Hypnosis for smoking cessation

1. Introduction

Version followed: a two-session clinical format that adds hypnosis to standard smoking cessation care. It follows the published outline of Carmody et al. (2008, 2017): two 60-minute face-to-face sessions, telephone follow-up, and nicotine patches prescribed by a clinician. Session content draws on the components named in Green & Lynn's "Winning Edge" programme (2018: two sessions combining CBT, mindfulness and hypnosis, plus self-hypnosis practice). Suggestion and imagery techniques come from the fully published one-session case protocol of Kraft (2012). Two single-session variants are given as alternatives: Spiegel's restructuring session with self-hypnosis, as studied by Spiegel et al. (1993), and Kraft's one-hour session. The full Winning Edge manual and the Carmody trial methods are not drawn on here. Details that depend on them are marked [uncertain].

Hypnosis for smoking cessation is not one manualised therapy. It is a family of brief protocols that use hypnotic suggestion and imagery as one part of a quit attempt. The main sources share a core idea of how change happens. A motivated smoker sets a firm quit date. In hypnosis the clinician links quitting to the smoker's own reasons for quitting and to a non-smoker identity. The smoker rehearses meeting each personal trigger without smoking and feeling cravings fade, and practises self-hypnosis afterwards to keep that commitment and handle urges. [source: Kraft 2012; Green & Lynn 2017 abstract; Green, ISH Encyclopedia 2026; Spiegel et al. 1993 abstract]

Scope of this guide: it covers clinical hypnosis delivered by licensed health professionals within their competence, as an add-on to evidence-based cessation care. That care means behavioural support plus stop-smoking medication assessed and prescribed by a medical prescriber, and no medication dosing is given here. A Colombian psychiatric review of 51 studies also recommends combining nicotine replacement, behavioural and hypnotic techniques with long-term abstinence strategies. Stage hypnosis, covert or non-consensual induction, and any technique meant to bypass consent are not clinical methods and are excluded. [source: Rev Colomb Psiquiatr review abstract]

2. Framework

Format options [source: Carmody 2008 UCSF page; Carmody 2017 abstract; Green & Lynn 2018 Wiley contents; Spiegel et al. 1993 abstract; Kraft 2012; Green ISH 2026]:

Two-session standard (followed here): two 60-minute sessions, then three or four 20-minute phone calls. In Carmody 2017 the calls were twice a week. Nicotine patches were given for about two months in both arms of Carmody 2008. Winning Edge also uses two treatment sessions, delivered to groups or individuals.
Single session: one session of about an hour that teaches self-hypnosis (Spiegel et al. 1993, 226 consecutive referred smokers; Kraft 2012). Kraft offered booster sessions.
Longer course: Elkins & Rajab (2004) used three sessions. Elkins et al. (2006) combined about 8 weeks of counselling with hypnosis. Their session-by-session content is not drawn on here [uncertain].
Relapse-prevention format: Carmody 2017 enrolled smokers who had already stopped for at least 3 days, confirmed by carbon monoxide (CO) testing. They then received two hypnosis sessions plus phone calls.
Inpatient setting: Hasan et al. (2014) compared hypnosis, NRT, both together, and self-help in hospitalised patients. Their protocol is not drawn on here [uncertain].

Phases:

Phase 0, referral and readiness check (before session 1). Goals: confirm the person wants to stop completely, not cut down; agree a quit date; contact the medical prescriber about stop-smoking medication. Kraft confirmed readiness and the total-abstinence goal by phone before booking. Move on when the client says they are ready to stop completely and screening raises no exclusion. [source: Kraft 2012; synthesis for the medical link]
Phase 1, assessment and preparation (first 20–30 minutes of session 1, or a separate visit). Goals: map smoking history and triggers; record the client's own reasons for quitting, past quit attempts and social support; screen for contraindications; explain hypnosis and get consent; optionally measure hypnotisability. Move on when the trigger map and reasons for quitting are written down and consent is documented. [source: Kraft 2012; Spiegel et al. 1993 abstract; synthesis]
Phase 2, quit session (rest of session 1, around the quit date). Goals: run the hypnosis session (induction, ego-strengthening, motivational and identity suggestions, trigger rehearsal, craving suggestions); teach self-hypnosis; set home practice. In Kraft's case the client smoked his last cigarette the day before the session and removed all smoking items from home. Move on once the client can run self-hypnosis on their own and has a written plan for the first week. [source: Kraft 2012; Green & Lynn 2018 contents]
Phase 3, consolidation and relapse prevention (session 2). The gap between sessions in Carmody's trials is not drawn on here; about one week is suggested here [uncertain; synthesis]. Goals: review lapses and urges, adjust suggestions to triggers that proved hard, strengthen self-hypnosis, plan for high-risk situations. [source: Carmody 2017 abstract; Green & Lynn 2018 contents; synthesis]
Phase 4, follow-up (calls over 2–4 weeks, boosters as needed). Goals: support abstinence, solve problems with lapses, check medication use with the prescriber, and record outcome at set points. Kraft phoned at one week and interviewed the client at one year. CO verification is good practice [synthesis]. [source: Carmody 2008/2017; Kraft 2012]

When to change course: for a client who keeps smoking after a lapse, re-set the quit date and step up the behavioural and medical parts of care. Do not simply repeat the same hypnosis session [synthesis].

3. Guiding principles

Hypnosis is an add-on, not the treatment. In practice, every client is also offered behavioural support, and medication is assessed by a prescriber; hypnosis never replaces medical care. [source: Rev Colomb Psiquiatr review abstract; Carmody 2008 design]
Readiness first. Book the hypnosis session only for a client who says they want to stop completely. With an ambivalent client, work on motivation first. [source: Kraft 2012; Green & Lynn 2017 abstract; Stanford NCT03931772 used motivation of at least 5/10 for entry]
Build motivation before, during and after treatment. Green & Lynn argue that wavering motivation undermines adherence. Revisit commitment at every contact, not only during trance. [source: Green & Lynn 2017 abstract]
Make suggestions personal. Build every suggestion from the client's own stated reasons (Kraft's client: his health and his expected daughter) and their own daily triggers. [source: Kraft 2012]
Make it a full stop with a fixed date. In practice: one quit date, no cutting-down plan, smoking items removed beforehand. [source: Kraft 2012]
Give the client the method. Kraft's discussion treats all hypnosis as self-hypnosis. Spiegel's protocol is built around self-hypnosis the client practises. In practice, teach a short self-hypnosis routine in session 1 and present the clinician as a coach. [source: Kraft 2012; Spiegel et al. 1993 abstract]
Work on identity, not only on habit. Frame the change as "becoming a non-smoker". [source: Kraft 2012; Green ISH 2026, citing Ekanayake & Elkins 2025]
More contact is better. The more successful interventions usually used several sessions. In practice: plan session 2 and phone calls, and do not depend on a single session alone. [source: Green ISH 2026; Carmody 2008/2017]
Use hypnotisability and history as information, not as a gate. Hypnotisability and a past quit of a month or more predicted early abstinence. Hypnotisability and living with a significant other predicted abstinence at 2 years. In practice: add support for low scorers and people living alone rather than excluding them [synthesis]. [source: Spiegel et al. 1993 abstract]
Watch mood. Smokers with a history of depression did better with hypnosis than with standard counselling in Carmody's trials. In practice: screen for depression, do not exclude on that basis, and monitor mood through withdrawal. [source: Carmody NCTOH 2012 abstract; Carmody 2008 UCSF page]
Bring in the client's social network. Ask the client to tell family and friends about the quit and recruit a supporter. [source: Kraft 2012; Spiegel et al. 1993 abstract]
Be honest about what to expect. Kraft told his client that some people stop in one hour. The recommendation here is more cautious: describe hypnosis as one tool among several, so that a lapse is not read as personal failure [synthesis].
Consent and transparency. Explain what will happen, ask permission before induction, and agree any aversive imagery in advance. Use no covert or surprise techniques. [synthesis]
Stay within competence. Use hypnosis only for problems you could treat without it. Refer psychiatric or medical complications on. [synthesis]

4. Intervention inventory

For every technique below, the example wording is the author's own and is marked (illustrative). No founder's script is reproduced.

