Group behaviour therapy programmes for smoking cessation

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Abstract
Group therapy offers individuals the opportunity to learn behavioural techniques for smoking cessation, and to provide each other with mutual support. The aims of this review were 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; to determine the effect of adding group therapy to advice from a health professional or nicotine replacement and to determine the rate at which offers of group therapy are taken up. We searched the Cochrane Tobacco Addiction Group trials register. We considered randomised trials which compared group therapy with self-help, individual counselling, another intervention or usual care or waiting list control. We also considered trials which compared two group programmes with manipulation of the group interaction and social support components. 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. We extracted data in duplicate on the type of subjects, the nature of the groups and the controls, 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 model. Thirteen studies compared a group programme with a self-help programme. There was an increase in cessation with the use of a group programme (odds ratio 2.10, 95% confidence interval 1.64 to 2.70). Group programmes were more effective than no intervention or minimal contact interventions (odds ratio 1.91, 95% confidence interval 1.20 to 3. 04). There was no evidence from two trials that group therapy was more effective than a similar intensity of individual counselling. There was no evidence that manipulating the social interactions between participants in a group programme had an effect on outcome. There was limited evidence that the addition of group therapy to other forms of treatment, including 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 is evidence that groups are better than self-help, and other less intensive interventions. There is not enough evidence on their effectiveness compared to intensive individual counselling.