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No More Butts: Cognitive and Behavioral Strategies for Your Quit Smoking Plan

Last updated: Dec 06, 2018
Cigarette smoking is one of the leading cause of preventable premature death worldwide. Despite this, millions of people continue to smoke. Although many people want to quit, smoking is a learned behavior that results in physical addiction and is very difficult to give up. Clinical guidelines suggest that smoking cessation, or the process of quitting smoking, is reliant on both medication therapy and behavioral interventions. Medications include nicotine replacement therapy products as well as other therapies that either reduce craving and reduce withdrawal symptoms. Behavioral interventions include counseling, education, self-help materials, or any other plan based on replacing a negative behavior with a positive one.

Clinical Psychologist and Behavioral Health clinician, Katherine DiDonato, feels strongly that one the most important actions a person can take to improve their overall health is to quit smoking. Below are some of her “go to” cognitive and behavioral strategy recommendations that can help guide smokers on a long-term, smoke-free path.  


Change Your Thinking.

“There are several common ‘loopholes’ in the logic of one's thinking,” says Dr. DiDonato. These are also known as rationalizations and they are what make quitting so difficult. Some common rationalizations for smoking include:

                                          Rationalization                            Reality
 Smoking relaxes you. Once your body becomes dependent on nicotine, you feel more relaxed when you give it to your body and more tense when you don’t. Remember that smoking is an addiction, not stress relief and in the longer term you will feel more relaxed once you break the habit.
 Smoking makes you more effective. When you first quit you may notice that your concentration is affected. Remember, smoking actually deprives your brain of oxygen and you’ll think more clearly once your nicotine addiction is gone.
 I smoke at a "safe level". While it’s always good to cut down, no level of smoking is safe. You goal should always be to quit completely.
 Quitting is too difficult. Quitting is hard. But with proper support, it is possible.
 If I quit, I'll gain weight. Quitting may initially cause some weight gain. However, if you continue to eat and exercise the same as when you were smoking, the new weight should fall away quickly.
 I need to keep my hands busy. Quitting smoking means you now will often have a free hand. This may make you fidgety. Find something else to occupy your hands and your mind and the feeling should pass.
 The urge is irresistible. Satisfy underlying urges. Cravings may actually be from hunger, fatigue, or anger. So, instead of lighting a cigarette, take a nap, take a break, or do some simple exercises.

Learning to catch these loopholes and challenge them is critical to changing behavior.

Recognize and deal with triggers that disguise themselves as cravings.

Dr. DiDonato explains, “It is nearly impossible to avoid all smoking triggers, but if you have plans and strategies in place, you will be more prepared to handle them. Know that most cravings last only five to ten minutes. The ‘delay’ strategy may help you push through that time. When you commit to delaying, you make a contract with yourself to wait to smoke for five minutes. If you still want a cigarette after that time, you can have it. But, in the interim, you must do something engaging to get your mind off the urge.”


Use the A's.

  • Find an Alternative to a cigarette, such as carrot sticks or a toothpick.
  • Avoid the situations that tend to trigger you to smoke, like a favorite location for smoking.
  • Find an Alternative to your trigger. If coffee is a trigger for you to smoke, try having orange juice instead.


Quitting smoking takes more than just willpower. People also need support and guidance. As a large health care organization, we are in a unique position to offer that much needed support. Our doctors, pharmacists, and behavioral health clinicians are great resources for providing tools, education, and motivation. Additionally, Summit Medical Group offers a patient program called, Stop Smoking Now, led by Dr. Katherine DiDonato which gives patients skills to quit smoking and stay smoke free! The program consists of five individual appointments. If interested, you can call (908) 277-8900.


Katherine DiDonato, PhD, ACT, is a clinical psychologist and Diplomate of the Academy of Cognitive Therapy with an expertise in cognitive behavioral therapy for anxiety disorders, including panic disorder, obsessive-compulsive disorder, and phobias. Dr. DiDonato also treats patients who have depression, relationship problems, stress, and anger management issues. She has provided therapy in many settings, including community mental health clinics, hospitals, correctional institutions, day treatment programs, and schools.