On an early fall morning, psychologist Bonnie Spring was already on the run. Dressed in a crisp navy blue suit, her blond bob flying, she rushed into a conference room that’s part of her laboratory in the University of Illinois at Chicago’s Behavioral Sciences building. She arrived in the nick of time for her first appointment of the day. At any point along the way, were she still addicted, she might have hit a trigger to light a cigarette.
But now it’s her mission to help others find those triggers and disarm them. She has built a career on the psychology of smoking, and she has made a name as one of the best in the field.
She was debriefing Bob, a onetime heavy cigarette smoker who had participated in a combined study and smoking-cessation program at the university and managed to quit and stay smoke-free for a year.
Spring, a professor of psychology at UIC and a research scientist at Hines VA Hospital, is one of the nation’s foremost experts on smoking–why people start, what keeps them hooked and what enables some of them to quit.
Nearly 1 in 4 American adults smokes. Each year more than 430,000 deaths in this country–about 1 in 5–can be attributed to tobacco use, according to the U.S. Centers for Disease Control and Prevention. Since 1964, the year the first Surgeon General’s report on smoking and health was released, 10 million people have died from smoking-related causes.
Bob (not his real name) had quit smoking before but, in a typical scenario, he relapsed one night in a smoky bar when a few bummed cigarettes from friends quickly led to his buying a whole pack and resuming the tobacco habit.
Spring wanted to know what parts of the program worked for Bob, who managed to quit at a most difficult time in his life. He was over 50, had been downsized out of a job and had a prior history of depression, a factor some studies have shown to be a liability in quitting smoking.
“You were successful,” Spring told Bob, who was on a placebo medication in the study rather than the antidepressant Prozac. “You must have done something I can learn from.”
Learning is what drives Spring. Most of the treatment that she does is in the context of studies funded by the government and supervising graduate students in clinical psychology who treat people in UIC’s smoking-cessation clinic.
Spring’s research focuses on the mechanisms, or “hooks,” that maintain unhealthy behaviors, such as smoking and problematic eating leading to obesity, in an effort to translate that knowledge into health-promoting interventions. She concentrates on hard-core smokers but has explored many aspects of smoking.
She views both smoking and problematic eating as behaviors that people use to regulate their mood and concentration. That’s part of what makes it difficult for them to quit.
Spring, a New Jersey native, knows about this firsthand. She was a pack-a-day smoker for 20 years, after first lighting up as an undergraduate at Bucknell University in Pennsylvania.
“I think I discovered a form of self-regulating that worked for me,” she said. “Nicotine is a drug that enhances concentration. “It spills dopamine [a neurotransmitter] in the brain, so it’s directly a source of pleasure. The way I got locked into smoking was that I write a lot in solitary, and it became a way of enhancing my concentration and also a form of pleasure.”
Her own relapse
She once quit for about a year during her clinical-psychology internship, but after completing her advanced degrees at Harvard University and entering academic life there as a faculty member, she relapsed. The job required writing many grant proposals and research papers, the solitary pursuits that triggered her nicotine craving.
Spring, 52, began her career studying schizophrenia, but she became frustrated because she felt nothing that she could do as a psychologist would contribute to finding either a cause or a cure for the devastating mental illness.
But she was intrigued by the self-help strategies (including smoking) that people with schizophrenia used to change their brain chemistry and their mood and concentration, so she decided to switch to studying smoking and eating behaviors, two ways that other people do that same thing.
Spring began her “retraining” by collaborating with colleagues who were treating smokers and those with problematic eating behavior at Texas Tech University. That, she said, kept her away from cigarettes.
“The thing I couldn’t bring myself to do was to be helping other people to quit and then be closeting away cheating myself,” she said. “It kept me honest while I was learning to help other people to do this. I applied it to myself and it worked.”
Smoking can be both a physical and a psychological addiction.
Spring said that “not all smokers are physically dependent; all of them are psychologically dependent. What I mean by psychologically dependent is that smoking is a habit that becomes ingrained.”
The rationalizing
Smokers, she said, will offer rationalizations about why they smoke: “It makes me happy.” “It’s a way to relax.” “It helps my concentration.” “It’s something I do with my friends.” “It’s a treat.”
“What people don’t realize,” she said, ” is that the reasons they’re smoking are probably [things like] the steering wheel of the car, the telephone. Such things trigger these conditioned cravings. It’s just a stimulus and a response. We act like laboratory rats in a cage when the light goes on. You see the telephone, the craving starts and you immediately light up.”
