[Podcast] How to stop smoking

Speaker 1: Julia Ebbens

Hello and welcome to the Bupa Healthy Me podcast. My name is Julia Ebbens. I’m a health writer here at Bupa, and today I will be chatting to Caroline Wood who is the head of Behavioural Insights at Bupa.

We will be discussing how to stop smoking. We’ll be focusing on why we smoke, and why it's so difficult for us to stop, as well as some really useful tools and tips around evidence-based approaches for stopping smoking successfully.

Hi, Caroline. It's lovely to have you with us. Thank you for joining us today. Would it be OK if you could start with a little introduction about yourself and your background?

Speaker 2: Caroline Wood

Of course. Thank you for inviting me to come along today.

I'm Caroline Wood, I’m head of Behavioural Insights and Research at Bupa UK. My background is in psychology and behavioural science. My PhD focused on smoking cessation and the impact of graphic warnings on smokers’ intentions to quit smoking, and also how it affects the relationship between smokers and non-smokers.

Moving on from my PhD, I started a post at University College London in research and particularly in digital health and behaviour change and I've been at Bupa now for about two years.

Julia Ebbens:

Perfect. It sounds like you’re the right person for the for the job here then. So obviously it's January and this time of year tends to make people think about having a fresh start health-wise. My first question is why do you think people start at this time of year to think about stopping smoking?

Caroline Wood:

The New year can be a really popular time of year to start thinking about making those important changes to your lifestyle, and there's plenty of prompts from our society too in our environment.

So, for example, in the media we see around us, we're prompted to reflect on the year that's just come to an end. And to really think about how we can improve on ourselves in the next year coming up. It's been coined the fresh start effect by psychologists and it relates to the fact that we use significant dates to kick start changes.

It’s not limited to ends and starts of the year, studies have found that we're more likely to start out on achieving new goals on a Monday than on a Thursday, and also around significant life events like moving house or starting a new job, or indeed having a family.

It's also to do with the tendency to view our past and future selves differently. So, we blame our previous bad habits on the old version of ourselves and hold the belief that the new and improved version will have more success in the coming year. It's absolutely a popular but a very logical time of the year to turn intentions into action, if you get all of the right tools and support in place.

Julia Ebbens:

That's an interesting point about getting everything in place because it seems as if maybe it would be more successful than if we go it alone to make sure we have that framework in place before we proceed. So that's a good point. Why do smokers often find it hard to stop even when it's so clear that it's actually quite bad for us?

Caroline Wood:

When it comes to making changes to our lifestyle, it's not simply that case of knowing something is bad for us and then deciding to change and hopefully making it happen. It’s more complicated than that.

Most of us, for example, will know all too well that eating the wrong types of foods, things like not getting enough exercise, or perhaps drinking too much, are all examples of poor lifestyle choices that we tend to make that are ultimately bad for us.

Now, one of the reasons that breaking bad habits, in other words, anything that we do that can prove harmful to us, either on an emotional level, mental level, physically or perhaps all three can prove particularly tricky because as humans our brains are actually hard wired to develop those habits as a way of trying to make life easier for us.

In life, if people had to think about everything we are doing in a conscious manner, it would become quickly overwhelming. For that reason our brain puts us all, on almost autopilot for those behaviours that we do on a regular basis to save those conscious thought processes for when we really need them. When we’re doing something complicated, complex or maybe something for the first time.

So when it comes to unhealthy habits, they also have the rather annoying trait of being rather enjoyable. I for one have never met a chocolate bar that I didn't like, and the chemicals in my brain know this too. When we enjoy something our brain releases that chemical dopamine. So if we do that enjoyable behaviour over and over again, you get that hit of dopamine each time, and it strengthens that habit.

So our brains are working chemically as well as us getting that behaviour hit over and over again. Dopamine is also responsible for creating that craving to do the behaviour again if you stop doing it. So your brain is trying to be helpful, but it can create some problems along the lines for us.

Julia Ebbens:

OK. That's actually very interesting and is there a particular thing that we do or a habit that we do which actually reinforces this dopamine response in the brain for example?

