Growth Through Change:
Good Therapy with Jody Koval, LPC
Growth Through Change:
Good Therapy with Jody Koval, LPC
6-Month Behavioral Modification
Program for Smoking Cessation
The Behavioral Modification Program
For many smokers the association of cigarettes with other stimuli may have been deeply ingrained over a period of several years or even decades and therefore when they quit smoking they usually tend to overlook the need to break down psychological associations such as the pairing of coffee or a stressful situation with a cigarette. They tend to temporarily avoid the situations that usually trigger an urge to smoke and consequently do not resolve this classical conditioning dilemma. This avoidance through cognitive forms of thought suppression has been concluded to be ineffective (Hagga & Allison, 1994; Salkovsk & Reynolds, 1993). The pairings that they have been avoiding invariably do come back into play, quite often giving rise for these unresolved urges to lead to recidivism.
This program targets the gradual psychological, as well as physiological weaning from the cigarette smoking habit. Many smoking cessation programs only address the physiological components of breaking the habit while neglecting the psychological aspect (i.e., the deeply ingrained associations of cigarettes with various stimuli). Perhaps the reason for recidivism or relapse in many cases, particularly after a considerable amount of time has elapsed, is due to the neglect of this psychological component being addressed.
The objective of this program, in addition to the physiological weaning, is to systematically over a 6-month period of time break down these detrimental associations and extinguish the habit with a long-term goal in mind. This can be accomplished through the gradual increasing of time increments between cigarettes until an indefinite time period is reached (ie. cessation).
The weaning off of cigarettes with an increased scheduled interval method (progressive increase with the intercigarette interval) has been concluded to be twice as effective as by quitting ‘Cold Turkey’ (Cinciripini, Van Vunakis, Lapitsky, Seay, Wallfisch, & Kitchens, 1995).
This program is only for those who genuinely feel that they want to quit smoking... ‘If there was only a way that could work’. If you’re being pressured by others into quitting and you really don’t want to, virtually nothing short of confinement or death will make you a nonsmoker. If you’re instructed by your doctor to quit immediately due to imminent health concerns then you need to seriously consider quitting ‘Cold Turkey’.
The essence of this program is simply to stretch out your withdrawal symptoms, over time, to a tolerable level. And, more importantly, changing your habits. Specifically, learning over time to change associations and successfully deal with such typical behavioral areas as smoking; after a meal, while enjoying a cup of coffee, during stressful situations, while having a drink at a smoke filled establishment, after other events, etc.
The program lasts for 6 months. However, the results can last a longer lifetime! Why so long? Quitting ‘Cold Turkey’ or as with other similar methods only addresses your nicotine (ie. physiological) addiction not your psychological addiction. This may very well be why many of these people who quit ‘Cold Turkey’, at sometime down the road (usually not too long), during a stressful situation fall back on a cigarette and shortly afterwards go into relapse.
Well, your habits (routines/pairings associated with smoking) may have taken several years to take root and consequently you may need time to learn to break these associations. While gradually cutting down on your cigarette consumption over a 6-month period with this program, you’re gradually and tolerably extinguishing your nicotine addiction as well as cigarette habits. By cutting down and only smoking at preset intervals of time, you’re learning to deal with life’s endless bounty of stress evoking, “have to have a cigarette” situations. All the while assuring yourself that you can hang in there just that much longer (and longer as time goes on and you develop a stronger hold over it) until the next prescribed time for your next precious cigarette (which after a few months should become less and less precious).
No, it’s not as easy as it may sound (this program was not designed for the very small percentage of the population who can put a cigarette out and successfully quit, seemingly with ease). There may be times that it can be very tough and require that extra push from within to make it to the next interval. But it should get easier as time goes on, and quite easy after you extinguish that last cigarette 6 months after you’ve started the program. If it were easy to quit smoking, you probably would have already done it by now. The bottom line is that if you really want to stop smoking, this program and you, can make you a nonsmoker.
Remember, you’re not going to change those things that you associate with or prior to having a cigarette, such as having a cup of coffee, intimacy, etc. You’re just taking cigarettes out of the yellowed picture... you’re not quitting life!
To begin with, you’ll need a start date. This will be a few days down the road. This should be sufficient time to psych yourself up and to prepare for what’s ahead of you. Preparation simply consists of familiarizing yourself with the procedure so you’ll feel comfortable with it.
Prior to day 1, you’ll have to figure out how far apart you’ll initially be spacing your cigarettes. This will depend on how many you currently smoke and what you honestly feel most comfortable with. If you’re a one pack a day smoker, you should start at one cigarette every 45 minutes and one every 30 minutes if you smoke more. If you smoke one half of a pack a day you should start at one cigarette every 90 minutes, etc. Remember, it should be a little uncomfortable as you’re trying to wean yourself.
