Archive for April, 2008

Behavior Modification, a New Way to Quit Smoking?

Saturday, April 26th, 2008
Sherafgan Khan asked:


Behavior Modification: Smoking

Even as a child, I’ve always known smoking was bad for your health. My dad smoked when I was very young, but quit due to the health risks he imposed on his family as well as himself. He quit cold turkey, meaning immediately and solely by himself. He said it was hard, but he got over it. Since then he told me never to smoke. Now I can’t exactly tell you how I picked up smoking, but it definitely started after my 18th birthday when I was legally able to purchase cigarettes. I bought my first pack just because I could, and I smoked them periodically at school, especially when others were doing it, and especially if they were attractive females. This made me think I was cool enough to associate with them. As the months went on, I started getting more and more stressed with school and work, I slowly grew dependent on cigarettes. By the time I was 19, I needed to smoke whenever I studied, worked, or socialized with my friends, because most of my friends were also smokers. I have quit numerous times and succeeded at the goals I’ve set because I would set goals such as not smoking for two weeks, however I have never set a permanent goal due to fear of losing my crutch. For example, I would not smoke for two weeks, what allowed me to abstain was the thought that I can have a cigarette after two weeks.

Tracy Orleans, et al., (1991) conducted a research study on quitting smoking interventions. The study consisted of four groups, (a) the self help group, who were given a standard self quitting guide to quit with no other support, (b) the social support group, who were given the same self quitting guide along with a support guide for their family and friends, (c) the telephone group, who were given the same self quitting material, but with four telephone calls to a counselor, and (d) the control, who were given only tips to quit smoking and a referral to local quit smoking programs. The results of the study were not significant, the quit rates of the control and experimental groups were about the same, the only difference was the way the two groups quit. The experimental groups tended to quit using behavioral requiting strategies (e.g. setting a quit date, switching brands, etc.) while the control group tended to use outside interventions (like voluntary group therapy, nicotine gum/patches, etc). An interesting finding in this article was that heavier, long time smokers were less likely to quit using self help interventions alone, than were lighter, less addicted smokers (Orleans et al., 1991). This may appear like common sense in hindsight, because clearly longer, heavier smokers are more addicted, therefore its harder for them to quit, similar reasoning could be added to the opposite; lighter smokers are less likely to quit because they feel that the health threats are trivial because there is no immediate concern, whereas long time smokers are more likely to be diagnosed with a chronic illness as a result of their smoking, thus forcing them to stop due to their health. Although the former is a finding as a result of the study, the latter was found in my specific intervention, as well as my brief encounter with smokers in the past.

My specific strategy was to monitor my smoking for five days, then implement my plan, which was to smoke one less cigarette a day. Now I only smoked about 4-5 cigarettes a day so my plan was to start with five, then kick it down to zero. Of course, as I’ve stated before I knew this would be easy because my goal for the future was to smoke again. I started my change in behavior smoking five the first day, only three the next day, but then on the third day I was angry at the thought that nicotine was controlling me, so using self control, I smoked no cigarettes on day three. Day four I was supposed to smoke two, but only smoked one at night, this one cigarette at night felt better than any cigarette I had previously smoked in weeks. I wanted this feeling again; I knew it was from nicotine withdrawal. The next three days I went off track of my original plan and smoked one cigarette a night. I used a form of operant conditioning, where “the individual performs a behavior, and the behavior is followed by positive reinforcement” (Taylor et al., 2006). In this case the very euphoric feeling of a nicotine rush is the reward due to a nicotine withdrawal from not smoking all day (which is the behavior). Sure this may not be the ideal goal of operant conditioning, but it did greatly reduce the number of cigarettes I smoked in a day.

