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Cognitive Behavioral Therapy for Smoking Cessation NBCC approved.

By Dr. Kenneth A. Perkins, Dr. Cynthia A. Conklin and Dr. Michele D. Levine

Course Description

The Practical Clinical Guidebooks Series provides clinicians, students, and trainees with clear descriptions of practical, empirically supported treatments for specific disorders and their sequelae.

Practitioners helping smokers to quit can be more effective by learning key therapeutic techniques aimed at increasing any smoker’s chances of success. Cognitive-Behavioral Therapy for Smoking Cessation is a valuable guidebook to an empirically based CBT approach to smoking cessation that has been shown to be effective with or without the use of medications. This approach emphasizes techniques for enhancing the smoker’s motivation and confidence to quit, and teaching the smoker steps for preparing to quit, coping with the difficulties that emerge after quitting, and transitioning to become a long-term nonsmoker.

Cognitive-Behavioral Therapy for Smoking Cessation offers the fundamental counseling strategies and intervention that have been established, researched, and refined over the past decades. This program outlines essential components that should be included in the treatment of any smoker as well as steps to take when faced with smokers likely to have particular difficulty quitting. Unique to this volume is the inclusion of a specifically tailored CBT model designed to address weight gain concerns, in the smoker. Perkins, Conklin, and Levine are leading researchers on effective smoking cessation intervention for those concerned about the potential gain in weight that accompanies quitting, and offer a flexible approach that allows the practitioner to tailor interventions to each individual. An invaluable addition to any health professional’s repertoire, the treatment model presented in this book provides practitioners with the tools necessary to help their clients to quit smoking

About the Authors

Dr. Kenneth A. Perkins received his Ph.D in clinical psychology from the University of Iowa and is currently professor of psychiatry at the University of Pittsburgh. He has served on the editorial boards of several journals and on NIH grant review committees and advisory boards. Dr. Perkins has published over 150 scientific articles and chapters, mostly on the addictive effects of nicotine or smoking. He is a past president of the Society for Research on Nicotine and Tobacco (SRNT) and is a fellow of the American Psychological Association and of the Society of Behavioral Medicine.

Dr. Cynthia A. Conklin received her Ph.D. in clinical psychology from Purdue University and is currently assistant professor of psychiatry at the University of Pittsburgh. Dr. Conklin has contributed book chapters on understanding and treating addiction, and has numerous journal articles investigating the effects of drug-related cues in smokers. Dr. Conklin’s research is funded primarily by the National Institute on Drug Abuse, and she is the 2006 recipient on the APA Wyeth Young Psychopharmacologist award.

Dr. Michele D. Levine received her Ph.D. from the University of Pittsburgh and is currently assistant professor of psychiatry at the University of Pittsburgh. A licensed clinical psychologist, Dr. Levine studies the relationships among mood, weight, and health behaviors. She has published journal articles on the roles of mood and weight concerns in smoking postpartum, the prevention of weight gain among women, and the treatment of pediatric obesity. Her research is funded by the National Institutes of Health.

Learning Objectives

After completing this course you’ll be able to:

  1. List several constituents in tobacco that cause damaging health effects from smoking.
  2. State which developing country has the prevalence of smoking especially increased.
  3. Discuss the relationship of heart disease and smoking.
  4. State why dependence is a chronic condition.
  5. State why tobacco smoking is more addictive than chewing tobacco.
  6. Compare “lights” to regular cigarettes.
  7. Define proximal cues and contexts.
  8. List four situations where contexts become paired with smoking.
  9. Define acute tolerance, chronic tolerance and abstinence.
  10. List several physiological effects of smoking.
  11. List several predictors for smoking in teen years.
  12. State the cognitive component and behavioral component of CBT.
  13. Describe the five A’s to address when helping smokers to quit.
  14. List the single most important question to ask to assess tobacco dependence and predict future quitting success.
  15. List the five stages of change with regard to smoking.
  16. Describe the “Reasons to Quit List” and the “Reasons to Continue List.”
  17. List three additional reasons for ambivalence as to why people want to continue smoking.
  18. Define delay discounting.
  19. Define self-efficacy.
  20. List the most common triggers for smoking.
  21. List several ideal times to quit smoking.
  22. List the five coping strategies when triggers remain.
  23. Describe scheduled reduction and narrowing the smoking environment.
  24. Describe the amount of contact time needed to design an effective smoking cessation program with an individual.
  25. Describe the two general ways smoking cessation medications work clinically.
  26. State several reasons why nicotine replacement therapy does not cause abuse liability.
  27. Compare the peak of the nicotine patch with nicotine gum.
  28. State the amount of time nasal spray requires to deliver nicotine.
  29. Compare basal and active dosing.
  30. List three reasons nicotine replacement therapy fails.
  31. List four physiological symptoms of nicotine withdrawal.
  32. Discuss psychological manifestations of nicotine withdrawal.
  33. Compare lapse and relapse.
  34. Discuss the work of Marlott and George regarding the abstinence violation effect and prevention training.
  35. State how smoking lowers body weight.
  36. List three findings regarding dieting to prevent post-cessation weight gain to increase a smoker’s chance of quitting.
  37. List the four key aspects of CBT for weight-gain concerns.
  38. Define restrained eating.
  39. Discuss the type of exercise in CBT for smokers.
  40. State the number of months of continuous abstinence from cigarettes that should be achieved prior to initiation of a weight-loss program.
  41. List several reasons women have a more difficult time quitting smoking than men.
  42. List additional benefits that may encourage pregnant women to stop smoking.
  43. Compare social factors with pharmacological factors regarding adolescent smoking.
  44. Discuss the long-term quit rate among coronary heart disease patients.
  45. Define sensory gating.
  46. Compare cross-tolerance and cross-sensitization.
  47. Define the “gold standard” of success from Sidebar 8.1.
  48. State the two reasons for rapid relapse after smokers try to quit on their own.
  49. Describe carbon monoxide readings.
  50. Discuss adaptation methods of being a nonsmoker.

Course Contents

  1. The Consequences of Smoking and the Nature of Tobacco Dependence
    • Health Consequences of Smoking
    • The Nature of Tobacco Dependence
    • The Natural Course of Smoking
    • Key Points
  2. Preparing Smokers to Quit
    • Starting the Process
    • The Five A’s
    • Exploring Ambivalence
    • Increasing Motivation to Quit
    • Triggers for Smoking
    • The Five R’s
    • Key Points
  3. Time to Quit
    • Set a Quit Date
    • Steps Prior to the Quit Day
    • How to Cope When Triggers Remain
    • If Quitting Right Away Is Too Difficult
    • Structuring a Treatment Plan
    • Key Points
  4. Medications to Aid Quitting
    • Optimum Cessation Treatment Involves Both Counseling and Medication
    • Nicotine Replacement
    • Bupropion
    • Varenicline
    • Other and Experimental Medications
    • Why Cessation Medications Often Fail
    • Key Points
  5. Handling Withdrawal and Dealing with Lapses
    • Nicotine Withdrawal
    • Relapse Prevention: How to Deal with Slip-Ups
    • Key Points
  6. Addressing Weight Gain Concerns.
    • Weight Gain, Weight Concerns, and Quitting Smoking
    • Cognitive-Behavioral Treatment (CBT) to Decrease Weight Gain Concerns
    • Effects of Cessation Medications on Weight
    • When and How to Lose Weight
    • Key Points
  7. Cessation Treatment for Subpopulations and Smokers with Comorbid Disorders
    • Subpopulations of Smokers Requiring Special Attention
    • Smokers with Comorbid Medical Conditions
    • Smokers with Comorbid Psychiatric or Substance Abuse Disorders
    • Key Points
  8. Follow-Up and Long-Term Maintenance
    • Need for Long-Term Follow-Up
    • Follow-Up Procedures
    • Conclusions
    • Key Points

Appendix: Internet Resources for Smoking Cessation Information

References