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Batra A, Eck S, Riegel B, Friedrich S, Fuhr K, Torchalla I, Tönnies S. Hypnotherapy compared to cognitive-behavioral therapy for smoking cessation in a randomized controlled trial. Front Psychol 2024; 15:1330362. [PMID: 38476396 PMCID: PMC10929270 DOI: 10.3389/fpsyg.2024.1330362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024] Open
Abstract
Worldwide, more than eight million people die each year as a result of tobacco use. A large proportion of smokers who want to quit are interested in alternative smoking cessation methods, of which hypnotherapy is the most popular. However, the efficacy of hypnotherapy as a tobacco cessation intervention cannot be considered sufficiently proven due to significant methodological limitations in the studies available to date. The aim of the present study was to compare the efficacy of a hypnotherapeutic group program for smoking cessation with that of an established cognitive-behavioral group program in a randomized controlled trial. A total of 360 smokers who were willing to quit were randomly assigned to either hypnotherapy (HT) or cognitive-behavioral therapy (CBT) at two study sites, without regard to treatment preference. They each underwent a 6 weeks smoking cessation course (one 90 min group session per week) and were followed up at regular intervals over a 12 months period. The primary outcome variable was defined as continuous abstinence from smoking according to the Russell standard, verified by a carbon monoxide measurement at three measurement time points. Secondary outcome variables were 7 days point prevalence abstinence during the 12 months follow up and the number of cigarettes the non-quitters smoked per smoking day (smoking intensity). Generalized estimating equations were used to test treatment condition, hypnotic suggestibility, and treatment expectancy as predictors of abstinence. The two interventions did not differ significantly in the proportion of participants who remained continuously abstinent throughout the follow-up period (CBT: 15.6%, HT: 15.0%) and also regarding the 7 days abstinence rates during the 12 months follow-up (CBT: 21.2%, HT: 16.7%). However, when controlling for hypnotic suggestibility, CBT showed significantly higher 7 days abstinence rates. In terms of the continuous abstinence rates, it can be concluded that the efficacy of hypnotherapeutic methods for smoking cessation seem to be comparable to established programs such as CBT. Clinical trial registration ClinicalTrials.gov, identifier NCT01129999.
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Affiliation(s)
- Anil Batra
- Department for Psychiatry and Psychotherapy, Section for Addiction Research and Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Sandra Eck
- Department for Psychiatry and Psychotherapy, Section for Addiction Research and Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | | | | | - Kristina Fuhr
- Department for Psychiatry and Psychotherapy, Section for Addiction Research and Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | | | - Sven Tönnies
- Department of Clinical Psychology and Psychotherapy, University Hamburg, Hamburg, Germany
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Pellegrini M, Carletto S, Scumaci E, Ponzo V, Ostacoli L, Bo S. The Use of Self-Help Strategies in Obesity Treatment. A Narrative Review Focused on Hypnosis and Mindfulness. Curr Obes Rep 2021; 10:351-364. [PMID: 34050891 PMCID: PMC8408071 DOI: 10.1007/s13679-021-00443-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this narrative review was to summarize the evidence evaluating the possibilities and limitations of self-hypnosis and mindfulness strategies in the treatment of obesity. RECENT FINDINGS Psychological factors, such as mood disorders and stress, can affect eating behaviors and deeply influence weight gain. Psychological approaches to weight management could increase the motivation and self-control of the patients with obesity, limiting their impulsiveness and inappropriate use of food. The cognitive-behavioral therapy (CBT) represents the cornerstone of obesity treatment, but complementary and self-directed psychological interventions, such as hypnosis and mindfulness, could represent additional strategies to increase the effectiveness of weight loss programs, by improving dysfunctional eating behaviors, self-motivation, and stimulus control. Both hypnosis and mindfulness provide a promising therapeutic option by improving weight loss, food awareness, self-acceptance of body image, and limiting food cravings and emotional eating. Greater effectiveness occurs when hypnosis and mindfulness are associated with other psychological therapies in addition to diet and physical activity. Additional research is needed to determine whether these strategies are effective in the long term and whether they can be routinely introduced into the clinical practice.
