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The Use of Hypnosis in Controlling Cigarette Smoking
Abstract
This very interesting study reveals that hypnosis, only in four sessions, is successful in the majority of instances in the elimination of cigarette smoking. The authors emphasize the strong motivation in those treated since each patient had been referred by a physician who had unsuccessfully advised the patient to stop smoking because of a matter of health.
... 17,18 They also use suggestions to encourage smokers to believe that they will lose the desire to smoke and cope well during withdrawal. 19,20 Most smokers come to treatment with the idea that hypnosis will obliterate their desire to smoke and often carry with them the hope that this will happen in one visit. A brief review of the published reports finds that the modal hypnosis intervention mirrors this wish. ...
Although nicotine replacement and other pharmacological treatments head the list of popular interventions for smoking cessation, approaches based on psychology can also assist smokers. Hypnosis, suggestion, and behavior therapies have been offered to patients and studied experimentally for several decades. Although no single psychological approach has been found to be superior to others, psychological interventions contribute significantly to successful treatment outcome in smoking cessation. This article describes common hypnotic and behavioral approaches to smoking cessation and critically reviews some of the findings from clinical and experimental research studies. The authors also offer suggestions regarding treatment and future research.
The main objective of this systematic review is to comprehensively describe and evaluate the evidence on hypnotherapy for smoking cessation. Included studies were comprised of adults, had measurable objective/subjective data reflecting smoking cessation, hypnosis or hypnotherapy studied alone or as part of a multicomponent intervention, and at least ten participants. A total of 745 nonduplicate publications were screened, and 63 papers were included for analysis. Based on 33 of these studies, 66.7% reported a positive impact of the hypnosis intervention for smoking cessation. Positive impact studies had longer average treatment duration, greater number of hypnotherapy sessions, and utilized both self-report and objective measures of smoking cessation outcome (40.9% of positive studies using both vs 20% of no impact studies). The efficacy of hypnotherapy for smoking cessation is positive; however, more studies using biologically confirmed abstinence and reduction in the number of cigarettes smoked are needed. Hypnotherapy is a useful approach for smoking cessation that warrants additional inquiry. Future studies are needed that assess treatment fidelity and hypnotizability, provide information on race/ethnicity, and report on side effects and adverse events.
Background:
Hypnotherapy is widely promoted as a method for aiding smoking cessation. It is intended to act on underlying impulses to weaken the desire to smoke, or strengthen the will to stop.
Objectives:
To evaluate the effect and safety of hypnotherapy for smoking cessation.
Search methods:
For this update we searched the Cochrane Tobacco Addiction Group Specialized Register, and trial registries (ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform), using the terms "smoking cessation" and "hypnotherapy" or "hypnosis", with no restrictions on language or publication date. The most recent search was performed on 18 July 2018.
Selection criteria:
We considered randomized controlled trials that recruited people who smoked and implemented a hypnotherapy intervention for smoking cessation compared with no treatment, or with any other therapeutic interventions. Trials were required to report smoking cessation rates at least six months after the beginning of treatment. Study eligibility was determined by at least two review authors, independently.
Data collection and analysis:
At least two review authors independently extracted data on participant characteristics, the type and duration of hypnotherapy, the nature of the control group, smoking status, method of randomization, and completeness of follow-up. These authors also independently assessed the quality of the included studies. In undertaking this work, we used standard methodological procedures expected by Cochrane.The main outcome measure was abstinence from smoking after at least six months' follow-up. We used the most rigorous definition of abstinence in each trial, and biochemically validated abstinence rates where available. Those lost to follow-up were considered to still be smoking. We summarized effects as risk ratios (RRs) and 95% confidence intervals (CIs). Where possible, we performed meta-analysis using a fixed-effect model. We also noted any adverse events reported.
