My

Smoking

Cessation

Workbook

My

Smoking

Cessation

Workbook
Acknowledgements

The provider manual HIV Provider Smoking Cessation Handbook and the accompanying My 

Smoking Cessation Workbook were developed by the HIV and Smoking Cessation (HASC) 

Working Group of the Veterans Affairs Clinical Public Health (CPH). The authors primary goal 

was to develop materials promoting smoking cessation interventions, based on published 

principles of evidence- and consensus-based clinical practice, for use by HIV-care providers 

treating HIV+ patients who smoke. 

With permission from Dr. Miles McFall and Dr. Andrew Saxon, several materials used in these 

publications were modified from smoking cessation workbooks they developed for providers 

of patients with post traumatic stress disorder as part of the Smoking Cessation Project of 

the Northwest Network Mental Illness Research, Education & Clinical Center of Excellence 

in Substance Abuse Treatment and Education at the VA Puget Sound Health Care System. 

The Public Health Service Clinical Practice Guideline (Fiore, 2000) and the treatment model 

described by Richard Brown (2003) provided the foundation for their work and therefore 

indirectly ours as well.1

Many thanks to Kim Hamlett-Berry, Director of the Office of Public Health Policy and Prevention 

of CPH, for supporting this project; Hannah-Cohen Blair and Michelle Allen, research assistants, 

for their help organizing materials; and Leah Stockett for editing the manual and the workbook. 

As well, the HASC Working Group: Ann Labriola, Pam Belperio, Maggie Chartier, Tim Chen, 

Linda Allen, Mai Vu, Hannah Cohen-Blair, Jane Burgess, Maggie Czarnogorski, Scott Johns, and 

Kim Hamlett-Berry.

1 Brown, R. A. (2003). Intensive behavioral treatment. In D. B. Abrams, R. Niaura, R. Brown, K. M. Emmons, M. G. Goldstein, & 

P. M. Monti, The tobacco dependence treatment handbook: A guide to best practices (pp. 118-177). New York, NY: Guilford Press.

Fiore, M. C., Bailey, W. C., Cohen, S. J., Dorfman, S. F., Goldstein, M. G., Gritz, E. R., Heyman, R. B., Jaén, C. R., Kottke, T. E., 

Lando, H. A., Mecklenburg, R. E., Mullen, P. D., Nett, L. N., Robinson, L., Stitzer, M. L., Tommasello, A. C., Villejo, L., & 

Wewers, M. E. (2000). Treating tobacco use and dependence. Clinical practice guideline. Rockville, MD: U.S. Department of Health 

and Human Services, Public Health Service.
Table of Contents

I. HIV and Smoking ......................................................1

What You Need to Know......................................2

II. A Stop-Smoking Plan .................................................7

STEP 1: Setting My Quit Date!................................8

STEP 2: Identifying My Smoking Triggers and

Beginning to Delink..................................9

STEP 3: Identifying My Reasons to Quit and My 

Support System .................................... 13

STEP 4: Talking to My Provider to Identify Smoking 

Cessation Medications to Use With My

Quit Plan............................................ 15

STEP 5: Getting Ready to Quit............................. 17

STEP 6: Developing Strategies and Skills

for Quitting ......................................... 20

STEP 7: Planning to Cope with Smoking Triggers ........ 24

STEP 8: STOP SMOKING! .................................... 26

STEP 9: My Strategies to Use Immediately

After Quitting ...................................... 27

STEP 10: Identifying and Coping with

 Nicotine Withdrawal ............................. 30

STEP 11: Preventing a Smoking Relapse .................. 32

STEP 12: Preventing Weight Gain After Quitting......... 34

STEP 13: Developing an Exercise Program................ 36

III. Next Steps .......................................................... 41

IV. Appendices ......................................................... 43

Appendix A ................................................... 44

Appendix B ................................................... 46

Appendix C ................................................... 48

Appendix D ................................................... 50

i
HIV and Smoking

A Stop-Smoking Plan

Next Steps

Appendices
I. HIV and Smoking

What You Need to Know

1
What You Need to Know

THE PROBLEM

 Almost 2-3 times as many HIV+ adults smoke compared to adults who are HIV 

negative.

 HIV+ smokers develop lung diseases; respiratory problems; heart disease; and 

lung, bladder, and prostate cancers just like HIV-negative smokers.

 BUT HIV+ smokers are more likely than HIV+ non-smokers to have:

•	 More AIDS-related illness such as Pneumocystis jirovecii pneumonia, 

tuberculosis, and oral candidiasis

•	 More non-AIDS related diseases such as cardiovascular and pulmonary 

conditions (e.g., pneumothorax, pneumonia, lung cancer) and 

non-AIDS cancers

•	 An increased risk of death compared to HIV+ individuals who never smoked

 Smoking can make your HIV disease worse.

 Continuing to smoke can undo much of the hard work you’ve done to manage 

your HIV.

THE GOOD NEWS

 Smoking cessation (quitting smoking) can decrease the risk of heart disease 

in HIV+ individuals, perhaps more so than the use of lipid-lowering drugs or 

antiretroviral therapy (ART).

 The risk of cardiovascular events (e.g., heart attack, stroke) in HIV+ individuals 

decreases the longer one has stopped smoking.

 HIV-related symptoms tend to decrease the longer you go without smoking.

 Every attempt to quit improves the chance of eventual success.

2

I. HIV and Smoking
THE CHALLENGE

 It’s very hard to quit smoking.

 It may take several attempts for you to permanently quit.

 Quitting works best when you have lots of support and work with your health 

care team.

 A combination of nicotine replacement therapy (e.g., gum, patch, lozenge) or other 

FDA-approved smoking cessation medications and counseling is the most effective 

way to quit.

 Counseling helps you stick to your plan and overcome barriers to quitting. Counseling 

can be done through a telephone quitline, as part of a group, individually with your 

provider, or online.

THE PROGRAM

Thinking about quitting can be overwhelming. You must do it for yourself, but you don’t 

have to do it alone. This manual was created to help you quit and can be used in a number 

of ways:

1. Follow the steps starting on p. 7, which are designed to help you quit smoking 

within 30 days.

2. Start where you are in the quitting process and decide which steps in this 

workbook are most helpful to you.

3. Share information in this workbook with your provider, friends, and family to help 

them understand your plan.

I. HIV and Smoking

3
THE REWARDS1

From 20 minutes to 20 years, the benefits of quitting smoking last a lifetime.

20 minutes after quitting

Your blood pressure drops and the circulation in your hands and feet improves.

12 hours after quitting

The carbon monoxide level in your blood returns to normal.

2 days after quitting

Your taste and smell senses improve.

2 weeks to 3 months after quitting

Your heart attack risk drops and your lung function improve.

1 to 9 months after quitting

Your coughing and shortness of breath decrease.

1 year after quitting

Your added risk of heart disease is half that of a smoker’s.

5 to 15 years after quitting

Your risk of stroke is now equal to a non-smoker’s.

10 years after quitting

If you are an average smoker (one pack a day) your lung cancer death rate drops by almost half. 

Risk of cancers of the mouth, throat, esophagus, bladder, kidney, and pancreas decreases.

15 years after quitting

Your added risk of heart disease is the same as a non-smoker’s.

1 Note. Adapted from Tobacco Smoking and HIV, California Smokers Helpline, www.californiasmokershelpline.org and It’s 

Time to Live!

I. HIV and Smoking

4
20 minutes to 20 years...