When a smoker tries to willfully drop that automatic response, Spring said, “It hurts. You feel it.”
Bob, the former smoker whom Spring labeled a psychological smoker, said he found the “self-awareness” the program offered him to be a big help. He employed a variety of mental techniques such as hanging on to a printed description of the benefits gained from not smoking in the first 20 minutes, the first 8 hours, 24 hours, 48 hours, 72 hours, 2 weeks, 3 months, etc. He put up Post-it notes to tally the money he was saving by not smoking and then “rewarded” himself with a gym membership to cope with a 10-pound weight gain.
Spring’s research “toggles back and forth between studies that focus on mechanisms that try to tell us what’s the nature of the hooks that are keeping people stuck and then we translate what we learn into treatments. It’s an endless experiment. Each person is novel.”
David Gilbert, a professor of psychology at Southern Illinois University who studies the impact of nicotine on the brain waves of chronic smokers, said Spring “is in class by herself of big-name researchers. She’s doing state-of-the-art work.
“A lot of people do quick-and-easy questionnaire sorts of data with none of the biological interventions and really don’t bother to look at individual difference factors between smokers. Her research is rigorous.”
Dr. William Redd, a cancer specialist at Mt. Sinai/New York University Medical Center, has known Spring for 15 years and tried to recruit her before she joined UIC three years ago after 10 years at the Chicago Medical School.
Intellect and warmth
“She has research grants in conjunction with our faculty, and she’s a renowned researcher in behavioral medicine, meaning psychological issues around disease both in terms of prevention and the course of disease. She’s dynamic, very bright and very rich in her theoretical and clinical perspective. She’s also a master clinical psychologist.”
Indeed, Spring embodies a winning combination of adroit intellect and earthy warmth. She loves to mentor students, and as a single mother, she juggles her career with the demands bringing up her 11-year-old daughter.
Some of her research studies deal with the psychological dependency that leads to the use of tobacco for feelings of depression, tension, nervousness, irritability and anger.
In one type of study involving “mood management,” she and her colleagues give some participants special shakes to drink that produce dysphoria, or a feeling of malaise. It’s a “dress rehearsal,” she said, for the mood change that accompanies nicotine withdrawal.
Celina Acquaro of Bloomingdale, another successful ex-smoker, called the shake experience “an adult version of spanking” in her debriefing with Spring.
“What did you feel?” Spring asked.
“Sad, light-headed, muddled,” Acquaro said.
“You got cranky. That’s what we wanted. You were complaining, edgy.”
After the malaise-inducing shake, study participants were offered an array of techniques to manage the bad mood, including distractions such as doing crossword puzzles or word games, deep breathing and listening to music.
They also received cognitive-behavioral training to help them to understand the cues that cause them to light up and to learn ways to substitute rational thought and make choices other than smoking.
“I still do those techniques [to keep from smoking] and also apply them to other things,” Acquaro told Spring.
“Sometimes I make noise instead of smoking,” she said, knocking her plastic bottle of water on the table. ” I make a motion, some expression. Sometimes I eat.”
Support from a graduate psychology student who worked with her helped a great deal during the quitting process, Acquaro said, but the induced lousy mood “was like tasting a disease before you got it. You would think more about creating it.
“[In the past] I would quit and then go back, but so far I haven’t gone back.”
“Don’t!” admonished Spring.
Tips for beating the habit
So you want to quit smoking? Here are some tips from psychologist Bonnie Spring:
– Get ready. Write down your reasons for quitting and post them in a visible place. Set a quitting date on which you will get rid of all cigarettes, lighters and ashtrays and not smoke anymore.
– Get support. Quit with a friend or ask friends and family not to smoke around you or leave cigarettes out. Get individual or group counseling.
– Practice new behaviors. Avoid cues that trigger your urge to smoke. If it’s the car, take a train or bus to work. Drink tea or juice instead of coffee. Brush your teeth after a meal. Take a walk instead of a smoking break.
– Take steps to ease stress. Plan ways to lighten up stressors at home and work. Plan fun and relaxing activities. Assemble a “tool kit” of things besides smoking that you can do if you feel anxious, angry or sad.
– Be prepared for difficult situations or relapse. Drinking alcohol or being around other smokers can lower your resolve to quit. Try to avoid those triggers and don’t try “just one cigarette.”
— Connie Lauerman
