, Volume 2, Issue 1, pp 14–26 | Cite as

Coping with Cigarette Cravings: Comparison of Suppression Versus Mindfulness-Based Strategies

  • Jenny Rogojanski
  • Lisa C. Vettese
  • Martin M. AntonyEmail author


Mindfulness- and acceptance-based therapies have been explored within the context of addiction treatment, with some preliminary success. The current empirical study investigated the effectiveness of a brief suppression versus mindfulness-based strategy for coping with cigarette cravings. Participants (N = 61; M age = 40.34 years, SD = 12.42) were randomly assigned to using one of the two coping strategies to help them manage cravings during an experimental cue exposure to cigarettes. Participants completed self-report measures of self-efficacy, craving, negative affect, depression, and nicotine dependence before and after the cue exposure and at a 7-day follow-up assessment session. Participants in both conditions reported significantly reduced amount of smoking and increased self-efficacy in coping with smoking urges at the 7-day follow-up. However, only participants in the mindfulness condition demonstrated reductions in negative affect, depressive symptoms, and marginal reductions in their level of nicotine dependence. These findings suggest that, although both conditions were associated with improvements on smoking relevant outcomes, only mindfulness had beneficial effects on reported nicotine dependence and emotional functioning over the course of the study. These findings provide preliminary support for the use of mindfulness-based strategies for coping with smoking urges, as these strategies appear to provide some additional benefits not obtained when coping with smoking cravings through suppression.


Smoking Mindfulness Craving Substance abuse Acceptance 


  1. Anda, R. F., Croft, J. B., Felitti, V. J., Nordenberg, D., Giles, W. H., Williamson, D. F., et al. (1999). Adverse childhood experiences and smoking during adolescence and adulthood. Journal of the American Medical Association, 282, 1652–1658.PubMedCrossRefGoogle Scholar
  2. Arch, J. J., & Craske, M. G. (2006). Mechanisms of mindfulness: Emotion regulation following a focused breathing induction. Behaviour Research and Therapy, 44, 1849–1858.PubMedCrossRefGoogle Scholar
  3. Baer, J. (2002). Student factors: Understanding individual variation in college drinking. Journal of Studies on Alcohol, 14, 40–53.Google Scholar
  4. Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10, 125–143.CrossRefGoogle Scholar
  5. Baer, J. S., Holt, C. S., & Lichtenstein, E. (1986). Self-efficacy and smoking reexamined: Construct validity and clinical utility. Journal of Consulting and Clinical Psychology, 54, 846–852.PubMedCrossRefGoogle Scholar
  6. Bagot, K. S., Heishman, S. J., & Moolchan, E. T. (2007). Tobacco craving predicts lapse to smoking among adolescent smokers in cessation treatment. Nicotine & Tobacco Research, 9, 647–652.CrossRefGoogle Scholar
  7. Baker, T. B., Morse, E., & Sherman, J. E. (1986). The motivation to use drugs: a psychobiological analysis of urges. Nebraska Symposium on Motivation, 34, 257–323.PubMedGoogle Scholar
  8. Barnier, A. J., Levin, K., & Maher, A. (2004). Suppressing thoughts of past events: are repressive copers good suppressors? Cognition and Emotion, 18, 513–531.CrossRefGoogle Scholar
  9. Bishop, S. R. (2002). What do we really know about mindfulness-based stress reduction? Psychosomatic Medicine, 64, 71–83.PubMedGoogle Scholar
  10. Bowen, S., & Marlatt, G. A. (2007, November). Effects of mindfulness-based strategies on urges, negative affect, and smoking. Paper presented at the meeting of the Association for Behavioral and Cognitive Therapies, Philadelphia, PA.Google Scholar
  11. Bowen, S., & Marlatt, G. A. (2009). Surfing the urge: brief mindfulness-based intervention for college student smokers. Psychology of Addictive Behaviors, 23, 666–671.PubMedCrossRefGoogle Scholar
  12. Bowen, S., Witkiewitz, K., Dillworth, T. M., & Marlatt, G. A. (2007). The role of thought suppression in the relationship between mindfulness meditation and alcohol use. Addictive Behaviors, 32, 2324–2328.PubMedCrossRefGoogle Scholar
