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Hypnotherapy for smoking cessation

Discussion in 'Medical Students - MD' started by Perrotfish, Dec 23, 2008.

  1. Perrotfish

    Perrotfish Has an MD in Horribleness
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    Does anyone have links to papers (in respectable journals) on the effectiveness of hypnotherapy for smoking cessation? I'm having some trouble finding data here, and the AAFP doesn't seem to offer much in the way of guidelines and success rates.
     
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  3. masterofmonkeys

    masterofmonkeys Angy Old Man
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    google is your friend.

    http://foreversmokefree.com/science.html

    Didn't actually read the article but a long bibliography that looks like it may be a good starting point.

    1992 meta-analysis had a quit rate of 36% Which is, astonishing to say the least.

    It looks like, overall just about as effective as chantix, if not more. No word on if it causes you to do crazy things while you're still asleep though.
     
  4. surftheiop

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    do you happen to go to MUSC? I live in the charleston, SC area and last week there have been a ton of ads on radio talking about some "famous" hypno therapist coming. I made a mental note that I wanted to read about its effectiveness online and i was curious if those adverts were what inspired your post haha.
     
  5. stewiegriffin81

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    *Fail*

    Google is only your friend when you know how to use it. Getting references from hopelessly biased websites is not a good idea.

    Abbott, et al (2000). "Hypnotherapy for Smoking Cessation". The Cochrane Database of Systematic Reviews. 2.

    The above cochrane review states: "We have not shown that hypnotherapy has a greater effect on six month quit rates than other interventions or no treatment."
     
  6. masterofmonkeys

    masterofmonkeys Angy Old Man
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    I know, I know, if it isn't a pill it can't possibly work. The list of references at the end of that link (which is the ONLY thing I referred them to) is mostly papers from peer reviewed lit, though.

    http://www.ncbi.nlm.nih.gov/pubmed/18569754?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

    RCT with a high rate of cessation.

    http://www.ncbi.nlm.nih.gov/pubmed/16766441?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

    Another RCT with a high rate of smoking cessation.

    http://www.ncbi.nlm.nih.gov/pubmed/8729705?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

    RCT showing no difference

    Regardless, a quick romp through the literature reveals that smoking cessation rates at one year following hypnosis routinely come up in the mid-20% range or higher, which is about the same as varenicline or intensive behavioral modification groups.

    MORE effective than the others? Maybe not. But on balance, probably better than nothing.

    The cochrane database is nice in some ways, not so nice in others.

    GENERALLY when they say something is effective it's true.

    A lot of times, though, they quibble over minutiae and require gigantic numbers of independently run homogeneous trials to pronounce something effective. Problem being that's a near impossibility without some serious drug money behind it. Not talking conspiracy theory here, just the truth. AstraZeneca will front tons of money to get hundreds of patients to try the brand new SDNRI/antipsychotic du jour versus prozac. Who exactly will fund an RCT of hundreds of patients getting an exercise vs. TAU

    And if you really understand the nitty gritty of statistics, you should realize that you can usually get a pretty decent idea of whether something is effective or not WITHOUT the statistical (rather than scientific) rigor that the cochrane database demands.

    Don't get me wrong, I think they're doing a good thing, but if we sit around and wait for enough studies to be done on non-pharmacologic interventions in just about anything for cochrane to make a positive recommendation of the intervention, we'll still be sitting around and waiting when the universe implodes.

    And I'll give them some serious credit for how they say things. "we have not shown that x is effective" note the syntax not "we have shown that x is NOT effective" which is a horse of an entirely different color.

    That's what happens when you demand the high level of statistical rigor and trial homogeneity that they do and you only get 9 heterogeneous RCTs to look at. Then again, 9 heterogeneous RCTs is really a butt load of information.

    Given the dismal rates of efficacy of cold turkey and/or patch without counseling, and the fact that the patient might have a psychological/personal/financial barrier to undergoing counseling, and you may not want to create a psychotic varenicline zombie, it might not be a bad idea to say 'eh what the heck, it's worth a try' to hypnosis.

    BTW, one way or another, I haven't made up my mind about hypnosis. Sounds kinda hokey. But even Cochrane agrees that there is some positive evidence for it in management of pain, both psychologically and in terms of reduced use of analgesics, so why not for something else that's very physical and psychologically uncomfortable?
     
    #5 masterofmonkeys, Dec 24, 2008
    Last edited: Dec 24, 2008
  7. Droopy Snoopy

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    So not only is google not your friend, but reading comprehension fails you as well. I especially like the part where you site 3 statistical studies, then paragraphs down say statistics is bunk. And then at the end say hypnotherapy is probably bunk. But let's all give it a try, hey it's not your money right? WTF mate, you just like to practice your debating skills? I agree that you need the practice, but it's 5 AM on Christmas Eve. Hope you're up with your sick 5-month-old like I am or on call, else you seriously need to get a life.
     
  8. masterofmonkeys

    masterofmonkeys Angy Old Man
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    you question my debating skills? lol! You completely failed to actually rebut anything I wrote, instead putting up your own straw men and knocking them down. Which I'll admit you did with impressive efficiency. Granted, I've come to accept that from med students, what with the total lack of formal education in statistical methods in science, study design, and *gasp* the philosophical questions of statistical versus scientific validity and robustness.

    I never said statistics was bunk. I should hope not or everything I've worked on is bunk, too. But its very easy to get carried away with statistical analysis and get on the *omg more statistical power/rigor is ALWAYS better!* bandwagon. I said that the Cochrane consortium has very very strict guidelines for what they will include in their studies and very strict criteria for judging a treatment modality to be effective.

    Due to the nature of their selection criteria and the type of analysis they use which is very robust statistically, certain treatment modalities will have a tough time meeting their requirements, not through any fault of their own or because of any fault on the part of the researchers, but because of the logistical issues involved in studies that don't have big research money behind them.

    The cochrane databases aim to be the be all end all in statistical validity and I think they do a very good job of that. (However, even they aren't perfect, see the recent antidepressant efficacy controversy for more on that) Consequently, they tend to be rather conservative in endorsing any given treatment modality.

    Just because a cochrane review fails to conclude that a given therapy is effective does NOT mean that the therapy is INeffective. They are careful in their syntax in that regard. In fact, what they are saying is that, by their statistical standards, there is not enough information to make a conclusion one way or another.

    I would further submit that simply because a cochrane review can't confirm that a therapy is effective does not mean that an individual clinician, looking at the primary literature him or herself, can't make a sound judgment on whether or not a treatment modality on balance of evidence is worth considering.

    If you give me a series of small trials, some no better than no treatment, but most being statisticaly better than no treatment, and on average similar in efficacy to 'gold standard' treatment (i.e. in this case group behavioral counseling), I can with fair confidence (even using statistics if you want me to with fancy p values and sigma and F and all sorts of other numbers if you want me to) say that the therapy is at least considering.

    As I was trying to say in the above, I haven't looked into it enough to say one way or another if I think hypnosis has any use in smoking cessation, but I've read enough to want to read more if this was something I was actually thinking about telling a patient to try.

    I was not up with a sick 5 year old, just handling family drama since my grandfather passed away a couple of hours ago.

    By the way, for anyone interested in taking a stab at doing their own statistical analysis if the cochrane consortium doesn't have an opinion yet, clintools is a simple program that allows you to easily pool results from different studies.

    Pretty useful, especially when you're trying to do a mini-meta-analysis of a certain therapy in a certain population or in something like the above hypnotherapy situation.
     
    #7 masterofmonkeys, Dec 24, 2008
    Last edited: Dec 24, 2008

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