Effectiveness of psychological interventions for smoking cessation in adults with mental health problems: A systematic review

Lightfoot, Katie, Panagiotaki, Georgia and Nobes, Gavin (2020) Effectiveness of psychological interventions for smoking cessation in adults with mental health problems: A systematic review. British Journal of Health Psychology. ISSN 1359-107X (In Press)

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Purpose People with long-term mental health problems are heavier smokers than the general population, and suffer greater smoking-related morbidity and mortality. Little is known about the effectiveness of psychological smoking cessation interventions for this group. This review evaluates evidence from randomised controlled trials (RCTs) on the effectiveness of psychological interventions, used alone or with pharmacotherapy, in reducing smoking in adults with mental health problems. Methods We searched relevant articles between January 1999 and March 2019 and identified 6200 papers. Two reviewers screened 81 full-text articles. Outcome measures included number of cigarettes smoked per day, 7-day point prevalence abstinence, and continuous abstinence from smoking. Results Thirteen RCTs, involving 1497 participants, met the inclusion criteria. Psychological interventions included Cognitive Behavioural Therapy (CBT), Motivational Interviewing (MI), counselling, and telephone smoking cessation support. Three trials resulted in significant reductions in smoking for patients receiving psychological interventions compared with controls. Two trials showed higher 7-day point prevalence in intervention plus nicotine replacement therapy (NRT) versus standard care groups. Four trials showed that participants who combined pharmacotherapy (Buproprion or Varenicline) with CBT were more likely to reduce their smoking by 50% than those receiving CBT only. Four out of five trials that compared different psychological interventions (with or without NRT) had positive outcomes regardless of intervention type. Conclusions This study contributes to our understanding in a number of ways: the available evidence is consistent with a range of psychological interventions being independently effective in reducing smoking by people with mental health problems; however, too few well-designed studies have been conducted for us to be confident about, for example, which interventions work best for whom, and how they should be implemented. Evidence is clearer for a range of psychological interventions – including CBT, MI and behavioural or supportive counselling – being effective when used with NRT or pharmacotherapy. Telephone-based and relatively brief interventions appear to be as effective as more intense and longer-term ones. There is also good evidence for a strong dose-response relationship – increased attendance predicts improved outcomes – and for interventions having more positive than negative effects on psychiatric symptoms.

Item Type: Article
Uncontrolled Keywords: smoking cessation and reduction,mental health,psychological interventions,health inequalities
Faculty \ School: Faculty of Social Sciences > School of Psychology
Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: LivePure Connector
Date Deposited: 08 May 2020 00:02
Last Modified: 10 Jul 2020 00:03
URI: https://ueaeprints.uea.ac.uk/id/eprint/75090

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