Group behaviour therapy programmes for smoking cessation

 

Abstract

Background

Group therapy offers individuals the opportunity to learn behavioural techniques for smoking cessation, and to provide each other with mutual support.

Objectives

We aimed to determine the effects of smoking cessation programmes delivered in a group format compared to self-help materials, or to no intervention; to compare the effectiveness of group therapy and individual counselling; and to determine the effect of adding group therapy to advice from a health professional or to nicotine replacement. We also aimed to determine whether specific components increased the effectiveness of group therapy. We aimed to determine the rate at which offers of group therapy are taken up.

Search methods

We searched the Cochrane Tobacco Addiction Group Trials Register, with additional searches of MEDLINE and PsycINFO, including the terms behavior therapy, cognitive therapy, psychotherapy or group therapy, in July 2008.

Selection criteria

We considered randomized trials that compared group therapy with self help, individual counselling, another intervention or no intervention (including usual care or a waiting list control). We also considered trials that compared more than one group programme. We included those trials with a minimum of two group meetings, and follow up of smoking status at least six months after the start of the programme. We excluded trials in which group therapy was provided to both active therapy and placebo arms of trials of pharmacotherapies, unless they had a factorial design.

Data collection and analysis

We extracted data in duplicate on the participants, the interventions provided to the groups and the controls, including programme length, intensity and main components, the outcome measures, method of randomization, and completeness of follow up.
The main outcome measure was abstinence from smoking after at least six months follow up in patients smoking at baseline. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Subjects lost to follow up were analysed as continuing smokers. Effects were expressed as a relative risk for cessation. Where possible, we performed meta-analysis using a fixed-effect (Mantel-Haenszel) model.

Main results

A total of 53 trials met inclusion criteria for one or more of the comparisons in the review. Thirteen trials compared a group programme with a self-help programme; there was an increase in cessation with the use of a group programme (N = 4375, relative risk (RR) 1.98, 95% confidence interval (CI) 1.60 to 2.46). There was statistical heterogeneity between trials in the comparison of group programmes with no intervention controls so we did not estimate a pooled effect. We failed to detect evidence that group therapy was more effective than a similar intensity of individual counselling. There was limited evidence that the addition of group therapy to other forms of treatment, such as advice from a health professional or nicotine replacement, produced extra benefit. There was variation in the extent to which those offered group therapy accepted the treatment. Programmes which included components for increasing cognitive and behavioural skills were not shown to be more effective than same length or shorter programmes without these components.

Authors' conclusions

Group therapy is better for helping people stop smoking than self help, and other less intensive interventions. There is not enough evidence to evaluate whether groups are more effective, or cost-effective, than intensive individual counselling. There is not enough evidence to support the use of particular psychological components in a programme beyond the support and skills training normally included.

 

Plain language summary

Do group-based smoking cessation programmes help people to stop smoking

Group programmes are more effective for helping people to stop smoking than being given self-help materials without face-to-face instruction and group support. The chances of quitting are approximately doubled. It is unclear whether groups are better than individual counselling or other advice, but they are more effective than no treatment. Not all smokers making a quit attempt want to attend group meetings, but for those who do they are likely to be helpful.

 

摘要

背景

戒菸的團體行為治療方案

團體治療提供個案機會學習戒菸的行為技巧並得到彼此間的互相支持。

目標

我們希望確定不同戒菸方案間的療效。比較團體模式與自助模式或無任何介入；比較團體治療與個別諮商；及確認在健康專家建議或尼古丁取代法外，另加上團體治療的效果。我們也希望確認是否團體治療會因為特定的內容而更有療效。最後是確認團體治療提供的治療頻率。

搜尋策略

我們在2005年一月搜尋考科藍登錄的菸癮群組試驗(the Cochrane Tobacco Addiction Group Trials Register)，也另外搜尋MEDLINE及PsycINFO文章中含有行為治療，認知治療，心理治療或團體治療的關鍵字的研究。

選擇標準

我們考量隨機試驗其比較自助模式、個別諮商、其他介入方式或無介入(包含一般性照顧或在等候名單中)。我們也考量試驗是比較一種以上的團體方案。被納入的試驗至少要有兩次團體聚會及在方案開始後追蹤最少六個月。我們排除在藥物試驗中提供團體治療及安慰性治療的研究，除非該研究有在這項因素上做因素規劃。

資料收集與分析

被選用的資料有受試者的部分及團體及控制組的介入方式，包含方案的長度、治療強度及主要的內容、結果評估、隨機分配的方式及追蹤的完成度。主要的結果評估是從基準點算起至少六個月追蹤期的戒菸狀況。在資料允許下，我們嚴格定義每個試驗中的戒菸狀態及生物化學檢驗下的有效機率。個案無法被追蹤到則被定義為持續吸菸者。若可行的話，後設分析(metaanalysis)使用固定效應模式(fixedeffects (MantelHaenszel))。

主要結論

共有55個試驗符合收入標準有一個或以上的比較組而被收入這篇回顧。16篇研究比較團體方案與自助方案。使用團體方案的戒菸成功較多(N = 4395, 勝算比odds ratio (OR) 2.04, 95%信賴區間95% confidence interval (CI) 1.60 to 2.60)。團體方案相較於毫無介入者更有療效，共七個試驗, 個案數 = 815, OR 2.17, 95% CI 1.37 to 3.45)。沒有任何證據顯示團體治療比相同強度的個別諮商有效。有限的證據顯示在健康專家建議或尼古丁取代療法外，額外的團體治療產生額外的效果。提供團體治療的程度有許多不同。有限的證據顯示包含增加認知行為技巧及避免復發課程內容的方案比相同長度或較短的方案且缺乏這些內容更為有效。其中一個研究包含多種狀況讓這些分析有其敏感性。我們沒有發現因團體方案成員間的社交互動而被操縱的情形。

作者結論

團體治療比自助模式或其他消極的介入方式更能幫助人們戒菸。沒有足夠的證據顯示哪一種團體比深度個別諮商更有效果或更便宜。也沒有足夠證據支持使用特定的心理內容在方案中比平常使用的支持及技巧訓練好。

翻譯人

本摘要由彰化基督教醫院李柏賢翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

參與團體戒菸方案協助吸菸者戒菸。團體方案比缺少面對面指示與團體支持的自助方式更有療效。成功戒菸的機會超過兩倍。仍不清楚的部分是團體與個別諮商或其他的方式，何者較佳，但是都比毫無治療佳。並非所有的吸菸者都願意參與團體，可是那些有意願的人都可以得到協助。