Caroline Wood:

Another reason habits can be hard to break is because by the very nature they're likely to be well ingrained in our day-to-day routines. Something we do becomes a habit – we’re reminded or cued in some way to do it and we do it repeatedly in this same context, over and over again. And rather unhelpfully the same process is true whether it's a bad or good habit. So what we've got is a situation where our brains are trying to be helpful but end up making it more difficult for us. And in addition, we've got our daily routines creating that perfect environment for bad habits to form and stick around.

Julia Ebbens:

Yeah, that does sound rather unhelpful. Can you think of a behaviour or maybe a routine that we have which might actually make us more likely to smoke?

Caroline Wood:

Absolutely. So think of your morning routine. You may always have a cigarette with your morning coffee. Maybe it's something more about the evening when we’re meeting up with friends, who perhaps smoke as well. Or indeed relying on smoking to help you cope with emotions such as stress or anxiety, when things get a little tough. Because your brain has learned that association, it may find it difficult at first when you try and convince it to do something different and then replace that behaviour with something else.

Julia Ebbens:

That’s really interesting. It sounds like our daily routines and behaviours can actually have a big role in our ability to stop smoking or not. Aside from the behavioural routines that we have, what makes stopping smoking particularly hard?

Caroline Wood:

Smoking remains the leading cause of preventable illness today. The trouble is, is that it's a complicated behaviour. Like we said, it's made-up of all those environmental triggers as well. But there's also some chemical triggers going on as well. So tobacco products obviously include a substance called nicotine, which is the main addictive drug that triggers that release of those feel good chemicals such as dopamine in our brains.

Over time that nicotine changes how the brain works. So it feels like it needs that nicotine to function normally. So when a smoker stops smoking, their brain doesn't like it, which may cause those uncomfortable feelings, such as feeling a little bit irritable or angry, which is often associated with that process of withdrawing from. These types of feelings pass after a while as the brain gets used to not having that nicotine around. But it can really make it feel that breaking the habit is a particularly tricky process as you get through those withdrawal feelings.

Julia Ebbens:

Definitely, it sounds like you really need to stick with it when you start to experience these withdrawal symptoms, and that sounds like a really challenging part of the process. Do you think that stress plays a role in our smoking addiction?

Caroline Wood:

For sure, stress is a big one. So when we're stressed it’s easier for those bad habits to form because the mental resources that we need to fight that stressful situation is just not available. Instead our mental resources are being directed towards fighting whatever it is that's causing us to feel stress and as a result, we go back into those bad habits or in case of smoking, we're just reaching for a cigarette. Many smokers will say that they smoke because they feel it calms them down. On one hand they’re probably right, because nicotine is that mood altering drug. It may temporarily mask those emotions that we associate with feeling stress, such as anger and feeling frustrated.

But really, behind the scenes, it increases the levels of stress in your body, causing that increase in blood pressure, increase in heart rate, and your muscles tense up as well. As soon as that hit from the nicotine wears off and leaves your blood stream, the chances are that you’ll feel worse than you did before you lit up. Worse still, you will have only dealt short term with the symptoms of stress rather than the root cause. Meaning that you're probably more likely to stress return and then that cycle continues.

Julia Ebbens:

OK, if it does sound like a bit of a vicious circle going on. Does that mean that if we took attempts to manage our stress through say, yoga or another sort of relaxation technique, do you think that would help us when we’re trying to quit smoking?

Caroline Wood:

Yes, I would say so because it removes you from the situation so your mind is distracted. You've got your focus elsewhere. But also it gives you that practical outlet for knowing how to deal with that stress in the moment and then sort of way forward and plan of action for when those feelings come up again.

Julia Ebbens:

Definitely, that does sound good. So imagine that someone has managed to temporarily quit smoking. What causes them to relapse and is there something we can do to avoid these smoking relapses?

Caroline Wood:

Relapses are a strange one because we often see it as a point of failure. But many people who quit smoking will relapse at some point. It’s a difficult change to make and it can take a few tries to quit smoking for good. That's the reality. But the most important thing to bear in mind is that just because you've relapsed, it doesn't mean that your right back at square one. You've actually made a lot of progress in doing that quit attempt and seeing it through.

