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HYPNOSIS &

SMOKING CESSATION

 

Jennifer Wilson

 

IMAGE

 

What is the Purpose of Hypnotherapy in Stopping the Smoking Habit?

 

            The subconscious mind is considered a place in the brain that contains powerful thoughts that create and treat desirable and undesirable behavior (http://www.noboundarieshypnosis.com/StopSmoking.htm).  Consequently, the use of hypnosis in smoking cessation requires a person to access his or her subconscious mind.  By making lifestyle changes in the subconscious mind, a person is able to stop smoking by changing the subtle thoughts that encourage the habit.  Of course, a person must truly desire to change the unwanted behavior for the hypnotherapy to succeed (http://www.hypnotherapy.com/). 

 

            Hypnosis:

Ø     Enables a permanent change by reaching the subconscious mind and making the goal emotional.

Ø     Makes the goal emotional so that a person truly wants to change.  The desire to change must be heartfelt and not simply due to the knowledge that a person’s health will improve if he or she quits smoking.

Ø     Self-empowers a person to stop the addiction by replacing the habit of smoking with alternative suggestions that are introduced during hypnosis (http://www.hypnosisforhealth.com/).

Ø     Enables a person to ignore the stimuli that instigate smoking by substituting alternative behaviors when he or she encounters the stimuli that formerly led to smoking (http://www.hypnotherapy.com/).

Ø     Matches subconscious negative cravings with conscious positive options that allow the individual to choose his or her response to stimuli rather than automatically resort to smoking (http://www.integralhypnosis.com/smoking.htm).

Ø     Lessens the withdrawal symptoms by making the behavior a personal choice rather than a habit and helping the individual to occupy his or her mind rather than focus on physiological responses (http://www.utexas.edu/student/health/uhs1/utqt.html).

           

 

How Does Hypnotherapy Result in Smoking Cessation?

 

Ken Steinmetz defines hypnosis as “either interactive guided imagery or applied meditation toward a specific goal while in various levels of a trance state” (http://www.hypnosisforhealth.com/).  There are multiple methods for entering a trancelike state (http://www.acs.ohio-state.edu/units/research/archive/hypsmoke.htm).  The hypnotherapist guides a patient to focus on the goal of quitting smoking and, thus, to encourage a permanent change by making the goal emotionally persuasive (http://www.hypnosisforhealth.com/).  A patient focuses on the goal as hypnosis facilitates the body to relax, and he or she concentrates on breathing and the benefits of a healthy lifestyle (http://www.asktheinternettherapist.com/hypnosis_smoking_cessation_CD.asp).  While the patient is in this trancelike state, the hypnotherapist provides the individual with alternative suggestions to smoking.  In this manner, hypnosis works “with the subconscious mind to modify cravings” by interrupting the habit with these substitutes (http://www.integralhypnosis.com/smoking.htm).  After attending a hypnosis session, the suggestions arise in the conscious mind when the patient is tempted to smoke; however, hypnotherapists often provide a tape to reinforce the suggestions learned during the session (http://www.hypnosisforhealth.com/).

            Oftentimes, hypnosis is more effective than nicotine patches or gum because it teaches the individual that he or she has the power to change the unwanted behavior.  The individual has control over the behavior rather than the behavior having control over the individual.  Additionally, attitude can affect the results of hypnosis:  If you believe that you or the hypnosis will fail, then you will not be successful at quitting smoking (http://www.hypnosisforhealth.com/).  Arthur Schwartz tells his patients that “hypnotherapy is fifty percent positive thinking and fifty percent hypnosis” (http://www.integralhypnosis.com/smoking.htm). 

 


                                                                                 

 

What Claims are Made About the Treatment’s Effectiveness?

 

            Some basic claims:

Ø     Quit smoking (http://www.noboundarieshypnosis.com/StopSmoking.htm).

Ø     Lose weight (http://www.hypnosisforhealth.com/).

Ø     Prevents overeating (http://healingwatershypnotherapy.com/smoking.htm).

      Why would quitting smoking cause a person to overeat?  Overeating is a method to compensate for smoking.  If a person does not overeat, he or she is not likely to gain weight.  

Ø     Safe.

      Let’s take a look at this safety claim.  First and foremost:  Is hypnosis approved by an accredited agency?  Yes.  In 1958, the American Medical Association’s Council of Mental Health approved hypnosis “as a safe practice with no harmful side effects” (http://www.hypnosisforhealth.com/).

 

            Some proponents make sweeping claims:

Ø     “Hypnotherapy for smoking cessation can and very often does work!” (http://www.integralhypnosis.com/smoking.htm)

Ø     “If you really believe you can change or heal yourself, you can!” (http://www.hypnosisforhealth.com/)

Ø     “Become more relaxed . . . in one session” (http://www.hypnosisforhealth.com/). 

Ø     “Wonderfully natural experience compared to other [smoking cessation] methods” (http://www.integralhypnosis.com/smoking.htm). 

Ø     Prepares you to make a permanent change in behavior (http://www.hypnosisforhealth.com/). 

Ø     The ease varies with which a smoker stops smoking, but even a person who struggles to quit benefits from hypnosis because he or she is better equipped to fight the urge to smoke (http://www.integralhypnosis.com/smoking.htm). 

     

            Some proponents are cautious:

Ø     Starting “at the behavioral level,” the handful of people who believe that smoking is simply a habit providing only physiological pleasure are able to quit after one session (http://www.hypnotherapy.com/).   

Ø     Most people have a psychological component (the habituation) along with the physiological component (the addiction) which must both be treated.  If a person really wants to quit smoking and realizes that hypnosis is not a magic cure, then the individual is likely to profit from the treatment (http://www.hypnotherapy.com/). 

            Some individuals are even more cautious:

Ø     Approximately 60 studies reveal that hypnosis possibly has an effect as a smoking cessation treatment; however, hypnotherapy is “by no means an end-all and be-all treatment for smoking cessation” (http://www.acs.ohio-state.edu/units/research/archive/hypsmoke.htm). 

Ø     Individuals who utilized hypnosis were more likely to stop smoking than individuals who did not utilize any form of intervention. 

Ø     Little proof exists that hypnosis is more effective than many other smoking cessation treatments. 

      Let’s take a look at this claim about the evidence.  The question remains as to whether hypnosis is more beneficial than other treatments because hypnosis is often one of many treatments that a person employs simultaneously (http://www.acs.ohio-state.edu/units/research/archive/hypsmoke.htm).  When researchers study hypnosis, they want to be certain that the cause is attributable only to hypnosis and not to another cause such as the person’s motivation or another treatment.

 

 

What is the Evidence?

           

Ø     Testimonials

      Steinmetz’s website provides many testimonials of people who successfully quit smoking with hypnosis.  Let’s delve a little deeper into the use of testimonials as evidence.  If you are a hypnotherapist wanting to increase the size of your practice, are you going to publish any testimonials complaining about the service you provide?  Probably not. 

 

Ø     Claims

      Steinmetz asserts that “hypnotizability is a sign of intelligence and was used extensively by such brilliant authors as Aldous Huxley” (http://www.hypnosisforhealth.com/).  No evidence is offered to support the allegation.

 

Ø     Approval

      Hypnosis is approved by the American Medical Association’s Council of Mental Health, the National Institute of Health, and local Public Health community resources (http://www.hypnosisforhealth.com/, http://www.hypnotherapy.com/).

 

 

Ø     Research

      Where is the hard evidence that hypnosis is effective?  Where are the results of medical and scientific research?  Ohio State researchers performed a literature review of many hypnosis studies and found that hypnosis is unlikely to be more effective than other methods to quit smoking (http://www.acs.ohio-state.edu/units/research/archive/hypsmoke.htm).  This literature review, as well as other published journal articles, will be discussed in a moment.  First, let’s take a look at the individuals who present hypnosis on the World Wide Web.

 

 

Who is Presenting the Information on the Web and Why?

      

       Of the many websites pertaining to hypnosis, only a handful were established by universities or research institutions.  The majority of the websites were created by individuals or small businesses.  Personal web pages are used for informative purposes with the underlying intention of increasing awareness of the presenter’s hypnotherapy practice.  Most websites pertaining to hypnosis provide an explanation of hypnosis and what occurs during a hypnotherapy session.  The goal of the websites is to clarify any misinformation so that a potential patient understands the use of hypnosis in smoking cessation.  Along with sharing the information, the presenter is, oftentimes, attempting to increase the size of his or her hypnotherapy practice and to sell self-hypnosis audio tapes. 

