Tim Brunson DCH

Welcome to The International Hypnosis Research Institute Web site. Our intention is to support and promote the further worldwide integration of comprehensive evidence-based research and clinical hypnotherapy with mainstream mental health, medicine, and coaching. We do so by disseminating, supporting, and conducting research, providing professional level education, advocating increased level of practitioner competency, and supporting the viability and success of clinical practitioners. Although currently over 80% of our membership is comprised of mental health practitioners, we fully recognize the role, support, involvement, and needs of those in the medical and coaching fields. This site is not intended as a source of medical or psychological advice. Tim Brunson, PhD

The neural mechanisms of immediate and follow-up of the treatment effect of hypnosis...

Full title: The neural mechanisms of immediate and follow-up of the treatment effect of hypnosis on smoking craving.

Hypnosis has a therapeutic effect on substance dependence. However, its neural basis remains unclear, which impedes its further clinical applications. This study investigated the mechanisms of smoking treatment based on hypnosis from two perspectives: immediate and follow-up effects. Twenty-four smokers screened from 132 volunteers underwent hypnosis suggestion and performed a smoking-related cue task twice during functional magnetic resonance imaging (fMRI) scanning (in normal and hypnotic states). The number of cigarettes smoked per day was recorded at follow-up visits. The smokers reported decreased craving after hypnosis. The activations in the right dorsal lateral prefrontal cortex (rDLPFC), the left insula and the right middle frontal gyrus (rMFG), and the functional connectivity between the rDLPFC and the left insula were increased in the hypnotic state. The reduced craving was related to the DLPFC-insula network, which reflected the immediate mechanism of hypnosis on smoking. The number of cigarette use at the 1-week and 1 month follow-up was correlated with the rMFG activation which reflecting hypnotic depth, suggesting the follow-up effect of hypnosis on smoking depended on the trait of smokers. We identified two different mechanisms of hypnosis effect on smoking, which have important implications for design and optimization of hypnotic treatments on mental disorders.

Brain Imaging Behav. 2020 Oct;14(5):1487-1497. doi: 10.1007/s11682-019-00072-0.

Hypnotherapy is more effective than nicotine replacement therapy for smoking cessation...

Full title: Hypnotherapy is more effective than nicotine replacement therapy for smoking cessation: results of a randomized controlled trial.

BACKGROUND: The efficacy of pharmacotherapy for smoking cessation is well documented. However, due to relapse rates and side effects, hypnotherapy is gaining attention as an alternative treatment option. The aim of this one-center randomized study was to compare the efficacy of hypnotherapy alone, as well as hypnotherapy with nicotine replacement therapy (NRT), to conventional NRT in patients hospitalized with a cardiac or pulmonary illness. METHODS: We evaluated self-reported and biochemically verified 7-day prevalence smoking abstinence rates at 12 and 26 weeks post-hospitalization. Patients (n=164) were randomized into one of three counseling-based treatment groups: NRT for 30 days (NRT; n=41), a 90-min hypnotherapy session (H; n=39), and NRT with hypnotherapy (HNRT; n=37). Treatment groups were compared to a "self-quit" group of 35 patients who refused intervention. RESULTS: Hypnotherapy patients were more likely than NRT patients to be nonsmokers at 12 weeks (43.9% vs. 28.2%; p=0.14) and 26 weeks after hospitalization (36.6% vs. 18.0%; p=0.06). Smoking abstinence rates in the HNRT group were similar to the H group. There was no difference in smoking abstinence rates at 26 weeks between "self quit" and participants in any of the treatment groups. In multivariable regression analysis adjusting for diagnosis and demographic characteristics, H and HNRT were over three times more likely than NRT participants to abstain at 26-weeks post-discharge (RR=3.6; p=0.03 and RR=3.2; p=0.04, respectively). CONCLUSION: Hypnotherapy is more effective than NRT in improving smoking abstinence in patients hospitalized for a smoking-related illness, and could be an asset to post-discharge smoking cessation programs.

Complement Ther Med. 2014 Feb;22(1):1-8. doi: 10.1016/j.ctim.2013.12.012. Hasan FM(1), Zagarins SE(2), Pischke KM(3), Saiyed S(3), Bettencourt AM(3), Beal L(3), Macys D(3), Aurora S(3), McCleary N(4). Author information: (1)Division of Pulmonary, Critical Care and Sleep Medicine, North Shore Medical Center Salem Hospital, Salem, MA, United States; Department of Medicine, Massachusetts General Hospital, Boston, MA, United States. (2)Department of Psychiatry, Tufts University School of Medicine, Boston, MA, United States; Department of Behavioral Medicine Research, Baystate Medical Center, Springfield, MA, United States. Electronic address: Sofija.Zagarins@baystatehealth.org. (3)Division of Pulmonary, Critical Care and Sleep Medicine, North Shore Medical Center Salem Hospital, Salem, MA, United States. (4)Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.

Copyright © 2014 Elsevier Ltd. All rights reserved.

Digital detection for tobacco control: online reactions...

Full title: Digital detection for tobacco control: online reactions to the 2009 U.S. cigarette excise tax increase.

INTRODUCTION: The Internet is revolutionizing tobacco control, but few have harnessed the Web for surveillance. We demonstrate for the first time an approach for analyzing aggregate Internet search queries that captures precise changes in population considerations about tobacco. METHODS: We compared tobacco-related Google queries originating in the United States during the week of the State Children's Health Insurance Program (SCHIP) 2009 cigarette excise tax increase with a historic baseline. Specific queries were then ranked according to their relative increases while also considering approximations of changes in absolute search volume. RESULTS: Individual queries with the largest relative increases the week of the SCHIP tax were "cigarettes Indian reservations" 640% (95% CI, 472-918), "free cigarettes online" 557% (95% CI, 432-756), and "Indian reservations cigarettes" 542% (95% CI, 414-733), amounting to about 7,500 excess searches. By themes, the largest relative increases were tribal cigarettes 246% (95% CI, 228-265), "free" cigarettes 215% (95% CI, 191-242), and cigarette stores 176% (95% CI, 160-193), accounting for 21,000, 27,000, and 90,000 excess queries. All avoidance queries, including those aforementioned themes, relatively increased 150% (95% CI, 144-155) or 550,000 from their baseline. All cessation queries increased 46% (95% CI, 44-48), or 175,000, around SCHIP; including themes for "cold turkey" 19% (95% CI, 11-27) or 2,600, cessation products 47% (95% CI, 44-50) or 78,000, and dubious cessation approaches (e.g., hypnosis) 40% (95% CI, 33-47) or 2,300. CONCLUSIONS: The SCHIP tax motivated specific changes in population considerations. Our strategy can support evaluations that temporally link tobacco control measures with instantaneous population reactions, as well as serve as a springboard for traditional studies, for example, including survey questionnaire design.