Benefits of quitting smoking 

last a lifetime

I. HIV and Smoking

5
A Stop-Smoking Plan

HIV and Smoking

Next Steps

Appendices
II. A Stop-Smoking Plan

STEP 1: Setting My Quit Date!

STEP 2: Identifying My Smoking Triggers and 

Beginning to Delink

STEP 3: Identifying My Reasons to Quit and My 

Support System

STEP 4: Talking to My Provider to Identify 

Smoking Cessation Medications to Use 

With My Quit Plan

STEP 5: Getting Ready to Quit

STEP 6: Developing Strategies and Skills 

for Quitting

STEP 7: Planning to Cope with Smoking Triggers

STEP 8: STOP SMOKING!

STEP 9: My Strategies to Use Immediately 

After Quitting

STEP 10: Identifying and Coping with 

Nicotine Withdrawal

STEP 11: Preventing a Smoking Relapse

STEP 12: Preventing Weight Gain After Quitting

STEP 13: Developing an Exercise Program

7
STEP 1: Setting My Quit Date!

 YOUR QUIT DATE SHOULD BE WITHIN 30 DAYS FROM TODAY

When is the last day and time I am going to use tobacco?

Pick a day that feels comfortable to you. If the day has special meaning to you (e.g., 

the birthday of someone close to you, an anniversary, and so forth), even better! Try 

to pick a date that you know won’t be stressful for you for other reasons (e.g., first day

of a new job, a time when friends and/or family won’t be available to provide support).

MY QUIT DATE

Month_______ Day________ Year________ Time_________

8

II. A Stop-Smoking Plan
9

STEP 2: Identifying My Smoking Triggers and 

Beginning to Delink

MY SMOKING TRIGGERS WORKSHEET

IDENTIFYING SMOKING TRIGGERS

Smoking is an addiction that includes a physical dependence on nicotine (a dependence 

that can last for a few months and be helped with medications) as well as behavioral 

conditioning.

Behavioral conditioning is the “habit” part of the addiction, and is your response to 

your smoking triggers.1 You may, for example, find yourself lighting up because you

always smoke when you talk on the phone, drive the car, take a break, or have a cup of 

coffee. In these situations, you have learned to smoke (automatic smoking) in response 

to a trigger. In order to stay smoke-free, you must decide ahead of time what actions 

you will take to deal with these triggers. It is important to break the link between 

these triggers and automatic smoking and if you can do so before your quit date, your 

quit effort will be easier.

Worksheet Instructions:

Several common triggers are listed below. Check your key triggers and add any 

that are missing. Then, circle your top 5 triggers.

£ Nicotine cravings

•	 When I get cravings after I haven’t smoked in a while

•	 When I get cravings because I’m restless or irritable 

•	 When I miss the taste or pleasure of a cigarette

£ Needing to handle something

•	 When I need to do something with my hands

•	 When I want to go through the ritual of lighting up and handling a cigarette

£ Needing an energy boost

•	 When I’m tired and need a “pick me up”

1 It’s important to remember that cravings due to behavior can last for years so changing behavior is a key part of 

long-term success.

II. A Stop-Smoking Plan
£ Thinking and concentration

•	 When I want to concentrate better

•	 When I’m thinking through a problem

£ Feeling down, depressed, or bored

•	 When I’m feeling sad, blue, or down in the dumps

•	 When I think about difficult or stressful memories

•	 When I am thinking about my HIV infection

•	 When I’m bored

£ Feeling stressed out

•	 When I’m restless, fidgety, or uptight

•	 When I’m worried or frightened 

•	 During a crisis or unexpected event

•	 When I’m under pressure or a time crunch

£ Relaxation

•	 When I need to relax

•	 When I’m taking a break

£ Feeling angry

•	 When I’m angry and need to calm down

•	 When I need something to settle me down so I won’t do something I’ll regret

•	 When I’m in an argument

£ Feeling “up” and positive

•	 When I’m having a good time

•	 When I want to reward myself for having done a good job on something

£ Social situations

•	 Social events or gatherings such as parties, playing cards, or dining out

•	 Being around other people who are smoking

•	 When my friends or family invite me to smoke with them

II. A Stop-Smoking Plan

10
£ Drinking coffee 

•	 When I have my morning coffee

•	 When I take a coffee break

£ Drinking alcohol or being around others who are drinking

•	 When I’m drinking alcohol

•	 When I’m in a bar or restaurant where other people are drinking

£ Other activities of daily living (check all that apply):

Driving in a car

Reading a newspaper, magazine, or book

Watching television

During a meal

After a meal

Talking on the telephone

Waking up in the morning

My other smoking triggers

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

II. A Stop-Smoking Plan

11
BREAKING THE LINK BETWEEN SMOKING AND OTHER HABITS WORKSHEET

Once you identify your top five triggers, you can make a plan to delink your smoking from

these trigger activities and/or other situations. For example, if you always smoke with your 

coffee in the morning, make a plan to either smoke before or after your coffee, but not with 

it. If you delink far enough in advance of your quit date, your craving to have a cigarette 

with your coffee will be greatly reduced, if not eliminated, by the time you stop smoking. 

Once you’ve successfully delinked your strongest trigger and smoking, look at your next 

strongest trigger and implement a similar plan.

Worksheet Instructions:

In the space below rank your top five triggers (from p. 9) and write down your 

plan to break the link between them and your smoking.

1. Trigger:______________________________________________________________

Plan to delink: ________________________________________________________

____________________________________________________________________

2. Trigger: _____________________________________________________________

Plan to delink: ________________________________________________________

____________________________________________________________________

3. Trigger:______________________________________________________________

Plan to delink: ________________________________________________________

____________________________________________________________________

4. Trigger:______________________________________________________________

Plan to delink: ________________________________________________________

____________________________________________________________________

5. Trigger:______________________________________________________________

Plan to delink: ________________________________________________________

____________________________________________________________________

II. A Stop-Smoking Plan

12
13

STEP 3: Identifying My Reasons to Quit and 

My Support System

REASONS TO QUIT WORKSHEET

MY REASONS TO QUIT

Write down the five most important reasons why you want to stop smoking.

1. ________________________________________________________________

2. ________________________________________________________________

3. ________________________________________________________________

4. ________________________________________________________________

5. ________________________________________________________________

Consider using a 3x5 index card

 Copy your top three reasons to quit onto a 3x5 

index card

 Keep the card in the pocket where you used to 

keep your cigarettes

 Read the card when you want to smoke

 On the back of the card write “The urge to 

smoke will pass, whether I smoke or not”

 Read both sides of the card when tempted 

to smoke

The urge to smoke 

will pass, whether

I smoke or not

II. A Stop-Smoking Plan
GETTING SUPPORT

Choosing to quit is a tough decision. You must do it for yourself, but you don’t have to do it 

alone. Asking for help is a key part of the quitting process. Think about who can help you 

quit. Consider family members and other people with whom you spend a lot of time. Also 

consider getting support from former smokers who have successfully quit.

