Sunday, November 8, 2015

THE EVER EFFECTIVE APPROACH TO QUIT SMOKING- By R.Manoj Clinical Psychologist Psychotherapist and counselor, Chennai

             A good percentage of people who smoke want to quit the habit, few who understand the physical and psychological damage it can do to them and many because they feel that the they are losing control over the habit and its going well beyond the levels at which they want to maintain it and some because it eats into their pocket. They even express the wish to quit which only follows their version of inability to do so and a feeling helplessness. A considerable number of people make plans to quit and even fix up the dates to quit only to find, some excuses to postpone it.  Few even take some measures to quit such gradual reduction in the number of cigarettes they use everyday only to see that they lose control very soon. Few even quit complete only to get back in to the habit within a few days at the slightest provocation.
          Smoking is more of a habitual behaviour than the physical need for nicotine for whatever the purpose it may serve. The habituation is consistently maintained by the various factors such as the cost involved in each smoke, the ease at which it can be possessed, carried and used, the absence of social stigma associated with it and its lack of impact on the functional capacity of an individual, rather a irrational belief that it helps in improving the alertness and functional ability.
            The commencement of the habit can be mostly traced to the mid or late adolescence or early adulthood, usually with a social smoke, either under peer pressure or as crowd behaviour with the intention to be an integral part of the young energetic risk taking community rather than being an odd man out who sticks to his principles. In some cases it is just done which the intention to mimic the machismo appearance and personality of some film actor whom they adore. Tobacco companies working all out to increase their profits by issuing subtle attractive ads and sponsoring events which have mass following where their ads about their products just coerce anyone to give a try has its own role in people taking up the habit.
      Later this practice becomes a widely used method for having short breaks from continuing activities or as mechanism for distracting from preoccupations associated with stress, fear, anxiety, depression or even boredom. Associating this habit with regular activities of day to day life such as having a smoke after every coffee or tea, every meal, every snack and even as a positive reinforcement when some immediate goals are achieved, making it an automatic response to such activity is another factor that helps in maintaining is consistency. Availability of a smokers around who would willing offer a cigarette even without you asking for it, and many a times force you to take one, just for the sake of giving them a company and lack of assertiveness on the part of most of the smokers to say a no to such offer is another important factor.
        The consistent maintenance of the habit gradually leads to status where it seems as natural as eating and sleeping and cigarettes becomes an essential ingredient of everyday life such as water and air.

How to quit smoking

Step 1: Prepare

Level 1: make the indispensable plans

      Most of people who smoke fail to quit because of the false belief that the habit of smoking is well within their control and they can quit smoking whenever they want. The first thing anyone has to do is to get over this belief. Realize that smoking is a very difficult habit to quit and it cannot be done unless and otherwise you are willing to go through a tough initial period of abstinence.
  • Plan for complete exit not a partial one or gradual reduction
  • List down the merits and demerits of the habit. Analyze the details to confirm whether you should really quit. While analyzing the details, if at any point of time you feel that there are some benefits of continuing the habit, be clear that its going to be vey difficult for you to quit and you really need to take some extra burden on yourself if you really want to quit
  • List down all the stimulus triggers the intention of smoking. It may well be anything from having tea, coffee, meals to whenever you feel down, stressed or bored. Sometime it may be a planned one like having a fag every hour or whenever your friend or colleague offers one. Maintaining a journal to record of each time you smoke and the antecedent incident will help in having the complete details of the instigators.
  • Highlight the situations in which you have intense craving to smoke
  • List down the names of all your friends who smoke and highlight the ones who offer you a cigarette whenever you meet with special reference to people who start discussions only after they light a cigarette
  • If you are preparing a journal also list down whether having a smoke had just helped you to distract yourself from and unpleasant feeling which you have been preoccupied with or whether it has provided a relief. If so identify the problem or the feeling and list it down
  • Also list down the alternative activities which can provide you the same level of distraction or the methods in which you can really get over the overwhelming negative feelings
  • If you have tried being abstinent earlier, list down the negative feelings and any specific physical symptoms you had while you had been maintaining abstinence. Also note down the incident which resulted in your failure to continue the same.