 

Provided below is a synopsis of the websites used for this project:

http://www.hypnosisforhealth.com/

            Ken Steinmetz is a Certified Clinical Hypnotherapist who found that hypnosis helped him overcome personal weakness.  He presents the information on the web in order to explain hypnosis and its benefits as well as to sell his own products and advertise his hypnotherapy practice.

 

http://www.hypnotherapy.com/

            Ken Saichek answers questions about hypnosis at Hypnotherapy.com.  The two main focuses of the website are to explain hypnosis and to advertise his practice in a professional and scientific manner.

 

http://www.acs.ohio-state.edu/units/research/archive/hypsmoke.htm

            Ohio State University discusses a study performed by OSU professors.  Results find that hypnosis may not be the perfect method to quit smoking.  The article is published with the intent of describing the basic findings of the study as well as to increase awareness of the article’s publication in the International Journal of Clinical and Experimental Hypnosis. 

 

http://www.utexas.edu/student/health/uhs1/utqt.html

            The University of Texas Health Services website indicates hypnosis as part of their Smoking Cessation Program.  However, the website merely mentions that a self-hypnosis tape or CD is one of several tools utilized in the smoking cessation program.

 

http://www.asktheinternettherapist.com/hypnosis_smoking_cessation_CD.asp

            Ask the Internet Therapist offers many services, including chat sessions and email inquiries, on topics ranging from psychiatric nursing to veterinarian medicine to chiropractic therapy.  As part of the online therapists’ mental health practice, the site provides audio tapes to enable people to improve themselves in areas such as stress management, weight reduction, and smoking cessation in the privacy of their own home.  A small description of each tape’s audio qualities lacks any explanation as to how the tape works to stop the unwanted behavior.

 

http://healingwatershypnotherapy.com/smoking.htm

            Healing Waters Hypnotherapy is owned by Roger C. Frazier, a member of the National Guild of Hypnotists.  His website explains hypnosis and what occurs in a hypnosis session at his office.  Mr. Frazier also advertises his smoking cessation workshop.

 

http://www.integralhypnosis.com/smoking.htm

            Dr. Schwartz advertises his Integral Hypnosis practice on the web.  He explains hypnosis and its use in areas such as weight loss, phobias, stress, and smoking cessation.

 

http://www.noboundarieshypnosis.com/StopSmoking.htm

            Tonya R. Reiman of No Boundaries Hypnosis discusses hypnosis and its use in areas such as childbirth, weight loss, and smoking cessation.  She also describes what occurs in a hypnosis session and provides links to order gift certificates and make appointments to see a hypnotherapist at the practice.

 


What Does the Research Say?

 

            Many studies have attempted to determine whether or not hypnosis is an effective treatment to help individuals quit smoking.  However, past studies lack standards to ensure that the results are constructive.  As a result, more studies need to be performed in accordance with strict standards before the absolute effectiveness of hypnosis in smoking cessation is known (Green & Lynn, 2000).  Hypnosis is “a heightened state of awareness . . . an acquired level of relaxation” (Ahijevych, Yerardi, Nedilsky, 2000, p. 377).  Currently, hypnosis meets the least stringent criteria for a smoking cessation treatment.  It is deemed “possibly efficacious,” which requires that one study shows that the hypnosis “is superior to a no-treatment control, placebo group, or alternate treatment, or that the treatment in question matches the effectiveness of an alternative treatment of established efficacy” (Green & Lynn, 2000, p. 197).  This literature review will look at results of studies involving smoking treated as an addiction (Hajeck, 1994), hypnosis combined with aversion therapy (Barber, 2001), the effect of gender on hypnosis (Johnson & Karkut, 1994), and the patient’s ability to be hypnotized (Holroyd, 1991).

