A Randomized Controlled Trial of Mindfulness, Goal Setting, and MiCBT for Smoking Cessation and Resilience in Low SES Smokers

Background Smoking rates remain disproportionately high among individuals of low socio-economic status (SES), contributing significantly to health inequities. Resilience-based interventions offer a potential strengths-focused approach to address this challenge. This study aimed to evaluate the efficacy of Mindfulness Training, Setting Realistic Goals, and Mindfulness-integrated Cognitive Behavioural Therapy (MiCBT) for promoting smoking cessation and enhancing resilience in low SES adult smokers. Methods A four-arm, parallel-group, 12-month online randomized controlled trial was conducted with 346 adult regular smokers in Australia classified as low SES. Participants were randomized to one of four conditions: Mindfulness Training, Setting Realistic Goals, MiCBT, or an active control group that received referrals to standard quit services. The active interventions consisted of eight 1-hour online group sessions over 6 months, followed by 6 months of online forum-based peer support. The primary outcome was self-reported 14-day smoking abstinence at 6 months. Secondary outcomes included internal resilience (Connor-Davidson Resilience Scale-25), external resilience (social support), nicotine dependence, self-efficacy, and stress. Data were analyzed using mixed-effects modelling. Results All study groups achieved substantial self-reported quit rates at the 6-month primary endpoint, ranging from 29.9% in the control group to 36.4% in the Mindfulness Training group. Significant reductions in nicotine dependence were also observed across all groups over the 18-month study period. However, there were no statistically significant between-group differences for the primary outcome of smoking abstinence or for secondary outcomes, including internal resilience and social support, at any time point. Conclusions Participation in a structured smoking cessation trial was associated with reduced smoking behaviors among low SES adults. However, none of the online resilience-enhancing interventions demonstrated superior efficacy for smoking cessation or for enhancing internal resilience compared to an active control. These findings suggest that low-intensity online interventions may be insufficient for this population and highlight the need for more intensive or blended support models. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12621000445875. Registered 19 April 2021.