Level 2:prepare yourself

  • Get the knowledge about the various withdrawal symptoms that you may experience and the time period it may be present when you quit smoking
  • Develop the belief that all the physical and psychological distress you undergo will cease to exist in a few days and you need to  go through these short term sufferings for long term befits
  • Develop assertiveness altleast to say” NO” to anyone who offers you cigarettes and “NO” to yourself whenever you have an intense craving to smoke
  • Get trained in a few relaxations techniques, the most suitable one being the Jacobson’s progressive relaxation technique
  • Decide a date and time to quit. Always remember that today is the best day. You can even do the level one preparation after you have decided that you are quitting.
  • Discard any cigarettes in your possession, without worrying about wastage of resources because sometimes your intention to quit after exhausting all the available recourses may become a never ending process
  • Remove all the products associated with smoking such as ash trays, mouth fresheners, lighters etc in your vicinity that may remind you of your habit
  • Take a short break from any professional demand such as working long hours in the night or stressful deadlines which can increase the intensity of craving
  • List out a number of activities of your interest and start doing it
  • Prepare yourself to counter the de-motivating comments or intentions from people around you or the smoking populations intensions to isolate you for your decision. Have the clarity that they are exhibiting these behaviours just to cover up their own helplessness and failure related to quitting

Level 3: prepare your environment

  • Inform everyone around about your plans to quit and once you have quit and ask for their support to maintain it
  • Tell your friends and other social contact assertively that they should not offer cigarettes whenever you meet
  • Ask your friends and loved ones to remind you of gaol of total abstinence frequently and to restrain you whenever you exhibit any symptoms of relapse


Step 2 sustaining abstinence

  • Don’t have cigarettes or tobacco related products or any products which remind you of smoking in your vicinity
  • Don’t have any doubts about you decision or your capacity to quit because self doubts are slippery and it may gradually break down your confidence and efforts to quit.
  • Remind yourself about the antecedent activities such a having a meal, coffee etc, which trigger your intention to smoke to avoid doing it whenever you involve in the activity
  • Find a healthy alternative such as having a fruit or nuts or mouth freshening spices such a cardamom 
  • If there is any antecedent activity that you can avoid, avoid it
  • Keep yourself engaged with activities of interest and entertainment
  • Start maintaining a consistent schedule for sleeping. This will help in overcoming any sleep disturbances that may arise after you quit.
  • Also develop the practice of consistent schedule for eating and having a healthy balanced diet.
  • Start practicing some physical exercises or yoga in the morning to make your body and mind active which will help you to overcome the withdrawal symptoms such as depression, fatigue and constipation
  • Practice some relaxation exercises preferably Jacobson’s progressive relaxation to overcome the withdrawal symptoms of restlessness, anxiety , irritability etc. This can also help in improving the concentration. Controlled breathing or pranayma can also be very effective.
  • Remind yourself the reasons based on which you decided to quit and the possible benefits from your decision
  • Remind yourself that you are not a loner by being a non-smoker, there is a good percentage of people who are non-smokers with whom you can have sociable and friendly relationships.
  • Avoid tempting situations such as being in the company of smokers, who me even compel you to smoke
  • Challenge the irrational thoughts associated with smoking that arise time and again such as “smoking relaxes you”, “making you function effectively” with rational thoughts that there are safe activities which can help you to achieve the same. Support these rational thought with various benefits you  enjoy being a non smoker.
  • Avoid places which is associated with your smoking habit
  • Be assertive and say an emphatic “NO” to anybody who offer you a smoke, irrespective of who they are and what consequences you may have to face by doing so. Understand that accepting it will harm you more than anything else
  • Whenever there is intense craving to smoke try to distract yourself from the thought by involving yourself in any activity that can really be interesting or that can keep you mind occupied. Activities such as listening to music, solving puzzles, reading stories or novels etc can be very helpful
  • Overcome your oral carving by taking water or healthy fluids such as fresh fruit juices or snacks frequently
  • Overcome your psychomotor craving associated with your fingers by drawing or just scribbling on paper or even squeezing a ball, whenever you have a sense of restlessness in your fingers. Even playing games on mobile can also be useful. But be careful not to get addicted to that habit.
  • Avoid stressful situations if possible, but the better way is to learn stress management techniques and use them to overcome your stress and anxiety
  • Avoid being awake in the night for long time. Better to avoid even professional demands of staying awake in the night. If you cant avoid it try some other methods such a frequent short walk, having water frequently etc to keep yourself alert and awake.
  • Avoid all alcoholic beverages because it may bring down your capacity to control psychological cravings
  • Save the money you spend every day for cigarettes on a day to day basis. Use the money to buy yourself or your loved ones a gift periodically
  • Provide positive reinforcement to yourself in the form of rewards periodically. But be careful that that your reward is not a smoke.
  • Make a list of the situations in which you wanted to smoke and how you overcame your intensions on a day to day basis. Appreciate yourself for doing the same. As days go by you can see that the numbers decrease which by itself will keep you motivated.
  • If there are any specific alternative activities which you feel as easy and effective try doing it frequently whenever the intensions arise
  • Preferably don’t use any substitutes such as nicotine coated gums, or nicotine replacement therapy using nasal sprays or patches because it may only sustain the nicotine addiction. if you really feel that you need a substitute you may use normal gums, nuts etc
  • Get feedback from your loved ones and non-smoking friends on how it has helped them.
  • Start advocating the harmful effects of smoking among your friends who smoke and others. This will help in reminding you of the need to quit completely and at the same time help you in having a social control, because after advocating a cause you know that you can never smoke in their presence again at any point of time.
  • Have the clarity of thought that now you are a non-smoker and you have an healthy life like every other non-smokers. 
  • Always remember that you are only one cigarette away from being a smoker.  By taking even one puff you have lost the fight to quit and to achieve your goal you need to take extra efforts and self control
  • Even if you slip don’t give up, try to learn from your experience about what triggered your slip, evolve methods of handling it effectively and get back with more vigour to fight the habit

