Hypnosis for Smoking Relapse Prevention
Initial Award Abstract
Cigarette smoking is the major preventable cause of death in the United States. It has been estimated that more than 440,000 deaths occur each year in this country as a result of tobacco use. The prevalence of smoking in the U.S., which had been decreasing, has now remained at a plateau. Although millions of Americans have quit smoking, approximately one in four continue to smoke. The rate of cigarette smoking among veterans is higher than the rate of smoking in California’s population at large. A majority of cigarette smokers who quit resume smoking within one year. According to a recent meta-analysis, the content areas of counseling that are significantly associated with cessation include in-treatment social support, extra-treatment social support, problem solving (including skills training), and aversive smoking procedures. We still do not understand exactly the process by which these treatment components work. There has not been much innovation in developing new behavioral cessation treatments in the past 15 years. There is a clear need to identify and investigate more effective methods of treating nicotine addiction, particularly interventions that promote maintenance of abstinence or relapse prevention. Hypnosis for relapse prevention is designed to sustain the ex-smoker’s commitment to remain abstinent, to provide a review of strategies for resisting the temptation to smoke, and to encourage attempts to quit again if relapse occurs.
The primary purpose of the proposed study will be to investigate the effects of hypnosis in facilitating smoking relapse prevention. To accomplish this objective, we will enroll 520 current smokers into the study. All subjects will participate in an initial smoking cessation intervention involving brief counseling and nicotine replacement therapy. Participants who are able to achieve at least 7 consecutive days of abstinence during the first month of treatment will be randomized to one of two relapse prevention interventions. The participants in Study Arm 1 will receive a hypnosis intervention designed to facilitate relapse prevention. Participants in Study Arm 2 will participate in empirically-supported behavioral relapse prevention counseling, utilizing the National Cancer Institute’s Forever Free materials. Both interventions will be conducted in two 60-minute individual sessions scheduled one week apart with four follow-up phone calls at weeks 3 and 4 of the relapse prevention phase of the study.
Outcomes for the two study arms will be compared by assessing biochemically-validated smoking status at 2 months (end of relapse prevention treatment) and at 6 and 12 months post-target quit date. Both continuous and point-prevalence abstinence rates will be determined. Saliva cotinine levels will be measured in all participants reporting abstinence at each assessment. The findings from this study may provide the first empirical support for the use of hypnosis as a relapse prevention strategy in the treatment of nicotine dependence. |