Quiting Smoking: A Cognitive Behavioral Therapy Session

John asked for our help for quiting smoking, and it has been a few sessions that we have been working together with him on this issue. In this session, we try to understand his need and desire to smoke when he is bored, and he is feeling uncomfortable.

T: So John, you told me that you don’t smoke while at home, but you do when you are out, especially out with friends. Can you tell me what happens at those times?

J: I guess I get bored. Yeah, most of the time, I smoke because I get bored.

T: I see. And how do you feel at those times when you get bored?

J: I don’t know. Not very well. Uncomfortable, I guess. You know that feeling of discomfort.

T: So you smoke when you are with your friends because you get bored, and you have a feeling of discomfort? And how do you feel afterwards?

J: I feel relieved. Especially, the first few seconds after I light the cigarette.

T: And then?

J: Towards the end of it, that feeling of discomfort starts to rise again, and this time, I feel guilty too.

T: Why is that?

J: Because I know “I shouldn’t be smoking.”.

T: So you end up feeling worse, and maybe as an end result, smoking more?

J: Exactly.

T: I wonder what would happen if you were there out with your friends, listening them talk, and got bored, and felt that discomfort, but you didn’t smoke?

J: I would feel worse I guess.

T: And what would happen then?

J: What would happen? I’d go crazy!

(seems like the vicious cycle of smoking for John looks like something like this):

T: I see. Do you ever get bored while at home?

J: Yes, of course.

T: But you don’t smoke.

J: No.

T: What do you do?

J: I don’t know. I guess I sleep, or go get a beer.

T: How about TV?

J: Yeah. I like watching series on Netflix actually.

T: OK. Are there other things you do when you are at home, and get bored?

J: I play video games in the evenings usually, and in between the games, I go to the fridge and look for something to eat or drink.

T: So, those are the things that make you feel better when you have that feeling of discomfort while at home.

J: Yeah, but I don’t smoke at home any way.

T: No, you don’t. Let me summarize what I heard then. When you are out with your friends, and you get bored, you have this feeling of discomfort, and you light a cigarette. On the other hand when you are home, and you get bored, again, you have the feeling of discomfort, and this time, you drink a beer, you eat something, you play video games, or watch series on Netflix. Am I correct?

J: Yes.

T: And would you agree that you do all these for the same purpose: in order to get rid of boredom. Actually to get rid of the discomfort you feel when you are bored.

J: Yeap.

T: Is it because that you think you would go crazy if you were bored, and you are feeling uncomfortable, and you didn’t get rid of this feeling?

J: Yes. I can’t stand it. That feeling I have when I’m bored.

T: I wonder if anything like that has ever happened? That you got bored, you felt the discomfort, and you didn’t smoke, and got crazy?

J: No, I guess not. I don’t know actually because I light a cigarette whenever I’m bored.

T: Tell me. What would you think of the possibility of someone going crazy out of boredom? out of 100?

J: I don’t know. I think it is pretty high. Like 85.

T: Tell me how does it look like in your head, when you imagine yourself gone crazy?

J: I don’t know. My head explodes?

T: Oh. Have you ever seen anything like that happening to somebody?

J: No. Not in real life.

T: Maybe in movies?

J: Yes.

T: What else can happen when you go crazy out of boredom?

J: I don’t know. You got mentally ill? you become schizophrenic or you become a psychopath… I don’t know really…

T: Have you ever seen anybody having become schizophrenic because he got really bored, started to feel bad, and didn’t do anything about this feeling?

J: No, of course not, but I don’t know… I just feel like I’d be feeling worse if I don’t do anything when I’m bored.

T: That is one possibility, yes, you might feel worse. Are there any other possibilities?

J: Like what?

T: Like it doesn’t change. It doesn’t get worse?

J: I don’t know maybe.

T: …or the discomfort might fade away?

J: Just like that? I don’t think so.

T: Actually, it is quite possible. Many studies have shown that discomfort will fade away if you give it enough time. It even has a name. It is called habituation. (drawing a anxiety-habituation curve).

J: So If I get bored, but I don’t do any of those things that I normally do, my boredom will go away? just like that?

T: I don’t know about your boredom, but the discomfort you feel, when you are bored is expected to go away. You know the bad feeling that makes you smoke when you are bored.

J: That terrible feeling will go away. I wouldn’t believe it, but OK.

T: Has it never occured to you that you were home, and bored, and had the same uncomfartable feeling, and you wanted to do something you would normally do in order to get rid of that feeling, but that time, you couldn’t because you had a very important homework to do, and you just sat at your desk, and did the homework.

J: Oh, actually, yes it has. It was a very important exam though. I wouldn’t do that just for a homework.

T: OK. How did it feel back then? Do you remember? Did that uncomfortable feeling get worse?

J: No, actually it didn’t. I remember that I forgot about it while trying to prepare a cheat sheet for the exam.

T: So it faded away?

J: Yes.

T: Tell me. How much do you believe now that you will go crazy if you get bored, have a feeling of discomfort, and don’t do anything to get rid of this feeling? Is it still 85?

J: I guess I would say 50.

T: So if you are out with your friends, and you get bored during a conversation, and you have this feeling of discomfort, and you want to light a cigarette, but you don’t, there is a 50% chance that you will go crazy, get mentally ill, and become a schizophrenic or a psychopath?

J: (laughs) No. When you say it like that… It sounds a bit silly.

T: So what will happen then?

J: Even if I don’t light a cigarette, there is a possibility that that feeling of discomfort will go away.

T: Would you like to test it and see it for yourself?

J: So, if I get bored, and wanna light a cigarette, I won’t do that. Instead, I will wait until that feeling goes away. I guess I can give it a try.

T: How about preparing a little reminder on which you can write the summary of the things we talked about today? Something you can carry in your pocket and check it out whenever you feel like smoking out of boredom.

J: Yeah, that will be great because I know I’ll need to remember these. I can even put it in my cigarette pack.

T: What a great idea!

Here is what John wrote on a little paper:

“When I feel bored and uncomfortable, I believe that I must get rid of that feeling as soon as possible, or else, I might go crazy. At those times, for the purpose of getting rid of that feeling, I tend to smoke. However, although I feel better when I light a cigarette, after a few seconds that feeling of discomfort rises again, and this time I feel guilty too, so smoking actually makes me feel worse. On the other hand, if I choose not to smoke,  there is a possibility that the feeling of discomfort will not get worse, and even fade away. In fact, I do believe that I might feel even much better afterwards considering the many benefits of being a non-smoker. “

I guess this is all for today. 

If you’d like to learn more about how to identify, and challenge automatic thoughts, see articles “Automatic Thoughts: What are They and How can We Identify Them?”, and “How to Challenge Automatic Thoughts” .

I would love to hear about your thoughts and ideas! Please share them with me below at the comments section, or send me a message.

Write to you soon,

Aysegul.

This short story was written for educational purposes only. The character in this article is fictitious. No identification is intended and should be inferred.