To help yourself quit, you can:

 Tell everyone that you’re quitting and when

 Ask family, friends, and roommates to smoke outside

 Ask a friend or spouse to quit with you

 Make a list of people who can give you support (fill in chart below)

 Call a quitline such as 1-800-QUIT-NOW (1-800-784-8669) for free telephone counseling 

 Access an online quit program such as www.smokefree.gov or www.ucanquit2.org

MY ALLIES IN QUITTING

Name Phone Number Email Address

Family Friends and 

Social Contacts

Co-Workers

II. A Stop-Smoking Plan

14
15

STEP 4: Talking to My Provider to Identify 

Smoking Cessation Medications to 

Use With My Quit Plan

Medications can play an important role in helping you quit. Your primary care provider 

can prescribe these medications for you, let you know how to take them, and monitor 

any side affects you may have. Studies have shown that using two medications together—

one that helps with nicotine withdrawal and one that helps with nicotine craving—can 

help smokers quit. Here is list of the medications your provider may prescribe:

NICOTINE REPLACEMENT THERAPY

 Nicotine patch therapy is the most common medication used to help people stop 

smoking cigarettes. This therapy replaces the nicotine you were getting from 

cigarettes so you don’t have withdrawal symptoms when you quit.

 Nicotine chewing gum acts as a substitute oral activity and provides a source 

of nicotine that reduces the withdrawal symptoms experienced when smoking 

is stopped. It is not chewed like regular chewing gum and must be used in a 

specific way.

 Nicotine lozenge is another substitute oral activity and provides a source of 

nicotine that reduces the withdrawal symptoms experienced when smoking is 

stopped. It can also help with cravings.

SMOKING CESSATION MEDICATIONS 

 Bupropion (Zyban®) is a pill that reduces a person’s urge to smoke. Many patients 

report that cigarettes do not taste as good after starting this medication.

 Varenicline (Chantix®) helps people stop smoking by reducing their urge to 

smoke. It is possible that this medication may make health problems (like 

depression and heart conditions) worse, so ask your doctor or pharmacist for 

more information about it.

II. A Stop-Smoking Plan
OTHER MEDICATIONS THAT MAY BE AVAILABLE

These medications may not be available at all VA Medical Centers. Please talk with your 

provider if you are interested in using them.

 Nicotine nasal spray temporarily replaces the nicotine you were getting from 

cigarettes so you don’t experience uncomfortable withdrawal symptoms when 

you quit.

 Nicotine inhaler temporarily replaces the nicotine you were getting from cigarettes so 

you don’t experience uncomfortable withdrawal symptoms when you quit.

COMBINATION THERAPY

Nicotine replacement products can be combined to increase your chances of quitting, 

especially if you smoke more than one pack a day. There are several possibilities for 

combination therapy including:

 Nicotine patch and nicotine gum

 Nicotine patch and nicotine lozenge

 Bupropion and nicotine gum

 Bupropion and nicotine lozenge

 Bupropion and nicotine patch 

II. A Stop-Smoking Plan

16
17

STEP 5: Getting Ready to Quit

GETTING READY TO QUIT WORKSHEET

The behavioral changes listed below will help reduce your nicotine dependence so your 

withdrawal symptoms will be less severe after you quit. These changes will also help 

break up your smoking routine and delink, or cut the ties, between your triggers and 

automatic smoking.

Making small changes will remove cigarettes from the comfortable role they now play in 

your everyday life. Quitting will be easier after you make some of these small changes.

Worksheet Instructions:

Below are suggestions for small changes you can make. Check one (or a few) 

and try to stick with it. As you get used to one change, try another.

Break up your smoking routine

£ When you smoke, hold your cigarette with the hand opposite the one you 

usually use.

£ Try switching to a brand of cigarettes you don’t like.

Build your confidence

£ Use the “5-minute timeout” rule. Each time you want a cigarette, wait five

minutes before reaching for a cigarette. This strategy will improve your 

confidence and help you deal with cravings.

£ Each day, postpone by one hour the lighting of your first cigarette.

£ Delay each cigarette by first using substitute behaviors such as having a piece

of gum, going for a walk, or doing deep breathing exercises.

£ Change your eating habits to help you cut down on smoking. For example, end 

meals or snacks with a food that won’t lead to a cigarette. Create a list of 

what healthy foods might be (e.g., fruits, vegetables, Melba toast, a slice of 

whole wheat toast) and keep them on hand.

_________________ _________________ _________________

_________________ _________________ _________________

II. A Stop-Smoking Plan
Resist “automatic smoking”

£ Smoke only those cigarettes you really want—catch yourself before you light up a 

cigarette out of pure habit.

£ Don’t empty your ashtrays. This will remind you how many cigarettes you’ve 

smoked each day, and the sight and the smell of stale cigarettes butts can be 

very unpleasant.

£ Make yourself more aware that you are going for a cigarette (the automatic reach) 

by using the opposite hand or putting cigarettes in an unfamiliar location (e.g., a 

different pocket).

£ If you light up many times a day without even thinking about it, try to look into a 

mirror each time you light your cigarette. You may decide you don’t need it.

Make smoking awkward

£ Stop buying cigarettes by the carton—finish one pack before you buy another.

£ Stop carrying cigarettes with you at home or at work. Make them difficult to get.

Keep your cigarettes in one place and ALWAYS go to that place to smoke.

£ Eliminate the places where you will smoke: the car, your favorite chair, 

the bedroom.

Make smoking unpleasant

£ Smoke only under circumstances that aren’t especially pleasurable for you. If you 

like to smoke with others, smoke alone. Turn your chair to an empty corner and 

focus only on the cigarette you are smoking and its many negative effects.

£ Collect all your cigarette butts in one large glass container as a reminder of the 

trash made by smoking.

£ Only smoke outside.

Reduce your smoking

£ Smoke only half of each cigarette.

£ Decide you’ll only smoke during odd or even hours of the day.

£ Make a plan to smoke fewer cigarettes each day (e.g., if you smoke 10 cigarettes a 

day, smoke one less each day). 

II. A Stop-Smoking Plan

18
£ Identify a minimum of three cigarettes that would be the easiest for you to give up 

(e.g., before brushing your teeth at night, while walking to your car, with your 

coffee). Give up smoking these cigarettes before your Quit Date.

Limit where you smoke

£ Before your Quit Date, it’s important to reduce the number of places and situations 

where you smoke. For example, if you normally smoke while talking on the phone, 

wait until the call is completed, and then go have a smoke.

Avoid “high-risk” triggers

£ After finishing a meal, leave the table immediately and take a walk or do

another activity.

£ Have your morning coffee or coffee breaks without a cigarette.

£ Instead of smoking at your usual break time, go for a walk when you need a break.

Avoid people who smoke

£ Encourage other smokers in the household to quit with you or not smoke in 

your presence.

£ Limit going to places where you know other people will be smoking (e.g., bars, 

smoking sections of restaurants).

Talk to your primary care provider and/or counselor

£ Discuss smoking cessation medications and nicotine replacement therapy with your 

provider. Ask about using combination therapy.

£ Talk with your provider about a referral to a smoking cessation counselor for 

individual or group therapy.

II. A Stop-Smoking Plan

19
STEP 6: Developing Strategies and Skills 

for Quitting

STRATEGIES AND SKILLS FOR QUITTING WORKSHEET

After you quit, expect to make changes in the way you think and act. Below are a 

number of ways to cope based on the three types of smoking triggers:

1. External situations where you tend to smoke automatically like when driving 

a car, drinking coffee, or being around other people who smoke.

2. Thoughts and feelings like depressed moods, anger, anxiety or worry about 

the future.

3. Cravings and urges to smoke, which may sometimes be connected to having 

nicotine withdrawal symptoms like thinking “I ‘need’ a cigarette” or dwelling 

on how good a cigarette would taste.

