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- Habit-Breaking, Smoking Cessation
Copyright © Donald Robertson, 2002-2011. All rights reserved.
- See the UK College website for details of our two-day certificate workshop on cognitive-behavioural hypnotherapy for smoking cessation, approved by the National Council for Hypnotherapy (NCH) for CPD.
Numerous research studies show hypnotherapy to be effective as a means of stopping smoking. However, results are highly variable; more so perhaps than for any other problem. Some approaches to hypnotherapy appear inadequate, such as direct/scripted suggestion or regression, whereas others have been found to work much better, usually by integrating hypnosis with elements of established cognitive and/or behavioural therapy.
Nevertheless, many hypnotherapists employ simple direct suggestion scripts for smoking cessation. I’ve heard several times of clients being treated by hypnotherapists who read a script to them from a sheet of paper or leave the room while they play a recorded script. (That’s clearly not very professional, of course!) By contrast, most modern researchers and evidence-based practitioners agree that direct verbal suggestion, of the kind found in most CDs and scripted approaches, is the bedrock of hypnotherapy for smoking cessation but totally inadequate by itself to achieve significant outcomes,
The most basic procedure, one on which you can build your own approach, involves a hypnotic induction and deepening routine, followed by suggestions that from now on the client will be a non-smoker and have no desire to smoke ever again. This approach is unlikely to yield an abstention rate (continuous over, say, 1 year) that is much above the 5-7% rate achieved by those smokers who spontaneously decide to quit. (Heap & Aravind, 2002: 299)
A more detailed review of the research on smoking cessation (and weight loss) hypnotherapy concluded that direct suggestion hypnosis was not particularly effective when used alone (Waddon & Anderton, 1982). Hence, hypnotherapy methods for smoking cessation which are based on simple direct suggestion scripts are unlikely to be anywhere near as effective as more sophisticated multi-component treatments. The most effective treatments for smoking cessation, across the board, are “multi-component” in nature and tend to involve several cognitive-behavioural strategies used in conjunction. In the case of hypnotherapy, the most effective approaches tend also to be highly multi-component and to incorporate elements of cognitive-behavioural therapy (CBT).
Multi-Component / Cognitive-Behavioural Hypnotherapy
As no single (“uni-modal”) therapy intervention has been found to be particularly effective for smoking cessation when used in isolation, the general consensus is that a package or combination of techniques specially tailored for the problem is indicated, i.e., a multi-component or “multi-modal” approach.
Cognitive-behavioural approaches to smoking cessation typically include a range of different interventions designed to tackle the problem at different levels, and can therefore also be designated “broad spectrum” or “multimodal.” The combination of hypnotherapy and CBT called “cognitive-behavioural hypnotherapy” (CBH) is even more broad spectrum in nature, as it combines a wide range of different, evidence-based, interventions. As Marks, a specialist in this area, observes, “CBT methods can improve the results of any treatment programme.” (2005, 16). The inclusion of hypnosis also seems to generally improve outcomes, so it is not surprising that the combination of a tailored CBT and hypnosis package might be considered the treatment of choice for smoking cessation.
In 2000, Green and Lynn conducted a careful systematic review of the research on hypnotherapy for smoking cessation which concluded that hypnotherapy was a promising treatment for smoking but that it probably achieved its results mainly by the incorporation of cognitive and behavioural strategies rather than because of the inherent power of hypnotic suggestion alone,
This article reviews 56 studies of hypnosis and smoking cessation as to whether the research empirically supports hypnosis as a treatment. Whereas hypnotic procedures generally yield higher rates of abstinence relative to wait list and no treatment conditions, hypnotic interventions are generally comparable to a variety of nonhypnotic treatments. […] Furthermore, in many cases, it is impossible to rule out cognitive/behavioral and educational interventions as the source of positive treatment gains associated with hypnotic treatments. Hypnosis cannot, as yet, be regarded as a well-established treatment for smoking cessation. Nevertheless, it seems justified to classify hypnosis as a “possibly efficacious” treatment [according to APA criteria for empirically-validated treatments] for smoking cessation. (Green & Lynn, 2000)
In short, hypnosis may work well as a means of enhancing a combination of cognitive-behavioural interventions, and may even be superior to standard CBT in some cases, but direct hypnotic suggestion used alone is unlikely to be effective. Individuals seeking hypnotherapy to stop smoking would therefore be well-advised to check whether their therapist intends to employ a scripted or direct suggestion approach alone or whether they plan to work according to an evidence-based “multi-component” model, incorporating a number of cognitive-behavioural strategies supported by the clinical research literature.
