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them only partial, not total, relief. For most patients, the experience of
quitting seems to be far easier than they expected it would be but is still
harder than they would like it to be. They are surprised, though, that
they tolerate the discomfort more easily than they had expected.
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Following this discussion, I might then say, “I wonderhoweasy it will be
for you. ” This statement constitutes both a challenge to the patient’s
motivation and a suggestion for ease of success. I then proceed to
describe the following treatment plan.
Explaining the Treatment Plan
For 4 days, beginning 3 days prior to the day on which the patient has
decided to stop smoking (the date will be determined by the patient at
this first appointment), he or she is to undergo RS. Even though the
instructions for RS are explained orally, they are also described on a
printed sheet that will be taken home by the patient.
This procedure is to be done in the morning before leaving for work
(or otherwise beginning the day).
1. Smoke continuously for 5 minutes exactly, inhaling once every 4 seconds,
no more.
2. Write continuously for 5 minutes, describing, “How I feel right now.”
3. Repeat step 1—5 more minutes of RS.
4. Repeat step 2—5 more minutes of writing. Take this opportunity to edit
what you have just written so that it accurately describes how you feel
right now.
5. Continue on throughout the rest of the day, smoking as much or as little as
you want.
6. Repeat this procedure for 3 more consecutive days. The last cigarette you
have on the morning of the 4th day is the last cigarette you will have. From
that moment on, you are a former smoker.
Before asking the patient to agree to this treatment, it is emphasized
that undergoing this procedure produces significant, though temporary,
physiological changes, including tachycardia and hypertension, may result
in nausea and, in rare cases, may cause vomiting. This is a potentially
dangerous treatment if the patient is pregnant or has cardiovascular
or pulmonary difficulties.
Consultation with the patient’s physician is essential.
Patient/Therapist Decision to Proceed
It is at this point, as the patient receives the instructions for RS, that I
decide whether or not to treat this patient for smoking addiction, based
primarily on my judgment of the patient’s motivation to succeed. If I
decide to proceed with treatment, the patient is given the opportunity to
choose to participate in the treatment. If the patient decides to undergo
treatment, then future appointments are made, and a date for stopping
smoking is determined. Follow-up appointments are made for: (a) the
last day of RS (the day of smoking cessation), (b) the day after cessation,
(c) the second day after cessation, and 4) 1 or 2 days or 1 week following,
depending on how comfortable the patient is. Again, depending on the
patient’s needs, whereas many patients in my experience require only
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the four initial treatment appointments, some patients in this sample
have needed an additional 1 to 12 appointments to express satisfaction
that they no longer feel the need to smoke.
First Treatment Appointment
The first treatment appointment occurs on the morning of the first day
of smoking cessation. This appointment provides an opportunity to further
assess the patient’s motivation by exploring the RS experience. I
inquire, for instance, if the patient carefully complied with the RS
instructions. This appointment is also an opportunity to consolidate
whatever unpleasant associations (because that is the object of RS) that
may have developed as a result of the procedure. This is done in a casual
manner with care taken not to make the patient feel insulted or manipulated
for having complied with the instructions. I may simply ask, for
instance, “What did you notice about this experience?” And “Did the
procedure have any effect on your interest in smoking?”
This appointment affords further the opportunity for the patient to