This behavior change was only temporary in my mind, as were the past attempts. I chose to monitor my smoking habits because it is probably my most health compromising behavior (aside from riding my motorcycle but I don’t think that is a “health” issue, more of a “lifestyle” issue). According to the text, “smoking is the single greatest cause of preventable death…In the United States, it accounts for at least 430,700 deaths each year” (Taylor et al., 2006) Even without the book, and without the media telling me the negative effects of smoking, I knew it could not be good for me. When I go to sleep just after smoking, I notice my heart rate is very high, anytime I do strenuous physical activity, I always gasp for air after, although I do notice that I can hold my breath longer than many of my non smoking peers. I smoke mainly because the immediate payoffs outweigh the immediate consequences, and because I am human, evolutionary psychology shows that my immediate future is more salient than anything many years ahead (Ornstein, 1991). Sure I can get lung cancer or heart disease in 20-30 years, but that is less salient on my mind, besides I, like many others fall into the false consensus effect theory; I believe that the same health compromising behavior that kills hundreds of thousands a year, probably won’t affect me.

After the twelve day period, I continued with the one cigarette a night, after a few days of that, I went to one every other night. As I am writing this paper, I am down to two a week. My goal is to bring it down to zero, however as I have implied, the thought of being able to smoke in the future is the only thing allowing me to go without a cigarette for a period of time. What worked well in my intervention was that I did not give in to the abstinence violation effect which is “a feeling of loss of control that results when a person has violated self-imposed rules” (Taylor et al., 2006). On a couple of days I gave in and smoked more then I was supposed to, mainly because I was with my smoking friends, a main effect of abstinence violation is relapse, but I made sure I did not by telling myself it was a one time thing and I will continue with my original plan, that definitely helped me from saying “screw it” and continue to my old ways of four to five cigarettes

This intervention has taught me a lot about my specific cues for smoking and I have realized that for the most part it is not a severe addiction for me; rather it is just something to do between classes, lunch breaks, or socializing with friends. I am very thankful that I had the opportunity to do this, as I probably would have never monitored my smoking otherwise. Because of this project, I have cut my cigarettes down to only six percent of what I used to smoke, with no signs of relapse, or cravings during the day. Perhaps for the future, I will only smoke when girls hit on me, which is never. :)

References

1) Orleans, CT, Schoenbach, VJ, Wagner, EH, et al. (1991). Self-help quit smoking interventions: effects of self-help materials, social support instructions, and telephone counseling. Journal of consulting and clinical psychology, 59(3), 439-448.

2) Ornstein, R (1991). Evolution of Consciousness: The Origins of the Way We Think. New York: Touchstone

3) Taylor, S.E (2006). Health Psychology: Sixth Edition, Health-Compromising Behaviors (pp. 133-148), Health Behaviors (pp. 54-78). New York: McGraw Hill



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Preparing to Quit Smoking

Tuesday, April 22nd, 2008
Rich Danger asked:


If you want to quit smoking it can be very helpful to do a little preparation first. This preparation will allow you to preview the challenges ahead and it will give you a way to decide how to cope with those challenges before they become a problem. The idea is to learn to disassociate yourself entirely from nicotine and the feelings you might have for it while at the same time coping with nicotine withdrawl symptoms. A day or two of this type of preparation can mean the difference between success and failure.

Making Peace

For a lot of smokers, cigarettes are almost like little friends with personalities and human-like qualities. These “friends” have been with us through good times and bad and that bond that must be broken. To do this, you should really look at your cigarettes and analyze the entire smoking experience. You’ll discover that there is nothing magical about any of it and as much as you might love your cigarettes, they sure don’t love you back. You are emotionally attached to paper, tobacco, a filter, and some added chemicals and this makes no sense whatsoever. With that realization, you can begin to separate yourself from cigarettes and it will be that much easier for you to quit.

Trial Runs

A trial run isn’t really a quit attempt but rather it is a way to educate yourself about what to expect. It is very simple – you just go as long as you can without smoking and then when you finally do light up, you take note of what happened and why. For example, if you smoke when you go out then you know you need to stay home for a while. If you just couldn’t fight the nicotine fit any longer then you need to learn how to do that. If you light up just for something to do then you need to train yourself to find an alternative. This is a guilt-free way to quit without quitting and to gather all the facts you need to be successful. Knowledge is power and this knowledge can be very powerful indeed.

