IAMSPH 3 .
Pages:.
Journal homepage: https://pcijournal.
org/index.
php/iamsph International Archives of Medical Sciences and Public Health
Published: Pena Cendekia Insani
PSYCHOLOGICAL APPROACH TO SMOKING RELAPSE PREVENTION : A
SYSTEMATIC REVIEW
Miskah Afriani1.
Yuzana Binti Mohd.
Yusop2.
Harmy Bin Muhamed Yusof3 Department of Medicine.
University Sultan Zainal Abidin Kuala Terengganu.
Malaysia
1,2,3
Article Info
ABSTRACT
Article history:
Background: An estimated that the number of smokers reaches 1.
billion daily smokers worldwide.
Some countries show a high prevalence of cigarette consumption among men, such as Russia 59.
Ukraine 49.
Morocco 45.
China 47.
Indonesia 76.
2%, and Pakistan 41.
Thus.
Asian countries such as Indonesia consume more cigarettes than Western countries.
In the Western countries, there are some countries with the highest mortality rates caused by smoking for instance the United States of 492,400 annual mortality rates, and another one is Russia with more than 309,500 annual mortality rates.
The next country in the Asia region with the highest annual mortality rate led by Indonesia, which is more than 225,700 annual mortality rates, then China has more than 195,200 annual mortality rates.
One of the efforts to stop smoking is to conduct behavioral/psychological approaches such as counseling.
Counseling or therapy can increase the tendency to stop smoking compared to not doing counseling.
Objectives: to provide comprehensive information about psychological approaches to relapse prevention such as CBT, hypnosis therapy, positive psychology, individual counseling and group therapy.
Result:
this study found 18 literature that discussed psychological approaches is evidenced to relapse prevention about 20-45% single or multi counseling and additional pharmacological treatment.
Behavioral approaches such as counseling can increase the tendency to relapse prevention compared to not doing counseling and the combination of two behavioral treatments in one intervention will produce higher effectiveness, such as CBT plus telephone counselling Received : 12 March 2022 Revised : 07 April 2022 Accepted : 19 May 2022 Keywords:
Counseling.
Psychology.
Relapse Prevention.
Smoking This is an open access article under the CC BY-SAlicense.
Corresponding Author:
Miskah Afriani.
Department of Medicine University Sultan Zainal Abidin Kuala Terengganu.
Malaysia Email: miskahafriani@gmail.
INTRODUCTION
An estimated that the number of smokers reaches 1.
3 billion daily smokers worldwide.
Some countries show a high prevalence of cigarette consumption among men, such as Russia 59.
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php/iamsph/index 146 A E-ISSN: 2798-5156 P-ISSN: 2798-5377 Ukraine 49.
Morocco 45.
China 47.
Indonesia 76.
2%, and Pakistan 41.
(Organization, 2.
Thus.
Asian countries such as Indonesia consume more cigarettes than Western countries.
Indonesia is the country with the highest number of smokers in ASEAN, amounting to 65.
2 million people.
This figure is equivalent to 34.
0% of the total population of Indonesia.
The Philippines followed it with the second-highest number of smokers, 16.
5 million people, or 16.
0% of the total population.
And Vietnam is in the third position with the number of smokers, 15.
6 million people, or 16.
5% of the total population (Kadata, 2.
Smoking cigarettes is a risk factor for several of the world-leading causes of death.
The smoke had been the second leading risk factor for death globally.
And cigarettes have killed more than 8 million people per year around the world.
More than 7 million deaths result from direct tobacco use, while around 1.
2 million results from passive smoke (Organization, 2.
In Indonesia, high smoking behavior is followed by high mortality and morbidity.
Diseases that occur due to smoking are babies with low birth weight .
,050 from 962,403 case.
, chronic obstructive pulmonary disease 284,310 cases, coronary heart disease 183,950 cases, and stroke disease 144,780 cases (INFODATIN, 2.
Smoking culture is difficult to eliminate even though its effects are visible.
Cigarettes have become part of Indonesian society because smoking has been a culture in various organizations and social activities in Indonesia.
Cigarettes are easy to get, and cigarettes are sold freely in the community, including young people.
