Psychosocial interventions can improve a smoker's chance of making a successful quit attempt. The greater the number of professionals involved in the smoking cessation intervention, the greater the likelihood of success (i.e., higher cessation rates).
Why Use Psychosocial Interventions?
In an overview of the research on smoking cessation, Skaar, et al.1 found that "cessation rates resulting from a single attempt using assisted methods are generally much higher than those resulting from unassisted attempts."
Who Can Provide Psychosocial Interventions?
According to Skaar, et al. 1 the effectiveness of smoking cessation interventions delivered by providers did not significantly differ when it was delivered by providers from different professional disciplines, such as smoking cessation specialists, practicing clinicians, and health care administrators. Recent research shows that pharmacists can also provide meaningful psychosocial interventions that significantly help individuals to quit smoking.7
What is the goal of Psychosocial Interventions?
The goal of psychosocial interventions is to improve one or more of the following outcomes: to “[…] reduce the impact of stressful events and situations; decrease distress and disability; minimize symptoms; improve the quality of life; reduce risk; improve communication and coping skills; and/or enhance treatment adherence.”6
The more intensive the intervention, the greater the success.
Note: It is suggested that individuals providing psychosocial interventions should obtain training in smoking cessation strategies and/or behavior change.
Types of Psychosocial Interventions
Group behavioral therapy, or group counseling, is found to be more effective in helping smokers quit than self-help materials alone.2 Group therapy based around the stages of change assists individuals establish an awareness and motivation to change their behavior. In group therapy, a smoker can learn behavioral techniques (i.e. modeling and reinforcement) for aiding in their quit attempt and foster mutual support.1 Ideal groups include 4-8 individuals with one therapist or 9-15 individuals with two co-therapists. Group therapy sessions should ideally take 1 hour for a group with less than 12 individuals and 2 hours for a group with more than 12 individuals. Group therapy is most efficient when used in conjunction with other forms of treatment and intervention (e.g. nicotine replacement therapy, telephone counseling, self-help materials).8
The effectiveness of individual counseling on smoking cessation is related to the intensity of the treatment, or the amount of face-to-face contact with the client. An ideal individual treatment program might include four to seven sessions lasting at least 20 to 30 minutes. During these sessions, a provider can offer problem-solving, skills training, and support that is tailored to each client to increase smoking cessation rates. Treatment also includes encouragement, reinforcement for quitting attempts, and discussions of coping strategies for situations that increase temptation for smoking.1 Furthermore, repeated contact is important in individual counseling to help maintain motivation. One study showed that individuals who completed three counseling sessions (5-10 minutes) with a pharmacist was significantly more effective at helping individuals quit smoking than one session of counseling.7
The following are examples of interventions that are designed to enhance smoking cessation when combined with psychological interventions and/or nicotine replacement therapy:
Audiotapes & Relapse Prevention Clients are provided with computer-controlled audio taped therapeutic messages called "digital therapists," and they are encouraged to listen to the recording any time they may feel tempted to smoke. This treatment appears to predict the use of post-treatment coping skills, especially for clients that showed negative affect prior to treatment. It does not, however, promote stronger abstinence rates than interventions alone.1
Scheduled & Non-scheduled Smoking These methods help clients to reduce their smoking, whereby preparing them to begin nicotine replacement therapy and also demonstrating that they have control over their own smoking patterns. Non-scheduled smoking is gradual, with the goal of reaching a reduced number of cigarettes per day (i.e., down to half a pack) and at certain hours of the day, over time.3 Scheduled smoking is a more fixed program of incrementally increasing the time that passes in between cigarettes and has shown better abstinence rates than non-scheduled tapering off and the "cold turkey" approach to quitting.1
Multi-Media Interventions Text messages, emails, and the Internet are now being used as mediums for psychosocial interventions in smoking cessation. Ecological Momentary Interventions (EMIs) are contacts made to the individual throughout the day through text messages, email, phone, and/or the Internet to help the person stay engaged in quitting smoking. Research has shown that psychosocial interventions that included EMIs significantly increased smoking quit rates.9
For smokers who wish to quit privately or on their own, the following methods have been developed. From a public health perspective, they are cost-effective and have the potential to help many people quit.