Arm Yourself

Your trial run should reveal what you’ll need help with when you quit. Some people need something to do with their hands, some people need to eat, other people just need a way to make it past the nic fits. If you think you’ll need something to munch on, go grocery shopping. If you think drinking a ton of ice water will help, make some ice cubes. If the sight of an ashtray gives you the shakes, throw them all away (do this anyway). Gather up everything you think you’ll need so you won’t be able to blame the lack of these items on your decision to give up and smoke.

Your Last Cigarette

Now that you are ready to quit there is the matter of that last cigarette. Savor it, enjoy it, smoke it nice and slow and when you are done you can put it out knowing that it was your last one. It can be extremely helpful to time it to coincide with your bedtime so you can go to bed satisfied and wake up 8 or 10 hours into your quit. Without even trying, you’ll already be about 1/3 through your first day!



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Quit Smoking in 7 Steps The Nancy Reagan Way

Tuesday, April 15th, 2008
Tony Yost asked:


Do you want to stop smoking cigarettes? I don’t mean your wife/husband, girlfriend/boyfriend, mother/father, or doctor wants you to stop smoking.

Do you want to stop smoking?

If you do, then I can help! If you’re just trying to please someone else, don’t bother. Quitting is very, very hard to do, and doing it because you want to is the only way you’re going to be able to do what it takes to quit.

Some background… I smoked like the proverbial choo-choo train for about 20 years. Not “I didn’t inhale”, or “One cigarette every now and then”… I mean “chain-smoking, if you can’t smoke there, I don’t want to go there”, 2-3+ packs a day, smoking. See, I smoked before the “non-smokers revolted”. In those days, you could smoke on airplanes. You could smoke at work. (In fact, the CFO at one of the places I worked had a (humorous?) sign that read, “This is a smoking area. Please smoke. If you persist in non-smoking you will be asked to leave.” So I could chain smoke, even at work… no waiting for “a smoke break”. You could smoke in restaurants, too. And I did.

Later, I became an independent computer consultant. Somewhere around 1991 companies started restricting smoking. I began to have a tough time with some of my clients. After about 45 minutes in a non-smoking meeting, I would agree to just about anything… if they would just let me take a quick break (this was not a good negotiating tactic).

I also found that I didn’t really enjoy smoking any more. I just had to smoke. I was addicted to smoking cigarettes. And the coughing that came with it didn’t make me feel better either. I made the decision that I was going to quit.

There are many reasons to quit.

- You will have more money for things that you do enjoy (cigarettes are expensive!).

- You will not stink to your non-smoking friends (yes, I know you can’t smell it, but they can).

- You will get your sense of smell back (I didn’t even know mine was gone until a few weeks after I quit, I started smelling things again. What a pleasure!).

- You will be healthier. (I am told that after 10 years, an ex-smoker’s lungs are about as healthy as a non-smoker’s).

- If you’re a lady, maybe you don’t want to develop those wrinkles around your mouth.

- Ultimately, you will feel better, have more energy, and live longer.

You may have other reasons…

If you really want to quit, for your own reasons, I can tell you how I did it, and how you can do it, too.

Some of the things I will suggest are the exact opposite of what others say to do. I am not a doctor, or a psychologist. I am not giving medical or psychological advice. I am just telling you what worked for me. I quit on Saturday, Feb 22, 1992 and I haven’t had more than 6 cigarettes since. (I had those with my Mother when my Dad passed away).

Ready?

Step 1: You have to decide that, this time, you are going to do it. “There is no try, there is only do, or not do”. (I thought that was an ancient Chinese proverb, but someone told me it came from Star Wars). Regardless, either decide you are really going to quit, or don’t put yourself through the pain of trying.

