Elsevier

Clinical Psychology Review

Volume 59, February 2018, Pages 101-117
Clinical Psychology Review

Review
Mindfulness and craving: effects and mechanisms

https://doi.org/10.1016/j.cpr.2017.11.003Get rights and content

Highlights

  • Mindfulness strategies may reduce cravings by loading working memory.

  • Mindfulness strategies may also extinguish cravings by promoting response inhibition.

  • Such effects are not unique to mindfulness strategies.

  • Mindfulness may have unique benefits where it is practiced over an extended period.

  • More controlled research on the effects of extended mindfulness practice is needed.

Abstract

Mindfulness meditation has a long tradition of being used to manage cravings. This paper reviews 30 experimental studies that have examined the effects of different types of mindfulness practice on cravings for food, cigarettes and alcohol. The findings are interpreted in light of relevant theories of craving. The studies show most support for the elaborated intrusion theory of desire and conditioning models. They suggest that whilst mindfulness strategies may bring about immediate reductions in craving, such effects are likely to stem from working memory load, and will not necessarily be superior to alternative strategies that also load working memory. Likewise, reductions in craving over the medium term may occur due to extinction processes that result from the individual inhibiting craving-related responses. Again, alternative strategies that promote response suppression may be equally effective. Nevertheless, a smaller number of studies show promising results where mindfulness exercises have been repeatedly practiced over a longer period of time. The results of these studies provide tentative support for Buddhist models of craving that suggest mindfulness practice may confer unique benefits in terms of both craving reduction and reducing the extent to which craving leads to consumption. Further research would be needed to confirm this.

Introduction

Craving can be defined as an intense, conscious desire, usually to consume a specific drug or food (Drummond, 2001, May et al., 2015, Pelchat, 2002, Tiffany and Wray, 2012). Although the clinical relevance of craving has been questioned (Wray, Gass, & Tiffany, 2013), there is also a significant body of research that suggests it is causally linked to behavior. For example, craving predicts relapse episodes in substance use (Serre, Fatseas, Swendsen, & Auriacombe, 2015) and food cravings predict both eating and weight gain (Boswell & Kober, 2016). As such, cravings are often considered an appropriate target for intervention, the assumption being that reducing craving, or changing a person's response to craving, will impact upon the related behavior.

Mindfulness meditation has a long tradition of being used to address cravings. According to ancient Buddhist texts, craving leads to suffering but can be avoided through mindfulness meditation practice (Dhammacakkappavattana Sutta: Setting in Motion the Wheel of Truth [SN 56.11], 2013). More recently, mindfulness-based interventions have been used to explicitly target cravings with the aim of bringing about clinically relevant changes to behavior (e.g., Alberts et al., 2010, Ruscio et al., 2016, Zemestani and Ottaviani, 2016). However, such interventions often comprise a range of mindfulness and non-mindfulness components, making it difficult to unequivocally attribute any changes in craving to the mindfulness-based elements of the intervention (e.g., Bowen et al., 2009, Bricker et al., 2014, Garland et al., 2016, Zemestani and Ottaviani, 2016; see also Tapper, 2017). As such, the effects of mindfulness practice on craving have yet to be scientifically established.

Mindfulness interventions also typically employ a range of different types of strategy, for example they may include exercises designed to promote greater awareness of bodily sensations, to develop an attitude of acceptance toward uncomfortable feelings, or to help individuals see themselves as separate from their thoughts and emotions (Tapper, 2017). However, we currently have limited understanding of the ways in which these different types of strategy may influence craving-related outcomes, either independently, or in combination. Although some authors have proposed models to account for potential effects (Brewer, Elwafi, & Davis, 2013), many aspects of these have yet to be tested experimentally. As such we lack a full understanding of the ways in which mindfulness practice might influence cravings. This is important because a sound theoretical basis is essential for the development of effective interventions (Michie & Abraham, 2004).

