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National Institutes of Health • National Center for Complementary and Alternative Medicine

NCCAM Clinical Digest. For health professionals.

Complementary Health Approaches for Smoking Cessation :
What the Science Says

January 2014

Mindfulness Meditation

Mindfulness meditation is a mind-body practice which cultivates abilities to maintain focused and clear attention, and develop increased awareness of the present. Research has demonstrated that mindfulness-based approaches may help reduce symptoms of anxiety, depression, and chronic pain.

Strength of Evidence

  • To date, there have been a few randomized studies on mindfulness-based interventions for smoking cessation, but overall, there is not enough evidence to know whether mind-body practices are as efficacious as other more established smoking cessation treatments.

Research Results

  • A 2011 randomized controlled trial comparing mindfulness training with a standard behavioral smoking cessation treatment found that individuals who received mindfulness training showed a greater rate of reduction in cigarette use immediately after treatment and at 17-weeek follow-up.
  • A couple of studies have used functional magnetic resonance imaging to examine the effects of mindful attention on the anterior cingulate and prefrontal cortex in smokers, the areas of the brain associated with cravings and self-control. In one study, participants’ self-reported results demonstrated that mindful attention reduced cravings. In addition, the brain imaging results indicated that mindful attention reduced neural activity in a craving-related region of the subgenual anterior cingulate cortex. In another study, a 2-week course of meditation (5 hours in total) produced a significant reduction in smoking, compared to a relaxation training control. Results of brain imaging showed increased activity for the meditation group in the anterior cingulate and prefrontal cortex.

Safety

  • Meditation is considered to be safe for healthy people.
  • There have been rare reports that meditation could cause or worsen symptoms in people who have certain psychiatric problems, but this question has not been fully researched.

Hypnotherapy

Hypnosis (also called hypnotherapy) has been studied for a number of conditions, including state anxiety (e.g., before medical procedures or surgeries), headaches, smoking cessation, pain control, hot flashes in breast cancer survivors, and irritable bowel syndrome.

Strength of Evidence

  • Many studies have investigated the effects of hypnotherapy on smoking cessation.

Research Results

  • A 2010 Cochrane review of eleven studies compared hypnotherapy with 18 different control interventions. The authors found that hypnotherapy did not have a greater effect on 6-month quit rates than other interventions or no treatment. They concluded that there is not enough evidence to show whether hypnotherapy could be as effective as counseling treatment.
  • A 2012 meta-analysis of randomized controlled trials found that acupuncture, hypnotherapy, and aversive smoking increased smoking abstinence, but the patient population in the analysis was small and reports of smoking cessation were not validated by bio-chemical means.
  • A 2008 randomized trial of 286 smokers found that hypnosis combined with nicotine patches yielded long-term smoking cessation rates that were slightly higher than those for behavioral counseling and nicotine patch.

Safety

  • Hypnosis is considered safe when performed by a health professional trained in hypnotherapy.
  • Self-hypnosis also appears to be safe for most people. There are no reported cases of injury resulting from self-hypnosis.

Yoga

Yoga is a mind and body practice with origins in ancient Indian philosophy. The various styles of yoga typically combine physical postures, breathing techniques, and meditation or relaxation. There are numerous schools of yoga. Hatha yoga, the most commonly practiced in the United States and Europe, emphasizes postures (asanas) and breathing exercises (pranayama). Some of the major styles of hatha yoga are Iyengar, Ashtanga, Vini, Kundalini, and Bikram yoga.

Strength of Evidence

  • Only a few studies have been conducted on yoga for smoking cessation.

Research Results

  • A 2012 NCCAM-funded study examined the effect of yoga on smoking cessation. Results of this study provide preliminary evidence that yoga may be an effective adjunctive treatment for smoking cessation in women.
  • A 2011 study examined the effects of physical activity, including cardiovascular exercise and Hatha yoga, on craving to smoke and smoking withdrawal. Participants who engaged in physical activity reported a decrease in craving to smoke, an increase in positive affect, and a decrease in negative affect.

Safety

  • Yoga is generally low-impact and safe for healthy people when practiced appropriately under the guidance of a well-trained instructor.
  • Overall, those who practice yoga have a low rate of side effects, and the risk of serious injury from yoga is quite low. However, certain types of stroke as well as pain from nerve damage are among the rare possible side effects of practicing yoga.
  • Women who are pregnant and people with certain medical conditions, such as high blood pressure, glaucoma (a condition in which fluid pressure within the eye slowly increases and may damage the eye's optic nerve), and sciatica (pain, weakness, numbing, or tingling that may extend from the lower back to the calf, foot, or even the toes), should modify or avoid some yoga poses.

Acupuncture

The term “acupuncture” describes a family of procedures involving the stimulation of points on the body using a variety of techniques. The acupuncture technique that has been most often studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.

Although millions of Americans use acupuncture each year, often for chronic pain, there has been considerable controversy surrounding its value as a therapy and whether it is anything more than placebo. Research exploring a number of possible mechanisms for acupuncture’s pain-relieving effects is ongoing.

Strength of Evidence

  • Several studies have been conducted on the effects of acupuncture or acupressure for smoking cessation.

Research Results

  • A 2011 Cochrane review concluded that there is no consistent, bias-free evidence that acupuncture, acupressure, laser therapy or electrostimulation are effective for smoking cessation, but firm conclusions cannot be drawn because of the limited quantity and quality of available evidence.

Safety

  • Relatively few complications from the use of acupuncture have been reported to the FDA, in light of the millions of people treated each year and the number of acupuncture needles used. Still, complications have resulted from inadequate sterilization of needles and from improper delivery of treatments.
  • When not delivered properly, acupuncture can cause serious adverse effects, including infections and punctured organs.

Tai Chi

Tai chi, which originated in China as a martial art, is sometimes referred to as “moving meditation”—practitioners move their bodies slowly, gently, and with awareness, while breathing deeply.

Strength of Evidence

  • To date, only a few studies have examined the effects of tai chi for smoking cessation.

Research Results

  • Findings from a 2013 study on the effects of tai chi for smoking cessation suggest that tai chi may be an effective method for enhancing mindfulness and awareness for breaking cycles of addiction and habit.

Safety

  • Tai chi is a relatively safe practice for most people. Those who are pregnant, or have a hernia, joint problems, back pain, fractures, or severe osteoporosis, may want to modify or avoid certain postures in tai chi.

NCCAM Clinical Digest is a service of the National Center for Complementary and Alternative Medicine, NIH, DHHS. NCCAM Clinical Digest, a monthly e-newsletter, offers evidence-based information on CAM, including scientific literature searches, summaries of NCCAM-funded research, fact sheets for patients, and more.

The National Center for Complementary and Alternative Medicine is dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCAM's Clearinghouse toll-free at 1-888-644-6226, or visit the NCCAM Web site at nccam.nih.gov. NCCAM is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.

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