Addendum: Dave Elman & Regression Hypnotherapy
We still hear, albeit very rarely, of therapists employing regression as their primary technique in smoking cessation. (Despite the fact that Sigmund Freud, the originator of the hypnotic regression approach died from mouth cancer due to a cigar-smoking habit he was unable to extinguish.) Regression therapy has never been widely employed as a treatment for smoking cessation and is not supported by any credible research evidence in this area. As Spiegel, an authority on hypnotherapy for smoking cessation, writes,
To delve into the reasons they started to smoke is irrelevant, because at the time most adults of today [1978] started smoking it was not known to be harmful. No matter what reasons are uncovered, the critical information is not there. Smoking was not known with any certainty to be malignant until 1964. The reasons for stopping the habit were then based on information not available when the smoking started. This specific habit became a fair starting point to study habit change without taking the time to explore the [historical] reasons behind the habit. (Spiegel & Spiegel, 1978: 210)
In other words, after the US Surgeon General’s report condemning smoking was published in 1964 a strong motivation to stop smoking was introduced which people were not widely aware of when they initially developed the habit. This suggested that “regression to cause” might be irrelevant in treating these clients and so the cognitive-behavioural treatment of smoking, focused on the here and now, became common practice.
Dave Elman, one of the most popular and influential advocates of regression hypnotherapy, emphasised his failure with smoking cessation, in the following exchange,
Doctor: What can we do about the cigarette habit?
Elman: Hypnosis is of as little value in permanently correcting the cigarette habit as superficial suggestion is in correcting alcoholism. I have succeeded in giving hypnotic suggestions to people who declared sincerely that they wanted to stop smoking or stop drinking, and I have managed to make the suggestions hold for as long as a month, sometimes for two or three months or even longer. But if you follow up these same cases six months or a year after the hypnotic suggestions have been given, you find that the patients are smoking or drinking as much as ever; the hypnotic suggestions have had no permanent effect. […] Moreover, since the smoking habit isn’t usually based on any very serious emotional disturbance, even hypnoanalysis is of little value. You cannot unearth and correct a traumatic event when there is no trauma. (Elman, Hypnotherapy, 1964: 324-325)
Of course, Elman was himself a smoker and apparently smoked in front of his class when hypnotising patients. However, Elman was also unfamiliar with the principles of cognitive-behavioural therapy, such as relapse prevention, cognitive restructuring, etc. His limited set of tools, even in the hands of an acknowledged master of his art, were deeply unsuited to the task of smoking cessation. However, subsequent researchers reported considerably more success employing hypnosis in conjunction with simple cognitive-behavioural methods. Consequently, even advocates of hypnoanalysis have tended to favour the combination of hypnosis with elements of CBT or behaviour therapy.
- See the UK College website for details of our two-day certificate workshop on cognitive-behavioural hypnotherapy for smoking cessation, approved by the National Council for Hypnotherapy (NCH) for CPD.
About the author
Donald is a writer and trainer, with over twenty years’ experience. He’s a specialist in teaching evidence-based psychological skills, and known as an expert on the relationship between modern cognitive-behavioural therapy (CBT) and and classical Greek and Roman philosophy. Donald is the original founder of The UK College of Hypnosis & Hypnotherapy, setting up in 2003 under the name Hypnosynthesis. Donald developed the evidence-based hypnotherapy approach taught in the College. He also has been instrumental in the further integration of hypnosis with CBT – both via the training courses of the College and his publication: The Practice of Cognitive Behavioural Hypnotherapy. He passed the College along to Mark Davis in 2013. He now lives in Canada