Main results:
We included three new trials in this update, which brings the total to 14 included studies that compared hypnotherapy with 22 different control interventions. The studies included a total of 1926 participants. Studies were diverse and a single meta-analysis was not possible. We judged only one study to be at low risk of bias overall; we judged 10 studies to be at high risk of bias and three at unclear risk. Studies did not provide reliable evidence of a greater benefit from hypnotherapy compared with other interventions or no treatment for smoking cessation. Most individual studies did not find statistically significant differences in quit rates after six months or longer, and studies that did detect differences typically had methodological limitations.Pooling small groups of relatively comparable studies did not provide reliable evidence for a specific effect of hypnotherapy relative to controls. There was low certainty evidence, limited by imprecision and risk of bias, that showed no statistically significant difference between hypnotherapy and attention-matched behavioural treatments (RR 1.21, 95% CI 0.91 to 1.61; I2 = 36%; 6 studies, 957 participants). Results were similarly imprecise, and also limited by risk of bias, when comparing hypnotherapy to intensive behavioural interventions (not matched for contact time) (RR 0.93, 95% CI 0.47 to 1.82; I2 = 0%; 2 studies, 211 participants; very low certainty evidence). Results from one small study (40 participants) detected a statistically significant benefit of hypnotherapy compared to no intervention (RR 19.00, 95% CI 1.18 to 305.88), but this evidence was judged to be of very low certainty due to high risk of bias and imprecision. No significant differences were detected in comparisons of hypnotherapy with brief behavioural interventions (RR 0.98, 95% CI 0.57 to 1.69; I² = 0%; 2 studies, 269 participants), rapid/focused smoking (RR 1.00, 95% CI 0.43 to 2.33; I2 = 65%; 2 studies, 54 participants), and pharmacotherapies (RR 1.68, 95% CI 0.88 to 3.20; I2 = 5%; 2 studies, 197 participants). When hypnotherapy was evaluated as an adjunct to other treatments, the pooled result from five studies showed a statistically significant benefit in favour of hypnotherapy (RR 2.10, 95% CI 1.31 to 3.35; I² = 62%; 224 participants); however, this result should be interpreted with caution due to the high risk of bias across studies (four had a high risk or bias, one had an unclear risk), and substantial statistical heterogeneity.Most studies did not provide information on whether data specifically relating to adverse events were collected, and whether or not any adverse events occurred. One study that did collect such data did not find a statistically significant difference in the adverse event 'index' between hypnotherapy and relaxation.
Authors' conclusions:
There is insufficient evidence to determine whether hypnotherapy is more effective for smoking cessation than other forms of behavioural support or unassisted quitting. If a benefit is present, current evidence suggests the benefit is small at most. There is very little evidence on whether hypnotherapy causes adverse effects, but the existing data show no evidence that it does. Further large, high-quality randomized controlled trials, and more comprehensive assessments of safety, are needed on this topic.
This chapter is intended to provide a comprehensive overview of hypnosis and its clinical applications. The chapter will review the history and will shed some light on current scientific theories regarding the hypnotic process based recent neuroimaging, electrophysiological and neurochemical understanding. It will particularly discuss a proposed model to understand the clinical hypnotic process, as well as how hypnosis is viewed by members of different cultures. It will discuss a practical way of assessing hypnotizability, the hypnotic induction profile. The correlation between hypnotizability, personality style and DSM-IV diagnostic categories will be discussed as the basis to develop treatment strategies for a wide range of psychosomatic and medical disorders, as well as selected psychiatric problems.
Hypnotherapy has been found of value in rehabilitation of many patients experiencing difiiculty in the usual procedures which follow cerebrovascular or traumatic brain injury. 3 cases are reported to illustrate the approach taken. Of 25 similar cases seen over a 9-year period, 4 were unresponsive to hypnosis. Although an increase in motivation for recovery seemed to be the major change elicited by hypnotherapy, other theoretical possibilities are mentioned. Hypnosis may be a useful way of approaching motivational problems in rehabilitating patients who manifest negativism toward conventional treatment.
Different types of hypnotherapy are used to try and help people quit smoking. Some methods try to weaken people's desire to smoke, strengthen their will to quit, or help them concentrate on a 'quit programme'. Trials have used different types and amounts of hypnotherapy and compared them with different control conditions, including no treatment, brief advice, or smoking cessation counselling. Although it is possible that hypnotherapy could be as effective as counselling treatment there is not enough good evidence to be certain of this.
This paper outlines a multidimensional model for conceptualizing and treating cigarette smoking and for integrating a variety of research findings. Three main components are included in the model. The first is the cognitive component which includes personal and social attitudes related to smoking and beliefs about the effects of smoking. Next, the behavioral aspects of the smoking act are considered in terms of its respondent, operant, and modeling components. Third the affective properties of cigarette smoking are separated into physiological and subjective emotional experiences. A treatment program derived from this multidimensional model is presented along with suggestions for future research.
