Kenneth A. Perkins, Cynthia A. Conklin, & Michele D. Levine. (2007). Cognitive-Behavioral Therapy for Smoking Cessation: A Practical Guide to the Most Effective Strategies. Routledge.
Length: 280 pp.
ISBN 0415954630
For more information on this book: Click here
MAY/JUNE 2008
Volume 14 - No. 2
Treating Tobacco Use and Dependence
Treating Smoking with Cancer Patients
SRNT Latin America and Iberoamerican Heart Foundation Conference
SRNT Newsletter
MAY/JUNE 2008, Volume 14, Number 2
Book Review
In finding the most effective treatments in smoking cessation, health care providers have but to look to the updated 2008 Clinical Practice Guideline. However, to have a comprehensive description of how to provide recommended counseling for smokers attempting to quit, "Cognitive-Behavioral Therapy for Smoking Cessation" by Kenneth Perkins, Cynthia Conklin, and Michele Levine is an invaluable resource. Across eight chapters these authors provide concise background information and a detailed yet practical guide on smoking cessation counseling targeting health care providers who may or may not feel comfortable with the process. Nicotine researchers can also benefit from this book as a `one stop' resource that pulls together a great deal of literature addressing counseling within a cognitive-behavioral approach across varying stages of change in smoking cessation. Ultimately, this book will provide clinicians a highly accessible reference on the why and how to counsel clients through the cessation process.
Beginning in chapter one, the authors provide an engaging overview of the negative affects of smoking, discuss the contribution of nicotine to tobacco dependence, and touch upon the non-pharmacological factors (e.g., environmental factors) associated with the intake of nicotine. This chapter also highlights the effect of nicotine on the brain, mood, behavior, and physiology. Upon closing chapter one, the authors finally present a concise overview of smoking across the lifespan. It would have been helpful if in this chapter the authors would have provided some discussion, no matter how brief, of smoking-related consequences across ethnic groups. Understanding the population-based approach, this chapter may lead some to believe that smoking-related health outcomes are the same across groups. Chapter one, however, is but a mere entry point into what can be considered the `meat' of the book, which appears to be representative within chapters two through five.
In chapter two, which offers insight into how to prepare smokers to quit, clinicians are also being prepared or oriented into the theoretical underpinnings of the proposed counseling approach _ Cognitive-Behavior Theory and the application of the five stages of change (SoC) in smoking cessation. The interesting aspect of their discussions of CBT is that while they are sure to acknowledge the limitations of the SoC, there is no such discussion of any limitations associated with CBT. On the other hand, the reader is presented a clear outline of the five A's, which is a counseling technique supported by the 2008 Clinical Practice Guidelines to guide practitioners in helping smokers through the quitting process. This chapter is completely focused on the preparation of smokers to quit. It provides extremely rich and well thought out explanations and strategies of what clinicians can do to rebut smokers' diversity of reasons to continue to smoke, to increase motivations to quit, and offers a tool to remember how to prepare and motivate smokers to quit. This resource is termed the five R's _ relevance, risks, rewards, roadblocks, and repetition. An explanation of each `r' is provided and represents an easy means for clinicians to recall the finer points presented in chapter two.
Tacking the dynamics associated with guiding the quitting process, chapters three, four, and five are full of useful information. Chapter three highlights effective CBT strategies to integrate into smoking cessation treatment, such as nailing down a quit date, dealing with smoking triggers, and how to help folks having a hard time quitting. It ends with guidelines for developing treatment plans. Due to the evidence supporting the use of medication to aid the cessation process, Chapter four outlines how to integrate discussions of over-the-counter nicotine replacement therapy (NRT) and cessation pharmacotherapy requiring a prescription into counseling. The best parts of this chapter are its brief but informative overview all evidence-based NRT and prescription-based aids, noting both the advantages and disadvantages of each neatly organized within a sidebar and a guide for exactly how to discuss/bring up these cessation medications in the actual counseling. Finally, the `meat' of this book ends with chapter five, which is devoted to withdrawal and relapse. The authors outline symptoms and provide strategies for preventing full relapse. Chapters two through five offers a substantive and highly accessible resource for clinicians and researchers alike in gaining more insight into, being provided useful strategies, as well as refining five A counseling.
The remaining chapters (six through eight) address special interest areas. These include weight gain concerns of smokers, subpopulations, and long-term maintenance. In line with CBT, chapter six substantively and clearly addresses weight concerns from the perspective that changing attitudes toward one's weight is more effective than directing efforts toward weight gain. As with most chapters in this book, Chapter six provides the reader a number of sidebars that present practical tools (e.g., "Thoughts Diary", "measures of smoking related weight concerns") for immediate implementation. These tools also appear viable for possible integration into research interventions addressing weight and/or smoking cessation. Chapter seven delves into subpopulations that have a harder time quitting or may prove to be a challenge to clinicians. The authors do acknowledge the diversity within these special groups to have differing chances of success or failure in quitting. Some of the subpopulations included are, women, pregnancy/postpartum, adolescents, and smokers with comorbid medical conditions, including those with psychiatric and substance use disorders. In this chapter, while it is for the most part cursory, the discussion of comorbid psychiatric and substance use disorders is extremely interesting, engaging, and informative. Throughout this portion of the chapter (and discussion of other comorbidities), the reader is provided sidebars with case studies including background as well as actual snippets of clinician/client conversation. These case studies are extremely helpful with giving a `for instance' in a brief but impactful manner. Finally, chapter 8 gives insightful information on follow up procedures.
The authors do a great job covering a vast amount of information in a clear, concise, and accessible manner. The sidebars are a quick reference and invaluable component of this text. In the areas noted in this review, the sidebars help the reader more easily digest the information and put great strategies/resources in a highly visible place. Additionally, there is an appendix of internet-based smoking cessation resources. What was disappointing, however, was the lack of attention giving to light smoking (generally ten or less cigarettes per day), considering the increased prevalence light smoking in American society. Moreover, the text could have really used more discussion regarding ethnic differences in smoking as well as how these differences consideration and strategizing in how they may impact the smoking cessation counseling or use of the five A's. Providing a brief discussion on these areas would have really rounded out this text. Overall, this book is a great resource for clinicians, researchers, and even graduate students in tobacco control.
About the Author: Jennifer Warren is a postdoctoral associate in the Program in Health Disparities Research at University of Minnesota where she studies tobacco control.