Nicotine Tob Res. 2014 May;16(5):576-83. doi: 10.1093/ntr/ntt186. Ayers JW(1), Althouse BM, Ribisl KM, Emery S. Author information: (1)Graduate School of Public Health, San Diego State University, San Diego, CA;

Group hypnosis vs. relaxation for smoking cessation in adults: a cluster-randomised controlled trial

BACKGROUND: Despite the popularity of hypnotherapy for smoking cessation, the efficacy of this method is unclear. We aimed to investigate the efficacy of a single-session of group hypnotherapy for smoking cessation compared to relaxation in Swiss adult smokers. METHODS: This was a cluster-randomised, parallel-group, controlled trial. A single session of hypnosis or relaxation for smoking cessation was delivered to groups of smokers (median size = 11). Participants were 223 smokers consuming = 5 cigarettes per day, willing to quit and not using cessation aids (47.1% females, M = 37.5 years [SD = 11.8], 86.1% Swiss). Nicotine withdrawal, smoking abstinence self-efficacy, and adverse reactions were assessed at a 2-week follow-up. The main outcome, self-reported 30-day point prevalence of smoking abstinence, was assessed at a 6-month follow up. Abstinence was validated through salivary analysis. Secondary outcomes included number of cigarettes smoked per day, smoking abstinence self-efficacy, and nicotine withdrawal. RESULTS: At the 6-month follow up, 14.7% in the hypnosis group and 17.8% in the relaxation group were abstinent. The intervention had no effect on smoking status (p = .73) or on the number of cigarettes smoked per day (p = .56). Smoking abstinence self-efficacy did not differ between the interventions (p = .14) at the 2-week follow-up, but non-smokers in the hypnosis group experienced reduced withdrawal (p = .02). Both interventions produced few adverse reactions (p =.81). CONCLUSIONS: A single session of group hypnotherapy does not appear to be more effective for smoking cessation than a group relaxation session.

BMC Public Health. 2013 Dec 23;13:1227. Dickson-Spillmann M, Haug S, Schaub MP. Swiss Research Institute for Public Health and Addiction ISGF, University of Zurich, Konradstrasse 32, Postfach, 8031 Zürich, Switzerland. maria.dickson@isgf.uzh.ch.

Hypnosis for smoking cessation: group and individual treatment-a free choice study.

Eighty-five smokers chose either a group or individual treatment using manualized hypnosis. Abstinence rates in group treatment at follow-up are 19.6% in comparison to 13.8% in individual treatment. This difference did not reach statistical significance. It is concluded that group treatment is as effective as the better established individual treatment and therefore can be seen as an alternative approach in smoking cessation using hypnosis.

Int J Clin Exp Hypn. 2013 Apr;61(2):146-61. doi: 10.1080/00207144.2013.753824. Riegel B. Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Germany. b.riegel@uke.de

The pharmacist "toolbox" for smoking cessation...

Full title: The pharmacist "toolbox" for smoking cessation: a review of methods, medicines, and novel means to help patients along the path of smoking reduction to smoking cessation.

Annually there are 500 000 preventable deaths in the United States caused by smoking; as health care professionals, pharmacists have a unique opportunity to advise, assess, and assist patients to quit smoking. This review article provides pharmacists with a "toolbox" containing an overview of pharmacologic and nonpharmacologic methods for smoking cessation. Currently approved over-the-counter (OTC) and prescription medications (nicotine replacement therapy, varenicline, and bupropion) are summarized, and nonpharmacologic therapies discussed include cognitive therapy and hypnosis. In addition to traditional therapies some potential approaches to smoking cessation are addressed, including nicotine immunizations and electronic cigarettes.

J Pharm Pract. 2012 Dec;25(6):591-9. doi: 10.1177/0897190012460823. Wynn WP 3rd, Stroman RT, Almgren MM, Clark KJ. Department of Pharmacy Practice, South University, Columbia, SC, USA.

Group hypnotherapy versus group relaxation for smoking cessation: an RCT study protocol.

ABSTRACT:BACKGROUND: A significant number of smokers would like to stop smoking. Despite the demonstrated efficacy of pharmacological smoking cessation treatments, many smokers are unwilling to use them; however, they are inclined to try alternative methods. Hypnosis has a long-standing reputation in smoking cessation therapy, but its efficacy has not been scientifically proven. We designed this randomised controlled trial to evaluate the effects of group hypnosis as a method for smoking cessation, and we will compare the results of group hypnosis with group relaxation. METHODS/DESIGN: This is a randomised controlled trial (RCT) to compare the efficacy of a single session of hypnosis with that of relaxation performed in groups of 8-15 smokers. We intend to include at least 220 participants in our trial. The inclusion criteria include smoking at least 5 cigarettes per day, not using other cessation methods and being willing to quit smoking. The intervention is performed by a trained hypnotist/relaxation therapist. Both groups first receive 40 min of mental preparation that is based on motivational interviewing. Then, a state of deep relaxation is induced in the hypnosis condition, and superficial relaxation is induced in the control condition. Suggestions are made in the hypnosis condition that aim to switch the mental self-image of the participants from that of smokers to that of non-smokers. Each intervention lasts for 40 min. The participants also complete questionnaires that assess their smoking status and symptoms of depression and anxiety at baseline, 2 weeks and 6 months post-intervention. In addition, saliva samples are collected to assess cotinine levels at baseline and at 6 months post-intervention. We also assess nicotine withdrawal symptoms at 2 weeks post-intervention. DISCUSSION: To the best of our knowledge, this RCT is the first to test the efficacy of group hypnosis versus group relaxation. Issues requiring discussion in the outcome paper include the lack of standardisation of hypnotic interventions in smoking cessation, the debriefing of the participants, the effects of group dynamics and the reasons for dropouts. TRIAL REGISTRATION: Current Controlled Trials, ISRCTN72839675.

