Research has found that coping techniques involving changes in thinking or doing (behavior) are highly protective against relapse.[1] Maximum protection occurs when we're skilled in applying more than one coping strategy if needed.
So, how do you successfully navigate the sudden onset of a brief yet possibly intense crave episode? Let's review a few crave coping techniques.
Reach for your core recovery motivations
If a significant crave episode occurs, it's normal to forget many of reasons that motivated us in the first place. But, what if you could immediately pull out a full list of reasons from your pocket, purse or wallet?
Why not make them your first line of defense—a defense that pits reason against impulse?
As with achievement in almost all human endeavors, the wind beneath your recovery wings won’t be strength or willpower, but robust dreams and desires.
If you have a smartphone, launch Notes and begin building your list. As un-expected benefits emerge during recovery, add them to the list.
Keep your dreams alive, vibrant and on center-stage.
Distraction crave coping
Distraction or diversion crave coping is any mental exercise or physical activity that occupies the mind long enough to allow challenge to pass.
A popular 3 minute coping exercise is to say your ABCs while associating each letter with your favorite food, person or place.
For example, the letter "A" is for grandmother's hot apple pie. "B" is for warm buttered biscuits. You may never reach the challenging letter "Q" before the challenge passes.
Counting exercises can be as simple as counting backward from 350 by 7s. That would involve your mind doing 50 simple math calculations.
Consider playing a hand of solitaire or reaching for a crossword puzzle. Can you draw?
Sing your favorite song, reorganize a closet or drawer, look through your photo album, play with your pet, phone a friend, read a book or magazine, check your mail or email, do the dishes or start a load of laundry.
Distraction isn't about avoiding a craving but about temporarily diverting your attention and focus until the intensity and risk of relapse subsides.
Physical distraction possibilities include turning to your favorite non-nicotine activity such as playing music or dancing, a brief period of physical exercise, going for a short walk or bike ride, taking a shower, or something as simple as brushing your teeth.
If you ever feel a need to vent, try screaming into a pillow, squeezing a tree, or biting your lip. I promise, the pillow won't scream back, you won't hurt the tree, and your lip will heal.
Slow deep breathing
It isn't normal to breathe deeply. Most of us breathe from the chest. It's called shallow breathing.
When you breathe deeply, your body takes in more oxygen and you exhale more carbon dioxide. The body "resets" itself to a more relaxed and calm state.
We normally breathe at a rate of 12 to 15 breaths per minute. Research shows that slow deep breathing at a rate near 6 breaths per minute—roughly one breath every ten seconds—promotes relaxation.[2]
The use of slow deep breathing as a coping strategy isn't for everyone. Some of us have damaged our lungs more than others. Your number of breaths per minute may need adjusting.
Also, initial attempts at controlled breathing can lead to hyperventilation with lightheadedness. A couple of practice sessions may be needed before trusting deep breathing as a go-to coping strategy.
Allow at least 2 minutes to complete the following U.S. Department of Veterans Affairs relaxation exercise:
1. Sit comfortably or lie down. Place one hand on your stomach and the other on your chest.
2. Breathe in slowly through your nose. Feel your stomach expand as you inhale. If you are breathing from the stomach, the hand on your chest shouldn't move. Focus on filling up your lower lungs with air.
3. Slowly exhale, releasing all the air out through your mouth. Use your hand to feel your stomach fall as you exhale.
4. To begin, try breathing at or near 6 breaths per minute (about one full inhale and exhale every 10 seconds). Return to normal breathing if you begin feeling lightheaded. If lightheadedness occurs again during your next practice session try adding 1-2 additional breaths per minute.
5. Repeat the above steps up to 10 times.[3]
Listen to two additional audio deep breathing exercises at WhyQuit: Exercise 2 [4] | Exercise 3 [5].
Mindfulness crave coping
Mindfulness is a state of hyper-awareness of something. It's achieved by focusing on the present moment, while calmly acknowledging and accepting our feelings, thoughts, and bodily sensations.[6]
While engaging in slow deep breathing, remain aware and monitor your crave. Accept your thoughts and feelings about it without judging them. See yourself as being separate from the craving.
