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.
PICOs
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.