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Affiliation(s)
- Marianna Pellegrini
- Department of Medical Sciences, University of Torino, c.so AM Dogliotti 14, 10126, Torino, Italy
| | - Sara Carletto
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | - Elena Scumaci
- Department of Medical Sciences, University of Torino, c.so AM Dogliotti 14, 10126, Torino, Italy
| | - Valentina Ponzo
- Department of Medical Sciences, University of Torino, c.so AM Dogliotti 14, 10126, Torino, Italy
| | - Luca Ostacoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Simona Bo
- Department of Medical Sciences, University of Torino, c.so AM Dogliotti 14, 10126, Torino, Italy.
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Erşan S, Erşan EE. Effects of Hypnotherapy on Weight Loss and thus on Serum Leptin, Adiponectin, and Irisin Levels in Obese Patients. J Altern Complement Med 2020; 26:1047-1054. [PMID: 32716207 DOI: 10.1089/acm.2020.0104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective: This study aimed to investigate effects of hypnotherapy on weight loss and thus on leptin, adiponectin (ADP), and irisin levels in obese patients who presented to the psychiatry outpatient clinic to participate in hypnotherapy sessions to develop a healthy and balanced diet. Methods: The study sample included 32 individuals with a body mass index (BMI) of ≥30 and who completed the 10-week hypnotherapy. First, the Personal Information Form was handed out to the participants and then each participant's weight (in the morning on an empty stomach) and height were measured and BMI was determined. Five-milliliter blood samples were drawn before the first session, and then irisin, leptin, and ADP levels were measured using the enzyme-linked immunosorbent assay method. Then, they participated in hypnotherapy sessions once a week for 10 weeks. At the end of the 10-week hypnotherapy, 5 mL of blood was taken again and the aforementioned biochemical analyses were performed. BMIs were measured again. Results: The mean BMI values of the patients were 33.43 ± 5.28 and 31.45 ± 4.98 at the beginning and end of the hypnotherapy sessions, respectively. Serum leptin, ADP, and irisin levels, which were 9.48 ± 5.48, 6.73 ± 3.27, and 1.43 ± 1.14, respectively, at the beginning of the hypnotherapy sessions, were 6.47 ± 2.69, 7.68 ± 3.34, and 1.53 ± 1.21, respectively, at the end of the hypnotherapy sessions. The results showed that BMI and serum leptin levels decreased significantly after the hypnotherapy sessions, whereas serum ADP and irisin levels increased significantly. Conclusions: This study indicates that hypnotherapy in obesity treatment leads to weight loss in obese patients and thus to considerable changes in leptin, ADP, and irisin levels. Hypnotherapy is easy to apply, cheap, and effective; has no potential for side effects; and can be applied both alone and in combination with other treatments. However, to confirm its effects, further studies should be conducted on this issue.
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Affiliation(s)
- Serpil Erşan
- Department of Medicinal Biochemistry and Medical Faculty, Niğde Ömer Halisdemir University, Niğde, Turkey
| | - Etem Erdal Erşan
- Department of Psychiatry, Medical Faculty, Niğde Ömer Halisdemir University, Niğde, Turkey
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Dai R, Zhang J, Zhang H, Zhao N, Song F, Fan J. Effect of acupuncture and auricular acupressure on smoking cessation: Protocol of a systematic review and Bayesian network meta-analysis. Medicine (Baltimore) 2020; 99:e20295. [PMID: 32481398 DOI: 10.1097/md.0000000000020295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Tobacco epidemic remains a major challenge to public health, with >7 million deaths attributable to tobacco smoking p.a. Quitting smoking is a proven way of reducing the harm of smoking. Nicotine replacement therapy (NRT), auricular acupressure and acupuncture are used for quit smoking, but it remains to be explored which is relatively more effective. Furthermore, a Bayesian network meta-analysis will be applied to determine the relative effects and/or safety of different smoking cessation treatments. METHODS/DESIGN A literature search for randomized controlled trials (RCTs) will be performed in five electronic databases from inception to December 2019, including PubMed, the Cochrane library, EMBASE, Web of Science, and Chinese Biomedical Database (SinoMed). Cochrane Collaboration quality assessment tool will be used for the risk of bias assessment. A Bayesian network meta-analysis will be performed using WinBUGS 1.4.3, and Stata 14 will be applied to draw the network diagram, while RevMan 5.3.5 will be used to produce funnel plot for assessing the risk of publication bias. Recommended rating, development and grade methodology will also be utilized to assess the quality of evidence. RESULTS We will evaluate the effect of different smoking cessation treatments (e.g., acupuncture, auricular acupressure, and NRT) by directly traditional meta-analysis and indirectly Bayesian network meta-analysis. CONCLUSION Our study will provide smokers with the available evidence on the efficacy and safety of quitting regimens.
