For people living with HIV (PLWH) who cite anxiety as a barrier to smoking cessation, mindfulness training may be a useful tool for reducing anxiety prior to a cessation attempt, according to research presented by Patricia A. Cioe, PhD, at the Association of Nurses in AIDS Care (ANAC) annual meeting held November 17 to 19, 2022, in Tampa, Florida.

More PLWH are smokers than the general population and PLWH often respond poorly to common smoking cessation treatments. Key barriers in successful smoking cessation in the HIV setting include anxiety and stress, explained Dr Cioe, who is associate professor of Behavioral and Social Sciences at Brown University.

This open pilot study was designed to evaluate whether a mindfulness-based training intervention was feasible and acceptable for PLWH who smoke and whether mindfulness had an effect on anxiety. Investigators at the Brown School of Public Health recruited 15 PLWH who smoked and desired to stop smoking into the study.  

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Participants completed daily modules from Unwinding Anxiety, which is a mindfulness-based training mobile app. At baseline and weeks 4 and 8, anxiety was evaluated using the Generalized Anxiety Disorder (GAD-7) instrument and readiness to quit using the Contemplation Ladder. At week 4, individuals who were ready to set a quit date were provided with 2 weeks of nicotine replacement therapy and a session of cessation counseling with a nurse.

The study participants had an average age of 51.5 years (range, 30-67) and had been living with HIV for 17.8 years (range, 3-35). Nearly half (47%) were women. The participants smoking history included an average smoking habit of 11.4 cigarettes per day (range, 3-20), duration of smoking of 35 years (range, 15-54), and 5.3 previous quit attempts (range, 0-25).

The participants completed an average of 2.7 of the 3 study sessions and completed 16 of the Unwinding Anxiety modules (range, 4-38). Overall, 93% completed the study.

At baseline, the average GAD score was 14.4 points (range, 9-12) and 93.3% met the criteria for anxiety (GAD >10). At the week 4 follow-up, GAD scores had decreased to 8.5±6.8 points and remained stable until week 8. The readiness to quit score increased from 5.5±1.6 at baseline to 6.4±0.9 at week 4.

Anxiety and readiness to quit scores were correlated at baseline (P <.001), and an interaction was found between anxiety and readiness to quit scores at week 4, in which individuals with higher anxiety were less prepared to quit (P =.009).

The major limitation of this study was the small sample size.

This study found that an app-based mindfulness training intervention was acceptable and feasible for PLWH who smoked and thought their anxiety was a significant smoking cessation barrier. After 4 weeks of using the mindfulness app, anxiety was reduced and participants were more ready to quit smoking. Clinicians may consider recommending such mindfulness-based apps for PLWH who have anxiety and are considering smoking cessation, the study investigators concluded.

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Cioe PA, Sokolovsky AW, Brewer JA, et al. Project MindUP: An open pilot study examining the use of mindfulness training to reduce anxiety in people with HIV who smoke. Poster presented at: ANAC2022; November 17-19, 2022; Tampa, FL.

This article originally appeared on Clinical Advisor