People in Indonesia tend to smoke while drinking coffee, hang out with a group, and give cigarettes to someone who is helping as an appreciation.
Another study explained that the factor that influences the readiness to quit smoking is the belief in the benefits of smoking is the main determinant of readiness to smoke.
Smokers who feel the benefits or positive impact of quitting smoking will maintain their behavior compared to smokers who do not feel the benefits of quitting smoking (Husna, 2.
In line with the results of this study, in mini research conducted by researchers in Medan, it showed that the smoking behavior of adult women was due to an escape from problems, cigarettes were considered to be able to calm themselves from stress and personal problems and the strong factor of the influence of friends (Afriani et al.
, 2.
Start to smoke after stopping in smoking is called relapse.
Relapse occurred because of a strong inner desire to smoke.
Relapse most often occurs in the first few days of a quit attempt when withdrawal symptoms occur.
Thus, over 75.
0% of quitters relapse in the first week, and 35.
0% of quitters probably relapse after 12 months of staying smoke-free (ENSP, 2.
Stop smoking Behavioral approaches such as counseling can increase the tendency to stop smoking compared to not doing counseling.
Counseling methods for more than 10 minutes affect smoking cessation with an odds ratio of 2.
3 (Herman & Sofuoglu, 2.
Meanwhile.
Efdadali .
states that a behavioral approach with training activities is important to overcome smoking Behavioral treatment is one of the complex therapies for smoking cessation programs.
Various types of behavioral therapy are motivational treatment.
Cognitive Behavior Therapy (CBT).
Efficacy of CBT.
Individual and group counseling, positive psychotherapy treatments (PPT.
, and Brief Advice.
Some of the proven behavioral approaches are positive psychotherapy and text message intervention.
Positive psychotherapy was proven to sustained smoking abstinence for six months after their quit date by 40.
0% (Kahler et al.
, 2.
Likewise, with text-message intervention through the Happy Quit program, high or low frequency messaging can lead to smoking cessation (Liao et al.
, 2.
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RESEARCH METHODE
The source of the data is collected from NCBI and Google Scholar.
The keywords were smoking cessation, behavioral therapy to smoking cessation and psychological approach.
National and international journals with inclusion criteria are primary data.
The number of journals is reviewed as 18 journals.
RESULT AND ANALYSIS
Behavioral Therapy to Stop Smoking The average success rate of smoking cessation programs using linguistic treatment such as Hypnosis.
CBT.
The 5As, group, or individual counseling is only about 20.
0% to 30.
0% success Meanwhile, positive psychotherapy intervention has evidence of a benefit to prevent relapse.
In one to four sessions of PPT can reduce smoking behavior by about 40.
This percentage is higher than other behavioral interventions such as CBT, group counseling, and individual counseling (Kahler et al.
, 2.
In addition, the combination of more than one intervention in an intervention showed a high percentage to stop smoking.
Kinds of behavioral approach are Hypnosis approach for smoking relapse prevention consists of two meetings and each meeting has 60 minutes face-to-face sessions and four meetings has 20 minutes follow up phone calls.
The results showed that hypnosis warrants further investigation as an intervention for facilitating the maintenance of stopping smoking.
Positive psychotherapy and additionally receiving daily texts to remind them of their personal strengths is effective to stop smoking (Kahler et al.
, 2.
Success Rates of the Relapse Prevention Based on several studies that have been carried out on behavioral approaches to quit smoking and prevent smoking relapse, a description of the success of the methods can be seen from the prevalence of quit smoking and the number of counseling sessions.
Table1.
Success Rates of the Relapse reversion to Smoking Cessation Method Source Country Intervention Number of Longset Result follow up Kahler 2015 America Intervention group 6 session Follow up prevalence abstinence at 8, 16, and was 40.
0% in PPT-S psychotherapy plus 26 weeks daily texts (PPT.
Standart Treatment (ST) at 8 weeks and Nicotine PPT as 22.
9% versus Replacement ST 6.
5% at 16 weeks Therapy (NRT) Control group :
cessation counseling Utap MS.
