Quit smoking: see techniques to kick the habit – 01/27/2024 – Balance

Psychologist Eliane Camarini, 69, remembers that she started smoking when she was young, at 18 years old. The reason? Having recently entered higher education, she wanted to be part of the group of those considered supporters of freedom. “I took my cigarette and my mini ashtray [para a sala de aula]”, he recalls.

This beginning of a relationship with smoking could be compared to a honeymoon in Camarini’s life. Cigarettes represented status and were restricted to specific moments, such as fun. Over time, however, dependence increased. By the time she was around 22 and married to a smoker, Camarini was already smoking around 10 to 12 cigarettes a day.

Over time, the quantity increased. When he was around 50 years old, he experienced personal problems, which worsened his dependence, leading him to smoke up to a pack a day. “Cigarettes became my crutch,” he says.

She even wanted to stop smoking, but the main reason was the pressure she felt from others to give up smoking. The psychologist even tried to reduce the habit on her own, but it was only in 2017 that she found a solution to the problem. Camarini discovered that Cratod (Reference Center for Alcohol, Tobacco and other Drugs), in the state of São Paulo, has a specific service for those looking to quit smoking.

Initially, Camarini joined a group where people in the same situation as her shared their challenges with smoking. In these contexts, she also had psychological support.

During this period, which lasted about a month, she reduced the number of cigarettes smoked per day, reaching ten. So, in September of that year, she informed her desire to permanently stop smoking to the psychiatrist who was with her.

It was on September 11 of that year that Camarini smoked his last cigarette. She continued with the group psychological support she had already been receiving, but also started using an antidepressant and nicotine replacement patch.

The psychologist says that the withdrawal wasn’t very long, “but, at first, I felt grief for having lost my best friend.” Anger, anxiety, tachycardia and sadness were felt by her during the first moments she stopped smoking. Over time, it got better and she left the smoking cessation service about nine months after smoking her last cigarette.

“In my case, the process was extremely important, without it I wouldn’t have been able to stop smoking”, he says.

The adoption of strategies derived from psychology and medication to treat smoking, as occurred in Camarini’s case, is considered essential to stop the addiction. Silvia Cury, mental health manager at Hcor (Hospital do Coração) and psychologist who works with smokers, explains that the main psychological current for this purpose is Cognitive Behavioral Therapy (CBT).

CBT works on the emotional aspects surrounding tobacco dependence. And this is important because cigarettes cause physical dependence, associated with tobacco substances, but also emotional dependence. This process is associated with the fact that nicotine releases endorphins, which automatically reduces anxiety and increases pleasure. Therefore, smokers tend to associate cigarettes with resolving difficult situations they experience, even if the individual does not realize this association.

The idea of ​​therapy, then, is to understand what are the circumstances that generate these triggers and what the person can do to deal with them without smoking. In Cury’s case, she initially creates a profile of the smoker through a questionnaire. “I ask since when he starts smoking, in what situations”, she reports. With these answers, she assesses the person’s degree of dependence.

In addition, there is another mechanism that helps to understand how cigarettes are used by the user – whether to generate pleasure or control anxiety, for example. This way, smokers better understand how their relationship with cigarettes works and, through therapy, work on mechanisms to deal with these situations without using cigarettes.

The psychologist also uses a cigarette diary, in which the patient writes about the cigarettes smoked that day and the situations in which this occurred. “He’s starting to understand a little better what he’s like as a smoker,” says Cury.

Other strategies

This type of therapy alone, however, may not be enough to make a person quit smoking. Taking medications, such as antidepressants, may be necessary. Sabrina Presman, psychologist and member of the advisory board of Abead (Brazilian Association for the Study of Alcohol and other Drugs), states that medications reduce abstinence, helping to work on the psychological parts of addiction through CBT.

But she says it’s important to understand that there is no silver bullet – for example, nicotine replacement or antidepressants won’t work miracles alone. “Each of the separate strategies is less effective than everything together,” she says.

Something that can also be done is to integrate other methodologies into CBT. One of these is mindfulness, which can be translated as full attention. Using exercises that seek to focus on the person’s feelings, emotions and thoughts, the technique could generate positive effects on smoking cessation.

A 2022 systematic review published by Cochrane, however, did not see a clear association between mindfulness and reduced smoking. Pressman, on the other hand, explains that the technique can help with anxiety and stress. Because many smokers experience anxiety as a withdrawal symptom and stress as a trigger for cravings, mindfulness can be helpful.

But the psychologist draws attention to the fact that the strategy alone may not have much impact. “Just using mindfulness does not work to reform habits and beliefs regarding smoking.”

Jacqueline Scholz, director of Incor’s smoking treatment program, defends the restricted smoking technique as a way to stop smoking. The idea suggests that every time someone wants to smoke, they need to leave the room and look at the wall. The aim is to remove the feelings of pleasure that are associated with smoking – by taking it out of a positive scenario, this can reduce the smoking habit.

Even so, the doctor reiterates the importance of using medication. “There is a chemical part that, when the individual is deprived of cigarettes, they feel irritability, anxiety, cravings. Medication has the possibility of changing this”, she summarizes.

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