BMC Public Health. 2012 Apr 4;12:271. Dickson-Spillmann M, Kraemer T, Rust K, Schaub M. Swiss Research Institute for Public Health and Addiction, Konradstrasse 32, 8031 Zurich, Switzerland. maria.dickson@isgf.uzh.ch.

Use of the target group index survey to evaluate the cigarette smoking profile in Saudi Arabia.

OBJECTIVE: To draw a profile, and study the media habits for cigarette smokers in Saudi Arabia using the Target Group Index survey (TGI). METHODS: A household survey using the TGI sample was conducted in March 2008 in 21 cities in Saudi Arabia. A sample of 7003 individuals aged 15 years or more, male and females, living in town and cities, were randomly selected using the multistage sampling technique. One individual per household was interviewed using a structured questionnaire covering socio-economic profile, media exposure, and cigarette consumer information. The study was conducted in Arabian Center for Tobacco Control, Riyadh, Kingdom of Saudi Arabia. RESULTS: Cigarette smoking was 35.9% in males, and 2.3% in females. This was significantly higher in the age group 30-49 years compared with younger ages (p=0.001). Among smokers, 22.3% were heavy smokers, 69.3% were using regular flavor cigarettes, and 22.4% tried to quit smoking but failed. The most common methods of quitting smoking were; nicotine gum (18.5%), hypnosis (14%), nicotine patch (8%), and acupuncture (3%). Ninety-eight percent of the smokers watched TV daily, noticed mainly big outdoor ads, and 46% used the Internet daily. Favorite TV and radio channels, newspaper, magazine, and interesting topics for the smokers were recorded, and the main smoker profile was drawn. CONCLUSION: The TGI can be used to draw a smoker profile and identify different segments with the greatest opportunities to send anti-smoking messages.

Saudi Med J. 2011 Oct;32(10):1055-9. Albedah AM, Khalil MK, Khalil AA, Elolemy AT. Arabian Center for Tobacco Control, Ministry of Health, Riyadh 11176, Kingdom of Saudi Arabia.

The challenge of smoking cessation

by Tim Brunson, PhD

Why does anyone still smoke? Just about everywhere you go nowadays you see signs that clearly state that smoking is not allowed. Yet despite all of the sanctions, taxes, peer pressure, and with over 440,000 deaths every year in the US, there remain millions of hardcore tobacco users who just don't seem to want or be able to stop this habit.


An investigation of smoking cessation video content on YouTube.

(Editor's Note: The author's of this article fail to substantiate their statements regarding the ineffectiveness of the techniques demonstrated in the referenced videos. It is surprising that this article survived the proper peer-review and was accepted by Substance Use & Abuse. My concern about the accuracy of the article does not imply that additional documentation regarding case studies and the need for more peer-reviewed scientific articles regarding the use of hypnosis for smoking cessation.)

This study examines smoking cessation content posted on youtube.com. The search terms "quit smoking" and "stop smoking" yielded 2,250 videos in October 2007. We examined the top 100 as well as 20 randomly selected videos. Of these, 82 were directly relevant to smoking cessation. Fifty-one were commercial productions that included antismoking messages and advertisements for hypnosis and NicoBloc fluid. Thirty-one were personally produced videos that described personal experiences with quitting, negative health effects, and advice on how to quit. Although smoking cessation content is being shared on YouTube, very little is based on strategies that have been shown to be effective.

Subst Use Misuse. 2011;46(7):893-7. Richardson CG, Vettese L, Sussman S, Small SP, Selby P. School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. chris.richardson@ubc.ca

Effects of a mindfulness-based smoking cessation program for an adult...

Full title: Effects of a mindfulness-based smoking cessation program for an adult with mild intellectual disability.

Smoking is a major risk factor for a number of health conditions and many smokers find it difficult to quit smoking without specific interventions. We developed and used a mindfulness-based smoking cessation program with a 31-year-old man with mild intellectual disabilities who had been a smoker for 17 years. The mindfulness-based smoking cessation program consisted of three components: intention, mindful observation of thoughts, and Meditation on the Soles of the Feet. A changing-criterion analysis showed that this man was able to fade his cigarette smoking from 12 at baseline to 0 within 3 months, and maintain this for a year. Follow-up data, collected every 3 months following the maintenance period, showed he was able to abstain from smoking for 3 years. Our study suggests that this mindfulness-based smoking cessation program merits further investigation.

Res Dev Disabil. 2011 May-Jun;32(3):1180-5. Epub 2011 Feb 1. Singh NN, Lancioni GE, Winton AS, Singh AN, Singh J, Singh AD. American Health and Wellness Institute, Verona, VA, USA. nnsingh@ahwinstitute.com

Stop smoking easily with hypnosis - amazing 95% success!

High expectation in non-evidence-based smoking cessation interventions among smokers-

Full title: High expectation in non-evidence-based smoking cessation interventions among smokers-The Colaus study.

OBJECTIVE: To assess the preferred methods to quit smoking among current smokers. METHOD: Cross-sectional, population-based study conducted in Lausanne between 2003 and 2006 including 988 current smokers. Preference was assessed by questionnaire. Evidence-based (EB) methods were nicotine replacement, bupropion, physician or group consultations; non-EB-based methods were acupuncture, hypnosis and autogenic training.

RESULTS: EB methods were frequently (physician consultation: 48%, 95% confidence interval (45-51); nicotine replacement therapy: 35% (32-38)) or rarely (bupropion and group consultations: 13% (11-15)) preferred by the participants. Non-EB methods were preferred by a third (acupuncture: 33% (30-36)), a quarter (hypnosis: 26% (23-29)) or a seventh (autogenic training: 13% (11-15)) of responders. On multivariate analysis, women preferred both EB and non-EB methods more frequently than men (odds ratio and 95% confidence interval: 1.46 (1.10-1.93) and 2.26 (1.72-2.96) for any EB and non-EB method, respectively). Preference for non-EB methods was higher among highly educated participants, while no such relationship was found for EB methods.

DISCUSSION: Many smokers are unaware of the full variety of methods to quit smoking. Better information regarding these methods is necessary.