So as to change your morning habits, you won’t have your first cigarette of the day until half of your interval time has elapsed from waking up. For example if your interval time is up to one cigarette every 60 minutes and you wake up at 7:00, you can have your first cigarette at 7:30. You can also round off a few minutes before or after, as the events of the day don’t always occur at precise intervals. Furthermore, resist the temptation to get ahead of yourself and the program. While there may be days when you feel that you can skip an interval or two, or stretch them out further, this is supposed to be a long-term behavioral modification program. You don’t want to throw yourself off and later during a withdrawal pang, guilt yourself into feeling that you’re owed one.
Also, to make life a little easier, space your intervals not from when you finish your prescribed cigarette, but rather from when you had started it. So that when you’re up to one cigarette every 2 hours, you’ll remember that they’re spaced at all of the odd or even hours of the day or at a quarter past... Towards the end of the program you should not be as anxious. However, in the beginning, you’ll no doubt know exactly when your next cigarette is due to the nearest second.
For your last cigarette of the day you get to cheat a little. You can smoke your last one if at least half of the prescribed interval time has elapsed. For example, if you’re up to one cigarette every 3 hours and it has been at least 1½ hours since your last cigarette and this is your last one of the day, you can then light up. This is so you don’t have to pace around half asleep for the next hour and a half, otherwise depriving yourself of that last cigarette that’s ‘rightfully yours’. This is the only major exception to the rule. Otherwise, you may not learn how to deal with all of life’s stressful events without having or insatiably craving a cigarette and run the risk of relapse after you’ve worked so hard through out the 6-month program.
However, if you do have a weak moment and have a cigarette out of turn, it shouldn’t be the end of the world. Just go right back on schedule, affirming to yourself with the determination that had gotten you this far that next time you can hang in there. If it were such an easy habit to break, you would most likely have broken it already.
For those who smoke 1 pack a day or more the intervals will be spaced out into 6 or 7 periods of 3 to 5 weeks long (see Figure 2). The first interval will be 1 cigarette every 45 minutes (30 minutes followed by a 45 minute interval for those who smoke more than 1 pack a day). The next interval will be one cigarette every 1 hour, then a 1 ½ hour interval, a 2 hour interval, a 3 hour interval and down the home stretch with one cigarette every 4 hours for the final interval.
As people inherently are different, the program can be customized here to ensure your best chance for success. You’ll decide when to start the next interval so long as you (a) feel somewhat comfortable with it, (b) psych yourself up for the new interval day about one week in advance, and (c) keep the intervals somewhat evenly spaced (3-5 weeks for 1 pack and over a day smokers – see chart) over the 6 months.
NOTE: Adjust the time intervals to your current smoking intake. For example, if you smoke ½ of a pack a day you’ll start at the 90-minute interval. Consequently, you’ll now only have 4 different intervals (1 ½ hours, 2 hours, 3 hours, and finally, one cigarette every 4 hours – see figure 2). You’ll now space the 4 intervals out over the 6 months, with each being approximately 1 ½ months long.
Likewise, if you smoke ¾ of a pack a day you’ll start at the 1-hour interval. You’ll now only have 5 different intervals (1 hour, 1 ½ hours, 2 hours, 3 hours, and finally one cigarette every 4 hours). You will then space the intervals out over the 6 months with each therefore being approximately 5 weeks long.
Of foremost importance, remember to live your normal life during the program. Because, sooner or later you will have to confront all of those cigarette provoking situations. Learning to deal with them during the program (hanging in there just a little longer until the appropriate time) will make them easy to deal with afterwards.
The insatiable withdrawal pangs typically don’t last for more than a few minutes. To get help through the rough spots, drink a glass of water, chew gum, carrot and celery sticks, licorice, breath mints or whatever works for you. Try sunflower seeds with the shells on. This will certainly keep your mouth busy. Chew prudently however as you don’t want to replace one habit with another. If you do though chances are good that you’ll beat the gum chewing habit.
The inhalation of the vapor from black pepper extract as a cigarette substitute has been found to be effective (Rose and Behm, 1994). Also, try exercising. Exercise has been found to be helpful when quitting smoking (Hill, Rigdon & Johnson, 1993). Why not reap the full reward of a healthy lifestyle. In addition to being healthier, more attractive, you can speed up your body’s metabolism to help counter effect the calories from any extra chewing.
When the pangs hit try slow deep breaths and picture a pleasant relaxing place in your mind. Initial research looking into guided imagery and relaxation techniques and their effect on smoking cessation looks to be promising (Wynd, 1992).
