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Smoking and anxiety live chat: Mar'13

Tags: Anxiety , smoking

Expert Dr Mark Winwood joined our live chat, to answer your questions on smoking and the anxiety around giving up.

becs asked: Morning, I have a question about a friend who's trying to quit alone...

Dr Mark Winwood answered: ask away  i am ready to take questions

becs commented: Whats the best way to give up, as they are trying alone and I want to tell them about other options

Dr Mark Winwood answered: It is possible to quit alone or in a group.  If your friend would like some support there are really good web-sites that have chat forums - these can be found on www.smokefree.nhs.uk.  Alternatively - his or her local GP surgery may run a support group.

becs commented: thanks - great, I will pass on the details

Dr Mark Winwood answered: Try and get regular exercise, use 'regular breaks' where possible at work to try and clear your head, attempt to understand what is causing you to feel anxious or stressed, take it through with someone at work like your manager or a colleague.  Things like cutting down on alcohol (if you drink) and regulating caffeine can also be helpful

Claire commented: Hi! I would like some advice on staying stopped. I am smoking again currently but would like to really stop and stay stopped.  I seem to cope ok to start off with, but find it incredibly difficult after that initial period.  Once the novelty of not smoking has worn off, I struggle with the feeling of something being missing and just feeling really unsettled.  Much of the advice is around the initial quitting....any tips and suggestions about how to stay with it and become a real non-smoker?

Katy Coulson commented: As a suggestion think about another positive anchor (e.g. speaking to a friend on the phone, going for a walk) that you like doing and practice it becoming a habit to replace your cigarette break at work. Holding your belief that smoking helps you deal with stress I suggest you  ask yourself this question What could I do to begin my stop smoking journey by changing this belief?

Casey asked: How can I quit without it having a bad effect on my work? I smoke to help the stress and keep alert.

Dr Mark Winwood answered: Many people use smoking as a way of reducing stress - The idea that people smoke cigarettes to help ease the signs and symptoms of stress is known as ‘self-medication’. Stress is very common, affecting us when we feel unable to cope with unwelcome pressure. It can cause physical symptoms like headaches or breathlessness as well as making people feel irritable, anxious or low.  Some other ways of combating the stress at work maybe:

fiona asked: Hi there. Are there any positive thinking or mental training exercises that can help you quit smoking when moving away from patches or gum?  

Dr Mark Winwood answered: Key to quitting smoking is preparation.  this may involve deciding upon a 'day to quit', alerting your friends and family that you might need some support, think of yourself as a non-smoker and get rid of ash-trays, lighters etc....  Understanding your smoking triggers might also be really helpful so you know when you might have to deal with cravings.

Kerry asked: I often find that when I am having a busy day I smoke more to cope.  How can I kick this habit?

Dr Mark Winwood answered: Hi Kerry - your question is not uncommon so i will start with a bit of research ;  Research into smoking and stress has shown that, instead of helping people to relax, smoking actually increases anxiety and tension. Nicotine creates an immediate sense of relaxation so people smoke in the belief that it reduces stress and anxiety. This feeling of relaxation is temporary and soon gives way to withdrawal symptoms and increased cravings.
Smoking reduces nicotine withdrawal symptoms, which are similar to the symptoms of anxiety, but it does not reduce anxiety or deal with the underlying causes.
So - in fact smoking to relieve tension actually increases your need to smoke - so its a vicious circle.

The key may be to try and find different ways to try and relax - here are some that have been found to be useful
meditation and breathing exercises

  • regular exercise
  • cutting down on alcohol
  • eating a well-balanced diet
  • acupuncture
  • clinical hypnosis

Counselling or talking things through with a supportive friend or family member can also help.
Making changes takes time and effort – progress is often slow. Be patient. You may not be able to control all the factors that contribute to your stress, but identifying the source of your anxiety and trying to find ways to reduce or overcome it are as important as finding new ways to cope with it.

Kerry commented: Thanks Mark!

Claire asked: Hi! I would like some advice on staying stopped. I am smoking again currently but would like to really stop and stay stopped. I seem to cope ok to start off with, but find it incredibly difficult after that initial period. Once the novelty of not smoking has worn off, I struggle with the feeling of something being missing and just feeling really unsettled. Much of the advice is around the initial quitting....any tips and suggestions about how to stay with it and become a real non-smoker?

Dr Mark Winwood answered: Hi Claire - staying stopped or not relapsing is sometimes the most difficult part of the process.  It is important to stay positive think how much healthier you are now you have stopped.  Consider all the positives like how much more you prefer yourself now you are a non-smoker, this will help you through the tough times.  Learn to relax, get exercising and stay busy - if your initial enthusiasm has worn off give yourself loads of things to do - start a new hobby, visit new places - spend some of the money you have saved not smoking.  In the same vien - start a piggy bank wand put into it all of cigarette money - watch it grow - your confidence will also grow.  Don't beat yourself up if you have a cigarette - start again straight away - never stop giving up!  Loads of luck!

Claire commented:Thank you!

ianto asked: Hi Mark. Does smoking make it more likely that someone could have panic attacks?