One mindfulness strategy is to mentally reach out to and embrace your crave. A crave cannot cut, burn, bruise or harm you.
Try to be brave. In your mind, wrap your arms around the crave's anxiety energy and then feel as it slowly fizzles while within your embrace.
Yes, another trigger bites the dust as you reclaim yet another aspect of life.
Muscle relaxation
Progressive muscle relaxation is the intentional tensing and releasing of successive muscle groups. It's based on the fact that muscle tension is the body's physiological response to anxiety-provoking thoughts and that muscle relaxation blocks anxiety.[7]
A 2015 study found that "progressive muscle relaxation significantly reduces cigarette craving, withdrawal symptoms, and blood pressure in smokers undergoing acute abstinence."[8]
Before attempting the following exercise, stop if any movement causes you pain. Be cautious about stretching or tensing parts of your body that have caused you problems in the past. Consult your doctor first if unsure about safety due to an injury or condition.
Allow at least 10 minutes to complete this U.S. Department of Veterans Affairs muscle relaxation exercise:
1. Take a few slow, deep breaths. Inhale deeply through your nose with your mouth closed to a count of four. Exhale slowly through your mouth—also to a count four. On the exhale, imagine tension leaving your body, flowing out with each exhale. Repeat this 3 to 4 times. If at any point you feel dizzy or light-headed, return to normal breathing.
2. Continue to breathe deeply as you move into the muscle tension and relaxation parts of this exercise. You will begin with your feet and work your way up. As you inhale, tense and hold each muscle for a count of four. Relax that muscle group as you breathe out. Take several breaths before you move to the next part of your body. Allow time to feel the relaxation.
3. Tense the muscles of your feet by pointing your toes and tightening your feet as you inhale. Hold this tension briefly, and then relax your toes and feet as you breathe out. Imagine the tension flowing out with your breath. Notice the difference between tension and relaxation.
4. Press the balls of your feet into the floor and raise your heels, allowing your calf muscles to contract. Feel the tension in your calves for a moment. Then release and notice your muscles relax. Again, have the tension and relaxation match your breath.
5. Tighten your knees and allow your legs to straighten. Feel the tightness in the front of your legs. Notice the sense of tension as you inhale. Release on the exhale, allowing your legs to bend and relax back onto the floor.
6. Squeeze the muscles of your buttocks. Notice the feeling of tension as you inhale. Hold this for just a moment. And on your exhale, release and allow your muscles to relax, letting the tension melt away.
7. Continue up through your body. Concentrate now on your stomach. Contract your stomach and continue to breathe. Hold the tension for a count of 4. Inhale deeply. As you exhale, let your stomach relax. Again, notice the difference the tension and relaxation.
8. Move your attention now to your hands. Curl your fingers into a tight fist in each hand. Hold your fists tight and notice the sense of tension as you continue to breathe. As you release your fists, let your hands relax back to a natural position. Notice the difference between the feeling of tension and relaxation in your hands.
9. Now, bend both arms at the elbow (like Popeye). Flex both of your arms by making fists and pulling your fists up tightly to your shoulders. Notice the feeling in the tensed muscles of your upper arms. Take another inhale and as you exhale and relax your arms down to your sides. Take notice of any change in what you feel as you go from a state of tension to relaxation.
10. Push your shoulders up to your ears now. Hold this "shrugging" position for just a moment. Feel the tension in your neck and shoulder muscles. Feel the tension melt away as you relax your shoulders back down. Continue to breathe in and out.
11. Finish by tensing the muscles in your face. Scrunch your face as if you just bit into something sour. Feel your eyebrows pull together, your eyes pinch tightly shut, and your lips purse together. Notice the sensation of tenseness in your face for just a moment. Then allow your face to relax. Notice the release of tension from your forehead, eyes, cheeks, mouth and jaw.
