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Excerpts from
“Smoking Cessation and Hypnosis”
by
Michael O' Driscoll B.Sc., M.Sc. (Oxon)
A comparative review
of the effectiveness of hypnosis, an advanced method
of hypnosis, and other interventions used for the
cessation of smoking.
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 smoking
cessation (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 program 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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Table 1.
Effectiveness of different types of intervention to
achieve smoking cessation adapted from data in
Chockalingam and Schmidt
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Advice (cardiac
patients)
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42
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4553
|
34
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Hypnosis
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36
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6020
|
48
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Miscellaneous
|
35
|
1400
|
10
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Advice (pulmonary
patients)
|
34
|
1661
|
17
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Smoke aversion
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31
|
2557
|
103
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Group withdrawal
clinics
|
30
|
11580
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46
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Acupuncture
|
30
|
2992
|
19
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Instructional methods
in workplace
|
30
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976
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13
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Other aversive
techniques
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27
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3926
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178
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5 day plans
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26
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7828
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25
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Aversive methods in
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25
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1041
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26
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Educational (health
promotion initiatives)
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24
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3352
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27
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Medication
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18
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6810
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29
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Physician
interventions (more than advice)
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18
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3486
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16
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Nicotine chewing gum
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16
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4866
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40
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Self-care (self-help)
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15
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3585
|
24
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Physician advice
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7
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7190
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17
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Law and Tang (1995) looked at 10 randomised trials,
carried out between 1975 and 1988, of hypnosis in
smoking cessation. They found that the effect of
hypnosis was highly statistically significant1. The
research they examined involved 646 subjects and
cessation rates at 6 months post-treatment ranged from
10% to 38% (the average figure was 24%).
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Table 2.
Effectiveness of different types of intervention to
achieve smoking cessation (adapted from data in Law
and Tang 1995)
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Supportive group
session (heart attack survivors)
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36
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223
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1
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Hypnosis
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24
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646
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10
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Supportive group
session (healthy men in high risk for heart attack
group)
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21
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13205
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4
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Nicotine patch
(self-referral)
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13
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2020
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10
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Nicotine gum
(self-referral
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11
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3460
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13
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Supportive group
session (in pregnancy)
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8
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4738
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10
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Advice from GP
(additional sessions)
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5
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6466
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10
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Gradual reduction in
smoking
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5
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630
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8
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Nicotine patch (GP
initiated treatment)
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4
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2597
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4
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Nicotine gum (GP
initiated treatment)
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3
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7146
|
15
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Acupuncture
|
3
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2759
|
8
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Advice from GP
(one-off)
|
2
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14438
|
17
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Supportive group
session
|
2
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2059
|
8
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Advice from nurses in
health promotion clinics
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1
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3369
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2
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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.
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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 standardized 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 programs 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
personalized 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.
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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
favorite brand of cigarettes and resolve to never
smoke that brand again. The smoker is then told that
they are not to smoke at all:
-
Before breakfast
-
For one half-hour
after each meal
-
For 30 minutes
before retiring
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.
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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)
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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 client was interviewed to make sure that they
wanted to stop smoking for their own reasons, and were
not being pressured into it by someone else (doctor,
loved one etc.).
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).
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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?'
- 'What do you know about hypnosis?'
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:
A basic stop smoking technique is used. This type of
standard technique doesn't allow for much in the way
of personalizing a session, as it is the same for
every client. The wording of some of the best basic
techniques uses hypnotic language patterns (Neuro
Linguistic Programming). The client is then emerged.
For subjects treated
with the advanced technique:
Hypnosis is induced using a progressive test induction
tailored to the client. Ideo-motor techniques are used
to gain subconscious communication. The client's own
motivations, Meta programs, and values are utilized in
the session using a combination of metaphor and
suggestion. NLP sub-modality and anchoring techniques
are used according to the client's processing style.
At the end of the session, the client is emerged from
hypnosis and the change is tested, then future paced
and ratified.
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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.
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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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1.
Combined results were statistically significant at the
.001 level, meaning that there is less than a one in a
thousand chance that these results happened by chance.
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