MINDFULNESS
1
Tapper,K.(2018).Mindfulnessandcraving:effectsandmechanisms.ClinicalPsychology
Review,59,101-117.
Mindfulnessandcraving:effectsandmechanisms
KatyTapper
City,UniversityofLondon
PsychologyDepartment
SchoolofSocialSciences
CityUniversityLondon
WhiskinStreet
London
EC1R0JD
UK
Tel:+44(0)2070408500
Fax:+44(0)2070408887
MINDFULNESS
2
Abstract
Mindfulnessmeditationhasalongtraditionofbeingusedtomanagecravings.This
paperreviews30experimentalstudiesthathaveexaminedtheeffectsofdifferenttypes
ofmindfulnesspracticeoncravingsforfood,cigarettesandalcohol.Thefindingsare
interpretedinlightofrelevanttheoriesofcraving.Thestudiesshowmostsupportfor
theelaboratedintrusiontheoryofdesireandconditioningmodels.Theysuggestthat
whilstmindfulnessstrategiesmaybringaboutimmediatereductionsincraving,such
effectsarelikelytostemfromworkingmemoryload,andwillnotnecessarilybe
superiortoalternativestrategiesthatalsoloadworkingmemory.Likewise,reductions
incravingoverthemediumtermmayoccurduetoextinctionprocessesthatresultfrom
theindividualinhibitingcraving-relatedresponses.Again,alternativestrategiesthat
promoteresponsesuppressionmaybeequallyeffective.Nevertheless,asmaller
numberofstudiesshowpromisingresultswheremindfulnessexerciseshavebeen
repeatedlypracticedoveralongerperiodoftime.Theresultsofthesestudiesprovide
tentativesupportforBuddhistmodelsofcravingthatsuggestmindfulnesspracticemay
conferuniquebenefitsintermsofbothcravingreductionandreducingtheextentto
whichcravingleadstoconsumption.Furtherresearchwouldbeneededtoconfirmthis.
Keywords
mindfulness;craving;food;cigarettes;alcohol;behaviorchange
MINDFULNESS
3
Mindfulnessandcraving:effectsandmechanisms
Cravingcanbedefinedasanintense,consciousdesire,usuallytoconsumea
specificdrugorfood(Drummond,2001;May,Kavanagh&Andrade,2015;Tiffany&
Wray,2012;Pelchat,2002).Althoughtheclinicalrelevanceofcravinghasbeen
questioned(Wray,Gass&Tiffany,2013),thereisalsoasignificantbodyofresearchthat
suggestsitiscausallylinkedtobehavior.Forexample,cravingpredictsrelapseepisodes
insubstanceuse(Serre,Fatseas,Swendsen&Auriacombe,2015)andfoodcravings
predictbotheatingandweightgain(Boswell&Kober,2016).Assuch,cravingsare
oftenconsideredanappropriatetargetforintervention,theassumptionbeingthat
reducingcraving,orchangingaperson’sresponsetocraving,willimpactuponthe
relatedbehavior.
Mindfulnessmeditationhasalongtraditionofbeingusedtoaddresscravings.
AccordingtoancientBuddhisttexts,cravingleadstosufferingbutcanbeavoided
throughmindfulnessmeditationpractice(DhammacakkappavattanaSutta:Settingin
MotiontheWheelofTruth[SN56.11],2013).Morerecently,mindfulness-based
interventionshavebeenusedtoexplicitlytargetcravingswiththeaimofbringingabout
clinicallyrelevantchangestobehavior(e.g.,Alberts,Mulkens,Smeets&Thewissen,
2010;Ruscio,Muench,Brede&Waters,2016;Zemestani&Ottaviani,2016).However,
suchinterventionsoftencomprisearangeofmindfulnessandnon-mindfulness
components,makingitdifficulttounequivocallyattributeanychangesincravingtothe
mindfulness-basedelementsoftheintervention(e.g.,Bowenetal.,2009;Brickeretal.,
2014;Garland,Robert-Lewis,Tronnier,Graves&Kelly,2016;Zemestani&Ottaviani,
2016;seealsoTapper,2017).Assuch,theeffectsofmindfulnesspracticeoncraving
haveyettobescientificallyestablished.
MINDFULNESS
4
Mindfulnessinterventionsalsotypicallyemployarangeofdifferenttypesof
strategy,forexampletheymayincludeexercisesdesignedtopromotegreater
awarenessofbodilysensations,todevelopanattitudeofacceptancetoward
uncomfortablefeelings,ortohelpindividualsseethemselvesasseparatefromtheir
thoughtsandemotions(Tapper,2017).However,wecurrentlyhavelimited
understandingofthewaysinwhichthesedifferenttypesofstrategymayinfluence
craving-relatedoutcomes,eitherindependently,orincombination.Althoughsome
authorshaveproposedmodelstoaccountforpotentialeffects(Breweretal.,2013),
manyaspectsofthesehaveyettobetestedexperimentally.Assuchwelackafull
understandingofthewaysinwhichmindfulnesspracticemightinfluencecravings.This
isimportantbecauseasoundtheoreticalbasisisessentialforthedevelopmentof
effectiveinterventions(Michie&Abraham,2004).
Thecurrentarticleaimstoaddresstheselimitationsbyreviewingstudiesthat
haveexaminedtheindependenteffectsofmindfulnessoncraving.Inotherwords,the
reviewisrestrictedtostudiesinwhichtheexperimentalmanipulationorintervention
consistsonlyofmindfulnesscomponents.Suchanapproachinevitablyexcludes
interventionsthatcombinemindfulnessstrategieswithothertherapeuticapproaches1
1Anumberofexistingreviewsalreadyexaminetheeffectsofthesetypesofmulti-
componentmindfulness-basedinterventionsinareasrelevanttocraving,including
substanceusedisorders(Chiesa&Serretti,2014;Zgierskaetal.,2009),substance
misuse(Li,Howard,Garland,McGovern&Lazar,2017),smokingcessation(Maglioneet
al.,2017),bingeeating,emotionaleatingandweightloss(Katterman,Kleinman,Hood,
Nackers&Corsica,2014;Olson&Emery,2015;O’Reilly,Cook,Spruijt-Metz&Black,
2014).
MINDFULNESS
5
(e.g.,Mindfulness-OrientedRecoveryEnhancement,seeGarland,2013;Acceptanceand
CommitmentTherapy,seeHayes,Strosahl&Wilson,1999).However,restrictingthe
reviewinthiswayshouldallowanyeffectsoncravingtobemoreconfidentlyattributed
tothemindfulnessmanipulation.Itshouldalsomakeiteasiertocomparetheeffectsof
differenttypesofmindfulnesspracticeaswellasevaluatepotentialmechanismsof
action.Assuch,thereviewhasthreekeyaims:(a)toexaminetheeffectsofmindfulness-
basedpracticesoncraving,(b)tocomparetheeffectsofdifferenttypesofmindfulness-
basedpracticesoncraving,and(c)toexplorethemechanismsviawhichmindfulness-
basedpracticesmayexertanyeffectsoncraving.
Thereviewisinformedbyconceptualizationsofmindfulnessthatdistinguish
betweenthreekeycomponents;presentmomentawareness,acceptanceand
decentering(Creswell,2017;Tapper,2017).Presentmomentawarenessreferstothe
self-regulationofattentionsothatitismaintainedonpresentmomentexperience,for
exampleonesbreath,bodilysensationsorthecontentofonesthoughts;acceptance
involvestakinganon-judgmentalattitudetowardsonesthoughts,feelingsandbodily
sensations;decenteringmeansviewingonesthoughtsandfeelingsastransientevents
thatareseparatetooneself.Inpracticeitmaybedifficulttocompletelydistinguish
betweentheeffectsofthesethreedifferenttechniquessinceacceptanceand
decenteringlikelyrequireacertainamountofpresentmomentawareness.Itisalso
possiblethatacceptanceanddecenteringarisespontaneouslyfromrepeatedpresent
momentawareness(Bishopetal.,2004;Brown&Ryan,2004;Shapiro,Carlson,Astin&
Freedman,2006).Nevertheless,itispossibletotargetthesetechniquesindependently
anddifferenttheoriesofcravingmakedifferentialpredictionsabouttheirrelative
importance.Forthisreason,thecurrentreviewisguidedbytheemphasiseachstudy
placesoneachofthesethreedifferentcomponents.
MINDFULNESS
6
Thereviewbeginsbylookingatthewaysinwhichmindfulnessrelatesto
selectedtheoriesofcraving,inordertoidentifypotentialmechanismsofactionand
specificpredictionsthatcanbeexperimentallytested.Itthenexaminesstudiesof
mindfulnessandcravinginlightofthesetheorieswithaviewtoidentifyingfuture
directionsformoreexperimentalworkintheareaaswellasinformingthedevelopment
ofmoreevidence-basedmindfulnessinterventionsdesignedtotacklecravings.
TheoriesofCraving
Awiderangeofdifferenttheoriesandmodelshavebeenputforwardtoaccount
forcravings(seeSkinner&Aubin,2010).Afulldiscussionoftheseisbeyondthescope
ofthecurrentarticle;onlythosewithrelevancetothepotentialimpactofmindfulness
practiceoncravingwillbeconsideredhere.Thesearegroupedunderthebroad
headingsofconditioning-basedmodels,cognitivemodels,andBuddhistmodels.
Conditioning-basedmodels.Conditioning-basedmodelsdrawonclassicalor
Pavlovianconditioning.Theystatethatcuesthatpredicteitherdruguseitself,or
withdrawalfromadrugcancometoelicitphysiologicalresponsesthatoccurduetouse
ofthedrug,orinhomeostaticresponsetotheuseofthedrug.Theseinturnresultina
feelingofcraving(Skinner&Aubin,2010).Suchmodelshavealsobeenappliedtofood
cravings(Jansen,Havermans&Nederkoorn,2011).Forexample,ifapersonalways
stopsforadoughnutontheirwaytowork,cuesassociatedwithtraveltoworkmay
eventuallycometoelicitinsulinandsalivaryresponses.Accordingtoconditioning-
basedmodels,thesewillbeexperiencedbytheindividualasacravingandtheywillbe
morelikelytoeat.Whereacueisassociatedwithdruguse,oreating,preventingthe
behavioralresponsewilleventuallyextinguishtheassociationwiththecue.Inother
words,thecuewillnolongerpredictdruguseoreatingandthereforewillnolonger
MINDFULNESS
7
elicitthephysiologicalresponseandtheexperienceofcraving.Accordingtosuch
models,cravingscouldalsobereducedbysimplyavoidingthecuesthatelicitthem.
Thusintermsofmindfulness,anystrategythatpromotesexposuretorelevant
cuesintheabsenceofthebehavioralresponsewill,accordingtosuchmodels,reduce
boththefrequencyandstrengthofcravingsthroughextinction.Thiscouldapplyto
acceptancestrategiesinwhichtheindividualisencouragedtoacceptuncomfortable
thoughtsandfeelingsratherthantrytoavoidorcontrolthem.Althoughsuchastrategy
wouldnothaveanyeffectoncravingsintheshortterm,wemayseeareductionovera
longertimeperiodifthetechniqueisconsistentlyappliedandprovidedtheindividual
managestosuccessfullyinhibitthebehavioralresponse.Iftheindividualisunableto
suppressthebehaviorwewouldnotexpecttoseeanychangeinlevelofcraving.
However,itisunclearwhetherthistechniquewouldbeanymoresuccessfulcompared
tootherprogramsormotivationalstrategiesthatpromoteresponsesuppression(e.g.
Jansenetal.,2011).Onewayinwhichitmightbemoreeffectiveisifitleadsto
increasedexposuretoconditionedstimuli.Forexample,iftheindividualisencouraged
toacceptcravingsratherthantrytoavoidthem,theymaybemorewillingtomaintain
exposuretorelevantcues.Thisinturnwouldleadtomorerapidextinction,again
assumingtheindividualisabletoresistthetargetsubstance.Thesametypeofeffects
mayalsoapplytopresentmomentawarenesstechniquesthatdirecttheindividual’s
attentiontorelevantcues(whichmaybeinternal,suchasnegativemood,aswellas
external);providingthebehavioralresponseisinhibited,increasedexposuremaylead
tomorerapidextinctionandhencetoarelativelyfasterreductioninthefrequencyand
strengthofcravings.
Onepotentialdifficultywiththistypeofstrategyinrelationtofoodcravings,is
thatindividualsneedtoeat.Thismeansthatitmaybedifficulttoconsistentlyinhibit
MINDFULNESS
8
eatinginresponsetoaparticularcue.Forexample,ifoneisapplyinganacceptance
strategytochocolatecravingsingeneral,butisaimingtoreduce,ratherthanquiteating
chocolate,effectsoncravingsmaybemorelimitedsinceontheoccasionswhen
chocolateiseaten,associationsbetweencues(e.g.thesightofchocolate)andeatingwill
inevitablybestrengthened.Acceptanceandpresentmomentawarenessstrategiesmay
bemoresuccessfulatreducingcravingswheretheyareusedtotargetaveryspecific
cue-responseassociation,andwheretheindividualispreparedtocompletelyquitthat
specificresponse,suchaseatingachocolatebarduringamid-morningcoffeebreak.
Nevertheless,evenwheresuchstrategiesareappliedmoregenerally,iftheindividual
successfullymanagestoinhibittheireating,thismayincreaseself-efficacyinrelationto
resistingcravings.Sinceself-efficacyisanimportantdeterminantofbehaviorchange
(Bandura,1998;Teixeiraetal.,2015)thismayhelppromotereducedconsumption.
