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Complementary Therapies for Smoking Cessation – A Useful Tool or Merely a Smoke Screen?
Since the publication of the Cochrane review, there have been two • smoking is poison for your body;
randomised controlled trials. The first used a single acupuncturist • you need your body to live; and
to avoid possible bias and ensure biochemical validation of • to the extent that you want to live, you owe your body respect
smoking cessation.
12
The trial randomised 131 adults to receive and protection.
either auricular or sham acupuncture on a weekly basis. A total of
118 patients were included in the final analyses. Smoking cessation Patients are taught self-hypnosis and encouraged to repeat these
rate showed no difference between the treatment group (27.1%) ideas every one to two hours and any time they crave a cigarette. In
and control group (21%) at the end of treatment or at the end of uncontrolled studies employing this technique, six-month abstinence
six-month follow-up (16.6 and 12.1%, respectively). Hence no rates are reported to vary from 20 to 35%. Spiegel found that in
significant benefit was observed in the smoking cessation rate a consecutive series of 226 patients referred for a smoking
between true acupuncture and sham acupuncture. However, the
treatment group did show a significant decrease in the nicotine
withdrawal symptom score.
A meta-analysis of 24 studies found
The second trial (double-blind, placebo-controlled) compared body
that there was a small but significant
acupuncture with sham acupuncture in relation to improving nicotine
effect of male participants successfully
withdrawal symptoms.
13
Eighty adults were randomised to receive
either real acupuncture or sham acupuncture three times a week for
quitting smoking with hypnosis compared
two weeks and followed up two weeks later. Only 46 participants
with females.
completed the study. The Minnesota Nicotine Withdrawal Scale
(MNWS) was the primary end-point. The intervention reduced
the MNWS by 65 and 62% in the real and sham acupuncture groups, cessation programme treated with a single-session habit-
respectively, with no statistically significant difference between the restructuring intervention involving self-hypnosis, 23% maintained
two groups. The secondary outcome measures looking at depression abstinence at two years.
18
Furthermore, living with a significant other
and anxiety scores also showed no difference. and having made a previous attempt at smoking cessation lasting one
month predicted the likelihood of a two-year maintenance of
A further open randomised pilot study in 2007 evaluated acupressure treatment response.
as an adjunct to NRT.
14
Unfortunately, the drop-out rate in this
study was high, with poor reporting of NRT consumption and much A Cochrane review in 2000 identified nine randomised controlled
missing data. Therefore, it was impossible to demonstrate any effects trials that were suitable for analysis.
19
These studies varied greatly
of acupressure. in the type of hypnotic induction used and its duration.
Furthermore, the range of control interventions was also broad,
These studies highlight the difficulties in obtaining well-designed with some studies comparing more than one intervention. In view
large studies in acupuncture. The interventions employed in these of this significant heterogeneity between studies, no attempt at a
studies have been varied, from the acupoints used to the frequency meta-analysis was made.
and length of treatment. The effect of sham acupuncture has also
been questioned and the duration of follow-up has ranged from two The five main comparisons made in this review were between
weeks to 18 months, with few studies looking at biochemical hypnotherapy and the range of control/alternative interventions
confirmation of smoking cessation. Current evidence does not used. These included no treatment, advice, formal counselling,
support the use of acupuncture as a sole modality for smoking rapid/focused smoking and group therapy. In each of these
cessation. Neither short- nor long-term benefits have been proved in comparisons, no good evidence of sustained quit rates was
a consistent manner. Existing well-designed studies have not obtained. A few studies showed better quit rates, but these studies
demonstrated that acupuncture helps smokers to quit. have been small with methodological problems,
20–23
the primary
problem being the beneficial effect of attending the therapist
Hypnotherapy regardless of receiving hypnotherapy.
Hypnotherapy has been promoted as a method for aiding smoking
cessation. Hypnotherapy utilises hypnosis, which is a state of altered Since the Cochrane review in 2000, there has been one randomised
consciousness in which a person is able to bypass certain aspects controlled trial of 286 current smokers comparing hypnosis with
of reality, tolerate logical inconsistency, experience distortions of standard behavioural therapy in combination with NRT. At six and 12
perception and memory as real and feel a compulsion to follow cues months the validated point-prevalence quit rate was significantly
from an outside source, namely a trained therapist.
15
The ability to be higher in the hypnosis arm among the subgroup of patients with a
hypnotised is felt to be a normally distributed trait, with 15% of the history of depression. However, the magnitude of the benefit
population being highly suggestible and 25% resistant to hypnosis.
16
associated with both interventions at one year was similar, with no
added benefit from hypnosis.
24
Most smokers attend hypnotherapy with the idea that hypnosis will
obliterate their desire to smoke in one visit. The method usually A meta-analysis of 24 studies found that there was a small but
employed was first described by Spiegel. This is a ‘one-session, significant effect of male participants successfully quitting smoking
three-point method’ that attempts to modify the perceptions of with hypnosis compared with females, hence suggesting that gender
patients concerning smoking. Hypnotised smokers are encouraged differences should be accounted for with regard to hypnosis.
25,26
At
to focus on three ideas:
17
best, and based on the literature available, hypnotherapy is a modality
EUROPEAN RESPIRATORY DISEASE 43
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