Group behaviour therapy programmes for smoking cessation

Abstract

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