University Malaya Malaysia Medical Centre Malaysia Population 850 Sample: 104 each Intervention group :
5A model and self helf materia.
Follow up at one and four
Follow up 1 month
Intervention quit 15 from 77
Follow up 4 month: 13
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Liao 2018 China Control group : self help material only without explanation .
elf help material topics: harmfullness of smoking, benefit quit smoking, tips on quit smoking Happy quit .
ext High Follow up 4.
Frequency 12 and 24 message : 3-5 weeks Text message to sms per day increase self-efficacy for 12 weeks Low message: 3-5 weeks for 12 Catley al Missouri.
America Control:
sms/week Sample 255 MI dan HE 4 .
ession 1 and Randomized 3 by face to Control Trial with fac.
, session 2 and 4 by phone calls .
:2:.
Motivational (MI).
BA : meet a Health Education counselor (HI), and brief during smokers are MI consists of 4 minute.
conducted in person HE sessions of In HE counselors deliver participants to quit.
Journal homepage: http://pcijournal.
org/index.
php/iamsph/index Follow up 1 month Control group: quit 8 Follow up 4 month: 9 Happy quit programme had a small effect Prevalence rate High Frequency Message (HFM): 6.
Low Frequency Message (LFM): 6.
Control : 1.
Compare the happy quit programme to cessation tretament 4 stages of readiness to .
The effectiveness of substantially in weeks remained below the effectiveness of BA
from week 12 onward
International Archives of Medical Sciences and Public Health
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Brief advice (BA):
Participants meet with a counselor for which they are asked symptoms and are provided with clear.
Leontari et.
al Yunani.
Greece Timothy et.
al San Fransisco America Dickson Swiss.
Switzerland Sample Motivational interviewing .
ased on Bandura theori and health belief Sample : 102 The Follow up 3 Number of respondent 6 quit smoking : 3 consisted of monthly 12 individual Both relapse follow up 26 perevntion : weeks and 52 Experimental six sessions 2 weeks Hypnosis sessions for 60 minutes face to face Control Group : dan 4 session behavioral relapse by Experimental follow up 2 Hypnosis intervention .
elfweeks and 52 efficacy approac.
Control Group :
Killen al California.
America
Sample : 180 men
121 women
CBT
8 Follow up at 20 weeks combine and CBT plus voicemail nicotine and patch therapy with 9 weeks of bupropion Prevalence quit in 26 Hypnosis 35.
Behavioral counseling :
52 weeks Hypnosis : 29.
Counseling : 28.
hypnosis was not more effective for smoking cessation than group prevalence of quit smoking : .
hypnosis : 33.
relaxaxion : 24.
CBT
higher 7-day point prevalence abstinence rate: 45.
0% versus 0%.
P = 0.
weeks the difference in abstinence rates .
0%) was not E-ISSN: 2798-5156 P-ISSN: 2798-5377 Laude .
America Stead, 2017 Daniel et.
Indiana America Lei Wu et al,.
China Segan et.
al Victo ia.
Australia Sample Patients .
= .
= .
219 CBT were combine and to nicotine nonAa patch therapy CBT combined or with 9 weeks CBT of bupropion .
xtended Sample 66 Group Behaviour Therapy Randomized trials Programmes compared for smoking group therapy and cessation selfAahelp individual Sample : 1785 Telephone Standard quitline, 2 sessions enhanced quitline Tehnology Enhanced Quitline (TEQ-.
, standard plus 20 TEQ assessments (TEQ-.
Face-to-face Individual Counselling Group (FC), and Face-toface Counselling telephone follow-up counselling group (FCF grou.
Telephone Session Follow up 52 Prevalence of quit :
and CBT : 39.
104 weeks E-CBT : 33.
Group therapy is better for helping people stop smoking than selfAahelp.
Follow up :
Standart .
TEQ : 38.
Follow up 1 week, three The majority of the occurred during the first 2 weeks after the quit date.
Further research is required to identify effective methods to help individuals with high risk of smoking 4-6 Follow up 4 Prevalence rate 32.
Topics included .