Worksheet Instructions:

Place a check by the strategies that might work for you. Refer back to this 

worksheet often, and use it to help you complete the My Action Plan for 

Coping with Smoking Triggers Worksheet (p. 24).

Use strategies that remove temptations

£ Make sure all cigarettes are destroyed. Do not keep any in your house, the car, 

or at work.

£ Get rid of all smoking reminders such as ashtrays and lighters.

£ Clean your clothes to rid them of the cigarette smell, which can linger for a 

long time.

£ Ask your friends or family who smoke to not smoke around you and not offer 

you cigarettes.

Get support

£ Talk to an ex-smoker. Find out how he/she stopped.

£ Remind your family and friends that you are quitting. Ask them to help you 

over the rough spots of the first couple of days and weeks.

20

II. A Stop-Smoking Plan
£ Buddy up with another Veteran who has decided to stop smoking and support each 

other. This could be another HIV+ Veteran who smokes. 

£ Talk to your therapist or provider about adjusting medications that may make 

smoking urges easier to handle.

£ Call someone and talk about your feelings.

Change your routine 

£ Drink lots of water (eight glasses per day).

£ Drive a different route to work.

£ Don’t sit in your favorite smoking chair.

£ Keep busy.

£ Begin some projects you’ve been putting off.

£ Stay in non-smoking areas as much as possible.

£ Get plenty of rest.

Use behavioral coping strategies

£ Take a 5-minute timeout when you feel a craving for tobacco.

£ Take a walk or engage in other exercise.

£ Close your eyes and take 10 deep breaths.

£ Try deep breathing and/or relaxation exercises.

(See Appendix A and B for instructions)

£ Brush your teeth more often than usual.

£ Keep your hands busy (e.g., handle a coin or polished rock, squeeze a rubber ball).

£ Leave a situation when the urge to smoke is strong.

£ Wear a rubber band around your wrist and snap it when you have strong urges 

to smoke.

£ Turn on some soothing music.

£ Distract yourself by engaging in a hobby or pleasurable activity.

II. A Stop-Smoking Plan

21
Use mental coping strategies

£ Review the list of reasons why you want to quit.

£ Remind yourself of the health benefits of quitting.

£ Remind yourself of the money you’ll save by not smoking.

£ Remind yourself that by quitting, you’ll be less likely to get an AIDS-related illness 

such as pneumonia or thrush.

£ Think about how hard you’ve worked to manage your HIV and how much quitting 

will help.

£ Imagine your future if you continue to smoke, then imagine how your life will 

change if you stop.

£ Remind yourself that the urge to smoke will go away in a few minutes.

£ Recognize that “just one” cigarette can undo all your hard work and lead to 

a relapse.

£ Think about some aspect of smoking that is negative to you.

£ Think about enjoyable activities or relaxing places for a brief time.

£ Don’t think of never smoking again. Think of quitting in terms of one day at a time 

or one urge at a time.

£ Think of being a good role model for someone you love and how quitting will enable 

you to do more things with this person.

£ Review your progress and reward yourself.

£ Realize that YOU are CHOOSING not to smoke. No one is making you stop.

II. A Stop-Smoking Plan

22
Develop healthy eating habits

£ Limit or avoid coffee and caffeinated drinks. Reduce caffeine intake by 50% when 

you quit to avoid some common withdrawal symptoms such as insomnia.

£ Limit or avoid alcoholic beverages.

£ Limit sugar intake.

£ Drink eight glasses of water daily.

£ If you want a snack, choose vegetables, fruits, sugarless gum, Melba toast, water 

or seltzer.

II. A Stop-Smoking Plan

23
STEP 7: Planning to Cope with 

Smoking Triggers

MY ACTION PLAN FOR COPING WITH SMOKING TRIGGERS WORKSHEET

Worksheet Instructions:

Use this worksheet to summarize your triggers and coping strategies. First, list 

your top 5 smoking triggers from your My Smoking Triggers Worksheet (p.9). 

Then, refer to your Getting Ready to Quit Worksheet (p. 17, STEP 5) and 

Strategies and Skills for Quitting Worksheet (p. 20, STEP 6) for ideas on 

coping strategies. In the chart on the following page, write down the coping 

strategies that will help you handle the three kinds of triggers:

1. External situations where you tend to smoke automatically like when driving 

a car, drinking coffee, or being around other people who smoke.

2. Thoughts and feelings like depressed moods, anger, or worry about 

the future.

3. Cravings and urges to smoke, which may sometimes be connected to 

having nicotine withdrawal symptoms like thinking “I ‘need’ a cigarette” or 

dwelling on how good a cigarette would taste.

24

II. A Stop-Smoking Plan
My Smoking Triggers

(p. 9)

Temptation Removal 

Strategies (p. 20)

Behavioral Coping 

Strategies (p. 21)

Mental Coping

Strategies (p. 22)

My Action Plan for Coping with Smoking Triggers Worksheet

II. A Stop-Smoking Plan

25
STEP 8: STOP SMOKING!

26

II. A Stop-Smoking Plan
27

STEP 9: My Strategies to Use Immediately 

After Quitting

MAKE A PLAN FOR SUCCESS!

Reduce your stress on 

“Quit Day”

Assume the identity of 

a non-smoker

 Schedule a day that is as stress-free as you can 

make it.

 Keep busy on the big day. Go to the movies, 

exercise, take long walks, go bike riding.

 Buy yourself a treat or do something special 

to celebrate.

 Develop a clean, fresh, nonsmoking environment 

at work and at home. Buy yourself flowers. You

may be surprised how much you can now enjoy 

their scent.

 For the first 1-3 weeks, avoid situations you

associate with the pleasurable aspects of 

smoking, such as watching your favorite TV 

program, sitting in your favorite chair, or having a 

cocktail before dinner.

 The first few days after you quit, spend as much

free time as possible in places where smoking 

isn’t allowed, such as libraries, museums, 

theaters, department stores, and churches.

 Drink large quantities of water and fruit juice, but 

avoid sodas that contain caffeine and sugar.

 Try to avoid alcohol, coffee, and other beverages 

that you associate with cigarette smoking.

 If you miss the sensation of having a cigarette in 

your hand, play with something else, such as a 

pencil, a paper clip, or a marble.

 If you miss having something in your mouth, try 

toothpicks or cinnamon sticks.

II. A Stop-Smoking Plan
Assume the identity of 

a non-smoker

(continued)

Plan for the “crazies”

 Instead of smoking after meals, get up from the 

table and brush your teeth or go for a walk.

 Until you are confident of your ability to stay

off cigarettes, limit your socializing to healthful, 

outdoor activities or situations where smoking is 

not allowed.

 If you must be in a situation where you’ll be 

tempted to smoke, such as a dinner party, try to 

associate with nonsmokers.

 Take a close look at cigarette ads to understand 

how they attempt to “sell” you on individual 

brands. It’s your health in exchange for 

their profit.

 Keep oral substitutes for cigarettes, like carrots, 

pickles, sunflower seeds, apples, celery, raisins,

or sugarless gum, handy.

 Take 10 deep breaths and hold the last one while 

lighting a match. Exhale slowly and blow out the 

match. Pretend it’s a cigarette and crush it out in 

an ashtray.

 Use your nicotine replacement medications 

and/or other smoking cessation medications, 

as directed.

 Take a shower or bath if possible.

 Learn to relax quickly and deeply using the stress 

reduction methods found in Appendix A and B. 