Prev Med. 2011 Mar-Apr;52(3-4):258-61. Epub 2011 Feb 17. Marques-Vidal P, Melich-Cerveira J, Paccaud F, Waeber G, Vollenweider P, Cornuz J. Institute of Social and Preventive Medicine (IUMSP), University Hospital Center and Faculty of Biology and Medicine, Lausanne, 17 rue du Bugnon, 1005 Lausanne, Switzerland.

Hypnotherapy for smoking cessation.

BACKGROUND: Hypnotherapy is widely promoted as a method for aiding smoking cessation. It is proposed to act on underlying impulses to weaken the desire to smoke or strengthen the will to stop. OBJECTIVES: To evaluate the efficacy of hypnotherapy for smoking cessation. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group Specialized Register and the databases MEDLINE, EMBASE, AMED, SCI, SSCI using the terms smoking cessation and hypnotherapy or hypnosis. Date of most recent searches July 2010. There were no language restrictions. SELECTION CRITERIA: We considered randomized controlled trials of hypnotherapy which reported smoking cessation rates at least six months after the beginning of treatment. DATA COLLECTION AND ANALYSIS: Three authors independently extracted data on participant characteristics, the type and duration of the hypnotherapy, the nature of the control group, smoking status, method of randomization, and completeness of follow up. They also independently assessed the quality of the included studies.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 rates where available. Those lost to follow up were considered to be smoking. We summarised effects as risk ratios (RR). Where possible, we performed meta-analysis using a fixed-effect model. We also noted any adverse events reported. MAIN RESULTS: Eleven studies compared hypnotherapy with 18 different control interventions. There was significant heterogeneity between the results of the individual studies, with conflicting results for the effectiveness of hypnotherapy compared to no treatment, or to advice, or psychological treatment. We did not attempt to calculate pooled risk ratios for the overall effect of hypnotherapy. There was no evidence of a greater effect of hypnotherapy when compared to rapid smoking or psychological treatment. Direct comparisons of hypnotherapy with cessation treatments considered to be effective had confidence intervals that were too wide to infer equivalence. AUTHORS' CONCLUSIONS: We have not shown that hypnotherapy has a greater effect on six-month quit rates than other interventions or no treatment. There is not enough evidence to show whether hypnotherapy could be as effective as counselling treatment. The effects of hypnotherapy on smoking cessation claimed by uncontrolled studies were not confirmed by analysis of randomized controlled trials.

Cochrane Database Syst Rev. 2010 Oct 6;(10):CD001008. Barnes J, Dong CY, McRobbie H, Walker N, Mehta M, Stead LF. School of Pharmacy, University of Auckland, Private Bag 92019, Grafton Campus, Auckland, New Zealand. Update of: Cochrane Database Syst Rev. 2000;(2):CD001008.

How to Quit Smoking by "Focusing on breathing"

by Suryanarayana Chennapragada

I am sharing a proven technique called 'Focusing on breathing' to gradually get over the urge for smoking, without needing any other aids.

How can I do it? Try the following modes and use whatever works for you. Keep eyes closed whenever possible. Don't try to change the pattern of breathing except for the '911 mode'. Let the pattern change on its own.


The role of smoking cessation in the prevention of coronary artery disease

Smoking (tobacco addiction) is the most significant of the modifiable cardiovascular risk factors. Mistakenly described as a "habit" or "behavioral choice," the onset of tobacco addiction quickly follows the acquisition of an ability to inhale cigarette smoke and is reflected in a transformation of neurophysiologic function and nicotine-receptor density. Thereafter, comfort and a degree of neurophysiologic "equanimity" require the regular administration of nicotine. Smokers inhale thousands of other chemicals, many of which play critical roles in the initiation and accentuation of atherosclerosis by influencing vasomotor activity, vascular dysfunction, oxidation of lipids, atheroma development, and thrombosis. Smoking cessation is a priority in the management of any patient with cardiovascular disease. The benefits of cessation accrue rapidly in such patients and have a pronounced effect on the likelihood of disease progression, hospital readmission, and mortality. All physicians must be familiar with the principles of cessation practice and be able to initiate smoking cessation attempts.

Pipe AL, Papadakis S, Reid RD. Minto Prevention & Rehabilitation Centre, University of Ottawa Heart Institute, ON, Canada. apipe@ottawaheart.ca

Interventions for smoking cessation in hospitalised patients.

BACKGROUND: An admission to hospital provides an opportunity to help people stop smoking. Individuals may be more open to help at a time of perceived vulnerability, and may find it easier to quit in an environment where smoking is restricted or prohibited. Initiating smoking cessation services during hospitalisation may help more people to make and sustain a quit attempt. OBJECTIVES: To determine the effectiveness of interventions for smoking cessation that are initiated for hospitalised patients. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group register which includes papers identified from CENTRAL, MEDLINE, EMBASE and PSYCINFO in January 2007, and CINAHL in August 2006 for studies of interventions for smoking cessation in hospitalised patients, using terms including (hospital and patient*) or hospitali* or inpatient* or admission* or admitted. SELECTION CRITERIA: Randomized and quasi-randomized trials of behavioural, pharmacological or multicomponent interventions to help patients stop smoking, conducted with hospitalised patients who were current smokers or recent quitters (defined as having quit more than one month before hospital admission). The intervention had to start in the hospital but could continue after hospital discharge. We excluded studies of patients admitted for psychiatric disorders or substance abuse, studies that did not report abstinence rates and studies with follow up of less than six months. DATA COLLECTION AND ANALYSIS: Two authors extracted data independently for each paper, with disagreements resolved by consensus. MAIN RESULTS: Thirty-three trials met the inclusion criteria. Intensive counselling interventions that began during the hospital stay and continued with supportive contacts for at least one month after discharge increased smoking cessation rates after discharge (Odds Ratio (OR) 1.65, 95% confidence interval (CI) 1.44 to 1.90; 17 trials). No statistically significant benefit was found for less intensive counselling interventions. The one study that tested a single brief (<=15 minutes) in-hospital intervention did not find it to be effective (OR 1.16, 95% CI 0.80 to 1.67). Counselling of longer duration during the hospital stay was not associated with a higher quit rate (OR 1.08, 95% CI 0.89 to 1.29, eight trials). Even counselling that began in the hospital but had less than one month of supportive contact after discharge did not show significant benefit (OR 1.09, 95% CI 0.91 to 1.31, six trials). Adding nicotine replacement therapy (NRT) did not produce a statistically significant increase in cessation over what was achieved by intensive counselling alone (OR 1.47, 95% CI 0.92 to 2.35, five studies). The one study that tested the effect of adding bupropion to intensive counselling had a similar nonsignificant effect (OR 1.56, 95% CI 0.79 to 3.06). A similar pattern of results was observed in smokers admitted to hospital because of cardiovascular disease (CVD). In this subgroup, intensive intervention with follow-up support increased the odds of smoking cessation (OR 1.81, 95% CI 1.54 to 2.15, 11 trials), but less intensive interventions did not. One trial of intensive intervention including counselling and pharmacotherapy for smokers admitted with CVD assessed clinical and health care utilization endpoints, and found significant reductions in all-cause mortality and hospital readmission rates over a two-year follow-up period. AUTHORS' CONCLUSIONS: High intensity behavioural interventions that begin during a hospital stay and include at least one month of supportive contact after discharge promote smoking cessation among hospitalised patients. These interventions are effective regardless of the patient's admitting diagnosis. lnterventions of lower intensity or shorter duration have not been shown to be effective in this setting. There is insufficient direct evidence to conclude that adding NRT or bupropion to intensive counselling increases cessation rates over what is achieved by counselling alone, but the evidence of benefit for NRT has strengthened in this update and the point estimates are compatible with research in other settings showing that NRT and bupropion are effective.