4.1 Pre-treatment readiness contact and contract

Purpose: Book only clients who are ready to stop completely, and set expectations before the first session. [source: Kraft 2012]
Steps:
1. Make a short phone call before booking.
2. Ask whether the client wants to stop completely or only cut down, and confirm that the programme aims for total abstinence.
3. Agree a quit date at or just before session 1. Kraft's client smoked his last cigarette the day before.
4. Ask the client to remove cigarettes, tobacco, ashtrays, lighters and cases from home before the session.
5. Ask the client to contact their GP or prescriber about stop-smoking medication [synthesis].
Example language (illustrative): "This programme is for stopping completely, not cutting down. Is that what you want right now? If so, let's pick a date. Plan for your last cigarette to be the day before we meet."
Watch for: Hedging ("I'd like to cut down") or doing it for someone else. In either case, offer motivational work first and do not book hypnosis yet [synthesis].

4.2 Assessment interview

Purpose: Gather the material for tailored suggestions and the details that predict outcome. [source: Kraft 2012; Spiegel et al. 1993 abstract]
Steps:
1. Smoking history: age started, current daily amount, and other products used, including e-cigarettes [synthesis].
2. Past quit attempts: methods used (Kraft's client had used patches and gum), the longest abstinence (one month or more predicted success in Spiegel et al. 1993), and what triggered relapse.
3. Trigger map: go through a typical day hour by hour. Kraft's trigger points were mid-morning, after lunch, early afternoon, arriving home, after supper, late evening and before bed. Add situations such as alcohol, stress and other smokers [synthesis].
4. Reasons for quitting, in the client's own words, ranked by importance.
5. Social context: whether they live with a partner or other smokers, and who can support them.
6. Mood and mental-health history, including depression, plus alcohol and drug use [synthesis].
Example language (illustrative): "Take me through yesterday from waking up. Where was the first cigarette, and what was going on just before it?" / "If you stop for good, what matters most to you about that?"
Watch for: Reasons that are vague or not the client's own. Draw out at least one personal, emotionally vivid reason.

4.3 Screening and contraindications

Purpose: Keep hypnosis away from clients for whom it is unsafe or unsuitable. [source: Stanford NCT03931772 exclusions; synthesis where marked]
Steps:
1. Exclusions in Spiegel's group's trial: severe psychiatric or structural brain disease (for example psychosis, stroke with functional impairment, dementia); current or recent risk to self; recent misuse of dissociative anaesthetics, hallucinogens, opioids, cocaine or amphetamines; hearing impairment where audio is used.
2. Added cautions [synthesis]:
  - Active psychosis or mania: do not use hypnosis.
  - Severe dissociative disorder or untreated PTSD: no regression or age-progression work, and only brief, eyes-open, present-focused procedures if any, after consulting the treating clinician.
  - Uncontrolled epilepsy or seizure disorder: medical advice first.
  - Pregnancy: work alongside obstetric and midwifery cessation care.
  - Under-18s: guardian consent and a paediatric clinician involved.
  - Current substance-use disorder: refer for integrated addiction care.
3. Depression is not an exclusion. Monitor it, given Carmody's findings.
4. If suicidal ideation is disclosed, do a standard risk assessment and safety plan, and delay the hypnosis work until the client is stable [synthesis].
Watch for: Clients who play down psychiatric history. Get collateral information from the GP if unsure [synthesis].

4.4 Coordinating evidence-based cessation care

Purpose: Run hypnosis inside standard care. In Carmody's trials, both arms received nicotine patches. [source: Carmody 2008 UCSF page; Carmody 2017 abstract; Rev Colomb Psiquiatr review abstract]
Steps [synthesis]:
1. With consent, tell the client's prescriber about the plan.
2. Encourage a medication assessment (NRT or other licensed cessation medication). Do not advise on doses.
3. Point the client to the local stop-smoking service or quitline.
4. Agree who records CO readings if available.
5. Match the quit date to the medication start date the prescriber advises.
Example language (illustrative): "Hypnosis works best as one part of a full plan. Your doctor or pharmacist can sort out medication, and I'll focus on the habit and the cravings."
Watch for: Clients refusing medication because they think hypnosis will be enough. Note that Hasan et al. (2014) found no added benefit from NRT on top of hypnosis in hospital inpatients. Still, leave the medication decision with the prescriber and the client [uncertain; synthesis].

