Chapter 18

Staying the Course for the Next Five Months and Beyond

IN THIS CHAPTER

Bullet Facing troubling triggers head on

Bullet Breathing away urges

Bullet Respecting willpower

Bullet Understanding disruptive emotions

We’re going to assume here that one way or another, you made it through the first month with the help of your personal quit plan (see Chapter 15) and that, if you did slip, you managed to crawl back and get onboard the quit ship again. By now, your body is free of nicotine and the physical withdrawal symptoms are, for the most part, over.

The remaining uneasy feelings of quitting are likely more closely caused by the powerful psychological addiction of smoking. Therefore, in this chapter, we’re going to focus on how to deal with the emotional and psychological aspects of addiction.

First, we give you more tools to confront difficult triggers. Then we delve into the concept of willpower — what it is, how it gets depleted, and how to build it up again. We also discuss potentially disruptive emotional issues that could get in your way — specifically, anxiety and depression.

Next, we help you form an exercise plan to fit your lifestyle and boost your mood. We also look at discontinuing nicotine replacement therapy (NRT) over the next few months so that withdrawal symptoms won’t disrupt your quit plan. Finally, we suggest that you look back at your reasons for quitting to help solidify your resolve going forward.

Tip As you progress through these months, we recommend rereading your personal quit plan from time to time. Also review your cue cards (see Chapter 16). Repetition may seem a bit silly, but it works. Remember: You’re learning a new skill.

Boosting Your Plan for Problematic Triggers

During the first month, we strongly suggest that you avoid smoking, vaping, or chewing triggers as much as possible. We recommend that you stay away from people who smoke and avoid the places where you would normally smoke.

Avoidance usually works for a while. However, as the months go by, no matter how hard you try, you’re going to run into smoking triggers. Be prepared for using more active coping strategies to successfully get through problematic triggers.

Avoiding avoidance

Now it’s time to actively confront what you’ve been avoiding. Instead of allowing triggers to find you, you go after the triggers with this approach. Start small and pick an activity that you feel you can probably handle with minimal effort. For example, if you switched to tea because coffee sets off smoking urges, you may be able to try a cup of coffee again. Use the strategies in the following sections to prepare. Slowly work up to handling somewhat more powerful triggers. Go slow and easy.

Tip Then again, you may not be quite ready to confront your most problematic triggers. For example, if everyone at the poker game smokes and drinks, that activity may remain outside your comfort zone — the temptation may be insurmountable. Stay away from the poker game if you think you may slip up and smoke.

In fact, a few highly charged situations, like the poker game example, may be best avoided for the rest of your life, or at least until some of the other players quit smoking, too (it’s bound to happen). The decision about confronting the worst of the worst triggers ultimately is up to you. By the way, we hear that competitive Scrabble is extremely exciting, and most Scrabble players don’t smoke. Okay, Scrabble isn’t exactly poker, but you never know — maybe you could learn to love it!

Breathing through urges

Breathing is automatic. You spend your whole life breathing, and yet you probably don’t think about it much. Under stress, breathing typically becomes shallow and rapid. Controlled, paced breathing slows things down and reduces tension.

Technical stuff Slow, controlled breathing can slow nerve activity in the sympathetic nervous system, which is aroused under conditions of stress or physical activity. This breathing also increases the influence of the parasympathetic system, which is needed for relaxation.

A good way to get through a craving is to simply pay attention to your breathing. You should practice one or both of these techniques before you’re experiencing an urge so that the breathing pattern becomes an easy response to a smoking trigger. Focusing on your breathing takes your attention away from your urges.

Tip If either of the following breathing techniques work especially well for you, consider adding one or both to your personal quit plan.

Urge-busting belly breathing

This breathing technique is a good distraction from triggers because it takes concentration; it’s not what you’re used to. Follow these steps:

  1. Sit in a chair or lie on the floor.
  2. Place your hand on your belly slightly below your rib cage.
  3. Exhale slowly to a count of 5 and tighten your abdominal muscles.
  4. Pause and hold for a few seconds.
  5. Now, breathe in fully while expanding your belly and chest.
  6. Pause and hold for a few seconds.
  7. Repeat ten times.

Tip Make sure you can see if your belly is expanding and contracting while you do this exercise. You may experiment by putting a book on your stomach (if you’re lying down) and watching it rise and fall.