Underthesecircumstanceswemayseechangesineatingbehaviorintheabsenceofany
changeincravings.Indeed,thereissomeevidencetosupportthistypeofdecoupling
effectinresearchonsmoking,amongparticipantswhohavesimplycutbackon
smokingratherthanabstainedcompletely(Bowen&Marlatt,2009;Elwafi,Witkiewitz,
Mallik,Thornhill&Brewer,2013,seealsoLevin,Luoma&Haeger,2015).
Cognitivemodels.Whilstcognitivemodelsofcravingmayincludereferenceto
conditioningprocesses,theydifferfromconditioningmodelsinthattheyalsoassume
thathigherordercognitiveprocesses,suchasattentionandmemoryplayanimportant
roleinthecravingresponse.Thethreecognitivemodelswithmostrelevancefor
mindfulnesspracticearethecognitiveprocessingmodel(Tiffany,1990;Tiffany&
Conklin,2000),theelaboratedintrusiontheoryofdesire(Kavanagh,Andrade&May,
2005;May,Andrade,Kavanagh&Hethrington,2012;Mayetal.,2015),andthetheoryof
groundedcognition(Barsalou,2008).Thesewilleachbeconsideredinturn.
MINDFULNESS
9
Cognitiveprocessingmodel.Thecognitiveprocessingmodel(Tiffany,1990;
Tiffany&Conklin,2000)wasdevelopedtoaccountfordrugaddiction.Itstatesthatin
theaddict,druguseiscontrolledbyactionplansthatarestoredinmemoryandcarried
outinanautomaticmanner.Accordingtothistheory,episodesofcravingonlyarise
whensomethinginterruptstheexecutionofthisactionplan,preventingtheindividual
fromconsumingthedrug.Thismayoccurbecauseofanexternalevent,suchasthedrug
beingunavailable,orasaresultoftheindividual’sinternaleffortstoabstainfromthe
drug.
Accordingtothistheory,episodesofcravingarenotcausallyrelatedtodruguse
orrelapseandthereforeeffortstoreducecravingareunlikelytoimpactupondruguse
behavior.Instead,thetheorysuggeststhatinterventioneffortsshouldbefocusedon(a)
removingthestimulithatelicittheactionplans,or(b)protectingorenhancingthe
processingresourcesthatareneededtoinhibittheexecutionoftheactionplan(Tiffany
&Conklin,2000).Mindfulness-basedpresentmomentawarenesstechniquesare
relevantforthistheorybecauseoftheiremphasisonbecomingawareofwhatis
happeningatthatmomentintime,inotherwordsbringingconsciousawarenessto
whatmightotherwisebeautomaticprocessesandbehaviors.Thusforanindividual
whoismotivatedtoabstainfromdrugs,increasedpresentmomentawarenessmayhelp
betterenablethemtorecognizewhentheyareabouttoautomaticallyconsumeadrug
whichwouldinturnallowthemtoinhibittheaction;inotherwords,mindfulnessmay
increaseaperson’sabilitytoregulateautomaticbehaviours.However,althoughthis
mightleadtoareductionindrugusebehaviorwewouldexpectthistobecoupledwith
anincreasedfrequencyinepisodesofcraving.
Elaboratedintrusiontheoryofdesire.Theelaboratedintrusion(EI)theoryof
desire(Kavanaghetal.,2005;May,Andrade,Kavanaghetal.,2012;Mayetal.,2015)
MINDFULNESS
10
emphasizestheroleofcognitiveprocessesintheexperienceandmaintenanceof
episodesofcraving.Inkeepingwithconditioningmodels,itmaintainsthattheinitial
sourceofcravingsarelearnedassociationsbetweenspecificinternalorexternalcues
andaparticularbehavior(e.g.eating).These,togetherwithassociatedphysiological
responses,mayresultinintrusivethoughts.Whenthesethoughtselicitpowerful
affectivereactions,orasenseofdeficit,theyleadtocognitiveelaboration.Cognitive
elaborationisacontrolledprocessinwhichrelevantinformationissoughtfrom
memorythenmanipulatedinworkingmemoryinordertoconstructvividsensory
imagesrelatedtotheobjectofdesireanditsacquisition.AccordingtoEItheory,itisthis
cognitiveelaborationthatisexperiencedasdesireorcravingand,becauseofthe
similaritybetweenmentalimageryandrealcues,italsoservestomaintainand
augmentcraving.Thusaccordingtothismodel,anythingthatpreventsorinterruptsthe
elaborativeprocesseswillservetopreventorlimitthedurationofthecravingepisode.
Intermsofmindfulnesstechniques,bothpresentmomentawarenessand
decenteringstrategiesmayservethisfunction.Attendingtopresentmoment
experiencemaymeanthatattentionalprocessesaredirectedtowardarangeof
differentsensoryinputs,ratherthaninternalimageconstruction.Thismaypreventthe
elaborationofintrusivethoughts,andthuspreventcravingfromoccurring.Oritmay
interruptacravingepisode,restrictingitsduration.Aswithconditioning-basedmodels
ofcraving,ifthistechniqueisrepeatedlypracticed,withthebehavioralresponse
repeatedlysuppressed,associationsbetweencuesandtherelevantbehaviorwillbe
extinguishedsuchthattherewillbefewerintrusivethoughts,andareductioninthe
frequencyofcravingepisodes.Thetechniqueofdecenteringmayhaveasimilareffect;
encouragingapersontoseetheirthoughtsassimplythoughtsmayinterrupttheir
elaboration.Forexample,ifthoughtsaboutthepleasurablesmellofcigarettesmokeare
MINDFULNESS
11
followedbyanawarenessofthisassimplya‘thought’,thismaybemorelikelytobe
followedbythoughtsaboutabstinence-relatedgoals,ratherthanthoughtsaboutthe
satisfyingeffectsofsmokingacigarette(Tapper&Ahmed,2015).However,itisnot
clearthatthesestrategiesofpresentmomentawarenessanddecenteringwould
necessarilybemoresuccessfulthanothertechniquesthatpreventorinterrupt
elaboration,suchasdivertingattentionorengagingintasksthatloadworkingmemory
(e.g.Kemps&Tiggemann,2007;2013;VanDillen,Papies&Hofmann,2013).
Intermsofacceptancestrategies,accordingtoEItheory,itispossiblethatthey
mayactuallyexacerbatecravings;ifanindividualis,intheabsenceofanyother
instruction,encouragedtoaccepttheirthoughtsandfeelings,thismayresultinthem
engaginginmoreelaboration,whichmayinturnincreaseboththestrengthand
durationofthecravingepisode.
NegativeaffectalsoplaysanimportantroleinEItheory;byincreasingthe
individual’ssenseofdeficititincreasesthelikelihoodthatintrusivethoughtswillbe
elaborated.Thereisevidencetosuggestthatmindfulnesscanimproveemotional
regulationanddecreasenegativeaffect(Chambers,Gullone&Allen,2009).Arangeof
differentmechanismshavebeenputforwardtoexplainthiseffect,includingreduced
rumination(Williams,2008),reducedreactivitytopotentiallyemotivestimuli
(Chambersetal.,2009),exposureandextinctionprocesses(Hölzeletal.,2011)and
positivereappraisal(Garland,Gaylord&Park,2009;Hölzeletal.,2011).Assuch,
reductionsinnegativeaffectrepresentsanadditionalpathwayviawhichmindfulness
strategiesmayreducethefrequencyanddurationofcravingepisodes.However,such
processesareunlikelytobecapturedinalaboratorysetting.
Additionally,presentmomentawarenessexercisestypicallyinvolveattention
regulation.Continuedmindfulnesspracticemaythereforeresultinimprovementsin
MINDFULNESS
12
attentionregulation(Chiesa,Calati&Serretti,2011;Mrazek,Franklin,Phillips,Baird&
Schooler,2013).ConsistentwithEItheory,thisimprovedattentionregulationcould
impactuponcravingviaanumberofdifferentpathways.First,thereissomeevidenceto
suggestthatmindfulnesspracticemayhelpreduceattentionalbiastowardsubstance-
relatedstimuli(Garland,Boettiger,Gaylord,Chanon&Howard,2012;Garland&
Howard,2013),presumablybyenhancingattentionaldisengagement(Garland,
Froeliger&Howard,2014).Researchsuggeststhat,inkeepingwithEItheory,
attentionalbiasandcravinghavereciprocaleffectsononeanother,suchthat
attentionalbiascanincreasecravingandincreasesincravingcanalsoleadto
attentionalbias(Field&Cox,2008;Fieldetal.,2016).Assuch,ifmindfulnesspractice
canimproveattentionaldisengagement,andindoingsoleadtoreductionsin
attentionalbias,itshouldalsoresultinreducedcravingfrequency.
Asimilarprocesscouldalsocomeintoeffectafteracravingepisodehasbeen
initiatedsinceimprovedattentionaldisengagementcouldenhancetheindividual’s
abilitytodiverttheirattentionawayfromelaborativeprocessesinvolvedinthe
constructionofsensoryimages.Assuchwemayseereductionsinthedurationof
cravingepisodes.
Finally,thetwoprocessesoutlinedabove(divertingattentionawayfromstimuli
thatelicitcraving,anddivertingattentionawayfromelaborativeprocessesinvolvedin
themaintenanceofcraving)couldalsobeappliedtostimuliandruminationassociated
withnegativeaffect.Assuch,improvedattentionregulationcouldalsoreducecraving
viaareductioninnegativeaffect,asdetailedpreviously.
Thus,accordingtoEItheory,mindfulnesspracticecouldhelplimitthefrequency
anddurationofcravingepisodesviaimprovementsinattentionregulation.However,
MINDFULNESS
13
wewouldonlyexpectsucheffectstooccurafteracertainperiodofrepeated
mindfulnesspractice.
Theoryofgroundedcognition.Thefinalcognitivetheorythatwillbe
consideredhereisthetheoryofgroundedcognition(Barsalou,2008).Accordingtothis
theory,individualsdrawonpreviousexperiencetosimulateinteractingwithstimuli
theyencounterintheirenvironment,andthesestimulatesimilarareasofthebrainto
realinteractions,triggeringassociatedbodilyresponses,increasingbothconscious
desireandappetitivebehaviorsoutsideofconsciousawareness(Papies&Barsalou,
2015).Accordingtothistheory,applyingthemindfulnesstechniqueofdecentering,
shouldhelpreducethebelievabilityofthesementalsimulations,andindoingsoreduce
theextenttowhichtheyelicitdesire.Assuchweshouldseeimmediateeffectsonthe
strengthofcravingepisodes.Again,wherethesearecoupledwithsuppressionofthe
behavioralresponse,weshouldalsoeventuallyseereducedcravingfrequency,dueto
extinctionprocesses.
Buddhist-basedmodels.Severalacademicshaveproposedmodelsofcraving
anddesirederivedfromtraditionalBuddhistaccounts(Breweretal.,2013;Grabovac,
Lau&Willett,2011).Interestingly,thesearesimilartoEItheoryinthatcravingis
conceptualizedasacognitiveresponsetoautomatic,conditionedassociations.
AccordingtoBuddhisttexts,perceptualstimuliorthoughtsresultinautomaticaffective
reactions,basedonourpreviousexperiencewiththose,orrelatedstimuli.These
affectivereactionsleadtomentalelaborationandafeelingofdesire(orcraving),either
tomaintainpositivefeelingsoravoidnegativefeelings.Thisfeelingofdesiremotivates
aparticularbehavioralresponse.Wherethisbehaviorisreinforced(i.e.through
maintenanceoravoidanceofpositiveornegativefeelingsrespectively),ahabitmay
starttoemerge(Breweretal.,2013;Grabovacetal.,2011).Forexampleif,uponvisiting
MINDFULNESS
14
anewbar,wesampledandenjoyedanexoticliqueur,onournextvisitthesightsand
soundsofthebarmayelicitafeelingofpleasureassociatedwiththetasteoftheliqueur.
Thisfeelingofpleasuremayleadtoadesiretomaintainthispleasure.Thedesire
comprisesboththoughtsandemotionsandisexperiencedasacraving.Thecraving
leadsustoorderaglassoftheliqueur,whichisenjoyableandsoreinforcesthe
behaviorofdrinkingliqueurinthisparticularbarinordertomaintainafeelingof
pleasure.Withrepetitionwemaygetintothehabitofalwaysdrinkingthisparticular
liqueurinthisparticularbar.
Accordingtothisaccountthereareseveralwaysinwhichmindfulnesspractice
influencescravings.First,similartoEItheory,Buddhist-basedmodelsstatethatan
individualcanonlymaintainattentionononeobjectatatime.Thusincreasingpresent
momentawarenessofperceptualstimuli,and/orouraffectivereactiontothese,will
preventthesubsequentthoughtsandreactionsthatconstitutecraving(Grabovacetal.,
2011).Assuch,weshouldseeareductioninthefrequencyanddurationofepisodesof
craving.AccordingtoGrabovacetal.(2011),anattitudeofacceptancefacilitatesthe
individual’sabilitytomaintaintheirattentionontheirpresentmomentexperienceasit
helpspreventnegativethoughtssuchasself-judgment.Assuchwewouldnotexpect
acceptancestrategiesalonetoinfluencecravingbutwewouldexpectacceptanceplus
presentmomentawarenesstoreducethefrequencyanddurationofcravingepisodesto
agreaterextentthanjustpresentmomentawareness.
