Smoking addiction is a global affliction that affects millions of active and passive smokers, with common smoking-derived health issues including cancer, lung diseases, diabetes, depressive symptoms, moodiness, and anxiety. The FDA has recognized two forms of medication, certain nicotine replacement treatment (NRT) products such as patches, lozenges and chewing gum, and Deep Transcranial Magnetic Stimulation (Deep TMS) as safe and effective ways to facilitate smoking cessation. In addition to these methods, a number of psychotherapy options have recently gained attention as standalone and supplemental ways to work toward cessation. When it comes to ways to quit smoking, therapy (specifically talk therapy) can offer the necessary support to reach and maintain this goal.
Psychotherapy is also able to assist smokers reluctant to turn to medication or medical device treatments in their cessation process, and those looking to boost the results of such options. Additionally, with psychotherapy and counseling gaining wider public acceptance in regard to mental health issues and neurological conditions, primary care physicians are referring more of their patients to mental health professionals who can assist them with a variety of concerns; among them, smoking addiction.
Read on to discover some of the more effective and recommended smoking cessation-focused forms of psychotherapy.
Cognitive-behavioral therapy (CBT) developed out of the “cognitive revolution” of the 1950s-’80s, which aimed to gain a deeper understanding of the mental processes and how the mind works. CBT specifically has been found to be highly effective in facilitating smoking cessation.
CBT helps identify the patient’s feelings, thoughts, behaviors, and bodily reactions they have learned to associate with their smoking addiction. Bringing these aspects of their smoking experience to the forefront helps them develop a better grasp on the ways they normally respond to the urge to smoke, and the frustration that arises when they refrain from smoking.
As a result of CBT, patients are able to begin deconstructing the maladaptive responses they have constructed for themselves, which over time have contributed to their dependence on cigarettes. Instead, they are able to start considering new ways of reacting to the physical and mental withdrawal symptoms they have become used to experiencing when they have refrained from smoking.
Behavioral therapy has also been found to help individuals quit smoking. This form of therapy highlights the contextual factors that make it difficult for smokers to avoid a relapse. Such factors can include social, environmental, and behavioral cues that have been linked to the calm and relief induced by nicotine smoke inhalation.
Research from the last 20 years has found both brief and long-term intensive behavioral therapy treatments to increase the percentage of adult smokers successfully quitting and remaining nicotine-free over time. The treatment aids smokers by equipping them with strategies to avoid tempting triggers and manage cravings and thus reduce the severity of their experienced withdrawal symptoms. These include a focus on the source of the patient’s incentives to quit, identifying their personal triggers to smoke and coming up with ways to manage them, managing their fluctuating moods (particularly while going through the withdrawal process), and learning how to support their own cessation journey following treatment.
Initially developed as a way to treat alcohol addiction, motivational interviewing was eventually adapted for tobacco cessation. This form of counseling relies on a non-confrontational, nonjudgmental, and collaborative style of dialogue. This aims to help patients to work through the hesitation and ambivalence that many of them experience when faced with the daunting task of quitting smoking.
Motivational interviewing is normally used with patients who are not yet fully committed to their own cessation and who would likely benefit from discussing their concerns with available support as they begin this process. Expressing empathy, actively listening, working through their comments, and building their belief in their ability to achieve cessation are at the heart of this technique.
Empirical evidence has shown that when motivational interviewing is performed by clinicians or trained counselors, it is more effective in increasing the patient’s readiness to quit, versus brief sessions of advice-giving or self-help materials.
Though its efficacy with smoking cessation has not yet been fully established, acceptance and commitment therapy (ACT) has been proven to facilitate general behavioral change. Like CBT, ACT grew out of the cognitive revolution. But while CBT attempts to break down and better recognize the different aspects that comprise the patient’s link to smoking, ACT seeks to build up the patient’s sense of agency, through the belief in their ability to change how they respond to and manage their addiction.
Rather than trying to minimize the frustration and unpleasant physical withdrawal symptoms that arise when they refrain from smoking, ACT leans into them, and works to hold the patients steady when faced with these stimuli. This treatment aims to accept and encompass such unpleasant sensations, instead of constantly running from them.
After the foundation of acceptance is established within the treatment, the patient and therapist are able to turn their attention to the patient’s willingness to commit to successfully quitting smoking. This is done by focusing on their values and on the motivations driving them to quit.
Hypnosis has also been shown to assist with smoking cessation. Patients who undergo hypnosis remain conscious and in control throughout the session, but are able, through the therapist’s guidance, to focus on the ideas and connections introduced during therapy. As a result, they begin associating cigarette smell to an unpleasant sensorial experience, such as exhaust fumes. This causes a repulsive sensation to arise when they are around cigarettes, encouraging them to avoid these scenarios moving forward.