The Stress Management Institute Stress Management Consultants & Trainers since 1995 Stress Management Training Courses by Distance Learning

Session One Treatment Model -Smoking Cessation

Treatment for smoking cessation can be booked as six separate sessions, lasting 50 minutes each.

Clients who approach you will be in different stages of the quitting process. Some will have already stopped smoking, some will be thinking about it, some will have stopped and then relapsed. The Client does not have to decide exactly when they are going to stop smoking, they just need to know that they are going to stop with your help.

Clients need to know that stopping smoking does not need to be hard or horrible. Smokers have been brainwashed into thinking that stopping smoking is a very difficult process requiring iron will-power and causing misery. The fact is that stopping smoking can be relatively easy. By undertaking the exercises in this programme Clients will be able to stop smoking with a positive attitude and get rid of all those negative ideas about stopping that may have prevented them from succeeding in the past.

There are two kinds of exercises in this programme: the paper exercises and the CD/Digital exercises. These exercises will enable clients to stop smoking by getting them to develop a positive attitude to stopping smoking. This is done using the twin techniques of cognitive therapy and the relaxation techniques of hypnotherapy. Clients should consult their G.P.s about undertaking this programme as deep relaxation can occasionally exacerbate a some existing conditions.

There are 12 paper exercises in the programme and two deep relaxation exercises. Clients do have to actually do the exercises in order for this programme to work, and should work through all the exercises to enable them develop a positive attitude.

Work though this programme at a pace that suits the Client. They must decide when they are ready to stop smoking forever. That time could be in a few days or a few months - its up to them.


Smoking Cessation, Session One

1. Exercise One. This Exercise is only for Clients who are still smoking. (If the Client has already stopped smoking just have the discussion about past smoking behaviour). Ask the Client during the next week to concentrate on smoking. Ask them not to smoke without thinking. Give them the Form for Exercise One and ask them do the exercise once in front of a mirror, to complete the form and bring to the next Session.

2. Exercise Two. Discuss the client's smoking triggers. Give them the form to fill in and bring to the next session.

3. Give the Client the Handout ‘Cutting Down’ to read at home.

Exercise One

How did the cigarette feel?

How did the cigarette smell?

How did the cigarette taste?

How did you think you look when you were smoking?

How did you feel when you were smoking?

When you smoke please concentrate on smoking. Do not smoke without thinking. Do the exercise once in front of a mirror. Complete the form and bring to the next Session.

Exercise Two

Ask the Client to list their smoking triggers.

What situations make you want to smoke?

What feelings make you want to smoke?

What people make you want to smoke?

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20;

Discuss. Bring this list to the next session.

3. Handout - Cutting Down

Every smoker has done it. If you have cut down before, you will know how horrible it makes you feel. This is because you are keeping yourself in a state of nicotine addiction but refusing to feed that addiction as often as your body tells you to. Thus you are in a permanent state of craving. This makes you feel that stopping smoking forever will be impossible because you feel so bad when you merely cut down. The reality is however, that when you do stop smoking forever you will soon leave your nicotine addiction behind you. Thus, cutting down on your smoking is the worst thing you can do. It only reinforces all the negative ideas you have learned about stopping smoking and will make you feel deprived. Wait until your positive attitude has developed and you will find it much easier to quit.


Smoking Cessation Session Two

1. Greetings and Review
Discuss the smoking exercise with the Client. Have they changed the way they feel about smoking? Discuss the triggers exercise. Discuss the Cutting Down handout.

2. Exercise Three. Ask the client to put their top ten triggers in order with number one being the situation in which they most want to smoke. Keep this sheet for Session Three.

3. Play the first Smoking Cessation Exercise for the client. Discuss.

4. Give the client the CD or digital copy to listen to at home. Give the client the Handout on the First Relaxation Exercise.

5. Give the client the Handout on ‘The three aspects of smoking addiction’ to take home and study.

Exercise Three

Now put your top ten triggers in order with number one being the situation in which you most want to smoke.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Smoking Cessation - The first relaxation exercise

After you have completed exercise Three and have identified your smoking triggers, you can listen to the first relaxation exercise. This will help you to break the link between your triggers and smoking. The exercise is designed to help you develop a positive attitude to stopping smoking. Over the next week or so practise this exercise every day. During the exercise, each time you are prompted to do so, visualise yourself in one of your top ten trigger situations.

Visualise yourself happily not smoking in this trigger situation. Visualise one trigger situation each time you do this relaxation exercise, starting with number ten and working your way up to number one. You can stay with each trigger for as many days or weeks as it takes for you to be able to visualise yourself relaxed and happily not smoking in that particular trigger situation.

