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


OBJECTIVE
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 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.


METHODS
We searched the Cochrane Tobacco Addiction Group trials register, with additional searches of PsycInfo and MEDLINE, including the terms behavior therapy, cognitive therapy, psychotherapy or group therapy, in December 2001.


METHODS
We considered randomised 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 programmes. 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.


METHODS
We extracted data in duplicate on the people recruited, the interventions provided to the groups and the controls, including programme length, intensity and main components, the outcome measures, method of randomisation, 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 counted as smokers. Where possible, we performed meta-analysis using a fixed effects (Peto) model.


RESULTS
A total of fifty two trials met inclusion criteria for one or more of the comparisons in the review. Sixteen studies compared a group programme with a self-help programme. There was an increase in cessation with the use of a group programme (N=4,395, odds ratio 1.97, 95% confidence interval 1.57 to 2.48). Group programmes were more effective than no intervention controls (six trials, N=775, odds ratio 2.19, 95% confidence interval 1.42 to 3.37). There was no 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. There was limited evidence that programmes which included components for increasing cognitive and behavioural skills and avoiding relapse were more effective than same length or shorter programmes without these components. This analysis was sensitive to the way in which one study with multiple conditions was included. There was no evidence that manipulating the social interactions between participants in a group programme had an effect on outcome.


CONCLUSIONS
Groups are better than self-help, and other less intensive interventions. There is not enough evidence on their effectiveness, or cost-effectiveness, compared to intensive individual counselling. The inclusion of skills training to help smokers avoid relapse appears to be useful although the evidence is limited. There is not enough evidence to support the use of particular components in a programme beyond the support and skills training normally included.
Dept of Health Care and Epidemiology, University of British Columbia, Mather Building, 5804 Fairview Avenue, Vancouver, Canada, V6T 1Z3. lindsay.stead@dphpc.ox.ac.uk
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Stead
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Lancaster
D001521:Behavior Therapy / Q000379:methods*; D006801:Humans; D015397:Program Evaluation; D011615:Psychotherapy, Group; D016032:Randomized Controlled Trials as Topic; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention