Mindfulness, Acceptance and Defusion Strategies in Smokers: a Systematic Review of Laboratory Studies

Abstract

The psychological flexibility model (PFM) provides a framework for understanding and treating behavioural dysregulation in addictions. Rather than modulating the intensity of subjective experience, interventions based on, or consistent with, the PFM (PFM interventions) seek to alter the individual’s relationship to internal states, such as craving, negative affect and drug-related thoughts, using mindfulness, acceptance and related strategies. Experimental (non-clinical) studies in smokers have examined the effects of specific isolated strategies informed by or consistent with the PFM (PFM strategies). Here, we systematically review these studies and determine the extent to which they conform to methodological standards indicative of high levels of internal validity. Eligible studies were identified through electronic database searches and assessed for the presence of specific methodological features. Provisional aggregate effect sizes were determined depending on availability of data. Of 1499 screened publications, 12 met the criteria. All examined aspects of private subjective experience relevant to abstinence (craving n = 12; negative affect n = 10), demonstrating effects favouring PFM strategies relative to inactive control conditions. However, only six assessed outcome domains consistent with the PFM and provided no consistent evidence favouring PFM strategies. Overall, most studies had methodological limitations. As such, high-quality experimental studies continue to be needed to improve our understanding of necessary and/or sufficient constituents of PFM-guided smoking cessation interventions. Recommendations for future research are discussed.

Cognitive defusion versus experiential avoidance in the reduction of smoking behaviour: an experimental and preliminary investigation

“…Various comparisons of ACT components and EA procedures in the management of smoking behaviour can now be found in the literature [see Serfaty, Gale, Beadman, Froeliger and Kamboj (2017) for a recent systematic review of mindfulness, acceptance and defusion laboratory-based smoking studies]. However, one investigation in particular, in combination with the aforementioned Erskine et al…”

Ultra-Brief Mindfulness Training Reduces Alcohol Consumption in At-Risk Drinkers: A Randomized Double-Blind Active-Controlled Experiment

“…In contrast, other lab-based mindfulness studies (particularly in smokers) have demonstrated a larger downregulation of craving following brief mindfulness instructions. However, these effects have generally been observed when mindfulness was compared with an inactive control condition (see review by Serfaty et al, 2017 ).…”

“…Other clinical trials suggest that, despite not directly aiming to reduce craving, reductions in craving are nonetheless observed following mindfulness-based treatments (e.g., Bowen et al, 2009 ; Davis et al, 2014 ; Garland et al, 2016 ; see Li et al, 2017 for other examples). Laboratory experiments have also shown acute reductions in craving following mindfulness in smokers, although this effect is most robust when mindfulness strategies are compared with inactive control strategies (see Serfaty et al, 2017 ). Alternatively, some laboratory studies have shown that, relative to active control strategies (e.g., distraction or reappraisal), brief mindfulness-like strategies result in increased ( Szasz et al, 2012 ), or limited reductions in, cue-induced craving ( Murphy and McKillop, 2014 ).…”

“…However, while these and other laboratory experimental studies are informative, they have some limitations. These include lack of experimenter blinding, limited matching of conditions or nonoptimal controls, limited use of theoretically appropriate outcomes, and use of research participants whose alcohol/drug-use patterns are unlikely to be habitual (see Serfaty et al, 2017 ). As such, it remains to be established whether brief mindfulness instructions can have effects that endure beyond a laboratory training session and affect consumption behavior in drug-/alcohol-using populations, including at-risk drinkers.…”

Kabul ve kararlılık temelli danışmanlığın sigara bırakma ve yaşam kalitesi üzerindeki etkisi

“…The psychopathology model of acceptance and commitment-based interventions emphasizes the need to reduce the preponderance of the conceptual past and future, dysfunctional behaviors, attachment to the theoretical self, cognitive fusion and experiential avoidance and increase the bond with values 13 . Although in the literature many studies have been conducted on smoking cessation with acceptance and commitment-based approaches 15,16 , there is no study on this issue in Turkey. In this respect, its application to different cultures is believed to provide evidence for the field.…”