Smokers who receive six to eight sessions of a group behaviour treatment were almost twice as likely to quit as those using self-help programmes. However this represents only about four extra successes in every 100 who try.
The quit rates after individual advice or brief support were very similar, but adding nicotine replacement gum and patches to group therapy or individual therapy did provide further benefits. The logistics of setting up these groups might be a deterrent for commissioners of these services.
Giving smokers the chance to share the difficulties they face when trying to quit may help to increase their chances of quitting successfully and allow them to choose a group programme if available.
Healthcare providers should continue to consider group behaviour therapy in combination with other interventions, such as nicotine replacement therapy, as an option for helping smokers to quit, especially in settings such as the workplace, where support to attend sessions can also be given.
Why was this study needed?
In the UK, just under 96,000 people a year die from smoking. Hospital admissions for conditions thought to be caused by smoking are rising. Recent estimates in England show an increase from 1.6 million admissions in 2013 to 1.7 million in 2014.
The researchers wanted to find out how effective group behaviour therapy is for smoking cessation in the long-term. Previous Cochrane reviews have shown that group behaviour therapy is more effective than self-help. This is the third version of the review, and updates the 2005 version with 13 new studies and a summary table.
Behavioural interventions are known to be effective for smoking cessation, but it’s unclear which specific psychological components contribute the most to improving quit rates. If these components can be identified, it may be possible to create programmes that are particularly beneficial for people known to be less successful at quitting (for example, people with depression).
What did this study do?
This Cochrane systematic review identified 66 randomised controlled trials that examined the effectiveness of group behaviour therapy in 22,303 adult smokers (men and non-pregnant women).
Group behaviour therapy involves delivering interventions, such as cognitive behavioural therapy or training in social and coping skills, to groups of smokers during scheduled meetings.
The researchers compared group behaviour therapy with self-help, brief advice, health education, pharmacotherapy (NRT or bupropion), individual counselling and no intervention. Most trials involved six to eight sessions of therapy and the follow-up period was at least six months.
Randomisation was often interrupted by putting family members and friends into the same groups, which could have biased results in favour of group therapy.
Overall, the main outcome was supported by evidence of moderate quality, suggesting we can be moderately confident that the precise quit rate is close to a true effect.
What did it find?
- Group behaviour therapy may improve the estimated quit rate from five people per 100 with self-help to nine per 100 people. This was a relative increase of 88% compared with self-help (relative risk [RR] 1.88, 95% confidence interval [CI] 1.52 to 2.33; 13 studies, 4395 participants).
- Group therapy plus pharmacotherapy was similar to brief support plus pharmacotherapy, which helped around 18 to 20 people per 100 quit (RR 1.11, 95% CI 0.93 to 1.33; five studies, 1,523 participants).
- Group therapy (six per 100 quitting) may be slightly more effective than brief advice from a healthcare professional (five per 100), but this finding needs to be interpreted with caution because there was significant variability between the studies. There was no difference in effectiveness between face-to-face individual therapy and group therapy. Both types of programme led to about 11 per 100 quitting.
- There was insufficient evidence to compare the cost-effectiveness of group therapy with other interventions.
What does current guidance say on this issue?
The NICE 2013 guidelines on stop smoking services recommend offering everyone who smokes or uses tobacco in any other form behavioural counselling, group therapy, pharmacotherapy or a combination of treatments that have been proven to be effective. Other effective treatments include telephone counselling, brief interventions, mass media campaigns, and self-help using materials in written or electronic format.
The NICE 2013 guidelines on reducing harm from smoking recommend offering behavioural support to people who want (or need) to abstain temporarily. This support may be provided in one-to-one or group sessions by specialist services.
The NICE Quality statement on supporting people to stop smoking recommends commissioning evidence‑based smoking cessation services that offer people who smoke behavioural support with pharmacotherapy.
What are the implications?
Group therapy could be considered as one component of a local smoking cessation strategy that offers other interventions. For example, NRT combined with individual counselling or group therapy. But practicalities in setting up group programmes will need consideration.
There doesn’t appear to be a difference in effectiveness between group behaviour therapy plus pharmacotherapy and pharmacotherapy combined with brief support. Absolute quit rates when including NRT seem better than counselling alone.
It may not be practical to run group therapy sessions in rural locations so individual interventions are an essential alternative. Whereas workplaces may be better placed to offer support for group attendance. NICE suggests that group therapy is more cost-effective than individual counselling as the cost of therapist time is shared.
Citation and Funding
Stead LF, Carroll AJ, Lancaster T. Group behaviour therapy programmes for smoking cessation.
Cochrane Database Syst Rev. 2017;(3):CD001007.
The Cochrane Tobacco Addiction Group receives funding from the NIHR.
Health and Social Care Information Centre. Statistics on Smoking. England, 2016. Leeds: NHS Digital; 2016.
Health and Social Care Information Centre. Statistics on Smoking. England, 2014. Leeds: NHS Digital; 2014.
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NICE Smoking: supporting people to stop. QS43. London: National Institute for Health and Clinical Excellence; 2013.
NICE Stop Smoking Services. PH10. London: National Institute for Health and Clinical Excellence; 2008.
NICE. Smoking: workplace interventions. PH5. London: National Institute for Health and Clinical Excellence; 2007.
NICE. Smoking: brief interventions and referral. PH1. London: National Institute for Health and Clinical Excellence; 2006.
Welsh Government. Smoking. Cardiff: Welsh Government; updated April 2017.
Produced by the University of Southampton and Bazian on behalf of NIHR through the NIHR Dissemination Centre