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HOME PAGE Paul Rieker,
Certified Clinical Hypnotherapist – Credentialed by American Council of
Hypnotist Examiners
Excerpts from “Smoking Cessation
and Hypnosis”
A
comparative review of the effectiveness of hypnosis, an advanced method of
hypnosis, and other interventions used for the cessation of smoking.
by
Michael O' Driscoll B.Sc., M.Sc. (Oxon)
This paper presents some of the findings
from a study looking at all methods of smoking cessation, including standard hypnotherapy
techniques and compares those to a specially developed advanced method of
hypnotherapy for smoking cessation. High quit
rates for hypnosis compared to other methods
A larger meta-analysis of research into
hypnosis to aid Stop Smoking (Chockalingam and Schmidt 1992) (48 studies,
6,020 subjects) found that the average quit rate for those using hypnosis was
36%, making hypnosis the most effective method found in this review with the
exception of a programme which encouraged pulmonary and cardiac patients to
quit smoking using advice from their doctor (such subjects are obviously atypical
as they have life-threatening illnesses which are aggravated by smoking and
therefore these people have very strong incentives to quit). |
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|
|
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|
Type of intervention |
% who quit smoking |
no. of subjects |
no. of trials |
|
|
Advice (cardiac patients) |
42 |
4553 |
34 |
|
|
Hypnosis |
36 |
6020 |
48 |
|
|
Miscellaneous |
35 |
1400 |
10 |
|
|
Advice (pulmonary patients) |
34 |
1661 |
17 |
|
|
Smoke aversion |
31 |
2557 |
103 |
|
|
Group withdrawal clinics |
30 |
11580 |
46 |
|
|
Acupuncture |
30 |
2992 |
19 |
|
|
Instructional methods in workplace |
30 |
976 |
13 |
|
|
Other aversive techniques |
27 |
3926 |
178 |
|
|
5 day plans |
26 |
7828 |
25 |
|
|
Aversive methods in |
25 |
1041 |
26 |
|
|
Educational (health promotion initiatives) |
24 |
3352 |
27 |
|
|
Medication |
18 |
6810 |
29 |
|
|
Physician interventions (more than advice) |
18 |
3486 |
16 |
|
|
Nicotine chewing gum |
16 |
4866 |
40 |
|
|
Self-care (self-help) |
15 |
3585 |
24 |
|
|
Physician advice |
7 |
7190 |
17 |
|
|
|
||||
|
Table 2. Effectiveness of different types
of intervention to achieve smoking cessation (adapted from data in Law and
Tang 1995) |
|||
|
Type of intervention |
% who quit smoking |
no. of subjects |
no. of trials |
|
Supportive group session (heart attack
survivors) |
36 |
223 |
1 |
|
Hypnosis |
24 |
646 |
10 |
|
Supportive group session (healthy men in
high risk for heart attack group) |
21 |
13205 |
4 |
|
Nicotine patch (self-referral) |
13 |
2020 |
10 |
|
Nicotine gum (self-referral |
11 |
3460 |
13 |
|
Supportive group session (in pregnancy) |
8 |
4738 |
10 |
|
Advice from GP (additional sessions) |
5 |
6466 |
10 |
|
Gradual reduction in smoking |
5 |
630 |
8 |
|
Nicotine patch (GP initiated treatment) |
4 |
2597 |
4 |
|
Nicotine gum (GP initiated treatment) |
3 |
7146 |
15 |
|
Acupuncture |
3 |
2759 |
8 |
|
Advice from GP (one-off) |
2 |
14438 |
17 |
|
Supportive group session |
2 |
2059 |
8 |
|
Advice from nurses in health promotion
clinics |
1 |
3369 |
2 |
|
Table 2 (above) shows that the
meta-analysis of Law and Tang confirms, to a large extent, the meta-analysis
of Chockalingam and Schmidt (1992); in both cases hypnosis appears as the
most effective form of intervention to achieve smoking cessation with the exception
of groups who are highly motiviated to quit for medical reasons, such as
those with existing heart or pulmonary problems. |
|||
|
A more recent study, by Ahijevych et al (2000),
produces a similar overall figure for the success of hypnosis. This study
looked at a randomly selected sample of 2,810 smokers who participated in
single-session, group hypnotherapy smoking cessation programs sponsored by
the American Lung Association of Ohio. A randomly selected sample of 452
participants completed telephone interviews 5 to 15 months after attending a
treatment session. 22 percent of participants reported not smoking during the
month prior to the interview. Tailored
Hypnosis—Taking It to the Next Level
The results discussed so far indicate that
when the bulk of random trials are considered hypnosis is shown to be the
most effective intervention for achieving smoking cessation. Yet this is only
half the story—many of the trials discussed so far have used very brief
sessions, using standardised hypnosis techniques, many have in fact taken
place in group sessions (making it difficult to tailor to each individual's
needs) and have not necessarily been carried out by expert practitioners of
hypnosis. If, under these circumstances, hypnosis can achieve such positive
outcomes in terms of enabling smokers to quit, then what might be achieved
using programmes of hypnosis which are carried out by expert hypnotists and
are tailored to the needs of the individual who wants to stop smoking? Nuland and Field (1970) found an
improvement rate of 60% in treating smokers with hypnosis. The increased
effectiveness was achieved by a more personalised approach, including
feedback (under hypnosis) of the client's own personal reasons for quitting.