This study sought to obtain empirical data on the issue of whether susceptibility to hypnosis influences the outcome of an hypnotic therapy. At the first of two sessions, Ss had their susceptibility evaluated unobtrusively. At the second session, they learned Spiegel's self-hypnotic method to stop smoking. At the end of 3 months' follow-up 7 of 54 volunteers were completely abstinent (13%), while 31% had reduced smoking by 50% or more. Of the 7 totally abstaining Ss, 1 was high, 1 was low and 5 were medium susceptible, which is not unlike the distribution of hypnotic susceptibility in the general population. However, it was found that significantly more Ss of higher susceptibility reduced by 50% or more than did less susceptible Ss.
2 methods of helping cigarette smokers stop smoking were compared in treating a total of 181 patients. After 6 months, 60% of those treated with an active, personalized approach were not smoking. This approach emphasized: (a) the feedback, under hypnosis, of the patient's own reasons for quitting, (b) m a h a g contact with the patient by telephone, (c) use of meditation during hypnosis to obtain individuaLized motives, and (d) Sell-hypnosis. Only 25% of smokers were successfully treated by an earlier hypnotic procedure that did not systexnaticdy employ these features.
4 hypnotic sessions were found successful, in the majority of cases, in eliminating cigarette smoking without undesirable substitution symptoms. Patients were strongly motivated by the referring physicians and by various non-hypnotic techniques incorporated into the treatment program. Examples are given of the specific nature of both the hypnotic and the non-hypnotic suggestions employed.
The results of the present experimental approach to the treatment of smoking habituation tend to be consistent with the view of smoking habituation aa a dependence reaction, parallel to drug addiction, and with the concept that habituation must be examined, as other investigators have indicated, as a psychosomatic entity. Therapeutic approaches designed to deal with this problem must take into account the psychophysiological characteristics of deprivation behavior.Hypnosis, and particularly extended periods of hypnotherapy involving the reduction and control of deprivation behavior, seems to offer a promising approach to the therapeutic treatment of smoking habituation.
Dr. Spiegel's dramatic approach to smoking modification fits the behavioral paradigm with hypnosis acting as a catalyst. Comparison is made to behavior therapy and suggestions offered applying these principles to smokers not responding to Dr. Spiegel's approach.
This article reviews 59 studies of hypnosis and smoking cessation as to whether the research empirically supports hypnosis as a treatment. Whereas hypnotic procedures generally yield higher rates of abstinence relative to wait-list and no-treatment conditions, hypnotic interventions are generally comparable to a variety of nonhypnotic treatments. The evidence for whether hypnosis yields outcomes superior to placebos is mixed. In short, hypnosis cannot be considered a specific and efficacious treatment for smoking cessation. Furthermore, in many cases, it is impossible to rule out cognitive/behavioral and educational interventions as the source of positive treatment gains associated with hypnotic treatments. Hypnosis cannot, as yet, be regarded as a well-established treatment for smoking cessation. Nevertheless, it seems justified to classify hypnosis as a "possibly efficacious" treatment for smoking cessation.
Hypnotherapy is widely promoted as a method for aiding smoking cessation. It is proposed to act on underlying impulses to weaken the desire to smoke or strengthen the will to stop.
The objective of this review was to evaluate the effects of hypnotherapy for smoking cessation.
We searched the Cochrane Tobacco Addiction Group trials register.
We considered randomised trials of hypnotherapy which reported smoking cessation rates at least six months after the beginning of treatment.
Two reviewers extracted data on the type of subjects, the type and duration of the hypnotherapy, the nature of the control group,the outcome measures, method of randomisation, and completeness of follow-up. The main outcome measure was abstinence from smoking after at least six months follow-up in patients smoking at baseline. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Subjects lost to follow-up were counted as smokers. Where possible, we performed meta-analysis using a fixed effects model.
Nine studies compared hypnotherapy with 14 different control interventions. There was significant heterogeneity between the results of the individual studies, with conflicting results for the effectiveness of hypnotherapy compared to no treatment or to advice. We therefore did not attempt to calculate pooled odds ratios for the overall effect of hypnotherapy. There was no evidence of an effect of hypnotherapy compared to rapid smoking or psychological treatment.
We have not shown that hypnotherapy has a greater effect on six month quit rates than other interventions or no treatment. The effects of hypnotherapy on smoking cessation claimed by uncontrolled studies were not confirmed by analysis of randomised controlled trials.
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