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 Table of Contents  
Year : 2022  |  Volume : 66  |  Issue : 3  |  Page : 334-336  

Need for mindfulness-based relapse prevention strategies for postpartum smoking relapse prevention

1 Assistant Professor, Department of Liberal Arts and Design Studies , Vidyashilp University, Bengaluru, Karnataka, India
2 Professor, Department of Psychology, Christ (Deemed to be University), Bengaluru, Karnataka, India

Date of Submission07-Jul-2021
Date of Decision23-Nov-2021
Date of Acceptance25-May-2022
Date of Web Publication22-Sep-2022

Correspondence Address:
Anita Mary Vadivale
6, Rogers Road, Richards Town, Bengaluru - 560 005, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijph.ijph_1494_21

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The health concerns for women are varied from that of men and are of higher concern. To increase this concern, women have recorded higher smoking relapse rates than men were an alarming 60% to 90% of the women who have attempted to quit relapse within their first year. Women who quit during pregnancy are seen to have higher rates of relapse than others. Such postpartum relapse has detrimental effects on the mother as well as the newborn. Mindfulness-based interventions have seen benefits in the areas of substance abuse and relapse prevention. Although research in the area of mindfulness and its benefits on smoking cessation has been limited, literature shows positive outcomes. This brief article examines the need for mindfulness-based relapse prevention strategies for women who are undergoing postpartum smoking relapses so that they could benefit from the same.

Keywords: Mindfulness, mindfulness-based interventions, nicotine dependence in women, postpartum smoking relapse

How to cite this article:
Vadivale AM, Sathiyaseelan A. Need for mindfulness-based relapse prevention strategies for postpartum smoking relapse prevention. Indian J Public Health 2022;66:334-6

How to cite this URL:
Vadivale AM, Sathiyaseelan A. Need for mindfulness-based relapse prevention strategies for postpartum smoking relapse prevention. Indian J Public Health [serial online] 2022 [cited 2022 Sep 28];66:334-6. Available from:

As the rates of smoking relapse have seen a rise among postpartum women, there is a need to research new strategies that could help in relapse prevention among this vulnerable population. Over the years, a lot of research has gone into mindfulness and smoking behavior showing positive outcomes on different smoking populations. This article reviews the need for mindfulness-based relapse prevention (MBRP) strategies and how they may contribute to postpartum relapse prevention.

Research has gained importance in the area of nicotine dependence during pregnancy and the harm it causes to the fetus. Smoking during pregnancy results in several health problems and complications during delivery and postdelivery ranging from preterm delivery, fetal mortality, low birth weight, to other abnormalities. Although the need to quit is high, the relapse rate postdelivery is a need for concern.

The reasons for relapse vary based on specific pathologies that influence individuals' nicotine dependence. Identifying the underlying pathology of the individual may help in the formulation of interventions that consider individual differences when developing strategies for relapse prevention. Interventions include motivational techniques, suggestions on how to avoid triggers and cues that compel the individual to smoke, and stressors that contribute to nicotine dependence, for example, behavior therapy, education/support groups, exercise, hypnosis, nicotine fading, and nicotine replacement therapy. Group interventions have proven to be highly effective among western working populations. However, they are not widely accepted in some countries like India.[1]

Using alternate therapies for substance use interventions among women is particularly effective. The supportive nature of therapy, increased retention, availability of service, acceptance by the family, and focus of these therapies on relationships makes them particularly effective. Further, alternative therapies for substance use may be less stigmatizing than conventional treatment. Women who smoke also benefit more from nonnicotine-based medications, and behavioral interventions. This may be because these interventions focus on underlying pathologies rather than symptomatic treatment.[2]

The foundation of mindfulness techniques finds its grounding from a Buddhist meditative technique called Vipassana. Mindfulness trains the mind to observe thoughts, sensations, and emotions where they are viewed as being impermanent. An understanding of this is considered to be the key to relief from suffering.

Attachment and aversion are believed to be the root causes of psychological distress according to mindfulness theory. Attachment to thoughts, emotions, and pleasurable physical sensations, and aversion to the unpleasant cause suffering. Further, this attachment and aversion may cause individuals to engage in habitual behavior for pleasure and to avoid pain. The concept of attachment and aversion, and its role in creating habitual behavior is particularly evident in substance use, including nicotine dependence. Aversion to the unpleasant aspects of withdrawal and attachment to the positive effects of nicotine consumption help in the maintenance of smoking behavior. Thus, by practicing mindfulness, the individual may be better able to look at their experience nonjudgmentally.

