The behavioral therapy for smoking cessation is a therapeutic procedure of psychology and psychoanalytics, which is to support the smoker in giving up smoking with the help of a so-called reconditioning. This reconditioning is the basis for the therapeutic procedure and describes the abandonment or the change of an existing stimulus-response pattern. The conditioning is seen as a subsequent reaction to a stimulus. However, for reconditioning to occur, it must be assumed that smoking is a response to a stimulus and thus has been “learned.” Behavioral therapy for smoking cessation can be conducted using a variety of psychoanalytic methods. However, the methods all have in common that as a goal of the procedures, the existing conditioning is extinguished and reconditioning takes place with the help of a substitution (exchange) of the action. However, to carry out behavioral therapy, linear problem solving is not useful; instead, a promotion of both motivation and other factors, such as the social environment and the support arising from this, must be carried out.
Indications (areas of application)
- Prevention of secondary diseases
- Secondary prevention of already existing diseases – e.g. chronic obstructive pulmonary disease (COPD) or hypertension (high blood pressure).
- (Part of the) rehabilitation after diseases associated with smoking.
- Protection of non-smokers
- Protection of the unborn child during pregnancy
Contraindications
If the smoker finds the procedure unsuitable for quitting smoking, this should be taken as a sign of a necessary discontinuation of therapy, since no success can be achieved on the basis of cessation. However, there are no medical reasons for the compulsory abandonment of the procedure.
The procedure
In order to conduct successful behavioral therapy for smoking cessation, an individual assessment of addictive behavior is essential. However, various factors can be demonstrated for emergence of smoking behavior. Regardless of the behavioral therapy method chosen, the probability of permanent smoking abstinence increases significantly. However, in addition to the general success rate, it is important to keep in mind when selecting a procedure that not every patient has the same desires and needs in therapy, so an individual assessment of the patient is necessary. Conditions for the development of addiction
- Attractiveness of smoking – the attraction to smoke is not initially generated by biological factors, but instead by social conditions. Especially role models or peer groups (classmates or friends and acquaintances) and the image of smoking primarily lead to the uptake of smoking behavior. In particular, the image created in advertising of the association of freedom and self-determination with smoking represents a stimulus to which adolescents in particular react by starting to smoke. On the basis of this, reconditioning can only be achieved if the image is erased, which primarily contributed to the uptake of addictive behavior.
- Perceptual distortion – looking at tobacco addiction from the perspective of psychoanalysis, smoking can be represented as a disorder of the ego. The disorder is based on a weakness of the ego, which is accompanied by altered perception and thus represents a direct defense mechanism. Thus, smoking represents a compensation for this weakness. Therefore, behavioral therapy stimulates that the patient’s perception is corrected, so that a permanent freedom from smoking can be achieved.
- Nicotine intake through tobacco use – although behavioral therapy is an exclusively mental process for addiction treatment, it is crucial to note the function of nicotine and the impact on the human organism. Tolerance development is particularly problematic with nicotine, as the amount needed to reach the same state as at the beginning of addictive behavior can only be achieved through increased intake. In addition to the effect of vasoconstriction, the substance leads to an increase in well-being, alertness and reduction of anxiety.In addition, the feeling of hunger is significantly reduced, so that especially young women use the cigarette for weight reduction. However, the release of hormones such as serotonin, which among other things cause feelings of happiness, is particularly problematic. However, these positive effects of smoking must be put into context with the disadvantages by the treating therapist in order to achieve a cessation of addictive behavior. For this purpose, the withdrawal symptoms are addressed, which include a strong desire to smoke, irritability, restlessness, frustration, anger, negative mood, anxiety and sleep disturbance.
Methods of behavioral therapy for smoking cessation.
Brief intervention
- Smokers are often at a stage where they would like to quit the addictive behavior, but do not make precise plans for quitting. The brief intervention intervenes at this point, in which increased motivation of the smoker to give up the addiction should be achieved.
- As a strategy serves, for example, the motivational strategy according to Schmidt, in which, in addition to the query of the smoking status, an advice to give up and a motivational enhancement are carried out. The goal of this motivation enhancement is the realization of the smoker that only through an agreement with a defined time a smoking stop is feasible. In addition to the agreement, however, an active and on the person related assistance must be given by the therapist.
- Of crucial importance, however, is also the relapse prophylaxis, which is done with the help of follow-up appointments after the actually completed treatment.
- The basic principle of brief intervention is based on different approaches to smoking cessation, which must be combined for successful therapy. It is necessary both a demonstration of the positive effects of quitting smoking in terms of health and social factors, and a precise naming of the risks of maintaining the behavior. It is also necessary to determine and name possible factors that may make quitting difficult, in order to find ways to work around these factors. Should a person relapse, new motivational strategies are important.
Group therapy
- Compared to individual therapy, group therapy offers the possibility that the therapy takes place together with other affected persons and thus a positive effect is achieved through social support. As a rule, treatment comprises between three and ten appointments. However, the basic principle of group therapy varies only slightly from the individual intervention.
- Analogous to this method, group therapy in the first phase also determines and promotes motivation. As measures of the first phase can be called, for example, the advantage justification for quitting the addictive behavior or a balance for decision-making.
- In the second phase of therapy, the treatment focus is on self-control methods that serve to ensure that no relapse into addictive behavior can occur. This is done by, among other things, avoiding settings (situations) that might tempt the patient to smoke. Alternatives to smoking are also mentioned and evaluated (assessed) in the second phase.
- The third phase of therapy is mainly aimed at stabilizing the learned behavior pattern. The freedom from smoking should be supported, for example, by sports activities.