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Smoking Cessation Interventions; Behavioural interventions |
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| Supportive Group Sessions Group therapy offers individuals the opportunity to learn behavioural techniques for smoking cessation, and to provide each other with mutual support. Groups may be led by professional facilitators, clinical psychologists, health educators, nurses, doctors, or successful peers. They may be conducted in different settings and may vary in intensity, number and duration of sessions as well as total duration. Suggested components of a best practice group cessation clinic program include: • Setting a specific quit date; • Learning to interrupt the conditioned responses that support smoking by self-monitoring; • Making plans for coping with temptations to smoke following cessation; and • Providing follow-up contact and social support for quitting and continued abstinence (32). Other optional components are: • Instructions for effective use of NRT. Attendance rates of smokers invited to participate in group cessation programs reviewed by Stead and Lancaster (2000)(33) varied from 8 to 88 per cent. Group therapy can be an effective cessation method that should be available for those who are willing to participate. Aversion therapy Adding an unpleasant (aversive) stimulus to an attractive behaviour reduces the attractiveness and may extinguish the behaviour (34). Aversion therapy pairs the pleasurable stimulus of smoking a cigarette with an unpleasant stimulus, with the aim of extinguishing the urge to smoke. |
The most frequently examined procedure has been rapid smoking. 'Rapid smoking' usually consists of asking subjects to take a puff every six to 10 seconds for three minutes, or until they consume three cigarettes or feel unable to continue. This is repeated two or three times, and subjects are asked to concentrate on the unpleasant sensations it causes. Explanation and supportive counseling is usually provided with application of the rapid smoking technique. Other aversive techniques include rapid puffing (smoke not inhaled), smoke holding, excessive smoking, paced smoking, self-paced smoking, focused smoking, covert sensitization, symbolic aversion, electric shocks administered by therapist or subject, and behavioural treatments with bitter pills. Each of these methods is described in more detail by Hajek and Stead (2000)(34). There is no evidence of benefit from aversion methods other than rapid smoking techniques (34) . Aversion therapy techniques are outdated and not recommended in most countries. References 1. Doll R, Peto R, Wheatley K, Gray R, Sutherland I. Mortality in relation to smoking. 40 years observations on male British doctors. BMJ.1994; 309: 901-911. 2. Hirdes J, Maxwell M. Smoking cessation and quality of life outcomes among older adults in the Cambell survey on well-being. Can J Public Health 1994; 85: 99-102. 3. World Health Organization (WHO). Tobacco or health: a global status report. Geneva: WHO, 1997. 4. Winstanley M, Woodward S, Walker N. Tobacco in Australia: facts and issues (second edition). Victorian Smoking and Health Program: Melbourne .1995. 5. Rashid M, Rashid H. passive maternal smoking and pregnancy outcome in a Saudi population . Saudi Med J. 2003; 24(3): 248-53. |
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