Stopping Smoking - The Mill Technique
Mary has been smoking since she was 16. She is now 33 and is hoping to start a family soon. She has been told to stop smoking but she likes it. She also finds smoking is the only way that she can get a break at work. Money isn’t an issue as she earns plenty, as does her boyfriend who also smokes and isn’t interested in quitting.
Despite nearly 100,000 people in the UK dying from smoking-related illnesses each year, nearly one sixth of adults are still smokers.
While it wasn’t until the early 20th century that the harmful effects of smoking were explored, studies continue to expose the dangers of the habit. Quitting smoking is a big challenge for a person to face and they will often need more than just willpower. For many people, hypnotherapy is an effective solution.
- Nearly 50 per cent of all smokers die prematurely due to smoking-related diseases.
- The life expectancy of a smoker is about 10 years less than that of a non-smoker.
- In the UK is it estimated only half of long-term smokers live past the age of 70.
- Up to 17,000 children under the age of five are admitted to hospital each year as a result of passive smoking-related illnesses.
It is important for the person to know why they want to quit before any successful attempts can be made. It is common for people to relapse if they are quitting for somebody else. If the individuals are making the decision for themselves, the chances of success can improve. As with all hypnotherapy success cannot be guaranteed although it is sufficiently higher if they are highly motivated to stop smoking.
Some of the most common smoking-related illnesses include:
- Infertility - Smoking affects the fertility of men and women, making it difficult to conceive.
- Gum disease - As well as staining your teeth, smoking can cause premature tooth loss due to gum disease.
- Heart disease - This is considered the UK’s biggest killer. Nearly one in six cases is smoking-related.
- Lung cancer - More than eight in 10 cases of lung cancer are directly related to smoking.
- Other cancers - This includes mouth, throat, nose, blood, cervical and pancreatic cancer
Therefore it is important during the assessment session to find out if the client is on any medication for any of the above, or if any of the above are a concern to them. Should they already be under the care of their GP of other NHS consultant permission to contact must be obtained prior to onset of therapy.
A great number of people find hypnotherapy for smoking an effective treatment. The method works to break the negative behaviours and thinking patterns associated with smoking. The thoughts and behaviours the smoker holds is often what prevents them from successfully giving up. Areas to consider are secondary gains and behaviour patterns as people don’t smoke for all the same reasons. However addiction is one that they all share. Some people, like Mary, are guaranteed a break from work if they smoke and may also enjoy the friendships they have gained (secondary gain) through smoking. In addition some people only smoke in certain situations. e.g. when they have coffee, first thing in a morning and last thing at night, with alcohol. I know someone who looks forward to their first cigarette with a cup of coffee each morning. So the body has got accustomed to only smoking at certain times thereby displaying a behaviour bias. It is uncertain if Mary has a behaviour bias for smoking although it
is clear that she smokes at work. It can be assumed that she smokes with her boyfriend too as he is a smoker.
When a person makes the decision to stop smoking, the key aspect is to let go of the routine and change their perspective of cigarettes. The routine, for Mary, at work and home must be broken. It will be difficult for Mary to break the routine with both work and her boyfriend; especially as she does point out that she likes smoking and can afford it. Breaking an addiction like this is a challenge. Many people find changing how they think about something difficult. As hypnotherapy focuses on this change, it is an idea form of treatment for Mary.
When considering stop smoking hypnosis, the first thing the person has to do is make sure they are choosing to quit for themselves. It would appear that Mary has chosen to try and stop smoking because she is going to start a family. Therefore, to prevent risk to the unborn child, it is essential that she does stop. Literature for Mary, or web sites she can look on to show the risk should compliment therapy. Hypnosis for smoking has been found to be most effective when the person really wants to quit. It would appear to me that Mary does not really want to stop but is concerned about the effect smoking will have on the unborn child so is going to try to stop. This is not ideal. The focus for stopping needs to be from her and not an outside intervention. Therefore changing her routines will be the main focus as well as the effect on the unborn child.
