1. Nico-hosp-intro 1.1 Smoke-free hospital European Training guide From: Nicomède DGS France Smoking cessation and short psychotherapy The mourning length is incompressible. This means that the patient has necessarily to go through different steps-acceptation, depression, re-investment so that the behaviour changes persist. Mourning repetition tends to add them up. This is the reason why, during smoking cessation request, it is necessary to systematically investigate the mourning episodes (see pathological mourning) In many cases, the impossibility to cease smoking on the long term, corresponds to a difficulty to engage mourning work, hat s to say to engage in the depressive phase. Daprès Dr Juan Coulon Fédation Belge Contre le Cancer Juillet 2001

2. Nico-hosp-intro 1.2 Smoke-free hospital European Training guide From: Nicomède DGS France Smoking cessation and short psychotherapy 1. Smoking cessation and short psychotherapy Use of strategic psychotherapy of conversational hypnoses Application of the psycho dynamic theory of mourning Multi-faceted approach of psychological dependence: bulimia, depression, anxious troubles, alcoholism, etc… The characteristic of smoking cessation is not only the difficulty of stopping smoking but also the psychological aspects associated with grieving. Daprès Dr Juan Coulon Fédation Belge Contre le Cancer Juillet 2001

3. Nico-hosp-intro 1.3 Smoke-free hospital European Training guide From: Nicomède DGS France Smoking cessation and short psychotherapy 2. Psycho-strategic approach of smoking cessation: In order to change ones behaviour, usually attempted solutions have to be modified, block them in order to interrupt the circle which maintains the problem. The therapeutic intervention aims at inducing a different past in order to modify perceptions and after reach the emotional, cognitive and behavioural levels. « Action precede cognition » Daprès Dr Juan Coulon Fédation Belge Contre le Cancer Juillet 2001

4. Nico-hosp-intro 1.4 Smoke-free hospital European Training guide From: Nicomède DGS France Smoking cessation and short psychotherapy Principals of the strategic theory 1. Show the patient that the changing of point of view modifies the perception of reality and behaviours. 2. Do not isolate the smoking problem from its psychic environment. 3. Emphasise the means of change and not the causes of the problem. 4. Weaken resistances. 5. Propose minimal goals in order to reduce resistances to change. 6. The therapist stimulates creativity and patients self-esteem in a positive atmosphere. Daprès Dr Juan Coulon Fédation Belge Contre le Cancer Juillet 2001

5. Nico-hosp-intro 1.5 Smoke-free hospital European Training guide From: Nicomède DGS France Smoking cessation and short psychotherapy Prescriptions of duties or behavioural prescriptions: They must be proposed according to an hypnotic way of communication (conventional hypnoses). There are strategic action protocols according to the type of problems encountered at a particular time (depression, anxious troubles, etc.). Daprès Dr Juan Coulon Fédation Belge Contre le Cancer Juillet 2001

6. Nico-hosp-intro 1.6 Smoke-free hospital European Training guide From: Nicomède DGS France Smoking cessation and short psychotherapy 3. Conversational hypnoses The therapist converses with the patient regarding the installation dissociated climate (modified conscience state). Once installed, indirect changing suggestions are made. Daprès Dr Juan Coulon Fédation Belge Contre le Cancer Juillet 2001

7. Nico-hosp-intro 1.7 Smoke-free hospital European Training guide From: Nicomède DGS France Smoking cessation and short psychotherapy Resume of current techniques used in strategic psychotherapy completed by hypnotic approach: Mimetism Re-framing Positives formulations Resistance use Metaphor use Prescription of behaviour or direct, indirect or paradoxical duties (diary writing, observe non-smokers, symptom prescription, voluntary ritual, etc.) Daprès Dr Juan Coulon Fédation Belge Contre le Cancer Juillet 2001