Is self-hypnosis (autogenic training) effective for smoking cessation?

Self-Hypnosis for Smoking Cessation: Limited Evidence of Effectiveness

Self-hypnosis (autogenic training) has not been shown to be an effective standalone intervention for smoking cessation, with insufficient evidence to recommend it over established evidence-based treatments. 1

Evidence-Based Smoking Cessation Approaches

Most Effective Interventions (In Order of Effectiveness)

1. Combined Behavioral Support + Pharmacotherapy

   • Highest success rates: 20% long-term abstinence when combining behavioral counseling from smoking cessation specialists with nicotine replacement therapy (NRT) 1
   • Combination increases cessation rates from approximately 8% to 14% compared to usual care 1

2. Pharmacotherapy Alone

   • FDA-approved options:
     • Varenicline: 28% abstinence rate vs 12% for placebo 1
     • Bupropion SR: 19% abstinence rate vs 11% for control 1
     • NRT (various forms): 17% abstinence rate vs 10% for control 1
   • Using two types of NRT together is more effective than using a single type 1

3. Behavioral Support Alone

   • Intensive counseling (≥20 minutes plus >1 follow-up): 10% abstinence rate 1
   • Brief counseling (<10 minutes): Less effective but still beneficial 1
   • Telephone counseling: Effective with at least 3 calls 1
   • Self-help materials (tailored): Modestly effective 1

Hypnosis and Other Alternative Approaches

1. Hypnosis:

   • Limited evidence for effectiveness as a standalone intervention 1
   • One study showed hypnosis combined with NRT had higher quit rates at 12 months (24%) compared to behavioral counseling with NRT (16%), but the difference was not statistically significant 2
   • A more recent study suggested hypnotherapy might be more effective than NRT alone (36.6% vs 18.0% abstinence at 26 weeks), but this is a single study 3
   • Not recommended as a primary intervention by major guidelines 1

2. Other Alternative Approaches:

   • Acupuncture: No consistent evidence of effectiveness 1, 4
   • Exercise-based interventions: Limited data with small study sizes 1
   • Nutritional supplements: Insufficient evidence 1

Clinical Recommendation Algorithm

1. First-line treatment: Combined approach

   • Behavioral counseling (multiple sessions over 4+ weeks)
   • PLUS pharmacotherapy (varenicline, bupropion SR, or NRT)

2. Second-line treatment: If first-line fails or is declined

   • Pharmacotherapy alone (preferably combination NRT)
   • OR intensive behavioral counseling alone

3. Alternative approaches (including hypnosis):

   • Consider only after evidence-based treatments have failed
   • May provide placebo effect for some patients
   • Should not be funded by health services due to insufficient evidence 1

Important Considerations

• Success rates for all interventions are relatively modest (typically <30% long-term abstinence)
• Multiple quit attempts are often necessary
• Weight gain is common after quitting (typically 10 lbs, but up to 30 lbs in 10% of quitters) 1
• Patients should be informed about all treatment options, including those with limited evidence, but counseled on the most effective approaches first

While some patients may be interested in self-hypnosis, healthcare providers should emphasize that evidence-based combinations of behavioral support and pharmacotherapy offer the best chance of successful smoking cessation.