Despite a nationwide decline in smoking rates, the prevalence of smoking among individuals with mental illness remains disproportionately high.

Haruka Minami, Ph.D., assistant professor of psychology, hopes to find out whether practicing mindfulness can help these individuals quit smoking, especially those with depression.

“Depressed individuals tend to smoke at higher rates; at the same time, depressive symptoms make it more difficult to quit,” said Minami. “Consequently, depressed individuals suffer from a higher rate of smoking-related diseases. Developing and implementing effective smoking cessation interventions for this vulnerable population is a public health priority.”

Haruka Minami became interested in smoking cessation when she was studying the effects of stress on health. Stress is a trigger for smoking.
Photos by Dana Maxson

Minami is leading a treatment development study, together with her graduate and undergraduate students and colleague, Rivera-Mindt, at Montefiore Behavioral Health Center in the Bronx that provides smoking cessation treatment to depressed patients. This study uses a multi-pronged approach: in addition to providing no-cost nicotine replacement therapy and smoking cessation counseling, it asks participants to practice mindfulness with the aid of audio recordings.

Mindfulness is the act of “purposeful attention to the present moment, including sensations, thoughts, and feelings, in a non-judgmental way,” said Minami. “It also encourages openness, curiosity, and acceptance toward one’s experience.” This, Minami believes, can foster awareness and help smokers respond to cravings and other smoking triggers in a less impulsive and more reflective way.

“Smokers have learned to reach for a cigarette whenever they experience internal discomfort including craving, negative feelings, and stress.” she said. “We want to help them be more aware of their triggers, and be willing to experience discomfort without smoking.

“Taking a few minutes to be mindful of their internal experience throughout the day may help smokers respond to craving or stress with non-smoking strategies instead of reacting to them by smoking.”

This study does not take place solely in a clinic; it provides participants with smartphones to assess their mood, craving, and smoking behavior several times a day in real-time, a method known as ecological momentary assessment. This allows Minami to examine how changes over a matter of hours can influence smoking behavior in the context of an individual’s personal – as opposed to a clinic – environment.

These smartphones not only contain guided mindfulness audio recordings that participants can access at any time, but also prompts participants to blow into a device that measures carbon monoxide levels (akin to a smoking breathalyzer) and uploads results to a secure server in real time.

“This allows us to verify their smoking status without the need for participants to visit the clinic, thereby easing participant burden. We are also able to reward participants immediately for not smoking, a method called contingency management.”

This study is currently in the randomized controlled trial phase at Montefiore, and Minami is already impressed by some participant reactions in the pilot phase.

“Participants are enthusiastic about practicing mindfulness (sometimes more than 5 times a day!) and convey to us how helpful mindfulness practice is, not just in keeping them motivated to stay smoke-free, but in other aspects of their lives as well.”

In addition, the doctors and clinicians at the behavioral health center are excited and supportive of the study, said Minami. It fills a key need by providing patients with access to smoking cessation treatment.

“I hope this project will help improve cessation rates and further our understanding of protective and risk factors in this vulnerable population.”