  13. Brandon, T. H., Tiffany, S. T., Obremski, K. M., & Baker, T. B. (1990). Postcessation cigarette use: the process of relapse. Addictive Behaviors, 15, 105–114.PubMedCrossRefGoogle Scholar
  14. Breslau, N., Kilbey, M. M., & Andreski, P. (1992). Nicotine withdrawal symptoms and psychiatric disorders: Findings from an epidemiologic study of young adults. The American Journal of Psychiatry, 149, 464–469.PubMedGoogle Scholar
  15. Breslin, F., Zack, M., & McMain, S. (2002). An information-processing analysis of mindfulness: implications for relapse prevention in the treatment of substance abuse. Clinical Psychology: Science and Practice, 9, 275–299.CrossRefGoogle Scholar
  16. Brown, R. A., Lewinsohn, P. M., Seeley, J. R., & Wagner, E. F. (1996). Cigarette smoking, major depression, and other psychiatric disorders among adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1602–1610.PubMedCrossRefGoogle Scholar
  17. Brown, R. A., Burgess, E. S., Sales, S. D., Evans, D. M., & Miller, I. W. (1998). Reliability and validity of a smoking timeline follow-back interview. Psychology of Addictive Behaviors, 12, 101–112.CrossRefGoogle Scholar
  18. Carmody, T. P., Vieten, C., & Astin, J. A. (2007). Negative affect, emotional acceptance, and smoking cessation. Journal of Psychoactive Drugs, 39, 499–508.PubMedGoogle Scholar
  19. Centers for Disease Control and Prevention. (2005). Smoking—attributable mortality, years of potential life lost, and economic costs—United States, 1997–2001. Washington, DC: CDC.Google Scholar
  20. Clark, D. M., Ball, S., & Pape, D. (1991). An experimental investigation of thought suppression. Behaviour Research and Therapy, 29, 253–257.PubMedCrossRefGoogle Scholar
  21. Covey, L. S., Glassman, A. H., & Stetner, F. (1990). Depression and depressive symptoms in smoking cessation. Comprehensive Psychiatry, 31, 350–354.PubMedCrossRefGoogle Scholar
  22. Covey, L. S., Glassman, A. H., & Stetner, F. (1997). Major depression following smoking cessation. The American Journal of Psychiatry, 154, 263–265.PubMedGoogle Scholar
  23. Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F., et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65, 564–570.PubMedCrossRefGoogle Scholar
  24. Davis, J. M., Fleming, M. F., Bonus, K. A., & Baker, T. B. (2007). A pilot study on mindfulness based stress reduction for smokers. BMC Complementary and Alternative Medicine, 7, 1–7.CrossRefGoogle Scholar
  25. Devilly, G. J., & Borkovec, T. D. (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry, 31, 73–86.PubMedCrossRefGoogle Scholar
  26. DiFranza, J. R., & Wellman, R. J. (2005). A sensitization-homeostasis model of nicotine craving, withdrawal, and tolerance: Integrating the clinical and basic science literature. Nicotine & Tobacco Research, 7, 9–26.CrossRefGoogle Scholar
  27. Ellison, L. F., Mao, Y., & Gibbons, L. (1995). Projected smoking-attributable mortality in Canada, 1991–2000. Chronic Diseases in Canada, 16, 84–89.Google Scholar
  28. Erblich, J., & Bovbjerg, D. H. (2004). In vivo versus imaginal smoking cue exposures: Is seeing believing? Experimental and Clinical Psychopharmacology, 12, 208–215.PubMedCrossRefGoogle Scholar
  29. Fagerstrom, K. O., & Schneider, N. G. (1989). Measuring nicotine dependence: a review of the Fagerstrom Tolerance Questionnaire. Journal of Behavioral Medicine, 12, 159–182.PubMedCrossRefGoogle Scholar
  30. Fagerstrom, K. O., Heatherton, T. F., & Kozlowski, L. T. (1991). Nicotine addiction and its assessment. Ear, Nose, & Throat Journal, 69, 763–765.Google Scholar
  31. Feldman, G., Hayes, A., Kumar, S., Greeson, J., & Laurenceau, J. (2007). Mindfulness and emotion regulation: the development and initial validation of the Cognitive and Affective Mindfulness Scale—revised (CAMS-R). Journal of Psychopathology and Behavioral Assessment, 29, 177–190.CrossRefGoogle Scholar
  32. Fiore, M. C., Bailey, W. C., Cohen, S. J., Dorfman, S. F., Gritz, E. R., Heyman, R. B., et al. (2000). Treating tobacco use and dependence. Clinical practice guideline. Rockville, MD: United States Department of Health and Human Services, Public Health Service.Google Scholar