When you do this relaxation exercise you should be somewhere quiet and warm where you will not be disturbed, Lie down with your arms and legs uncrossed and close your eyes to listen. Continue practising this relaxation exercise until you feel relaxed and happy visualising yourself not smoking in your top ten trigger situations.

NEVER listen to the exercise when you are driving because you might fall asleep.

Smoking Cessation Handout - The three aspects of smoking addiction

There are three aspects to stopping smoking that need to be addressed in order to achieve and maintain the positive attitude that will enable you to enjoy being a non smoker.
These are:

Nicotine addiction.
Physical - affecting your body.

Your psychological addiction to smoking.
Mental - affecting your mind.

Your beliefs about stopping smoking.
Cognitive - affecting your thoughts.


Nicotine addiction

Nicotine is a deadly poison. If you injected the nicotine from one packet of cigarettes into your veins it would kill you. Part of the feeling that you enjoy when you smoke is your body trying to cope with a deadly poison that is constricting your blood vessels. Nicotine is also an addictive drug and smoking cigarettes causes you to develop a physical dependence on nicotine. Smoking a cigarette is a just a way of administering the drug to yourself and a cigarette is only enjoyable because it puts an end to your craving for nicotine. In itself it is pretty horrible. Cigarettes are not your friends but are parasites demanding your constant attention and cash.

Physical withdrawal from smoking takes up to three weeks, though most of the nicotine will have left your body after five days. The feeling of withdrawing from nicotine is a slightly anxious feeling. It is not as bad as having a cold, a sore throat or a headache. It is not difficult to go without nicotine even when you are heavily addicted. At night most smokers manage to sleep without needing to light up.

The psychological addiction to cigarettes

If stopping smoking is just a question of feeling a bit anxious and having occasional cravings why do we find it difficult to stop? The answer of course is the psychological addiction that goes along with the physical addiction.

You will have formed a psychological attachment to the physical feelings you get from smoking and will have acquired triggers that make you want to smoke. Many events during a day may act as a trigger for you to smoke; after breakfast, driving, break time, after lunch, or when other smokers light up. Smokers get into a habit of having a nicotine hit at certain times of the day and in certain company. Some smokers worry that they will never enjoy a meal again without a cigarette. Smoking can seem an integral part of the relaxing experience. Psychological craving is triggered by situations in which you are used to smoking and from the memories of good things associated with past smoking.

What we want to do is stop these situations acting as triggers for you to smoke. This is why we use a deep relaxation exercise to help extinguish the link between smoking and the situational triggers.

We will discuss the third aspect of smoking addiction, which is beliefs, in Session Three.


Smoking Cessation Session Three

1. Greetings and Review.
Discuss the handout on two of the three aspects of smoking addiction.
Discuss the first Relaxation Exercise.

2. Beliefs about stopping smoking. Give the client the Handout. Read and discuss.

3. Exercise Four. Go through the client’s top ten smoking triggers from Exercise Three and list their negative thoughts about stopping smoking.

Handout - Your beliefs about stopping smoking

This is the most important of the three aspects of stopping smoking forever. In order to have a positive attitude to stopping we have to banish negative thoughts about stopping smoking. We all have a running commentary of thoughts going on in our heads in every situation we are in. These thoughts can be positive and therefore helpful to us, or negative and unhelpful to us.

This does not just apply to smoking but to every situation in life. We often falsely attribute most of our problems to external events and circumstances, when in fact, they are attributable to our own beliefs about those events and circumstances. The meaning of an event for us determines our emotional response to the event.

The meanings that we give to things are determined by our habitual patterns of thinking. If we distort a situation in our minds, our emotional response is consistent with the distortion rather than with the actual facts of the situation. So these private meanings are sometimes unrealistic, and their truth is difficult to check. For example, if we believe that someone dislikes us, we will feel hurt whether or not they actually do dislike us, because our feelings are in line with our distorted beliefs, even if we have no proof that they dislike us.

There are two kinds of beliefs, rational and irrational. Rational beliefs are those which are consistent with reality, are logical, and which promote our well-being. Irrational beliefs are illogical, inconsistent with reality, and interfere with our well-being. Continuing to smoke when you want to stop is behaviour which is based on an irrational belief, the belief that it will be painful to stop, when as we have seen, nicotine withdrawal is not painful and does not last very long.

We have been led to believe that stopping smoking is difficult. Tied up with this expectation of difficulty are all kinds of fears and worries about deprivation, loss, disappointment, fear of failure etc. that are in fact groundless. However, if we believe these things to be true, we will act as if they are true. These wrong assumptions need to be challenged.

Smoking Cessation Exercise Four

Look back at your top ten smoking triggers. Think about not smoking in these situations and list your negative thoughts about stopping smoking.

Trigger - Negative thought

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

When these situations occur in your life mentally wrap an invisible cloak around yourself that these irritants cannot penetrate.
Choose to not let things or people upset or annoy you.


Smoking Cessation Session Four

1. Greetings and Review

2. Give clients the Handout ‘The costs of smoking’ to read and discuss.

3. Exercise Five. A positive attitude to stopping smoking

4. The Second Relaxation Exercise. Play the second exercise for the Client. Discuss.
Explain that his will help their positive attitude to develop further so that when they come to stop smoking forever they will do so with pleasure. If they are feeling relaxed visualising themselves in their trigger situations when practising the first exercise, they can stop practising that exercise. If they are not yet relaxed ask them to continue to practise the first exercise and add the second exercise daily.

5. Exercise Six. Ask them to complete Exercise Six on enjoying stopping smoking.

6. Ask them to complete Exercise Seven and set a date in the next week to stop smoking.

Handout - The costs of smoking

Physical
Wheezing, shortness of breath
Lack of energy, poor concentration
Dull skin, nicotine-stained fingers, premature wrinkling
Reduced fertility, risky pregnancy, baby at risk
Damaged taste buds, stained teeth
Lung cancer, emphysema, stroke, heart attack - the list goes on
Damaged circulation, gangrene, amputation

Social
Polluting the air with carcinogens
Children at higher risk of asthma, cot-death, bronchitis and glue ear
Smoke gets in your eyes
Dusty, stuffy home. Nicotine stains your walls as well as your fingers.
Spoilt clothes and furniture
Increased risk of fire in the home

Emotional
Being a turn off to potential partners and the possibility of missing out on relationships
Feeling a slave to cigarettes
Ever present, nagging sense of guilt that you should give up
Disapproval and dislike, increasing pressure from a society that doesn't want to be subjected to smoke

Exercise Five

Begin to look at your ceasing to smoke in a new and positive light. Write down below the answers to the following questions:

How can I make the most of this opportunity to stop smoking?

How do I choose to feel about stopping smoking?

What am I going to tell myself about stopping smoking?

How do I see myself as a non-smoker?

Exercise Six

Be happy when you stop smoking. Choose to enjoy yourself and have fun. Write down below ten ways you can have fun.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Enjoy yourself during your nicotine withdrawal. Arrange to do some of the things you enjoy during this time. Do you need to buy books/games? Do you need to make arrangements with friends? Gather all the information and things you will need to have fun before your quit date.

Exercise Seven

I,_______________________________________
Your name

make a commitment to stop smoking forever on

______________________________________
Stop smoking date


Smoking Cessation Session Five

1. Greetings and Review. Discuss the relaxation exercise. Discuss how clients are coping with quitting.

2. Give the Handout ’Reasons for Quitting’. Read and discuss.

3. Exercise Eight. It is usual to feel a little ambivalent about stopping smoking. The client will probably have compelling reasons for stopping smoking and for continuing to smoke. To get a clearer picture of their reasons for stopping or continuing ask them to complete this exercise: In the appropriate places ask them to write down the good things and the bad things about stopping smoking and about continuing to smoke. Discuss.

4. Exercise Nine. If the client has attempted to stop smoking in the past and been unsuccessful ask them to do this exercise now. Discuss.

5. Exercise Ten. Are you committed to stopping smoking? Discuss

6. Give the client the Handout on Cravings to read at home.

Handout - Reasons for Quitting

Better all-round health. Stopping smoking reduces risk of 50 different illnesses.
Heart attack risk drops to the same as a non-smoker three years after quitting
Cancer risk drops with every year of not smoking
Live longer - one in two long-term smokers die early and lose about 16 years of life
Set a good example to children - you don't want to be a smoking role model
Have lots of money to spend on other things
Improved fitness and easier breathing – better at sports and getting up stairs
Better chance of having a healthy baby
Food and drink tastes better
Better skin and complexion, and no early wrinkles
Fresher smelling breath, hair and clothes, and no more cigarette smells around the house
Back in full control and no longer craving or distracted when not smoking
Travel on trains, aircraft, buses will be easier
Work will be easier
Don't want to support tobacco companies
Concern about environmental impact of tobacco growing

Exercise Eight

Stopping Smoking
List the good things and the bad things about stopping smoking

Continuing to smoke
List the good things and the bad things about continuing to smoke

Give each item a rating out of ten for importance. When you have finished add the scores for each list. Is one list more compelling than the other?

Exercise Nine

If you have tried to stop smoking before write down the answers to the following questions about how you came to smoke the cigarette that stopped you quitting:

In what situation were you?

What had just happened?

What were you feeling?

Where did you get the cigarette?

Was anyone with you?

If so, what was their input/reaction?

Did you tell yourself that you can handle one cigarette?

How long had you stopped smoking before you had that cigarette?

What can you learn from the above that will ensure that this time you make a commitment to not smoking ever again.

“Insanity is doing the same thing over and over again
and expecting different results” - Albert Einstein

Exercise Ten

Rate yourself from 1 to 10 in terms of your commitment to stop smoking. 1 is not committed and 10 totally committed.
If you rate your commitment at lower than 8, increase the second relaxation exercise to twice a day.
Be happy about stopping smoking, keep up your positive attitude and you will find it easy

Handout - Cravings

When we first stop smoking and we intermittently feel a craving for a cigarette, this is just part of the physical withdrawal from nicotine and is a sign that the drug is leaving your body. It is a sign that you are getting over your addiction to cigarettes.

Cravings for nicotine are not the same as urges to smoke a cigarette. Cravings are associated with feelings of wanting gratification. Urges are concerned with doing something to get gratification. We can apply the ABC technique to the pause between the craving and the urge:

A is the craving.
B is the pause.
C is the urge to smoke.

The delay between the feeling of craving for nicotine and acting on the urge to smoke a cigarette provides an interval for you to remind yourself that the craving will go away in a minute and that you are so happy that you no longer need to smoke. Craving follows a natural pattern, it comes over you like a wave, reaches a plateau and then slowly subsides. If you ride out the wave you will find that the craving will pass.

One of the best ways to ride out a craving (A) is to use the pause at B to distract yourself from the craving until it has passed. Distraction can be physical or mental. There is only room for one thought at a time in your mind - if it is occupied with something else it cannot think about the craving. Your body will still feel the craving but your mind won’t be thinking about how to get a cigarette. If you are distracted from the craving at A, the urge to smoke at C need not occur.


Smoking Cessation Session Six

1. Discuss the Handout on cravings. Discuss how the quitting is going. Share coping strategies.

2. Give the client the Handout - ‘When to be on your Guard’ to read and discuss.

3. Give the client Exercise Eleven to complete. Discuss.

4. Give the client the Handout - ‘Will I gain weight’ to read and discuss.

5. Give the client Exercise Twelve to compete at home.

6. Give the client the Handout. ‘Keep a Diary’. Read and discuss

Handout - When to be on your guard

When you have stopped smoking the following situations are when you most need to be on your guard against negative thinking that might lead you to feel you need to smoke.

When you meet strangers.

When you have contact with people you find attractive.

When you have made a mistake.

When you feel criticised.

When you talk to people in authority.

When you feel hurt.

When you feel someone is angry with you.

When you feel angry with someone else.

In situations where you feel you risk rejection.

In situations where you feel you risk failure.

In conversations with anyone who may be disapproving.

When you are upset or excited.

Exercise Eleven

Calculate the amount that you spend on cigarettes in one year.
Make a guess at how many years you have left to live (barring accidents).
Calculate the sum of money you will spend if you continue to smoke for the rest of your life.
Write this sum down.
List below five other things you would like to do with this money.

1.

2.

3.

4.

5.

Keep this page and look at it often

Handout - Will I gain weight?

Some people put off the decision to give up smoking because they worry about weight gain. Many people do gain a few pounds after they stop smoking because nicotine suppresses your natural appetite and makes your body burn calories faster. There is also a tendency to replace cigarettes with snacks and sweets, or change your natural diet. However, even if you do gain weight, the benefits to your health will far outweigh the costs.

If you want to avoid weight gain, the key is to prepare. It makes sense to start eating well from the start. Steer clear of high calorie and fried foods, and avoid snacking on sweets – that way you'll avoid habits like eating chocolate instead of smoking a cigarette. Keeping active can also help control weight. Exercise doesn't need to be complicated – try taking the stairs instead of the lift, or get off the bus a stop or two
early.

Remember that once you've stopped smoking, you'll find it easier to be active and lose any extra weight!

Exercise Twelve

Repeat the following statements three times every day.

I take full responsibility for what happens to me in life.

I know I always have a choice.

I am courageous.

I am ready to change.

I am very optimistic about myself as a non-smoker.

Put this page where you will see it often.

Handout - Keep a Diary

Keeping a diary is important for three reasons :

1. It will remind you of your commitment to not smoking.
2. It will help to keep you focused on the task of quitting.
3. It will remind you that you can ride out a craving.

Adopt a positive attitude and a can do approach.
You are responsible for your thoughts so
choose to have positive ones about stopping smoking.

Stopping smoking is a time of real change and the future as a non-smoker can look a little frightening because it is so different. Once you have achieved your goal of becoming a non-smoker, you may wish to cease doing the exercises. You may wish to explore new ways of relaxing. Now is an excellent time to review your goals in life and decide to make any changes.


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