Step 2: Decide on a nicotine-containing product to help you with the withdrawal. There is a real physical addiction to smoking, and you should get help with that. I used the Nicoderm patches. In those days, you needed a prescription for them. It was a 10 week program. The large size for 6 weeks, the medium size for 2 weeks, and the small size for 2 weeks. The patches have the advantage of giving you the nicotine without you doing anything that reinforces the habit (chewing the gum, “smoking” the fake cigarette, etc). At the same time, it gives you the mental strength to know that you are only fighting the mental habits (which is no small feat), not the physical issues too. If you have questions about this one, ask your doctor.

Step 3: Decide when you are going to quit. I purposely decided on Saturday at noon. I could smoke as much as I wanted until then. (And believe me, I did! I sat in a chair and smoked and smoked until noon.)

Step 4: On the designated day, throw out all cigarettes, except for one unopened pack. You don’t need them anymore, right? So, throw them out. The one unopened pack is to remind you that this is a choice that you have made. No one is making you quit, it is your own choice.

Step 5: Keep it a secret. This is where I differ from most people who would give you advice. To me, keeping it a secret gave it power. While inside my head I would be screaming “I need a smoke!!!”, on the outside I would play a game. “Would these people notice that I am not smoking? I mean, how could they not? They never saw me without a cigarette before!” I was surprised how long it took most people to notice. If they did notice, I would very casually say, “No, not right now… “. That kept the game going. It was powerful!

The other reason to keep it a secret, is that well-meaning, non-smoking friends will try and encourage you. They mean well, but they really have no idea what you are going through, and so their advice seems hollow and useless. Maybe that’s just me…

Step 6: Do not allow the internal argument about smoking. When you quit smoking, you will almost certainly begin to have internal dialog, usually depicted by the devil sitting on your shoulder talking to you.

It goes something like this:

devil: “A cigarette would sure taste good now, wouldn’t it?”

You: “Yes it would, but I’ve quit smoking and I’m not going to have one!”

devil: “If it would taste so good, then why not?”

You: “Because I want to feel better.”

devil: “Oh, so you feel a lot better now, huh?”

You: “Actually, no, I feel like @#$%^*!”

devil: “Just 1 cigarette will make you feel better. You can cut down… then quit.”

You: “Well… I guess 1 wouldn’t hurt”

To me, this is the single most important step, and it’s the reason that I call this the “Nancy Reagan approach”. Ms. Reagan started the slogan “Just Say No!” Please don’t dismiss this as just a shallow slogan. Hear me out.

You must not allow this inner conversation to take place. If you do, there is a very good chance that you will lose. What I did, and what I suggest that you do, whenever this conversation starts in your head, immediately just say the word “No!” and force yourself to think about something else. Do not let that conversation begin. You will have to do this many times… that devil (a.k.a. your habit) is very persistent. And it will come at you when you are the weakest. Just say “No!”

Step 7: Make the rule for yourself that “Anything goes, as long as it’s not a cigarette.” You can eat, run, exercise, take a vacation, swim, drink, watch tv, shop… anything as long as it’s not a cigarette.

One thing I did was to eat sunflower seeds in the shell. That kept my hands and my mouth busy. I also took my family to the lake for weekend vacations… boating, walking… etc.

Looking back, I really don’t think I could have done it without this rule. But I have to be honest… for me it did have one undesired side effect. Since I mostly used eating to compensate for not smoking, I gained weight. Given the choice, it is a trade that I would make again, though. I watched my Mother gasp for air, unable to breathe properly for the last three years of her life (it’s like drowning very slowly… a very unpleasant way to go) because of cigarettes.

Maybe you can make this step work for you without the weight gain… or work on the weight issue after you’ve quit smoking. The point is… you chose to quit smoking, whatever it takes.

OK, that’s it. After you get through the hardest part (for me it was about 10 weeks), life begins to get good again. One day, I noticed that I could smell things again (and I found out why people say that smoking stinks). And food tastes better. And I could go the distance in long business negotiations. And I will more likely live long enough to play with my grandchildren (if I ever have any).

Good Luck! If I can do it, You can do it!

See you in the non-smoking section!



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