Heart, Stroke, Asthma | September 10, 2014 | Author: The Super Pharmacist
There are many therapies available to those who wish to reduce or quit tobacco smoking. The foremost of these tend to be pharmacological treatments, such as nicotine replacement or partial nicotine agonist therapy. Non-drug options, which mainly focus on behaviour modification or therapies that examine and treat the psychological dependence on smoking, e.g. counselling or cognitive behavioural therapy, are also popular. These may be used alone or in combination with pharmacological therapy. Another emerging drug-free treatment is hypnotherapy in smoking cessation, which typically uses the power of suggestion or negative association while the patient is in a 'trance'-like state to correct or alter some behaviours.
Hypnosis practitioners may, for example, influence patients to associate smoking with unpleasant effects or consequences, such as the cancers commonly linked to tobacco use. Although some researchers believe that nicotine-based therapy is the best route to smoking cessation, hypnotherapy is growing in popularity for people who wish to quit tobacco. Some evidence suggests that it may also be beneficial in managing the effects of nicotine withdrawal. This may be based on suggestions during hypnosis that lead the patient to believe that they have the ability to cope with the symptoms of withdrawal.
There are several types of hypnosis therapy available, e.g. group or individual hypnosis. A study comparing these two found no difference in efficacy as smoking cessation aids, indicating that they are equally effective as anti-smoking interventions. Research into hypnosis in smoking cessation tends to compare this therapy with other treatments commonly used to facilitate quitting, such as nicotine replacement treatments and relaxation therapies.
In many cases, abstinence from smoking was objectively measured through biochemical saliva analysis. The measurement of carbon monoxide in exhaled air may also be used to assess recent smoking habits. Trials of smoking cessation therapies, including those of hypnotherapy, tend to use outcomes such as six- or twelve-month quit rates, and/or abstinence from tobacco at certain numbers of weeks after the study interventions.
An early trial of hypnotherapy in smoking cessation randomly assigned twenty patients to either eight individual hypnotherapy sessions over two months or a standard therapy. The results showed a significant decrease in carbon monoxide readings in the hypnosis group at one, twelve and 26 weeks after the intervention.
In another study, 164 patients were randomised to a ninety-minute hypnosis session, nicotine replacement therapy for 30 days, or a combination of the two. The results of this trial showed that the probability of smoking abstinence in both the hypnotherapy and combination groups was over three times greater than that of the replacement therapy group at 26 weeks after the trial. This was a moderately significant difference.
Another trial compared the effects of hypnotherapy to that of relaxation therapy. This included 233 people smoking at least five cigarettes a day, wishing to stop smoking and not using other methods to do this. These were divided into groups of about eleven subjects each. These groups were randomised to one session of either relaxation or hypnosis. At a six-month follow-up, abstinence did not differ between the two group clusters. Smoking behaviour or the number of cigarettes per day was also unchanged by either intervention. However, for subjects that had stopped smoking, nicotine withdrawal symptoms were significantly reduced in those who had received hypnosis.
Yet another trial compared a combination of nicotine patches with either hypnosis or standardised counselling practices (286 smokers randomised to patches with two counselling sessions or patches with two sessions of hypnosis). Abstinence and quit rates were higher for the 'hypnosis' group at both six and twelve month follow-ups. Significant increases elicited were seen in this group who also had a history of depression.
This indicates that the presence of psychiatric conditions may affect the outcome of smoking cessation therapies, and may need to be better accounted for in future trials of these interventions.
A systematic review of 49 randomised-controlled trials of smoking cessation therapies found that a significant effect on smoking and cessation outcomes was exerted by both pre-existing depressive disorder and mood-managing treatments.
Hypnotherapy may be most useful in people who need to abstain from smoking, but may be unwilling to use pharmacological means to do so. These include pregnant women.
A study of 1899 pregnant women in two maternity hospitals reported hypnotherapy as the second highest preference for smoking cessation intervention. However, an evaluation of abstinence therapies during pregnancy indicated that nurse-managed counselling was superior to hypnotherapy.
A one year-long study in a Norwegian hospital provided two hypnotherapy sessions to all women attending who still smoked into the 18th week of pregnancy. The results showed no significant effect on smoking patterns or cessation. On the other hand, a review of 86 trials of other psychosocial therapies showed that these had a positive effect on smoking cessation during pregnancy.