4.5 Hypnotisability assessment (optional)

Purpose: Gauge how responsive the client is and plan extra support for low scorers. Spiegel's group measured hypnotisability with the Hypnotic Induction Profile (HIP), and it predicted outcome. [source: Spiegel et al. 1993 abstract; Stanford NCT03931772]
Steps:
1. If trained in a standardised scale such as the HIP, give it as published. Its items are not reproduced here.
2. Otherwise, treat responses to the first induction as an informal guide [synthesis].
3. Tell the client how they responded in a way that encourages them. Never present it as a verdict on whether they can stop.
Example language (illustrative): "You responded well. That suggests the practice will come easily." / "You stayed quite alert. That's common, and it means we'll lean more on the practical tools."
Watch for: A low scorer feeling hopeless. Stress that most of the work is behavioural [synthesis].

4.6 Preparation, explanation of hypnosis and consent

Purpose: Clear up myths, set realistic expectations, and get informed consent. [source: Kraft 2012 for expectation-setting; synthesis for consent content]
Steps:
1. Explain hypnosis as focused attention in which the client stays aware and in control and can stop at any time.
2. Describe the session sequence: induction, suggestions, rehearsal, coming back, self-hypnosis teaching.
3. Ask permission for any aversive or vivid health imagery (see 4.16–4.17) and agree a stop signal.
4. Record verbal or written consent.
5. Find out what the client expects and gently correct any "magic cure" belief.
Example language (illustrative): "Nobody can make you do anything in hypnosis. Think of it as a very focused, relaxed state where you rehearse being a non-smoker. If you lift your hand, I'll stop."
Watch for: Fear of losing control, or past experience of stage hypnosis. Spend extra time explaining.

4.7 Induction: eye fixation and eye fatigue, breathing, progressive relaxation

Purpose: Narrow attention and relax the client. This is the induction Kraft used. [source: Kraft 2012]
Steps:
1. Seat the client comfortably and have them fix their gaze on a point slightly above eye level.
2. Suggest that the eyelids grow heavy and tired and close when ready.
3. Guide slow breathing, linking each out-breath with letting go.
4. Relax the muscle groups progressively from the head down, or the feet up.
5. Allow about 5–10 minutes [synthesis].
Example language (illustrative): "Keep your eyes on that spot... notice the lids getting heavier... let them close whenever they're ready... and with each breath out, let your shoulders drop a little more."
Watch for: Signs it is working: slower breathing, a still face, slumped posture, delayed responses. If the client cannot close their eyes or becomes anxious, switch to an eyes-open, relaxation-based approach [synthesis].

4.8 Deepening and absorption: special place and repetition

Purpose: Deepen absorption. Kraft described no separate deepener: depth built through repeated, rhythmic ego-strengthening, chained suggestions and a safe-place image (the client chose his own home). [source: Kraft 2012]
Steps:
1. Ask before induction where the client feels safest and most at ease.
2. In trance, guide them there using all the senses.
3. Chain suggestions together so that each response leads into the next ("as you notice X, you can feel Y").
4. Use rhythmic repetition.
Example language (illustrative): "Find yourself at home, in your favourite spot... notice the light, the sounds... and as you settle there, you can feel even more settled, more comfortable."
Watch for: A "safe place" that brings up distress. Agree an alternative place beforehand and switch to it [synthesis].

4.9 Ego-strengthening

Purpose: Build confidence and the client's sense that they have the skills and self-control they need. [source: Kraft 2012]
Steps:
1. Remind the client of their real strengths, using examples gathered at assessment (past quits, other hard things they have achieved).
2. Suggest growing calm, confidence and self-control.
3. Repeat these themes rhythmically.
Example language (illustrative): "You've already shown you can go weeks without smoking. That strength is still there... and each day it becomes easier to rely on."
Watch for: Generic praise falls flat. Use the client's own examples.

