How to stop smoking – Part 2
Did you know that 500,000,000 people alive today will die ten years prematurely because of tobacco smoking? Yes, five hundred million!
In my previous article, I discussed why you should stop smoking. This month we look at how you can quit smoking. Stopping smoking brings you enormous benefits, but stopping can be hard. Even though you understand the risks, you continue to smoke because you are addicted to tobacco or more specifically the nicotine in the tobacco, one of the most addictive substances in the world.
Most persons who stopped smoking did not quit through a formal programme.
Four decades ago, psychologist James Prochaska and his graduate student Carlo de Clemente decided to find out how these self-quitters did it. Their model with the rather off-putting title ‘The transtheoretical model of behaviour change (TTM)’ developed in the late ’70s has become the most popular model for behaviour change. Three books written for the public; Changing for Good, Changing to Thrive and Changeology, all available online on Amazon, also are helpful.
Let me simplify the TT model for you. Prochaska and DiClemente found that a successful quitter moves through six stages of change:
These stages apply to all attempts of behaviour change and persons trying to overcome problems such as with alcohol, substances, gambling or obesity. Hence, they can help overcome a range of difficult problem behaviours.
The six stages are:
Precontemplation – the person is unaware of the problem even though it is visible to others.
Contemplation – the person is aware there is a problem but is not yet ready to do anything about it.
Preparation – there is heightened activity, and the person is now actively getting ready for action.
Action – the person has started new behaviours and in the case of smoking, has quit.
Maintenance – the quitter struggles to prevent lapses and relapses and strengthens the gains made in action.
Termination – Successfully gets rid of the problem behaviour.
The time spent in each stage may vary. Though Prochaska and DiClemente initially thought the model was linear, they later realised that smokers on average went through 4 to 5 cycles before finally quitting. Thus, the model can be looked at as a cycle or spiral (since individuals do not slip back to precontemplation always).
The first step in quitting smoking is to identify the stage you are in. In precontemplation, you will not be aware of the problem. But concerned family, friends or your doctor would have brought it to your notice. Be alert to these warnings and do not dismiss them without at least some thought. Remember that you can be at different stages for different problems. For example, you can be in the contemplation stage for smoking but in the action stage for regular exercise. The stages are specific to the problem. It is important to identify the stage, as in each stage there are certain actions which are more likely to be successful.
So what you can do if you are a smoker, to move from one stage to another? If in precontemplation, listen to your friends, family or doctor. Remember that there is a common psychological defence people use in this stage, called denial. Denial is a refusal to acknowledge unpleasant occurrences.
Another defence is rationalisation – offering plausible explanations for your behaviour even if that behaviour is irrational. So, if you are a smoker in precontemplation, stop and think, ‘am I in denial?’ Are you rationalising by saying ‘I really don’t smoke that much’. Remember, with smoking, there is no safe limit. All smoking is harmful to health.
A supportive relationship is important in this stage. Our defences rarely fool others, especially those close to us. If you are helping someone to quit smoking, here are a few things you should know. Don’t try to push a person to take action. Encourage but do not force. But remember that avoiding discussions and confrontations altogether, or excusing the person for his behaviour will not help either.
Once fully aware of the problem, you are in the contemplation stage, when smokers will talk about their problem and actively seek information. Sometimes people get stuck in this stage and never move on. They want to stop but they don’t and keep postponing the day of quitting.
Why this ambivalence? Psychologist James Bugental called the fear of change “a fate worse than death.” However healthy change may be, ultimately, it initially threatens our habitual way of being. Humans are creatures of habit, and any shift from the habitual groove of living is threatening. But don’t put off quitting for too long. Though premature change can be harmful, delaying long is also harmful.
Emotional arousal is a powerful force. You can use it to shift onwards from contemplation. There are a variety of emotional arousal techniques that can be useful. Watching a movie/documentary on the subject is one. Yul Brynner’s final interview on YouTube on how he got lung cancer because of his heavy smoking is a powerful example. Watch it. If you want a more contemporary celebrity, just Google.
Another technique is to make a balance sheet of the pro’s and con’s of smoking. Think of it under four categories: Consequences of change to self and others and reactions of self to and others because of change.
Preparation is the next change. This takes you from the decision to quit smoking to the specific steps necessary during the action stage. Continue to re-evaluate the problem. Focus on the future. Visualise a positive vision of your life once you quit smoking.
Commitment to change is also part of preparation. For example, a smoker should remove all cigarettes from the house and office, including any smoking paraphernalia. Now set a date and announce to your friends and family that you are quitting on that date. It takes courage to go public but will help prevent relapse if your resolve weakens.
Now you are in the Action stage. Here a useful technique is called countering – substituting healthy responses for problem behaviours. There are many you can choose from depending on your interest. One of the most beneficial is exercise. This is an essential part of any quit programme. You don’t have to run a marathon, but a routine of aerobic exercise – running, walking, skipping and swimming should take less than 20 minutes.
Controlling your environment is also important. Avoid friends who smoke and avoid situations where people are likely to smoke. Making public areas and vehicles smoke-free have gone a long way to help people quit smoking.
In maintenance, you are sustaining the changes you have made over a period of months and years. It is easy to slip back, as craving for nicotine is a powerful drive. The commonest threats to maintenance are social pressure and special situations. If you make it through to termination in one round you are exceptional. Most don’t. Relapse is a part of the change, not a disaster. It is unlikely you will slip right back to precontemplation. Try again and each time it will get easier.
Most persons stop smoking without professional help. But sometimes expert help can expedite the process. If you are a smoker, quitting smoking is worth it, for you as well as your family. Keep trying and you will succeed.
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