I remember how relieved I was when the smoking ban came into effect and the air in pubs and restaurants was no longer filled with cigarette smoke. I guess the aim of the policy was not only to protect the health of those of us who don’t smoke but also to encourage smokers to quit. Most of us understand that discontinuing an addictive habit is not that simple but what exactly is involved in quitting and why is it more difficult for some?
Most attempts to quit smoking, especially without help, result in failure (West, 2012). This is at least partly due to unpleasant withdrawal symptoms such as irritability, anxiety, low
mood, problems with concentration and difficulty sleeping (Hughes, 2007). However, success also depends on an individuals characteristics such as their ability to tolerate discomfort (Sirota, Rohsenow, Dolan, Martin, & Kahler, 2013) and distress, i.e. unpleasant psychological states (Leyro, Zvolensky, & Bernstein, 2010). If we believe that we can withstand the withdrawal symptoms, then we are much more likely to be successful, especially if we also reappraise the experience and tell ourselves that it will be worth it in the end. Some research also suggests that people smoke in order to soothe anxiety and negative feelings in the absence of better ways of coping with these unpleasant emotional experiences (Leyro et al., 2010). Thus, the nicotine users becomes trapped in a vicious cycle where they smoke because they believe that a cigarette will soothe their negative feelings, and smoking becomes a rewarding activity through its association with reduced distress. In other words, the less we can tolerate unpleasant feelings, the more rewarding smoking becomes.
Certain health problems, such as posttraumatic stress disorder (PTSD), can also make quitting smoking harder. This is due to the increased negative emotions, greater arousal, anger, and anxiety associated with such disorders. With regard to anxiety, a ‘fear of fear’ can also cause elevated worry, specifically worrying that stress/anxiety could have a harmful effect on our health (Kashdan, Zvolensky, & McLeish, 2008; Powers et al., 2016) therefore further diminishing an individual’s ability to cope (Leyro et al., 2010). Increased negative affect and severity of withdrawal symptoms also plague those with social anxiety who attempt to quit smoking (Buckner, Langdon, Jeffries, & Zvolensky, 2016). These additional difficulties are particularly important considering that those of us who have mental illness tend to smoke more and die earlier (Ziedonis et al., 2008). In addition, PTSD affects up to 30% of women who give birth (Grekin & O’Hara, 2014), and can therefore interfere with smoking abstinence among the new mothers addicted to nicotine.
Psychological therapy which teaches smokers to accept their internal feelings and sensations can considerably improve chances of quitting compared with standard intervention (quit planning, skills training, advice on pharmacotherapy, and social support for quitting) for smoking cessation (Bricker, Wyszynski, Comstock, & Heffner, 2013). For example, Acceptance and Commitment Therapy (ACT) encourages the individual to allow the thoughts, emotions and sensations that trigger smoking to come and go without attempting to control them. The resulting increased acceptance of these feelings allowed 23% of participants to remain smoke free up to 3 months after the therapy, compared with only 10% of those relying upon standard intervention alone. ACT also performed better than cognitive behavioural therapy (30% vs. 13% abstinence rate at 1 year) (Hernandez-Lopez, Luciano, Bricker, Roales-Nieto, & Montesinos, 2009).
It seems that the struggles with our own unpleasant feelings and the need to escape them play an important role in managing addiction: quitting smoking is not just about willpower or awareness of its harmful effect. Although this area needs a lot more research, it might be worth looking for help in increasing acceptance and mindfulness when battling withdrawal symptoms.
Post by: Jadwiga Nazimek
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