The current article aims to address these limitations by reviewing studies that have examined the independent effects of mindfulness on craving. In other words, the review is restricted to studies in which the experimental manipulation or intervention consists only of mindfulness components. Such an approach inevitably excludes interventions that combine mindfulness strategies with other therapeutic approaches1 (e.g., Mindfulness-Oriented Recovery Enhancement, see Garland, 2013; Acceptance and Commitment Therapy, see Hayes, Strosahl, & Wilson, 1999). However, restricting the review in this way should allow any effects on craving to be more confidently attributed to the mindfulness manipulation. It should also make it easier to compare the effects of different types of mindfulness practice as well as evaluate potential mechanisms of action. As such, the review has three key aims: (a) to examine the effects of mindfulness-based practices on craving, (b) to compare the effects of different types of mindfulness-based practices on craving, and (c) to explore the mechanisms via which mindfulness-based practices may exert any effects on craving.

The review is informed by conceptualizations of mindfulness that distinguish between three key components; present moment awareness, acceptance and decentering (Creswell, 2017, Tapper, 2017). Present moment awareness refers to the self-regulation of attention so that it is maintained on present moment experience, for example ones breath, bodily sensations or the content of ones thoughts; acceptance involves taking a non-judgmental attitude towards ones thoughts, feelings and bodily sensations; decentering means viewing ones thoughts and feelings as transient events that are separate to oneself. In practice it may be difficult to completely distinguish between the effects of these three different techniques since acceptance and decentering likely require a certain amount of present moment awareness. It is also possible that acceptance and decentering arise spontaneously from repeated present moment awareness (Bishop et al., 2004, Brown and Ryan, 2004, Shapiro et al., 2006). Nevertheless, it is possible to target these techniques independently and different theories of craving make differential predictions about their relative importance. For this reason, the current review is guided by the emphasis each study places on each of these three different components.

The review begins by looking at the ways in which mindfulness relates to selected theories of craving, in order to identify potential mechanisms of action and specific predictions that can be experimentally tested. It then examines studies of mindfulness and craving in light of these theories with a view to identifying future directions for more experimental work in the area as well as informing the development of more evidence-based mindfulness interventions designed to tackle cravings.

Section snippets

Theories of craving

A wide range of different theories and models have been put forward to account for cravings (see Skinner & Aubin, 2010). A full discussion of these is beyond the scope of the current article; only those with relevance to the potential impact of mindfulness practice on craving will be considered here. These are grouped under the broad headings of conditioning-based models, cognitive models, and Buddhist models.

Summary of key predictions based on models of craving

Table 1 provides a summary of key predicted effects of different mindfulness strategies on craving according to the models described above.

Table 1 illustrates the ways in which different models make different predictions. For example, EI theory and Buddhist models are the only ones that predict immediate reductions in craving as a result of increased present moment awareness, the cognitive processing model is the only one to predict increased craving as a result of present moment awareness, and

Literature search and study selection

A literature search of English language publications was conducted during May 2016 using Web of Science and the search terms ‘mindful*’, ‘attentive eating’ and ‘intuitive eating’, each paired with the terms ‘craving’, ‘desire’ and ‘urge’. This search was repeated in May 2017 and September 2017 to identify any additional publications. These searches led to the identification of 294 records. The titles and abstracts of these were reviewed and 250 were excluded on the basis of at least one of the

Conclusions

Some of the beneficial effects seen for mindfulness strategies in relation to craving are likely to stem from (a) interrupting craving related elaboration by loading working memory, and (b) extinction process that result from the individual inhibiting the craving-related behavior. Whilst it is important not to diminish the value of such outcomes, it is unclear whether mindfulness-based strategies have any advantages over other techniques that also promote such effects. For example, guided

Recommendations for future research

In terms of laboratory-based experimental work, it would be helpful to determine whether decentering strategies can have an immediate effect on craving over and above what could be achieved by simple visualization or distraction strategies. This should be relatively easy to establish with studies that compare levels of craving following a visualization and decentering task, a visualization only task and a no strategy control group. Such studies should help clarify the immediate effects of

Role of funding sources

This work did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Contributors

The author was solely responsible for conducting the review and preparing the manuscript.

Conflict of interest

The author declares no conflicts of interest.

. Characteristics of studies examining the independent effects of mindfulness on craving.

Craving typeStudySample sizeaSample detailsGender (% female)Primary mindfulness strategy(ies)/interventionControl strategy(ies)/interventionDependent variableResultsb
FoodHamilton et al. (2013)94University students, abstained from breakfast.77%Present moment awareness of bodily sensations and thoughts.1. Guided imagery.
2. Mind wandering.
Food cravings at

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