Additionally,Buddhist-basedmodelssuggestthatbymorecloselyobserving
theiraffectivereactions,theindividualdevelopsaninsightintotheircauses,their
transientnatureandthefutilityofattemptingtosustainoravoidthem.Thisincreased
metacognitiveawarenessmotivatestheindividualtoavoidactingontheircravings
(Breweretal.,2011;Grabovacetal.,2011).Assuch,whereanindividual’scraving
MINDFULNESS
15
relatedbehaviorisatoddswiththeirgoals,wewouldexpecttoseeadecoupling
betweencravingandbehavior,withepisodesofcravingnolongerpredicting
consumption.Eventually,becausecravingisnolongerbeingreinforced,wewouldalso
expecttoseeareductionincravingfrequencyandstrength.
Summaryofkeypredictionsbasedonmodelsofcraving
Table1providesasummaryofkeypredictedeffectsofdifferentmindfulnessstrategies
oncravingaccordingtothemodelsdescribedabove.
Table1.
Keypredictedeffectsofpresentmomentawareness,acceptanceanddecenteringstrategies
oncravingfrequency,strengthanddurationovertheshort,mediumandlongterm
accordingtodifferentmodelsofcraving.
Mindfulnessstrategy
Relativepointatwhicheffectshouldappear
Typeofeffectoncraving
Model(s)thatpredictsuchan
effectPresentmomentawareness
Immediate Reducedfrequencyandduration
EI;Buddhist
Mediumterm Increasedfrequency(whereindividualismotivatedtoinhibitcraving-relatedbehavior)
Cognitiveprocessing
Mediumterm Decouplingoftherelationshipbetweencravingandcraving-relatedbehavior
Buddhist
Mediumtolongterm
Reducedfrequencyandstrength(wherecraving–relatedbehaviorisconsistentlysuppressed)
Conditioning;EI,Buddhist
Mediumtolongterm
Reducedfrequencyandduration(viaimprovedattentionregulation)
EI
Acceptance Immediate Increasedstrengthandduration
EI
Immediate Reducedfrequencyandduration(whenemployedwithpresentmomentawareness)
Buddhist
Mediumtolong Reducedfrequencyand Conditioning
MINDFULNESS
16
term strength(wherecraving-relatedbehaviorisconsistentlysuppressed)
Mediumtolongterm
Reducedfrequencyandstrength(whenemployedwithpresentmomentawarenessandwherecraving-relatedbehaviorisconsistentlysuppressed)
Buddhist
Decentering Immediate Reducedfrequencyandduration
EI
Immediate
Reducedstrength Groundedcognition
Mediumtolongterm
Reducedfrequencyandstrength(wherecraving-relatedbehaviorisconsistentlysuppressed)
EI
Mediumtolongterm
Decouplingoftherelationshipbetweencravingandcraving-relatedbehavior
Buddhist
Table1illustratesthewaysinwhichdifferentmodelsmakedifferentpredictions.For
example,EItheoryandBuddhistmodelsaretheonlyonesthatpredictimmediate
reductionsincravingasaresultofincreasedpresentmomentawareness,thecognitive
processingmodelistheonlyonetopredictincreasedcravingasaresultofpresent
momentawareness,andEItheoryistheonlyonethatpredictsimmediateincreasesin
cravingasaresultofacceptancestrategies.Likewise,Buddhistmodelsaretheonly
modelstoexplicitlypredictadecouplingbetweencravingandcraving-relatedbehavior
andEItheoryandgroundedcognitionareuniqueinpredictingimmediatereductionsin
cravingasaresultofdecentering.Thenextsectionreviewsrelevantstudieson
mindfulnessandcravinginlightofthesepredictions.
EffectsofMindfulnessonCraving
Literaturesearchandstudyselection.AliteraturesearchofEnglishlanguage
publicationswasconductedduringMay2016usingWebofScienceandthesearch
MINDFULNESS
17
terms‘mindful*’,‘attentiveeating’and‘intuitiveeating’,eachpairedwiththeterms
‘craving’,‘desire’and‘urge’.ThissearchwasrepeatedinMay2017andSeptember2017
toidentifyanyadditionalpublications.Thesesearchesledtotheidentificationof294
records.Thetitlesandabstractsofthesewerereviewedand250wereexcludedonthe
basisofatleastoneofthefollowing:(a)nomindfulnessmanipulation,(b)nocontrolor
comparisongroup,(c)nocravingordesirerelatedoutcome,(d)anon-ingestivecraving
ordesirerelatedoutcome(e.g.sexualdesireorgambling),(e)meetingabstract
providinglimitedinformation.Theremaining44paperswereexaminedinfull.Ofthese,
27wereexcludedonthegroundsthatthey(a)combinedmindfulnesswithnon-
mindfulnesstechniques,(b)didnotincludeacravingrelatedoutcome,(c)hadno
controlorcomparisongroupand/or(d)reportedsecondaryanalysisofdataalready
includedinthereview.Afurthersixpaperswereidentifiedfromthereferencesections
ofthesepublicationsandalsoexaminedinfull.Twooftheseweresubsequently
excludedforhavingnocravingrelatedoutcomeandexaminingnon-ingestiverelated
craving.Anadditionalfivepaperswereidentifiedonthebasisofauthorknowledge.
Thisresultedinatotalof26publications,describing30studies,16ofwhich
examinedfood-relatedcravings,11cravingsforcigarettes,andthreecravingsfor
alcohol.ThekeyfeaturesofthesestudiesaresummarizedinAppendixA.Theyare
orderedaccordingtothetimeperiodoverwhichcravingswereassessed.Unless
otherwisestated,measuresofcravinganddesireprimarilyrefertostrengthofcraving
whilstmeasuresof‘traitcraving’includeassessmentsofstrength,frequencyand
duration.
Immediateeffects.Atotalof21studiesincludedmeasuresofcravingtaken
eitherduringorimmediatelyfollowingthemindfulnessmanipulation(seeAppendixA).
Withinthese21studiestherewereatotalof44comparisons;14showedsignificantly
MINDFULNESS
18
lowerlevelsofcravinginthemindfulnessconditioncomparedtoacontrolcondition
(Caselli,Gemelli,Spada&Wells,2016;Cropley,Ussher&Charitou,2007;Hamilton,
Fawson,May,Andrade&Kavanagh,2013;May,Andrade,Willoughby&Brown,2012;
Schumacher,Kemps&Tiggemann,2017;Ussher,Cropley,Playle&Mohidin,2009;
Westbrooketal.,2013),oneshowedatrendinthisdirection(Papies,Pronk,Keesman&
Barsalou,2015),22showednodifference(Adamsetal.,2013;Alberts,Thewissen&
Middelweerd,2013;Archetal,2016;Bowen&Marlatt,2009;Fisher,Lattimore&
Malinowski,2016;Hamiltonetal.,2013;May,Andrade,Batey,Berry&Kavanagh,2010;
Murphy&MacKilop,2014;Schumacheretal.,2017;Szasz,Szentagotai&Hofmann,
2012;Ussheretal.,2009;Vincietal.,2014),sixshowedahigherlevelofcravinginthe
mindfulnesscondition(Albertsetal.,2013;Archetal.,2016;Mayetal.,2010;Murphy&
MacKilop,2014;Szaszetal.,2012;Vincietal.,2014;),andoneshowedatrendinthis
direction(Archetal.,2016).Thus,takentogether,theseresultsfailtoprovide
compellingevidenceforanimmediatebeneficialeffectofmindfulnessoncraving.
However,giventhediversityofmindfulnessstrategiesandcomparisonconditions
employedinthesestudies,itisworthexaminingthemmoreclosely.
Ofthe15comparisonsthatshowedsignificantornearsignificantbenefitsof
mindfulness,fiveemployedpresentmomentawareness(Cropleyetal.,2007;Hamilton
etal.,2013;May,Andrade,Willoughbyetal.,2012;Ussheretal.,2009),oneemployed
bothpresentmomentawarenessandacceptance(Westbrooketal.,2013)andnineused
decentering(Casellietal.,2016;Papiesetal.,2015;Schumacheretal.,2017).However,
thecontrolconditionsin12ofthese15comparisonscomprisedlisteningto(asopposed
todecenteringfrom)apre-recordedaudioofalcoholrelatedthoughts(Casellietal.,
2016),listeningtoanaudiorecordingofanaturalhistorytext(Cropleyetal.,2007;
Ussheretal.,2009),nostrategy(Westbrooketal.,2013),mindwandering(Hamiltonet
MINDFULNESS
19
al.,2013;May,Andrade,Willoughbyetal.,2012;Schumacheretal.,2017)andviewing
picturesoffoodinarelaxedmanner(asopposedtodecenteringfromreactionstothem;
Papiesetal.,2015).Thus,arguably,thesestudiesmaynothavecontrolledforthe
additionalworkingmemoryloadthemindfulnessstrategieslikelyentailed.Asnoted
previously,accordingtoEItheoryanystrategythatengagesworkingmemory,
particularlythevisuospatialsketchpad,willpreventtheelaborationofintrusive
thoughtsandindoingsoreducecravings.Assuchwecannotbecertainthatthe
mindfulnessstrategiesbroughtaboutreductionsincravingoverandabovewhatmight
havebeenachievedwithotherstrategiesthatplacedanequivalentloadonworking
memory,forexamplevisualizationstrategies.
Outofthe44comparisons,14specificallyusedcontrolconditionsthatarelikely
tohavedrawnonvisualworkingmemory,throughtheuseofguidedimagery,imagery
diversion,wordpuzzlesandisometricexercises(Archetal.,2016;Fisheretal.,2016;
Hamiltonetal.,2013;Mayetal.,2010;Schumacheretal.,2017;Ussheretal.,2009).Of
these14comparisonsninefoundnodifferencebetweenthemindfulnessandcontrol
conditions(Archetal.,2016;Hamiltonetal.,2013;Mayetal.,2010;Schumacheretal.,
2017;Ussheretal.,2009),threefoundlowerlevelsofcravinginthemindfulness
condition(Schumacheretal.,2017),onefoundhigherlevelsofcravinginthe
mindfulnesscondition(Archetal.,2016),andonefoundatrendinthisdirection(Arch
etal.,2016).Thethreecomparisonsthatfoundlowerlevelsofcravinginthe
mindfulnessconditionusedadecenteringtechnique(Schumacheretal.,2017).These
findingssupportthetheoryofgroundedcognitionthatpredictsthatdecenteringwill
havebeneficialeffectsoverandaboveguidedimagery.However,areplicationofthis
studyfailedtoshowanysignificantdifferencesbetweenthesetwoconditions
(Schumacheretal.,2017).Thestudiesthatusedpresentmomentawarenesstechniques
MINDFULNESS
20
(Archetal.,2016;Fisheretal.,2016;Hamiltonetal.,2013;Mayetal.,2010;Ussheret
al.,2009)allfoundnodifferenceincraving,orhigherlevelsinthemindfulness
condition.TheseresultsareconsistentwithEItheoryinthattheysuggestthatpresent
momentawarenessdoesnotleadtoimmediatereductionsincravingsoverandabove
whatcanbeachievedviaothertechniquesthatalsopreventtheelaborationofcraving-
relatedthoughts.
Afurtherthreestudiesusedlisteningtoaudioasacontrolcondition,eithera
naturalhistorytext(Cropleyetal.,2007;Ussheretal.,2009),oradescriptionofa
rainforest(Fisheretal.,2016).Onemightexpectthesetoeffectivelypreventthe
elaborationofcraving-relatedthoughtsonlyinsofarastheyincludedvisualimageryand
engagedparticipants’attention.Wherepresentmomentawarenesswascomparedto
thedescriptionofarainforestitshowednorelativereductionsincravingontwo
separateoccasions(Fisheretal.,2016);whereitwascomparedtolisteningtoanaudio
recordingofanaturalhistorytext,bothstudiesshowedgreaterreductionsincravingin
thepresentmomentawarenesscondition(Cropleyetal.2007;Ussheretal.,2009).
Arguablyhowever,thenaturalhistorytextemployedinthelattertwostudies(Natural
HistoryandAntiquitiesofSelborne,firstpublishedin1789)maynothavefullyengaged
theparticipants’attentionortheirvisualworkingmemory.
Intermsofthetypesofmindfulnessstrategiesemployedacrossthese21studies,
16involvedsometypeofpresentmomentawareness,forexampleofbodilysensations,
cravingsorthesensorypropertiesoffood.Justonestudy(Szaszetal.,2012)attempted
tomanipulateacceptanceinisolationandthisshowednosignificanteffectoncravings
comparedtothosewhoengagedinthoughtsuppression,andincreasedcravings
comparedtothosewhoengagedinreappraisal.Fourstudiesmanipulateddecentering
inisolation(Casellietal.,2016;Papiesetal.,2015;Schumacheretal.,2017).Asnoted
MINDFULNESS
21
previously,whilstoneofthesestudies(Schumacheretal.,2017)showedbeneficial
effectsofdecenteringoverandaboveguidedimagery,thiseffectwasnotreplicatedina
secondstudy(Schumacheretal.,2017).Alsoasnotedpreviously,althoughtwoother
studiesalsoshowedlowercravingsinthemindfulnesscondition(Casellietal.,2016;
Papiesetal.,2015),itispossiblethattheeffectsweredrivenbyworkingmemoryload
ratherthanthedecenteringstrategyperse.Furtherresearchwouldbeneededto
explorethisinterpretationaswellasestablishanyimmediatebenefitsofdecentering
overandaboveguidedimagery.
