A patch can quieten the craving in someone’s bloodstream. It cannot do anything about the fact that they always smoke outside that particular pub, with those particular friends, after that particular kind of day. CBT goes after the second problem — and that is why the two together beat either alone.
📚 What you need to know
CBT aims to change the faulty thinking patterns that maintain smoking behaviour.
Faulty thoughts are replaced with more adaptive ones through functional analysis.
Therapist and client identify high-risk situations where smoking is likely.
The therapist challenges cognitive distortions such as “I need to smoke” or “I can’t control my smoking”.
Clients complete homework, such as journaling daily smoking thoughts, to reinforce progress.
Four skill areas: nicotine-refusal skills, cognitive restructuring, relapse prevention training, and general skills.
Thurgood et al. (2015) is your study, and its conclusion is about combination.
The loop CBT is trying to break
Functional analysis means working out what a behaviour is actually doing for someone — what sets it off and what it delivers. Once you can see the chain, you can see where to cut it.
Every time the loop completes, the belief “I need one” gets stronger, because it just appeared to be true. CBT interrupts that confirmation; NRT weakens the craving that drives it.
What actually happens in the sessions
🧩 The four coping skill areas
Nicotine-refusal skills — strategies to resist both the physical temptation and the social pressure to smoke.
Cognitive restructuring — examining the thought patterns that come just before smoking and replacing them with healthier alternatives.
Relapse prevention training — a long-term focus on maintaining new thought patterns and giving the client control over the addiction.
General skills — problem-solving, assertiveness and relaxation, all of which strengthen relapse prevention.
Notice that the first skill is partly social. Refusing a cigarette offered by a friend is not a chemistry problem, and no patch will help with it. That is the clearest example of what a drug cannot reach.
🔬 Thurgood et al. (2015)
Comparing therapies for nicotine addiction
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, for example patches and gum, reduced cravings over time. CBT also reduced cravings over time. CBT and NRT combined was 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.
Pay attention to the word sustaining. The combined treatment did not just reduce cravings more; it kept them reduced for longer. Relapse is the real problem in addiction, so a treatment that holds is worth more than one that dips fastest. If a question asks which treatment is best, “best” should mean “lasts”, and saying so shows you understand what the outcome measure is really for.
Evaluating CBT for nicotine addiction
Strengths
CBT avoids the ethical issues associated with aversion therapy, such as deliberately inducing sickness, so people are more willing to continue treatment.
It addresses causes, not just symptoms, which helps prevent relapse by tackling the underlying thought processes — unlike drug therapy, which mainly treats symptoms.
Skills learned are transferable to other situations and stay with the person after treatment ends.
The evidence base includes randomised controlled trials, a strong design.
Limitations
High drop-out rates compared with other therapies, as clients lose motivation, skip homework or stop attending. This makes effectiveness hard to assess.
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 actually work.
It requires more time, trained therapists and often a waiting list, unlike a prescription.
It depends on the client’s willingness to engage, which cannot be assumed.
Why drop-out is worse than it sounds
High attrition is usually written up as a practical inconvenience. It is actually a threat to validity. The people who drop out are likely to be the least motivated, or the ones it is helping least. Everyone left at the end is a self-selected group of people for whom it is going reasonably well.
So the measured success rate is calculated on a group that has already been filtered in the treatment’s favour. That makes CBT look better than it is, and the same logic applies to any therapy with high drop-out. It is a sophisticated point and it is easy to make in one sentence.
Linking to the concepts
Bias: people from collectivist cultures may not respond as readily to CBT as those from individualistic cultures. CBT focuses on the individual and on how they can achieve their own behaviour change, which is at odds with the collectivist attitude that the group looks after and supports the individual. CBT may therefore be culture-biased.
Responsibility: a CBT therapist must be mindful of the possibly fragile nature of clients with addiction. It is a socially sensitive issue that may cause embarrassment, shame or feelings of low self-worth. Therapists should adhere to the ethical standards of their position and take care to reduce stress for clients during and beyond the sessions.
EXAM ANSWER
Evaluate one psychological treatment for one health problem. [22 marks]
Explain the mechanism, not just the name
CBT uses functional analysis to identify high-risk situations, then challenges distortions such as “I need to smoke” and replaces them with adaptive thoughts.
Name the techniques
Nicotine-refusal skills, cognitive restructuring, relapse prevention training, plus homework such as journaling.
Evidence
Thurgood et al.: 17 randomised controlled trials; CBT and NRT combined sustained reduced cravings longest.
Strength that contrasts with drugs
It targets causes rather than symptoms, which is why it protects against relapse.
Limitation with real biteHigh drop-out means the people measured at the end are a self-selected, more motivated group.
Conclude: strongest as part of a combined approachturning attrition into a validity argument is the standout move here
💡 Exam tips
Use the term functional analysis and explain it. It is precise and specific to this treatment.
Quote an actual cognitive distortion. “I can’t control my smoking” is far better than “negative thoughts”.
Contrast CBT with drug therapy explicitly — causes versus symptoms. Comparison earns evaluation marks.
The culture bias point is a genuine limitation of CBT everywhere it appears. Reuse it on the next page.
Explain drop-out as a validity problem, not just a practical one.
If a question asks about the “most effective” treatment, argue for combination and say why.
⚠ Common mix-ups
Confusing CBT with aversion therapy. CBT avoids exactly those ethical problems.
Saying CBT only changes thoughts. It builds behavioural and social skills too.
Calling Thurgood an experiment. It is a review of randomised controlled trials.
Treating homework as optional. Skipped homework is a named reason for drop-out.
Presenting CBT and NRT as rivals. The evidence says they work best together.
Forgetting the culture bias. It is a syllabus concept link, not an optional extra.
Up next: Using CBT to Treat Depression — the last page of the option, and the study on it contains a result that is far more important than the percentage everyone quotes.
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