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All programs are Individually Designed Private One on One Sessions
A typical session will involve sitting comfortably on a chair while engaging in imagery-work. However, since the primary goal of the session is to bring about change, other means can be taken to achieve that goal - such as breathing patterning, body-awareness and more. You are always an active participant in the session, not merely a passive recipient. You will be guided into trance and be assisted in utilizing it for your own benefits. The average session time is around 60 minutes (initial consultation is sometimes longer than the preceding sessions). The number of sessions is based upon the program, the nature of the problem and the person. However, hypnotherapy is a goal-oriented, brief and elegant therapy.
INTENSIVE HYPNOTHERAPY FOR SMOKING CESSATION
A Prospective Study: INTENSIVE HYPNOTHERAPY FOR SMOKING CESSATION GARY ELKINS ET AL. GARY ELKINS, JOEL MARCUS, JEFF BATES, AND M. HASAN RAJAB2 Scott and White Memorial Hospital and Clinic, Temple, Texas, USA TERESA COOK Baylor University
Intl. Journal of Clinical and Experimental Hypnosis
54(3): 303–315, 2006
Copyright © International Journal of Clinical and Experimental Hypnosis
ISSN: 0020-7144 print / 1744-5183 online
NHYP 0020-7144 1744-5183 Journal of Clinical and Experimental Hypnosis, Vol. 54, No. 03, April 2006: pp. 0–0 Intl.
The authors wish to thank Paul Cinciripini at University of Texas M.D. Anderson Cancer Center for his guidance in selection of outcome measures and study design. Also, appreciation is expressed to Matthew Ridley and Jennifer Gibbons-Rameriz who served as study coordinators. 2Address correspondence to Gary Elkins, Ph.D., ABPP, ABPH, Scott & White Clinic, 2401 South 31 Street, Temple, TX 76508, USA. E-mail: [email protected] 304 GARY ELKINS ET AL.
Several retrospective clinical studies of hypnotherapy have shown some encouraging promise for smoking cessation (Crasilneck, 1990;
Elkins & Rajab, 2004). However, most of the outcome studies of hypnotherapy for smoking cessation, to date, have failed to achieve randomization and have not included biological markers of smoking cessation (Fiore et al., 1996; 2000). As a result, the potential effectiveness of hypnosis remains largely unknown (Greene & Lynn, 2000). Further, many of the randomized studies of hypnosis have examined a minimal approach to hypnotherapy involving one or two sessions or group interventions (Berkowitz, Ross-Townsend, & Kohberger, 1979; Cornwell, Burrows, & McMurray, 1981; Hyman, Stanley, Burrows, & Horne, 1986; Javel, 1980; Neufeld & Lynn, 1988; Pederson, Scrimgeour, & Lefcoe, 1975; Rabkin, Boyko, Shane, & Kaufert, 1984; Spanos, Mondoux, & Burgess, 1995; Spanos, Sims, deFaye, Mondoux, & Gabora, 1992; D. Spiegel, Frischholz, Fleiss, & Spiegel, 1993; H. Spiegel, 1970; Stanton, 1978; Williams & Hall, 1988). The findings regarding this minimal
approach to hypnosis for smoking cessation have indicated outcomes of about 20% to 25% cessation (Cornwell et al.; Rabkin et al.). Recently, Green & Lynn (2000) completed a comprehensive review of studies utilizing hypnosis for smoking cessation and concluded that it seems apparent that minimal hypnotic interventions, such as that developed by H. Spiegel (1970) and group hypnosis interventions (Lynn, Neufeld, Rhue, & Matorin, 1993) achieve abstinence rates of only around 20% or less. Hypnosis may yet be shown to be a very effective treatment for smoking, however, an intensive treatment approach may be necessary for hypnosis to be of greater benefit for smoking cessation (Green & Lynn, 2000).
Also, it has been suggested that more intensive interventions with more contact in general may result in higher cessation rates (Fiore et al., 2000).We have developed an innovative new intensive approach to hypnosis for smoking cessation that is consistent with these recommendations. The purpose of the present study was to establish the beneficial effect of an intensive approach to hypnotherapy for smoking cessation in a prospective randomized pilot study using biological markers of abstinence. We hypothesized that the intervention would result in
smoking-cessation rates of 30% or higher that would be sustained at 6-month follow-up visits.
Subjects were recruited from physician referral and advertisements. A total of 28 volunteers who were interested in stopping smoking were evaluated, of whom 20 met the study criteria (see below). This study was approved by the Scott and White Clinic and Hospital Institutional Review Board. After the initial screening, subjects INTENSIVE HYPNOTHERAPY FOR SMOKING CESSATION 305 attended an informational meeting at which the study was explained, questionnaires completed, and written informed consent provided. The subjects were eligible for inclusion if they were at least 18 years of age, reported smoking 10 or more cigarettes per day, were interested in quitting smoking in the next 30 days, had the ability to attend weekly sessions and spoke English.
