Change Your Life: Living Skillfully

I’ve been looking around for more studies on the effectiveness of hypnotherapy for smoking, since the big, impressive meta-study I quoted before was published more than 15 years ago in 1992. It’s turned out to be more complicated than I expected. We’re not yet at the stage where this kind of information is easily searchable online, all in one place, and even with my student login to the Massey University library, I can only get at a minority of the full texts of the studies that I can find.

One good, relatively recent resource from the respected Mayo Clinic, freely
available on the Internet, is Hypnosis in Contemporary Medicine by James H. Stewart, MD, published in 2005. He also goes into a number of other medical uses of hypnosis, including allergy treatment, anaesthesia, skin conditions, irritable bowel syndrome and other digestion-related illnesses, post-surgery healing, hemophilia, hypertension (high blood pressure), headaches, obesity, childbirth, the side effects of cancer treatment, tinnitus, asthma, and the symptoms of fibromyalgia as well as its use for smoking cessation. For all of these conditions, at least some studies have shown at least some effect at a statistically significant level for hypnotherapy; some have shown considerable benefit.

As Stewart says: “Evaluation of clinical trials of hypnosis is complicated by the nature of hypnosis. The gold standard of a randomized, double-blind, controlled trial is virtually impossible because cooperation and rapport between patient and therapist are needed to achieve a receptive trance state.” If you’re having hypnotherapy, you know it. In fact, the generally accepted mechanism of how it works is that it is altering your mental functioning, so it’s extremely difficult to apply hypnotherapy without your awareness. (Stewart does cite some studies where chemically anaesthetized surgery patients were played hypnotic tapes.) Also, the person administering it to you knows that they are doing it; it’s not like a drug study where you can blind the person administering the pill to whether it’s the real pill or the fake one. It is certainly possible to blind the researchers who measure the effects, and this is done in the best studies. Psychotherapy in general has the same problem of blinding, of course.

Basically, if you can see a substantial improvement in some studies of hypnotherapy vs non-hypnotherapy – and this is the case – then you can state with some confidence that, when capably used, hypnotherapy is effective. Showing that hypnotherapy had no effect in another study doesn’t invalidate the studies which showed it had an effect, since the lack of effect could be down to the ability of the hypnotherapist or the techniques used.

photo credit: kozumel

Also, many studies use only a single session of hypnotherapy, often versus multiple sessions of another treatment. For example, A randomized trial comparing smoking cessation programs utilizing behaviour modification, health education or hypnosis by Rabkin, Boyko, Shane and Kaufert found no significant difference between the three approaches, but when you dig further into the full text (not available free online, unfortunately), you find that the behavior modification intervention was a series of five group meetings over a three-week period taking 45-90 minutes each, the health education intervention was a lecture to a small group followed up one week later by a personal one-on-one interview including counselling, but the hypnotherapy intervention was a single 30-minute one-on-one session including instruction in self-hypnosis, an eye-roll induction, suggestions “that smoking is dangerous and that the individual must give up smoking”, and a post-hypnotic suggestion to self-hypnotize every hour and a half for a week and whenever necessary thereafter and repeat the suggestions three times. The results were measured with several techniques including blood serum thiocyanate, which correlated well with self-report of giving up smoking. (Despite this, another widely-cited study 11 years later in the Archives of Internal Medicine dismisses hypnotherapy as “unproved” because “no trials have used biochemical markers”.)

By the nature of things, then, it’s difficult to compare the use of hypnotherapy with the use of drugs directly. People who are given drugs and told that they will help them to get better tend to do so to a degree, even if the “drugs” are inactive – the so-called “placebo effect”, which may well itself be a form of suggestion as used in hypnosis. This is why placebo-controlled, double-blind trials are used for drug studies – so that the effect of the drug itself is not confounded by the expectation of the participants or the behavior of the experimenters. Of course, in some cases – and nicotine replacement therapy is one – you can tell whether what you are getting is the active drug because of its effects (warning: heavily partisan anti-NRT website), so these trials aren’t truly placebo-controlled either.

NRT isn’t completely ineffective, but it’s not highly effective either, and it’s expensive. So why do governments – including the New Zealand government and the UK government – continue to make it a cornerstone of their quit-smoking programmes? My wife, who works in the health system as an administrator, sent me an email this morning about the programme being promoted at her workplace. (Nurses are often heavy smokers.) It’s connected to World Smokefree Day, which is 31 May, incidentally. The programme consists of a “quit pack” (presumably informational), a face-to-face assessment where participants discuss a quit plan, pre-quit tips and post-quit support via emails and phone calls, and a quit card for subsidised NRT – “save $85 to $90 per NRT product”. I’ve found via another source that this leaves $5 for the user to pay. I charge $90 for a hypnotherapy session, but the government won’t pay for any of it, so the cost to the would-be ex-smoker is greater.

This is why I’m keen to get some good local studies going on hypnotherapy for smoking cessation, and promote them to the government.

The other thing that I’ve concluded by looking through all these studies is this: as with other problems treated with hypnosis, taking a multi-pronged approach to stopping smoking is likely to work best. This is why, as well as giving people suggestions about changing their behavior, I also show them alternative ways to handle stress and advise them to do things like drink water and walk around if they feel like smoking. Better still, I suspect, would be getting them into groups for mutual support.

NOTE: I’ve now come to a more favourable position on NRT as part of such a multi-pronged approach.

And I’ve collected the best advice I could find together into a free ebook, How to Stop Smoking, which you can download right here.

Technorati Tags: smoking, stop smoking, smoking cessation, quit smoking, quitting, hypnosis, hypnotherapy, nicotine replacement therapy, NRT, clinical trials, scientific studies, behavior change, behavior therapy

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