            Treatments currently define smoking as a habit that is reinforced by the behavior’s therapeutic value and by environmental cues.  In other words, smoking is not considered a psychological disorder, or an addiction.  Consequently, this definition suggests that individuals who deeply desire to stop smoking are able to do so despite difficulties.  While smoking is not considered a psychological disorder, hypnosis is a psychological approach to quitting smoking, and the treatment’s success may be due to the “implicit promise of effortless success” (Hajeck, 1994, p. 1544).  Unfortunately, little evidence supports the claims that hypnosis has the specific result of enabling individuals to quit smoking.  However, the relaxation taught by hypnosis can help an individual through the withdrawal period, which often lasts between three and four weeks (Hajeck, 1994).  Hypnosis provides alternative therapeutic behaviors, such as relaxation, to help the patient quit his or her smoking addiction.  

            Many studies compare hypnosis combined with other treatments such as aversion (Barber, 2001) and nicotine as well as whether group or individual hypnosis creates longer lasting effects (Hajeck, 1994).  Rapid smoking (RS) is a commonly employed aversion treatment that requires the smoker to take a puff from a cigarette every few seconds until the cigarette is gone; oftentimes, the patient repeats this process several times in a row (Johnson & Karkut, 1994).  Due to the nature of RS, temporary hypertension and vomiting may result (Barber, 2001).  Unlike RS, no ill effects resulting from hypnosis are mentioned in the articles.  In fact, hypnosis has been used since 1847 to help tobacco users quit the habit (Green & Lynn, 2000).  Articles note the benefits of hypnosis such as equipping individuals to relax and handle stress and cravings when they experience withdrawal symptoms including anxiety (Johnson & Karkut, 1994; Barber, 2001).  Also, nicotine has proven to be an efficacious treatment, but the effectiveness of this behavioral treatment increases when paired with a psychological treatment such as hypnosis.  Studies might find that hypnosis is the best psychological treatment to pair with nicotine because of the focus on teaching the individual to relax.  This literature review focuses on the individual because research has not compared individual and group hypnosis; however, some evidence suggests that the effectiveness of group hypnosis depends on group processes, style, and size (Hajek, 1994).   

            Many people use smoking as a tool to avoid experiencing certain emotions.  Thus, hypnosis helps a patient understand his or her emotions and find alternative methods of coping with unpleasant feelings.  Used alone, “hypnotic suggestion . . . is not likely to be effective in the long-term treatment of smoking addiction,” but hypnosis combined with RS treatment is successful (Barber, 2001, p. 257).  The combination of hypnosis and RS increases the individual’s awareness of his or her reasons for smoking, encourages the patient by facilitating the development of positive behaviors to replace smoking, lessens the effects of withdrawal, and increases the patient’s daily activity.  Hypnosis equips a patient to experience the craving for a cigarette while empowering him or her to withstand the desire.  Patients are often encouraged to exercise and drink more water in order to ease withdrawal.  Agreeing with Green and Lynn (2000), Barber (2001) “emphasizes that the single most important factor that will insure treatment success is the patient’s own interest in and motivation for success” (p. 259).  Specifically, if a person desires to stop smoking, hypnosis aids the patient through withdrawal and encourages continued abstinence from smoking (Barber, 2001).  Unlike the Johnson and Karkut (1994) research, Barber’s (2001) research completely avoids negative ideas during the hypnosis stage in order to focus on the benefits of being a non-smoker.  The aversion and psychological therapies are combined with appointments where therapists provide encouragement and explain any abnormal feelings which the patient is experiencing.  43 patients were treated with this combination of hypnosis and RS over three years.  At follow-ups occurring anywhere from six months to three years after the end of treatment, only four patients confessed to returning to their smoking habit (Barber, 2001).  This is an extremely high number of patients who remained abstinent compared to Holroyd’s (1991) finding of a majority returning to smoking within a few months of ending treatment.