Cochrane Database Syst Rev. 2007 Jul 18;(3):CD001837. Rigotti NA, Munafo MR, Stead LF. Massachusetts General Hospital, General Internal Medicine Unit, S50-9, Boston, Massachusetts 02114, USA. nrigotti@partners.org

Self-reported smoking cessation activities among Swiss primary care physicians.

BACKGROUND: Individual counselling, pharmacotherapy, and group therapy are evidence-based interventions that help patients stop smoking. Acupuncture, hypnosis, and relaxation have no demonstrated efficacy on smoking cessation, whereas self-help material may only have a small benefit. The purpose of this study is to assess physicians' current clinical practice regarding smokers motivated to stop smoking. METHODS: The survey included 3385 Swiss primary care physicians. Self-reported use of nine smoking cessation interventions was scored. One point was given for each positive answer about practicing interventions with demonstrated efficacy, i.e. nicotine replacement therapy, bupropion, counselling, group therapy, and smoking cessation specialist. No points were given for the recommendation of acupuncture, hypnosis, relaxation, and self-help material. Multivariable logistic analysis was performed to identify factors associated with a good practice score, defined as >or= 2. RESULTS: The response rate was 55%. Respondents were predominately over the age of 40 years (88%), male (79%), and resided in urban areas (74%). Seventeen percent reported being smokers. Most of the physicians prescribed nicotine replacement therapy (84%), bupropion (65%), or provided counselling (70%). A minority of physicians recommended acupuncture (26%), hypnosis (8%), relaxation (7%), or self-help material (24%). A good practice score was obtained by 85% of respondents. Having attended a smoking cessation-training program was the only significant predictor of a good practice score (odds ratio: 6.24, 95% CI 1.95-20.04). CONCLUSION: The majority of respondents practice recommended smoking cessation interventions. However, there is room for improvement and implementing an evidence-based smoking cessation-training program could provide additional benefit.

BMC Fam Pract. 2009 Mar 25;10:22. Jacot Sadowski I, Ruffieux C, Cornuz J. Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland. Isabelle.Jacot-Sadowski@chuv.ch

Smoking cessation with varenicline: a suicidal fatality.

The most effective smoking cessation programs involve a combination of pharmacotherapy and behavioral and/or cognitive counseling to improve abstinence rates. Varenicline (Champix in France and the U.K.), the most recently approved agent for tobacco cessation, is the first drug in a new class (alpha4beta2 partial agonist) that binds to the nicotinic receptors to release dopamine and alleviate withdrawal symptoms. As the literature reports psychiatric disorders being linked to varenicline as an issue, we describe the case of a man who committed suicide while receiving therapy with this drug. The deceased (a 39-year-old man) was found dead at his home address with slash wounds to his wrist. The deceased had been prescribed varenicline for several months at a dose of 1 tablet (1 mg) twice daily. The lab received a blood specimen to perform a screening for unknown drugs, including varenicline. Because of its selectivity and sensitivity, liquid chromatography coupled to tandem mass spectrometry was chosen as the best approach to develop a procedure for varenicline. One milliliter of blood was extracted with 5 mL of a mixture of dichloromethane/isopropanol/n-heptane (25:10:65) at pH 9.5 (phosphate buffer) in the presence of diazepam-d(5), which was used as an internal standard (IS). The resultant blood extract was separated on an XTerra MS C18 column using a gradient of acetonitrile and formic acid in water. Drugs were identified by three or two transitions (m/z 212 > 169, 212 > 183, and 212 > 195 and 290 > 154 and 290 > 198 for varenicline and IS, respectively). The limit of quantitation of varenicline was 1 ng/mL. The concentration of varenicline in the blood was determined to be 10 ng/mL. This concentration could not be compared with therapeutic levels, as there are no therapeutic concentrations reported in the literature. Because of its potential effects on behavior, the influence of the drug on the mental functioning of the user should be considered in cases of suicide.

J Anal Toxicol. 2009 Mar;33(2):118-20. Kintz P, Evans J, Villain M, Cirimele V. Laboratoire ChemTox, 3 rue Gruninger, 67400 Illkirch, France. pascal.kintz@wanadoo.fr

Differences between daily smokers, chippers, and nonsmokers with co-occurring anxiety and alcohol-us

Tobacco use is disproportionately represented among both alcohol-use disorders (AUDs) and anxiety disorders (ANX) compared to the general population [Kalman, D. A., Morissette, S. B., & George, T. P. (2005). Co-morbidity of nicotine and tobacco use in psychiatric and substance use disorders. The American Journal on Addictions, 14, 1-18]. Despite this common overlap, little is known about how smokers with co-occurring AUD-ANX differ from their nonsmoking counterparts. Seventy-two patients participated in a larger clinical trial evaluating the efficacy of venlafaxine and cognitive-behavioral therapy for AUD-ANX. Differences between daily smokers (n=23), chippers (n=12) and nonsmokers (n=37) with AUD-ANX were examined with respect to intensity and frequency of alcohol use, anxiety symptoms, depressed mood, and stress. Point prevalence of current daily smoking was 31.9%, which is considerably lower than traditionally reported in AUD studies. Consistent with predictions, daily smokers reported higher levels of alcohol dependence, average drinks per drinking occasion, and peak blood concentration levels in a day than nonsmokers during the 90 days prior to assessment. Chippers were nonsignificantly different from either smokers or nonsmokers. Smokers and nonsmokers did not differ with respect to percent heavy drinking days or emotional symptoms.