This also doesn't mean that you're more likely to relapse again in the future. So I would always say try and see it as an opportunity to learn a bit more about yourself. Think about what factors led you to fall back into those old habits. Don't stop trying as it’s likely to just be a minor slip up rather than a full blown relapse.

Cravings are absolutely the number one predictor of relapse. Finding ourselves in that situation, where we've previously smoked, or perhaps feeling under stress where we would previously calmed ourselves by reaching for a cigarette are all likely to kick off those cravings and get us smoking again. Knowing what's likely to trigger those cravings allows you to prepare for them ahead of time a bit more and get in place those strategies to manage those cravings and stay on target.

The key really is in being able to make it easy for that new behaviour to happen and create what we call friction between you and the behaviour that we used to do and are trying to stop i.e smoking. We want to make it harder for cravings to derail your best intentions, in other words.

Julia Ebbens:

That makes a lot of sense. So it really sounds like there's so many different aspects to stopping smoking. You know, you need all these different tools in place to help. I just wondered. There's any evidence to suggest which approach is best when it comes to stopping smoking?

Caroline Wood:

Yes, there's very good evidence to show that a combination of having behavioural support, but also stop smoking aids such as E cigarettes and prescription medication can greatly increase your chances of successfully quitting smoking. It’s definitely about the combination of the two.

Studies have shown that having a program of support that involves setting a quit date, having a plan for dealing with things that make you reach for a cigarette, and getting support from trained stop smoking advisers, whether that be speaking with your GP or Pharmacist, is key to success. Part of that program might be getting support from other stop smoking aids such as nicotine patches, E cigarettes and or other medications such as Chantix, also known as Varenicline, to support you in managing those cravings as you transition through your quitting journey. It's the best form of support just to help you with those initial symptoms, which might be a little off putting as you go through that withdrawal process.

Julia Ebbens:

Interesting and that makes sense that if you're trying to wean yourself off something, it could be harder if you do that over a period of time.

Caroline Wood:

Yes, if you let yourself have one puff every now and again. It's really harder to see yourself as a non-smoker. You’ll always sort of have one foot in one camp and one in another.

Julia Ebbens:

Ok. I wondered if you had three top tips that you would recommend to someone that's really keen to stop smoking this year.

Caroline Wood:

So I would say that there's good news for us as humans and that is that we're much better than any other animal at changing and orientating our behaviour towards long term goals or benefits.

Psychologists studying willpower and motivation have likened self-control to muscles. So once you've exerted some self-control, let's say that you've maybe successfully stopped smoking on willpower alone for a whole week, which is excellent. Like a muscle, your self-control will get tired over time. So you need to have that set of plans or tools in place to strengthen that muscle so it can stand up to more, and help you to resist temptation next time you try to quit, setting yourself up for success.

There's not a one size fits all approach when it comes to quitting, but there are some strategies you can try to see if they'll work for you. My number one tip would be to expect and to plan for those urges to smoke, so you're more prepared. Cravings to reach for a cigarette can be really strong, particularly in those first few days after your quit date. So anticipate those cravings and really think about how you'll deal with these by thinking of some easy to do 5 minute activities that will just take your mind off of it, that’ll take you out of that moment and help you think about something else.

It could be going for a brisk walk around the block, calling a friend, or playing a distracting game on your phone. Anything to avoid just sitting there, dwelling in the moment and waiting until that craving is gone.

A second top tip I would say would be to start referring to yourself as a non-smoker, rather than someone who is trying to quit. This is really quite a strange one, you don't really see this in top tips to stop smoking, it’s a different way of thinking about things. But our identity and how we see ourselves plays such a big part, a much bigger part than we would have thought, in determining whether we achieve our goals or not by seeing ourselves as someone who's a non-smoker rather than someone who's in that process and may slip back. Using a bit more of a concrete hold around that identity.

Julia Ebbens:

Sure, it sounds like your mindset and how you actually see yourself has such a big impact on your success, which I don't think many people know about so that's a really useful point.

