RESEARCH FINDINGS USING GUIDED
IMAGERY FOR
STOPPING
SMOKING
July, 2006
SCOPE
AND DIMENSIONS OF THE PROBLEM
According to the Centers for
Disease Control, cigarette smoking is the largest
preventable cause of illness, death, and medical
expenditures in the U.S.A. In 1993, direct medical costs
associated with smoking totaled an estimated $50 billion,
and smoking was responsible for approximately 7 percent of
total U.S. health care costs (CDC, 1994).
This $50 billion figure is highly conservative. Many
factors were not included in the total medical costs:
smoking-related burns from fires; perinatal care for low
birth weight infants whose mothers smoked; and the costs of
treating diseases in others caused by secondhand smoke.
Also not included were the indirect costs of lost
productivity and early death (CDC, 1994). A more recent
study found that annual smoking-related medical
expenditures for California alone reached $72.7 billion in
1997, about 11% of total health care costs (Miller, Zhang
et al, 1998).
The CDC
estimates that 44.5 million adults in the United States
smoke cigarettes, resulting in death or disability for half
of all regular users. Cigarette smoking is responsible for
more than 440,000 deaths each year, or one in every five
deaths; counting direct and indirect costs,
smoking related
illness costs the nation more than $167 billion each year
(NCCDPHP, 2006).
It is estimated that Medicare will spend $800 billion over
the next 20 years caring for people with smoking-related
illnesses (Rodgers, 1997).
Effectiveness
and Cost-effectiveness of Smoking Cessation
Programs
Smoking-related illness
consumes so many health resources that smoking cessation
has been called the “gold standard” of medical
cost-effectiveness (Warner, 1997). His report from the
University of Michigan School of Public Health found that:
“A considered review of the evidence recommends support of
all of the major forms of smoking-cessation intervention;
even the most expensive are highly cost effective compared
with all medical treatments studied.”
For example, a simple instruction from a physician to stop
smoking resulted in a 2% quit rate one year later, an
effect study authors called “modest but highly cost
effective. It cost $1500 to save one life (Law, Tang,
1995).” As interventions become more intensive, costs go
up. However, even modestly effective programs will save far
more than they cost (Westmaas, Nath & Brandon, 2000).
Issues
in Smoking Cessation
While
it is typical for stop-smoking programs to achieve
short-term success rates of 50-60%, the rate of relapse is
often 60-80% in the year following the program (Wynd,
1992a). Most widely-used programs have long-term success
rates under 35% (Colletti, Supnick & Rizzo, 1982;
Hensel, Cavanagh et al, 1995).
Non-drug programs include psychotherapy, behavioral
therapy, providing information, support groups, hypnosis,
telephone monitoring, and rapid-smoking. The most commonly
used medication is nicotine, given as a patch or in chewing
gum. The prescription drugs bupropion and fluoxetine are
also used. All these treatments have similar long-term
success rates, varying from 15-32% in different studies
(Sykes & Marks , 2001; West, McNeill & Raw, 2000).
Combining nicotine replacement and/or bupropion with
behavioral therapy and psychological support has
consistently shown itself more effective than a single
treatment alone, with 35% or more of patients remaining
smoke-free for a year (McGhan & Smith, 1996).
A recent study combined CBT with community reinforcement
and naltrexone to achieve an abstinence rate of 43% at
three-month follow-up (Roosen, Van Beers et al, 2006). In
two other studies, 58.5% of those using behavior therapy
and nicotine patches were abstinent at five years (Garcia
Vera, 2004), while 80% of those in a multicomponent CBT
program that also incorporated relaxation training and
imagery rehearsal changed their behavior (30% has reduced
their cigarette consumption; 50% were abstinent) (Huang,
2005).
Imagery and self-hypnosis in smoking
cessation
In two
studies, groups who used guided imagery to relax and gain a
sense of personal power had much higher 3-month abstinence
rates than a control group which received only counseling
(Wynd, 1992a; Wynd, 1992b. Smokers who practiced imagery at
home and continued practicing after the training program
ended had abstinence rates over 52% at three months (Wynd,
a). In a 2005 study of guided imagery, smokers using an
audio-taped imagery program had twice the abstinence rates
as the control group (25% versus 12%) at 24-month follow-up
(Wynd, 1995).
Using self-hypnosis even once resulted in 22% of 226
patients remaining smoke-free after two years. Similar
success rates also occurred in a group single-session
hypnosis program (Ahijevych, Yerardi, et al, 2000). While
the results are modest, it is better than trying to quit
without any help (Spiegel, Frischholtz et al, 1993).
However, hypnosis, which incorporates relaxation, imagery
and positive suggestion, has been reported to have a
success rate as high at 90% (Klager, 2004).
A clinical hypnosis study at the College of Medicine at
Texas A&M University had an 81% success rate in the
three-session hypnosis group, with a 48% success rate at 12
months post-treatment (Elkins & Rajab, 2004). Thus,
imagery and self-hypnosis have been as effective as other
behavioral and psychological approaches. The techniques
were even more effective in patients who found them
pleasant.
Conclusion
A
low-cost, guided imagery based, self-care program is likely
to be at least as effective as other behavioral or
psychological treatments. It should help at least 20-32% of
users stop smoking in the long term. The results may be
even better if nicotine replacement is used at the same
time. The benefits of smoking cessation in terms of patient
outcomes and lower need of medical services make this
program highly cost-effective.
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