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Affiliation(s)
- Runjing Dai
- School of Public Health, Center for Evidence-Based Medicine
| | - Jie Zhang
- The Graduate School, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, P.R. China
| | - Hailiang Zhang
- School of Public Health, Center for Evidence-Based Medicine
| | - Na Zhao
- School of Public Health, Center for Evidence-Based Medicine
| | - Fujian Song
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Jingchun Fan
- School of Public Health, Center for Evidence-Based Medicine
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Livingstone‐Banks J, Norris E, Hartmann‐Boyce J, West R, Jarvis M, Chubb E, Hajek P. Relapse prevention interventions for smoking cessation. Cochrane Database Syst Rev 2019; 2019:CD003999. [PMID: 31684681 PMCID: PMC6816175 DOI: 10.1002/14651858.cd003999.pub6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND A number of treatments can help smokers make a successful quit attempt, but many initially successful quitters relapse over time. Several interventions have been proposed to help prevent relapse. OBJECTIVES To assess whether specific interventions for relapse prevention reduce the proportion of recent quitters who return to smoking. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group trials register, clinicaltrials.gov, and the ICTRP in May 2019 for studies mentioning relapse prevention or maintenance in their title, abstracts, or keywords. SELECTION CRITERIA Randomised or quasi-randomised controlled trials of relapse prevention interventions with a minimum follow-up of six months. We included smokers who quit on their own, were undergoing enforced abstinence, or were participating in treatment programmes. We included studies that compared relapse prevention interventions with a no intervention control, or that compared a cessation programme with additional relapse prevention components with a cessation programme alone. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 81 studies (69,094 participants), five of which are new to this update. We judged 22 studies to be at high risk of bias, 53 to be at unclear risk of bias, and six studies to be at low risk of bias. Fifty studies included abstainers, and 30 studies helped people to quit and then tested treatments to prevent relapse. Twenty-eight studies focused on special populations who were abstinent because of pregnancy (19 studies), hospital admission (six studies), or military service (three studies). Most studies used behavioural interventions that tried to teach people skills to cope with the urge to smoke, or followed up with additional support. Some studies tested extended pharmacotherapy. We focused on results from those studies that randomised abstainers, as these are the best test of relapse prevention interventions. Of the 12 analyses we conducted in abstainers, three pharmacotherapy analyses showed benefits of the intervention: extended varenicline in assisted abstainers (2 studies, n = 1297, risk ratio (RR) 1.23, 95% confidence interval (CI) 1.08 to 1.41, I2 = 82%; moderate-certainty evidence), rimonabant in assisted abstainers (1 study, RR 1.29, 95% CI 1.08 to 1.55), and nicotine replacement therapy (NRT) in unaided abstainers (2 studies, n = 2261, RR 1.24, 95% Cl 1.04 to 1.47, I2 = 56%). The remainder of analyses of pharmacotherapies in abstainers had wide confidence intervals consistent with both no effect and a statistically significant effect in favour of the intervention. These included NRT in hospital inpatients (2 studies, n = 1078, RR 1.23, 95% CI 0.94 to 1.60, I2 = 0%), NRT in assisted abstainers (2 studies, n = 553, RR 1.04, 95% CI 0.77 to 1.40, I2 = 0%; low-certainty evidence), extended bupropion in assisted abstainers (6 studies, n = 1697, RR 1.15, 95% CI 0.98 to 1.35, I2 = 0%; moderate-certainty evidence), and bupropion plus NRT (2 studies, n = 243, RR 1.18, 95% CI 0.75 to 1.87, I2 = 66%; low-certainty evidence). Analyses of behavioural interventions in abstainers did not detect an effect. These included studies in abstinent pregnant and postpartum women at the end of pregnancy (8 studies, n = 1523, RR 1.05, 95% CI 0.99 to 1.11, I2 = 0%) and at postpartum follow-up (15 studies, n = 4606, RR 1.02, 95% CI 0.94 to 1.09, I2 = 3%), studies in hospital inpatients (5 studies, n = 1385, RR 1.10, 95% CI 0.82 to 1.47, I2 = 58%), and studies in assisted abstainers (11 studies, n = 5523, RR 0.98, 95% CI 0.87 to 1.11, I2 = 52%; moderate-certainty evidence) and unaided abstainers (5 studies, n = 3561, RR 1.06, 95% CI 0.96 to 1.16, I2 = 1%) from the general population. AUTHORS' CONCLUSIONS Behavioural interventions that teach people to recognise situations that are high risk for relapse along with strategies to cope with them provided no worthwhile benefit in preventing relapse in assisted abstainers, although unexplained statistical heterogeneity means we are only moderately certain of this. In people who have successfully quit smoking using pharmacotherapy, there were mixed results regarding extending pharmacotherapy for longer than is standard. Extended treatment with varenicline helped to prevent relapse; evidence for the effect estimate was of moderate certainty, limited by unexplained statistical heterogeneity. Moderate-certainty evidence, limited by imprecision, did not detect a benefit from extended treatment with bupropion, though confidence intervals mean we could not rule out a clinically important benefit at this stage. Low-certainty evidence, limited by imprecision, did not show a benefit of extended treatment with nicotine replacement therapy in preventing relapse in assisted abstainers. More research is needed in this area, especially as the evidence for extended nicotine replacement therapy in unassisted abstainers did suggest a benefit.
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Affiliation(s)
| | - Emma Norris
- University College LondonCentre for Behaviour ChangeLondonUK
| | | | - Robert West
- University College LondonDepartment of Behavioural Science and Health1‐19 Torrington PlaceLondonUKWC1E 6BT
| | - Martin Jarvis
- University College LondonHealth Behavior Research Centre of Cancer Research UK, Department of Epidemiology and Public Health2‐16 Torrington PlaceLondonUKWC1E 6BT
| | - Emma Chubb
- Cardiff UniversitySchool of PsychologyCardiffUK
| | - Peter Hajek
- Barts & The London School of Medicine and Dentistry, Queen Mary University of LondonWolfson Institute of Preventive Medicine55 Philpot StreetLondonUKE1 2HJ
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Abstract
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.
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Affiliation(s)
- Joanne Barnes
- University of AucklandSchool of PharmacyPrivate Bag 92019Grafton CampusAucklandNew Zealand
| | - Hayden McRobbie
- Barts & The London School of Medicine and Dentistry, Queen Mary University of LondonWolfson Institute of Preventive Medicine55 Philpot StreetWhitechapelLondonUKE1 2HJ
| | | | - Natalie Walker
- University of AucklandNational Institute for Health InnovationPrivate Bag 92019AucklandNew Zealand
| | - Jamie Hartmann‐Boyce
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
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Herring M. Strategies and Design of Hypnosis Intervention for Tobacco Cessation. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2019; 61:345-369. [PMID: 31017546 DOI: 10.1080/00029157.2018.1491386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this article is to share approaches and program design to assist healthcare professionals trained in hypnosis help tobacco users become tobacco free. Helping tobacco users overcome their tobacco dependency is generally seen as challenging to healthcare professionals. Efforts to stop a tobacco habit have components which are both physical and emotional in nature and which produce periods of discomfort and high relapse rates. Hypnosis can be supportive for both the physical and emotional aspects necessary for successful cessation. Health risks of tobacco use cannot be overlooked, and individuals burdened by tobacco habits will benefit from health professionals' greater appreciation for the contributions hypnosis can offer. Tobacco cessation incorporating hypnosis can be successful when careful attention is given to the program design.