Exclusion criteria included regular use of any noncigarette tobacco product, reported current abuse of alcohol or psychoactive drugs, current use of any other smoking-cessation treatments, any reported history of borderline personality disorder, or currently using hypnotherapy for any reason. . The average age of the participants was early to mid-40s and the majority were female; Caucasian; married; with a high school education; were smoking more than 20 cigarettes per day; and had a Fagerstrom score of slightly greater than 10. Baseline data assessments were completed regarding demographic information, smoking behaviors, reasons for wanting to stop smoking, and perceived benefits from smoking cessation. Also at baseline, nicotine dependence was assessed with the 8-item Fagerstrom Test for Nicotine Dependence (FTND) scale. The FTND is a widely used measure of nicotine dependence with a score ranging from 0 to 11; a score of 6 or greater indicates higher levels of dependence (Fagerstrom &Schneider, 1989). Self-reported abstinence was confirmed by expired carbon monoxide (CO) measured at baseline, at the end of treatment(Week 8) and at Weeks 12 and 26. Subjects were classified as abstainers if they reported no smoking in the 7 days prior to assessment and hadCO values of less than 8 ppm (Cinciripini et al., 2003). Inconsistencies in self-reports and CO values were noted in 7% of measurements.
Any inconsistency in self-reports and CO values was resolved with saliva cotinine analysis less than 20 ng/mL. Procedure At the baseline visit, subjects were randomly assigned to either receive intensive hypnotherapy for smoking cessation or to a waiting list control group. Subjects in the waiting-list control group received self-help material from the National Cancer Institute (Glynn & Manley, 1990) and encouraged to set a date to quit smoking. Assessments of smoking cessation were completed at Weeks 8, 12, and 26. Participants received $25 for each follow-up appointment attended. Research staff provided brief supportive phone calls to all of the participants at 3 days after the target quit date and at Weeks 2, 4, and 5. The supportive phone call lasted 5 to 10 minutes each. The intensive hypnotherapy intervention was provided by a doctoral clinical psychologist (PsyD) or physician (MD). The therapists completed 40 hours of training in hypnotherapy provided by the primary investigator. Training followed the guidelines and learning objectives outlined in the publication, Standards of Training in Clinical Hypnosis (Hammond & Elkins, 1994). Therapists also received additional training in the hypnotherapy treatment used in the study. Subjects assigned to the intensive hypnotherapy intervention met with a research therapist and at the first visit (preparation visit) were provided with a brief discussion regarding myths and misconceptions about hypnosis and the process used in hypnotic induction (Elkins & Handel, 2001).
At the first visit (preparation visit), subjects also received self-help material from the National Cancer Institute (Glynn & Manley, 1990). Subjects received a 30-minute counseling session that included exploring ambivalence about quitting, preparing to quit, problem solving difficult situations, and commitment following semistructured counseling scripts. Subjects were asked to set a target quit INTENSIVE HYPNOTHERAPY FOR SMOKING CESSATION 307 date approximately 7 days later. Also, subjects in the intensive hypnotherapy group were provided with a self-hypnosis tape recording and a tape player and instructed in the daily practice of self-hypnosis. We collected self-reports of average number of cigarettes smokedper day for each of the 7 days prior to assessment of abstinence.
Subjects who were unavailable for assessment were counted as nonabstainers. We allowed participants to miss no more than one inperson visit prior to each assessment. The 26-week outcome period was chosen because there is evidence to suggest that cessation rates at 26 and 52 weeks do not differ substantially (Fagerstrom, 1989; Hjalmarson, 1984; Hughes, Gust, Keenan, Fenwick, & Healey, 1989; Hurt et al., 1994; Kornitzer, Boutsen, Dramaix, Thijs, & Gustavsson, 1995; Russell et al., 1993; Fee & Stewart, 1982; Sachs, Sawe, & Leischow, 1993; Tonnesen, Norregaad, Simonsen, & Sawe, 1991).
Subjects in the intensive hypnotherapy intervention group received eight sessions, and each session lasted approximately 1 hour. A brief
counseling session occurred at each visit at which time subjects received encouragement to practice self-hypnosis. The hypnotic inductions were completed at Sessions 1, 2, 4, and 7 and were standardized following a transcript. Suggestions were given for deepening relaxation, absorption in relaxing imagery, commitment to stop smoking, decreased craving for nicotine, posthypnotic suggestions, practice of self-hypnosis, and visualization of the positive benefits of smoking cessation. Subjects were asked at each session for their preferences for specific imagery for relaxation and dissociation. The suggestions followed a transcript; however, the specific imagery for relaxation and the positive benefits for smoking cessation were individualized based upon questions to determine the patient’s preference regarding such imagery. The hypnotic induction used is summarized below. (a) Eye-focus induction. Begin by focusing your attention on a spot on the wall. As you concentrate, begin to feel more relaxed. Concentrate intensely so that other things begin to fade into the background.