Mindfulness has only recently been integrated into interventions for addiction. Controlled research studies show that mindfulness helps in the acceptance of craving and withdrawal, and hence environmental cues do not affect relapse.[3]

Comparative studies have shown that mindfulness-based intervention's (MBI's) resulted in a significant reduction in the number of cigarettes smoked.[4] Mindfulness interventions also focus on improving distress tolerance as a way of ensuring long-term abstinence. Practicing mindfulness regularly was seen to reduce stress[5] which is one of the major causes for relapse among those who try to quit smoking.

Mindfulness practice is also reported to have an indirect influence on relapse prevention through its positive effect on factors such as self-efficacy. It helps reduce urges, perceived stress, and experiential avoidance, among smokers.[6] Further, it helps reduce negative affective states and cravings that serve as perpetuating factors in substance dependence, including nicotine use.

Studies show that women benefit more from MBI's, especially for smoking cessation and relapse prevention. Although not many studies have been conducted specifically in women, there have been positive results seen among the female population about cessation. A study with 54.9% of its participants as women showed MBIs lowering anxiety, concentration difficulties, craving and dependence, and increasing self-efficacy in managing negative effects.[7] Other studies at workplace also show similar results.[8]

With the increasing prevalence of smoking behavior among women in India from 1.4% to 2.9% along with high rates of relapse,[9] there is a great urgency for relapse prevention interventions that prove to be beneficial with higher success rates.

Although MBI's have proved to show higher rates of success among populations showcasing addictive behaviors and relapse prevention, as MBRP is a relatively new intervention, the research examining the effectiveness of this intervention is in its infancy. Moreover, research on MBRP has primarily focused on the effectiveness of the intervention in decreasing the prevalence and severity of relapses as well as the feasibility of using the intervention in different settings and among different populations. Less researched are the mechanisms of change involved in generating the benefits emerging from MBRP interventions, how the specific factors commonly implicated in relapse are altered as a result of the intervention, and the components of the intervention that are most beneficial for individuals with substance use disorders. In addition, research assessing for gender differences in the effectiveness of mindfulness-based interventions for substance use disorders is also lacking.

Pregnancy comes with its challenges and sacrificing pleasures for the welfare of the newborn adds to the changes in hormones which may result in deterioration of mental health. Delivery and postpartum causes stress and anxiety. Those who give up smoking during the pregnancy term may fall back on old habits and there is a need for sustainable measures to arrest relapse. Mindfulness has proven beneficial in various addictions and also in nicotine addiction and dependence. With the number of mindfulness-based therapies rising and showing positive results, such interventions could be customized to work with postpartum women to prevent a situation of relapse. Clinical practitioners could conduct focused research on this vulnerable population to help them abstain from this habit. More research in this area could help develop interventions that specifically work on the problems faced by postpartum mothers and work toward preventing their relapse. Such interventions would directly be beneficial to the health of the new mother but on the infant as well.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Dutta S, Annapoorna HB, Tripathi J, Sinha N, Roy S, Agrawal R. Prevalence of habit of tobacco and their effects: A clinical study. J Adv Med Dent Sci Res 2016;4:88-91.  Back to cited text no. 1
Perkins KA. Smoking cessation in women. Special considerations. CNS Drugs 2001;15:391-411.  Back to cited text no. 2
Brewer JA, Elwafi HM, Davis JH. Craving to quit: psychological models and neurobiological mechanisms of mindfulness training as treatment for addictions. Psychol Addict Behav 2013;27:366-79.  Back to cited text no. 3
Elwafi HM, Witkiewitz K, Mallik S, Thornhill TA, Brewer JA. Mindfulness training for smoking cessation: moderation of the relationship between craving and cigarette use. Drug Alcohol Depend 2013;130:222-9.  Back to cited text no. 4
Vadivale AM, Sathiyaseelan A. Mindfulness-based relapse prevention – A meta-analysis. Cogent Psychol 2019;6:1567090.  Back to cited text no. 5
Davis JM, Manley AR, Goldberg SB, Smith SS, Jorenby DE. Randomized trial comparing mindfulness training for smokers to a matched control. J Subst Abuse Treat 2014;47:213-21.  Back to cited text no. 6
Spears CA, Hedeker D, Li L, Wu C, Anderson NK, Houchins SC, et al. Mechanisms underlying mindfulness-based addiction treatment versus cognitive behavioral therapy and usual care for smoking cessation. J Consult Clin Psychol 2017;85:1029-40.  Back to cited text no. 7
Weng X, Luk TT, Lau OS, Suen YN, Lee JJ, Li WH, et al. Brief mindfulness training for smoking cessation in Chinese women in workplaces: A pilot randomized controlled trial. Addict Behav 2020;113:106677.  Back to cited text no. 8
Goel S, Tripathy JP, Singh RJ, Lal P. Smoking trends among women in India: Analysis of nationally representative surveys (1993-2009). South Asian J Cancer 2014;3:200-2.  Back to cited text no. 9
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