Quitting #5: Addressing the Psychological Track

Now for the psychological track – the third of the Triple Tracks – to complete this series describing how applying the disease model to nicotine use disorders helps improve the likelihood of success in quitting and staying quit. We focus on three psychological tasks, all of which relate to paying attention to internal experience. Here is a brief summary: 

1. Resolving internal indecision about using nicotine. Our patients struggle with the uncomfortable psychological dilemma of simultaneously desiring two contradictory things: continuing to smoke or vape while also quitting. This psychological state, known as “ambivalence,” is a source of discomfort during active nicotine use as well as in the early stages of abstinence. At Triple Track, we help people resolve this ambivalence. Our aim is to replace the unstable and uncomfortable cycle of Using 🡪 Quitting 🡪 Using 🡪 Quitting with a stable and ultimately comfortable abstinence from nicotine. We accomplish this by blending two established treatment approaches, Motivational Interviewing and Internal Family Systems.

   
   

2. Expanding awareness of the process of nicotine use. For our patients, the use of nicotine has become a process that is both automatic and puzzling. We use Cognitive Behavioral Therapy to help them understand that the behavior of smoking and vaping is the result of an interaction between external stimuli or “triggers” and internal cravings and thoughts. When our patients grasp this intellectual framework of the relapse process, they can use their higher levels of thinking to interrupt the process before it leads to a return to actual use.

   
   

3. Stress management. After physical withdrawal symptoms have resolved, the most common reason for people returning to nicotine use is in response to stress. Because nicotine has the ability to rapidly relieve the uncomfortable feelings that result from stress it can become the default way of managing every-day, low level stress. For example, the irritation resulting from a frustrating interaction with a supervisor at work or family member can be quickly relieved with a smoke or vape break. We work with our patients to be aware of this connection and develop alternative tools to manage these situations.

What sets the psychological track of our program apart from other smoking and vaping cessation programs are:

• We use a unique combination of established psychotherapy treatment models

  
  

• Our treatment sessions are more frequent and continue for a longer period of time

Combining this psychological approach with the biological and interpersonal/social aspects of a comprehensive disease model approach is, I believe, what helps our patients to quit and stay quit from nicotine at much higher rates than at conventional smoking cessation programs. Until this approach becomes more widespread, I urge any of you who have become discouraged by previous unsuccessful quit and stay quit efforts to contact us by clicking here.