Emerging research suggests a smartphone app that helps people stop smoking reduces activity in a brain region typically stimulated when a person experiences a craving to smoke. The app uses a mindfulness-based approach and was effective at reducing study participants’ self-reported daily cigarette consumption.
Researchers found that those who reduced their cigarette consumption the most also showed decreased brain reactivity to smoking-related images.
In the study, Dr. Jud Brewer, an associate professor of behavioral and social sciences and psychiatry at Brown University, and his team conducted a randomized controlled trial that compared smoking-cessation apps.
For four weeks, one group of 33 participants used a mindfulness-based app, while another group of 34 participants used a free smoking-cessation app from the National Cancer Institute (NCI).
“This is the first study to show that mindfulness training could specifically affect a mechanism in the brain and to show that changes in this brain mechanism were connected to improved clinical outcomes,” said Brewer.
“We’re moving in the direction of being able to screen someone before treatment and offer them the behavior-change interventions that will be most likely to help them. This will save everybody time and money.”
The findings appear in the journal Neuropsychopharmacology.
The mindfulness app includes daily videos and activities to help users identify their smoking triggers, become more aware of cravings and learn mindfulness methods to ride out the cravings. In contrast, the NCI app helps users track smoking triggers, provides inspirational messages and delivers distractions to help users deal with cravings.
The research team found that participants who used the mindfulness app for a month reduced their self-reported daily cigarette consumption by a wide range, with an average drop of 11 cigarettes per day.
The NCI app users also reduced cigarette consumption by a wide range, with an average decrease of nine per day. Some participants in both groups reported smoking no cigarettes by the end of the month.
Participants in both groups completed an average of 16 out of 22 stand-alone modules of the app. Participants in the mindfulness group who completed more modules were likely to have a greater reduction in their cigarette consumption; this correlation was not found for the NCI group.
Participants in the mindfulness group were also significantly more likely to say that they would recommend the app to a friend than participants in the NCI group.
As a part of the study, the researchers conducted functional magnetic resonance imaging (fMRI) brain scans of the participants as they looked at smoking-associated images or other images not associated with smoking. These scans were conducted before and after participants used one of the two apps. This procedure helped researchers determine how the mindfulness app worked in the brain.
Specifically, the researchers looked at the changes in brain activity in the posterior cingulate cortex, a ping-pong-ball-sized brain region known to be activated when someone gets caught up in craving cigarettes, cocaine or even chocolate, Brewer said.
The posterior cingulate cortex has also been shown to be deactivated by meditation, so Brewer hypothesized that this region would play a critical role in how mindfulness-based interventions — app-based or otherwise — affect the brain and change behaviors.
When the researchers directly compared the changes in brain reactivity in the target region between the two groups before and after they used the apps, they found no statistical differences.
However, when they looked at the individual level and compared the reduction in cigarettes smoked to the changes in brain reactivity, they found that the participants in the mindfulness group who had the greatest reduction in number of cigarettes per day also showed a significant reduction in brain reactivity to smoking images.
They saw no correlation between number of cigarettes smoked and brain reactivity for the participants who used the NCI app. They also noted that the correlation between number of cigarettes smoked and brain reactivity was particularly significant for women in the mindfulness group.
Therefore, investigators concluded that for some participants — those for whom the app was most effective — the training helped decrease brain reactivity to smoking urges.
Surprisingly, 13 percent of participants were non-reactive to smoking images before they used either app, a phenomenon not encountered in previous scientific literature, Brewer said.
Other participants became more reactive to smoking images after they used either app; this has been seen before in people who craved cigarettes more while trying to quit, he added.
Source: Brown University