Breathing to counteract big bad triggers

Occasionally, you may encounter a very, very strong craving set off by one of your triggers. You really want to smoke, but you’ve come so far, you really don’t want to slip. This breathing technique is for situations like that. Take the following steps:

  1. Inhale through your nose, deeply and slowly to a count of four.
  2. Hold your breath and count slowly to four again.
  3. Exhale through your mouth, to a slow count of five.

  4. While exhaling, make a soft hissing sound.

    You can make it so quiet that no one around you can hear it.

  5. Repeat until your urge passes.

Remember With practice, controlled breathing has been shown to decrease anxiety, reduce blood pressure, and improve mental acuity. Controlled breathing may sound simple, but it has a lot to offer your quitting efforts and more.

Giving yourself a pep talk

Perhaps you’ve heard of the term daily affirmations, in which you’re asked to write down a series of brief supportive self-statements focused on your strengths, abilities, and positive outcomes. When we first heard of daily affirmations, they were the subject of Al Franken’s Stuart Smalley comedy routine on Saturday Night Live. We thought they were as silly as they sounded. The routine went something like “I’m good enough, I’m smart enough, and doggone it, people like me.”

However, as time has gone on, there are reasons for thinking that Stuart Smalley was on to something. Such daily affirmations may have value for a range of goals. There isn’t strong evidence yet, but why not give them a try? Affirmations are easy to do, don’t cost anything, and just may help. Try a few of the following, or make up your own:

  • I’m happy to breathe fresh air.
  • The more I practice, the more in control I can be.
  • I am capable, and I will succeed.
  • Healthy living is my priority.
  • I can do this.
  • I have a lot to look forward to as a nonsmoker.
  • I am proud of my growing willpower.

Tip If you like this idea, write a few affirmations down and include them in your stack of cue cards. Repeat them as often as you like. Can’t hurt.

Rehearsing what to do

As you can see, we encourage engagement with your triggers — engagement accompanied by coping actions. One coping strategy is to anticipate a future situation that may trigger an urge for smoking and plan how you’re going to handle it before it happens.

Think about situations that trigger your smoking urges. Plan to take an action or two to counter the craving. You may want to have something to do with your hands or something like gum to chew on. You could do some breathing techniques, or you may have some coping statements or affirmations. It’s not a bad idea to have two or three actions ready to go.

Keeping Your Confidence Level in Check

Warning You got through a month smoke-free, but there’s a lifetime of quitting to go. Fortunately, in the long run, it’s a much-improved life. However, watch out for feeling overconfident. Unrealistic, overly optimistic expectations do many people in during this phase of quitting. You may believe that you’ve won the battle and start to let down your guard.

Think of confidence as a balloon. Not enough confidence is like a deflated balloon. Pretty useless. Without enough confidence, you’re unlikely to gather up the strength to carry on. You need confidence to be able to get through these next months.

The right amount of confidence is like a properly inflated balloon. It’s resilient. An inflated balloon can bounce and fly. That amount of confidence will serve you well. You know that you’re up to the task of quitting — even though it’s hard.

Too much confidence, however, is like an overly inflated balloon — highly vulnerable to popping at the slightest touch. If you’re overly confident, you may just burst at the touch of a trigger. That’s because your overconfidence has made you feel invulnerable. When you start to struggle, overconfidence leads you to feel shocked and surprised. Such inflated expectations could even make you feel you could get away with cheating — just a few puffs or a cigarette or two should be no problem for you!

Remember So, keep your confidence in check. Of course, you want to feel proud and capable — just not immune to urges, slips, and desires to cheat. Stay the course. You’ve done great so far, but remain realistic and prepared for more tussles with triggers.

Knowing What to Do When Your Willpower Wanes

Think of willpower (or self-control) as a muscle. You can exercise your willpower regularly and build it up. You can also carelessly deplete it if you don’t manage willpower carefully. Willpower becomes exhausted, like a fatigued muscle when you don’t get enough sleep or experience excessive stress. Willpower also needs to be fed a healthy, balanced diet to keep working. A hungry, tired body results in weakened willpower.

Remember Willpower is required to resist temptations like smoking. Willpower helps you manage your emotions and thoughts about almost everything, including smoking cessation. It can also focus your energy on seeing an arduous task to completion, such as the gargantuan undertaking of giving up an addiction.

Also, realize that people tend to run low on willpower at certain times of the day. Late mornings and late afternoons are especially problematic because the body’s glucose levels tend to be at a low ebb as the length of time since eating increases. Therefore, gird yourself for those times and be prepared to deal with increased urges. Consider a small snack at those times as well.

