Psychological Self-Help

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149
"Relaxation" smokers need to find some other relaxing activity, like
reading, knitting, walking, etc. Smoking for concentration under stress
could be replaced by tapping your fingers, chewing gum, stroking a
smooth stone. For "boredom" smoking, you could substitute a fun
mental or physical activity. For "emotional-stress" smoking, substitute
relaxation (Methods #1, #2, & #5 in chapter 12). Any new activity
that also improves your general health or is just plain fun, e.g.
reading, napping, joking, playing with the kids, cuddling, can be
substituted for a smoke. All these things make stopping the bad habit
easier. 
As described in the classical conditioning section early in the
chapter, cigarettes are paired so often with reducing high anxiety that
the smoking process becomes a temporary tranquilizer. Thus, if we
become anxious, angry, or depressed, smoking (or the smoking
"break") becomes a brief self-medication for these unpleasant
emotions. If cigarettes have soothed our stress or hidden our
depression many thousands of times, it may become harder to quit
smoking because we are both withdrawing from an addictive drug,
nicotine, and re-experiencing (or getting no relief from) our dreaded
old emotions. Indeed, some depressed smokers do experience
especially strong urges to smoke after quitting (researchers report this
reaction is related to your genes). And, a variety of increased
psychological distress may occur when the self-medication is stopped.
For instance, people who have a history of recurrent major depression
become depressed again 30% of the time after stopping smoking
(Covey, Glassman & Stetner, 1997). I suspect this increasing
(uncovering) of psychological stress is fairly rare in persons who have
no psychiatric history of depression because, as mentioned, on
average the anxiety level tends to go down (not immediately but
gradually) after quitting smoking. In any case, one needs to be alert to
the possibility of depression and find or develop ways, including
medications for a while, of handling any increasing emotions (chapters
5, 6 & 7). Don't delay getting help if needed... and try to avoid falling
back on your old self-medication--smoking. 
For ex-smokers, even those without a history of depression, feeling
down is the most common cause of a relapse. Be especially cautious
during "down" times. It takes several weeks for the urges to smoke to
fade away. So, in any case, expect to suffer for a while, the first week
may be nicotine withdrawal but after that the urges are probably
psychological or habits. Researchers report that most people
experience the strongest urges just prior to quitting and that the "urge
for a cigarette" gradually declines after the moment you quit. You will
usually find that the urges to smoke are not continuous, they come
only episodically--just like in the past you only needed a cigarette
episodically. The trick is to distract your attention from the brief high
urge phase--or to tough it out, saying "I can handle this." The urge will
soon fade away, so Nicotine Anonymous says "take it one urge at a
time." 
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