Restructuring Reward Mechanisms in Nicotine Addiction: A Pilot fMRI Study of Mindfulness‐Oriented Recovery Enhancement for Cigarette Smokers

Abstract

The primary goal of this pilot feasibility study was to examine the effects of Mindfulness-Oriented Recovery Enhancement (MORE), a behavioral treatment grounded in dual-process models derived from cognitive science, on frontostriatal reward processes among cigarette smokers. Healthy adult (<i>N</i> = 13; mean (SD) age 49 ± 12.2) smokers provided informed consent to participate in a 10-week study testing MORE versus a comparison group (CG). All participants underwent two fMRI scans: pre-tx and after 8-weeks of MORE. Emotion regulation (ER), smoking cue reactivity (CR), and resting-state functional connectivity (rsFC) were assessed at each fMRI visit; smoking and mood were assessed throughout. As compared to the CG, MORE significantly reduced smoking (<i>d</i> = 2.06) and increased positive affect (<i>d</i> = 2.02). MORE participants evidenced decreased CR-BOLD response in ventral striatum (VS; <i>d</i> = 1.57) and ventral prefrontal cortex (vPFC; <i>d</i> = 1.7) and increased positive ER-BOLD in VS (<i>d</i>_VS = 2.13) and vPFC (<i>d</i>_vmPFC = 2.66). Importantly, ER was correlated with smoking reduction (<i>r</i>'s = .68 to .91) and increased positive affect (<i>r</i>'s = .52 to .61). These findings provide preliminary evidence that MORE may facilitate the restructuring of reward processes and play a role in treating the pathophysiology of nicotine addiction.