12. Now, conduct a body scan. Try to find any other spot of tension in your body. Notice it and let it go. Let yourself be still for a few moments. Just experience your relaxed muscles. Continue to breathe slowly and deeply. Feel any tension flow out. Feel your relaxation grow deeper with each breath.[9]
Listen to 3 additional progressive muscle relaxation audio exercises at WhyQuit: Exercise 2 [10] Exercise 3 [11] Exercise 4 [12].
Guided imagery
Guided imagery or visualization is a mind-body management technique where you call upon mental images to help induce relaxation or stress reduction.[13]
The more it’s practiced the more effective it becomes at diminishing stress.
A 2005 study divided 71 smokers into two groups. While both groups received counseling, one also received guided imagery training and was encouraged to practice it at least once daily. The long-term (2-year) success rates were twice as high in the guided imagery group.[14]
Allow at least 2 to 3 minutes to complete the following U.S. Department of Veterans Affairs guided imagery exercise:
1. Position your body in a way that feels comfortable for you (either sitting in a chair or laying on a comfortable surface) and close your eyes.
2. Take a few deep breaths using the deep breathing technique described above.
3. Take a moment to imagine yourself in a scene where you feel relaxed. It can be a place you have been to in your past or a relaxing scene you imagine. It can be indoors or out in nature. Choose something that is calming for you.
4. Although it is normal to have doubts this will work, give yourself permission to visualize it. Put yourself in the scene.
5. Use your senses to experience the relaxing sights, sounds, smells, textures, and physical sensations in your scene. Fill in as many details as possible.
6. Allow yourself to relax into this scene. Focus your attention on the peaceful calm of this place.
7. Continue to focus your attention on the details of the scene and the feelings of calm that flow from it. See if you can stay with the image for at least 60 seconds.
8. If you find your attention being pulled away by distractions, gently bring your awareness back to the scene. With practice, it will become natural and relaxing. If prone to falling asleep you might want to set a timer to alert you after a few minutes.[15]
Listen to two additional guided imagery audio exercises at WhyQuit: Exercise 2 [16] Exercise 3 [17]
Laughter
Let's close relaxation with laughter. First, try to laugh without smiling. Can you do it? Notice something missing?
Research shows that laughter activates various muscle groups for a few seconds each, which leads to general muscle relaxation which may last up to 45 minutes.[18]
Laughter also induces random deep breathing.[19] There's also evidence suggesting that among those with a sense of humor, that laughter and smiling can result in diminished anxiety and stress.[20]
Helping your subconscious switch teams
Our subconscious is in control of our body’s panic switch, our fight or flight pathways. Your primitive subconscious mind (the lizard brain) may see ending nicotine use as similar to going without eating or starvation.
Yes, your subconscious was as fooled as you were. For years, it guarded against blood nicotine levels falling too low and sounded alarms to prevent it.
Is it possible to get your subconscious to switch teams, to help protect against nicotine entering your body? What do you have to lose by trying?
Use your conscious thinking mind to calm and reassure your lizard brain, especially in the fleeting seconds before dosing off into sleep.
It's in those precious moments when communication becomes possible as the two draw near.
Here's a sample message while slumbering off:
"Yes, we did it! Please continue helping arrest our addiction to nicotine. Nicotine is an insecticide and poison. Help me ensure that tomorrow remains nicotine-free too. Aid me in staying as calm and as comfortable as possible as together we celebrate breaking free."
References:
2. Noble DJ and Hochman S, Hypothesis: pulmonary afferent activity patterns during slow, deep breathing contribute to the neural induction of physiological relaxation, Frontiers in Physiology, Sept. 2019, 13;10:1176.
3. U.S. Department of Veterans Affairs, Veterans Employment Toolkit: Relaxation Exercise: Deep Breathing, https://www.va.gov/vetsinworkplace/docs/em_eap_exercise_breathing.asp Accessed 15 Dec. 2022.
