By Clinical Psychologist, Dr Matthew Evans
Tomorrow, 31st May is World No Tobacco Day, so we’ve taken the opportunity to interview Dr Evans about how you can help loved ones take the right steps towards quitting once and for all.
I was listening to a discussion on a radio show the other day about taxing cigarettes. One person on radio was arguing against these taxes as she believed it denied people the right to make choices about their behaviour.
On the one hand, I can understand that she might feel frustrated by what could be seen as over-involvement by the government in people’s personal decisions. On the other hand, I can understand the government’s concern about needing to reduce smoking and it harmful effects in Australia. About 20% of Australian males and 16% of Australian females smoke. Smoking is one of the most important preventable causes of sickness and death, and taxing tobacco products has been found to be the most cost effective way to reduce smoking (Australian Bureau of Statistics; 2011-2012).
Over the years of working with patients at the thoracic medicine clinic at a major teaching hospital, I have seen similar disagreements to that which I heard on radio happening in the families of people who have lung disease and continue to smoke. Well-meaning family members often try hard to convince their loved one to stop smoking, and in return the person who is smoking can feel their rights to make decisions are being violated and that they are being judged. Everyone feels frustrated and generally there is no reduction in smoking. Overall, no one ends up winning.
Similarly, health professionals, knowing the benefits of not smoking and unsure of how to get people to stop, confront smokers with negative health messages of the dire consequences of smoking that are rarely effective in changing people’s behaviour. Who hasn’t heard that smoking is bad for your health? Merely repeating that message isn’t likely to work. Here are a few tips to help those who are finding it hard to help a person who smokes to stop smoking or cut back.
Ask not tell (avoid the “righting reflex” or trying to persuade)
The “righting reflex” is a desire to correct something/someone that you think is heading down the wrong path. It involves offering advice, tips or information to someone in order to try to persuade them to do what YOU think THEY should do. Although well-intentioned, it can cause the receiver to feel that their autonomy is threatened and therefore they become defensive. Importantly, trying to persuade someone to change can often actually reduce the chance that they will. Usually, it is better to ask questions first, find out where someone is at, and then help them explore the options of what they should do. People are much more likely to follow through with a plan that they have come up with themselves. If you think some information might be useful ask for permission to share first.
Empathise with the person’s experiences
Empathy helps people feel heard and understood. It helps people to feel that you are on their side and with them through their struggles. When done well, it opens people’s ears to what you have to say. When missing or done badly, you can lose any legitimacy to comment. Why would you listen to advice given by someone who doesn’t listen nor understand the problem in the first place?
Distinguish between “not wanting” and “not feeling able”
Often people will give lots of seemingly tenuous reasons why they won’t stop smoking. Often this masks their real reasons for not trying to stop – they don’t believe they can. It helps maintain someone’s self-esteem to believe that they are choosing not to change rather than being unable to change. Smoking is highly addictive and can be a very difficult behaviour to change. Often, smokers have had several unsuccessful prior attempts at quitting or are aware of other people’s struggles. Finding out if they have tried to give up before and if so what have they tried can help someone who smokes feel like you are genuinely wanting to help rather than just being judgemental or critical.
Know some facts about effective ways to stop smoking and build confidence
Related to the point above, when talking to people who smokes, the most common information provided is why they should stop smoking. The idea presumably is that people will feel anxious and do something about their smoking. This will only work if the person believes they can do something about it. If they don’t believe they can change, a state called “learned helplessness” can occur, which, in terms of smoking, means that people who smoke either accept the health risks or become desensitised to the health messages because there’s no point worrying about things you can’t avoid.
A better approach in such cases is to increase the person’s sense that they can change their smoking behaviour if they want to. This can involve highlighting any successes they have had as well as providing information about effective treatments. For example, it has been found that people are three times more likely to successfully give up smoking if they receive psychological support in giving up smoking in comparison to trying to just try to stop by themselves and five times more likely if they combine psychological support and pharmacological treatments (Laniado-Laborium, 2010).
Do not pursue the issue if you get a negative response
Sometimes even with the best communication skills in the world you may get a negative response, in which case leave it for the time being. If the negative response is mild or just involves not recognising a problem it might be worth just enquiring gently about concerns in a couple of months in case things have changed. Attempts to repeatedly bring up the issue that cause annoyance or frustration should be avoided as it can prevent people from acknowledging problems rather than be helpful.
Know where to get help
Often people need additional help to quit smoking or cut down. Knowing what services are available can really help. Some services that can be useful are:
Psychological treatments, such as cognitive behavioural therapy.
QUITline for general advice and counselling.
Seeing your GP for information about pharmacological treatments.
For more information on Matt and the team at Psychology Consultants, visit www.psychologyconsultants.com.au
Laniado-Laborim, R (2010). Smoking cessation intervention: an evidence-based approach.
Postgrad Medicine, 122(2):74-82
WHO report on Global Tobacco Epidemic (2013)
Bureau of statistics webpage. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4125.0main+features3320Jan%202013