4.10 Motivational and value-linked suggestions

Purpose: Link not smoking to the client's own most important reasons. Green & Lynn present hypnotic suggestion as a way to build cognitive, behavioural and emotional commitment to treatment and to a smoke-free life. [source: Kraft 2012; Green & Lynn 2017 abstract]
Steps:
1. Take the top two or three reasons from the assessment.
2. Have the client vividly imagine each reason being fulfilled while smoke-free (for example, holding their child while healthy).
3. Suggest that whenever the thought of smoking comes up, these reasons come to mind straight away.
4. Include respect for, and protection of, the body if the client values this [synthesis].
Example language (illustrative): "See yourself a year from now, smoke-free, playing with your daughter, breathing easily... and any time the old thought of a cigarette shows up, this picture comes with it, clear and strong."
Watch for: Visible emotion and nodding are signs it is landing. If the client looks indifferent, the reason is probably not theirs. Revise it at the debrief.
Spiegel variant: Spiegel's single session builds the session around a few short key ideas about the body that the client repeats in self-hypnosis. The exact wording is not taken from a primary source here, so it is not reproduced or attributed [uncertain].

4.11 Non-smoker identity suggestions

Purpose: Shift the client from "a smoker trying to stop" to "a non-smoker". [source: Kraft 2012; Green ISH 2026]
Steps:
1. Give direct suggestions that the client is already a non-smoker.
2. Add indirect suggestions that they will think about smoking less and less over time.
3. Offer a short phrase the client can repeat to themselves after the session. Kraft offered "I am a non smoker", to be used if helpful.
Example language (illustrative): "From today you're someone who doesn't smoke... and you may be surprised how rarely the thought even crosses your mind."
Watch for: Clients who say "I'm a smoker who isn't smoking." Explore and reframe this at the debrief.

4.12 Trigger-by-trigger rehearsal (conditioning trials)

Purpose: Practise meeting each personal trigger and staying smoke-free. This is the core behavioural rehearsal in Kraft's protocol. [source: Kraft 2012]
Steps:
1. Using the trigger map, take the client through each trigger point in turn (for example mid-morning, after lunch, arriving home, after the evening meal, before bed).
2. At each point, have them picture the scene in detail and notice the old cue.
3. Have them see themselves choosing not to smoke.
4. Suggest the urge fades and give praise.
5. Check each scene with an ideomotor signal (see 4.18) before moving to the next. In Kraft's protocol, aversive suggestions were sometimes paired with this rehearsal (see 4.17).
Example language (illustrative): "It's after lunch now... you push your chair back, the moment when you'd usually reach for a cigarette... and you notice you simply don't need it. Lift a finger when you've seen yourself walk on without it... well done."
Watch for: Hesitation or a delayed signal on a particular trigger. Repeat that scene, or bring it to session 2.

4.13 Future pacing ("fast-forward" rehearsal)

Purpose: Practise future days and many future triggers, with cravings fading. [source: Kraft 2012]
Steps:
1. Have the client run through a typical day at their own pace in imagination.
2. Extend this to weeks ahead: social events, stress, holidays.
3. Suggest that cravings fade or wash away at each refusal.
4. Congratulate each success.
5. Ask for an ideomotor signal when they have finished.
Example language (illustrative): "Now let the days roll forward at your own speed... a busy Monday, a Friday evening out... each time you notice the old cue, the urge washes through and away. Signal when you've reached next month."
Watch for: Scenes where the client "sees" themselves smoking. Stop, rehearse that scene again with a coping response, and note it as a high-risk situation [synthesis].

4.14 Craving-management suggestions

Purpose: Reduce how strong and how long cravings are, and give a response the client can use straight away. [source: Kraft 2012 (cravings absent or much reduced, fading); synthesis for coping cues]
Steps:
1. Suggest that cravings, if they come, will be milder and pass more quickly.
2. Link a cue the client can trigger themselves (a slow breath, a short phrase) to the passing of an urge [synthesis].
3. Rehearse a craving rising, peaking and falling.
Example language (illustrative): "If an urge comes, it will be a weaker one... take one slow breath, and notice it start to fade... rising, peaking, and passing like a wave."
Watch for: Claiming cravings will disappear entirely can backfire on the first strong urge. Present them as passing waves the client can ride [synthesis].
Note: The Winning Edge combines mindfulness with hypnosis. Its specific mindfulness exercises (for example for urges) are not drawn on here [uncertain].

