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 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) vs. experience sampling-only (ES) to (1) increase one-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±12yr.).

Results: No group difference was found in smoking abstinence at 6 months (overall, 11.1%; MMT-ES, 9.8%; ES, 12.1%; χ2(1)=.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 experience sampling data, a craving by group interaction (F(1,3785)=3.71, p=.05) was observed, 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.

Trial registration: Clinicaltrials.gov NCT02134509. Registered 7 May 2014.

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 mindfulness training with experience sampling may lessen the association between craving and smoking, an effect that did not lead to reduced smoking abstinence rates compared with control but may be meaningful to support quitting and prevent relapse in the longer-term.