  33. Fonder, M. A., Sacco, K. A., Termine, A., Boland, B. S., Seyal, A. A., Dudas, M. M., et al. (2005). Smoking cue reactivity in schizophrenia: effects of a nicotinic receptor antagonist. Biological Psychiatry, 57, 802–808.PubMedCrossRefGoogle Scholar
  34. Garvey, A. J., Bliss, R. E., Hitchcock, J. L., Heinold, J. W., & Rosner, B. (1992). Predictors of smoking relapse among self-quitters: a report from the normative aging study. Addictive Behaviors, 17, 367–377.PubMedCrossRefGoogle Scholar
  35. Ghadirian, P. (2004). Sleeping with a killer: The effect of smoking on human health. A report from Tobacco Control Programme, Health CanadaGoogle Scholar
  36. Glassman, A. H. (1993). Cigarette smoking: Implications for psychiatric illness. The American Journal of Psychiatry, 150, 546–553.PubMedGoogle Scholar
  37. Glassman, A. H., Helzer, J. E., Covey, L. S., Cottler, L. B., Stetner, F., Tipp, J. E., et al. (1990). Smoking, smoking cessation, and major depression. Journal of the American Medical Association, 12, 1546–1549.CrossRefGoogle Scholar
  38. Gonzalez, A., Vujanovic, A. A., Johnson, K. A., Leyro, T. M., & Zvolensky, M. J. (2009). The role of mindful attention in regard to the relation between negative affect reduction outcome expectancies and emotional vulnerability among adult cigarette smokers. Cognitive Therapy Research, 33, 645–656.CrossRefGoogle Scholar
  39. Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85, 348–362.PubMedCrossRefGoogle Scholar
  40. Gwaltney, C. J., Shiffman, S., Norman, G. J., Paty, J. A., Kassel, J. D., Gnys, M., et al. (2001). Does smoking abstinence self-efficacy vary across situations? Identifying context-specificity within the relapse situation efficacy questionnaire. Journal of Consulting and Clinical Psychology, 69, 516–527.PubMedCrossRefGoogle Scholar
  41. Haaga, D. A. F., & Allison, M. L. (1994). Thought suppression and smoking relapse: a secondary analysis of Haaga (1989). The British Journal of Clinical Psychology, 33, 327–331.PubMedGoogle Scholar
  42. Hall, S. M., Munoz, R. F., Reus, V. I., & Sees, K. L. (1993). Nicotine, negative affect, and depression. Journal of Consulting and Clinical Psychology, 61, 761–767.PubMedCrossRefGoogle Scholar
  43. Havermans, R. C., Debaere, S., Smulders, F. T. Y., Wiers, R. W., & Jansen, A. T. M. (2003). Effects of cue exposure, urge to smoke, and nicotine deprivation on cognitive performance in smokers. Psychology of Addictive Behaviors, 17, 336–339.PubMedCrossRefGoogle Scholar
  44. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behaviour change. New York, NY: Guilford Press.Google Scholar
  45. Heatherton, T. F., Kozlowski, L. T., Frecker, R. C., & Fagerstrom, K. (1991). The fagerstrom test for nicotine dependence: a revision of the fagerstrom tolerance questionnaire. British Journal of Addiction, 86, 1119–1127.PubMedCrossRefGoogle Scholar
  46. Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. New York, NY: Hyperion.Google Scholar
  47. Kabat-Zinn, J. (2005). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness: 15th Anniversary. New York, NY: Delta Trade Paperback/Bantam Dell.Google Scholar
  48. Kassel, J. D., Stroud, L. R., & Paronis, C. A. (2003). Smoking, stress, and negative affect: correlation, causation, and context across stages of smoking. Psychological Bulletin, 129, 270–304.PubMedCrossRefGoogle Scholar
  49. Lerman, C., Audrain, J., Orleans, C. T., Boyd, R., Gold, K., Main, D., et al. (1996). Investigation of mechanisms linking depressed mood to nicotine dependence. Addictive Behaviors, 21, 9–19.PubMedCrossRefGoogle Scholar
  50. Leventhal, A. M., Waters, A. J., Boyd, S., Moolchan, E. T., Lerman, C., & Pickworth, W. B. (2007). Gender differences in acute tobacco withdrawal: effects on subjective, cognitive, and physiological measures. Experimental and Clinical Psychopharmacology, 15, 21–36.PubMedCrossRefGoogle Scholar
  51. Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the beck depression and anxiety inventories. Behaviour Research and Therapy, 33, 335–343.PubMedCrossRefGoogle Scholar
  52. Marlatt, G. A., & Gordon, J. R. (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York, NY: Guilford Press.Google Scholar