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Livingstone‐Banks J, Norris E, Hartmann‐Boyce J, West R, Jarvis M, Hajek P. Relapse prevention interventions for smoking cessation. Cochrane Database Syst Rev 2019; 2:CD003999. [PMID: 30758045 PMCID: PMC6372978 DOI: 10.1002/14651858.cd003999.pub5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A number of treatments can help smokers make a successful quit attempt, but many initially successful quitters relapse over time. Several interventions have been proposed to help prevent relapse. OBJECTIVES To assess whether specific interventions for relapse prevention reduce the proportion of recent quitters who return to smoking. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group trials register, clinicaltrials.gov, and the ICTRP in February 2018 for studies mentioning relapse prevention or maintenance in their title, abstracts, or keywords. SELECTION CRITERIA Randomised or quasi-randomised controlled trials of relapse prevention interventions with a minimum follow-up of six months. We included smokers who quit on their own, were undergoing enforced abstinence, or were participating in treatment programmes. We included studies that compared relapse prevention interventions with a no intervention control, or that compared a cessation programme with additional relapse prevention components with a cessation programme alone. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 77 studies (67,285 participants), 15 of which are new to this update. We judged 21 studies to be at high risk of bias, 51 to be at unclear risk of bias, and five studies to be at low risk of bias. Forty-eight studies included abstainers, and 29 studies helped people to quit and then tested treatments to prevent relapse. Twenty-six studies focused on special populations who were abstinent because of pregnancy (18 studies), hospital admission (five studies), or military service (three studies). Most studies used behavioural interventions that tried to teach people skills to cope with the urge to smoke, or followed up with additional support. Some studies tested extended pharmacotherapy.We focused on results from those studies that randomised abstainers, as these are the best test of relapse prevention interventions. Of the 12 analyses we conducted in abstainers, three pharmacotherapy analyses showed benefits of the intervention: extended varenicline in assisted abstainers (2 studies, n = 1297, risk ratio (RR) 1.23, 95% confidence interval (CI) 1.08 to 1.41, I² = 82%; moderate certainty evidence), rimonabant in assisted abstainers (1 study, RR 1.29, 95% CI 1.08 to 1.55), and nicotine replacement therapy (NRT) in unaided abstainers (2 studies, n = 2261, RR 1.24, 95% Cl 1.04 to 1.47, I² = 56%). The remainder of analyses of pharmacotherapies in abstainers had wide confidence intervals consistent with both no effect and a statistically significant effect in favour of the intervention. These included NRT in hospital inpatients (2 studies, n = 1078, RR 1.23, 95% CI 0.94 to 1.60, I² = 0%), NRT in assisted abstainers (2 studies, n = 553, RR 1.04, 95% CI 0.77 to 1.40, I² = 0%; low certainty evidence), extended bupropion in assisted abstainers (6 studies, n = 1697, RR 1.15, 95% CI 0.98 to 1.35, I² = 0%; moderate certainty evidence), and bupropion plus NRT (2 studies, n = 243, RR 1.18, 95% CI 0.75 to 1.87, I² = 66%; low certainty evidence). Analyses of behavioural interventions in abstainers did not detect an effect. These included studies in abstinent pregnant and postpartum women at end of pregnancy (8 studies, n = 1523, RR 1.05, 95% CI 0.99 to 1.11, I² = 0%) and at postpartum follow-up (15 studies, n = 4606, RR 1.02, 95% CI 0.94 to 1.09, I² = 3%), studies in hospital inpatients (4 studies, n = 1300, RR 0.95, 95% CI 0.81 to 1.11, I² = 0%), and studies in assisted abstainers (10 studies, n = 5408, RR 0.99, 95% CI 0.87 to 1.13, I² = 56%; moderate certainty evidence) and unaided abstainers (5 studies, n = 3561, RR 1.06, 95% CI 0.96 to 1.16, I² = 1%) from the general population. AUTHORS' CONCLUSIONS Behavioural