Psychosocial Interventions
Psychosocial interventions can improve a smoker's chance of making a successful quit attempt. The greater the number of professionals involved in the smoking cessation intervention, the greater the likelihood of success (i.e., higher cessation rates).
Why Use Psychosocial Interventions?
In an overview of the research on smoking cessation, Skaar, et al.1 found that "cessation rates resulting from a single attempt using assisted methods are generally much higher than those resulting from unassisted attempts."
Who Can Provide Psychosocial Interventions?
According to Skaar, et al.1 the effectiveness of smoking cessation interventions delivered by providers did not significantly differ when it was delivered by providers from different professional disciplines, such as smoking cessation specialists, practicing clinicians, and health care administrators.
The more intensive the intervention, the greater the success.
Note: It is suggested that individuals providing psychosocial interventions should obtain training in smoking cessation strategies and/or behavior change.
Types of Psychosocial Interventions
Group Therapy
Group behavioral therapy, or group counseling, is found to be more effective in helping smokers quit than self-help materials alone.2 In group therapy, a smoker can learn behavioral techniques for aiding in their quit attempt and foster mutual support.1
Individual Counseling
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
Adjuvant Interventions
The following are examples of interventions that are designed to enhance smoking cessation when combined with psychological interventions and/or nicotine replacement therapy:
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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.1
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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 inbetween cigarettes and has shown better abstinence rates than non-scheduled tapering off and the "cold turkey" approach to quitting.1
Home-based Interventions
For smokers who wish to quit privately or from home, the following methods have been developed. From a public health perspective, they are cost-effective and have the potential to help many people quit.
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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.1
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Personalized Computer Feedback
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.5
Note: A provider should consider the risk of attrition if the intervention is too high intensity (uses too many methods) for a client.
References:
1 Skaar, K. L., Tsoh, J. Y., McClure, J. B., Cinciripini, P. M., Friedman, K., Wetter, D. W., & Gritz, E. R. (1997). Smoking cessation 1: An overview of research. Behavioral Medicine, 23, 5 -
2 Stead LF, Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD001007. DOI: 10.1002/14651858.CD001007.pub2.
3 Therapeutic Strategies in Smoking Cessation. Retrieved September, 2006 from http://www.uspharmacist.com/index.asp?page=ce/105302/default.htm
4 Prochaska, J.O., DiClemente, C.C., Velicer, W.F. & Rossi, J.S. (1993). Standardized, individualized, interactive, and personalized self-help programs for smoking cessation. Health Psychology. 12: 399-405.
5 Curry, S.J., McBride, C., Grothaus, L.C., Louie, D. & Wagner, E.H. (1995). A randomized trial of self-help materials, personalized feedback, and telephone counseling with nonvolunteer smokers. Journal of Consulting and Clinical Psychology. 63: 1005-1014.