Dr Mark Winwood answered: The short answer is - yes.  Research in the US in 1999 found that smokers are 3 times more likely to experience panic-attacks than non-smokers.  This confirms more recent research that shows us that one of the many negative aspects of smoking is an increase in the susceptibility of anxiety.

ianto commented: Thanks for response. The reason I ask is that I actually gave up smoking during the day because it made me feel nauseous/ nervous - although no panic attacks.

Dr Mark Winwood answered: Hi Ianto - best of luck with quitting and I hope your symptoms resolve.  

ianto commented: Thanks - am now using a Paul McKenna "stop smoking" hypnosis CD - we'll see how it goes!

Dr Mark Winwood answered: Clinical Hypnosis can be really helpful in quitting - also if you have difficulty with cravings you could also try some Nicotine Replacement Therapy (NRT) - either patches or gum.  All the best

Anonymous20 asked: is it normal to suffer from anxiety after quitting smoking?

Dr Mark Winwood answered: Hello - many people use smoking  to 'self-medicate' when they are feeling stressed or anxious.  If you have been doing this then it would be expected that you might feel more anxious as you are not using your normal coping technique.

Dr Mark Winwood answered: But - try these techniques to alleviate your stress - deep breathing, visualise (close your eyes and imagine you are in a place where you feel safe and secure), exercise (when you are active your body produces natural chemicals to reduce your stress), focus on relaxing your body, talk to friends or family for support, cut out caffeine and moderate alcohol and take care of yourself by eating properly.

Anonymous20 commented: thanks!

Callum asked: Social smoking is very annoying, as friends often disappear on a night out for ages at a time.  How can I help stop them doing this?

Dr Mark Winwood answered: as smoking is such an insidious habbit that is very hard to break - people really need to want to quit.  However, there may be some things that you can do to help your friends consider their behaviour.  Tell them what these absences on a night out mean to you, explain that you are concerned about their health, highlight that they are spending alot of money that they could spend on other - more exciting things.  By concentrating on both the negative aspects of their behaviours and the positive consequences associated with quitting - may - help then re-consider what they are doing.  Good luck!

Anonymous21 asked: I take citalopram for anxiety and depression. Would smoking interfere with this?

Dr Mark Winwood answered: Hi - i am not aware of any counter indications of smoking whilst on ant-depressant medication - although I am aware that there are on-going studies looking at possible interactions.
However, in the UK, smoking rates among adults with depression are about twice as high as among adults without depression. Quitting may be more difficult for people with depression - Nicotine (which is in cigarettes) stimulates the release of the chemical dopamine in the brain. Dopamine is involved in triggering positive feelings. It is often found to be low in people with depression, who may then use smoking as a way of temporarily increasing their dopamine supply.
However, smoking encourages the brain to switch off its own mechanism for making dopamine, so in the long term the supply decreases, which in turn prompts people to smoke more.
Most people start to smoke before they show signs of depression so it is unclear whether smoking leads to depression or depression encourages people to start smoking. The most likely explanation is that there is a complex relationship between the two.

I think you will agree - we need to do more research on smoking and depression!

AXA PPP asked: Hi Mark, we have recieved a question through our twitter. I smoke when I feel stressed - are there better ways of dealing with stress?

Dr Mark Winwood answered: In general because smoking is often used as a way of coping, smokers need other ways of dealing with stress, anxiety or other problems if they want to stop smoking.
Methods that people have found helpful include:

  • meditation and breathing exercises
  • regular exercise
  • cutting down on alcohol
  • eating a well-balanced diet
  • acupuncture
  • clinical hypnosis.

Counselling or talking things through with a supportive friend or family member can also help.
Making changes takes time and effort – progress is often slow. Be patient. You may not be able to control all the factors that contribute to your stress, but identifying the source of your anxiety and trying to find ways to reduce or overcome it are as important as finding new ways to cope with it.

Anonymous22 asked: Does anxiety cause people to smoke or does smoking cause anxiety?

Dr Mark Winwood answered:
This is a really interesting question - and one we could debate for some time. But research into smoking and stress has shown that, instead of helping people to relax, smoking actually increases anxiety and tension. Nicotine creates an immediate sense of relaxation so people smoke in the belief that it reduces stress and anxiety. This feeling of relaxation is temporary and soon gives way to withdrawal symptoms and increased cravings.
Smoking reduces nicotine withdrawal symptoms, which are similar to the symptoms of anxiety, but it does not reduce anxiety or deal with the underlying causes.

Although many people with anxiety problems say that they smoke to reduce their symptoms, they usually start smoking before their problems begin. Heavy smoking does not necessarily lead to fewer symptoms of anxiety or any other mental health problem in the long term. Any short term benefits that smoking seems to have are outweighed by the higher rates of smoking-related physical health problems, such as lung cancer and heart disease, that are common in people with mental health problems.

So - to answer your question - I think it might be a little like my previous response about depression -it is unclear as many people start to smoke before symptoms of anxiety are diagnosed - are they smoking to counter early symptoms or are symptoms exacerbated by the heavy reliance on nicotine?  There is probably a complex relationship between the two.

fiona asked: What do you think of the idea of quitting gradually by cutting down on number of cigarettes per day instead of going cold turkey?