To keep your hands busy and help get rid of some of the stress, squeeze a hand gripper, tennis ball, hunk of clay like putty, play with a pencil, a yo yo...
Don’t change your cigarette brand. Otherwise you may feel cheated, thinking about how good and smooth your brand was while having to put up with brand ‘X’. Quitting smoking is arduous enough without making the process anymore difficult.
You may want to cut down on your caffeine consumption. With fewer cigarettes you may notice that you crave fewer cups of coffee and can really do without the extra caffeine.
Reward yourself with something special. Look at all of the money that you’re saving. Besides, you deserve it!
You may want to keep a diary to help vent your frustrations on paper instead of on those around you. An internet chat group (there are several out there to investigate and choose from) may also help to vent, in knowing that you are not alone and pulling from a collective strength. More than likely it was some sort of peer pressure that had gotten you hooked to begin with. Why not get some support and turn it around now to your advantage.
Tell your friends, family and co-workers what you’re doing. This will further commit you and get their support and understanding. Which can be especially important when your personality becomes a little tense and less than pleasant at times. Perhaps a co-worker will even join you. The workplace has been shown through peer pressure (again, the reason most start to smoke) and its inherent authoritative presence to be an effective environment for quitting smoking (Fisher et al., 1993; Dawley et al., 1993).
While you will surely know when your intervals are to the minute with only the help of a time piece you still may wish to keep a daily record of your success in a date book so you can see your progress and thereby get a better feeling of accomplishment, ie. regaining more of a feeling of control.
Avoid the temptation that may avail itself a few weeks or months into the program of just quitting early. Try to see it through the entirety of the prescribed 6 months. As confident as you may feel, it’s not worth the risk of a later relapse, because you thought that you had broken those cigarette associations that had taken years to bond, in just a couple of months or so. You’ve invested all of this time and energy into the program... you owe it to yourself to see it through.
Lastly, after you’ve quit, remember all of the struggling effort and time involved in your quitting, when you’re looking at a cigarette and pondering the smug thought “it’s been some time since I’ve had a cigarette now. I can take them or leave them”. LEAVE THEM!
May you make GOOD LUCK!
Cinciripini, P., Lapitsky, L., Seay, S., Wallfisch, A., Kitchens, K., & Van Vunakis. (1995). The Effects of Smoking Schedules on Cessation Outcome: Can We Improve on Common Methods of Gradual and Abrupt Nicotine Withdrawal? Journal of Consulting and Clinical Psychology, 13, 388-399.
Retrieved July 13, 2006, from the PsycARTICLES database.
Cinciripini, P., Cinciripini, L., Wallfisch, A., Haque, W., & Van Vunakis, H. (1996). Behavior Therapy and the Transdermal Nicotine Patch: Effects on Cessation Outcome, Affect, and Coping. Journal of Consulting and Clinical Psychology, 64, 314-323. Retrieved July 19, 2006 from the PsycARTICLES database.
Fisher Jr., E. B., Bishop, D. B., Levitt-Gilmour, T., Capello, M. T., Ashenberg, Z. S., & Newman, E. (1994). Social Support in Worksite Smoking Cessation: Qualitative Analysis of the EASE Project. American Journal of Health Promotion, 9, 39-47.
Gerrard, M., Gibbons, F., Lane, D., & Stock, M. (2005). Smoking Cessation: Social Comparison Level Predicts Success for Adult Smokers. Health Psychology, 24, 623-629. Retrieved July 20, 2006, from the PsycARTICLES database.
Haaga, D. F. & Allison, M. L. (1994). Thought Suppression and Smoking Relapse: A Secondary Analysis of Haaga. British Journal of Clinical Psychology, 33, 327-331.
Helvig, T., Sobell, L., Sobell, M., & Simco, E. (2006). Smokers’ Narrative Accounts of Quit Attempts: Aids and Impediments to Success. Psychology of Addictive Behaviors, 20, 219-224. Retrieved July 20, 2006, from the PsycARTICLES database.
Rose, J. E., & Behm, F. M. (1994). Inhalation of Vapor From Black Pepper Extract Reduces Smoking Withdrawal Symptoms. Drug and Alcohol Dependence, 34, 225-229.
Waters, A., Shiffman, S., Sayette, Paty, M., Gwaltney, C., & Balabanis, M. (2004). Cue-Provoked Craving and Nicotine Replacement Therapy in Smoking Cessation. Journal of Consulting and Clinical Psychology, 72, 1136-1143. Retrieved July 20, 2006, from the PsycARTICLES database.
Wynd, C.A. (1992). Personal Power Imagery and Relaxation Techniques Used in Smoking Cessation Programs. American Journal of Health Promotion, 6, 184-189.