A Pilot Randomized Controlled Trial of Smartphone-Assisted Mindfulness-Based Intervention With Contingency Management for Smokers With Mood Disorders

Cigarette smoking disproportionately affects individuals with mood disorders, but smoking cessation interventions have modest effects in this population. Home mindfulness practice during abstinence incentivized via contingency management (CM) may help those in affective distress quit smoking. Method: Adult smokers receiving outpatient psychiatric treatment for mood disorders were randomized to receive a smartphone-assisted mindfulness-based smoking cessation intervention with contingency management (SMI-CM, n = 25) or enhanced standard treatment (EST, n = 24) with noncontingent rewards. Participants in SMI-CM were prompted to practice audio-guided mindfulness five times per day for 38 days (vs. no comparison intervention in EST), and received monetary incentives for carbon monoxide (CO) <= 6 ppm. The primary outcome was biochemically verified 7-day point prevalence abstinence rates 2, 4, and 13 weeks after a target quit day. Results: Of the 49 participants, 63.3% were Latinx and 30.6% Black; 75.5% reported household incomes <$25,000. Abstinence rates for SMI-CM were 40.0%, 36.0%, and 16.0% versus 4.2%, 8.3%, and 4.2% in EST at weeks 2, 4, and 13. A generalized estimating equations (GEE) model showed significant overall differences in abstinence rates in SMI-CM versus EST (adjusted odds ratio [AOR] = 8.12, 95% CI = 1.42-46.6, p = .019). Those who received SMI-CM reported significantly greater reduction in smoking-specific experiential avoidance from baseline to 3 days prior to quit date (beta = -7.21, 95% CI = -12.1-2.33, p = .006). Conclusions: SMI-CM may increase cessation rates among smokers with mood disorders, potentially through reduced smoking-specific experiential avoidance. SMI-CM is a promising intervention, and warrants investigation in a fully powered randomized controlled trial (RCT). Public Health Significance This pilot randomized controlled trial (RCT) suggests that a smartphone-assisted mindfulness-based smoking cessation intervention with contingency management (SMI-CM) is feasible and efficacious in improving short-term cessation success, possibly through its impact on smoking-specific experiential avoidance, among smokers with mood disorders, from diverse racial/ethnic backgrounds, and with low socioeconomic status. A fully powered RCT is needed to further elucidate the underlying mechanisms of change in SMI-CM.