Morissette SB, Gulliver SB, Kamholz BW, Duade J, Farchione T, Devine E, Brown TA, Barlow DH, Ciraulo D. VA Boston Healthcare System, USA; Boston University School of Medicine, USA; Boston University Department of Psychology, USA. Addict Behav. 2008 Jun 12.

Outpatient interventions for adolescent substance abuse: A quality of evidence review.

Previous reviews of outpatient interventions for adolescent substance abuse have been limited in the extent to which they considered the methodological quality of individual studies. The authors assessed 31 randomized trials of outpatient interventions for adolescent substance abuse on 14 attributes of trial quality. A quality of evidence score was calculated for each study and used to compare the evidence in support of different outpatient interventions. Across studies, frequently reported methodological attributes included presence of an active comparison condition, reporting of baseline data, use of treatment manuals, and verification of self-reported outcomes. Infrequently reported attributes included power and determination of sample size, techniques to randomize participants to condition, specification of hypotheses and primary outcomes, use of treatment adherence ratings, blind assessment, and inclusion of dropouts in the analysis. Treatment models with evidence of immediate superiority in 2 or more methodologically stronger studies included ecological family therapy, brief motivational interventions, and cognitive-behavioral therapy. (PsycINFO Database Record (c) 2008 APA, all rights

Becker SJ, Curry JF. Department of Psychology and Neuroscience. J Consult Clin Psychol. 2008 Aug;76(4):531-43.

Message framing for smoking cessation: the interaction of risk perceptions and gender.

Because quitting smoking is clearly linked to preventing health problems such as lung cancer, research on health message framing based on prospect theory suggests that gain-framed messages (i.e., emphasizing the benefits of quitting smoking) would be more persuasive in promoting cessation than loss-framed messages (i.e., emphasizing the costs of continuing to smoke). However, because women tend to anticipate greater perceived risk from quitting smoking than men, this may affect how receptive they are to specific message framing interventions. Data from 249 participants (129 females, 120 males) in a clinical trial of message framing for smoking cessation with bupropion were used to examine how gender differences in perceptions of the risks associated with quitting influence the effects of framed interventions using number of days to smoking relapse as the criterion. Perceived risk of quitting scores were dichotomized using a median split for the entire sample. Women reported a higher perceived risk of cessation than men. Participants who anticipated high risks associated with quitting smoking reported fewer days to relapse. Further, females in the gain-framed condition who reported low perceived risks of cessation had a greater number of days to relapse, as opposed to females in the loss-framed condition. These findings suggest that message framing interventions for smoking cessation should consider the influence of gender and risk perceptions associated with quitting on the effectiveness of framed interventions.

Nicotine Tob Res. 2008 Jan;10(1):195-200. Toll BA, Salovey P, O'Malley SS, Mazure CM, Latimer A, McKee SA. Department of Psychiatry, Yale University School of Medicine, New Haven CT 06511, USA. benjamin.toll@yale.edu

The ABC of smoking cessation

The professional support increased chances of success for smoking cessation and is an important goal in health politics. A short advice by pharmacists can make a significant contribution to this. This article describes tobacco dependence and the "stages of change-model". Afterwards we explain possible therapies: besides cognitive-behavioral intervention, different forms of medical treatment, e.g. nicotin replacement therapy, bupropion and varenicline, are discussed.

Bölcskei PL, Walden K. Institut für Raucherberatung und Tabakentwöhnung Bayern, München. info@irt-rauchfreiwerden.de Med Monatsschr Pharm. 2008 May;31(5):173-8.

Hypnosis for smoking cessation: A randomized trial.

The purpose of this study was to determine whether hypnosis would be more effective in helping smokers quit than standard behavioral counseling when both interventions are combined with nicotine patches (NP). A total of 286 current smokers were enrolled in a randomized controlled smoking cessation trial at the San Francisco Veterans Affairs Medical Center. Participants in both treatment conditions were seen for two 60-min sessions, and received three follow-up phone calls and 2 months of NP. At 6 months, 29% of the hypnosis group reported 7-day point-prevalence abstinence compared with 23% of the behavioral counseling group (relative risk [RR] = 1.27; 95% confidence interval, CI 0.84-1.92). Based on biochemical or proxy confirmation, 26% of the participants in the hypnosis group were abstinent at 6 months compared with 18% of the behavioral group (RR = 1.44; 95% CI 0.91-2.30). At 12 months, the self-reported 7-day point-prevalence quit rate was 24% for the hypnosis group and 16% for the behavioral group (RR = 1.47; 95% CI 0.90-2.40). Based on biochemical or proxy confirmation, 20% of the participants in the hypnosis group were abstinent at 12 months compared with 14% of the behavioral group (RR = 1.40; 95% CI 0.81-2.42). Among participants with a history of depression, hypnosis yielded significantly higher validated point-prevalence quit rates at 6 and 12 months than standard treatment. It was concluded that hypnosis combined with NP compares favorably with standard behavioral counseling in generating long-term quit rates.

Nicotine Tob Res. 2008 May;10(5):811-8. Carmody TP, Duncan C, Simon JA, Solkowitz S, Huggins J, Lee S, Delucchi K. San Francisco Veterans Affairs Medical Center, University of California, San Francisco, CA.

Test Your Knowledge: Ten Questions on Tobacco Addiction

We just came across this interesting on-line quiz regarding tobacco addiction. It was published on the Public Library of Science Web site.

The quiz can be found at Click Here.

The Great American Nicotine Myth

Hypnosis is Needed More Than Ever for Safe and Effective Smoking Cessation

by George Wissing

Twenty years ago, the esteemed C. Everett Koop penned the words, "Nicotine is addictive in the same sense as heroin." [Emphasis added.] This provocative statement opened the 1988 Surgeon General's report on the topic of nicotine addiction.


