Last updated: Jul 29, 2008
smoker-therapy
Individual therapy can be costly, but it can greatly improve your chances of quitting.
(CORBIS)
Individual counseling can be a big help for smokers who are trying to quit. Just under 11% of smokers are able to quit without some type of therapy, according to the latest U.S. Public Health Service (USPHS) guidelines. But one-on-one counseling increases the average success rate to nearly 17%.


"Sure, medication is effective at curbing withdrawal symptoms," says Bruce Christiansen, PhD, lead researcher at the University of Wisconsins Center for Tobacco Research and Intervention (UW-CTRI). "But it still takes a great deal of effort and behavior modification to quit smoking."

Though the USPHS meta-analysis found that group therapy and phone counseling increase success rates, experts say that those methods can't compare to a one-on-one session that is tailored specifically to each patient.

"Individual therapy is much more beneficial," says Patricia Summers, a counselor at the Cleveland Clinics Tobacco Treatment Center. "Patients need a plan that is customized just for them. That is something you cant get on the Internet or phone."

Summers also notes that one-on-one therapy is helpful for smokers who feel uncomfortable opening up in a group setting. "It is just like a doctors visit," she says. "They dont have to worry about their pride and they can openly voice their frustrations."

That was certainly the case with Arrie Thomas, 57, of Cleveland. Her individual therapy session at the Cleveland Clinic was instrumental in helping her quit. "I had too much pride to go to counseling when I had tried to quit in the past—I wanted to do it on my own," she says. "But counseling was really what I needed. It helped me realize what behaviors and patterns were causing me to want cigarettes."

What happens at an individual counseling session?
It is difficult to know exactly what to expect in a one-on-one session, says Doug Jorenby, PhD, director of clinical services at UW-CTRI. "There isnt a one-size-fits-all approach," he says. "Every program is different."

In general, Jorenby says, the first order of business is typically to agree on a quit date and discuss how to prepare for it. "We talk about how important it is to get rid of all cigarette stashes, ashtrays, and matches," he says. Some counselors may also suggest informing your friends and family about your decision and enlisting their support.

Once a quit date is set, counselors usually ask smokers to focus on the behaviors and stressors that put them at risk of lighting up. One way to do this is to have smokers visually walk through their day and discuss when and where they get the urge to smoke. Some counselors, like Summers, may recommend keeping track of this in a diary.

"Smoking is an embedded part of their lives," says Iyaad Hasan, director of the Cleveland Clinics Tobacco Treatment Center. "Counseling can help change that by focusing on the situations or emotions that influence people to smoke."

Thomas says that visually going through her day made her realize what actions, such as talking on the phone, triggered her to light up. "It helped open up my eyes," she says.


How do I apply what I learn at a counseling session?
After the smoker identifies his or her triggers, the therapist then helps the patient develop a new set of behaviors and coping skills. For example, if coffee has been revealed to be a smoking trigger, a counselor may suggest drinking water instead; likewise, he may suggest substituting breathing exercises for a cigarette before a stressful meeting. "It is all about changing your routine," says Hasan.

A counselor may ask what times of day you find cigarette cravings most challenging—and then suggest ways to distract yourself or avoid triggers during those hours. If you typically smoke right after breakfast or while reading the morning newspaper, for example, Jorenby suggests that you leave the house soon after you wake up. "Pick up coffee on the way to work or go out to breakfast," he says. "Do something that will disrupt your usual pattern."

For Thomas, that distraction was exercise. "The more I walked, the less I wanted cigarettes," she says of replacing smoking with physical activity. "It took my mind off it. I used to need a cigarette to relax me, but now walking does the trick." Her counselor also helped her realize that letting friends and family smoke inside her home was an important trigger that she needed to avoid.

How many sessions do I need?
According to the USPHS guidelines, your chances of quitting increase every time you engage in a counseling session that involves interpersonal contact. The USPHS recommends four individual sessions. However, if this type of counseling is too expensive, the guidelines state that even one brief session can be helpful.

As smoking-cessation therapy becomes more prevalent, some health plans are beginning to cover individual counseling. Though Medicare and Medicaid will cover counseling only if you have a health condition related to smoking (or are taking medication that is affected by tobacco), both the USPHS guidelines and the Task Force on Community Preventive Services, an independent organization appointed by the Centers for Disease Control and Prevention, recommend that all insurers help defray the cost of smoking-cessation counseling. Check with your insurance provider to see what type of counseling, if any, it will pay for or reimburse. If you are unable to afford a one-on-one session, experts recommend group therapy or quit lines.

Where do I find a therapist?
If you live near a university or hospital, call and find out if they have a tobacco-cessation program. You can also ask your doctor or insurance company for a recommendation, or call 1-800-QUIT-NOW (the National Cancer Institute's smoking-cessation hotline) for advice on finding a therapist in your area.