While sitting or lying down, make your body limp, 

visualize a soothing, pleasing situation, and get 

away from it all for a moment. Concentrate on 

that peaceful image and nothing else.

 Light incense or a candle instead of a cigarette.

 Never allow yourself to think that “one won’t 

hurt” — it will.

II. A Stop-Smoking Plan

28
 Change your habits to make smoking difficult,

impossible, or unnecessary. For example, it’s 

hard to smoke while you’re swimming, jogging, 

or playing tennis or handball. When your desire 

for a cigarette is intense, wash your hands or do 

the dishes.

 Do things that require you to use your hands. Try 

crossword puzzles, needlework, gardening, or 

household chores. Go bike riding, take the dog for 

a walk, give yourself a manicure, or write letters.

 Enjoy having a clean-mouth taste and maintain 

it by brushing your teeth frequently and 

using mouthwash.

 Pay attention to your appearance; look and 

feel sharp.

Find new habits

II. A Stop-Smoking Plan

29
STEP 10: Identifying and Coping with 

Nicotine Withdrawal

COPING WITH NICOTINE WITHDRAWAL

Nicotine withdrawal symptoms usually last from 2-4 weeks. Below are a list of common 

withdrawal symptoms and some suggestions for coping with them.1

Withdrawal Symtoms Coping Strategy

Craving

 Distract yourself

 Do deep breathing exercises 

 Realize the urge will pass

Irritability

 Listen to a relaxation tape

 Use progressive muscle 

relaxation exercises

 Exercise

 Listen to soothing music

Insomnia

 Take a walk several hours before going 

to bed

 Unwind by reading for a while

 Take a warm bath

 Eat a banana or drink warm milk

 Avoid beverages with caffeine after 

noon and reduce caffeine by 50% 

upon quitting

2 If you continue to have withdrawal symptoms even after using these strategies and your smoking cessation medication 

as directed, please contact your health care provider. Changes to your medication may be needed. For continued cravings 

refer to the Strategies and Skills for Quitting Worksheet (p. 20).

2

30

II. A Stop-Smoking Plan
Withdrawal Symtoms Coping Strategy

Increased appetite

 Make a personal survival kit including 

straws, cinnamon sticks, coffee 

stirrers, licorice, toothpicks, gum, or 

fresh vegetables

 Drink water or low-calorie liquids

Fatigue

 Get more exercise

 Get an adequate amount of sleep 

each night

 Take a nap

 Try not to push yourself too hard for 

the first 2-4 weeks after quitting

Constipation, gas, or stomach pain

 Drink plenty of fluids

 Add roughage to your diet (e.g., fruit, 

raw vegetables, whole grain cereals)

Dry mouth; sore throat, gums, 

or tongue

 Sip ice-cold water or fruit juice

 Chew gum

Headaches

 Take a warm bath or shower

 Try relaxation or meditation exercises

II. A Stop-Smoking Plan

31
STEP 11: Preventing a Smoking Relapse

To prevent a relapse, keep your guard up for at least one year after quitting. A number 

of triggers can tempt you to return to smoking including:

 A flare-up of negative moods, like depression or anger

 A crisis or some event that makes you feel stressed out

 Drinking alcohol

 Positive moods and relaxation that makes you want to “reward” yourself with 

a smoke

 Being around other people who are smoking

 Rationalizations, such as telling yourself: “It’s OK to just have one cigarette!”

or “I really need a smoke to deal with the stress.” or “I’ll quit later when 

the stress dies down!”

Use ALL the skills described in this workbook to anticipate smoking triggers and plan 

for how to cope with them without smoking. Be sure to refer to your My Action Plan 

for Coping with Smoking Triggers Worksheet (p. 24, STEP 7). As these triggers 

occur, and you don’t smoke, the urges will become weaker and go away over time.

•	 Do whatever it takes to avoid taking even one puff/drag on a cigarette 

after your Quit Date! Your success in doing this will make becoming a 

permanent non-smoker much easier and much more likely.

•	 Remember that any smoking after your Quit Date usually leads to a 

return to regular smoking, which makes the job of quitting again all the 

more difficult.

•	 Smoking to deal with stress never solves the problem that caused you to 

return to smoking in the first place and only gives you one more reason to

feel bad.

RECOVERING FROM A LAPSE TO SMOKING: DO’S AND DON’TS

It is not uncommon for successful ex-smokers to have had a smoking lapse along the 

way. A smoking lapse usually consists of smoking a few cigarettes or smoking for a 

day or two. Avoiding a smoking lapse should be your first goal. However, if a lapse

occurs, it is vital to prevent the lapse from becoming a full-blown relapse to regular, 

daily smoking.

32

II. A Stop-Smoking Plan
Even if you return to any smoking at all, you can still achieve success and become a permanent 

non-smoker. Remember, most permanent ex-smokers tried to quit multiple times before 

they achieved their goal.

 Put out your cigarette. Get rid of all 

other cigarettes in your home, car, 

and place of work.

 View your smoking lapse as a slip or 

mistake, not a personal failing. All is 

not lost because you lapsed. A lapse 

doesn’t make you a regular smoker 

again unless you allow it to. Your 

return to smoking is not a matter of 

lacking willpower—it’s a matter of 

lacking preparation for coping with 

smoking triggers and situations. That’s 

a problem that can be fixed!

 Learn from smoking lapses by 

identifying the smoking trigger and 

analyzing the problem that led to your 

return to smoking.

 Commit yourself to use better skills 

for coping with the triggers that 

tempted you to return to smoking. 

Review your My Action Plan for 

Coping with Smoking Triggers 

Worksheet (p. 24) and other 

materials in this workbook in order to 

find the best coping skills.

 Seek support from people recorded

on your My Allies in Quitting

table (p. 14).

 Get telephone support.

Call your therapist, health care 

provider, or a quitline

(1-800-QUIT-NOW/1-800-784-8669).

 Get online support through the “Quit 

Tobacco. Make Everyone Proud”

website at www.ucanquit2.org.

 Tell your provider or therapist about 

your smoking lapse and ask for help 

in recovering quickly. Ask about 

starting back on smoking cessation 

medications and attending counseling 

sessions so you can get back on track.

DON’T

 Beat yourself up by feeling guilty 

or like a failure for smoking. These 

feelings will just make you want to 

smoke more.

 Put off quitting smoking again until 

later, when the stress or other reason 

for your lapse goes away. Stress is 

part of life; it will always be there in 

one form or another. Trying to quit as 

soon as possible after a failed attempt 

is easier than waiting until you’re fully 

addicted to nicotine again.

 Tell yourself negative messages, like:

• “It’s no use, I can’t quit. I may as 

well give up because I smoked!”

• “I smoked because I’m weak and 

don’t have the willpower.”

• “I’m too old to quit smoking—it’s 

too late for me anyway.”

DO

II. A Stop-Smoking Plan

33
STEP 12: Preventing Weight Gain 

After Quitting

WEIGHT CONTROL AFTER QUITTING

Some smokers gain a little weight after they quit, usually 5-10 pounds. This happens 

because their metabolism temporarily slows down after stopping smoking. Also, right 

after quitting, ex-smokers often take in more calories than they burn off because they 

eat more than usual. This weight gain often reverses itself after about six months because 

the metabolism of ex-smokers returns to normal (i.e., higher level) at some point.

