential or self-acceptance. Conclusion: These findings suggest that women may have more favorable responses than men to school-based mindfulness training, and that the effectiveness of mindfulness-based interventions may be maximized by gender-specific modifications.

A randomized controlled trial of smartphone-based mindfulness training for smoking cessation: a study protocol

BACKGROUND

Tobacco use is responsible for the death of about 1 in 10 individuals worldwide. Mindfulness training has shown preliminary efficacy as a behavioral treatment for smoking cessation. Recent advances in mobile health suggest advantages to smartphone-based smoking cessation treatment including smartphone-based mindfulness training. This study evaluates the efficacy of a smartphone app-based mindfulness training program for improving smoking cessation rates at 6-months follow-up.

METHODS/DESIGN

A two-group parallel-randomized clinical trial with allocation concealment will be conducted. Group assignment will be concealed from study researchers through to follow-up. The study will be conducted by smartphone and online. Daily smokers who are interested in quitting smoking and own a smartphone (n = 140) will be recruited through study advertisements posted online. After completion of a baseline survey, participants will be allocated randomly to the control or intervention group. Participants in both groups will receive a 22-day smartphone-based treatment program for smoking. Participants in the intervention group will receive mobile mindfulness training plus experience sampling. Participants in the control group will receive experience sampling-only. The primary outcome measure will be one-week point prevalence abstinence from smoking (at 6-months follow-up) assessed using carbon monoxide breath monitoring, which will be validated through smartphone-based video chat.

DISCUSSION

This is the first intervention study to evaluate smartphone-based delivery of mindfulness training for smoking cessation. Such an intervention may provide treatment in-hand, in real-world contexts, to help individuals quit smoking.

TRIAL REGISTRATION

Clinicaltrials.gov NCT02134509 . Registered 7 May 2014.

Aging enhances classical activation but mitigates alternative activation in the central nervous system

The roles of microglia and macrophages during neuroinflammation and neurodegenerative diseases remain controversial. To date, at least 2 activations states have been suggested, consisting of a classical response (M1) and the alternative response (M2). Identifying selective biomarkers of microglia that representative their functional activation states may help elucidate disease course and enable a better understanding of repair mechanisms. Two cocktails containing either tumor necrosis factor (TNF)-α, interleukin (IL)-12, and IL-1β (referred to as CKT-1) or IL-13 and IL-4 (referred to CKT-2) were injections into the hippocampus of mice aged 6, 12, or 24 months. Microarray analysis was performed on hippocampal tissue 3 days postinjection. Gene transcripts were compared between CKT-1 versus CKT-2 stimulator cocktails. Several selective transcripts expressed for the CKT-1 included CXCL13, haptoglobin, MARCO, and calgranulin B, whereas a smaller subset of genes was selectively induced by the CKT-2 and consisted of FIZZ1, IGF-1, and EAR 11. Importantly, selective transcripts were induced at all ages by CKT-1, whereas selective gene transcripts induced by CKT-2 decreased with age suggesting an age-related reduction in the IL-4/ IL-13 signaling pathway.