Effects of Auricular Acupressure and Group Therapy on Smoking Cessation Tobacco Withdrawal Symptoms, Depressive Symptoms, Resilience, and Serum Serotonin Level

1. Introduction South Korea takes second place for its smoking rate among 22 member countries in the Organization for Economic Co-operation and Development (OECD). The smoking rate in the U.S. is 16.8% among adults aged 18 years or older, while the smoking rate in South Korea is 42.6%. Medical costs spent on diseases caused by smoking are estimated to be 1.53 billion dollars, accounting for 3.7% of all health insurance medical costs spent in 2012 in South Korea. In 2010, 54.9% of smokers tried to quit smoking. Concerns about health accounted for 67.7% of the motivation for smoking cessation. Compared to non-smoking men, male smokers have a 6.5, 4.6, and 3.6 fold increased risk of getting cancer of the larynx, lungs, and esophagus, respectively. Of smokers who tried to quit smoking, 84.7% did not have any assistance. Smokers reported that main reasons for failing smoking cessation were stress and withdrawal symptoms.

To increase the success rate in smoking cessation, stress management and reduction of withdrawal symptoms are very important. Many methods have been used to assist smoking cessation. These methods include cognitive behavioral therapy, antidepressants, nicotine patches, nicotine gum, positive psychology, motivational interviewing, acupuncture, and acupressure. Traditional psychiatric approaches focus on what is wrong, while positive psychology focuses on strength and values that empower individuals. Positive psychology deals with stress management using gratitude, love, forgiveness, and hope. Motivational interviewing is a "directive client-centered counseling approach for initiating behavior change by helping clients to resolve ambivalence". Acupuncture uses needles to stimulate acupuncture points, while acupressure uses fingers, hands, beads, or pellets to stimulate acupuncture points. Stimulation of acupuncture points reduces withdrawal symptoms by reducing desire or changing tastes. The mechanism of acupuncture on smoking cessation has not examined well. Cabioglu and his colleagues suggested that acupuncture may increase the levels of several neurotransmitters such as dopamine and serotonin.

There is no consistent evidence that acupuncture is effective for smoking cessation. Tahiri and his colleagues reported the smoking rate of acupuncture was 3%-55% at 6-month follow-ups based on 6 randomized controlled trials. Authors have suggested more randomized controlled studies are needed. A few studies have examined the effect of positive group psychotherapy on smoking cessation. In addition, only a few studies have examined the mechanism of acupressure on smoking cessation.

The purpose of this study was to examine the effects of auricular acupressure and group counseling with positive psychology and motivational interviewing on smoking cessation and reduction, tobacco withdrawal symptoms, depressive symptoms, and serum serotonin levels. 2. Methods 2.1. Design and setting The design of this study is a single blind randomized controlled trial. This study will be conducted at a University in South Korea from July 2013 to July 2017.

2.2. Sample selection Smokers will be recruited by internet advertisement or face-to-face contacts. All smokers were informed about the study protocol, benefits and side effects of interventions, and the right to withdraw from the study at any time without penalty. Smokers who agree to participate in this study signed consent forms before data collection. Ethical approval was obtained from the institutional review board in Incheon, South Korea.