Thusintermsofrelevanttheoriesofcravings,identifiedinTable1,theresults
arebroadlyconsistentwithEItheory;wherepresentmomentawarenessand
decenteringstrategieshavebroughtaboutimmediatereductionsincraving,thismaybe
becausetheyentailedagreaterloadonworkingmemorythatinterruptedelaborative
processes;wherepresentmomentawarenessstrategieshavebeencomparedtoother
strategiesthatalsoengageworkingmemory,theylosetheiradvantage.Additionally,
consistentwithEItheory,theonlystudytoattempttoexamineacceptanceinisolation,
foundthatitincreasedcravingsrelativetoareappraisalstrategy(Szaszetal.,2012).
Theothertwotheoriesthatrelatetotheimmediateeffectsofmindfulnessare
groundedcognitionandBuddhistmodels.Groundedcognitionpredictsthatdecentering
strategieswouldproduceimmediatereductionsincraving,andwhilstthreestudies
haveshownsucheffects(Casellietal.,2017;Papiesetal.,2015;Schumacheretal.,
2017),asmentionedpreviouslyonlyoneofthesestudiescompareddecenteringwith
guidedimageryandtheadvantageofdecenteringwasnotreplicatedinasecondstudy
(Schumacheretal.,2017).Assuch,furtherresearchwouldbeneededtotestthis
predictionanddistinguishbetweenanEIversusgroundedcognitionaccountof
decenteringeffects.Likewise,itisdifficulttodrawanyfirmconclusionsaboutBuddhist
MINDFULNESS
22
modelsfromthesestudies.Buddhistmodelswouldpredictimmediatereductionsin
cravingasaresultofpresentmomentawarenessstrategies,withacceptanceenhancing
theseeffects.Althoughsucheffectsarenotsupportedbythestudiesreviewedhere,itis
importanttonotethatinnoneofthesestudiesdidparticipantsreceivemindfulness
training;theywereinsteadsimplyprovidedwithbriefinstructiontohelpthememploy
aspecifictechnique.Itispossiblethatsuchtechniquescanonlybeemployedeffectively
withacertainamountofpractice.Assuchonecouldarguethattheseparticularstudies
arenotagoodtestofBuddhistmodelsofcraving.Furtherresearchlookingatthe
immediateeffectsofpresentmomentawarenessstrategies,amongindividualswho
havereceivedsometraininginthistechnique,wouldbeamoreappropriatetest.
Latereffects:within24hours.Twelvestudiesincludedmeasuresofcraving
takenatleast5minutesafterthemanipulation,butwithin24hours.Ofthesetwelve
studies,oneshowedsignificantbeneficialeffectsofthemindfulnessstrategy
(Schumacheretal.,2017),fiveshowednosignificanteffectsofthemindfulnessstrategy
(Bowen&Marlatt,2009;Fisheretal.,2016;May,Andrade,Willoughbyetal.,2012;May
etal.,2010),fourshowedamixofsignificantbeneficialeffectsandnon-significant
effects(Cropleyetal.,2007;Ussheretal.,2009;Nosen&Woody,2013;Schumacheret
al.,2017)andtwoshowedamixofsignificantdetrimentaleffectsandnon-significant
effects(Albertsetal.,2013;Szaszetal.,2012).Thusonceagain,takentogether,the
overallevidenceforaneffectofmindfulnessoncravingisnotverycompelling.
Ofthefivestudiesthatfoundsignificantbeneficialeffects,twoarethose
discussedpreviouslythatcomparedapresentmomentawarenessstrategywith
listeningtoanaudiorecordingofanaturalhistorytext(Cropleyetal.,2007;Ussheret
al.,2009).Assuchonecannotruleoutthepossibilitythatthemindfulnessmanipulation
exerteditseffectsimplybyloadingworkingmemory.Nevertheless,thesestudies
MINDFULNESS
23
provideausefulinsightintothetimecourseofsucheffects;inoneofthesestudies,
reducedcigarettecravingextendedto5minutesafterthemanipulation,buthad
disappearedby10minutes(Cropleyetal.,2007),whilstintheotherstudyreduced
cigarettecravinginside(butnotoutside)thelaboratorywasstillmaintainedwhen
assessed30minutesafterthemanipulation(Ussheretal.,2009).Thesefindingscould
beinterpretedasindicatingthatstrategiesthatinterrupttheelaborationofcraving-
relatedthoughtsmayhavebenefitsthatextendbeyondthepointatwhichtheyare
implemented.Thiscouldbeduetoareductioninthelikelihoodofcraving-related
intrusivethoughtsafterthemindhasbeenoccupiedwithunrelatedsubjectmatter.This
interpretationwouldbeconsistentwiththefactthateffectsweremoreshort-lived
outsidethelaboratory(Ussheretal.,2009)whereonewouldexpectparticipantstobe
exposedtoagreaternumberofcuesthatwouldelicitsmoking-relatedintrusive
thoughts.
Twoofthestudiesthatfoundsignificantbeneficialeffectsarealsothose
discussedpreviouslythatcompareddecenteringwithbothguidedimageryandmind
wanderingconditions(Schumacheretal.,2017).Inoneofthesestudiesthedecentering
strategymaintainedreducedlevelsofcravingintensity10minutesafterthe
manipulation,relativetobothmindwanderingandguidedimageryconditions.Inthe
secondstudythedecenteringstrategywasonlysuperiortothemindwandering
condition.
Thefifthstudythatfoundbeneficialeffectsformindfulness(Nosen&Woody,
2013)compared60-90minuteinstructioninpresentmomentawarenessand
acceptanceofcigarettecravingswiththeprovisionofstandardpsycho-educational
materialornotreatment.Eightassessmentofsmokingurgeswerethenmadeacrossthe
courseof1-dayperiodofadlibsmokinganda1-dayperiodthatcoincidedwithaquit
MINDFULNESS
24
attempt.Whilsttherewerenosignificantdifferencesincravingsbetweenthethree
groupsduringtheperiodofadlibsmoking,duringthequitattemptthepatternof
cravingsacrossthecourseofthedayvariedsuchthatduringtheevening,smoking
urgesweresignificantlyloweramongthoseinthemindfulnessgroupcomparedtoboth
thoseinthepsycho-educationalgroupandnotreatmentcontrol;butonlyamongst
participantswhosuccessfullymanagedtoabstainfromsmoking(n=122).Whenthose
whohadfailedtoabstainwereincludedintheanalysis(n=153),thesedifferences
disappeared.
TheseresultsareconsistentwithEI,conditioningandBuddhistmodelsof
cravingthatpredictthatwhereacraving-relatedbehaviorissuccessfullysuppressed,
cravingsmaysubsidemorerapidlywherepresentmomentawarenessandacceptance
strategiesareemployed,duetotheincreasedcontactwithconditionedstimulithat
presentmomentawarenessandacceptanceentail.However,itisimportanttonotethat
thisstudywasconductedwithsmokerswhowereattemptingtoquitsmoking;these
theorieswouldpredictthatsucheffectswouldbelesslikelytooccurforbehaviorsthat
onecannotcompletelyquit,forexampleasmayoccurinrelationtofoodrelated
cravings.Futureresearchwouldalsobeneededtoestablishwhetheramindfulness-
basedinterventionmaybemorelikelytoleadtorelapse,particularlyintheearlypartof
theintervention.
Again,themajorityofthetwelvestudiesthattookmeasuresofcravingwithina
24-hourperiodusedeitherpresentmomentawarenessoracombinationofpresent
momentawarenessandacceptance.Onlytwostudiesexamineddecentering
(Schumacheretal.,2017)andonlyonestudy(Szaszetal.,2012)attemptedtoexamine
acceptanceinisolation;thislatterstudyfoundincreasedcravingsrelativetoa
MINDFULNESS
25
reappraisalstrategyandnosignificantdifferenceincravingswhencomparedtoa
suppressionstrategy.
Thusagain,thesestudiesareconsistentwithEItheory,andconditioningmodels
ofcraving.Thereissometentativesupportforthetheoryofgroundedcognitionbut
furtherresearchwouldbeneededtoconfirmthis.Therearenostudieswithinthis
groupthattestspecificpredictionsmadebycognitiveprocessingtheory.
Latereffects:after24hours.Elevenstudiesincludedmeasuresofcraving
takenlaterthan24hoursaftertheinitialmanipulationorinterventiondelivery(see
AppendixA).Thetimeframeoverwhichthesemeasuresweretakenrangedfrom3
daysto7weeks.Ofthese11studies,threefoundsignificantreductionsincravinginthe
mindfulnessgroup(Albertsetal.,2010;Davis,Manley,Goldberg,Smith&Jorenby,
2014;Tang,Tang&Posner,2013),twofoundamixtureofsignificantandnon-
significantreductionsinthemindfulnessgroup(Lacaille,Zacchia,Bourkas,Glaser&
Knauper,2014;Ruscio,Muench,Brede&Waters,2016),fivefoundnosignificant
differences(Bowen&Marlatt,2009;Forman,Hoffman,Juarascio,Butryn&Herbert,
2013;Moffitt,Brinkworth,Noakes&Mohr,2012;Murphy&MacKilop,2014;Nosen&
Woody,2013;)andonefoundatrendtowardshighercravinginthemindfulnessgroup
(Hooper,Sanoz,Ashton,Clarke&McHugh,2012).However,ifwelookatthepatternof
significantandnon-significanteffectsaccordingtothetimeframeoverwhichcravingis
observed,aclearerrelationshipbeginstoemerge.Thethreestudiesshowingsignificant
reductionsinthemindfulnessgroupassessedcravingoverthelongestdurations:7
weeks(Albertsetal.,2010),6weeks(Davisetal.,2014),and2weeks(Tangetal.,
2013).Thesixstudiesshowingnosignificantdifferences,oratrendtowardhigher
cravinginthemindfulnessgroup,assessedcravingovertheshortestdurations,ranging
fromthreedays(Formanetal.,2013)tosevendays(Bowen&Marlatt,2009;Moffittet
MINDFULNESS
26
al.,2012;Murphy&MacKilop,2014).Thetwostudiesthatfoundamixtureofsignificant
andnon-significanteffectsassessedcravingovera2-weekperiod(Lacailleetal.,2014;
Ruscioetal.,2016).
Thereareseveralpossibleexplanationsforthispatternofresults;itmaybethat
thosestudiesthatwerecarriedoutoveralongertimeframeemployedhigherintensity
interventionsthatledtoparticipantsmoreeffectivelyimplementingthemindfulness
techniques.Similarly,participantsmayhaveacquiredtheseskillsonlyafteramore
extendedperiodofpractice.Alternatively,consistentwithconditioning,EIandBuddhist
modelsofcraving,itmaybethateffectsonlystarttoemergeafteracertainperiodof
practice.
Itisdifficulttoclearlydistinguishbetweenthesethreepossibilitiesonthebasis
ofthestudiesreportedinAppendixA.Thethreestudiesshowingsignificanteffects
includedthemostintensivemindfulnesspractice,equivalentto5hours(Tangetal.,
2013),morethan24hours(Davisetal.,2013)ora7-weekmanualthatparticipants
workedtheirwaythrough(Albertsetal.,2010).Bycontrast,inthestudiesthatfound
nosignificanteffects,instructionrangedfromwhatisdescribedas‘brief’(Murphy&
MacKilop,2014),to5-10minutes(Hooperetal.,2012),to2hours(Formanetal.,2013).
Additionally,allthestudiesthatreportedsignificantreductionsincravingonatleast
onemeasureaskedparticipantstorepeatedlypracticethetechniqueonadailybasisas
wellasapplythetechniqueeachtimetheyhadacraving.Thistypeofspecific
instructiontorepeatedlypracticethetechniqueisgenerallynotreportedinthose
studiesthatdidnotfindanysignificanteffects.Thusthosestudiesthatdidfind
significanteffectsarenotonlymorelikelytohaveassessedcravingoveralonger
timeframe,theyarealsomorelikelytohaveincludedmoremindfulnesspracticeandto
haveensuredparticipantswererepeatedlypracticingthesetechniquesonadailybasis.
MINDFULNESS
27
Onlyonestudy(Ruscioetal.,2016)tooklongitudinalmeasuresofcraving
allowingfortheassessmentofchangeovertime.Thisshowednoeffectofmindfulness
practiceonlevelsofcravingassessedatrandomtimesthroughouttheday.Cravings
assessedimmediatelyfollowinga20-minutemindfulnessmeditation,versusasham
meditation,weresignificantlylower,butthiseffectdidnotchangeovertime.Assuch,
andgiventhattheshammeditationincludedinstructionsto‘gobacktolettingyour
mindwanderfreely’,theeffectscouldbeexplainedbyworkingmemoryload.However,
thetimeframeforthisstudywasrestrictedtojust2weekssomaynothavebeen
sufficientforothereffectstoemerge.
