• Logo
  • SBMUJournals

Transcranial Direct Current Stimulation Combining Mindfulness Based Relapse Prevention for Smoking Cessation: A Case Report

Zahra Khayyer, Razieh Saberi Azad, Mohsen Dadjoo, Azam Shojaei




Previous electroencephalography (EEG) researches have shown significant differences in terms of abnormal brain activity among smokers and non-smokers. Typically, EEG analysis showed decreased slow waves and increased fast waves in people with nicotine consumption. The present study tested a transcranial direct current stimulation (tDCS) technique combined with Mindfulness-Based Relapse Prevention (MBRP) to reduce nicotine cravings. Specifically, cathodal tDCS over Left Prefrontal Cortex (PFC), as well as anodal stimulation over the right central zone, tested. An 18-year-old right-handed male with almost three years of smoking participated. He had no anti-tobacco medical prescription. The participant received twelve sessions of tDCS treatment (two times a week). Anodal stimulation (1.5 mA, 15 min) performed on C3 (LORETA source localization) and cathodal stimulation on FP2. Also, the participant received 30-minute MBRP-based psychotherapy sessions in order to ameliorate aggression, stress, and craving. Clinical evaluations, Buss-Perry Aggression Questionnaire (AGQ), Fagerstrom Test for Nicotine Dependence (FTND), Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, 1994), and daily checklist for the number of smoked cigarettes administered along with Carbon monoxide (CO) levels. Also, subjective measures of craving intensity between zero and ten measured after treatment and 3-month follow-up. After treatment, the participant showed a substantial reduction in all clinical tests, and the number of cigarettes decreased from 30 to 2 a day. From a psycho neurotherapeutic perspective, the present study provides preliminary indications for a novel and efficient treatment of smoking during adolescence. Further studies are needed to determine generalizability and overall efficiency.


Cigarette smoking, transcranial direct current stimulation (tDCS); quantitative electroencephalogram (QEEG); mindfulness based relapse prevention (MBRP).



Kazem M, Noorbala A, Majdzadeh R, & Karimlo M. The changing process of smoking prevalence in Iran (1991-1999): based on two national projects of health and disease. Hakim Journal. 2000; 197: 290-94.

Scholte RH, Poelen EA, Willemsen G, Boomsma DI, Engels RC. Relative risks of adolescent and young adult alcohol use: The role of drinking fathers, mothers, siblings, and friends. Addictive behaviors. 2008 Jan 1;33(1):1-4.

Baška T, Warren CW, Bašková M, Jones NR. Prevalence of youth cigarette smoking and selected social factors in 25 European countries: findings from the Global Youth Tobacco Survey. International Journal of Public Health. 2009 Dec 1;54(6):439.

Brewer J, Pbert L. Mindfulness: an emerging treatment for smoking and other addictions. J. Fam. Med. 2015;2(1035):10-93.

Luigjes JV, Van Den Brink W, Feenstra MV, Van Den Munckhof P, Schuurman PR, Schippers R, Mazaheri A, De Vries TJ, Denys D. Deep brain stimulation in addiction: a review of potential brain targets. Molecular psychiatry. 2012 Jun;17(6):572.

Fritz HC, Wittfeld K, Schmidt CO, Domin M, Grabe HJ, Hegenscheid K, Hosten N, Lotze M. Current smoking and reduced gray matter volume—a voxel-based morphometry study. Neuropsychopharmacology. 2014 Oct;39(11):2594.

Rass O, Ahn WY, O’Donnell BF. Resting-state EEG, impulsiveness, and personality in daily and nondaily smokers. Clinical Neurophysiology. 2016 Jan 1;127(1):409-18.

Clarke AR, Barry RJ, Bond D, McCarthy R, Selikowitz M. Effects of stimulant medications on the EEG of children with attention-deficit/hyperactivity disorder. Psychopharmacology. 2002 Nov 1;164(3):277-84.

Lutz A, Brefczynski-Lewis J, Johnstone T, Davidson RJ. Regulation of the neural circuitry of emotion by compassion meditation: effects of meditative expertise. PloS one. 2008 Mar 26;3(3):e1897.

Esmaeili M, Basiri N, Khayer Z. The effects of mindfulness-based cognitive therapy (MBCT) on psychological wellbeing of mothers of children with learning disabilities. Journal of Learning Disabilities. 2016; 6(120): 26-39.

Stagg CJ, Nitsche MA. Physiological basis of transcranial direct current stimulation. The Neuroscientist. 2011 Feb;17(1):37-53.

Cosgrove KP, Wang S, Kim SJ, McGovern E, Nabulsi N, Gao H, Labaree D, Tagare HD, Sullivan JM, Morris ED. Sex differences in the brain's dopamine signature of cigarette smoking. Journal of Neuroscience. 2014 Dec 10;34(50):16851-5.

Knoch D, Gianotti LR, Baumgartner T, Fehr E. A neural marker of costly punishment behavior. Psychological science. 2010 Mar;21(3):337-42.

Boggio PS, Liguori P, Sultani N, Rezende L, Fecteau S, Fregni F. Cumulative priming effects of cortical stimulation on smoking cue-induced craving. Neuroscience letters. 2009 Sep 29;463(1):82-6.

Khayyer Z, Ngaosuvan L, Sikström S, Ghaderi AH. Transcranial direct current stimulation based on quantitative electroencephalogram combining positive psychotherapy for major depression. Journal of integrative neuroscience. 2018 Jan 1;17(2):141-55.

Desai R, Tailor A, Bhatt T. Effects of yoga on brain waves and structural activation: A review. Complementary therapies in clinical practice. 2015 May 1;21(2):112-8.

Fecteau S, Fregni F, Boggio PS, Camprodon JA, Pascual-Leone A. Neuromodulation of decision-making in the addictive brain. Substance use & misuse. 2010 Jun 1;45(11):1766-86.

Westbrook C, Creswell JD, Tabibnia G, Julson E, Kober H, Tindle HA. Mindful attention reduces neural and self-reported cue-induced craving in smokers. Social cognitive and affective neuroscience. 2011 Nov 22;8(1):73-84.

Wall MB, Mentink A, Lyons G, Kowalczyk OS, Demetriou L, Newbould RD. The effect of smoking on the brain revealed by using electronic cigarettes with concurrent fMRI. bioRxiv. 2017 Jan 1:107771.

Brunoni AR, Moffa AH, Fregni F, Palm U, Padberg F, Blumberger DM, Daskalakis ZJ, Bennabi D, Haffen E, Alonzo A, Loo CK. Transcranial direct current stimulation for acute major depressive episodes: a meta-analysis of individual patient data. The British Journal of Psychiatry. 2016 Jun;208(6):522-31.


  • There are currently no refbacks.