Appendix: The Evidence Behind the Practical Chapters

This guide makes no scientific claim for its spiritual frame. It does claim that its practical advice follows the evidence, and this list is offered so that the claim can be checked. The entries are grouped by the chapter they support.

The practical thread through the book

The book remains a spiritual guide. Its accounts of release, courage and the open country are ways of describing experience and meaning, not a clinical theory of emotion or a promise that symptoms disappear when a person allows them. A feeling that stays is not proof of resistance or inadequate willingness.

The brief practices for noticing a worry loop, considering another interpretation, trying a manageable action and reviewing what happened draw on cognitive behavioural therapy (CBT) self-help. The examples and their placement in this book are our adaptations. They are not a complete course of treatment, and evidence for a method does not establish that this book or app treats anxiety or improves vaping quit rates.

The following public clinical resources informed those additions, reviewed 14 September 2026:

• NHS, Self-help techniques and reframing unhelpful thoughts: recognising linked thoughts, feelings and actions, and considering a balanced interpretation.
• NHS, Problem solving and tackling worries: distinguishing actionable problems from hypothetical worries and setting aside a short time to consider the latter.
• Centre for Clinical Interventions, Helping Health Anxiety, especially modules 5 and 6: examining predictions and reducing repeated checking and reassurance. Appropriate care and clinician-directed monitoring remain distinct from unnecessary repetition.
• NHS, Health anxiety: gradually reducing repeated checking and seeking professional help when worry disrupts life or self-help is insufficient.
• NHS, Tackling your to-do list and staying on top of things: manageable activity, a balance of care and enjoyment, and a personal plan for difficult periods.
• NHS, Managing nicotine withdrawal and how to quit vaping: physical dependence is real, symptoms and duration vary, and help is available. Much of the withdrawal literature concerns stopping smoking; it does not set a deadline for an individual who stops vaping.

The practice of letting go (Chapters Three and Nine)

• Brewer, J. A. et al. (2011). Mindfulness training for smoking cessation: results from a randomized controlled trial. Drug and Alcohol Dependence. Eighty-eight nicotine-dependent adults, randomised to mindfulness training or the American Lung Association's Freedom From Smoking programme. Point-prevalence abstinence four months after treatment was 31% against 6%. This is the single strongest trial behind the practice in chapter nine, and it is one trial of eighty-eight people against an active comparator; read it with the Cochrane review below.
• Bricker, J. B. et al. (2020). Efficacy of smartphone applications for smoking cessation: a randomized clinical trial. JAMA Internal Medicine. An acceptance-based app (iCanQuit) outperformed a conventional quit app at twelve months.
• The technique of observing an urge rise and pass without acting on it is described in the addiction literature as "urge surfing" and is a component of mindfulness-based relapse prevention and acceptance and commitment therapy.

These are studies of whole programmes for smoking, not tests of this book's brief practice for vaping. Jackson and colleagues' 2022 Cochrane review of mindfulness for smoking cessation did not establish a clear benefit across comparisons; certainty was low or very low. Encouraging findings from individual studies should be read within that uncertainty.

Nicotine replacement and medicines (Interlude)

• Butler, A. R. et al. (2025). Interventions for quitting vaping. Cochrane Database of Systematic Reviews, CD016058. Evidence current to July 2025. Low-certainty evidence that varenicline may help; low-certainty evidence that text-message support may help young people; inconclusive evidence for nicotine replacement and cytisine.
• Hartmann-Boyce, J. et al. (2018). Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews, CD000146. All licensed forms of NRT raise quit rates from cigarettes.
• Lindson, N. et al. (2019, updated 2023). Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews, CD013308. Combining a patch with a fast-acting product is more effective than a single product.
• Lunell, E. et al. (2022). A randomised study to assess the nicotine pharmacokinetics of an oral nicotine pouch and two nicotine replacement therapy products. Scientific Reports. A 4 mg pouch delivered nicotine equivalently to a 4 mg lozenge and roughly twice as much as 4 mg gum.
• Nicotine delivery from and user reactions to nicotine pouches compared to cigarettes (2025). Psychopharmacology. A 9 mg pouch produced a higher peak blood nicotine level than a cigarette, reached within about thirty minutes, with craving relief lasting at least an hour.

The ground beneath (Chapter Nine)

• Ussher, M. H. et al. (2019). Exercise interventions for smoking cessation. Cochrane Database of Systematic Reviews, CD002295. No evidence that adding exercise raises long-term quit rates; low certainty.
• Haasova, M. et al. (2013). The acute effects of physical activity on cigarette cravings: systematic review and meta-analysis. Addiction. A single bout of exercise reduces craving in the short term.
• Balban, M. Y. et al. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine. Five minutes a day of "cyclic sighing" (double inhale, long exhale) improved mood and lowered respiratory rate more than an equivalent period of mindfulness meditation.
• Jaehne, A. et al. (2009). Effects of nicotine on sleep during consumption, withdrawal and replacement therapy. Sleep Medicine Reviews. Withdrawal disrupts sleep; sleep disturbance is associated with relapse.
• NHS Specialist Pharmacy Service, Considering drug interactions with smoking. Tobacco smoke, not nicotine, induces the relevant liver enzymes. Changes in caffeine clearance after stopping smoking should not be attributed to stopping nicotine vaping alone.
• Frattaroli, J. (2006). Experimental disclosure and its moderators: a meta-analysis. Psychological Bulletin. Expressive writing produces small but reliable improvements in psychological and physical health.
• Seligman, M. E. P. et al. (2005). Positive psychology progress: empirical validation of interventions. American Psychologist. The "three good things" exercise improved mood for up to six months.

The people around you (Chapter Ten)

• Graham, A. L. et al. (2021). Effectiveness of a vaping cessation text message program among young adult e-cigarette users: a randomized clinical trial. JAMA Internal Medicine. Ages 18–24: abstinence 24.1% with the programme versus 18.6% without.
• Graham, A. L. et al. (2024). Effect of a text message vaping cessation program for adolescents. JAMA. Ages 13–17: abstinence 37.8% versus 28.0%.
• Patrick, V. M. & Hagtvedt, H. (2012). "I don't" versus "I can't": when empowered refusal motivates goal-directed behavior. Journal of Consumer Research.
• Christakis, N. A. & Fowler, J. H. (2008). The collective dynamics of smoking in a large social network. New England Journal of Medicine. Quitting spreads through social ties; smokers who continued became progressively more peripheral in their networks.
• Notley, C. et al. (2019). Incentives for smoking cessation. Cochrane Database of Systematic Reviews, CD004307. High-certainty evidence that financial incentives raise quit rates, with the effect persisting after incentives end.
• Whittaker, R. et al. (2019). Mobile phone text messaging and app-based interventions for smoking cessation. Cochrane Database of Systematic Reviews, CD006611. Moderate-certainty evidence that text-message programmes help.

Where a study concerned cigarettes rather than vapes, this guide has said so in the text and has drawn the cautious inference that a mechanism which helps with one form of nicotine dependence is likely, though not certain, to help with another.