Many ex-smokers are able to avoid weight gain altogether by eating a more healthy 

diet after they quit. Ex-smokers often increase their activity level and burn off extra 

calories because they feel better. Some ex-smokers even lose weight since they can 

breathe better. This may be easier than you think because after you quit, you’ll notice 

you have more energy and stamina to do things.

Should you gain weight after quitting, remember that it would take 100 pounds or 

more of excess weight to do as much damage to your body as smoking. Even with 

extra weight, you will feel and look better as smoking causes body odor, bad breath, 

and yellowed skin.

After you quit smoking, try the following:

1. Stock up on healthy snacks:

•	 Replace potato chips with crunchy baby carrots and celery

•	 Replace candy with almonds, sunflower seeds, and other nuts

•	 Replace soft drinks with lots of water to flush toxins out of your body

2. Limit yourself to low calorie choices when eating outside your home.

3. Eat smaller portions to the point where you feel satisfied, not full or stuffed.

4. Drink a large glass of water before each meal.

5. Avoid fast-food restaurants or other ‘tempting’ places.

6. Avoid foods and drinks that remind you of smoking.

7. Eat slowly and mindfully. When you eat, only eat. Turn off the TV and unplug 

the phone—we are much more likely to overeat when we are multitasking. 

Never eat “on the run” or while driving.

34

II. A Stop-Smoking Plan
8. Try not to deny yourself an occasional food treat—we are much more likely to 

“binge” when we feel denied a favorite food on occasion. Here are some creative 

ideas for low-calorie treats that can replace high-calorie treats, which put 

on weight.

•	 Frozen pops in a paper cup: use applesauce, or combination fruit juice and 

chopped fruit, or just fruit juices. Put wooden stick in center after 1⁄2 frozen. 

Enjoy when frozen hard.

•	 Instead of a candy bar or chips, try toasted whole wheat bread lightly spread 

with honey

•	 Chocolate cravings can be satisfied with instant, no-sugar chocolate pudding

9. Eat three regular well-balanced meals each day.

10. Take a daily walk, and work your way up to 30 minutes of brisk exercise 

every day. If you exercise at least three times per week along with your new 

dietary program, you will find that your weight gain will probably be manageable

and temporary. Read STEP 13: Developing an Exercise Program for more 

information about starting an exercise program.

For more information about controlling your weight

1. Talk to your provider about getting a referral to a VA nutritionist for 

dietary planning.

2. Talk to your provider about a referral to the VA MOVE! or 

TeleMove! Programs.

3. Go to: www.move.va.gov

www.nutrition.gov

www.ucanquit2.org/facts/AvoidWeightGain.aspx

www.women.smokefree.gov/topic-weight.aspx

www.smokefree.gov/pubs/FF%20Booklet3_smokefree.gov.pdf

II. A Stop-Smoking Plan

35
STEP 13: Developing an Exercise Program

PHYSICAL EXERCISE CAN HELP YOU REMAIN SMOKE-FREE

Increasing your physical activity through exercise can help you stay tobacco-free by:

 Preventing weight gain, which eliminates a common reason why some people 

return to smoking

 Reducing stress and tension, which is a better way to manage emotions 

than tobacco

 Creating a new self-image as a healthy person, which will add motivation to 

stay smoke-free

How Exercise can Improve the Quality of Your Life

Exercise can improve or raise your:

 Sleep

 Sex life

 Energy and self-esteem

 Mood and outlook on life

 Metabolism, so you can burn 

more calories

Exercise can lower your:

 Weight

 Stress and tension

 Depression

 Appetite

 Risk of heart attack and stroke

 Blood pressure

 Problems related to diabetes

 Cholesterol level

WHAT STEPS ARE INVOLVED IN STARTING AN EXERCISE PROGRAM?

First, you should know that you can achieve many health benefits by simply becoming

more physically active in your daily life. These benefits will occur whether or not you

add a formal exercise program to your routine activities. Even small everyday changes 

can make a big difference in strengthening your body and controlling your weight:

36

II. A Stop-Smoking Plan
 Taking the stairs instead of the elevator

 Walking part way to work or the grocery store

 Parking so you’ll need to walk a little farther to your job, house, or store

 Gardening or chopping wood

 Increasing your involvement in physical chores, like raking leaves

 Taking hikes or playing sports, like tennis or softball

You can lose weight and gain other health benefits to a far greater degree if you have a

regular exercise program. By “regular exercise program,” we mean activities that increase 

your heart rate for a sustained period of time, like walking, jogging, swimming, cycling, or 

using a stair-step machine. Best results are achieved by doing four or more exercise sessions 

per week for at least 30 minutes. You can even do this in 10-minute chunks. Doing any 

exercise is better than no exercise at all, even if it falls short of four times per week.

It’s important to have a regular exercise program that’s safe and right for you. In order for 

this to happen:

1. Check with your health care provider before changing your current level of 

physical activity. Let him or her know your plans and ask for their input. He/she 

can help you set realistic goals that work around your preferences and limitations. 

Your provider can help you decide whether you should increase your daily 

physical activities, without starting a formal exercise program, or plan to start an 

exercise program as a way of becoming more physically active.

2. No matter what physical activities you increase, set realistic and achievable goals. 

It’s vital to start slowly and build up so that you don’t injure yourself or become 

too tired.

3. Increase physical activities that you enjoy and which are fun or rewarding.

4. Find a partner who will exercise with you—this makes it more likely you’ll stick 

with the program.

5. If you start an exercise program, you’ll have a better chance at success if you do 

your chosen activity at the same time each day. Make exercise a routine that has 

a place in your life, not something you fit in if and when time is left over after

everything else is done.

II. A Stop-Smoking Plan

37
6. Stop exercising if you experience shortness of breath, chest pain, or any other 

kind of pain. Do not start again until you get advice from a qualified health

care professional.

If you choose to start a regular exercise program, it is important to pick activities that don’t 

cause you pain or discomfort. For example, a Veteran with knee problems or severe arthritis 

would probably be better off swimming than jogging. Talk to your provider about the most 

appropriate exercise program for you and obtain medical clearance before you start. Your 

HIV infection should not prevent you from starting an exercise program.

If you do not have medical problems that interfere with walking comfortably, consider 

starting a walking exercise program. Walking is successful for many people because it:

 Costs very little

 Can be done either alone or with others (including your dog)

 Can be done at all times of the year (mall walking in cold climates works well)

 Works well in achieving weight loss goals and other health benefits

 Has a lower risk of injury than many other forms of exercise

The sample walking program below is geared toward males about 50 years old. Use the table 

below as a rough guide, not a rigid set of rules you have to follow. You will benefit even if

you don’t go as often, as fast, or as far as this guide suggests. Remember, you should set 

goals that are realistic and you feel comfortable with—do the best you can.

Walk, even at a slower pace, at the longer time under column Suggested Range of Walking 

Times if you haven’t been doing much exercise of any kind, are just starting your walking 

program, or have a physical problem or medical disorder that requires going at a slow pace.

Week Distance

(miles)

Suggested Range of 

Walking Times

(minutes)

Frequency

(per week)

1 1.0 20 – 25 4

2 1.5 30 - 35 4

3 2.0 40 – 45 4

4 2.0 38 – 43 4

5 2.0 36 – 41 4

II. A Stop-Smoking Plan

38
Week Distance

(miles)

Suggested Range of 

Walking Times

(minutes)

Frequency

(per week)

6 2.0 34 – 39 4

7 2.5 42 – 47 4

8 2.5 40 – 45 4

9 2.5 38 – 43 4

10 3.0 47 – 52 4

11 3.0 46 – 51 4

12 3.0 45 - 50 4

If you try this walking program, it is important to follow these steps:

1. Warm up before you walk. This requires about 3-5 minutes of light stretching, 

such as touching your toes.

