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this kind of comforting experience whenever you want to. You can
discover, for instance, that any time you want to feel more comfortable
than you do, all you have to do is sit back in a chair or sofa or bed and take
a very, very satisfying breath and hold it. And then, as you let it all the
way out, these feelings of comfort and well being will automatically
wash over you, just like water in a hot tub. Any time you feel anxious or
feel a craving, that is all you have to do.You can take comfort in knowing
that if any feelings were bothering you, they no longer need to.
262 JOSEPH BARBER
Subsequent Treatment Appointments
Subsequent appointments are made as needed; many patients
required two further treatment appointments. Ordinarily, the third
appointment is made for the next day. Some patients will require subsequent
daily treatment for a few days, whereas others will do well with
two or three appointments at weekly intervals.
Coping With Emotions
These subsequent appointments are used to bolster the patient’s
resources as he or she faces the emotional difficulties that may be highlighted
by having stopped smoking—difficulties that range fromsimple
fidgeting with now unencumbered hands to anxiety or depression secondary
to increased awareness of an unresolved problem.
Further hypnotic intervention can be used adjunctly, both to palliate
the symptoms of anxiety or of cravings and especially to reinforce the
previous posthypnotic suggestions. It may also be used for exploring
emotional conflicts that may develop as a result of greater emotional
awareness that usually follows smoking cessation. I find it helpful to
emphasize to patients that this change—no longer smoking in response
to a feeling of emotional tension—is not a temporary maneuver but a
long-term shift in coping, not just for a month or 6 months or even 6
years, but for the rest of his or her life.
Craving is Permitted
In order to “immunize” the patient against the compelling effect of
craving—and to disconnect the feeling fromsubsequent action to satisfy
it—it is also made very clear that it is perfectly permissible—and natural—
to feel craving, to miss this old habit. The differencenow, the patient
is told, is that, fromnowon, the craving is not going to be responded to in
the old way. Rather, it is explained, new responses can be discovered that
will lead to more satisfying results in the future. The patient is taught to
permit craving but not to permit the old response to craving.
Increased Activity
Although RS and hypnotic suggestion facilitate the patient’s comfort
during smoking cessation, other variables should not be overlooked.
For example, the patient is encouraged to increase activity levels. Sedentary
individuals may require only a slight increase in activity, such as
parking the car a little further away than is usual and walking the extra
distance. In more active people, this increase may involve the renewed
dedication to their favorite sport.
CLINICAL FORUM 263
Increased Fluid Intake
Patients are also encouraged to drink more water, particularly in the
first week. This offers a substitute oral behavior in response to craving; in
addition, it facilitates the elimination of the metabolites of smoking. To
support this, a hypnotic suggestion might be made such as: “Whenever
you feel a craving or would like to satisfy a feeling in your mouth, you
can really enjoy the pleasure of drinking a full glass of water. You might
be surprised how really satisfying that can be.”
Outcome
Over 3 years, 43 patients (25 females, age range 27-66, and 18 males,
age range 34-52) were treated with this combination of hypnotic suggestion
and RS. All patients underwent the full treatment protocol. All
patients were contacted for follow-up telephone interviews with me. At
follow-up intervals ranging from 6 months to 3 years, four patients