Change Your Life: Living Skillfully

I have just got hold of a copy of the study Hypnosis for smoking cessation: A randomized trial (Carmody, Duncan, Simon, Sulkowitz, Huggins, Lee & Delucci) from Nicotine & Tobacco Research Volume 10, Number 5 (May 2008) 811–818. I’ve posted about this study before, in Why I still use hypnosis for smoking cessation, but I was basing my remarks on the (very comprehensive) abstract rather than the full text. I’ve discovered that abstracts, even unusually informative abstracts like the one in this study, tend not to tell the whole story, so here’s a deeper analysis of what is interesting about this piece of research.

photo credit: xmatt

Firstly, it was very thoroughly done. The group of participants was relatively large compared with other hypnotherapy studies (286 at the start, of whom 246 were available at 12-month follow-up). The participants were randomized to two treatment conditions, hypnotherapy and behavioural therapy, and the two groups were very comparable on a large number of measures including age, race, education, current and past tobacco use, score on the Fagerstrom Test of Nicotine Dependence (which I use with my clients), how helpful they expected the intervention to be, and histories of illness, depression and alcohol and drug abuse.

They were followed up, thoroughly, at 6 and 12 months and their abstinence from smoking was not primarily measured by self-report (which tends to be exaggerated) but by biochemical testing and, where that wasn’t possible, proxy report by a spouse or significant other (which tends to be accurate). They were also asked how many of the strategies taught in the initial sessions they had used and how helpful they found them on a numerical scale, and the severity of their nicotine withdrawal symptoms was also assessed on a numerical scale, a modified version of the Minnesota Nicotine Withdrawal Scale. At week 2, but not later in the process at weeks 3 and 9, the hypnotherapy group reported significantly lower nicotine withdrawal symptoms.

photo credit: poolie

The amount of time given to the two interventions was the same – not the case in at least one other study which is sometimes cited as showing that hypnotherapy is not superior to behavioural therapy (Rabkin S.W., Boyko E., Shane F., Kaufert J. A randomised trial comparing smoking cessation programs utilising behaviour modification, health education or hypnosis. Addictive Behaviors 1984;9:157-73. [MEDLINE: 1984253195].) In that study, a single half-hour session of rather old-fashioned hypnotherapy was compared with a behaviour modification consisting of a series of five group meetings over a three-week period taking 45-90 minutes each. In Carmody et al., the researchers went to some trouble to put together what sounds like a very good hypnotherapy intervention (more on that shortly), which was given in two 60-minute face-to-face sessions, the same number and the same time as the behavioural intervention. Both groups also got three 20-minute follow-up phone calls at weeks 3, 4 and 6. There was one difference between the two, however: the hypnotherapy group received an audiotape of the training to use at home.

The actual content of the hypnotic intervention focussed on “learning, practicing and employing hypnotic skills in resisting the urge to smoke…and…increase motivation and self-efficacy”, not just suggestions, although there were suggestions which “encouraged relaxation, commitment to
quitting, self-image as a nonsmoker, ability to resist the urge to smoke, mood management, and development of a healthy lifestyle”. I’m pleased to say that most of these suggestions are in my own Smokefree for Life recording or the other material I use with smokers.

photo credit: giumaiolini

Also in Smokefree for Life and in the Carmody study is the use of “anchoring” gestures as a stress management tool and as an alternative to returning to smoking. The rated helpfulness of this technique (which some of my clients have recently dubbed “happy hands”) was associated with higher rates of quitting at 12 months, as was the rated helpfulness of using a key phrase. Using more strategies and listening to the recordings regularly were also associated with higher quit rates, which is not surprising but is nice to have experimentally confirmed.

Participants’ perceived depth of hypnosis was not correlated with the effectiveness of hypnosis, which is another thing I’ve been saying to people but is nice to have confirmed.

The behavioural strategies taught are worth mentioning. They were “reminding themselves of their reasons for quitting, using oral substitutes, planning responses for difficult situations, exercise, using relaxation, changing their daily routine, and rewarding themselves for not smoking”, all of which are in the smokefree brochure that I give my smoking cessation clients.

The researchers conclude:

the quit rates generated by the hypnosis treatment group in the present study, which compared favorably with those achieved by the behavioral counseling condition, provide support for
hypnosis as an additional smoking cessation intervention.

It should be noted that both groups also used nicotine patches. I am so far one of a small minority of smoking cessation practitioners in New Zealand who use nicotine replacement therapy and hypnotherapy together, along with behavioural counselling (on the grounds that anything that might help should be used). I find this study exciting because it suggests that I’m broadly on the right lines in my practice. I’m planning to follow through some of the references, if I can get hold of them, and refine my practice further to see if I can boost my clients’ success even more.

(Some of what I do is in my free ebook, How to Stop Smoking.)

Technorati Tags: smoking, cessation, behavioral counselling, hypnosis, hypnotherapy, nicotine patches, motivation, self-efficacy, anchoring

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