            Johnson and Karkut (1994) examined the influence of gender on hypnosis’s effectiveness.  The researchers performed a study with 93 men and 93 women participating in a 2-week program to quit smoking.  After an hour-long interview explaining the program and the dangers of smoking, participants began a treatment combining aversion therapy with hypnosis.  The therapy combined RS, electric shock, and negative thoughts.  While puffing, the therapist administered electric shocks as well as verbal suggestions of the negative aspects of smoking, such as taste, smell, and appearance.  Immediately after the twenty-minute aversion session, subjects participated in a hypnosis session designed to relax the individual and remind him or her of the discomfort produced by RS and of smoking’s detrimental effects.  The therapist then described positive aspects of being a nonsmoker and offered suggestions to increase the individual’s confidence and assurance without a cigarette.  After five of these aversion and hypnosis sessions, individuals were provided with a self-hypnosis tape and instructed to listen to the tape daily.  Immediately after the program ended, 92% of the men and 90% of the women no longer smoked.  At a three-month follow-up, 86% of the men and 87% of the women remained abstinent.  The results reveal that both men and women benefit from aversion and hypnotherapy.  Even if an individual was unsuccessful in his or her attempt to quit smoking, he or she benefited from the relaxation skills learned in hypnosis (Johnson & Karkut, 1994).       

            Ahijevych, Yerardi, and Nedilsky (2000) organized a study where 452 individuals out of 2,810 who had participate in an hour-long, group hypnosis session participated in further research testing the influence of a person’s ability to be hypnotized on his or her ability to quit smoking.  The researchers defined hypnosis as “a heightened state of awareness that enabled one to reach and maintain an acquired level of relaxation” so that patients could concentrate on the goal of quitting smoking (Ahijevych et al., 2000, p. 377).  This study employed one experienced therapist to conduct hypnosis as well as to record audiotapes provided to the participants for self-hypnosis instruction.  While the therapist promoted hypnosis as the solitary technique to help the patients quit smoking, motivation could not be eliminated as a possible source of a patient’s success.  Just fewer than half the participants used no other strategy than hypnosis to help them quit smoking, yet many participants utilized nicotine therapy to enhance their hypnosis treatment.  However, use of multiple treatments did not influence the success of the patients.  The researchers found that patients with a higher income, living with only non-smokers, and perceiving themselves to be easily hypnotized were more likely to remain abstinent.  Factors not affecting abstinence include gender, age, and number of cigarettes smoked each day.  Those who quit smoking after the program but began again smoked an average of six cigarettes less each day than before they participated in the treatment.  22% of the participants successfully quit smoking, but these individuals “represented a motivated group” (Ahijevych et al., 2000, p. 384).  In summary, the article finds that hypnosis is an alternative treatment for smoking cessation.  A person’s perceived ease of hypnotizability may be used to determine which individuals will gain from hypnosis (Ahijevych et al., 2000).

            Holroyd (1991) also studied the link between perceived ease of hypnotizability and smoking cessation.  While performing a literature review for her research, Holroyd (1991) found that seven studies do not show a link between hypnotizability and smoking cessation while others find that people who are more easily hypnotized remain abstinent from smoking for longer periods of time than people who are less easily hypnotized.  Similar to Johnson and Karkut’s (1994) findings, Holroyd (1991) found no difference between the abstinence rates of men and women.  Furthermore, 43% of the patients who quit smoking initially due to treatment remained abstinent at the end of treatment, and 16% remained abstinent six months after treatment ended.  The results match the commonly reported discovery that 2/3 of the individuals who quit smoking later returned to smoking shortly after the end of treatment.  It is difficult to predict whether or not a patient will quit smoking long-term (Holroyd, 1991).  Similar to Ahijevych, Yerardi, and Nedilsky’s (2000) research, these findings also note a possible, yet weak, direct relationship between the patient’s belief in the efficacy of the hypnosis and his or her ability to remain abstinent (Holroyd, 1991). 

            Reviewing 59 studies of hypnosis, Green and Lynn ( 2000) found that clinical reports are difficult to interpret because therapists alter their scripts, provide different numbers of hypnosis sessions to different individuals, encourage self-hypnosis outside of therapy, implement additional treatments, do not ensure patient abstinence with a biochemical test, and vary the suggestions offered during hypnosis (Green & Lynn, 2000).  In other words, the study of hypnosis has not been controlled effectively so that researchers can interpret the results of various studies.  In addition, Kinnunen (2001) focuses on Barber’s (2001) article concerning hypnosis’s effects on smoking cessation noting that the various success rates result from the different intensities, lengths, and types of treatment.  Kinnunen (2001) concludes that hypnosis is a possible treatment for smoking cessation, and he suggests that hypnosis would be best used as an enhancement to therapy and drug treatments.  More research must be performed to determine how best to integrate hypnosis into a smoking cessation program (Kinnunen, 2001). 