Similarly,theotherstudiesthatshowedsignificanteffectsoncravingdidnot
necessarilycontrolfortheeffectsofworkingmemoryload.Asdiscussedpreviously,
accordingtoEItheory,anystrategythatloadsvisualworkingmemoryshouldreduce
craving.Lacailleetal.(2014)comparedmindfulnessstrategiestorecitingthealphabet
thenmultiplesof2suntil100,whichisunlikelytoinvolvesignificantamountsofvisual
workingmemory.LikewiseDavisetal.(2014)andAlbertsetal.(2010)compared
mindfulness-basedinterventionstostandardalternatives.Whilstthesewouldhelp
controlforimportantvariablessuchashaloeffectsandsocialsupport,theyareunlikely
tohaveincludedstrategiesthatloadedvisualworkingmemorytothesamedegreeas
thestrategiesemployedinthemindfulnessconditions.Thestudythatbestcontrolsfor
sucheffectsisoneconductedbyTangetal.(2013).Theycomparedmindfulness
meditationwithrelaxationtrainingthatinvolvedguidedrelaxation,focusedondifferent
partsofthebody.Participantscompleted10daily30-minutesessionsofeither
mindfulnessmeditationorrelaxationtraining.Resultsshowedsignificantlyreduced
levelsofcravingat2weekscomparedtobaselineinthemindfulnessconditionbutnot
intherelaxationcondition.Thesefindingsprovidesupportforthenotionthat
MINDFULNESS
28
mindfulnesscanbringaboutreductionsincravingoverandabovewhatmightbe
achievedbydistractionorsimplevisualizationstrategies.Theyprovidesupportfor
Buddhistmodelsofcravingthatsuggestthatincreasedmetacognitiveawarenesshelps
motivatetheindividualtoavoidactingupontheircravings,whichinturnresultsina
reductionincravingfrequencyandstrength.Thefactthatthisstudyalsofounda
significantreductioninsmokinginthemindfulnessgrouprelativetotherelaxation
groupisconsistentwiththisview.However,contrarytothisinterpretation,participants
werenotselectedonthebasisofwantingtoquitsmoking,andthosewhointendedto
quitdidnotoutperformthosewithnointentiontoquit,suggestingthattheeffectson
behaviormaybemediatedbyunconsciousprocessing.Theauthorssuggestthatthey
mayhavebeenmediatedbystressreduction,thoughanalternativeexplanationisthat
theeffectsofincreasedmetacognitiveawarenessreferredtoinBuddhistmodels
prompttheindividualtoavoidrespondingtofeelingsofcravingevenwheretheydonot
holdgoalsthatareincompatiblewiththerelevantbehavior;itispossiblethatinsight
intothefutilityofpursuingcravingsissufficientforbehaviorchange.
Mostofthestudieswithinthisgroupemployedacombinationofstrategies,or
used‘mindfulnessmeditation’(Tangetal.,2013),or‘generalmindfulnesstraining’
(Davisetal.,2014)thatarelikelytohaveincorporatedseveraldifferenttypesof
mindfulnessstrategy.TheexceptionsareHooperetal.(2012)andMoffittetal.(2012)
whoexamineddecenteringinisolationandfoundatrendtowardhighercravingsinthe
decenteringconditionandnosignificanteffectrespectively.Similarly,Lacailleetal.
(2014)compareddifferentcombinationsofpresentmomentawareness,acceptanceand
decentering.Aftertwoweekstheyfoundnosignificantdifferenceincravingsfor
chocolateamongthosewhohadbeeninstructedtouseacceptance(eitherwithpresent
momentawareness,orwithpresentmomentawarenessanddecentering)but
MINDFULNESS
29
reductionsamongstthosewhohademployedpresentmomentawarenessinisolation
orpresentmomentawarenessplusdecentering.Incontrasttothestudiesconductedby
Hooperetal.(2012)andMoffittetal.(2012),participantswereinstructedtolistento5
minutesofaudioeveryday.Again,inlinewithEItheory,thesefindingsquestionthe
utilityofacceptancestrategiesforcravingreduction,atleastwhenemployedinthe
contextoflimitedmindfulnesstrainingandinrelationtoabehavioroneisnotintending
toquitcompletely.
Asnotedabove,theresultsofthestudybyTangetal.(2013)providesome
supportforBuddhistmodelsofcraving.Unlikeothermodelsofcraving,Buddhist
modelsalsopredictadecouplingofcravingandcraving-relatedbehaviors(seealso
Levinetal.,2015).Inotherwords,craving-relatedbehaviorsmaydeclineeveninthe
absenceofanyreductionincraving.Thisisassumedtobebecauseofincreased
metacognitiveawareness.ResearchbyBowenandMarlatt(2009)supportsthisview.
Theylookedattheeffectsofabriefpresentmomentawarenessandacceptance
interventiononsmokersinterestedincuttingdownorquitting.Althoughtheyfoundno
significanteffectonsmokingurges,eitherduringthemanipulation,24hourslateror7
dayslater,theydidfindareductioninthenumberofcigarettessmokedoverthe7-day
periodamongthoseinthemindfulnessgroup,butnotinthecontrolgroup.Similarly,
Elwafietal.(2013)reportedon33adultswhohadreceivedeightsessionsof
mindfulnesstrainingaspartofarandomizedcontrolledtrialforsmokingcessation.
Theyfoundthatwhilsttherewerestrongcorrelationsbetweenlevelsofcravingand
smokingatbaseline(r=0.582),theseweremuchlowerbytheendoftreatment(r=
0.126)suggestingthatthemindfulnesstreatmentwasdecouplingtherelationship
betweencravingandbehavior.Thisdecouplingeffectseemedtobedrivenbythe
amountofinformal,homepracticeparticipantsengagedin.However,theeffectwasnot
MINDFULNESS
30
sustainedwhenassessed2-weeksaftertheendoftreatmentorat3-or4-monthfollow-
ups,suggestingthatthedecouplingeffectmayonlybemaintainedforaslongasthe
individualcontinuestopracticethemindfulnessstrategies.
ThusthereisprovisionalsupportforsomeofthepredictionsmadebyBuddhist
modelsofcraving;firstthattheremaybereductionsincravingoverthemediumtolong
term,overandabovewhatmightbeachievedbyotherstrategiesthatinterrupt
elaborativeprocesses(Tangetal.,2013),andsecondthatoverthemediumtolongterm
theremaybeadecouplingbetweencravingsandcraving-relatedbehaviors(Bowen&
Marlatt,2009;Elwafietal.,2013).However,giventheverylimitednumberofstudies
theseconclusionsarebasedon,theyarenecessarilytentative.
Conclusions
Someofthebeneficialeffectsseenformindfulnessstrategiesinrelationto
cravingarelikelytostemfrom(a)interruptingcravingrelatedelaborationbyloading
workingmemory,and(b)extinctionprocessthatresultfromtheindividualinhibiting
thecraving-relatedbehavior.Whilstitisimportantnottodiminishthevalueofsuch
outcomes,itisunclearwhethermindfulness-basedstrategieshaveanyadvantagesover
othertechniquesthatalsopromotesucheffects.Forexample,guidedimagerymaybe
justaseffectiveatloadingworkingmemory,whilsteducationaboutresponse
suppressionmaybeequallyeffectiveatmotivatinganindividualtoresisttheircraving
urges.Furtherresearchcouldusefullycomparesuchapproaches.Inthemeantime,itis
importanttobeawarethatsucheffectsmaynotbeuniquetomindfulness-based
strategies.
However,akeyquestioniswhetherthesetypesofmindfulness-basedstrategies
mayhaveanadvantageoverotherstrategiesbecausetheyareeasiertosustainovera
longertimeframe.Forexample,learningtofocusonthepresentmomentwhencravings
MINDFULNESS
31
occurmaybeatechniquethatcanbemoreeasilyandflexiblyappliedinawiderangeof
differentsettingscomparedtoaspecificvisualizationstrategythatmayfeelmore
effortfuland,overtime,becomeratherrepetitive.Itisalsopossiblethatlevelof
meditationexperiencemoderatestheeffectsofsuchstrategies;mostofthestudiesthat
havetestedtheimmediateeffectsofpresentmomentawarenesstechniquesoncraving
wereconductedintheabsenceofmoreintensivemeditationtraining.Morelongitudinal
research,andresearchexamininguserviewsofdifferentstrategieswouldhelpaddress
suchquestions.
Thereisalsolimitedevidencetosupportthebeneficialeffectsofacceptance
strategiesoncravingand,aspredictedbyEItheory,apossibilitythatsuchstrategies
mayevenexacerbatecravings(Szaszetal.,2012)orunderminetheeffectsofother
strategies(Lacailleetal.,2014).Againhowever,sucheffectshaveonlybeenexamined
inthecontextofrelativelylimitedmindfulnesspractice;itispossiblethatacceptance
strategieshavedifferenteffectswhenemployedbythosewithmoreexperienceof
mindfulnessmeditation.
Thetheoryofgroundedcognitionpredictsthatdecenteringstrategieswould
reducelevelsofcravingoverandaboveanyeffectsthatoccurbecauseofworking
memoryload.However,onlyafewstudieshaveexamineddecenteringspecifically.
Wherebeneficialeffectshavebeenfound(Casellietal.,2016;Lacailleetal.,2014;
Papiesetal.,2015;Schumacheretal.,2017),replicationhasbeeninconsistent
(Schumacheretal.,2017)oritisdifficulttoruleoutthepossibilitythateffectsoccurred
duetoworkingmemoryload(Casellietal.,2016;Lacailleetal.,2014;Papiesetal.,
2015).Thus,atpresent,thereisanabsenceofgoodevidencetoshowthatdecentering
strategieshaveunique,immediatebeneficialeffectsoncraving.Additionalstudiesthat
manipulatedecenteringwhilstcontrollingforvisualizationareneeded.
MINDFULNESS
32
Morepromisingfindingsoccuramongthosestudiesthathaveaskedparticipants
toengageinregularpracticeofmindfulnesstechniques,andhaveassessedtheeffectsof
theseoveralongertimeframe.However,suchstudieswouldbenefitfromcontrolling
fortheeffectsofworkingmemoryloadinordertobetterestablishwhethersuch
interventionshavebenefitsoverandabovewhatmightbeachievedbysimple
distractionorvisualizationstrategies.
IntermsofthemodelsofcravingoutlinedinTable1,thereismostevidenceto
supportEItheory,togetherwiththeconditioningeffectsitencompasses.Inparticular,
researchsuggeststhatstrategiesthatloadworkingmemorybringaboutanimmediate
reductionincravings.Additionally,andconsistentwithEItheory,conditioningand
Buddhistmodelsofcraving,whereabehaviorisconsistentlysuppressed,present
momentawarenessandacceptancestrategiesmayleadtoamorerapidreductionin
cravingthanothertechniques.However,sincethisconclusionisbasedondatafromjust
onestudy(Nosen&Woody,2013),itshouldbeviewedaspreliminary.
ThereisalsosomeevidencetosupportBuddhistmodelsofcravinginrelationto
thedevelopmentofinsighteffectsandadecouplingofcravingandbehavior.However,
moreresearchwouldbeneededtofullytestthismodel.Longitudinaldatatracking
changeincravingsandbehaviorovertime,togetherwiththeirassociation,wouldbe
helpful.Likewise,therearecurrentlyinsufficientdatatofullytestthegrounded
cognitionaccountofcravingsorthecognitiveprocessingmodel.
RecommendationsforFutureResearch
Intermsoflaboratory-basedexperimentalwork,itwouldbehelpfulto
determinewhetherdecenteringstrategiescanhaveanimmediateeffectoncravingover
andabovewhatcouldbeachievedbysimplevisualizationordistractionstrategies.This
shouldberelativelyeasytoestablishwithstudiesthatcomparelevelsofcraving
MINDFULNESS
33
followingavisualizationanddecenteringtask,avisualizationonlytaskandano
strategycontrolgroup.Suchstudiesshouldhelpclarifytheimmediateeffectsof
decenteringandinformitsuseininterventiondevelopment.
Anotherimportantprioritymustberesearchthatexaminestheeffectsof
extendedperiodsofregularmindfulnesspractice.Whilstseveralstudiessuggestsuch
anapproachmaybepromisingfortacklingcravingsandcraving-relatedbehaviors,
existingdatamakeitdifficulttoidentifythemechanismsunderlyingsucheffectsandto
ruleoutmoreprosaicexplanations.Theuseofcarefullymatchedcomparisonconditions
thatcontrolforfactorssuchashaloeffectsandworkingmemoryloadwouldhelptest
Buddhistaccountsofcravingandestablishwhethermindfulnesspracticecaninfluence
cravingandcraving-relatedbehaviorsoverandabovealternativeapproaches.Such
studieswouldbenefitfromincludinglongitudinalmeasuresofcravingandbehaviorin
ordertotrackchangesovertime.Again,thiswouldhelptestBuddhistmodelsaswellas
informthedevelopmentofinterventions.Likewise,manipulating,oratleastmeasuring,
frequencyandlengthofpracticewouldalsohelpidentifyanyminimallevelofpractice
thatisrequiredtoseebenefits.
Relatedly,moremeasuresareneededtoidentifythemechanismsunderlyingany
beneficialeffectsofmindfulness.Itseemslikelythatincreasedself-efficacyandreduced
stressand/ornegativeaffectmayplaysomerole,thoughmeasuresofthesetendnotto
havebeenincludedinstudiesofcraving.Itwouldberelativelystraightforwardto
incorporatesuchmeasuresinfuture.
Likewisethereisevidencetosuggestthatmindfulnesscanimproveattention
regulation(Chiesaetal.,2011;Mrazeketal.,2013).Improvementsinattention
regulationmaybringaboutreductionsincravingbyreducingattentionalbiasandalso
byhelpingindividualsmaintaintheirattentiononwhatevertaskisathand,ratherthan
MINDFULNESS
34
engageincognitiveelaborationofcraving-relatedthoughts.Althoughthereissome
evidencetosuggestthatmindfulness-basedinterventioncanreduceattentionalbias
(Garland&Howard,2013),suchpossibilitieshaveyettobefullyexploredinmore
controlledstudiesofmindfulnessandcraving.
Similarly,researchbyTangetal.(2013)raisesthequestionofwhethereffects
aremediatedbyconsciousversusunconsciousprocesses.Thisisworthexploringasit
hasimplicationsforthetypesofpopulationswhomaymostbenefitfrommindfulness-
basedinterventions;ifeffectsaremediatedbyunconsciousprocessesthenan
individual’smotivationtochangetheirbehaviormaybelessimportant.Wemayalso
seeeffectsgeneralizingacrossawiderangeofdifferentdomains.However,ifeffectsare
mediatedbyconsciousprocesses,interventionsmaybebettertargetedatthosewhoare
alreadymotivatedtochangetheirbehavior.Wemayalsoexpecteffectstobemore
domainspecific.
Anotherimportantareaforfutureresearchistoconsiderwhetheranybeneficial
effectsofmindfulnessdifferbetweenthosewhoexperiencecravingswithinthecontext
ofclinicaldisordersversusthosewhoexperiencetheminotherareas,suchaswhen
tryingtoloseweightoreatmorehealthily.Giventhatindividualswithsubstanceuse
disorderstendtoexhibitdysregulatedneurocognitiveprocesses(Koob&Volkow,
2010)itseemsplausiblethateffectsmaydifferbetweenclinicalandnon-clinical
populations.Thestudiesincludedinthecurrentreviewcomprisemainlyofthose
withoutaclinicaldiagnosis,withjustonestudy(Casellietal.,2016)focusingon
individualsatanaddictioncenter.Itispossiblethatbeneficialeffectsofmindfulnesson
cravingonlyemergeformoresevereinstancesofcraving.Assuch,moreexperimental
workconductedwithclinicalpopulations,wouldbeinformative.Dismantlingstudiesof
MINDFULNESS
35
multi-componentinterventionsforclinicalpopulationswouldalsobehelpful,inorder
toestablishtheuniquecontributionofthemindfulness-basedelements.
Finally,researchersshouldtakecaretodescribeindetailthestrategies
employedinanymindfulnessstudy,togetherwithanycomparisonconditions.As
illustratedinthecurrentreview,awiderangeofdifferentpracticesarelabeledas
mindfulnessbut,accordingtoanumberoftheories,thesewillnotnecessarilyhave
equivalenteffects.Havingfulldetailsofsuchprocedureswillallowforeasierandmore
accuratecomparisonsacrossstudies.
MINDFULNESS
36
References
Adams,C.E.,Benitez,L.,Kinsaul,J.,McVay,M.A.,Barbry,A.,Thibodeaux,A.&Copeland,
A.L.(2013).Effectsofbriefmindfulnessinstructionsonreactionstobodyimage
stimuliamongfemalesmokers:anexperimentalstudy.NicotineandTobacco
Research,15,376-382.
Alberts,H.J.E.M.,Mulkens,S.,Smeets,M.&Thewissen,R.(2010). Copingwithfoodcravings.Investigatingthepotentialofamindfulness-basedintervention.
Appetite,55,160-163.
Alberts,H.J.E.M.,Thewissen,R.&Middelweerd,M.(2013).Acceptingorsuppressingthe
desiretoeat:Investigatingtheshort-termeffectsofacceptance-basedcraving
regulation.EatingBehaviors,14,405-409.
Arch,J.J.,Brown,K.W.,Goodman,R.J.,DellaPorta,M.D.,Kiken,L.G.&Tillman,S.(2016).
Enjoyingfoodwithoutcaloriccost:theimpactofbriefmindfulnessonlaboratory
eatingoutcomes.BehaviourResearchandTherapy,79,23-34.
Bandura,A.(1998).Healthpromotionfromtheperspectiveofsocialcognitivetheory.
PsychologyandHealth,13,623-649.
Barsalou,L.W.(2008).Groundedcognition.AnnualReviewofPsychology,59,617–645.
Bishop,S.R.,Lau,M.,Shapiro,S.,Carlson,L.E.,Anderson,N.D.,Carmody,J.,Segal,Z.V.,
Abbey,S.,Speca,M.,Velting,D.&Devins,G.(2004).Mindfulness:Aproposed
operationaldefinition.ClinicalPsychology:ScienceandPractice,11,230–241.
Boswell,R.G.&Kober,H.(2016).Foodcuereactivityandcravingpredicteatingand
weightgain:ameta-analyticreview.ObesityReviews,17,159-177.
Bowen,S.,Chawala,N.,Collins,S.E.,Witkiewitz,K.,Hsu,S.,Grow,J.,Clifasefi,S.,Garner,
M.,Douglass,A.,Larimer,M.E.&Marlatt,A.(2009).Mindfulness-basedrelapse
MINDFULNESS
37
preventionforsubstanceusedisorders:apilotefficacytrial.SubstanceAbuse,30,
295-305.
Bowen,S.&Marlatt,A.(2009).Surfingtheurge:briefmindfulness-basedintervention
forcollegestudentsmokers.AddictiveBehaviors,23,666-671.
Brown,K.W.&Ryan,R.M.(2004).Perilsandpromiseindefiningandmeasuring
mindfulness:observationsfromexperience.ClinicalPsychology:Scienceand
Practice,11,242-248.
Brewer,J.A.,Elwafi,H.M.&Davis,J.H.(2013).Cravingtoquit:psychologicalmodelsand
neurobiologicalmechanismsofmindfulnesstrainingastreatmentforaddictions.
PsychologyofAddictiveBehaviors,27,366-379.
Bricker,J.B.,Mull,K.E.,Kientz,J.A.,Vilardaga,R.,Mercer,L.D.,Akioka,K.J.&Heffner,J.L.
(2014).Randomized,controlledpilottrialofasmartphoneappforsmoking
cessationusingacceptanceandcommitmenttherapy.DrugandAlcohol
Dependence,143,87-94.
Caselli,G.,Gemelli,A.,Spada,M.M.&Wells,A.(2016).Experimentalmodificationof
perspectiveonthoughtsandmetacognitivebeliefsinalcoholusedisorder.
PsychiatryResearch,244,57-61.
Chambers,R.,Gullone,E.&Allen,N.B.(2009).Mindfulemotionregulation:an
integrativereview.ClinicalPsychologyReview,29,560-572.
Chiesa,A.,Calati,R.&Serretti,A.(2011).Doesmindfulnesstrainingimprovecognitive
abilities?Asystematicreviewofneuropsychologicalfindings.ClinicalPsychology
Review,31,449-464.
Chiesa,A.&Serretti,A.(2014).Aremindfulness-basedinterventionseffectivefor
substanceusedisorders?Asystematicreviewoftheevidence.SubstanceUse&
Misuse,49,492-512.
MINDFULNESS
38
Creswell,J.D.(2017).Mindfulnessinterventions.AnnualReviewofPsychology,68,491-
516.
Cropley,M.,Ussher,M.&Charitou,E.(2007).Acuteeffectsofaguidedrelaxationroutine
(bodyscan)ontobaccowithdrawalsymptomsandcravingsinabstinent
smokers.Addiction,102,989-993.
Davis,J.M.,Manley,A.R.,Goldberg,S.B.,Smith,S.S.&Jorenby,D.E.(2014).Randomized
trialcomparingmindfulnesstrainingforsmokerstoamatchedcontrol.Journalof
SubstanceAbuseTreatment,47,213-221.
DhammacakkappavattanaSutta:SettingtheWheelofDhammainMotion"(SN56.11).
(2013).TranslatedfromthePalibyThanissaroBhikkhu.AccesstoInsight
(LegacyEdition),30November2013.Retrievedfrom
http://www.accesstoinsight.org/tipitaka/sn/sn56/sn56.011.than.html13
September,2017.
Drummond,D.C.(2001).Theoriesofdrugcraving,ancientandmodern.Addiction,96,
33-46.
Elwafi,H.M.,Witkiewitz,K.,Mallik,S.,Thornill,T.A.&Brewer,J.A.(2013).Mindfulness
trainingforsmokingcessation:moderationoftherelationshipbetweencraving
andcigaretteuse.DrugandAlcoholDependence,130,222-229.
Field,M.,Werthmann,J.,Franken,I.,Hofmann,W.,Hogarth,L.&Roefs,A.(2016).The
roleofattentionalbiasinobesityandaddiction.HealthPsychology,35,767-780.
Field,M.&Cox,W.M.(2008).Attentionalbiasinaddictivebehaviors:areviewofits
development,causes,andconsequences.DrugandAlcoholDependence,97,1-20.
Fisher,N.,Lattimore,P.&Malinowski,P.(2016).Attentionwithamindfulattitude
attenuatessubjectiveappetitivereactionsandfoodintakefollowingfood-cue
exposure.Appetite,99,10-16.
MINDFULNESS
39
Forman,E.M.,Hoffman,K.L.,Juarascio,A.S.,Butryn,M.L.&Herbert,J.D.(2013).
Comparisonofacceptance-basedandstandardcognitive-basedcopingstrategies
forcravingsweetsinoverweightandobesewomen.EatingBehaviors,14,64–68.
Garland,E.L.(2013).Mindfulness-OrientedRecoveryEnhancementforAddiction,Stress,
andPain.Washington,D.C:NASWPress.
Garland,E.L.,Boettiger,C.A.,Gaylord,S.,Chanon,V.W.&Howard,M.O.(2012).
Mindfulnessisinverselyassociatedwithalcoholattentionalbiasamong
recoveringalcohol-dependentadults.CognitiveTherapyandResearch,36,441-
450.
Garland,E.L.,Froeliger,B.&Howard,M.O.(2013).Mindfulnesstrainingtargets
neurocognitivemechanismsofaddictionattheattention-appraisal-emotion
interface.FrontiersinPsychiatry,4,173.
Garland,E.,Gaylord,S.&Park,J.(2009).Theroleofmindfulnessinpositive
reappraisal.Explore:TheJournalofScienceandHealing,5,37-44.
Garland,E.L.&Howard,M.O.(2013).Mindfulness-orientedrecoveryenhancement
reducespainattentionalbiasinchronicpainpatients.Psychotherapyand
Psychosomatics,82,311-318.
Garland,E.L.,Robert-Lewis,A.R.,Tronnier,C.D.,Graves,R.&Kelly,K.(2016).
Mindfulness-orientedrecoveryenhancementversusCBTforco-occurring
substancedependence,traumaticstress,andpsychiatricdisorders:proximal
outcomesfromapragmaticrandomizedtrial.BehaviorResearchandTherapy,77,
7-19.
Grabovac,A.D.,Lau,M.A.&Willett,B.R.(2011)Mechanismsofmindfulness:aBuddhist
psychologicalmodel.Mindfulness,2,154-166.
MINDFULNESS
40
Hamilton,J.,Fawson,S.,May,J.,Andrade,J.&Kavanagh,D.J.(2013).Briefguided
imageryandbodyscanninginterventionsreducefoodcravings.Appetite,71,
158–162.
Hayes,S.C.,Strosahl,K.D.,&Wilson,K.G.(1999).AcceptanceandCommitmentTherapy.
AnExperientialApproachtoBehaviorChange.NewYork:GuildfordPress.
Hölzel,B.K.,Lazar,S.W.,Gard,T.,Schuman-Olivier,Z.,Vago,D.R.&Ott,U.(2011).How
doesmindfulnessmeditationwork?Proposingmechanismsofactionfroma
conceptualandneuralperspective.PerspectivesonPsychologicalScience,6,537-
559.
Hooper,N.,Sanoz,E.K.,Ashton,J.,Clarke,A.,McHugh,L.(2012).Comparingthought
suppressionandacceptanceascopingtechniquesforfoodcravings.Eating
Behaviors,13,62–64.
Jansen,A.,Havermans,R.C.&Nederkoorn,C.(2011).Cuedovereating.InV.R.Preedy,
R.R.Watson,C.R.Martin.(Eds.)HandbookofBehavior,FoodandNutrition.
Springer-Verlag:NewYork.
Katterman,S.N.,Kleinman,B.M.,Hood,M.M.,Nackers,L.M.&Corsica,J.A.(2014).
Mindfulnessmeditationasaninterventionforbingeeating,emotionaleating,
andweightloss:asystematicreview.EatingBehaviors,15,197-204.
Kavanagh,D.J.,Andrade,J.&May,J.(2005).Imaginaryrelishandexquisitetorture:the
elaboratedintrusiontheoryofdesire.PsychologicalReview,112,446-467.
Kemps,E.&Tiggemann,M.(2007).Modality-specificimageryreducescravingsforfood:
anapplicationoftheelaboratedintrusiontheoryofdesiretofoodcraving.
JournalofExperimentalPsychology:Applied,13,95-104.
Kemps,E.&Tiggemann,M.(2013).Hand-helddynamicvisualnoisereducesnaturally
occurringfoodcravingsandcraving-relatedconsumption.Appetite,68,152-157.
MINDFULNESS
41
Koob,G.F.&Volkow,N.D.(2010).Neurocircuitryofaddiction.
Neuropsychopharmacology,35,217-238.
Lacille,J.,Ly,J.,Zacchia,N.,Bourkas,S.,Glaser,E.Knauper,B.(2014).Theeffectsofthree
mindfulnessskillsonchocolatecraving.Appetite,76,101–112.
Levin,M.E.,Luoma,J.B.&Haeger,J.A.(2015).Decouplingasamechanismofchangein
mindfulnessandacceptance:aliteraturereview.BehaviorModification,39,870-
911.
Li,W.,Howard,M.O.,Garland,E.L.,McGovern,P.&Lazar,M.(2017).Mindfulness
treatmentforsubstancemisuse:asystematicreviewandmeta-analysis.Journal
ofSubstanceAbuseTreatment,75,62-96.
Maglione,M.A.,Maher,A.R.,Ewing,B.,Colaiaco,B.,Newberry,S.,Kandrack,R.,...&
Hempel,S.(2017).Efficacyofmindfulnessmeditationforsmokingcessation:a
systematicreviewandmeta-analysis.AddictiveBehaviors,69,27-34.
