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Original Article

Finding the Right Match: Mindfulness Training May Potentiate the Therapeutic Effect of Nonjudgment of Inner Experience on Smoking Cessation

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Pages 586-594 | Published online: 11 Mar 2014
 

Abstract

Mindfulness training (MT) is an emerging therapeutic modality for addictive disorders. Nonjudgment of inner experience, a component of mindfulness, may influence addiction treatment response. To test whether this component influences smoking cessation, tobacco smokers (n = 85) in a randomized control trial of MT vs. Freedom from Smoking (FFS), a standard cognitive-behaviorally-oriented treatment, were divided into split-half subgroups based on baseline Five Facet Mindfulness Questionnaire nonjudgment subscale. Smokers who rarely judge inner experience (nonjudgment > 30.5) smoked less during follow-up when randomized to MT (3.9 cigs/d) vs. FFS (11.1 cigs/d), p < .01. Measuring trait nonjudgment may help personalize treatment assignments, improving outcomes.

THE AUTHORS

Zev Schuman-Olivier, MD, is the medical director at WestBridge Community Services and conducts clinical research as a fellow at the Massachusetts General Hospital Center for Addiction Medicine. Before graduating with AOA honors from Tufts Medical School, he helped coordinate the first NIDA-funded, randomized controlled trial of a mindfulness-oriented treatment for substance dependence, Spiritual Self Schema therapy, designing and implementing the treatment for HIV-positive participants. He completed adult psychiatry residency at Harvard Medical School/Cambridge Health Alliance, and he was awarded the Young Investigator Award at the American Academy of Addiction Psychiatry for his research on buprenorphine for opioid dependence. He completed an addiction psychiatry fellowship and was a Dupont-Warren research fellow at Harvard Medical School Department of Psychiatry. WestBridge is a national nonprofit community treatment program, which uses an assertive community treatment approach and provides family-centered treatment for people with dual diagnosis. In his role at WestBridge, he directs the ONCOURSE college student support program. He now conducts research in several populations with addictive disorders, including buprenorphine treatment for opioid dependence, nicotine dependence, co-occurring mental illness and substance dependence, and emerging adults with substance misuse. He serves as a faculty member on the Institute for Meditation and Psychotherapy. He has received research funding from the National Institute for Drug Abuse and the Mind & Life Institute. He has been appointed as a clinical instructor in psychiatry at Harvard Medical School and as an adjunct assistant professor of psychiatry at the Geisel School of Medicine at Dartmouth.

Dr. Bettina B. Hoeppner is a health psychologist with expertise in fine-grained longitudinal methodology applied to explicate the mechanisms underlying behavioral change. During graduate training (University of RI, MA in psychology in 2003, M.S. in statistics in 2005, Ph.D. in psychology in 2007), she collaborated on numerous health behavior change projects, which used computer-delivered expert systems based on the Transtheoretical Model to provide participants with tailored intervention materials. Thereafter, she completed a postdoctoral fellowship at the Center of Alcohol and Addiction Studies at Brown University (2007–2010) that focused on addictive behaviors, particularly alcohol and tobacco use in adolescents and young adults. In May 2010, she joined the Center for Addiction Medicine (CAM) at the Massachusetts General Hospital, Harvard Medical School, where she is conducting K01 research, and serving as Director of Biostatistics at the CAM. This K01 research project uses Ecological Momentary Assessment (EMA) to delineate the temporal ordering of changes in smoking outcome expectancies relative to smoking cessation by collecting fine-grained, real-time data on college student smokers undergoing smoking cessation treatment. As such, her 5-year K01 training and research plan builds upon her existing strengths of advanced statistical training and experience with theory-driven health behavior interventions to enable her to take full advantage of modern technology to delineate the causal mechanisms underlying the process of smoking cessation.

Dr. A. Eden Evins is Director of the Center for Addiction Medicine and an Attending Psychiatrist in the Schizophrenia and Depression Clinical and Research Programs at the Massachusetts General Hospital. She is Associate Professor of Psychiatry at Harvard Medical School. Dr. Evins earned her undergraduate degree at the University of Virginia in Charlottesville, VA, and her medical degree at the Medical University of South Carolina in Charleston. She completed her residency in adult psychiatry at the Massachusetts Mental Health Center and Longwood Psychiatry Residency Training Program in Boston, where she was also Chief Resident. She conducted a fellowship in molecular biology at the Mailman Research Center of McLean Hospital and a second fellowship in schizophrenia research at the Massachusetts General Hospital with Dr. Donald Goff. She earned a Masters in Public Health in Clinical Effectiveness at the Harvard School of Public Health in 2005. Her research interests include pharmacotherapy for dual disorders of major mental illness and addiction, biological basis for responsiveness to reward and for craving, negative symptoms in schizophrenia, and treatment for cognitive dysfunction in schizophrenia. She is an expert in treatment of nicotine dependence in patients with schizophrenia and depression. She has authored book chapters, reviews, and articles that have been published in scientific journals, such as American Journal of Psychiatry, Biological Psychiatry, Neuropsychopharmacology, Journal of Clinical Psychiatry, Journal of Clinical Psychopharmacology, and Psychopharmacology. Dr. Evins has been the recipient of a career development award from the National Institutes of Drug Abuse (NIDA), the Massachusetts Department of Public Health Tobacco Control Program Young Investigator Award, the NIMH New Clinical Drug Evaluation Unit Young Investigator Award, and has twice been the recipient of the National Alliance for Research on Schizophrenia and Depression (NARSAD) Young Investigator Award. Dr. Evins is currently PI on two R01 grants, a R21 grant and is Project Director and co-PI on a U01 grant from NIDA to study novel treatments for smoking cessation and prevention of relapse to smoking and to develop translational surrogate markers for response. She is currently a mentor on three NARSAD Young Investigator Awards.

Dr. Judson A. Brewer is Assistant Professor of Psychiatry at the Yale School of Medicine and Medical Director of the Yale Therapeutic Neuroscience Clinic, is a board-certified psychiatrist who has been investigating the neural underpinnings of mindfulness training and its clinical efficacy for disorders such as addictions. Dr. Brewer received his AB from Princeton University and MD/PhD from Washington University in St. Louis, where his thesis work focused on molecular mechanisms of stress hormone regulation of the immune system. After training in mindfulness meditation during medical and graduate school, he shifted his focus from animal models of stress, to the elucidation of neurobiological mechanisms underlying the interface between stress, mindfulness, and the addictive process. He performed the first randomized controlled trials of mindfulness training for alcohol and cocaine dependence followed by a trial showing that mindfulness training was twice as effective as “gold standard” treatment for smoking cessation. In addition, his laboratory is interested in improving methods to track mindfulness practice and acquisition. His lab is working to delineate key brain activation patterns during meditation, and to link these to physiological and behavioral measures using methods such as real-time fMRI neurofeedback and experience sampling. Ultimately, his lab hopes this knowledge will increase accuracy in tracking neurophysiological correlates of mindfulness, leading to improvements in therapeutic delivery, both with directly measureable effects on health outcomes.

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