Many people find stop smoking hypnosis is enough to break the habit, while others prefer to combine the therapy with NRT (nicotine replacement therapy) or medication. This helps to tackle both the physical and the mental addiction together. By exploring all the options, a client gains a greater potential for success. However it is important to remember that hypnotherapy for smoking is not a quick fix. While for some people, just one therapy session is enough to quit smoking (or continue the journey alone), others may benefit from follow-up sessions. The ultimate aim of stop smoking hypnosis is to empower people to take control of their addiction. Hypnotherapy for smoking will promote healthier behaviours. It will also help the individual to develop new patterns of thinking.
It may be useful to make the client aware of the following during the assessment session, and even take a copy away with them so they can reaffirm the benefits between sessions simply by looking at it.
Benefits Of Stopping Smoking
Timeline Of How The Body Recovers After Stopping Smoking
Common fears And Misconceptions
The Holistic Approach
I believe taking a holistic approach to hypnotherapy is essential. It is never enough to assume that their GP, friends or their own research has made them aware of the health risks of smoking, the health benefits of not smoking and the common misconceptions related to stopping smoking. By arming Mary with all the information it can benefit her in her journey to being a non smoker. It can also make hypnotherapy easier and more likely to succeed.
Prior to treatment all the above will need to be considered and information collated. During the assessment session the form attached will be used as an assessment form. The form allows the therapist to know basic personal details like address and phone number, a list of concerns the client may have, medication they are taking, a baseline of their feelings to be reviewed throughout therapy, their GP details and finally their signed and dated consent to therapy. A signature here is essential prior to therapy.
Without all the above details it will not be an exact science when putting together a treatment plan for Mary. However a generalised treatment plan will be constructed. It is important to review the assessment form with the client to ensure that they have included all that is necessary. It is also an opportunity for the therapist to discuss the reasons for seeking hypnotherapy and well as expectations,
misconceptions of hypnotherapy and to alleviate any concerns. It is during the assessment session that it is important to build rapport with Mary to enable a positive therapeutic relationship to take place throughout therapy. This will be compounded upon throughout the course of therapy.
Next it is important to pinpoint when, where and why Mary smokes. A form like the one below could be used:
When, Where And Why?
Following this session I would put together, maybe with Mary, an alternatives form which might produce the same results. (there needs to be an alternative for every option Mary indicated on her form) Some examples are:
1 Instead of smoking when she feels isolated, an alternative may be to phone a friend, write a letter or email, visit a friend or family member, read a newspaper or book.
2 Instead of smoking too much while driving, an alternative may be to breathe deeply and relax, concentrate on tightening and relaxing muscles or planning her next activity in detail.
3 Instead of smoking whenever she needs a break in her routine, an alternative may be to engage in mental activity such as writing a report, a change in physical activity like stretching, getting up and chatting with someone or even making a cup of tea or coffee.
These answers would then be discussed with Mary and homework in the form of trying out just a few of these activities for the coming week before the next session. All the alternative options, when used will contribute to two major objectives:
Become a permanent non smoker. It is critical for Mary to see herself as a non-smoker. A non-smoker is a person who chooses not to smoke. She must not see herself as an ex-smoker who is a person who forces herself not to smoke.
Incorporate new habits into Mary’s life. These new habits are itemised in her new options chart that she was given by me in response to her when, where and why form she filled in.
The next stage of therapy will involve a hypnotic induction that is especially designed to help Mary meet her specific needs and to alleviate the demands created by her daily environment. The hypnotic induction will help to reprogram Mary’s life to live without smoking. Therefore the induction should:
- Build confidence to achieve her goal
- Perceive smoking as being unappealing and distasteful
- Perceive herself as a healthy, energetic person
- See herself as a non-smoker
- Incorporate into her life a new pattern of behaviour in regard to times, places and reasons for smoking
The induction will be used with a progressive relaxation induction. Following the non-smoking induction will be a ‘coming up’ induction.