Caroline Wood:

Exactly. It's one of those rare tips. So I put that in there as well, and then third and finally I would say try and find a way of tracking your progress and seeing how far you’ve come, because it would be really powerful as well.

There's some great apps out there built on scientific improvement techniques that can really help you to keep motivation up, and give you advice on managing those cravings in the moment, and get you back on track quickly if you fall off. But it also helps you to see how far you've come which is something that you might not realise if you just going through the motions day by day.

Julia Ebbens:

Definitely. It's nice to see the bigger picture, and seeing how far you’ve come over a period of time. How can other people in your life, such as friends or family for example, support you or someone as they're going through the process of stopping smoking?

Caroline Wood:

Having support from other people is definitely a key factor in success. Studies are showing that having support and encouragement from others around us is particularly important in those early stages of quitting. Those of us who feel the most supported by close family and friends are most likely to be the people who remain quit after at least three months, so social support has a really important part to play here and determine how successful we are at quitting.

In the simplest sense, having people around you that know that you've recently made that decision to become a non-smoker, thinking about the identity part again, means that you've got a ready-made circle of people who can listen to you or who you can go and talk to if you feel you need to. They can also remind you of how far you’ve come and the benefits you've gained from quitting like having fresher breath, smoke-free hair and clothes.

Also the practical things like the money that you've saved by not buying cigarettes, no doubt friends and family can also help with the spending of that saved money. Perhaps treats that you can enjoy together, or go somewhere you can visit as a reward for when you've met those targets that you want to make.

Don't forget that in stopping smoking you’re disrupting your normal routine. So you'll need help to change your day-to-day from those friends and family around you so that you don't feel tempted to slip back into those old habits. This could be maybe taking up a new hobby or starting something new, such as an exercise class in the evening with those friends or family members, if they want to come along too, to help reinforce that new habit to form. There are great ways to repurpose that time, but also having someone to keep you accountable to keep going with those changes will help it become a new habit more easily.

Julia Ebbens:

So it just sounds like support is so essential and not to go it alone seems to be the message which you're repeating there, so that's good. Aside from your friends, family and the people close to you, where would be the best place to go for support and help outside of your close circle of people.

Caroline Wood:

So my first point of call if I was considering quitting smoking would definitely be to visit my GP and my local Pharmacist. They’re really the best placed people to give you the up-to-date expert advice that you'll need and that will stand you in the best position to successfully quit and stay quit.

They will also be able to put you in touch with services such as your local free stop smoking service, who’ll be able to support you throughout the journey and also advise you on stop smoking aids, whether that be medication or other forms of stop smoking aids that will help you manage those cravings and other withdrawal symptoms, particularly in those first few days and weeks.

There’s also a lot of great content freely available on Bupa.co.uk of course. Top tips and articles written by our experts, as well as real life stories, which is a really good insight to have from smokers who have gone through that quitting journey like yourself and are being truthful about the barriers that they've encountered and how they’ve overcome them. They’re very interesting stories to read.

It's really important to remember that like with all behaviour change, smoking or otherwise, everyone is different. So what might have worked for a friend or a family member that you've spoken to might not work in the same way for you.

There's a really great tool which is available on the NHS website that enables you to create your own personal quit plan. It’s only three questions long and it lets you find the right combination of support based on things like how many cigarettes you smoke, the strength of your cravings, such as when you reach for your first cigarette in the morning, and any other previous quit attempts you've made as well. So having that personalised plan will enable you to plan for the right type of support that you think you will need.

Julia Ebbens:

Great. It's good to know there’s so many tools and resources people can use, that's really positive.

Well, thank you so much for answering all the questions. I think it's been very helpful to get a good overview of what people can do to help themselves, where to go for support and also just understanding the whys around, you know, why do we smoke? And so why is it so difficult to break the habit? But it's good to end on a positive and I think we can see now that there's lots we can do to help ourselves with this process.

Thank you very much, Caroline. I much appreciate your input and I hope it's been useful to people as well.

Caroline Wood:

You’re welcome, thank you for having me.