Tip In other words, it’s important to respect willpower. Everyone has some, and no one has it in unlimited amounts. Because it’s not unlimited, you must decide to manage or parcel out your willpower throughout your day.

Recharging willpower

Tip If you habitually run out of willpower when you need it, there are a few things you can do to rebuild your willpower muscles. The following suggestions will help you maximize your willpower reserves:

  • Don’t do everything at once. If you’re quitting smoking, don’t go on a difficult diet regimen at the same time — save that for later.
  • Make sure you give yourself enough time for sleep. A tired body is a willpower-depleted body. (See Chapter 17 for ideas.)
  • Eat small, healthy meals and healthy snacks throughout your day. Your body’s glucose supply provides fuel for your willpower reserves. Keep those levels as even as you can.
  • Start making regular use of to-do lists. These take important tasks off of your mind — what psychologists call decreasing cognitive load. When tasks are put on paper, you no longer have to spend so much time worrying about them.
  • Organize your work and personal spaces. Studies have shown that self-control or willpower increase when clutter decreases. Good organization wastes less time and takes less brain power to manage. If you’re a flat-out terrible organizer, ask a friend for help or hire a professional organizer. Work hard to keep it up — it will cost you far less in the long run if you do.
  • Keep track of your success. Count how many cigarettes you didn’t smoke each day and tabulate how much you’re saving. Even if you slip up, you’ll be able to see the progress you’ve made and feel inspired to get back on track.
  • Take time to relax and have fun. Watch a comedy show, go for a short hike in a park, take up a hobby, or stroll outside on a nice day. Recharge your batteries frequently.

Rewarding willpower

You can also increase your willpower reserves by rewarding yourself regularly for exerting good self-control. You don’t want willpower to be a drudgery in which you constantly deny yourself. Willpower needs to be rewarded for a job well done, just like you do.

Tip Steadily reward your willpower for achieving smoke-free days. Then plan for larger rewards for smoke-free weeks and, finally, months. Have a party after a smoke-free year. Don’t be cheap! You’re saving a fortune in the long run, not to mention saving your life.

Recognizing Problematic Emotions

Some smokers who want to quit have a history of emotional difficulties such as anxiety or depression. These problems may worsen with the additional stress of quitting. That doesn’t mean you shouldn’t try to quit! But it does mean that you have something extra to attend to.

Tip In the long run, quitting smoking will improve your mental health.

Other smokers have no history of anxiety or depression, but they acquire one or both problems when they try to quit. It’s kind of like a side effect of quitting for them.

Studies tell us that if you have a problem with anxiety or depression when you’re trying to quit smoking, your risk of relapse rises. That’s why, in the next two sections, we provide you an overview of what anxiety and depression look like so you can recognize them. Then we give you an idea of what sorts of treatments are available to help with these problems.

Remember All human beings experience anxiety or depressed feelings now and again. That’s completely normal. What makes these disorders problematic is when they reach the level that they persistently interfere significantly with your day-to-day living (at work, home, and play).

Analyzing anxiety

Many people report that smoking, vaping nicotine, or chewing tobacco, relaxes them. So, when they feel tense or anxious, they indulge and feel better. And most people who quit smoking feel increased tension, stress, and anxiety, at least for some period of time after quitting. That’s because nicotine withdrawal increases anxiety in the short run. Those feelings are normal and usually improve over the first couple of months of quitting.

But, for some, anxiety lingers and interferes with sustained smoking cessation success. Not only can anxiety mess up your quitting efforts, but it can also get in the way of daily life. If that happens to you, it’s entirely possible that you’re suffering from an anxiety disorder. About one in four people experience a full-blown anxiety disorder at one point or another in their lives.

There are various types of anxiety disorders. In this section, we cover some of the most common along with a brief description.

Warning These brief descriptions of anxiety disorders are not intended for you to diagnose yourself. However, if you think you may suffer from one or more of these problems, start by seeing your primary care doctor who may recommend that you see a psychologist, psychiatrist, counselor, or social worker.

Review the following list of anxiety problems to see if you think any may apply to you:

  • Generalized anxiety disorder (GAD): GAD is considered the common cold of anxiety. It’s characterized by excessive worry and apprehension that interferes with your life. It occurs more days than not. People with GAD have problems concentrating, feel restless, and on edge.
  • Social anxiety disorder: People with social anxiety disorder are fearful about rejection and negative evaluations from other people. They may avoid social situations, even when those situations may be important. Former smokers often report that social anxiety increases when they’re unable to reach for a cigarette.
  • Panic disorder: Panic disorder involves an eruption of intense, unexpected fear and discomfort. This fear and discomfort frequently involves a pounding heart, shortness of breath, chest pain, dizziness, and other symptoms that mimic a heart attack. People with panic attacks should work closely with their physician and therapist to learn how to manage their symptoms without making excessive, unnecessary trips to the emergency room. The good news is that panic attacks are highly treatable.
  • Agoraphobia: Agoraphobia is characterized by intense fear or anxiety about situations that involve being in open spaces, being trapped in places with no easy exit (theaters, shops, and so on), being in crowds, and having to be outside the home. Frequently these people fear not being able to escape, being embarrassed, or being unable to find help. Panic disorder often accompanies agoraphobia.
  • Specific phobias: These involve extreme fear or anxiety about an object or situation such as flying, traffic, seeing blood, snakes, spiders, heights, or certain diseases. People with phobias go to great lengths to avoid coming into contact with their feared object or situation. Their fear is way out of proportion to the actual danger.

If you think that you may have one or more of these problems with anxiety, refer to the section “Treating anxiety and depression,” later in this chapter.

Detecting depression

Depression disorders, like those of anxiety, come in a variety of categories. But these different types are more difficult to sort through for the average layperson. What really matters to you are the symptoms of depression in general. These symptoms include the following feelings:

  • Sadness
  • Emptiness
  • Hopelessness
  • Worthlessness
  • Lack of purpose
  • Inability to feel pleasure

In addition, depression may be in play if you

  • Have a sudden, unexplained weight loss or gain
  • Have trouble sleeping too little or too much
  • Feel very agitated
  • Have a lack of energy
  • Have unwarranted guilt
  • Experience changes in appetite
  • Have problems thinking and concentrating
  • Experience lowered interest in pleasurable activities
  • Have recurrent thoughts of death

Warning If you have any suspicion that you could be depressed, especially if you have thoughts of suicide, please seek help immediately. Call 911 or the national suicide prevention lifeline at 800-273-8255. Depression can be a serious, deadly disorder. Fortunately, it’s also treatable.

Treating anxiety and depression

Your odds of succeeding at smoking cessation are greatly enhanced if you get help for your anxiety and/or depression. These disorders are highly treatable, often without medications.

There are two major treatment types to inquire about. These are the most heavily researched and supportable as effective at this time. Other therapies may also be beneficial, but not as common and widely available. If you’re offered a different type of therapy, ask what the evidence says about its efficacy. You’re far better off in most cases to seek empirically supported treatments.

The two approaches we suggest you inquire about are

  • Cognitive behavioral therapy (CBT): CBT involves teaching you new ways of thinking about events, which, in turn, usually improves how you feel and lifts your moods. It also entails changing behaviors in a systematic way. CBT has been widely studied and supported as highly effective in treating both anxiety and depression. (Chapter 10 is largely based on CBT principles and strategies, both in terms of thinking and behaving.)
  • Medications: Some medications have been studied and found to be effective in treating both anxiety and depression. We usually recommend trying CBT first because it will teach you lifelong skills that can help prevent relapse. If you choose to try medication first, consider seeking therapy at the same time. Talk to your healthcare provider. (Chapter 9 covers medications designed to help specifically with smoking cessation efforts.)

Quitting smoking increases stress for most people. Increased stress can lead to a greater susceptibility to emotional problems such as anxiety and/or depression. Don’t ignore an uptick in difficult emotions. Early treatment works better and more quickly. Ignoring difficult feelings could lead to a relapse. You have too much to lose. For more help and information consider reading Overcoming Anxiety For Dummies or Depression For Dummies, both complements of yours truly (and published by Wiley).

Pumping Up Exercise

During your first weeks of quitting smoking, we encourage you to, well, baby yourself. Basically, do whatever you need, whether it’s eating a bit too much, binge-watching television, or getting daily massages, just get through this time without smoking, vaping, or chewing.

But now, as the strongest urges and cravings pass, it’s time to get moving. You know the benefits of exercise, but just in case you don’t, read Chapter 3, which summarizes them for you. With smoking cessation, exercise improves your health, gives you a nice strategy for battling urges, and helps keep your weight under control (see Chapter 20 for more information about controlling weight when stopping smoking).

The key is to start slowly. Respect that your willpower reserves are limited. Begin with a short, ten-minute walking routine. Gradually increase the duration and pace of your walks. If you watch TV, get up during commercials and walk around your living room. We highly recommend getting an activity tracker to give you feedback on how you’re doing — they’re amazingly motivating.

Tip Consider surveying all your exercise options to find a type you especially enjoy — including walks, weight lifting, yoga, dance classes, aerobic classes, or running. Find a partner to team up with if you can.

Looking Forward to Fading Nicotine Replacement Therapy

Too many people quit NRT prematurely. Most people should stay on NRT for 12 weeks or more. As your urges decrease, simply decrease your use of NRT very gradually. If urges increase with decreased NRT, consider upping your dose of NRT for a while. (See Chapter 9 for more information about NRT and medications.)

Although NRT has been established as a safe and effective way to increase smoking cessation success, many people don’t use it correctly, thereby decreasing its effectiveness. People have erroneous beliefs and worries about NRT, including the following:

  • I don’t want to get addicted to NRT — what’s the point? Studies tell us that NRT is much less addictive than smoking, for a variety of reasons, and it’s easier to discontinue, too.
  • It’s just not working for me — I still have urges. You may be taking too little NRT; many people do. Consult with your physician about dosage possibilities but realize that most people can take fairly high doses of NRT without excessive side effects. You can probably add an additional piece of gum or two or even another patch. You also may be relying too heavily on NRT for your quit plan. Strongly consider turning to your support system and reviewing your quit plan for strategies that you haven’t used enough. If you continue to struggle, consider adding an additional medication, such as varenicline or bupropion.
  • The side effects are too uncomfortable. Side effects from NRT usually soften with time. If your sleep is impaired, consider removing the patch at night. Take care to slightly reduce your use of oral products. Are you greatly exceeding the recommended doses? If so, pull back a bit. Sometimes people chew the gum too forcefully and long; if that’s you, be sure to follow instructions that come with gum and lozenges. You can also consider changing brands of NRT; that seems to help some people who experience side effects.
  • I prefer to do things without help from chemicals. Well, that sounds okay. But you need to appreciate that nicotine is a chemical, and most forms of smoking tobacco contain nicotine and upwards of thousands of other chemicals. Even vaping comes along with flavorings and sometimes unknown additives that may cause yet-to-be determined amounts of harm.
  • It costs too much. We hate to say it, but there’s some intense rationalization going on here. As costly as NRT is, it’s more affordable than cigarettes, especially over the long term. However, you can get help with the finances by calling 800-QUIT-NOW (800-784-8669), which can sometimes refer you to sources of subsidized help for purchasing NRT. In addition, generic brands from big box stores or drugstores are another option. Many insurance plans will cover NRT with a prescription. Some states also provide free NRT through Medicaid or the health department.
  • I caved and smoked a cigarette, so I stopped my NRT. You can still use NRT after a lapse. In fact, keeping up NRT may help you keep your lapse from becoming a relapse (see Chapter 19 for more information about lapses and relapses).
  • I’ll never get off it if I start. Even in the very unlikely event that you never get off NRT, your health will improve greatly as compared to what it would be if you continue to consume tobacco.
  • I read that you should stop at 12 weeks and that’s now. Use NRT until you’re able to handle smoking triggers without intense cravings. Many people continue to use gum or lozenges for urges long after the recommended 12 weeks. If you’re concerned, ask your doctor for advice.

Technical stuff You may wonder why NRT works. A small part of the equation is that NRT literally replaces some of the nicotine you were addicted to. But it’s not trading one addiction for another. We’ve already covered the greater safety profile of NRT, but there’s more. NRT also helps your brain disconnect the associations it has formed between various actions and events and smoking — things that trigger smoking like a cup of coffee, a beer, driving, you know the story. The nicotine is already in your system when you confront these situations. Over time, your brain disconnects the association of smoking with those events. It takes a while for this disconnection to happen, though, so give it time. Don’t discontinue prematurely.

Staying Vigilant Beyond Six Months

After six months of not consuming tobacco, you have every right to feel you’ve overcome your addiction. Good for you! Unfortunately, that’s not quite the case for many people. Studies tell us that the risk of relapse lingers on past a year for some. In fact, the potential for relapse never completely disappears.

That’s not cause for terrible concern, however. It’s not as though cravings continue to feel frequent and intense. It’s just that it’s easy to let down your guard. When you do that, your risk of relapse shoots up.

No one knows for sure how to prevent such long-term relapses, but we have a few thoughts on the subject. See Chapter 19 for information on bouncing back from relapse. And for building personal reserves, see Chapters 21 and 22 for strategies we believe you may find helpful over time. Meanwhile, keep up the fight! Good luck!