These researchers also employed a technique of having the client maintain
contact by telephone between treatments and utilized self-hypnosis in
addition. |
|
Von Dedenroth (1968) devised an innovative
unique approach which appears to have been extremely successful. He began by
inquiring how long the individual had smoked, whether they recalled why they
had begun, whether they had ever tried to stop smoking, why they wanted to
stop smoking at this particular point in time, what benefit, if any, they
felt that they derived from smoking, at what specific times they felt the
need most strongly (after meals, before breakfast etc.), and finally he asked
them how many cigarettes they smoked. Von Dedenroth believed that answering
these questions not only tended to increase rapport but also revealed, at
least in part, the smoker's own feelings regarding his smoking and his
reasons for wanting to give up the habit. The therapy proper did not begin
until the second session, and at this time the smoker was told that 'Q Day'
or 'Quitting Day' would be 21 days from that point. The smoker was also told
to change his favourite brand of cigarettes and resolve to never smoke that
brand again. The smoker is then told that they are not to smoke at all:
The smoker was told that, at the times
mentioned above, he was to get into the habit of going to the bath-room,
gargling with mouthwash and cleaning his teeth. He should have a glass of
fruit juice upon awakening and he was told to notice the fresh feeling in his
mouth in the morning and following each of these routines. After his
breakfast, he was to clean his teeth again and use the mouthwash, paying
close attention to the clean feeling in his mouth. Thirty minutes later he
was allowed to have a cigarette, but not before. This tended to break the
association between the taste of food and the inevitable cigarette that
usually followed a meal. He was also told to get a small note-book to carry
with him, and to write down, from time to time, his reasons for giving up
smoking (physical, financial and personal). Then a trance state was induced
and the above suggestions, given in the waking state, were repeated and
consequently greatly reinforced. Following the trance, the patient was
encouraged to ask questions, and the next appointment arranged. |
|
The third session occurred around one week
later (and a week before 'Q day')—in this session the smoker was told that
they should not drink alcohol at all, or at least to drink alcohol only with
meals, with the intention of breaking the association between alcohol and
smoking. A trance state is again induced and all the previous instructions
reinforced. It is also suggested that smoking will no longer be enjoyable. In
particular the smoker was told that the first puff of a cigarette may be
enjoyable, the second less enjoyable, and the third may possibly irritate the
nose, throat or chest. The aim of this is that by the time 'Q Day' arrives
the smoker may only be taking a few puffs of each cigarette a day; as the
number of cigarettes smoked, and the amount of each of those cigarettes
smoked, has declined, then it should be less painful for the individual to
quit. Von Dedenroth believed that the fact that
the individual is able to reduce and stop smoking (with the aid of hypnosis)
gives the individual a great feeling of self-accomplishment. 'Q day' begins
with the induction of a trance state and it is emphasised continually to the
smoker that bad habits have been replaced by good ones, and that for several
weeks cigarettes have become more and more unpleasant. Von Dedenroth found that his use of
hypnosis enabled 94% of 1000 subjects to stop smoking (when checked at 18
months). Practice
Builders Study (2000)
|
|
This research was carried out on 300
subjects (beginning in January 2000 and continuing until March 2002) who
responded to an advertisement. A 'blind trial' technique was used—subjects were
not aware that they were taking part in a research project although they all
ticked a box on their intake forms saying that they understood that the
hypnotist's methods were always being measured tested and improved, and that
results would be collated and studied. Client confidentiality was assured so
that their data could be used but not their names and these subjects were
randomly allocated to receive either 'standard' hypnotherapy or a special
formulation of hypnotherapy which Practice Builders has termed 'advanced
therapy'. 51% of respondents were male and 49% female; the median age of all
subjects was 44 years. No respondents had previous experience of
hypnosis—51% of subjects had tried nicotine patches, 14% had tried nicotine
gum, 7% had tried acupuncture, 6% had tried using a nicotine inhaler and 30%
had previously tried to quit using will-power alone. 11% of subjects had not
previously tried to quit smoking. For all subjects: The price was kept high to establish
commitment, and to avoid people who were casually or speculatively trying
hypnosis (as opposed to those who have some commitment, confidence or belief
that hypnosis would help them to stop smoking). |
|
Before the actual hypnosis, the client (or
subject) is asked a series of questions about their smoking habit and their
beliefs. They are asked, for example: - 'What fears do you have about stopping?' Hypnosis was then fully explained to the
client, as well as how the conscious and the subconscious mind works, and any
myths debunked (such as, you cannot make someone do something they don't want
to do, hypnosis is not sleep or unconsciousness, you will be aware of
everything that is going on and will remember everything that happened in
hypnosis after the session, you can stop the session at any time, etc.). This
is called the "pre-talk". A hypnotic contract is then entered into,
in which the client agrees to go along with all techniques and to accept all
the suggestions that are for their benefit. For subjects treated with the standard
technique: For subjects treated with the advanced
technique: |
Findings
Quit rates were established through
telephone interviews 1 month and 6 months after the first session of
treatment. Of those who received 'advanced therapy', 95%
had quit smoking after 1 session. The remaining 5% received a second
session of treatment leading to a further 1.3% of the group quitting smoking.
In total therefore, at 6 months,97% of those who received 'advanced
therapy' had quit smoking. Of those who received 'standard therapy'
51% quit smoking after one session and a further 6% quit after a second
session—a total of 57% had quit smoking at 6 months. |
|
Those who were still smoking at 6 months
did not differ from those who had successfully quit in terms of gender, age
or therapies previously tried. These results mean that for both standard
treatments and the 'advanced treatment' quit rates are extraordinarily high
and well above what has hitherto been reported in the literature. Results for
both treatments were significant at the 0.001 level (chi-square). Outcomes for the 'advanced therapy' are
considerably higher than any findings previously reported in the literature. In addition, the success rate achieved using the
standard technique was considerably higher than expected and this may be due
to the fact that the elements that the standard treatment and 'advanced
treatment' have in common have powerful effects on outcomes. |
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