Clients had encouraging lifestyle quit for 7 days changes to replace any real benefits of Journal homepage: http://pcijournal.
org/index.
php/iamsph/index International Archives of Medical Sciences and Public Health Cheung et.
Hongkong Chandradewi et al,.
Indonesia
Kusumawati Indonesia
Hodper 2020 Africa
A 151
high-risk situations and planning to .
warning signs and cessation fatigue, .
emotional issues WhatsApp Facebook WhatsApp (WA) .
Facebook .
, .
Sample Divided 3 group :
5AAos group, sms group dan control Group counseling in an effort to shape cessation behavior Sample:
Experimental group : Efficacy CBT Coping prevention strategies Control Group :
Follow up two Prevalence six smoking at 2 months WA:
Face book: 30.
Text : 1 times Follow up 2 Percentage ogf quit per day for 2 months 0% .
A and tex.
Sharing No follow up The results show that there is a decrease in cigarette consumption There were 6 Follow up 3 Result for 3 month CBT : 34.
Control group 20% Follow up for 6 months CBT : 31% Control group : 14% Future reseach : CBT emphasizes cognitive, behavior skill factor coping strategies E-ISSN: 2798-5156 P-ISSN: 2798-5377 From the previous literature, the effectiveness of the behavioral approach and psychological treatment can be described as follows:
Figure 1.
Rate of Successful Psychological Approach to Stop Smoking CBT relaxaxi text message telephone counseling extended CBT CBT telephone counselling CBT efficacy The Brief .
A) positive psychotherapy From the diagram, it can be concluded that the success rate of relapse prevention is about 20%-45%.
The lowest effective is The Brief Method, followed by relaxation method, text message method.
CBT combine relaxation, hypnosis method and the most effective is multiple therapy .
ombine more than one CBT therapy and telephone counsellin.
Some of the psychology therapies are combined with pharmacological approaches.
Positive psychotherapy is more effective than other behavioral therapies such as CBT, hypnosis, counseling, text messages and relaxation.
And the combination of two behavioral treatments in one intervention will produce higher effectiveness, such as CBT plus telephone This is in line with previous research which proved that the combination of more than one intervention in an intervention showed a high percentage to stop smoking (Flavia, 2.
Positive psychotherapy Kahler is a researcher who has researched PPT for smoking cessation in 2014.
Kahler succeeded in proving his research that 31.
6% of participants sustained smoking abstinence for six months after their quit date.
The researcher suggests conducting an initial investigation of Positive Psychotherapy for Smoking (PPT-S) used six sessions compared to a standard smoking treatment that does not contain mood management The PPT-S treatment was adopted from Seligman and modified by Kahler.
PPT-S consists of .
signature strength, .
three good things, .
savoring, .
active/constructive, .
savoring acts of kindness and .
maintenance (Kahler et al.
, 2.
The advantages of positive psychotherapy for smoking cessation are counseling sessions from one to four/eight sessions significantly increasing long-term abstinence rates, but abstinence rates appear to plateau at 6 to 7 sessions ((Kahler et al.
, 2.
In Indonesia , there have been several studies on the PPT approach to address psychological problems such as reducing anxiety and negative affect.
Still, no PPT study has been found for smoking prevention or smoking cessation programs Cognitive Behavior Therapy Journal homepage: http://pcijournal.
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Cognitive-behavioral strategies have two tasks:
Cope with craving and common high risk situations without relapse.
The second task, which comes to dominate around the time daily cravings subside, is embracing a smoke-free lifestyle.
The aim of this second task is for ex-smokers to minimize, and ideally eliminate, any perceived losses associated with quitting so that they find they are enjoying life more and coping better than when they were smoking and cannot think of any important situation where they would be better off reaching for a The elements include: .
hrough reflection on post-quitting experience.
that many perceived benefits of smoking were illusory, .
finding alternative coping behaviors where smoking produces real benefits and instituting these as lifestyle changes, .
facing old smoking situations to extinguish the urge to smoke and .
adopting a non- or ex-smoker image by rejecting or growing out of a smoker self-image.
CBT combined with a smoking cessation medication .
uch as the nicotine patch or/and nicotine gu.
is quite effective for smokers who are motivated to Thus, it is recommended to do CBT for 20 weeks by developing activities in the cognitive and behavioral phases to maintain non-smoking.