  53. Marlatt, G. A., Witkiewitz, K., Dillworth, T. M., Bowen, S. W., Parks, G. A., Macpherson, L. M., et al. (2004). Vipassana meditation as a treatment for alcohol and drug use disorders. In S. C. Hayes, V. M. Follette, & M. M. Linehan (Eds.), Mindfulness and acceptance: Expanding the cognitive-behavioral tradition. New York, NY: Guilford Press.Google Scholar
  54. Miranda, R., Rohsenow, D. J., Monti, P. M., Tidey, J., & Ray, L. (2008). Effects of repeated days of smoking cue exposure on urge to smoke and physiological reactivity. Addictive Behaviors, 33, 347–353.PubMedCrossRefGoogle Scholar
  55. Moore, P. (2008). Introducing mindfulness to clinical psychologists in training: an experimental course of brief exercises. Journal of Clinical Psychology in Medical Settings, 15, 331–337.PubMedCrossRefGoogle Scholar
  56. Myrsten, A., Elgerot, A., & Edgren, B. (1977). Effects of abstinence from tobacco smoking on physiological and psychological arousal levels in habitual smokers. Psychosomatic Medicine, 39, 25–38.PubMedGoogle Scholar
  57. Niaura, R., Britt, D. M., Borrelli, B., Shadel, W. G., Abrams, D. B., & Goldstein, M. G. (1999). History and symptoms of depression among smokers during a self-initiated quit attempt. Nicotine & Tobacco Research, 1, 251–257.CrossRefGoogle Scholar
  58. Orlando, M., Ellickson, P. L., & Jinnett, K. (2001). The temporal relationship between emotional distress and cigarette smoking during adolescence and young adulthood. Journal of Consulting and Clinical Psychology, 69, 959–970.PubMedCrossRefGoogle Scholar
  59. Peto, R., Lopez, A. D., Boreham, J., Thun, M., Heath, C., & Doll, R. (1996). Mortality from smoking worldwide. British Medical Bulletin, 52, 12–21.PubMedGoogle Scholar
  60. Pollack, M. H., Penava, S. A., Bolton, E., Worthington, J. J., III, Allen, G. L. A., Farach, F. J., Jr., et al. (2002). A novel cognitive-behavioural approach for treatment-resistant drug dependence. Journal of Substance Abuse Treatment, 23, 335–342.PubMedCrossRefGoogle Scholar
  61. Ree, M. J., & Craigie, M. A. (2007). Outcomes following mindfulness-based cognitive therapy in a heterogeneous sample of adult outpatients. Behaviour Change, 24, 70–86.CrossRefGoogle Scholar
  62. Salkovskis, P. M., & Reynolds, M. (1994). Thought suppression and smoking cessation. Behaviour Research and Therapy, 32, 193–201.PubMedCrossRefGoogle Scholar
  63. Sayette, M. A., Martin, C. S., Wertz, J. M., Shiffman, S., & Perrott, M. A. (2001). A multi-dimensional analysis of cue-elicited craving in heavy smokers and tobacco chippers. Addiction, 96, 1419–1432.PubMedCrossRefGoogle Scholar
  64. Shadel, W. G., & Shiffman, S. (2005). Assessment of smoking behavior. In D. M. Donovan & G. A. Marlatt (Eds.), Assessment of addictive behaviors (2nd ed., pp. 113–154). New York, NY: Guilford Press.Google Scholar
  65. Shiffman, S. (1991). Refining models of dependence: Variations across persons and situations. British Journal of Addiction, 86, 611–615.PubMedCrossRefGoogle Scholar
  66. Sobell, M. B., Maisto, S. A., Sobell, L. C., Cooper, A. M., Cooper, T. C., & Sanders, B. (1980). Developing a prototype for evaluating alcohol treatment effectiveness. In L. C. Sobell, M. B. Sobell, & E. Ward (Eds.), Evaluating alcohol and drug abuse treatment effectiveness: Recent advances (pp. 129–150). Elmsford, NY: Pergamon Press.Google Scholar
  67. Sommese, T., & Patterson, J. C. (1995). Acute effects of cigarette smoking withdrawal: A review of the literature. Aviation Space and Environmental Medicine, 66, 164–167.Google Scholar
  68. Stapleton, J. (1998). Cigarette smoking prevalence, cessation, and relapse. Statistical Methods in Medical Research, 7, 187–203.PubMedCrossRefGoogle Scholar
  69. Stuart, K., Borland, R., & McMurray, N. (1994). Self-efficacy, health locus of control, and smoking cessation. Addictive Behaviors, 19, 1–12.PubMedCrossRefGoogle Scholar
  70. Substance Abuse and Mental Health Services Administration (2004). Results from the 2003 national survey on drug use and health: National findings (Office of Applied Studies, NSDUH Series H–25, DHHS Publication No. SMA 04–3964). Rockville, MD.Google Scholar