interventions that teach people to recognise situations that are high risk for relapse along with strategies to cope with them provided no worthwhile benefit in preventing relapse in assisted abstainers, although unexplained statistical heterogeneity means we are only moderately certain of this. In people who have successfully quit smoking using pharmacotherapy, there were mixed results regarding extending pharmacotherapy for longer than is standard. Extended treatment with varenicline helped to prevent relapse; evidence for the effect estimate was of moderate certainty, limited by unexplained statistical heterogeneity. Moderate-certainty evidence, limited by imprecision, did not detect a benefit from extended treatment with bupropion, though confidence intervals mean we could not rule out a clinically important benefit at this stage. Low-certainty evidence, limited by imprecision, did not show a benefit of extended treatment with nicotine replacement therapy in preventing relapse in assisted abstainers. More research is needed in this area, especially as the evidence for extended nicotine replacement therapy in unassisted abstainers did suggest a benefit.
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Affiliation(s)
| | - Emma Norris
- University College LondonCentre for Behaviour ChangeLondonUK
| | | | - Robert West
- University College LondonDepartment of Behavioural Science and Health1‐19 Torrington PlaceLondonUKWC1E 6BT
| | - Martin Jarvis
- University College LondonHealth Behavior Research Centre of Cancer Research UK, Department of Epidemiology and Public Health2‐16 Torrington PlaceLondonUKWC1E 6BT
| | - Peter Hajek
- Barts & The London School of Medicine and Dentistry, Queen Mary University of LondonWolfson Institute of Preventive Medicine55 Philpot StreetLondonUKE1 2HJ
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Peiffer G, Underner M, Perriot J. [COPD and smoking cessation: Patients' expectations and responses of health professionals]. REVUE DE PNEUMOLOGIE CLINIQUE 2018; 74:375-390. [PMID: 30455124 DOI: 10.1016/j.pneumo.2018.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The importance of smoking cessation in the management of COPD is well-established: the benefit of quitting smoking as regards morbidity and mortality outcomes in patients, is unquestioned. The smoking cessation in COPD patients is difficult: high levels of consumption, the duration of smoking, high dependence level, psychological co-morbidities such as anxiety and depression, lower socio-economic and intellectual level, constitute barriers. Studies have shown that patients often minimize the risks of smoking, that others do not believe in the benefits of quitting or doubt their ability to quit smoking. The patients' experience, and expectations with regard to smoking cessation are incompletely satisfied: are considered, the smoking characteristics of these patients, the understanding of the tobacco dependence, the beliefs and ideas of smokers, the knowledge of smoking cessation methods, the role of validated aids and alternative treatments, failure management. The answers of the health professionals can be in several directions: establishment of a better communication patient-doctor (empathy), more centered on the needs of the smoker, the role of the motivation and the place of the motivational interview, the understanding of the mechanisms of addiction, a better individualisation of therapeutics, the necessity of a extended follow-up, the contribution of modern technologies, the electronic cigarette, the smoking cessation in respiratory rehabilitation, guidelines that address smoking cessation treatment.
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Affiliation(s)
- G Peiffer
- Service de pneumologie, hôpital de Mercy, CHR Metz-Thionville, 57038 Metz, France.
| | - M Underner
- Centre hospitalier Henri Laborit, unité de recherche clinique, 86000 Poitiers, France
| | - J Perriot
- Dispensaire Emile Roux - CLAT 63, 11, rue Vaucanson, 63100 Clermont-Ferrand, France
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