Gender-related differences in hypnosis-based treatments for smoking: a follow-up meta-analysis.

In an earlier meta-analysis of 12 studies using hypnosis-based treatments for smoking cessation, we provided preliminary evidence that males fare better than females when trying to quit smoking (Green, Lynn, & Montgomery, 2006). By excluding studies that reported no gender differences, but failed to report final outcome-statistics-by-gender, our previous conclusion may have overestimated the role of gender in hypnosis-based smoking cessation treatment. In the present analysis, we included 12 additional studies that reported no gender differences, but failed to report final outcome-by-gender statistics. Across each of these studies, we calculated identical success rates for male and female participants and then added these results to our database. Among all 24 groups of participants who completed hypnosis-based treatment for smoking, we found a small but significant effect for male participants being more successful in quitting smoking relative to females. Specific suggestions for tailoring hypnosis smoking cessation programs to take gender differences into account are discussed.

Am J Clin Hypn. 2008 Jan;50(3):259-71.Links Green JP, Lynn SJ, Montgomery GH. The Ohio State University, 4240 Campus Drive Lima, OH 45804, USA. green.301@osu.edu

Nonpharmacologic management of common skin and psychocutaneous disorders.

Data supporting the effectiveness of nonpharmacologic psychocutaneous techniques continues to accumulate. These interventions are used for the treatment of common and psychocutaneous skin conditions. They are most commonly used as adjuncts to traditional therapies. This article will review the data on the effectiveness of hypnosis, biofeedback, psychotherapy, meditation, support groups, guided imagery and progressive muscle relaxation, and psychotherapy. Data supporting the effectiveness of nonpharmacologic psychocutaneous techniques continues to accumulate. These interventions are used for the treatment of common and psychocutaneous skin conditions. They are most commonly used as adjuncts to traditional therapies. This article will review the data on the effectiveness of hypnosis, biofeedback, psychotherapy, meditation, support groups, guided imagery and progressive muscle relaxation, and psychotherapy.

Dermatol Ther. 2008 Jan-Feb;21(1):60-8. Fried RG, Hussain SH. Yardley Dermatology and Yardley Skin Enhancement and Wellness Center, Yardley, Pennsylvania, USA. dermshrink@aol.com

Gender-related differences in hypnosis-based treatments for smoking: a follow-up meta-analysis.

In an earlier meta-analysis of 12 studies using hypnosis-based treatments for smoking cessation, we provided preliminary evidence that males fare better than females when trying to quit smoking (Green, Lynn, & Montgomery, 2006). By excluding studies that reported no gender differences, but failed to report final outcome-statistics-by-gender, our previous conclusion may have overestimated the role of gender in hypnosis-based smoking cessation treatment. In the present analysis, we included 12 additional studies that reported no gender differences, but failed to report final outcome-by-gender statistics. Across each of these studies, we calculated identical success rates for male and female participants and then added these results to our database. Among all 24 groups of participants who completed hypnosis-based treatment for smoking, we found a small but significant effect for male participants being more successful in quitting smoking relative to females. Specific suggestions for tailoring hypnosis smoking cessation programs to take gender differences into account are discussed.

Am J Clin Hypn. 2008 Jan;50(3):259-71. Green JP, Lynn SJ, Montgomery GH. The Ohio State University, 4240 Campus Drive Lima, OH 45804, USA. green.301@osu.edu

A game for smokers: A preliminary naturalistic trial in a psychiatric hospital.

"Pick-Klop" is a game based on cognitive behavioral therapy. It aims to change smokers' attitudes towards tobacco addiction. This study tests the feasibility and the impact of one brief session of the intervention in a naturalistic setting within a psychiatric hospital. METHOD: Fifty-one smokers were recruited during their stay in a psychiatric hospital with a prohibitive smoking policy. They were assessed pre- and post-treatment with visual analogue scales designed to evaluate their intention to stop smoking. RESULTS: All patients completed the intervention. The outcome shows that the intention to stop smoking becomes significantly stronger after the intervention. This pilot study supports the feasibility and the effectiveness of the "Pick-Klop" game in a psychiatric hospital setting. The game seems to improve the intention to quit smoking. The data, however, should be confirmed by a controlled trial. Moreover, follow-up studies are needed to examine the potential impact of the game on smoking cessation attempts. PRACTICAL IMPLICATIONS: The game seems to be a useful and simple tool for education about smoking in a psychiatric hospital setting.

Patient Educ Couns. 2008 Feb;70(2):205-8. Khazaal Y, Chatton A, Prezzemolo R, Hoch A, Cornuz J, Zullino D. Division of Substance Abuse, University Hospitals of Geneva, Switzerland.

Successful interventions for smoking cessation in pregnancy.

The purpose of this article is to evaluate research regarding beneficial approaches to smoking cessation interventions during pregnancy. Research about nicotine replacement, nurse-managed counseling sessions, hypnosis, and behavioral modifications are presented. One of the most useful types of program for smoking cessation in pregnancy (as measured by cotinine-validated abstinence) described in the literature thus far has been the nurse-managed smoking cessation program, which includes a 15-minute individualized counseling session combined with a telephone contact 7-10 days after the prenatal visit. More research is needed in this important area of nursing practice.

Barron J, Petrilli F, Strath L, McCaffrey R. Jupiter Medical Center, Jupiter, FL, USA.

Complementary treatments for tobacco cessation: a survey.

Little information is available regarding the prevalence of use and interest in future use of complementary and alternative medicine (CAM) for tobacco cessation among tobacco users. We conducted a self-administered anonymous survey among 1,175 patients seen at a midwestern outpatient tobacco treatment specialty clinic between November 2003 and July 2005. Patient use of CAM for tobacco cessation, perceived efficacy of these treatments, and interest in future use of CAM were ascertained. Data were summarized using descriptive statistics, and logistic regression models were used to determine the characteristics associated with past CAM use or interest in future use of CAM for tobacco cessation. All of the patients who received the survey completed it. A total of 27% of patients reported previous use of CAM for tobacco cessation. The interventions most commonly used were hypnosis, relaxation, acupuncture, and meditation. CAM treatments most commonly perceived to be efficacious were yoga, relaxation, meditation, and massage therapy. A total of 67% of the patients reported interest in future use of CAM for tobacco cessation. The treatments of greatest interest for use in the future were hypnosis, herbal products, acupuncture, relaxation, and massage therapy. Female gender, previous use of conventional tobacco cessation products, previous use of CAM treatments, and a higher level of education were significantly associated with interest in future CAM use. The high level of interest in CAM among tobacco users underscores the need to conduct further research in this field.