It can help smokers to keep their abstinence longer (Killen et al.
, 2.
5A model (The Brief therap.
There are two types of the brief namely 5As Model and 5Rs Model (Organization, (ENSP, 2.
The 5As model is a treatment that has been proven to be able to increase smoking cessation.
The 5As program includes ask, advise, assess, assist and Firstly, smokers who want to quit will be asked about their smoking status, then smokers get advice to quit smoking, evaluate the smoker's readiness to quit smoking, assist the patient during the quit attempt and finally follow up the program.
In contrast, 5Rs is one treatment strategy focused on personally relevant reasons to quit, risk related to identifying potential personalized health risks of the smokers, rewards for quitting, barriers that might impede the success of a quit and repetition of the intervention/treatment till enough to quit smoking.
The 5Rs Model consists of relevance, risks, rewards, roadblocks, and repetition and the aim of 5Rs is to build motivation towards smoking cessations.
(ENSP, 2.
The affect of brief advice is lower than psychotherapy and pharmacological therapy (Stead et al.
, 2.
The one out of 40 smokers who were given advice for three to five minutes showed the results could give the effect of quitting smoking even though it has a very low impact (ENSP, 2.
Ulaps .
in his research proved that there was a success for the 5As approach to stop smoking even though it was only around 20.
Telephone Counseling Research conducted using the telephone counseling approach shows effective results in stopping smoking by 22.
In comparison, the extended telephone counseling program can have a smoking cessation effect of 58.
9% at four months of follow-up and decreases 0% at 12 months of follow-up (Segan & Borland, 2.
In contrast to these results.
Jyang's .
research showed that the majority of respondents lapses occurred during the first two weeks after the quit date through a standard telephone counseling program.
In Vietnam, from 469 smokers who got quit line services, only 31.
6% managed to quit While relapse due to environmental factors and craving symptoms (Chau et al.
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Hypnosis therapy Previous research conducted hypnosis of two meetings in 60 minutes for each of face-toface sessions and four meetings in 20 minutes for each of follow-up phone calls.
The results showed at 26 weeks prevalence stop rate of 35.
0% and the percentage decrease at 52 weeks to 29.
(Timothy.
Carmody.
Carol.
Duncan & Solkowitz, 2.
Hypnosis therapy has little effect on smoking cessation because:
Effective for only six months than other therapies or no therapy.
There are other factors that cause smokers to quit smoking, such as trust in a therapist.
Does not describe long-term results.
The same result showed the efficacy of a single session of group hypnosis for smoking cessation, containing a psycho-educational part and relaxation.
At the two-week follow-up 33.
reported smoking abstinence and follow-up at the 6-month only 14.
7 % in the hypnosis group were consistent to quit smoking (Dickson et al.
, 2.
Text Messages Text message interventions are capable of producing positive change in preventive health The benefit of messages as health promotion is that they can increase the health efforts of a person or group, so providing information through social media can increase individual knowledge and understanding of the dangers of smoking.
Smoking cessation research programs that are only in the form of text messages are generally in the way of applications such as Happy Quit.
NEXTit, and Stop My Smoking.
The contents of words based on the concept of cognitive behavior theory in the form of motivational sentences in reducing smoking and psychoeducation about the dangers of smoking and showing effective results for stopping smoking (Ybarra, 2013.
(Liao et al.
, 2.
CONCLUSION
It can be concluded that the success rate of relapse prevention is about 20%-45%.
The lowest effective is The Brief Method, followed by relaxation method, text message method.
CBT combine relaxation, hypnosis method and the most effective is multiple therapy .
ombine more than one CBT therapy and telephone counsellin.
Some of the psychology therapies are combined with pharmacological approaches.
Positive psychotherapy is more effective than other behavioral therapies such as CBT, hypnosis, counseling, text messages and relaxation.
And the combination of two behavioral treatments in one intervention will produce higher effectiveness, such as CBT plus telephone This is in line with previous research which proved that the combination of more than one intervention in an intervention showed a high percentage to stop smoking.
References