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In Smoking Cessation, Dr. Bonnie J. Spring demonstrates her behavioral approach to helping clients quit smoking. Nicotine addiction is a psychological as well as a physical phenomenon, so this approach focuses on recognizing the triggers for smoking and learning new ways to react to those triggers by replacing smoking with other behaviors.
In this session, Dr. Spring works with a 42-year-old woman who is also a recovering alcoholic. She first looks at how the client is conflicted over smoking, cataloging what attracts and repels the client about the habit and, without pressuring her, tries to move the client toward choosing her own path toward smoking cessation.
Approach
Multicomponent behavioral treatment to help individuals quit smoking integrates different intervention techniques that have been empirically validated to promote smoking cessation. Cigarette smoking is conceptualized as a biopsychosocial phenomenon. An underlying premise is that some smokers are physically dependent on nicotine and can expect quitting to bring on withdrawal symptoms. In addition, all smokers are psychologically dependent on smoking and need to learn new skills that will enable them to react to triggers by substituting new behaviors in place of smoking.
Treatment design is tailored to the individual and is based on an initial assessment of the pattern of smoking behavior and reasons for smoking. The client self-monitors the triggers and consequences of smoking to establish the temporal pattern of smoking urges and the contingencies that reinforce the habit (see Fagerstrom Tolerance Scale and Pack Wrap Log [PDF: 13KB]).
That information, paired with the client's self-perceived reasons for smoking, supports a functional analysis of the behavior pattern, which reveals how the smoker self-administers nicotine to self-regulate negative mood, other comorbidities, appetite and body weight, concentration, or pleasure.
As clients learn their smoking cues, they develop new skills in avoiding triggers and responding to smoking urges by performing behaviors incompatible with smoking. Through behavioral experiments in which they successfully resist the urge to smoke, clients increase self-efficacy, begin to build new habits, and learn healthier ways of giving themselves pleasure.
Treatment may incorporate cessation aides, such as nicotine replacement or pharmacotherapy whose efficacy in quitting smoking are supported by research evidence, if use of the tool meets the client's treatment preferences. Motivation to quit is heightened by the use of scaling exercises that highlight discrepancies between being a smoker and core personal values. Clients are encouraged to identify and use social supports to sustain motivation and buffer against the challenges associated with quitting.
About the Therapist
Bonnie J. Spring, PhD, is currently a professor of psychology at the University of Illinois at Chicago and research scientist at Hines Hospital VA Medical Center. She is a licensed clinical psychologist and a diplomate of the American Board of Professional Psychology in health psychology. Her major research and clinical interests focus on the mechanisms that underlie cigarette smoking and obesity and on developing interventions to promote smoking cessation and other healthful behavior changes.
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Suggested Readings
Borelli, B., Spring, B., Niaura, R., Kristeller, J., Ockene, J., & Keuthan, N. J. (1999). Weight suppression and weight rebound in ex-smokers treated with fluoxetine. Journal of Consulting and Clinical Psychology, 67, 124–131.
Hitsman, B., Pingitore, R., Spring, B., Mahableshwarkar, A., Mizes, J. S., Segraves, K. A., et al. (1999). Antidepressant pharmacotherapy helps some smokers more than others. Journal of Consulting and Clinical Psychology, 67, 547–554.
Hitsman, B., Spring, B., Borrelli, B., Niaura, R., & Papandonatos, G. (2001). Influence of antidepressant pharmacotherapy on behavioral treatment adherence and smoking cessation outcome in a combined treatment involving fluoxetine. Journal of Experimental and Clinical Psychopharmacology, 9, 355–362.
Johnsen, L., Spring, B., Pingitore, R., Sommerfeld, B. K., & McKirnan, D. (2002). Smoking as subculture: Influence on Hispanic and Caucasian women's attitudes about smoking and obesity. Health Psychology, 21, 279–287.
Mizes, J. S., Sloan, D. M., Segraves, K., Spring, B., Pingitore, R., & Kristeller, J. (1998). The influence of weight-related variables on smoking cessation. Behavior Therapy, 29, 371–385.
Richmond , M., Spring, B., Sommerfeld, B. K., & McChargue, D. (2001). Rumination and cigarette smoking: A bad combination for depressive outcomes. Journal of Consulting and Clinical Psychology, 69, 836–840.
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