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Combined with RS, hypnotic suggestion was intended to achieve
these goals:
1. Clarify and heighten the patient’s awareness of his or her own motivation
to stop smoking.
2. Provide ego-strengthening suggestions to encourage and support the patient’s
healthy decision and to inspire the development of new behavior
that competes with the old habit.
3. Ease the physiological and psychological effects of smoking withdrawal.
4. Encourage an increase in daily activity.
An emphasis is placed on determining whether smoking may constitute
self-medication for some chronic unpleasantness—anxiety or depression,
for example—in the patient’s life. Smoking often provides a
distraction from unpleasant emotions. If this is the case, if the emotion-
evoking problem is not solved, and if some other mood-altering solution
is not found, then it is likely the patient will begin smoking again,
rather than tolerate the unpleasantness.
In summary, the treatment plan described here includes attention to
motivational, behavioral, and physiological change in support of smoking
cessation.
Initial Patient Contact
Is this patient a candidate for this treatment? When a patient initially
requests treatment (often in a telephone contact), I specifically ask, “Do
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you want to stop smoking?” If the patient’s response is “Yes,” I arrange
an appointment. No further criteria were used for inclusion for treatment.
However, if the patient’s response is anything else, I consider that
the patient is probably not a candidate for this treatment. For example, if
the patient responds,“Well, I know I should, ” or “My doctor says I have
to, ” or another response that reflects the patient’s ambivalence (or lack
of interest), I explain that I cannot make him or her stop doing something,
including smoking, if he or she does not really want to stop. Frequently
at this point, the patient expresses relief and ends the
conversation.
Occasionally, however, the patient acknowledges the ambivalence
and asks for help in resolving it. If so, I offer to meet with the patient in
order to explore in what way I can be of help, but I make it clear that the
goal of treatment will not be smoking cessation. (To emphasize the
importance of a patient’s unambivalent clarity in wanting to stop smoking
to the success of the treatment, it is worth noting that more patients
were excluded from this treatment than were included.) However, if the
patient is a candidate for this treatment, the plan continues as follows:
Preliminary Evaluation Consultation
The essential plan involves an initial assessment followed by four
treatment appointments. At the first appointment, in addition to the
usual psychological intake interview, information is developed concerning
the patient’s physical health, attitude toward health, smoking history,
history of previous attempts at smoking cessation, and the specific
reasons why he or she wants to quit smoking now (rather than at some
previous time). In addition, the patient’s understanding and attitude
with respect to hypnotic methods is discussed. At the outset of this interview,
it is made clear that no commitment from either the patient or
myself for treatment has yet been made and that such commitment will
be made only after the treatment plan has been fully elaborated.
Following the intake, I reiterate to the patient that I have no power to
make him or her stop smoking if he or she does not want to do so but that
I can assist him or her, which will make stopping smoking an easier
experience. Further, I emphasize that the single most important factor
that will insure treatment success is the patient’s own interest in and
motivation for success. I then describe the range of possible effects of the
treatment based onmyexperience, including: Some patients have such a
complete lack of difficulty or discomfort that I find it hard to believe they
needed treatment in the first place, whereas other patients experience
moments of significant craving and the posthypnotic suggestions bring