4. Morisis S, Short relaxation, Dartmouth Student Wellness Center, https://students.dartmouth.edu/wellness-center/wellness-mindfulness/mindfulness-meditation/guided-audio-recordings/deep-breathing-guided-relaxation - Accessed 07/08/20.
5. U.S. Department of Veterans Affairs, Harry S. Truman Memorial Veterans' Hospital, Relaxation Recordings by Kathleen Darchuk, Ph.D, ABPP, https://www.columbiamo.va.gov/services/Relaxation_Recordings.asp - Accessed 07/04/20.
6. Lexico, mindfulness, https://www.lexico.com/en/definition/mindfulness, accessed June 2, 2020.
7. Wikipedia, "progressive muscle relaxation," https://en.wikipedia.org/wiki/Progressive_muscle_relaxation - Accessed 06/29/20.
8. Limsanon T and Kalayasiri R, Preliminary effects of progressive muscle relaxation on cigarette craving and withdrawal wymptoms in experienced smokers in acute cigarette abstinence: a randomized controlled trial, Behavioral Therapy, March 2015, Volume 46(2), Pages 166-176.
9. U.S. Department of Veterans Affairs, Relaxation exercise: progressive muscle relaxation, https://www.va.gov/vetsinworkplace/docs/em_eap_exercise_PMR.asp Accessed 06/29/20.
10. U.S. Department of Veterans Affairs, Harry S. Truman Memorial Veterans' Hospital, Relaxation Recordings by Kathleen Darchuk, Ph.D, ABPP, https://www.columbiamo.va.gov/services/Relaxation_Recordings.asp - Accessed 07/04/20.
11. U.S. Department of Veterans Affairs, Harry S. Truman Memorial Veterans' Hospital, Relaxation Recordings by Kathleen Darchuk, Ph.D, ABPP, https://www.columbiamo.va.gov/services/Relaxation_Recordings.asp - Accessed 07/04/20.
12. Dartmouth, Student Wellness Center, Progressive Muscle Relaxation Exercise, https://students.dartmouth.edu/wellness-center/wellness-mindfulness/mindfulness-meditation/guided-audio-recordings/progressive-muscle-relaxation - Accessed 07/08/20.
13. American Psychological Association, APA Dictionary of Psychology, "guided imagery," https://dictionary.apa.org/guided-imagery, retrieved 06/29/20.
14. Wynd CA, Guided health imagery for smoking cessation and long-term abstinence, Journal of Nursing Scholarship, 2005, Volume 37(3), Pages 245-250.
15. U.S. Department of Veterans Affairs, Relaxation exercise: visualization, https://www.va.gov/VETSINWORKPLACE/docs/em_eap_exercise_visualizing.asp Accessed 06/30/20.
16. Morgan P, Mountain Meditation, Free Mindfulness, Adapted from Jon Kabat-Zinn, freemindfulness.org - Accessed 07/08/20.
17. U.S. Department of Veterans Affairs, Harry S. Truman Memorial Veterans' Hospital, Relaxation Recordings by Kathleen Darchuk, Ph.D, ABPP,https://www.columbiamo.va.gov/services/Relaxation_Recordings.asp - Accessed 07/04/20.
18.Paskind J, Effects of laughter on muscle tone, Archives of Neurology & Psychiatry, 1932, Volume 28, Pages 623-628; as cited in Bennett MP, et al, Humor and Laughter May Influence Health: III. Laughter and Health Outcomes, Evidence-Based Complementary and Alternative Medicine, March 2008, Volume 5(1), Pages 37-40.
19. Fry W, The respiratory components of mirthful laughter, Journal of Biological Psychology, 1977, Volume 19, Pages 39-50; as cited in Bennett MP, et al, Humor and Laughter May Influence Health: III. Laughter and Health Outcomes, Evidence-Based Complementary and Alternative Medicine, March 2008, Volume 5(1), Pages 37-40.
20 Yovetich NA, et al, Benefits of humor in reduction of threat-induced anxiety, Psychological Reports, February 1990, Volume 66(1), Pages 51-58.
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Publication date: May 4, 2021