Tuesday, October 20, 2015

30 REASONS THAT MAKES QUITTING THE HABIT OF SMOKING DIFFICULT

Article by R.Manoj, Clinical psychologist, Psychotherapist and counsellor, Chennai
Its a well known fact that smoking tobacco is “INJURIOUS TO HEALTH” as prominently displayed on the cover of cigarette boxes which also has the photograph of a cancer affected patient which by itself should cause aversion towards the habit. More than 90% of people who smoke know that it can cause cancer and nearly the same percentage of non-smokers understand the impact of passive smoking.  But most of the habituated smokers just ignore or overlook the caution and their knowledge, because they believe that they cannot quit. Listed here are the 30 reasons that make quitting the habit of smoking difficult
1.    Smoking is more of a psychological habit rather than physical demand
2.    There is a strong feeling that it’s a very simple habit, it is not addictive and you can quit whenever you want to.
3.    The health hazards are not visible and the impact is known when it reaches a chronic stage
4.    Smoking is a habit which nearly everyone can afford to have. The cost of one time usage is very less when compared to any other habit, even though the cumulative cost may be very high and everyone has a choice according to their financial capacity.
5.    The habit seen as a very natural one such as eating, breathing and sleeping
6.    There is no social stigma associated with smoking
7.    Getting in to the habit of smoking is treated as a part of normal developmental process and not as an harmful habit
8.    The habit of smoking is believed to help you to create and maintain social circle with ease
9.    It is easy to carry and use
10. It enjoys the freedom of any where any time which is not possible in other addictive habits
11. It is felt to be the best way to get engaged while taking short breaks
12. It is supposed to be the best way to distract yourself from the thoughts associated with stress and distress
13. Availability of a number of successful role models who have the habit of smoking
14. Nearly every movie has at least one character that smoke and in most of the cases the prime hero himself using smoking on various positive and negative situations there by advocating the habit
15. It is believed that smoking can relax you whenever you are anxious of tensed
16. There is always a circle of friends or colleagues around you who motivate or even force you to smoke
17. It’s the easiest way of getting yourself in uncommitted engagement whenever you are bored
18. Smoking is believe to help in maintaining alertness, attention and concentration
19. It’s also believed that smoking can increase the courage and confidence.
20. The strong belief that once a person enters the habit he will never be able to quit and it needs extraordinary will power to quit
21. In many cases smoking is pursued more as a ritual without understanding why they do it and what they get out of it
22. The stimulation associated with smoking is mild and it never affects the functional abilities of an individual
23. There frequent reminders which remind you to have a smoke from various quarters such a people around, the attractive ads by tobacco companies done with the only motive of market their product etc.
24. The belief that the physical posture of smoking, manifests a macho effect.
25. The strong belief that there is something really useful in smoking and you cannot reject the fact just because you don’t feel it based, on the idea that if there is no real effect why a good percentage of the population are involving in it.
26. The strong feeling that you are missing something if you don’t smoke, what other people are enjoying
27. Most of the smokers never explore the reasons on why they should quit
28. There is significant fear associated with sustaining the decision to quit
29. The fear that you will be isolated if you are a non-smoker

30. The irrational reasoning by majority of the smoking population that there are lot more harmful things that are a part of our day to day life and which cannot be avoided such as air pollution. Also these people quoting the life span of smokers who have had reasonably long life and leaving out the scores of people who have died early due to their habit, just to prove the point that smoking does not reduce your lifespan. This can virtually break down your belief that smoking is harmful