Group Therapy for Nicotine Dependence

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DESCRIPTION (provided by applicant): Cigarette smoking is the leading preventable cause of morbidity and mortality in the United States and nicotine dependence is by far the most prevalent substance abuse disorder. Unfortunately, because quitting smoking is a major life stressor that can result in prolonged aversive consequences, quit rates are generally low (i.e., 5-25%). Smoking cessation treatments are needed that can improve emotional and behavioral regulation, and reduce the distress of quitting. The purpose of this 2-group randomized clinical trial is to develop and evaluate a Mindfulness-Based Treatment (MBT) for nicotine dependence that is delivered in a group format. Mindfulness reflects an intentional allocation of attention to the cognitions, emotions, perceptions, and sensations occurring in the present moment. That is, mindfulness reflects a purposeful control of attention and can be learned through training in attentional control procedures, the most common of which is meditation. The rationale for applying a mindfulness-based approach to the treatment of nicotine dependence is grounded in: 1) compelling evidence for the efficacy of mindfulness-based treatments delivered in group formats across a wide range of conditions, disorders, and populations, 2) the relevance of mindfulness-based treatment effects to the affective and cognitive mechanisms underlying smoking cessation and relapse, and 3) the existence of well-developed manuals and materials for implementing and evaluating mindfulness-based treatment delivery and content. Current cigarette smokers (N=300) will be randomly assigned to either Health Education (HE) or MBT. HE is a standard smoking cessation group program utilizing a problem-solving/coping skills approach based on relapse prevention theory and the Treating Tobacco Use and Dependence Clinical Practice Guideline (Guideline). MBT is specifically derived from Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy. HE and MBT are matched on contact time and all participants will receive nicotine patch therapy and self-help materials. MBT mechanisms and effects will be assessed using "implicit" cognitive psychological measures, structured interviews, and computer-administered questionnaires. Participants will be tracked from 5 weeks prior to their quit date through 26 weeks after their quit date. The primary specific aims are to: 1. Examine the effects of MBT on abstinence rates, 2. Examine the effects of MBT on mindfulness/metacognitive awareness, attentional control, smoking automaticity, positive smoking associations in memory, negative affect, depression, stress, affect regulation expectancies, self-efficacy, withdrawal, and coping across the pre- to postcessation period, and whether these variables mediate MBT effects on abstinence. A secondary and more exploratory aim is to: 3. Examine the effects of MBT on therapeutic process related measures such as group cohesion and therapeutic alliance, and whether these variables mediate MBT effects on abstinence.