2. Keep a “conversational” pace while walking. That is, you should not walk so fast 

that you can’t carry a conversation because you’re too winded. Your level of 

exertion should not be above a level that feels somewhat hard.

3. Cool down after your walk. It is very important to cool down for at least five

minutes after your walk. Cooling down means you should gradually slow down the 

pace of your walk until your heart rate and breathing returns to normal. 

4. Don’t sit down right after strenuous exercise. The cool-down period allows your 

heart rate to gradually slow down so that your blood returns to its normal pattern 

of flow. Without a proper cool down, you could feel dizzy or lightheaded, or faint.

II. A Stop-Smoking Plan

39
HIV and Smoking

Appendices

A Stop-Smoking Plan

Next Steps
III. Next Steps

Congratulations! You’ve taken some very 

important steps in the journey to become or 

remain smoke-free.

Quitting smoking is a process with ups and downs, but you can do 

this. Don’t give up, especially if you experience a relapse. 

Here are some ways to keep yourself motivated:

 Think about the benefits you’ve experienced since you have 

stopped smoking (e.g., the way you look, the way you feel).

 Try to anticipate situations that may make you crave a 

cigarette and think about how you can avoid or manage it.

 Use your support system: friends, family, quit lines, on-line 

chat, your provider, etc.

 Stay active!

 Continue to use the medication—don’t stop too soon.

 Congratulate and reward yourself! You’ve made a big 

difference in preventing your chance of future illness.

41
HIV and Smoking

A Stop-Smoking Plan

Appendices

Next Steps
IV. Appendices

A. Deep Breathing Exercises

B. Progressive Muscle

 Relaxation and Body Scan

C. Smoking Cessation Resources

D. Frequently Asked Questions

43
Appendix A

DEEP BREATHING EXERCISES1

 What is deep breathing?

Deep breathing involves using your diaphragm muscle to help bring about a state 

of physiological relaxation. The diaphragm is a large muscle that rests across the 

bottom of your rib cage. When you inhale, the diaphragm muscle drops, opening 

up space so air can come in. When watching someone do this it looks like their 

stomach is filling with air. This type of breathing helps activate the part of your

nervous system that controls relaxation. It can lead to decreased heart rate, 

blood pressure, and muscle tension; and an overall feeling of relaxation. It is also 

something you can do quickly and easily, most anyplace.

 Why be concerned with how I’m breathing?

•	 To increase your awareness of the role breathing plays in increased physical 

tension and your body’s response to stress.

•	 To lower your level of stress-related arousal and tension.

•	 To understand how to take calm, relaxing breaths that will break the cycle 

of increasing arousal during stressful situations.

 What is the best way to use deep breathing exercises?

•	 Use these exercises frequently.

•	 Take deep breaths at the first signs of stress, anxiety, physical tension, or

other symptoms.

•	 Schedule time for relaxation.

My scheduled time for deep breathing will be __________________________.

 Instructions

•	 Find a comfortable position, either sitting or lying down. It is sometimes 

easier to first learn deep breathing while lying on your back as it makes it

easier to feel the correct stomach motion.

•	 Place one hand, palm side down, on your chest. Place the other hand, 

palm side down, on your stomach.

•	 Breathe in through your nose to a slow count of 3 or 4. Notice the motion 

of each hand. When you breathe in and out, the hand on your chest should 

1 Hunter, C. L., Goodie, J. L., Oordt, M. S., & Dobmeyer, A. C. (2009). Integrated behavioral health in primary care: 

Step-by-step guidance for assessment and intervention, Washington, DC: American Psychological Association. Adapted from 

the Center for Integrated Healthcare (a VA Office of Mental Health Services’ Center of Excellence), Deep Breathing patient

handout (Version 1.0), March 2010. 

44

IV. Appendices
move very little, and the hand on your stomach should push out significantly

on your inhale, and go back down on your exhale. Your abdomen should gently 

expand as if you are filling a balloon in your stomach each time you inhale.

•	 Exhale through your nose and continue to notice the motion of your hands. 

Alternately, you can exhale through your mouth while making a sighing sound.

•	 Start with just a few deep breaths and stop if you feel light-headed. 

With practice, you can increase the number of deep breaths without 

becoming light-headed.

IV. Appendices

45
Appendix B

PROGRESSIVE MUSCLE RELAXATION AND BODY SCAN1

 What is progressive muscle relaxation (PMR)?

We all carry tension in different parts of our bodies. This tension may become 

so habitual that we don’t even realize our muscles are tense. PMR not only helps 

release tension from muscles, but it also helps you become more aware of your 

muscles. This exercise involves sequentially tightening and relaxing various 

muscle groups.

 Instructions

•	 Sit in a chair with eyes closed and your hands loosely in your lap. Take a 

few slow, deep breaths.

•	 Extend your right arm in front of you and tense your fist to the point of

pressure but not of strain. Hold the tension for 5-7 seconds, and then 

let your hand relax back into your lap. Let your hand and arm relax for 

10-20 seconds.

•	 Repeat the previous step, tensing and relaxing your right fist for a

second time.

•	 Continue alternating tension with relaxation for each of the remaining 

muscle groups. Remember to keep breathing as you tense your muscles. 

After you have tensed and relaxed one muscle group, move on to the next. 

•	 Below you will find a sample sequence of muscles to tense and relax, but

PMR can be done with a fewer number or greater number of muscle groups 

as well. For example, you may choose to tense just one fist at a time, both

fists at the same time, or perhaps even tense your entire arm along with

the fist in the first step. You may also choose to spend more time with an

especially tense muscle before moving on to the next muscle.

•	 It is not important that you tense your muscles in a certain way. Do this 

in whatever manner is comfortable for you. You should never tense to 

the point of pain. Try to keep any muscles not currently being tensed in a 

relaxed state. Practice once per day, if possible. It is an acquired skill and 

you will get better at it with practice.

 Possible PMR muscle sequence

•	 Hands – clench each fist

•	 Upper arms – bend elbows and tense your upper arms (i.e., make a muscle)

2 Adapted from the Center for Integrated Healthcare (a VA Office of Mental Health Services’ Center of Excellence),

Progressive Muscle Relaxation (PMR) and Body Scan patient handout (Version 1.0), March 2010.

2

46

IV. Appendices
•	 Shoulders – lift your shoulders towards your ear

•	 Neck – let neck drop to your chest

•	 Forehead and scalp – raise eyebrows

•	 Face – scrunch up face

•	 Tongue – press tongue against roof of mouth

•	 Chest – tighten chest muscles

•	 Upper back – pull shoulders forward

•	 Lower back – roll head and upper back down and forward, stretching the lower 

back (like touching your toes while sitting in a chair)

•	 Buttocks – squeeze buttocks

•	 Abdomen – tighten stomach muscles

•	 Thighs – while sitting with knees bent at 90 degree angle, tense thigh muscles or 

press upper legs together from knees to hips to create tension 

•	 Calves – lift toes off ground towards your shins

•	 Feet - gently curl toes down so they are pressing into the floor

When you have finished tensing and relaxing each muscle group, sit quietly for another

minute or two. Use your imagination to further relax your muscles. Focus on one 

muscle group at a time. Going from one to the next, visualize the muscles spreading 

out; getting long, loose, and more deeply relaxed. Sit quietly for a few more minutes 

and feel the relaxation.