Progressive Relaxation Induction
Take a nice deep breath, close your eyes, and begin to relax. Just think about relaxing every muscle in your body from the top of your head to the tips of your toes. Just begin to relax. And begin to notice how very comfortable your body is beginning to feel. You are supported so you can just let go and relax. Inhale and exhale. Notice your breathing. Notice the rhythm of your breathing and relax your breathing for a moment. Be aware of normal sounds around you. These sounds are unimportant, discard them, whatever you hear from now on will only help to relax you. As you exhale, release any tension, any stress from any part of your body, mind and thought. Just let that stress go. Just feel any stressful thoughts rushing through your mind, fell them begin to wind down, wind down, wind down, and relax.
And begin with letting all the muscles in your face relax, especially your jaw. Let your teeth part just a little bit and relax this area. This is a place where tension and stress gather so be sure and relax your jaw and feel relaxation go into your temples and relax the muscles in your temples and as you think about relaxing these muscles they will relax. Feel them relax and as you relax you’ll be able to just drift and float into a deeper and deeper level of total relaxation. You will continue to relax and now let all the muscles in your forehead relax. Feel those muscles smooth, smooth and relaxed and rest your eyes. Just imagine your eyelids feeling so comfortable, so heavy, so heavy, so relaxed and now let all the muscles in the back of your neck and shoulders relax, feel a heavy, heavy weight being lifted off your shoulders and you feel relieved, lighter and more relaxed.
And all the muscles in the back of your shoulders relax, and feel that soothing relaxation go down your back, down, down, down to the lower part of your back, and those muscles let go and with every breath inhale, just feel your body drifting floating down deeper, down deeper, down deeper into total relaxation. Let your muscles go relaxing more and more. Let all of the muscles in your shoulder, running down your arms to your fingertips relax. And let your arms feel so heavy, so heavy, so heavy, so comfortable, so relaxed. You may have warmth in the palms of your hands, and that’s fine. And you may feel that you can barely life your arms, they are so relaxed, they are so heavy, so heavy, so relaxed.
And now you inhale once again and relax your chest muscles. And now as you inhale once again and relax your chest muscles. And now as you exhale, feel your stomach muscles relax. As you exhale, relax all of the muscles in your stomach, let them go, and all the muscles in your legs, feel them relax and all the muscles in your legs, so completely relaxed right to the tips of your toes. Notice how very comfortable your body feels, just drifting and floating, deeper, deeper, deeper, deeper relaxed.
An as you are relaxing deeper and deeper, imagine a beautiful staircase. There are ten steps, and the steps lead you to a special and peaceful and beautiful place. In a moment you can begin to imagine taking a safe and gentle and easy step down, down, down on the staircase, leading a safe and gentle and easy step down, down, down on the staircase, leading you to a very peaceful, and a very special place for you. You can imagine it to be any place you choose, perhaps you would enjoy a beach or ocean with clean, fresh air, or the mountains with a stream, and place is perfectly fine.
In a moment I’m going to count backwards from ten to one and you can imagine taking the steps down and as you take each step, feel your body relax, more and more, feel it just drift down, down, down each step and relax even deeper. Ten, relax even deeper, nine... eight... relax even deeper... seven... six... five... feel a calmness come over you... four... three... two, deep and calm... one... deeper, deeper, deeper relaxed.
And now imagine your peaceful and special place. You can imagine this special place and perhaps you can even feel it. You are alone and there is no one to disturb you. This is the most peaceful place in the world for you. Imagine that you are there and feel that sense of peace flow through you and a sense of well being and enjoy these positive feelings and keep them with you long after this session is completed., for the rest of this day and evening, tomorrow. Allow these positive feelings to grow stronger and stronger, feeling at peace with a sense of well being and each and every time that you choose to this kind of relaxation you will be able to relax deeper and deeper. Regardless of the stress and tension that may surround your life, you may now remain more at peace, more calm, more relaxed, and allow the tension and stresses to bounce off and away from you, just bounce off and away from you. And these positive feelings will stay with you and grow stronger and stronger throughout the day as you continue to relax deeper and deeper.