As this occurs, noticing a relaxed and heavy feeling and allowing your eye-lids to close. (b) Relaxation. Noticing a wave of relaxation that begins at the top of your head and spreads across your forehead, face, neck, and shoulders. Every muscle and every fiber of your body becoming more and more completely relaxed. More and more noticing a feeling of letting go and becoming so deeply relaxed. (c) Comfort. . . . and as you become and remain more relaxed, finding a feeling of comfort. Feeling safe and secure. A peaceful feeling, calm and secure. Feeling so calm that nothing bothers or interferes with this feeling of comfort. (d) Mental imagery for relaxation. As you can hear my voice with a part of your mind, with another part going to a place where you feel safe 308 GARY ELKINS ET AL. and secure. A place where you become so deeply relaxed that you are able to respond to each suggestion just as you would like to, feeling everything you need to feel and to experience. (e) Commitment for smoking cessation. . . . and today becoming a nonsmoker, becoming free from nicotine and free from cigarettes . . . you will not smoke cigarettes or use tobacco again. With each day that passesh, your commitment to remain free from cigarettes will become stronger and each time you enter this relaxed state you will remember the reasons you want to stop smoking.
Dissociation from cravings. As you enter an even deeper level of hypnosis, you may notice a floating sensation, less aware of your body, just
floating in space. Your body floating in a feeling of comfort and your mind, just so aware of being in that pleasant place [individualized imagery for a pleasant place]. As your body floats, you will not be bothered by craving nicotine. Your mind blocks from conscious awareness any cravings and you can feel more detached from your body as you become more relaxed. (g) Posthypnotic suggestions. . . . and as you become and as you
remain free from nicotine and free from cigarettes, you will find a sense of satisfaction and accomplishment. You will find that, more and more,
you are able to sleep very well, your sense of smell will improve, and your sense of taste will improve. You will not eat excessively and you will find an appropriate amount of food to be satisfying to you. (h) Self-hypnosis. Each time you practice self-hypnosis or listen to the tape recording that I will provide to you today, you will be able to enter a very deep state of relaxation, just as deep as you are today . . . and within this relaxed state, you will find a feeling of control. You will be able to become so deeply relaxed that you will become very comfortable and you will be able to have a feeling of dissociation that keeps from conscious awareness any excessive craving for nicotine.
Within this relaxed state, your commitment to remain free from cigarettes will become even stronger, and you will find a kind of strength from your practice of self-hypnosis. (i) Positive imagery for benefits of smoking cessation. . . . now, seeing yourself in the future as a nonsmoker, free from nicotine and cigarettes. Notice all of the good things going on around you, how healthy you feel, and [here, individualized imagery is introduced, depending on the patients perceived benefits from smoking cessation].
The efficacy of the intervention for smoking cessation was evaluated with the use of weekly point-prevalence abstinence rates and rates of
continuous abstinence. In all cases, an intention-to-treat analysis was performed. For the point-prevalence rates, subjects were classified as
INTENSIVE HYPNOTHERAPY FOR SMOKING CESSATION 309 abstinent if they reported not smoking during the previous 7 days and this report was confirmed by an expired carbon monoxide value of 8 ppm or less. To be classified as continuously abstinent, the subject had to be confirmed as not smoking on the basis of carbon monoxide measurement at each visit. The biochemically confirmed point-prevalence smoking-cessation rates are shown in Table 2. Fisher’s Exact Test was utilized to compare the intervention to wait-list control. The respective point-prevalence smoking-cessation rates for the intensive hypnotherapy intervention and waiting-list control condition at the end of treatment, 12 weeks,and 26 weeks was 40% vs. 10% (p < .15), 60% vs. 0% (p < .005), and 40% vs. 0% (p < .043).
The rates of continuous abstinence from the target quitting date through the end of treatment are shown in Figure 1. Results indicated 30% continuous abstinence at the end of the treatment period. None of the subjects in the control group achieved continuous abstinence. The average numbers of cigarettes smoked per day at each assessment point are shown in Figure 2. At Week 26, the average number of cigarettes smoked by those in the intensive hypnotherapy group was three. In comparison, the average number of cigarettes smoked by those in the waiting-list control group remained stable at 20 cigarettes per day.
