Pshycological Intervntions for Tobacco Cessation - part 2
Types of Psychosocial Interventions
Group behavioral therapy, or group counseling, is found to be more effective in helping smokers quit than self-help materials alone.9 Group therapy based around the stages of change assists individuals establish an awareness and motivation to change their behavior. In group therapy, a smoker can learn behavioral techniques (i.e. modeling and reinforcement) for aiding in their quit attempt and foster mutual support. Ideal groups include 4-8 individuals with one therapist or 9-15 individuals with two co-therapists. Group therapy sessions should ideally take 1 hour for a group with less than 12 individuals and 2 hours for a group with more than 12 individuals. Group therapy is most efficient when used in conjunction with other forms of treatment and intervention (e.g. nicotine replacement therapy, telephone counseling, self-help materials). 10
The effectiveness of individual counseling on smoking cessation is related to the intensity of the treatment, or the amount of face-to-face contact with the client. An ideal individual treatment program might include four to seven sessions lasting at least 20 to 30 minutes. During these sessions, a provider can offer problem-solving, skills training, and support that is tailored to each client to increase smoking cessation rates. Treatment also includes encouragement, reinforcement for quitting attempts, and discussions of coping strategies for situations that increase temptation for smoking.1 Furthermore, repeated contact is important in individual counseling to help maintain motivation. One study showed that individuals who completed three counseling sessions (5-10 minutes) with a pharmacist was significantly more effective at helping individuals quit smoking than one session of counseling. 7
The following are examples of interventions that are designed to enhance smoking cessation when combined with psychological interventions and/or nicotine replacement therapy:
Audiotapes & Relapse Prevention Clients are provided with computer-controlled audio taped therapeutic messages called "digital therapists," and they are encouraged to listen to the recording any time they may feel tempted to smoke. This treatment appears to predict the use of post-treatment coping skills, especially for clients that showed negative affect prior to treatment. It does not, however, promote stronger abstinence rates than interventions alone. 11
Scheduled & Non-scheduled Smoking These methods help clients to reduce their smoking, whereby preparing them to begin nicotine replacement therapy and also demonstrating that they have control over their own smoking patterns. Non-scheduled smoking is gradual, with the goal of reaching a reduced number of cigarettes per day (i.e., down to half a pack) and at certain hours of the day, over time.3 Scheduled smoking is a more fixed program of incrementally increasing the time that passes in between cigarettes and has shown better abstinence rates than non-scheduled tapering off and the "cold turkey" approach to quitting. 11
Multi-Media Interventions Text messages, emails, and the Internet are now being used as mediums for psychosocial interventions in smoking cessation. Ecological Momentary Interventions (EMIs) are contacts made to the individual throughout the day through text messages, email, phone, and/or the Internet to help the person stay engaged in quitting smoking. Research has shown that psychosocial interventions that included EMIs significantly increased smoking quit rates. 12
For smokers who wish to quit privately or on their own, the following methods have been developed. From a public health perspective, they are cost-effective and have the potential to help many people quit.
Telephone Counseling Cessation rates for home-based clients given self-help materials alone are surpassed by those receiving pre-treatment telephone counseling, and even greater by those receiving several follow-up telephone sessions. The more intense the provider contact during quit attempts, the lower the relapse rate, especially within the first week after the quit attempt.11 Research has shown that even one 10-20 minute phone assessment and a individually-tailored letter based on the phone assessment can significantly help smokers to quit smoking and stay abstinent from smoking.13
Personalized Self-Help In addition to self-help materials and telephone counseling, clients can be provided with feedback on their home computers. A program based on the client's stage of change, decisional balance, coping behaviors, and temptations has shown improved abstinence rates.4 Another program based on the client's stage of change, self-efficacy, intrinsic motivation, and smoking/quitting history has shown improved initial cessation rates. Individually-tailored letters, based on responses to a questionnaire, can significantly help individuals stop smoking and remain abstinent from smoking.14 Self-help programs based on the stages of change help to personalize the intervention and increase the chance that the individual will quit smoking, compared to generic self-help programs. 15
Research has shown that even a single, 5-10 minute follow-up phone call from a smoking cessation counselor, made three weeks after self-help materials were mailed, significantly increased smoking cessation rates. 10 A meta-analysis of callbacks found that individuals who received phone callbacks (average of 2-3 calls, though the specific number was not significant) were significantly more likely to quit smoking than individuals who did not receive a telephone follow-up.16 The phone calls encouraged individuals to continue to be abstinent from smoking and allowed the individual to voice any concerns or difficulties in quitting smoking. 10,16
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