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Behavior Modification Program Comprehensive Program for Self-Management _______________________________________________________________________________________________________________________

Since smoking presents such a major health risk in America and since it has been successfully treated with behavior modification methods, I thought it might be appropriate to present such a method in this textbook. At least it will give you some direction as to what you could do to help yourself or others who are struggling with smoking addiction. This step-by-step program was designed for individuals who are willing to try to reduce or eliminate their cigarette smoking. Some smokers may say, “I enjoy smoking. I don’t want to quit.” Of course, one does not like to stop doing something pleasurable, but the quotation ignores the fact that if smoking is no longer pleasurable, one will certainly not miss it. The basic premise of behavior modification is that behavior is a function of its consequences. This is one reason why smoking is a hard behavior to deal with. As mentioned, when you smoke, you get immediate positive reinforcement. As a result, you’ll want to repeat the behavior. The problem is that you don’t receive the punishment until 20 or 30 years down the road when the myriad of health problems surface. The greatest difficulty in achieving self-control involves the conflict between long term and short term consequences of behavior. One of the designs of this program is to rearrange behavioral consequences so that desired behavior is immediately reinforced and undesirable behavior is rewarded less, not rewarded, or punished. This program does require some effort on the subject’s part, but if you follow instructions, in a few weeks you will no longer desire to smoke. Best yet, you will not have to continually struggle with yourself to avoid smoking. Disappearance of the urge to smoke is a natural consequence of the treatment and typically occurs a week or so after abstinence. You will develop a preference for not smoking. You may be wondering, “How will I survive the initial few weeks? Will I have sufficient willpower?” A critical feature of the program you are about to implement is its emphasis on a gradual reduction of smoking. The probability of success is maximized by setting initial goals which are readily attainable. Without going into detail, it is a fact that people often give up desirable goals because they set perfect standards, which virtually assure failure. People try to become long distance runners in a few days, get a good tan in a single blistering afternoon, or become slim in one week, etc. Your goal will not be to quit “cold turkey.” Although thousands of people each year quit smoking all at once, thousands more fail miserably in pursuit of this goal. What would happen if you unconsciously lit a cigarette one day? You might see yourself as having failed and consequently, resume smoking at full strength, perhaps making the all too familiar statement, “I’ve got to die sometime, so why not do it enjoying myself ?” Remember what I said about cognitive dissonance? Also, when you are told that you “can’t ever smoke another cigarette,” you may experience a psychological state called “reactance,” that is, when your sense of freedom is threatened, you engage in the prohibited behavior as a way of demonstrating independence. The program you will be following condones a little backsliding with such instances being termed “allowable transgressions.” The results of behavior modification studies are emphatic: gradually increasing the stringency of the goal is the most painless way to quit smoking and the surest! Desire to change usually originates with the reactions of others. When a behavior is consistently criticized (especially with good reason) we often desire to change that behavior, particularly if there is some rewarding alternative. Desire to change is a crucial component of self-management, but it is not sufficient. Motivated individuals may fail to control their behavior because of poorly designed self-

control strategies. Successful implementation of this program requires a desire to change and cooperation in following specific instructions, but does not require what is conventionally described as “will-power.”

Pre-Program Preparation ______________________________________________________________________________

- Medical Check-up If there is any doubt about your physical condition, get a thorough physical examination in order to determine if there are any medical problems which might occur from the withdrawal of cigarettes and/ or nicotine. Also, you may want to get your doctor to prescribe medication to help you overcome nicotine withdrawal. The most common smoking substitutes are the lobeline-baseproducts, such as Nikoban, Bantron, Tabusine, and Lobeline hydrochloride. All of the aforementioned drugs have been shown to be successful in decreasing the desire for and the withdrawal from nicotine.

- The Motivation to Quit In order to kick the smoking habit, you must first and foremost develop the motivation to do so. Longitudinal studies consistently indicate that smokers who are not intrinsically motivated to stop most likely do not. According to these studies, the drive to stop smoking is most effective and enduring when it comes from within: when the individual recognizes that he must stop for reasons which are important to him; when he will not deter from his goal to quit; when he’s willing to pay the price for his success, that’s when motivation is at its best and that’s when conditions are in favor of the smoker quitting. In short, there must be intrinsic reasons for quitting. The number one reason most people quit smoking is health. Some studies indicate that as many as 93 percent of the people who have quit smoking do so for health reasons. Generally, they want to escape the fear and harsh reality of developing a fatal disease such as cancer, emphysema or heart disease. Still, as scary as the health issue is, for many people it is not a good enough reason to break the habit. Some people are motivated more by social reasons, others by psychological reasons and still others by a combination of all these factors. We are all unique. Consequently, what motivates one person may not motivate another. For that reason, it’s a good idea to ascertain exactly what will drive you to success. In order to motivate yourself to quit, it is a good idea to construct a list of all the reasons why you want to quit. Some examples are as follows: To Save Money: The price of cigarettes is constantly increasing. Presently, a two-pack-a-day habit costs a smoker more than $1500 a year. For that kind of money, you could purchase a 50” fat screen TV with a DVD player and a number of classic movies. To Enhance Social Acceptance: As mentioned, there are psychological as well as medical hazards associated with smoking. Smokers are discriminated against with respect to employment, promotion, travel, and social acceptance. The public also has strong biases against smokers. They are often stereotyped as being dirty and sloppy or lacking in will power. To Enhance Health:

The office of the Surgeon General has linked cigarette smoking to such diseases as cancer, emphysema, chronic bronchitis, peptic ulcers, atherosclerosis, arteriosclerosis, hypertension and various heart diseases. It’s been estimated that the number of people who annually die prematurely from smoking is well over 300,000. As a matter of comparison, 55,000 people die each year in automobile accidents, less than 10,300 people die annually from the overdose of all other drugs-heroin, cocaine, barbiturates and less than 3,000 people die of AIDS each year. If everyone in America would stop smoking today, there would be: 300,000 less premature deaths each year in America. 33 percent fewer deaths in males from age 35 to 59. 85 percent fewer deaths from bronchitis or emphysema. 33 percent fewer deaths from arteriosclerosis. 33 percent fewer deaths from heart disease. 90 percent fewer deaths from cancer of the trachea and lungs. 50 percent fewer deaths from cancer of the bladder. To Improve Physical Appearance: Research indicates that smokers develop more facial wrinkles (and do so sooner) than people who don’t smoke. It also is common knowledge that smoking causes halitosis, stains the enamel of the teeth, the epithelial lining of the fingers and lips and causes hair, clothes and surroundings to smell. If that’s not enough, recent surveys have shown that males and females alike are generally more likely to be interested in or date someone who doesn’t smoke. After you’ve established your list, post it in a prominent place so that you will see it every day. Remember, the intrinsic desire to quit is the key to success here.

- Alter the Consequences of Smoking: Set up a system of rewards or punishments to provide additional incentives for reaching your goals. These incentives can be self-controlled or enforced by others. Individuals who have relied on selfreinforcement have been more successful in kicking the habit. Write down a number of things that you would like to have. Be reasonable. For instance, a new Corvette might be a little out of your range. Use items you desire to reward yourself for accomplishing specific goals. Some rewards should be relatively easy to obtain whereas others, perhaps more valuable, should require sustained success. You could assign a certain number of points for achieving various objectives and the points could then be exchanged for rewards. Make a monetary deposit to be gradually refunded as goals are met. For many, money alone can be a major incentive. Generally, you should reward desirable changes in smoking habits rather than just focusing on the number of cigarettes smoked. Punishment techniques can be employed to affect one’s behavior. Set up a relationship in which undesirable responses are costly and result in a forfeiture of something of value. You will find that this program contains both positive reinforcement and punishment. However, note that the more you reinforce appropriate behavior, the easier it will become to break your smoking habit.

- Engage in Incompatible Behavior: Write down a number of activities that you enjoy as much or more than smoking. The activities you select should in no way be associated with the response of smoking. Use these activities as an incompatible behavior for smoking. Every time you get an urge to smoke at an inappropriate time, engage in one of these activities instead. Since smoking is not ordinarily associated with these activities, there will be less of a temptation to smoke while performing them. Examples of these methods might include a

walk in the park instead of smoking, engaging in absorbing hobbies to take your mind off cigarettes or swimming instead of smoking.

- Intellectual Training: Engage in an extensive program of intellectual training. Learn as much as you can about cigarettes and their effect upon the body, along with the social and psychological effects of the drug. Also, develop a thorough understanding of human behavior. Be aware that we have biological motives, intrapsychic motives and social/behavioral motives. Understand that these three separate systems of emotional processes interact with and influence each other. To overemphasize the importance of any of these processes or to try to explain all human behavior by one process is an error of significant magnitude. Learn about all three systems and how they interact. Try to spend at least 30 minutes each day engaging in some type of intellectual training. Attend lectures, view films, read and perhaps learn from other smokers who have quit. Intelligence is a source of power that can elicit superior results. The more you know about your body, your psychological state and the dynamics of your environment, the easier it will be to control your own behavior. Research has consistently revealed that individuals who are afforded information about the physiological, psychological and environmental factors of behavior exhibit significantly greater control of themselves and the people they come in contact with. Although this book contains a great deal of information about all of the aforementioned topics, by no means is the material presented here all encompassing. Besides, intellectual training is not a one shot quest for knowledge, but rather a lifelong activity. In short, you’ll have to do a lot of work on your own. Acquire as much information as you possibly can and study it. Remember, the more you know, the better off you’ll be.

What is the best way to stop smoking? According to research, the best way to stop smoking is to go cold turkey. That’s right …just


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