Recently, I received a call from Ram (name changed) who wanted to terminate smoking. He was wondering whether therapy can help him for his concerns regarding to abort smoking. After having an initial conversation over the phone, we planned for a consultation session.
For details about the techniques mentioned in the case study, check the references at the end of the case study
Smoking Cessation Counselling – Step-by-Step Guide to quit smoking
Consultation or Pre-coaching :
Ram : I started smoking at the age of 17 when I was staying in the hostel. Most of my friends smoked, while I resisted initially but once before the exam, I was very stressed and picked up smoking as a way to manage stress. Initially, I began with casual smoking but recently I’m noticing that with the level of stress increasing at work, I am smoking at least 4 – 5 times every day. I am now worried that this is getting out of my hands and would want to terminate smoking before my health starts getting affected severely.
As always in the first consultation session, after hearing Ram’s challenges, I began by psycho-educating Ram about the core concepts behind the process I follow. I suggested Cognitive Hypnotic Psychotherapy (which is an eclectic approach to Psychotherapy) for working towards quit smoking. Then I walked him through the pre-coaching process.
After helping him understand the therapy process, I added that in his case, once we have defined the current problem and outcome clearly, I will help him-
- Defining the Existing problem clearly
- Defining the expected outcome from the sessions clearly
- Exploring the relationship between level of stress and no. of cigarettes.
- Identify trigger for stress and other triggers that lead to smoking
- Learning alternate strategies for stress management
- Identifying the specific thoughts that he has which allow him to continue to smoke and the feelings that are stopping him from quitting smoke
- Restructuring the thoughts and reconditioning the associated feelings
Session 1: Defining Challenge and Desired Outcome
The first session focused on helping Ram define his current situation, desired outcome, and expected future.
I asked Ram to summarize the current challenge he was facing and wanted to overcome via therapy in her own words.
Ram said I am not able to end smoking
I then asked Ram to reframe her problem statement using the following format:
I feel ……………………. about ………………………… when ……………………………
I feel helpless about not being able to cease smoking when I feel stressed.
I asked Ram to read the statement a couple of times and tell me what was the desired outcome that he wanted to achieve at the end of these sessions in the format:
I wish ……………………….
Ram: I wish to be able to terminate smoking completely and manage my stress more effectively.
I asked Ram to list down all the pros of quitting smoking and cons of continuing to smoke.
Ram created a chart with a list of the pros and cons.
I asked Ram Click a photo of the same and make it the background and screensaver on his phone/laptop.
I asked Ram to describe the thoughts in his mind when he is about to pick up the cigarette.
Ram said that he did not pay attention to that.
So I asked Ram to observe his thoughts during the day and especially just before, during and after he smokes as his home assignment. I also asked him to maintain a diary to make a note of his observations.
Session 2 : Working with Behaviours
We began session 2 in the next week by asking him about the week and any changes that he noticed in his behaviors, thoughts, or emotions. Ram mentioned that while he was writing about the pros and cons he realized that he had to take good care of his health.
I asked Ram to make a list of all the things in his life that were causing stress to him.
Ram mentioned his work, the sales targets and relationship with his boss as the primary reason for stress.
I asked him to tell me what was the first thought that comes to his mind the moment he sees his boss.
Once he shared that we made a When – then*1 statement
When = Trigger
Then = New thought
Similarly, I asked him to make two more for the other 2 stressors.
He was able to make those on his own. After each statement he made, I asked him to repeat those statements several times and check if repeating them gets better. Ram asked me if he could make changes and I said Yes.
For home assignment, I asked him to keep repeating those statements for the entire week.
Session 3 : Working with Behaviours continued….
In the third session, Ram reported that he had started feeling better in the past week. I asked him if he could see some observable changes in his behavior in all three situations. Ram reported that 2 situations were good but he still had some anger towards his boss.
I decided to do the empty chair technique with Ram, wherein I took Ram into a deeply relaxed state through a guided imagination process where I asked him to imagine his boss sitting right in front of him and asked him to vent out all his anger. I asked him to take his time and nod to me once he’s done. Ram nodded towards me, I asked Ram in the imaginary state to take his boss towards the exit of the room.
I further asked Ram how he was feeling, and he said he felt Relaxed. I asked him to tell me 3 future situations where he would like to feel relaxed. Once he told me about those situations, I did the NLP Anchoring*2 process.
At the end of the session, Ram looked visibly relaxed through his pitch and body language.
Session 4 : Working with Emotions
In the fourth session, Ram reported that he had started feeling better in the past week. He also mentioned that he felt relaxed when he met his boss in the past week. Ram reported that as the new month is approaching, he was a bit worried about the work. I next used Guided Imagination and Relaxation Technique*3 to help Ram feel more relaxed. I taught him breathing exercises for relaxation and stress management.
I asked him to practice these techniques every day in the morning after waking up and in the evening just before sleeping.
Session 5 : Working with Emotions Continued…
The fifth session began by asking him how his previous week was, he said he felt lighter like never before.
I taught Ram how to use When-then statements for restructuring his thoughts related to smoking.
I also used the emotional anchoring process to condition the smell of garbage with the act of smoking.
I used the N-step reframing process to help him identify the secondary gain behind smoking and finding alternate behaviours to be used for fulfilling the secondary gain without depending on smoking.
After this process, I asked Ram to take out cigarettes and literally break them into small pieces.
Ram did as asked and said he somehow feels free now.
Session 6 : Closure
At the beginning of the session, Ram reported that he was able to quit smoking for the last two weeks continuously and that he did not even feel like smoking any longer.
I taught him Self Hypnosis*4 for future concerns.
The N-Step reframing process was completely new for me and I was not sure if the process would work but it did and there was an observable difference in the client’s attitude towards smoking after the process.