And as you are relaxing deeper and deeper, reflect for a moment on all of the success you have already had in the past, the many positive goals that you have already reached and achieved, and feel proud, proud of yourself, proud of all the positive aspects of your life, your creativity, your intelligence. Feel proud of yourself. And know without a doubt that because you have been successful in the past and because you have reached so many positive goals, you will continue to be successful in every area of your life, in every area of your life. You are now more motivates and more determined than ever before to reject all that is unhealthy and harmful to you: bad habits, tension, stress, the habit of smoking cigarettes.
Now you reject this habit of smoking cigarettes. You have all the right reasons to be a non-smoker. You do it yourself, for your health and well being and that feels fine, and that feels
fine. And since you have been successful in the past, you will simply continue to be successful and reach every positive goal that you have, and now you choose to be a non smoker. You begin to feel and see an image of yourself without a cigarette or a pack near you. See yourself as a non smoker, , you are a non smoker and that feels fine. You reject the habit of smoking, your mind rejects it and your body rejects it.
Imagine throwing a pack of cigarettes out the window and away from you, and that feels great. You have made up your mind, you have made the choice to be a non smoker and that feels fine, it feels fine. Your body now rejects smoking cigarettes; your lungs no longer want those poisonous fumes in them. Your sinuses want to feel clean, fresh air. The smell of cigarettes is now disgusting and the taste is unappealing and unappetising. Your mouth is clear of smoke, without any trace of a cigarette taste and it feels fresh.
Your taste buds experience the appetising fresh tastes of your food. There are no poisonous and unhealthy fumes in your system. You now choose to be healthy; to be strong, to breathe clean air with your lungs clean and fresh. You have all the right reasons to be a non smoker. You will soon be starting a family and the idea of smoking a cigarette while pregnant, and the harm that it will cause to the baby, means that you are highly motivated to stop and never touch a cigarette again. And you have made up your mind and are now more motivated than ever to continue to create the most healthy, the most healthy and positive life for yourself and your family, you are now a non smoker. You feel it within. You now make a conscious choice not to smoke that cigarette and emotionally you feel just fine, feel just fine. You are a non smoker, a non smoker, and a positive feeling will stay with you throughout the day, wherever you go.
Imagine your daily routine, what you would normally be doing, and see yourself doing these routines all without a cigarette and feeling fine. You now have new ways of dealing with your old habits. When you want a break at work you will go to the kitchen area and make a cup of coffee or whatever your favourite drink is, without thinking about going outside to smoke. You will make new friends with none smokers and this will be easy for you. When you are at social events you will join the non-smokers and start a conversation with someone you have not met before. This is a new way to deal with an old habit, and it is a successful way. It works and you feel fine, just fine. Imagine your daily routine without a cigarette and there is a smile on your face and you feel just fine. Whatever your destination may be, see yourself going there in your usual manner without a cigarette, breathing clean, fresh air, enjoying, enjoying being a non smoker. Continue to see yourself go through the routine of your day, feeling calm, feeling calm and relaxed as you feel right now. There is a smile on your face. You are a non smoker and it feels wonderful. You have stopped smoking cigarettes. You consciously decide not to have that cigarette, and your emotions are fine, you feel just fine. It feels fine being a non smoker.
Imagine yourself going through a typical day without a cigarette and it feels great. The less you smoke, the better you feel. Soon you will begin to notice that every aspect of your life begins to improve more and more, every day and every night. You will breathe more easily and regain a new and healthy vital energy. You are a non smoker and that feels fine. You are a non smoker and that feels fine. See yourself in situations; see yourself in any situation, enjoying yourself, feeling great without a cigarette and that feels fine.
Coming Up Induction
Enjoy your special place for another moment and then I will begin to count from one to ten and as I count from one to ten you can begin coming back to full consciousness, and will come back feeling refreshed as if you had a long rest. Come back feeling alert and relaxed. Begin to come back now. One... two... coming up... three... four... five... six... seven... coming back... eight... nine... begin to open your eyes, and ten, open your eyes and come all the way back, feeling great, relaxed and alert. (reference for scripts: see at bottom of page)
In future sessions I would use this script if the feedback was good. However, following the review of post session feedback forms changes may be required. There would be homework between sessions to enable the client to still be focusing their energies on stopping smoking. Below are examples of homework I may give to Mary:
- Write a list of all the things you can replace smoking with.
