Goal-setting Helped Eliminate Cigarette Smoking
As a behavior scientist, sometimes you never know what targets you will work on or with whom. Enter a former client. I worked with Melissa (name changed) for well over a year, until she needed to take a break in services. See, she went through a stressful life event, and prioritizing our health and fitness work lowered in the context of all life-things for her.
We worked on a variety of health and fitness behaviors – increasing exercise days, minutes, and activities. She made fantastic progress and I was unsure if I would hear from her again. However, after a 10-month hiatus, to my surprise, I saw an email from her. She wanted to work on something different – smoking cessation.
Smoking Context and History
Melissa smoked before her kids were born, over 20 years ago. With the aforementioned life event, she picked up smoking again. I get it, it served as a coping mechanism, a source of anxiety relief.
Prior to reaching out to me, she had smoked about 15-20 cigarettes per day, going on for 6+ months now. From complete abstinence to regular smoking again! Oh no!
Melissa was ready to kick the habit. Where did we begin?
Smoking as a target behavior
No need to describe the harms of smoking here. They are common and well-documented.
Smoking is an observable and measurable behavior. I can see her smoke and measure the number of cigarettes smoked, or packs bought.
As my coaching model served Melissa via Telehealth, we relied on her counting cigarettes smoked each day and reporting back to me on a shared Google Sheet.
Eliminating Smoking With Behavioral Interventions
After a thorough functional assessment, I understood the environmental variables that led to and maintained Melissa’s current smoking behavior. Melissa was ready to stop smoking, and bring the number of cigarettes smoked down to ZERO!
Our Smoking Interventions
For any behavior change intervention, I rely on a multi-phased approach.
This approach always takes the form of:
- Baseline data collection: We need data before any intervention begins. Why? So that we can ensure which changes in Melissa’s smoking environment led to smoking cessation.
- Intervention: Creating behavioral and environmental changes with the client’s preferences and likelihood of adoption at the forefront of planning.
The intervention itself consisted of small incremental reductions of total cigarettes smoked per day relative to baseline levels.
For Melissa, she smoked 18 cigarettes on average during a baseline.
For the intervention, we set progressively lower goals each time that she met her goal.
- Goal #1 – Melissa will smoke 15 or fewer cigarettes on 5/7 days (criteria: weekly average MUST at or below 17.5)
- Goal #2 – Melissa will smoke 8 or fewer cigarettes on 5/7 days (criteria: weekly average MUST at or below 8)
- Goal #3 – Melissa will smoke 4 or fewer cigarettes on 5/7 days (criteria: weekly average MUST at or below 4)
- Goal #4 – Melissa will smoke 0 cigarettes for an entire week
You will see her progress here:
(Each horizontal dotted line represents the goal line for that phase.)
And WOW! Within a matter of 4 weeks, Melissa went from almost a pack-a-day to 0 cigarettes for 10 straight days! Well done Melissa!
Other intervention components
Now, the graph shows the intervention (i.e., goal-setting) that Melissa and I worked through together. I would be naïve to think that goal-setting was the only contingency that played a role in decreasing cigarettes smoked.
Here are the other relevant and potent contingencies that overlaid this goal-setting intervention:
- Paid services – Melissa paid me for expert coaching services
- Cost – Outside of goal-setting, we calculated Melissa’s monthly cigarette spend as $300/month; she wanted to eliminate this excessive cost
- Nicorette consumption – Melissa reported that she consumed 2-4 pieces of Nicolette to “curb her cravings”
- Self-Imposed Social Contingencies – likely the most potent aversive contingency, her children routinely gave her social disapproval for picking up smoking; they actually never knew their mom was a former smoker
When thinking about these other contingencies, you can visualize her progress like this:
I am confident had we intervened as we did, Melissa would still be smoking 15-20 cigarettes per day.
Smoking Cessation Maintenance
With a 10-day streak under her belt, Melissa faces maintenance of this behavior change as her next goal. She’s off to a great start, and coincidentally, her last cigarette came when she ran out of cigarettes. She thought about going to the gas station the other day when faced with a new stressful situation but succeeded and kept her streak alive. With her smoker ex-boyfriend in the rear-view mirror, and ashtrays thrown away, her environment set her up for success.
To a smoke-free future for Melissa!