May,J.,Andrade,J.,Batey,H.,Berry,L.M.,&Kavanagh,D.J.(2010).Lessfoodforthought.
Impactofattentionalinstructionsonintrusivethoughtsaboutsnackfoods.
Appetite,55,279-287.
May,J.,Andrade,J.,Kavanagh,D.J.,&Hetherington,M.(2012).Elaboratedintrusion
theory.Acognitive-emotionaltheoryoffoodcraving.CurrentObesityReports,1,
114–121.
May,J.,Andrade,J.,Willoughby,K.&Brown,C.(2012).Anattentionalcontroltask
reducesintrusivethoughtsaboutsmoking.NicotineandTobaccoResearch,14,
472-478.
May,J.,Kavanagh,D.J.&Andrade,J.(2015).TheElaboratedIntrusionTheoryofdesire:a
10-yearretrospectiveandimplicationsforaddictiontreatments.Addictive
Behaviors,29-34.
MINDFULNESS
42
Michie,S.&Abraham,C.(2004).Interventionstochangehealthbehaviours:evidence-
basedorevidence-inspired?Psychology&Health,19,29-49.
Moffitt,R.,Brinkworth,G.,Noakes,M.&Mohr,P.(2012).Acomparisonofcognitive
restructuringandcognitivedefusionasstrategiesforresistingacravedfood.
PsychologyandHealth,27,74-90.
Mrazek,M.D.,Franklin,M.S.,Phillips,D.T.,Baird,B.&Schooler,J.W.(2013).Mindfulness
TrainingImprovesWorkingMemoryCapacityandGREPerformanceWhile
ReducingMindWandering.PsychologicalScience,24,776–781.
Murphy,C.M.&MacKilop,J.(2014).Mindfulnessasastrategyforcopingwithcue-
elicitedcravingsforalcohol:anexperimentalexamination.Alcoholism:Clinical
andExperimentalResearch,38,1134-1142.
Nosen,E.&Woody,S.R.(2013).Briefpsycho-educationaffectscircadianvariabilityin
nicotinecravingduringcessation.DrugandAlcoholDependence,132,283-289.
Olson,K.L.&Emery,C.F.(2015).Mindfulnessandweightloss:asystematicreview.
PsychosomaticMedicine,77,59-67.
O’Reilly,G.A.,Cook,L.,Spruijt-Metz,D.&Black,D.S.(2014).Mindfulness-based
interventionsforobesity-relatedeatingbehaviours:aliteraturereview.Obesity
Reviews,15,453–461.
Papies,E.K.,&Barsalou,L.W.(2015).Groundingdesireandmotivatedbehavior:A
theoreticalframeworkandempiricalevidence.InW.Hofmann&L.Nordgren
(Eds.).ThePsychologyofDesire.NewYork,NY:GuilfordPress.
Papies,E.K.,Pronk,T.M.,Keesman,M.&Barsalou,L.W.(2015).Thebenefitsofsimply
observing:mindfulattentionmodulatesthelinkbetweenmotivationand
behaviour.JournalofPersonalityandSocialPsychology,108,148-170.
MINDFULNESS
43
Pelchat,M.L.(2002).Ofhumanbondage:foodcraving,obsession,compulsion,and
addiction.Physiology&Behavior,76,347-352.
Ruscio,A.C.,Muench,C.,Brede,E.&Waters,A.J.(2016).Effectofbriefmindfulness
practiceonself-reportedaffect,craving,andsmoking:apilotrandomized
controlledtrialusingecologicalmomentaryassessment.Nicotine&Tobacco
Research,18,64-73.
Schumacher,S.,Kemps,E.&Tiggemann,M.(2017).Acceptance-andimagery-based
strategiescanreducechocolatecravings:atestoftheelaborated-intrusion
theoryofdesire.Appetite,113,63-70.
Serre,F.,Fatseas,M.,Swendsen,J.&Auriacombe,M.(2015).Ecologicalmomentary
assessmentintheinvestigationofcravingandsubstanceuseindailylife:a
systematicreview.DrugandAlcoholDependence,148,1-20.
Shapiro,S.L.,Carlson,L.E.,Astin,J.A.,&Freedman,B.(2006).Mechanismsof
mindfulness.JournalofClinicalPsychology,62,373–386.
Skinner,M.D.&Aubin,H.J.(2010).Craving’splaceinaddictiontheory:contributionsof
themajormodels.NeuroscienceandBiobehavioralReviews,34,606-623.
Szasz,P.L.,Szentagotai,A.&Hofmann,S.G.(2012).Effectsofemotionregulation
strategiesonsmokingcraving,attentionalbias,andtaskpersistence.Behaviour
ResearchandTherapy,50,333-340.
Tang,Y.Y.,Tang,R.&Posner,M.I.(2013).Briefmeditationtraininginducessmoking
reduction.ProceedingsoftheNationalAcademyofScience,110,13971-13975.
Tapper,K.(2017).Canmindfulnessinfluenceweightmanagementrelatedeating
behaviors?Ifso,how?ClinicalPsychologyReview,53,122-134.
Tapper,K.&Ahmed,Z.(2015,September).Amindfulness-basedstrategyincreasesthe
accessibilityofhealthandweightlossrelatedgoals.Posterpresentedatthe
MINDFULNESS
44
BritishPsychologicalSocietyDivisionofHealthPsychologyAnnualConference,
London,UK.
Teixeria,P.J.,Carraca,E.V.,Marques,M.M.,Rutter,H.,Oppert,J.M.,DeBourdeaudhuij,I.,
Lakerveld,J.&Brug,J.(2015).Successfulbehaviourchangeinobesity
interventionsinadults:asystematicreviewofself-regulationmediators.BMC
Medicine,13,84.
Tiffany,S.T.(1990).Acognitivemodelofdrugurgesanddrug-usebehavior:roleof
automaticandnonautomaticprocesses.PsychologicalReview,97,147-168.
Tiffany,S.T.&Conklin,C.A.(2000).Acognitiveprocessingmodelofalcoholcravingand
compulsivealcoholuse.Addiction,95,S145-153.
Tiffany,S.T.&Wray,J.M.(2012).Theclinicalsignificanceofdrugcraving.Annalsofthe
NewYorkAcademyofSciences,1248,1-17.
Ussher,M.,Cropley,M.,Playle,S.,Mohidin,R.&West,R.(2009).Effectofisometric
exerciseandbodyscanningoncigarettecravingsandwithdrawalsymptoms.
Addiction,104,1251-1257.
VanDillen,L.F.,Papies,E.K.&Hofmann,W.(2013).Turningablindeyetotemptation:
howcognitiveloadcanfacilitateself-regulation.JournalofPersonalityandSocial
Psychology,104,427-443.
Vinci,C.,Peltier,M.R.,Shah,S.,Kinsaul,J.,Waldo,K.,McVay,M.A.&Copeland,A.L.
(2014).Effectsofabriefmindfulnessinterventiononnegativeaffectandurgeto
drinkamongcollegestudentdrinkers.BehaviourResearchandTherapy,59,82-
93.
Westbrook,C.,Creswell.,J.D.,Tabibnia,G.,Julson,E.,Kober,H.&Tindle,H.A.(2013).
Mindfulattentionreducesneuralandself-reportedcue-inducedcravingin
smokers.SocialCognitive&AffectiveNeuroscience,8,73-84.
MINDFULNESS
45
Williams,J.M.G.(2008).Mindfulness,depressionandmodesofmind.CognitiveTherapy
andResearch,32,721-733.
Wray,J.M.,Gass,J.C.&Tiffany,S.T.(2013).Asystematicreviewoftherelationships
betweencravingandsmokingcessation.NicotineandTobaccoResearch,15,
1167-1182.
Zemestani,M.&Ottaviani,C.(2016).Effectivenessofmindfulness-basedrelapse
preventionforco-occurringsubstanceuseanddepression.Mindfulness,7,1347-
1355.
Zgierska,A.,Rabago,D.,Chawla,N.,Kushner,K.,Koehler,R.&Marlatt,A.(2009).
Mindfulnessmeditationforsubstanceusedisorders:asystematic
review.SubstanceAbuse,30,266-294.
MINDFULNESS
39
AppendixACharacteristicsofStudiesExaminingtheIndependentEffectsofMindfulnessonCravingCravingtype
Study Samplesize1
Sampledetails
Gender(%
female)
Primarymindfulnessstrategy(ies)/intervention
Controlstrategy(ies)/intervention
Dependentvariable
Results2
Food Hamiltonetal.(2013)
94 Universitystudents,abstainedfrombreakfast.
77% Presentmomentawarenessofbodilysensationsandthoughts.
1.Guidedimagery.2.Mindwandering.
Foodcravingsattentime-pointsduringthemanipulation.
Nosignificantdifferencebetweenthemindfulnessandimageryconditions.Cravingshowedasignificantincreaseinthemindwanderingconditionbutnotinthemindfulnessorimageryconditions.
Cigarettes Bowen&Marlatt(2009)
123 Universitystudents,smokersinterestedincuttingdownorquitting,abstinentforatleast12hours.
27% Presentmomentawarenessandacceptanceofthoughts,sensationsandurges.
Askedtocopewithurgesinthemannertheyusuallywould.
Smokingurgesassessedat4timepointsduringthemanipulation,duringacueexposuresession.
Nosignificantdifferences.
MINDFULNESS
40
Smokingurges24hourslater.
Nosignificantdifferences.
Smokingurges7dayslater.
Nosignificantdifferences.
Alcohol Casellietal.(2016)
8(repeatedmeasuresdesign)
Patientsatanaddictioncenterwithadiagnosisofalcoholusedisorder,abstinentfromalcohol,aged35-50years.
50% Decenteringfromapre-recordedaudiooftheirownalcoholrelatedthoughts.
Habituationtoapre-recordedaudiooftheirownalcoholrelatedthoughts.
Intensityofurgetodrinkassessedat1,3and5minutesduringthemanipulation.
Significantlygreaterdecreasesinthemindfulnesscondition.
Food Archetal.(2016)
81 Universitystudents.
59% Presentmomentawarenessofthesensorypropertiesoffood.
Wordpuzzles. Desiretoeatanotherchocolatechip,assessedonfiveoccasions,eachimmediatelyafterapplyingthestrategy.
Atrendtowardshigherdesireinthemindfulnesscondition;p=.056.
MINDFULNESS
41
136 Universitystudents.
77% Presentmomentawarenessofthesensorypropertiesoffood.
Wordpuzzles. Desiretoeatanotherraisin,assessedonfiveoccasions,eachimmediatelyafterapplyingthestrategy.
Higherdesireinthemindfulnesscondition.
102 Universitystudents,abstainedfromeatingforatleast2hours.
42% Presentmomentawarenessofthesensorypropertiesoffood.
1.Wordpuzzles.2.Nostrategy.
Desiretoeatanotherraisin,assessedonfiveoccasions,eachimmediatelyafterapplyingthestrategy.
Nosignificantdifferencebetweengroupsinoveralllevelofdesire.Thoseinthemindfulnessconditionshowedasteeperinitialincreaseandslowerdeclineindesireoverthefivetime-points.
Alcohol Vincietal.(2014)
207 Collegestudents,reportingat-riskdrinking,endorsement
76% Presentmomentawarenessofbodilysensations,
1.Relaxation.2.Nostrategy.
Urgetodrinkimmediatelyafterthemanipulation.
Nosignificantdifferences.
MINDFULNESS
42
ofaffective-regulationmotivesfordrinking.
acceptance. Urgetodrinkimmediatelyafterpracticingthestrategyduringaneutralornegativemoodinduction.
Significantincreasesinthemindfulnessandrelaxationconditions,afteranegativemoodinduction.
Cigarettes Adamsetal(2013)
64 Universitystudents,smokers,temporarilyabstinent.
100% Presentmomentawarenessofbreath.Presentmomentawarenessandacceptanceofthoughtsandfeelings.
Nostrategy. Desiretosmokeimmediatelyafterthemanipulationthatwaspresentedsimultaneouslywitheitherabodyimagechallengeornobodyimagechallenge.
Nosignificantdifferences.
Cigarettes Westbrooketal.(2013)
54 Communitysample,smokeatleast10cigarettesaday,strongdesiretoquitwithinthefollowingmonth,temporarily
31% Presentmomentawarenessandacceptanceofthoughts,feelings,memoriesandbodilysensations.
Nostrategy. Cigarettecravingassessedon12occasions,eachimmediatelyafterapplyingthestrategywhilstviewingsmokingrelatedimages.
Significantlylowercravingsinthemindfulnesscondition.
MINDFULNESS
43
abstinent.
Food Papiesetal.(2015)
75 Universitystudents.
Notreported
Decenteringfromreactionstopicturesoffood.
Viewingpicturesoffoodinarelaxedmanner.
Foodcravingsimmediatelyfollowingthemanipulation.
Atrendtowardslowercravingsinthemindfulnesscondition;p=.058.
Cigarettes May,Andrade,Willoughbyetal.(2012)
27 Universitystaff,students,friendsandfamily,smokeatleast10cigarettesadayoverthelast6months,abstinentforatleast2hours.
59% Presentmomentawarenessofbodilysensations.
Mindwandering.
Cigarettecravingsimmediatelyafterthemanipulation.
Significantlylowercravingsinthemindfulnesscondition.
Cigarettecravingsafterasubsequent10-minutemindwanderingsession.
Nosignificantdifference.