  71. Thorsteinsson, H. S., Gillin, J. C., Patten, C. A., Golshan, S., Sutton, L. D., Drummond, S., et al. (2001). The effects of transdermal nicotine therapy for smoking cessation on depressive symptoms in patients with major depression. Neuropsychopharmacology, 24, 350–358.PubMedCrossRefGoogle Scholar
  72. Tidey, J. W., Rohsenow, D. J., Kaplan, G. B., & Swift, R. M. (2005). Subjective and physiological responses to smoking cues in smokers with schizophrenia. Nicotine & Tobacco Research, 7, 421–429.CrossRefGoogle Scholar
  73. Toll, B. A., Sobell, M. B., Wagner, E. F., & Sobell, L. C. (2001). The relationship between thoughts suppression and smoking cessation. Addictive Behaviors, 26, 509–515.PubMedCrossRefGoogle Scholar
  74. Toneatto, T., Vettese, L. C., & Nguyen, L. (2007). The role of mindfulness in the cognitive-behavioural treatment of problem gambling. Journal of Gambling Issues, 19, 91–100.CrossRefGoogle Scholar
  75. Traylor, A. C., Bordnick, P. S., & Carter, B. L. (2008). Assessing craving in young adult smokers using virtual reality. American Journal on Addiction, 17, 436–440.CrossRefGoogle Scholar
  76. United States Department of Health and Human Services (1988). The health consequences of smoking. In Nicotine addiction: A report of the US surgeon general. Washington, DC: Author.Google Scholar
  77. United States Department of Health and Human Services (1990). Psychological and behavioral consequences and correlates of smoking cessation. In Health benefits of smoking cessation: A report of the US surgeon general (pp. 517–578). Rockville, MD: Author.Google Scholar
  78. Vernig, P. M., & Orsillo, S. M. (2009). Psychophysiological and self-reported emotional responding in alcohol-dependent college students: The impact of brief acceptance/mindfulness instructions. Cognitive Behaviour Therapy, 38, 174–183.PubMedCrossRefGoogle Scholar
  79. Vettese, L. C. (2008, April). Mindfulness, mental health and addictive behaviour in outpatient substance use treatment. Paper presented at the Conference for Integrating Mindfulness-Based Interventions into Medicine, Health Care, and Society, Worcester, MA.Google Scholar
  80. Vettese, L. C., Toneatto, T., Stea, J. N., Nguyen, L., & Wang, J. J. (2009). Do mindfulness meditations participants actually practice? And does it make a difference? A review of the empirical evidence. Journal of Cognitive Psychotherapy: An International Quarterly, 23, 198–225.CrossRefGoogle Scholar
  81. Vidrine, J. I., Businelle, M. S., Cinciripini, P., Li, Y., Marcus, M., Waters, A. J., et al. (2009). Associations of mindfulness with nicotine dependence, withdrawal, and agency. Substance Abuse, 30, 318–327.PubMedCrossRefGoogle Scholar
  82. Vieten, C. (2005). A mindfulness-based approach to relapse prevention [Abstract]. Tobacco-related disease research program. Abstract for grant #14IT-0178.Google Scholar
  83. Watkins, E. R., & Moulds, M. (2007). Revealing negative thinking in recovered major depression: a preliminary investigation. Behaviour Research and Therapy, 45, 3069–3076.PubMedCrossRefGoogle Scholar
  84. Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: the PANAS scales. Journal of Personality and Social Psychology, 54, 1063–1070.PubMedCrossRefGoogle Scholar
  85. Wegner, D. M., & Zanakos, S. I. (1994). Chronic thought suppression. Journal of Personality and Social Psychology, 62, 615–640.Google Scholar
  86. Weiss-Gerlach, E., Franck, M., Neuner, B., Gentilello, L. M., Neumann, T., Tonnesen, H., et al. (2008). Motivation of trauma patients to stop smoking after admission to the emergency department. Addictive Behaviors, 33, 906–918.PubMedCrossRefGoogle Scholar
  87. Wenzlaff, R. M., Wegner, D. M., & Klein, S. B. (1991). The role of thought suppression in the bonding of thought and mood. Journal of Personality and Social Psychology, 60, 500–508.CrossRefGoogle Scholar
  88. West, R. J., & Grunberg, N. E. (1991). Implications of tobacco use as an addiction. British Journal of Addiction, 86, 485–488.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Jenny Rogojanski
    • 1
  • Lisa C. Vettese
    • 1
  • Martin M. Antony
    • 1
    Email author
  1. 1.Department of PsychologyRyerson UniversityTorontoCanada

Personalised recommendations