To finish this exercise, gently stretch and slowly open your eyes.

 Body scan instructions

During a body scan, you mentally “scan” your muscles looking for areas of tension. Close 

your eyes. Start with your head and move down your body. Ask yourself, “Where am 

I tense?” Scan your muscles looking for signs of tension. Ask yourself, “Is my forehead 

relaxed? Is my jaw relaxed?” and so forth. Scan your face, neck, shoulders, arms, 

hands, chest, back, stomach, buttocks, legs, and feet. Whenever you discover an area 

of tension, gently move the muscle to loosen it, and then relax it. In a body scan, you 

do not necessarily need to tense the muscle before you relax it.

IV. Appendices

47
Appendix C

SMOKING CESSATION RESOURCES

WEB AND TELEPHONE RESOURCES

 Quit Tobacco. Make Everyone Proud

www.ucanquit2.org

 Smokefree.gov

www.smokefree.gov

 National Quit Line

1-800-QUIT-NOW (1-800-784-8669)

24 hours a day, 7 days a week

 Women.smokefree.gov

www.women.smokefree.gov

 Womenshealth.gov

www.womenshealth.gov/smoking-how-to-quit

 VHA Smoking and Tobacco Use Cessation

www.publichealth.va.gov/smoking

 My HealtheVet

www.myhealth.va.gov

 Centers for Disease Control and Prevention

www.cdc.gov/tobacco and

www.cdc.gov/tobacco/data_statistics/sgr/2010/consumer_booklet

 U.S. Department of Health and Human Services

www.ahrq.gov/consumer/tobacco/helpsmokers.htm

 Office of the Surgeon General

www.surgeongeneral.gov/tobacco

48

IV. Appendices
 Healthfinder Tobacco Resources Page

www.healthfinder.gov/scripts/SearchContext.asp?topic=860

 National Cancer Institute

www.cancer.gov

1-877-44U-QUIT (1-877-448-7848)

8am-8pm, Monday-Friday (ET)

•	 LiveHelp chat: https://cissecure.nci.nih.gov/livehelp/welcome.asp

8am-11pm, Monday-Friday (ET)

SPIT TOBACCO RESOURCES

 Spit Tobacco: A Guide to Quitting

www.nidcr.nih.gov/OralHealth/Topics/SmokelessTobacco/

SmokelessTobaccoAGuideforQuitting.htm

 U.S. Food and Drug Administration

www.fda.gov/TobaccoProducts/ucm173429.htm

 Center for Disease Control and Prevention

www.cdc.gov/tobacco/basic_information/smokeless

IV. Appendices

49
Appendix D

FREQUENTLY ASKED QUESTIONS

 Does nicotine cause cancer?

Nicotine does not cause cancer but is the addictive chemical in tobacco that 

makes it so hard to stop smoking. Tobacco smoke has over 4,000 chemicals and 

more than 50 of these chemicals are cancer causing. Nicotine in the form of a 

patch, gum, or lozenge doesn't contain any of the cancer-causing agents that are 

found in cigarettes. These products give you a reduced amount of nicotine to 

help calm your cravings and irritability so you can focus on the emotional and 

behavioral aspects of your habit.

 Can I stay on nicotine gum indefinitely? What are the risks if I can't kick the

gum habit?

Typically, people use nicotine replacement therapy for about four to six months. 

The recommended course of therapy for nicotine gum is 12 weeks and you should 

use it for the full 12 weeks to improve your chances of success. In one clinical 

trial, gum was used for as long as one year without any negative effects. Beyond 

one year, the long-term effects of nicotine exposure aren't clear. If you are 

having difficulty giving up the gum try to gradually reduce your dependence by

substituting regular or sugar-free gum. If that doesn't work, you may want to seek 

assistance from a smoking-cessation expert who can help guide you through a 

behavioral program to change the habit part of your nicotine gum use. Work out a 

plan to wean yourself off of nicotine gum, and be willing to do the work it takes 

to achieve your goal.

 What is the best way to quit smoking?

There is no one way to quit smoking, but we do know that a combination of 

behavioral counseling and the use of FDA-approved smoking cessation medications 

are the most effective elements of any treatment plan. Behavioral counseling 

may include a brief session on how to quit from your primary care providers or 

a number of sessions through a smoking cessation clinic or telephone counseling. 

But the combination of both counseling and medication appears to be the key. 

We also know that the greater the number of behavioral counseling sessions, the 

more likely you will be successful in quitting.

 I have tried quitting before and I failed. How do I know if I will be more 

successful this time?

It’s important to keep in mind that it takes even the most motivated smoker 

several quit attempts before he or she is able to quit for good. To increase your 

chances of being successful this time, have a plan. Talk with your health care 

50

IV. Appendices
provider about quitting and ask about getting a prescription for smoking cessation 

medications such as nicotine replacement therapy or bupropion or a combination of 

medications. Set a quit date and plan to throw away all cigarettes in your home, 

workplace, and car. Tell your friends and family about your plan and let them know 

that you will need their help and support. Think about the ways your health will 

improve and think about all the money you will save by quitting smoking. Try to think 

about what worked or helped you the last time you tried to quit and think about the 

challenges that you faced as well.

 Are “light” or “low tar” or “natural” cigarettes less harmful than regular cigarettes?

No and in fact, there are new regulations that will prevent cigarette manufacturers 

from making these claims. They are all still harmful and carry the same health risks 

as “regular cigarettes.” Quitting is the only way to reduce your risk of smoking-related 

illnesses and premature death.

 I only smoke occasionally, like when I am at parties or at a bar. What are the health 

risks of occasional smoking?

Even occasional smoking carries health risks and there really is no safe amount to 

smoke. Anytime you inhale cigarette smoke (even that from someone else smoking), 

the smoke enters the lungs and damages tissue in the lungs. Cigarette smoke can also 

restrict blood flow to the heart and increase your risk for heart attack. Many people

who are casual or occasional smokers also convince themselves that they can quit 

whenever they want, but many of them find themselves becoming regular smokers.

Again, there is no safe amount to smoke. 

 Can hypnosis help me to quit?

There have been a lot of studies looking at just this question and the majority have 

found that hypnosis alone isn’t effective in helping smokers quit. It is still important to 

make sure you receive behavioral counseling and use FDA-approved smoking cessation 

medications as part of your quit attempt. Hypnosis or meditation or other therapies 

may help you with reducing or managing the stress of quitting smoking, but they often 

aren’t enough by themselves. 

 What about e-cigarettes or electronic cigarettes? Can they help me quit?

There has been a lot in the news about e-cigarettes or electronic cigarettes and 

you may have seen them on the internet. However, there are no studies to show 

that these are effective in helping smokers quit. In addition, there are international 

concerns about the safety of these products as they are currently not regulated. In 

fact, their sale is banned in a number of countries and the FDA has published updates 

to consumers about potential safety concerns. They are not the same as FDA-approved 

smoking cessation medications, which are known to be safe and effective in helping 

smokers quit.

IV. Appendices

51


U.S. Department of Veterans Affairs

Veterans Health Administration

Washington, DC 20420

My Smoking Cessation Workbook: A Resource for Patients

July 2012

IB 10-433; P96537

Sponsored by

U.S. Department of Veterans Affairs

Veterans Health Administration

Clinical Public Health