Food Schumacheretal.(2017)
94 Universitystudents,likechocolate
100% Decenteringfromthoughtsaboutchocolate
1.Guidedimagery2.Mindwandering
Intrusivenessofchocolatecravingsimmediatelyfollowingthemanipulation.
Significantreductioninthedecenteringcondition;nochangeintheimageryormindwanderingconditions.
MINDFULNESS
44
Vividnessofchocolatecravingsimmediatelyfollowingthemanipulation.
Significantreductioninthedecenteringcondition;nochangeintheimageryormindwanderingconditions.
Intensityofchocolatecravingsimmediatelyfollowingand10minutesafterthemanipulation.
Significantreductioninthedecenteringcondition,maintainedat10minutes;nochangeintheimageryormindwanderingconditions.
97 Universitystudents,cravechocolateatleastonceaday,wanttoreducetheirconsumptionofchocolate.
100% Decenteringfromthoughtsaboutchocolate
1.Guidedimagery2.Mindwandering
Intrusivenessofchocolatecravingsimmediatelyfollowingthemanipulation.
Significantreductionsacrossallthreeconditions.
Vividnessofchocolatecravingsimmediatelyfollowingthemanipulation.
Significantreductionsacrossallthreeconditions.
MINDFULNESS
45
Intensityofchocolatecravingsimmediatelyfollowingand10minutesafterthemanipulation.
Significantreductioninthedecenteringandimageryconditions,maintainedat10minutes;nochangeinthemindwanderingcondition.
Food Fisheretal.(2016)
40 Universitystaffandstudents.
100% Presentmomentawarenessofthoughts,emotionsandbodilysensations.
Audiodescriptionofarainforest.
Foodcraving10minutesafterthemanipulation.
Nosignificantdifference.
Foodcravingimmediatelyafter10minutesofself-practice/sittinginthepresenceoffoods.
Nosignificantdifference.
Desiretoeat10minutesafterthemanipulation.
Nosignificantdifference.
Desiretoeatimmediately
Nosignificantdifference.
MINDFULNESS
46
after10minutesofself–practice/sittinginthepresenceoffoods.
Food
Mayetal.(2010)
48
Universitystudents,tryingtocutdownonsnackfoods,abstainedfromeatingfor2hours.
81% Presentmomentawarenessofthebreath,decenteringfromthoughtsaboutsnackfoods.
1.Thoughtsuppression.2.Imagerydiversion.3.Mindwandering.
Cravingforsnackfoodimmediatelyfollowingthemanipulation.
Nosignificantdifferencesbetweenthemindfulness,imagerydiversionandmindwanderingconditions.Significantlylowercravingsinthethoughtsuppressioncondition
Cravingforsnackfood10minutesafterthemanipulation.
Nosignificantdifferences.
49 Universitystudents.
63% Presentmomentawarenessofbodilysensations.
1.Guidedimagery.2.Mindwandering.
Cravingforsnackfoodimmediatelyfollowingthemanipulation.
Nosignificantdifferences.
MINDFULNESS
47
Cravingforsnackfood10minutesafterthemanipulation.
Nosignificantdifferences.
Cigarettes Cropleyetal.(2007)
30 Samplerecruitedviaadvertsatauniversity,smokedatleast10cigarettesadayforatleast3consecutiveyears.
40% Presentmomentawarenessofbodilysensations.
Audiorecordingofanaturalhistorytext.
Strengthofdesiretosmokeimmediatelyfollowingthemanipulation.
Significantlylowerinthemindfulnessgroup.
Strengthofdesiretosmoke5minutesafterthemanipulation.
Significantlylowerinthemindfulnessgroup.
Strengthofdesiretosmoke10minutesafterthemanipulation.
Nosignificantdifference.
Strengthofdesiretosmoke15minutesafterthemanipulation.
Nosignificantdifference.
Food Albertsetal(2013)
61 Universitystudents.
80% Presentmomentawarenessof
1.Suppressionofcravingsandcravingrelated
Foodcravingsimmediatelyfollowingthe
Nosignificantdifferencebetweenthemindfulness
MINDFULNESS
48
foodcravings,acceptanceoffoodcravingsandcravingrelatedthoughts.
thoughts.2.Nostrategyandoptiontoeatfood.
manipulation. andsuppressiongroups.Significantlyhighercravingsinthemindfulnessandsuppressionconditionscomparedtothenostrategycondition.
Foodcraving20minutesafterthemanipulation.
Nosignificantdifferencebetweenthemindfulnessandsuppressiongroups.Significantlyhighercravingsinthemindfulnessandsuppressionconditionscomparedtothenostrategycondition.
Cigarettes Ussheretal.(2009)
48 Communitysample,ordinarilysmokedatleast10cigarettesadayforatleast3years,
35% Presentmomentawarenessofbodilysensations.
1.Isometricexercises.2.Audiorecordingofanaturalhistorytext.
Strengthofdesiretosmokeimmediatelyfollowingtheinterventioninthelaboratory.
Significantlylowerinthemindfulnessconditioncomparedtothetextcondition.Nosignificantdifferencebetweenthemindfulness
MINDFULNESS
49
temporarilyabstinent.
andisometricconditions.
Strengthofdesiretosmoke5minutesaftertheinterventioninthelaboratory.
Significantlylowerinthemindfulnessconditioncomparedtothetextcondition.Nosignificantdifferencebetweenthemindfulnessandisometricconditions.
Strengthofdesiretosmoke10minutesaftertheinterventioninthelaboratory.
Significantlylowerinthemindfulnessconditioncomparedtothetextcondition.Nosignificantdifferencebetweenthemindfulnessandisometricconditions.
Strengthofdesiretosmoke30minutesaftertheintervention
Significantlylowerinthemindfulnessconditioncomparedtothe
MINDFULNESS
50
inthelaboratory.
textcondition.Nosignificantdifferencebetweenthemindfulnessandisometricconditions.
Strengthofdesiretosmokeimmediatelyaftertheinterventionoutsidethelaboratory.
Significantlylowerinthemindfulnessconditioncomparedtothetextcondition.Nosignificantdifferencebetweenthemindfulnessandisometricconditions.
Strengthofdesiretosmoke5minutesaftertheinterventionoutsidethelaboratory.
Significantlylowerinthemindfulnessconditioncomparedtothetextcondition.Nosignificantdifferencebetweenthemindfulnessandisometricconditions.
MINDFULNESS
51
Strengthofdesiretosmoke30minutesaftertheinterventionoutsidethelaboratory.
Nosignificantdifferences.
Cigarettes Szaszetal.(2012)
94 Universitystudents,smokemorethan10cigarettesaday,havesmokedforatleast1year,wouldliketoquit.
88% Acceptanceofthoughtsandfeelings.
1.Reappraisal.2.Suppression.
Cigarettecravingsassessedatfourtimepoints:baseline,followingthemanipulation,followinga3-minutecravinginduction,followingadotprobeandserialadditiontask.
Nosignificantdifferencesbetweenthemindfulnessandsuppressiongroups.Cravingssignificantlylowerinthereappraisalgroupcomparedtothesuppressionandmindfulnessgroups.
Alcohol Murphy&MacKilop(2014)
84 Communitysample,heavydrinkers,aged21-29years.
50% Presentmomentawarenessofexperienceincludingcravings,acceptance,decentering.
1.Distraction.2.Nostrategy
Alcoholcravingassessedatseventimepointsimmediatelyfollowingthemanipulation.
Nosignificantdifferencebetweenthemindfulnessandnostrategyconditions.Significantlylowercravingsinthedistractioncondition.
MINDFULNESS
52
Distressfromalcoholcravingassessedatseventimepointsimmediatelyfollowingthemanipulation.
Nosignificantdifferencebetweenthemindfulnessandnostrategyconditions.Significantlylowerdistressinthedistractioncondition.
Alcoholcraving1weeklater.
Nosignificantdifferences.
Cigarettes
Nosen&Woody(2013)
122 Communitysample,smokedatleast10cigarettesadayfortheprevious2years,expressedacommitmenttoquit.
35% Presentmomentawarenessandacceptanceofcravings.
1.Standardpsycho-education;informationaboutsmokingcessationmethods.2.Notreatment.
Eightassessmentsofsmokingurgesduringa1-dayperiodofad-libsmoking,thedayafterthemanipulation.
Nosignificantdifferences.
Eightassessmentsofsmokingurgesduringa1-dayperiodcoincidingwithaquitattempt,thedayafterthe
Significantlylowerinthemindfulnessgroupcomparedtothepsycho-educationandnotreatmentgroupsintheevening.Significantlylower
MINDFULNESS
53
manipulation. inthemindfulnessgroupcomparedtothenotreatmentgroupinthemorning.Nosignificantdifferencebetweenthemindfulnessgroupandpsycho-educationgroupinthemorning.Nosignificantdifferencesbetweengroupsduringmidday/afternoon.
Smokingurges4dayslater,aftermanipulation.
Nodifferencesbetweengroups.
Food Formanetal(2013)
48 Communityparticipants,overweightorobese.
100% Acceptanceofcravings,decenteringfromcravings.
Distractionandcognitiverestructuring.
Sweetcravingassessedatthreetimepointsperdayover3days.
Nosignificantdifference.
Food Hooperetal.(2012)
47 Universitystudents,notdieting.
59% Decenteringfromfeelingsofchocolatecravingandthoughtsabout
1.Thoughtsuppression.2.Nostrategy.
Frequencyofchocolatecravingsexperiencedover6days,
Atrendtowardsasignificantgroupdifference,withthoseinthemindfulness
MINDFULNESS
54
chocolatecraving.
reportedattheendofeachday.
conditionexperiencingmostcravings,andthoseinthenostrategyconditionexperiencingleastcravings;p=.091.
Food Moffittetal.(2012)
110 Communitysample,regularlycraveandeatchocolate,desiretobettermanageeatingbehaviors.
85% Decenteringfromfoodrelatedthoughts.
1.Cognitiverestructuringoffoodrelatedthoughts.2.Nostrategy.
Strengthofchocolatecravingsexperienced‘throughoutthedaytoday’,assessed7daysaftertheintervention.
Nosignificantdifferences.
Traitfoodcravings7daysaftertheintervention.
Nosignificantdifferences.
Food Lacailleetal.(2014)
126
Samplerecruitedfrominandaroundauniversity,
89%
Presentmomentawarenessofcravings.
Recitalofthealphabetthenmultiplesof2suntil100.
Traitchocolatecravings2weeksaftertheintervention.
Significantlylowercravingsinthemindfulnesscondition.
MINDFULNESS
55
chocolatecravers,interestedinreducingchocolatecravings.
Chocolatecravingsfollowingacravinginductionadministered2weeksaftertheintervention.
Significantlylowercravingsinthemindfulnesscondition.
Presentmomentawarenessandacceptanceofcravings.
Traitchocolatecravings2weeksaftertheintervention.
Nosignificantdifference.
Chocolatecravingsfollowingacravinginductionadministered2weeksaftertheintervention.
Nosignificantdifference.
Presentmomentawarenessanddecenteringfromcravings.
Traitchocolatecravings2weeksaftertheintervention.
Significantlylowercravingsinthemindfulnesscondition.
Chocolatecravingsfollowinga
Significantlylowercravingsinthemindfulness
MINDFULNESS
56
cravinginductionadministered2weeksaftertheintervention.
condition.
Presentmomentawareness,acceptanceanddecenteringfromcravings.
Traitchocolatecravings2weeksaftertheintervention.
Nosignificantdifference.
Chocolatecravingsfollowingacravinginductionadministered2weeksaftertheintervention.
Nosignificantdifference.
Cigarettes
Ruscioetal.(2016)
44 Communitysample,18-65yearolds,smokedatleast10cigarettesadayforatleast2years.
50% Presentmomentawarenessofbodilysensations,thoughtsandemotions.Present
Shammeditation.
Urgetosmokeassessedatfourrandomtimepointsthroughoutthedayoveraperiodof2weeks.
Nosignificantdifference.
MINDFULNESS
57
momentawarenessandacceptanceofurgesandcravings.
Urgetosmokeassessedimmediatelyaftercompletingdailymindfulorshammeditationoveraperiodof2weeks.
Significantlylowerinthemindfulnessgroup.
Cigarettes
Tangetal.(2013)
27 Universitystudents,smokerswithnointentiontoquit.
30% Mindfulnessmeditation
Relaxation
Severityofcravingstosmokebeforeandafter2weeksoftraining.
Significantlyreducedcravingsinthemindfulnessconditionbutnotthecontrolcondition.
MINDFULNESS
58
Cigarettes
Davisetal.(2014)
95
Communitysample,livinginareasoflowsocio-economicstatus,smokingatleast5cigarettesaday,highmotivationtoquit.
48%
Generalmindfulnesstraining.
Standardsmokingcessationintervention.
Strengthofsmokingurgesovertheprevious24hours,assessedviatelephoneonthreeoccasionsduringtheweekbeforeandthreeoccasionsduringtheweekafterthequitdate.Thequitdatewasscheduledduringweek5oftheintervention.
Significantlygreaterreductioninpostquitversusprequiturgesinthemindfulnesscondition.
Food
Albertsetal(2010)
19
Communitysample,overweightorobese.
89%
Presentmomentawarenessofbodilysensations,eatingbehaviorsandcravingrelatedthoughts.
Informationandphysicalactivity.
Traitfoodcravings7weeksfrombaseline.
Significantlygreaterreductionincravingsinthemindfulnesscondition.
MINDFULNESS
59
1Restrictedtoparticipantsincludedintheanalysesofinterest.2Differencesarestatisticallysignificant,unlessotherwisestated.
Acceptanceofcravingrelatedbodilysensationsandthoughts.