November 5, 2013

I regularly provide counseling to help people stop smoking, and often use hypnosis as a part of my approach. One of the first questions I hear from people is: Does hypnosis really work? Can it really help me stop smoking?

I’m not an advertiser — I’m a clinician and a scientist, so I tend to be a little bit conservative about telling people just how much more effective hypnosis actually is than all other available treatments. So I’ve compiled this brief review of the scientific literature on methods to stop smoking so that you can make the comparison for yourself and really see the difference in effectiveness. In putting this together, I’ve focused strongly on rigorous, meta-analytic studies — which are studies that combine the results of many other smaller studies in order to get much more comprehensive results.

Here are the major interventions currently being used to help people stop smoking:

• Hypnotherapy
  • In a major meta-analysis of 633 studies on smoking cessation, including 48 studies which examined hypnosis on more than 6,000 participants, hypnosis showed a 36% success rate when no distinction is made between different types of hypnotic intervention (Viswesvaran & Schmidt, 1992). This is important to note, because there are many different ways that hypnosis can be used, and they are not all equally effective. Previous studies have shown, for example, that custom-tailored hypnosis is much more effective than the standardized, scripted variety typically used in scientific studies (Lynn, Green, Accardi, & Cleere, 2010). So with this study we can see that even when most of the treatments use a standardized, one-size-fits-all approach, more than 1/3 of participants still achieve and maintain abstinence from cigarettes.
  • An extremely rigorous, randomized controlled study in 2006 found that intensive (8-session) hypnotherapy resulted in 40% of patients being free from cigarettes at 6 month follow-up, as confirmed by measurement of carbon monoxide levels in their blood (Elkins, Marcus, Bates, Rajab, & Cook, 2006). Not a single person in the control group had managed to stop smoking on their own for this length of time.
  • New procedures for enhancing hypnotic responsivity and reinforcing treatment gains may provide even greater effectiveness for the use of hypnosis to stop smoking (Lynn, Green, Accardi, & Cleere, 2010)
• Counseling
  • A recent systematic review published in the journal Addiction found that behavioral counseling is superior to treatment with medication (Hartmann-Boyce, Stead, Cahill, & Lancaster, 2013)
  • Another meta-analysis showed that a type of counseling called Motivational Interviewing is also effective in enhancing smokers’ ability to quit successfully. (Heckman, Egleston, & Hofman, 2010)
  • However, counseling is substantially more effective when hypnosis is used (Lynn, Green, Accardi, & Cleere, 2010)
• Acupuncture
  • A meta-analysis of alternative smoking cessation aids published in the American Journal of Medicine found that acupuncture is an effective treatment for smoking — more effective than medication or nicotine replacement — but not as effective as hypnotherapy (Tahiri, Mottillo, Joseph, Pilote, & Eisenberg, 2012)
• Nicotine Replacement Therapy
  • Nicotine replacement is the most popular method to try and quit smoking, because products such as nicotine gums and patches are readily available over-the-counter, and people believe that replacing the nicotine from cigarettes will help them to break the habit before they have to deal with the physical effects of detoxification from nicotine. A 2008 meta-analysis found that nicotine patches and nasal spray were roughly as effective as other medications (Eisenberg et al, 2008), while nicotine tablets and gum were slightly less effective.
  • In total, only 7 to 9 percent of people succeed in stopping smoking by using this method (Shiffman et al, 2002).
• Medication
  • A meta-analysis published in the Canadian Medical Association Journal compared 7 popular medications used for smoking cessation including buproprion (Wellbutrin) and varenicline (Champix), as well as nicotine replacement products such as the nicotine patch, gum, or nasal spray (Eisenberg et al, 2008). While each of these medications was more effective than a placebo in helping smokers kick the habit, the overall effectiveness is not very good. All told, less than 10% of patients receiving any of these medications succeeded in remaining abstinent from cigarettes for 6 months.
• Aversive Smoking
  • This is the method of intentionally making yourself sick by smoking many cigarettes very quickly. This creates an intensely unpleasant experience which causes many people to feel a subsequent aversion to cigarettes. This method is actually slightly more effective than anti-smoking medications (Eisenberg et al, 2008), but not anywhere near as effective — or enjoyable — as hypnotherapy (Tahiri et al, 2012)

From reviewing the literature, my conclusion is that New Scientist was correct when they declared hypnosis “the best way of giving up smoking.” Particularly when used in a personalized manner, in conjunction with motivational interviewing and behavioral counseling, there is simply nothing that comes close to matching its effectiveness.

In 2011, I worked with Dr. Edward Frischholz, Ph.D., ABPH on further developing a brief hypnotic treatment for smoking originally developed in the 1960s and under continuous refinement since that time. The method’s effectiveness has been confirmed in numerous studies. In the most recent published study, from the American Journal of Psychiatry, this method achieved 30% success at a six-month follow-up (in a single session!) — measured by complete 100% abstinence for the entire six month period (Spiegel, Frischholz, Fleiss, & Spiegel, 1993). If a participant smoked even one cigarette at a party a single time during the entire six months, it was counted as a failure.

By studying the real-life circumstances associated with both successful and unsuccessful outcomes, we were able to modify the technique in order to achieve an additional 8% success at 6 months follow-up. I presented these findings to the Society of Clinical and Experimental Hypnosis at their annual conference in 2011.

And as we continue to update and refine this method, we find that more and more of our patients are finding it easy and enjoyable to become non-smokers… permanently.

References

• Eisenberg, M.J., Filian, K.B., Yavin, D., Belisle, P., Mottillo, S., Joseph, L., Gervais, A., O’Loughlin, J., Paradis, G., Rinfret, S., & Pilote, L. (2008). Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials. *Canadian Medical Association Journal, 179(*2), 135-144.