Dr Mark Winwood answered: Hi Fiona - there is a technique called nicotine fading where you carefully reduce the amount you smoke over a number of days/weeks in a very controlled way.  This helps deal with withdrawl but doesn't take it away immediately.  However, it may be challenging as it requires more 'self-control' in many respects as smoking is still a part of your life and part of the process of quitting.  There are perhaps more effective ways of reducing the effects of 'cold-Turkey' such as medications and NRT (Nicotine Replacement Therapy) - these are available from your GP and pharmacist.

AXA PPP asked: Hi Mark, another question via twitter. I worry that when I stop smoking I will gain weight - will I, and how should I tackle this?

Dr Mark Winwood answered: I'll answer this question in 2 halves:

Many smokers worry that they'll gain weight if they try to quit. Some even use that concern as a reason not to quit.  it is normal to enjoy food more when you do not smoke as smoking does damage your taste buds.  At most people put on 4 - 10lbs.  Which is far more healthy than continuing to smoke.  So yes - you may put weight on.

Indeed, for many ex-smokers, putting on a few pounds is healthy. Research shows that smoking actually makes some people unhealthily thin. Still, if you're worried, remember this: a few simple strategies can help limit weight gain while you kick the habit. Once you have successfully broken the addiction to tobacco, you can work on losing any weight you've gained.

Research shows that nicotine from tobacco boosts the body's metabolic rate, increasing the number of calories it burns. Immediately after you smoke a cigarette, your heart rate increases by 10 to 20 beats a minute. The unnatural stimulant effect of nicotine is one reason smoking causes heart disease.
When smokers quit, metabolic rate quickly returns to normal. That's a healthy change. But if ex-smokers keep getting the same number of calories as before, they put on pounds.

When smokers quit, nicotine isn't all they crave. They also discover that they miss the habit of lighting a cigarette and putting it to their mouths. Many smokers turn to food to satisfy this so-called need for "oral gratification."
That's fine if it helps you to quit. But by choosing low-calorie or zero-calorie foods, you can avoid putting on weight. Some smart alternatives include:

  • Sugar-free gum
  • Sugar-free sweets
  • Celery or carrot sticks
  • Sliced peppers

Another trick is to brush your teeth frequently throughout the day. This can satisfy a passing craving for oral gratification. When your mouth is fresh and clean, you may have less of an urge to smoke.

To distract yourself from the urge to smoke, fill your day with things to do that don't involve eating.

AXA PPP commented: Thanks Mark

Anonymous2 asked: I find I smoke often when I am stressed - what is the best alternative to de-stress?

Dr Mark Winwood answered: It is very common for people to self medicate using smoking to reduce levels of stress.  Research shows that smoking has the opposite effect and actually increases your feelings of stress.  Alternatives may be:

  • meditation and breathing exercises - this can include visualisation techniques
  • regular exercise - exercise causes the brain to produce natural chemicals to reduce stress
  • cutting down on alcohol - alcohol can have negative effects on our perceived ability to cope with life's stressor
  • eating a well-balanced diet
  • acupuncture
  • clinical hypnosis.

Counselling or talking things through with a supportive friend or family member can also help.

Mrs Rabbit asked: Is it the same sort of willpower required to give up smoking as it is to diet and reduce food intake, or is it the nicotine addiction which makes it different?  I gave up smoking many years ago, but find it much harder to lose weight!

Dr Mark Winwood answered: Hello Mrs Rabbit - I think that there are many similarities - and i think any health behaviour change share common themes.  Smoking cessation has its own idiosyncrasies due, in part, to addiction to Nicotine.  Changing eating behaviour is different as although smoking isn't essential to life - eating is.
I think that many of the techniques that are used in quitting smoking can be used to monitor and change eating behaviour.  It is important to identify what 'triggers' you to choose unhealthy foods, do you eat more when you are stressed or unhappy.  If you identify these sorts of things you are more able to design more 'healthy' alternatives.  Are there people around you who can help?  think of yourself as the person you want to be and how your life might be if you achieve this.  Think what techniques you applied to quitting smoking - did you do it alone or in a group, did you use NRT - use similar techniques to quit unhealthy food choices.

You have done an amazing job quitting smoking so you have already guaranteed yourself a more healthy future - using the same resolve will help you lose weight.

AXA PPP asked:
We have 15 mins remaining in our live chat, if you have any further questions for Mark, then please ask.

Dr Mark Winwood answered: Thank you to everyone who has contributed today - if you in the process of quitting, thinking about quitting or have already quit - keep going and NEVER STOP GIVING UP.

Ruth asked: Does smoking a cigarette faster cause anxiety? or a racing heart beat?

Dr Mark Winwood answered: Hi Nicotine has a direct effect on your heart and will increase the rate of its beating - hence it increases your metabolism and therefore your weight (slightly).  It has also been shown that smoking increases anxiety - so to answer your question - both!

AXA PPP asked: Thanks to everyone that joined our live chat today and special thanks to our expert Dr Mark Winwood.


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