IB Psychology HLTopic 1 — Prevention and TreatmentPaper 1 & 2Cognitive approach~9 min read
Using CBT to Treat Nicotine Addiction
NRT works on the body. CBT works on the sentence that arrives in your head about four seconds before you reach for the packet. Both are legitimate treatments, and the most interesting research finding in this whole sub-topic is what happens when you use them together.
📘 What you need to know
CBT aims to change the faulty thinking patterns that keep smoking behaviour going.
Those thoughts are replaced with more adaptive ways of thinking through functional analysis.
Therapist and client identify high-risk situations where smoking is likely, and challenge cognitive distortions such as “I need to smoke” or “I can’t control my smoking”.
Clients complete homework, such as journalling daily smoking thoughts, to reinforce progress.
CBT also builds general skills — problem-solving, assertiveness and relaxation — to strengthen relapse prevention.
Thurgood et al. (2015): CBT and NRT combined was more effective than either alone, and kept cravings down for longer.
Where CBT breaks the chain
A cigarette is not a random event. It sits at the end of a short, predictable sequence, and the sequence repeats until it feels automatic. Functional analysis maps that sequence so the client can see it, and then CBT targets the one link that can actually be changed.
Notice the last box in red. Every cigarette that follows a craving teaches the brain that the craving was right, which is why relapse prevention has to be trained deliberately.
Coping skills taught in CBT
Skill
What the client learns to do
Nicotine-refusal skills
Resist both the physical temptation and the social pressure to smoke
Cognitive restructuring
Examine the thought patterns that come before smoking and swap them for healthier alternatives
Relapse prevention training
Keep the new thought patterns going long term, so the client has lasting control over the addiction
General skills
Problem-solving, assertiveness and relaxation, which strengthen everything above
Relapse prevention is the part students skip and the part that makes CBT different from a drug. NRT ends when the last patch comes off. The skills learned in CBT are still there a year later.
Research support: Thurgood et al. (2015)
Aim: to investigate the effectiveness of therapies for nicotine addiction in adult smokers.
Method: a literature review of 17 randomised controlled trials on adult smokers.
Results: NRT such as patches and gum reduced cravings over time. CBT also reduced cravings over time. CBT and NRT combined was the most effective, sustaining reduced cravings for longer than either treatment alone.
Conclusion: combining CBT with NRT appears to be the most effective approach to reducing nicotine addiction.
Why the combination beats both. They attack different parts of the same problem. NRT manages the physical withdrawal so the client is not fighting their body; CBT rewrites the thought and builds the refusal skills so they are not fighting the same craving forever. Explaining why the combination works, rather than just reporting that it does, is what pushes an answer into the top band.
Evaluation
Strengths
It avoids the ethical problems of aversion therapy, which induced sickness to build a negative association. People are more willing to continue with CBT.
It addresses causes, not only symptoms. By tackling the underlying thought processes it helps prevent relapse, unlike drug therapy which mainly treats the physical side.
The evidence base is good. Seventeen randomised controlled trials is a solid foundation, and RCTs are the strongest design available for treatment research.
Skills outlast the treatment. Relapse prevention keeps working after the sessions end.
Limitations
High drop-out rates compared with other therapies. Clients may lose motivation, skip homework or stop attending, which makes it hard to assess how effective CBT really is.
It is not one thing. CBT can be delivered face to face, online or by phone, using a mixture of techniques. That variety makes it hard to pinpoint which elements are actually doing the work.
It demands more of the client than a patch does. Time, effort, homework and a willingness to talk are all required.
Culture bias. CBT focuses on the individual achieving their own behaviour change, which sits awkwardly with a collectivist attitude that the group supports the individual. CBT may therefore be culture-biased.
EXAM QUESTION
Evaluate one psychological treatment of one health problem. [22]
Step 1: state what CBT is targetingFaulty thinking patterns that maintain smoking; functional analysis to identify high-risk situations and cognitive distortions.Step 2: describe the actual techniquesNicotine-refusal skills, cognitive restructuring, relapse prevention, homework.Step 3: use Thurgood, including the combination result17 RCTs; both treatments reduced cravings; combined was best and lasted longest.Step 4: evaluate on four frontsEthics compared with aversion therapy, causes versus symptoms, drop-out rates, and the variety problem that makes CBT hard to measure. Add culture bias.Best conclusion: neither treatment alone is the answer, and the research says so
Link to concepts
Bias
People from collectivist cultures may not respond as readily to CBT as those from individualistic cultures. CBT asks the individual to take charge of their own behaviour change, which can sit at odds with a cultural attitude in which the group looks after and supports the individual. That makes CBT potentially culture-biased as a treatment, not just as a theory.
Responsibility
A CBT therapist has to be mindful of how fragile a client with an addiction may be. This is a socially sensitive issue that can bring embarrassment, shame or low self-worth, so therapists must follow the ethical standards of their profession and work to reduce stress for clients during and beyond the sessions.
💡 Exam tip
Name the techniques individually. “CBT changes thinking” is vague; naming refusal skills, restructuring and relapse prevention is not.
The combination finding is the headline. Explain the mechanism behind it, do not just report it.
Drop-out rates are a methodological criticism as well as a practical one — they distort effectiveness data.
Compare directly with NRT on cost, access, effort and durability. Comparison questions are common.
Use “functional analysis” as the technical term for mapping the trigger-thought-behaviour chain.
The culture-bias point works for CBT in both the addiction and the depression pages.
⚠ Common mix-up
Describing CBT as just talking about feelings. It is structured, skills-based and includes homework.
Confusing CBT with aversion therapy. They are different treatments, and the ethical contrast is a strength of CBT.
Saying CBT has no drawbacks because it uses no drugs. Drop-out and cultural fit are real problems.
Treating Thurgood as an experiment. It is a review of 17 randomised controlled trials.
Forgetting relapse prevention. It is the element that gives CBT its long-term advantage.
Assuming everyone can access it. Trained therapists, time and waiting lists are all real barriers.
Up next: Using CBT to Treat Depression — the last page of the topic, and the one where the theory from Beck’s model finally turns into a treatment room.
Want this explained one-to-one?
Book a free session with an experienced IB Psychology tutor and get your trickiest topics made simple.