The results of the present study revealed that an intensive hypnotherapy intervention can be an effective means of achieving smoking cessation. The rate of smoking cessation at 26-week follow-up was 40%, as confirmed by an expired carbon monoxide value of 8 ppm or less. This rate of smoking cessation is comparable to or higher than that achieved through pharmacological or nonhypnotic behavioral interventions. In this small sample, the hypnosis intervention was well accepted, and the overall results of the present study support the efficacy of an intensive approach to hypnotherapy for adult smokers.
Our hypothesis that the intervention would result in smoking-cessation rates of 30% or higher and would be sustained at 26-week follow up visits was confirmed and is consistent with previous observations that have suggested that interventions that involve considerable patient contact and are extended over a longer period of time may be more effective than minimal-interventions rates (Fiore et al., 2000). For example, Holroyd (1980) suggested that the likelihood of success for hypnosis in treatment of tobacco dependency may be increased by an approach that includes: (a) multiple sessions; (b) individualized hypnotic suggestions; (c) individualized counseling with follow-up; and (d) an intense interpersonal relationship. The present intervention was consistent with these observations and adds support to this approach to hypnotherapy for smoking cessation. However, the present study has limitations, and these include a small sample size and the lack of measurements of hypnotizability.
Additional research with a larger sample size would enhance confidence in the generalizability of the results and allow exploration of potential variables that may relate to the success of the intervention. .
In conclusion, an intensive hypnotherapy intervention was effective for smoking cessation and resulted in cessation rates that are
higher than previously achieved by minimal approaches in randomized prospective studies. Based on the results of this initial pilot
study, it would appear that intensive hypnotherapy may be an innovative behavioral intervention of significant benefit to some smokers.
A larger, randomized study that integrates state-of-the-art methods for achieving high follow-up rates (Scott, 2004) is warranted to fully
determine the effects of the intervention. Such a study could also reveal potential cost savings and mediating factors such as hypnotic
susceptibility and expectancies.
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Tired of all the Pills, Patches and Gum?
It's never too late to quit smoking! Studies show that if a person quits after 20 to 25 years of smoking, his or her chances of developing cancer are actually quite low. The body begins to correct damage caused by smoking in remarkable ways even within minutes of the last cigarette.
The Facts About Smoking:
Stopping smoking is difficult to do. Studies have demonstrated that individuals who attempt to stop smoking with no assistance are seldom effective. Truth be told, few of these people make it for a year, and most come up short in the first couple weeks.
Why is it so difficult to quit smoking?
First off, smoking is an addiction. What's more, similar to all addictions, it's difficult to break. It’s very likely that your smoking is automatic and a part of your daily routine. Perhaps it’s a satisfying companion to your morning coffee, a “treat” you give yourself at work breaks, or something to soothe your nerves after an unpleasant circumstance. The primary concern is that smoking has turned out to be a piece of your day by day life. As individuals, we cherish customs, and we loathe opposing our comfort zone and routine.
So Why Choose Hypnosis to Help You Quit Smoking?
Since many have found hypnotherapy to be an effective way to to address their smoking addiction, you owe it to yourself to try it for yourself.
Better Hypnosis - Better Results!
All sessions in our tranquil, serene, professional environment - free from distractions and outside interference. You will also receive post-hypnotherapy support to assist in increasing your odds for success!
It's Never Too Late:
Your original choice to begin smoking may have been the result of youthful foolishness, but there’s no reason to be trapped by that unfortunate decision for the rest of your life. You now have the opportunity to change your future by making the right decision this time around. So if you're at last prepared to feel that feeling of pride in realizing that you have at long last kicked this costly and unfortunate habit, then give us a call and begin TODAY!
Within 20 minutes after you quit smoking that last cigarette, your body begins a series of changes that continue for years.
20 Minutes After Quitting
Your heart rate drops.
12 Hours After Quitting
Carbon monoxide level in your blood drops to normal.
2 Weeks to 3 Months After Quitting
Your heart attack risk begins to drop.
Your lung function begins to improve.
1 to 9 Months After Quitting
Your coughing and shortness of breath decrease.
1 Year After Quitting
Your added risk of coronary heart disease is half that of a smoker’s
5 Years After Quitting
Your stroke risk is reduced to that of a nonsmoker’s 5-15 years after
10 Years After Quitting
Your lung cancer death rate is about half that of a smoker’s.
Your risk of cancers of the mouth, throat, esophagus, bladder, kidney, and
15 Years After Quitting
Your risk of coronary heart disease is back to that of a nonsmoker's.
Courtesy of the American Cancer Society. www.cdc.gov/tobacco/data_statistics/sgr/2004/pdfs/whatitmeanstoyou.pdf
Disclaimer: The services we render are held out to the public as non-therapeutic hypnotism, defined as the use of hypnosis to inculcate positive thinking and the capacity for self-hypnosis. Results may vary from person to person. We do not represent our services as any form of medical, behavioral, or mental health care, and despite research to the contrary, by law we make no health claim to our services.