Managing Cravings in ACT for Smoking Cessation

Fred Hutch Cancer Center, University of Washington

Key Points

  1. ACT strategies for smoking cessation emphasize understanding the reinforcing role of avoidance in smoking behavior, as illustrated through exercises like the paradox of avoidance.
  2. The ‘urge monster’ metaphor effectively conveys the concept of letting go of the struggle against cravings, highlighting the importance of acceptance rather than resistance.
  3. Linking the treatment techniques to the initial functional analysis ensures a comprehensive approach, focusing on allowing rather than acting on cravings, emotions, and thoughts.
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This section delves into specific strategies and exercises used in acceptance and commitment therapy (ACT) to address Jane’s smoking cessation, focusing on understanding and managing cravings.

Addressing Cravings and Avoidance

Identifying the Function of Avoidance

  • The initial step involved helping Jane understand the role of avoiding cravings in reinforcing smoking.
  • Smoking was identified as a temporary distraction from physical cravings, making it highly reinforcing.

Illustrative Exercise: The Paradox of Avoidance

  • Jane was asked to try not to think about smoking for 30 seconds.
  • This exercise demonstrated the paradox that trying to avoid a thought often leads to its increased presence.

Tug of War with the Urge Monster

Introducing the Urge Monster Metaphor

  • The concept of an ‘urge monster’ was used to illustrate the struggle with cravings.
  • The exercise involved envisioning a tug of war with this monster, symbolizing the battle against urges.

The Counterintuitive Solution: Letting Go

  • Jane was encouraged to consider dropping the rope in the tug of war, symbolizing ceasing the fight against cravings.
  • The key was to let cravings exist without acting on them by smoking.

Central Mechanism of Change: Letting Urges Pass

Focus on Sensations and Emotions

  • The primary mechanism of change in ACT for smoking cessation involves allowing cravings, emotions, and thoughts to occur without responding to them.          
  • Jane was taught to focus on physical sensations and emotions like anger or shame and to let them pass naturally.

Importance of Acceptance

  • Acceptance, a core component of ACT, was emphasized as crucial for success.        
  • Each exercise in ACT aims to teach how to experience and let cravings, emotions, and thoughts pass.

Linking Back to Functional Analysis

Connection with Initial Assessment

  • The exercises and strategies tie back to the initial clinical functional analysis.
  • Understanding triggers is vital for teaching skills to let emotions, thoughts, and cravings pass.

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Managing Cravings in ACT for Smoking Cessation