            In conclusion, some studies find that hypnosis is more effective than other treatments, other studies find that hypnosis is equally as effective as other treatments, and still other studies find that hypnosis is less effective than other treatments.  After reviewing numerous studies, researchers realized that it is “difficult to disentangle the specific effects of hypnosis from the behavioral and educational interventions it is combined with, implying that it is premature to argue that it is hypnosis per se that is responsible for the treatment gains observed” (Green & Lynn, 2000, p. 216).  Much research remains to be performed on hypnosis’s effects on smoking cessation, but hypnosis is likely to prove an effective component of an inclusive smoking cessation plan.


References

 

Ahijevych, K., Yerardi, R., & Nedilsky, N.  (2000, October).  Descriptive outcomes of the American Lung Association of Ohio hypnotherapy smoking cessation program.  The International Journal of Clinical and Experimental Hypnosis, 48 (4), 374 – 387.

Ask the Internet Therapist.  (2003).  Smoking cessation CD.  Ask the Internet Therapist.  Retrieved September 13, 2003 from the World Wide Web:

            http://www.asktheinternettherapist.com/hypnosis_smoking_cessation_CD.asp

Barber, J.  (2001, July).  Freedom from smoking:  Integrating hypnotic methods and rapid smoking to facilitate smoking cessation.  The International Journal of Clinical and Experimental Hypnosis, 49 (3).  257 – 266.

Frazier, R. C.  Special smoking cessation & weight loss workshop July 22-23.  Healing Waters Hypnotherapy.  Retrieved September 13, 2003 from the World Wide Web:  http://healingwatershypnotherapy.com/smoking.htm

Green, J. P., & Lynn, S. J.  (2000, April).  Hypnosis and suggestion-based approaches to smoking cessation:  An examination of the evidence.  The International Journal of Clinical and Experimental Hypnosis, 48 (2), 195 - 224.

Hajeck, P.  (1994).  Treatments for smokers.  Addiction, 89, 1543 - 1549.

Holroyd, J.  (1991, April).  The uncertain relationship between hypnotizability and smoking treatment outcome.  The International Journal of Clinical and Experimental Hypnosis, 39 (2).  93 – 102.

Johnson, D. L., & Karkut, R. T.  (1994).  Performance by gender in a stop-smoking program combining hypnosis and aversion.  Psychological Reports, 75, 851 - 857.

Kinnunen, T.  (2001, July).  Integrating hypnosis into a comprehensive smoking cessation intervention:  Comments on past and present studies.  The International Journal of Clinical and Experimental Hypnosis, 49 (3).  267 – 271.

Reiman, T. M.  Smoking cessation.  No Boundaries Hypnosis.  Retrieved September 13, 2003 from the World Wide Web:  http://www.noboundarieshypnosis.com/StopSmoking.htm

Saichek, K.  (1997, July).  Hypnosis – your questions answered!  Hypnotherapy.com.  (Vol. 2, Number 7)  Retrieved September 13, 2003 from the World Wide Web:  http://www.hypnotherapy.com/

Schwartz, A. D.  Smoking cessation.  Integral Hypnosis.  Retrieved September 13, 2003 from the World Wide Web:  http://www.integralhypnosis.com/smoking.htm

Steinmetz, K. (1997, January).  Hypnosis for Health.  Retrieved September 13, 2003 from the World Wide Web: http://www.hypnosisforhealth.com/

University of Texas Health Services  (2003, February 20).  UT smoking cessation program.  University Health Services.  Retrieved September 13, 2003 from the World Wide Web:  http://www.utexas.edu/student/health/uhs1/utqt.html

Wagner, H.  (2000, May 23).  Hypnosis as smoking cessation therapy needs further scrutiny.  Ohio State University:  Research News.  Retrieved September 13, 2003 from the World Wide Web: 

            http://www.acs.ohio-state.edu/units/research/archive/hypsmoke.htm

 

 

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