- What do you now do at work when friends go to smoke? How has your social life and work life changed as a result?
- What areas of your life have improved since stopping smoking?
- Who helps you not to smoke? Does anyone try to make you start again and how do you challenge this?
- If you do relapse and smoke again how will this make you feel? What can you do to make sure this does not happen again?
- What could you do with all the money you save by not smoking? (although I know that Mary can afford to smoke she will still be saving thousands of pounds each year)
Stopping and Post-Stopping CBT Help Guide
Once the session is finished revisiting the when section of the form is a good idea. It is important that Mary has a copy of the work we have done together. Behavioural patterns have to change and that’s where the CBT comes in again.
Managing smoking triggers: Once specific cues for smoking have been identified, Mary will actively break the links between these triggers and smoking in the following ways:
- By avoiding these triggers
- By changing her daily routines
- By substituting activities in place of smoking.
e.g. Before her quit date she will want to remove all smoking-related paraphernalia such as ashtrays, lighters, and cigarette packs. This will help turn a smoker’s home into the home of a non-smoker, which will reduce the availability of smoking while also reducing the number of triggers for smoking. She may also want to avoid “high-risk” situations for smoking.
For many smokers, this entails avoiding drinking alcohol, going to parties, or socializing with other smokers. It will also be important to change her daily routines in order to break the automatic links between daily activities and smoking. For example, Mary may benefit from taking a different route to work, changing the location of her break while at work, or altering her evening wind-down routines.
Medication: Pharmacotherapy is an effective option to help reduce nicotine withdrawal symptoms after Mary quits. One of the strongest predictors of relapse is the intensity of your urge to smoke. Medications, like the nicotine patch, deliver a safe and controlled amount of nicotine to the body so that she can reduce the physical aspects of her addiction while you utilize CBT techniques to address the psychological aspects of the habit.
Coping with triggers after quitting: No matter how much Mary prepares for quitting, she will likely experience smoking-related triggers at some point after she quits.
There are a number of CBT-oriented techniques that help her cope with your urges such as:
Restructuring her thinking patterns related to smoking (for example, challenging the belief that smoking is the only activity that relieves stress)
Identifying ways to stay busy (boredom is a common trigger to smoking)
Increasing physical activity (exercise has been shown to reduce smoking urges and to reduce weight gain associated with quitting)
Managing negative mood states (stress and other negative mood states increase smoking urges (9))
Coming up with alternate activities to keep your hands and mouth active (for example, eating healthy snacks, chewing gum, holding a pen)
Relaxation training using breathing-based methods and muscle relaxation techniques.
Unfortunately, most smokers who quit eventually resume smoking within several months. Therefore, learning relapse prevention techniques is critical to maintaining her smoking abstinence. One of the most important things to recognize is the difference between a lapse and a relapse. A lapse is a temporary “slip” or mistake, while a relapse is returning to regular smoking. CBT can help you understand how you evaluate a slip, and help you to learn from these experiences to better prevent them in the future. (Harte, 2016)
Although many people may only require on session, some may require a follow up and others may require a few session to permanently stop smoking. Some people are very resistant to change despite wanting to give up. Therefore looking at them smoking less could be a good idea. I would look at each situation, one by one, and stopping smoking in one situation at a time.
Therefore, in the script I may start off saying ‘reducing the number of cigarettes’ Mary smokes rather than ‘giving up completely’ could help a phased approach to stopping. Every case is different. Everyone will be different and their motivations, stresses, number of cigarettes, triggers and peer groups will all be different. It is important that I am fluid in my delivery of therapy ensuring that I am willing to backtrack, change the processes/scripts/methodology, according to what Mary requires, whilst still having a holistic approach in enabling her to be a non-smoker.