Understanding Mechanisms to Reduces Efficacious and Cost-Effective Treatments

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Understanding Mechanisms to Reduces Efficacious and Cost-Effective Treatments

Understanding Mechanisms to Reduces Efficacious and Cost-Effective Treatments

Understanding mechanisms could lead to the development of more

Understanding Mechanisms to Reduces Efficacious and Cost-Effective Treatments

efficacious and cost-effective treatments. For example, interventions could have greater

Understanding Mechanisms to Reduces Efficacious and Cost-Effective Treatments

impact by intensifying the focus on key mechanisms and/or removing treatment aspects that

Understanding Mechanisms to Reduces Efficacious and Cost-Effective Treatments

do not directly target these mechanisms.

Understanding Mechanisms to Reduces Efficacious and Cost-Effective Treatments

Potential Underlying Mechanisms

Understanding Mechanisms to Reduces Efficacious and Cost-Effective Treatments

Emotions and Stress

Understanding Mechanisms to Reduces Efficacious and Cost-Effective Treatments

Quitting smoking is associated with increased negative affect (Leventhal, Waters, Moolchan, Heishman, & Pickworth, 2010), and negative affect and stress are strong predictors of difficulty quitting (Baker, Piper, McCarthy,

Understanding Mechanisms to Reduces Efficacious and Cost-Effective Treatments

Majeskie, & Fiore, 2004). Positive emotions, on the other hand, may protect against relapse (Levine, Marcus, Kalarchian, Houck, & Cheng, 2010).

Understanding Mechanisms to Reduces Efficacious and Cost-Effective Treatments

Randomized controlled trials indicate that mindfulness training reduces negative emotions and stress (across healthy and clinical populations; Gotink et al., 2015), andincreases positive emotions (among adults in partial

Understanding Mechanisms to Reduces Efficacious and Cost-Effective Treatments

remission from depression; Garland, Geschwind, Peeters, & Wichers, 2015) to a greater extent than wait-list controls or treatment as usual. Goyal et al.’s (2014) meta-analysis in adult clinical populations indicated that

Understanding Mechanisms to Reduces Efficacious and Cost-Effective Treatments

mindfulness meditation programs reduced anxiety and depression, but did not affect positive emotions when compared to nonspecific active controls. However, there was insufficient

Understanding Mechanisms to Reduces Efficacious and Cost-Effective Treatments

evidence regarding the effects of mindfulness vs. more specific active controls (e.g., CBT).

 

Although there is a relative dearth of trials comparing mindfulness to CBT, some research

 

suggests that mindfulness training and CBT are equally efficacious for reducing depression

 

and anxiety (Sundquist et al., 2015; Tovote et al., 2014).

 

Affective Volatility

 

In addition to severity of negative affect, greater volatility (i.e., lability/scatter over time) of

 

negative affect over the course of smoking cessation predicts lower likelihood of abstinence

 

(Piasecki, Jorenby, Smith, Fiore, & Baker, 2003a, 2003b). Conceptually, mindfulness is

 

integrally related to affective volatility, particularly with regard to negative emotions. That

 

is, nonjudgmental observation of unpleasant internal and external stimuli is thought to lessen

 

the tendency for extreme mood fluctuations in reaction to those stimuli (Chambers, Gullone,

 

& Allen, 2009; Teasdale et al., 2002). Hill and Updegraff (2012) found that among college

 

students, dispositional mindfulness predicted lower volatility of both negative and positive

 

emotions. Adams et al. (2014) found that dispositional mindfulness predicted lower

 

volatility of negative emotions and depressive symptoms among smokers attempting to quit,

 

indicating higher stability in negative (but not positive) emotions. No study, to our

 

knowledge, has examined the effect of mindfulness-based treatment (or CBT) on affective

 

volatility.

 

Tobacco Dependence, Withdrawal, and Craving

 

Greater tobacco dependence and withdrawal symptoms predict more difficulty quitting

 

(Kenford et al., 2002; Piasecki et al., 2003a). However, smokers with greater dispositional

 

mindfulness tend to have lower levels of dependence (Vidrine et al., 2009). By promoting

 

nonjudgmental awareness and purposeful (rather than impulsive) action, mindfulness

 

Spears et al. Page 3

 

J Consult Clin Psychol. Author manuscript; available in PMC 2018 November 01.

 

Understanding Mechanisms to Reduces Efficacious and Cost-Effective Treatments

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