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تَأَمُّل اليقظة الذهنية باعتباره علاجاً لتعاطي التبغ: مراجعة منهجيّة

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Research Question

  1. What are the efficacy and safety of mindfulness meditation interventions, as an adjunctive or monotherapy, for smoking cessation or reduction compared with treatment as usual, waitlists, no treatment, or other active treatments?

RAND researchers conducted a systematic review that synthesized evidence from randomized controlled trials of mindfulness meditation interventions — used adjunctively or as monotherapy — to provide estimates of their efficacy and safety for treating tobacco use.

The primary outcome of interest was smoking/tobacco cessation. Other outcomes of interest included reduction in use, decrease in cravings, health-related quality of life, and adverse events. Meta-analyses for efficacy outcomes were conducted using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Quality of evidence was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (or GRADE) approach.

Nine studies met inclusion criteria. Studies compared mindfulness training for smokers, mindfulness training, and a mindfulness-based smoking cessation program with American Lung Association's Freedom from Smoking program, quitline counseling, interactive learning, or treatment as usual. Intervention duration and intensity varied considerably. Meta-analyses for smoking cessation and cigarettes smoked per day indicated no statistically significant differences between mindfulness interventions and comparator interventions. Analysis suggested effects vary by type of intervention. Only three studies reported on adverse events; they stated that there were no reportable medication reactions associated with the adjunctive nicotine replacement treatment or that no serious adverse events occurred.

We conclude that the body of evidence for mindfulness meditation for the treatment of tobacco use is very limited. Additional high-quality studies with samples large enough to detect effects and confirming smoking cessation through biochemical means are suggested.

Key Findings

The Evidence Base Is Too Limited to Draw Any Strong Conclusions

  • Only a small number of randomized controlled trials (RCTs) of mindfulness meditation interventions for treatment of tobacco use have been published, and the interventions, comparators, and outcomes vary considerably. Important aspects of methodology were often unreported in the journal articles describing these RCTs.
  • Effects on smoking cessation (abstinence) favored meditation but were not statistically different from comparator interventions, and the mean number of cigarettes per day was not statistically different between meditation and comparator interventions at follow-up. Analysis suggested that effects vary by type of intervention.
  • Only three RCTs addressed adverse events, and all reported no events.
  • No included studies reported the number of quit attempts or quality of life measures, and no studies obtained a "good" quality rating. Only one study reported on adverse events related to the mindfulness intervention.

Recommendations

  • More well-designed, rigorous, and large RCTs are needed in order to develop an evidence base that can more decisively provide estimates of the effectiveness of mindfulness mediation for tobacco use. Future studies should measure smoking cessation and achieve a sample size large enough to detect statistical differences in this outcome.
  • Chemical confirmation of cessation is encouraged for scientific validity.
  • Studies should follow up with participants for at least six to 12 months in order to assess the effects of meditation on long-term cessation; adherence to mindfulness practice, co-interventions, comparator interventions, and simultaneous use of other therapies should be monitored frequently.
  • The CONSORT (CONsolidated Standards of Reporting Trials) statement on reporting standards should be followed when publishing future RCTs on mindfulness meditation and tobacco use.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Methods

  • Chapter Three

    Results

  • Chapter Four

    Discussion

  • Appendix A

    Search Strategy

  • Appendix B

    Excluded Full-Text Articles

  • Appendix C

    Evidence Table of Included Studies

This research was sponsored by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

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