The research of hypnotherapy as an intervention in cigarette use while pregnant is very limited, but indicates that it is not effective in this application.
A systematic review of eleven trials comparing a total of eighteen other interventions found there was not enough evidence to confirm or deny any efficacy of hypnotherapy in smoking cessation.
This was due to a lack of conclusive analysis stemming from the inconsistency in the methods (similar to that seen in this article) and results of these studies.
A similar review of nine trials comparing hypnotherapy to fourteen other therapies found that hypnosis had no effect on six-month quit rates.
A meta-analysis of four randomised-controlled trials (including 273 patients) indicated that hypnotherapy had a moderately high probability of affecting smoking cessation, in comparison with an analysis of similar numbers of studies on acupuncture and aversive smoking.
Another review of 59 trials of hypnosis in smoking cessation found that results of studies comparing hypnosis to placebo were also inconsistent, and that the therapy was generally comparable to other anti-smoking interventions. This review also suggested that the inability to segregate the effects of other interventions (e.g. behavioural therapy or health education) also used by the subject from those of hypnosis may invalidate some results. On the other hand, the results of hypnotherapy in many studies were positive. In general, the evidence to support hypnosis as a smoking cessation strategy appears mixed at best.
Covino NA, Bottari M. Hypnosis, behavioral theory, and smoking cessation. Journal of dental education.2001;65(4):340-347.
Riegel B. Hypnosis for smoking cessation: group and individual treatment-a free choice study. The International journal of clinical and experimental hypnosis.2013;61(2):146-161.
Dickson-Spillmann M, Haug S, Schaub MP. Group hypnosis vs. relaxation for smoking cessation in adults: a cluster-randomised controlled trial. BMC public health.2013;13:1227.
Hasan FM, Zagarins SE, Pischke KM, et al. Hypnotherapy is more effective than nicotine replacement therapy for smoking cessation: results of a randomized controlled trial. Complementary therapies in medicine.2014;22(1):1-8.
Abbot NC, Stead LF, White AR, Barnes J, Ernst E. Hypnotherapy for smoking cessation. The Cochrane database of systematic reviews.2000(2):Cd001008.
Elkins G, Marcus J, Bates J, Hasan Rajab M, Cook T. Intensive hypnotherapy for smoking cessation: a prospective study. The International journal of clinical and experimental hypnosis.2006;54(3):303-315.
Carmody TP, Duncan C, Simon JA, et al. Hypnosis for smoking cessation: a randomized trial. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.2008;10(5):811-818.
van der Meer RM, Willemsen MC, Smit F, Cuijpers P. Smoking cessation interventions for smokers with current or past depression. The Cochrane database of systematic reviews.2013;8:Cd006102.
Hoekzema L, Werumeus Buning A, Bonevski B, et al. Smoking rates and smoking cessation preferences of pregnant women attending antenatal clinics of two large Australian maternity hospitals. The Australian & New Zealand journal of obstetrics & gynaecology.2014;54(1):53-58.
Barron J, Petrilli F, Strath L, McCaffrey R. Successful interventions for smoking cessation in pregnancy. MCN. The American journal of maternal child nursing.2007;32(1):42-47; quiz 48-49.
Valbo A, Eide T. Smoking cessation in pregnancy: the effect of hypnosis in a randomized study. Addictive behaviors.1996;21(1):29-35.
Chamberlain C, O'Mara-Eves A, Oliver S, et al. Psychosocial interventions for supporting women to stop smoking in pregnancy. The Cochrane database of systematic reviews.2013;10:Cd001055.
Barnes J, Dong CY, McRobbie H, Walker N, Mehta M, Stead LF. Hypnotherapy for smoking cessation. The Cochrane database of systematic reviews.2010(10):Cd001008.
Tahiri M, Mottillo S, Joseph L, Pilote L, Eisenberg MJ. Alternative smoking cessation aids: a meta-analysis of randomized controlled trials. The American journal of medicine.2012;125(6):576-584.
Green JP, Lynn SJ. Hypnosis and suggestion-based approaches to smoking cessation: an examination of the evidence. The International journal of clinical and experimental hypnosis.2000;48(2):195-224.