Telephone Counseling Cessation rates for home-based clients given self-help materials alone are surpassed by those receiving pre-treatment telephone counseling, and even greater by those receiving several follow-up telephone sessions. The more intense the provider contact during quit attempts, the lower the relapse rate, especially within the first week after the quit attempt.1 Research has shown that even one 10-20 minute phone assessment and a individually-tailored letter based on the phone assessment can significantly help smokers to quit smoking and stay abstinent from smoking.10
Personalized Self-Help In addition to self-help materials and telephone counseling, clients can be provided with feedback on their home computers. A program based on the client's stage of change, decisional balance, coping behaviors, and temptations has shown improved abstinence rates.4 Another program based on the client's stage of change, self-efficacy, intrinsic motivation, and smoking/quitting history has shown improved initial cessation rates.5 Individually-tailored letters, based on responses to a questionnaire, can significantly help individuals stop smoking and remain abstinent from smoking.11 Self-help programs based on the stages of change help to personalize the intervention and increase the chance that the individual will quit smoking, compared to generic self-help programs.12
Note: A provider should consider the risk of attrition if the intervention is too high intensity (uses too many methods) for a client.
For more information on self help, please see our other page.
Research has shown that even a single, 5-10 minute follow-up phone call from a smoking cessation counselor, made three weeks after self-help materials were mailed, significantly increased smoking cessation rates.8 A meta-analysis of callbacks found that individuals who received phone callbacks (average of 2-3 calls, though the specific number was not significant) were significantly more likely to quit smoking than individuals who did not receive a telephone follow-up.13 The phone calls encouraged individuals to continue to be abstinent from smoking and allowed the individual to voice any concerns or difficulties in quitting smoking.8,13
1 Skaar, K. L., Tsoh, J. Y., McClure, J. B., Cinciripini, P. M., Friedman, K., Wetter, D. W., & Gritz, E. R. (1997). Smoking cessation 1: An overview of research. Behavioral Medicine, 23, 5 -13.
2Stead LF, Lancaster T. Group behavior therapy programs for smoking cessation. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD001007.
3 Therapeutic Strategies in Smoking Cessation. Retrieved September, 2006 from http://www.uspharmacist.com
4 Prochaska, J.O., DiClemente, C.C., Velicer, W.F. & Rossi, J.S. (1993). Standardized, individualized, interactive, and personalized self-help programs for smoking cessation. Health Psychology. 12: 399-405.
5 Curry, S.J., McBride, C., Grothaus, L.C., Louie, D. & Wagner, E.H. (1995). A randomized trial of self-help materials, personalized feedback, and telephone counseling with non volunteer smokers. Journal of Consulting and Clinical Psychology. 63: 1005-1014.
6 Collaborating Centre for Mental Health (Great Britain)., & Institute for Health and Clinical Excellence (Great Britain). (2009). Schizophrenia core interventions in the treatment and management of schizophrenia in primary and secondary care (update).
7 Costello, M., Sproule, B., Victor, J., Leatherdale, S., Zawertailo, L., & Selby, P. (2011). Effectiveness of pharmacist counseling combined with nicotine replacement therapy: a pragmatic randomized trial with 6,987 smokers. Cancer Causes & Control: CCC, 22(2), 167-180.
8 Becoña, E., & Míguez, C. (2008). Group Behavior Therapy for Smoking Cessation. Journal Of Groups In Addiction & Recovery, 3(1/2), 63-78.
9 Heron, K. E., & Smyth, J. M. (2010). Ecological momentary interventions: Incorporating mobile technology into psychosocial and health behaviour treatments. British Journal Of Health Psychology, 15(1), 1-39.
10 Borland, R., Balmford, J., & Hunt, D. (2004). RESEARCH REPORT The effectiveness of personally tailored computer-generated advice letters for smoking cessation. Addiction, 99(3), 369-377.
11 Sutton, S., & Gilbert, H. (2007). Effectiveness of individually tailored smoking cessation advice letters as an adjunct to telephone counselling and generic self-help materials: randomized controlled trial. Addiction, 102(6), 994-1000.
12 Travis, H. E., & Lawrance, K. G. (2009). Randomized Controlled Trial Examining the Effectiveness of a Tailored Self-Help Smoking-Cessation Intervention for Postsecondary Smokers. Journal Of American College Health, 57(4), 437-444.
13 Stead, L., Perera, R., & Lancaster, T. (2007). A systematic review of interventions for smokers who contact quitlines. Tobacco Control, 16 Suppl 1i3-i8.