Mayo Clinic College of Medicine, Rochester, MN 55905, USA. sood.amit@mayo.edu

Smoke-free hospitals and the role of smoking cessation services

The NHS must be smoke free by the end of 2006 (Department of Health, 2004). The necessary elements to introducing a smoke-free policy, which is workable and equitable, are the management of the policy and offering support to smokers. Smoking and second-hand smoking are responsible for many illnesses, premature deaths and reduced productivity. Employers have a responsibility to ensure the health of their employees by protecting them from exposure to cigarette smoke in the workplace. Although smoking restrictions in the workplace are popular, it is important to ensure good communication with everyone who will be affected, since there are many fears associated with the introduction of the policy. Help must be offered to people who wish to quit through behavioural and pharmacological interventions and support must also be given to the smoker who must abstain from smoking on the premises during work or hospital stay.

Charing Cross Hospital, Fulham Palace Road, London.

Intensive hypnotherapy for smoking cessation: a prospective study

This study reports on a prospective pilot trial of intensive hypnotherapy for smoking cessation. The hypnotherapy involved multiple individual sessions (8 visits) over approximately 2 months, individualization of hypnotic suggestions, and a supportive therapeutic relationship. Twenty subjects were randomly assigned to either an intensive hypnotherapy condition or to a wait-list control condition. The target quitting date was 1 week after beginning treatment. Patients were evaluated for smoking cessation at the end of treatment and at Weeks 12 and 26. Self-reported abstinence was confirmed by a carbon-monoxide concentration in expired air of 8 ppm or less. The rates of point prevalence smoking cessation, as confirmed by carbon-monoxide measurements for the intensive hypnotherapy group, was 40% at the end of treatment; 60% at 12 weeks, and 40% at 26 weeks (p < .05).

Scott and White Memorial Hospital and Clinic, Temple, Texas, USA. gelkins@swmail.sw.org

A meta-analysis of gender, smoking cessation, and hypnosis:a brief communication

Results of a meta-analysis showed that males were more likely to report smoking abstinence than female participants following hypnosis-based treatments for smoking. Across 12 studies that used hypnosis in the treatment of smoking and reported outcome statistics by gender, the authors found that the odds of achieving smoking abstinence were 1.37 times greater for male than female participants. The results are consistent with the nonhypnosis literature suggesting that females have a more difficult time achieving smoking abstinence compared to males.

The Ohio State University, Lima, Ohio 45804, USA. green.301@osu.edu

Alternative methods of nicotine dependence treatment

The methods of tobacco dependency treatment, which are alternative to pharmacological ones, have in recent years increasingly gained popularity. The most popular include: acupuncture, laser therapy, electrostimulation, hypnosis and autohypnosis, bioresonance, as well as herbalism, aromatherapy and homeopathic methods. The above mentioned methods have been shortly characterized in this paper. Their effectiveness and usefulness of application have as well been brought up for discussion on the basis of available specialist literature. The aspects related to safety of particular methods of therapy for the patient have also been presented. The analysis showed that effectiveness of the methods is often disputable and the main advantage of those methods is a support effect to patient who wants to give up smoking. Thus, it seems that alternative methods may be applied in combination with pharmacological ones because they increase the smoker's motivation to stop smoking and at the same time increase the chance to overcome the addiction in general.

Kolo Studenckiego Towarzystwa Naukowego przy Katedrze Chemii Ogolnej i Analitycznej, Sosnowiec. bartoszkoszowski@wp.pl

Nicotine addiction and current therapy of smoking cessation

Nicotine is defined as substance which provokes addiction because it creates both physiological and biochemical modifications in the nervous system stimulating the activity of dopaminergic neurons releasing dopamine in the areas of the brain that control pleasure. In this paper, after a short overview of neurobiological and cellular mechanisms involved in the pathway of nicotine addiction, the main therapies, used in order to provide support to smokers who decide to reduce their cigarette consumption or to quit smoking, are examined. These therapies can be enclosed in the following categories: nicotine replacement therapy (NRT), non-nicotine pharmacological therapy (NNPT), psychological-behavioural therapies (PBT), alternative therapies (AT). In this work the advantages and disadvantages of various therapies are analysed, assessing the criteria found in literature. Results from randomised and controlled clinical studies which examine some of these therapies, alone or in association, also related to relapse time are reported. In conclusion, results of this analysis confirm that, as well as therapies and their treatment time, psychological support and personal motivation are indispensable for successful smoking cessation.

Dipartimento Salute e Prevenzione, British American Tobacco ITALIA Spa, Centro Ricerche, Napoli, Italia. picciolo@chemistry.unina.it

Alternative therapies for tobacco dependence

For both hypnotherapy and acupuncture, the evidence of any effect is anecdotal. There are insufficient rigorous studies that are homogeneous in design or results to allow a reliable conclusion on whether or not these therapies are effective. At best, individual smokers who choose one of these interventions for preference should not be discouraged provided that they are informed about the state of the evidence.

Center for Tobacco Control, North Shore Long Island Jewish Health System, 225 Community Drive, South Entrance, Great Neck, NY 11021, USA. Lvillano@nshs.edu

Treatment of smoking

Smoking is difficult to treat, since addiction to tobacco is very strong and a deprivation syndrome may follow cessation of nicotine consumption. The ultimate goal of treatment is smoking cessation. Anti-smoking counseling and self teaching manuals are used as public health strategies, while nicotine chewing gum, clonidine, hypnosis, acupuncture and negative conditioning are individual strategies. Success rates in treatment of smoking vary between 5 and 40% at 1 to 2 years. Individualized therapy including care for the smoker as a person, family and labor support are needed to increase the chance of success.

Instituto Nacional de Enfermedades Respiratorias y Cirugia Toracica (INERYCT), Servicio de Salud Metropolitano Oriente, Ministerio de Salud, Santiago de Chile.

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