4.15 "Non-smoker walk" observational imagery

Purpose: Strengthen the new identity by having the client see smokers from a non-smoker's point of view. [source: Kraft 2012]
Steps:
1. In trance, have the client imagine walking through a familiar place where people smoke.
2. They notice the smokers and the smell, feel calm and free, and keep walking.
Example language (illustrative): "You walk past the doorway where people are smoking... you notice it from the outside now, as someone who doesn't smoke... and you carry on, breathing clean air."
Watch for: Envy or longing coming up. Treat this as material for session 2, not as failure.

4.16 Split-screen choice imagery

Purpose: Turn the decision into something felt, through a contrast the client chooses. [source: Kraft 2012]
Steps:
1. With prior consent, have the client picture two screens: healthy lungs on one, and on the other, lungs damaged by smoking.
2. Invite them to choose the healthy image by drawing their hands to their chest.
3. Link that movement to warmth, health and no wish to smoke.
Example language (illustrative): "Two screens: on one, healthy pink lungs; on the other, lungs darkened by smoke. When you're ready, choose by bringing your hands to your chest... feel the warmth there, the health you're choosing."
Watch for: Clients with smoking-related illness, or health anxiety, may find the damaged image distressing. Agree the imagery beforehand or use a neutral alternative such as two paths [synthesis].

4.17 Aversive suggestions (use with caution)

Purpose: Kraft paired imagined smoking with nausea and self-disgust as part of his rehearsal, and asked the client in trance whether he would take the cigarette. [source: Kraft 2012]
Steps (if used at all, only with explicit consent beforehand):
1. Explain this option before the session and get agreement.
2. In trance, suggest that bringing a cigarette near brings mild unpleasant sensations.
3. Follow at once with a positive alternative and relief on refusal.
4. Remove any lingering discomfort before re-alerting.
Example language (illustrative): "As you imagine bringing it closer, notice how unappealing it has become... and how good it feels to put it down."
Watch for: Caution [synthesis]: aversive imagery can cause real nausea and shame, and it reinforces self-disgust. Do not use it with clients who have eating disorders, emetophobia, pregnancy-related nausea, or high shame or self-criticism. Prefer the positive approaches in 4.10–4.16. Aversion is not a necessary part of the method.

4.18 Ideomotor signalling

Purpose: Get non-verbal confirmation during trance that a rehearsal is complete or a decision has been made. [source: Kraft 2012]
Steps:
1. Before or early in trance, set up a finger signal for "yes" or "done".
2. Ask for the signal after each scene.
3. Wait patiently. If no signal comes, ask a softer question or repeat the scene.
Example language (illustrative): "When you've seen yourself handle that moment, your finger can lift all by itself."
Watch for: A signal that never comes may mean ambivalence about that trigger. Explore it afterwards.

4.19 Re-alerting and debrief

Purpose: Bring the client back fully and safely and collect material for adjusting the work. [synthesis; Kraft describes no formal re-alerting]
Steps:
1. Give a post-hypnotic suggestion that self-hypnosis practice will be easy and the effects will last.
2. Count up while suggesting the client is alert, refreshed and fully oriented.
3. Check orientation: ask them to stand and describe the room.
4. Ask what stood out and which scenes were hard.
5. Note anything distressing and remove it before they leave.
Example language (illustrative): "In a moment I'll count from one to five. With each number you'll become more alert... five, eyes open, fully here. What stood out for you?"
Watch for: Grogginess, headache or emotional upset. Re-orient, ground the client, and do not let them drive until they are alert.

4.20 Self-hypnosis training and home practice

Purpose: Give the client a method they can run themselves to renew their commitment and handle urges. Spiegel's single session teaches self-hypnosis as the main tool. Winning Edge includes a self-hypnosis script after session 1. [source: Spiegel et al. 1993 abstract; Green & Lynn 2018 contents; Kraft 2012]
Steps:
1. Before the end of session 1, teach a short routine [synthesis]:
  - a brief induction (a few breaths, eyes closing);
  - recall of the client's two or three key reasons and their non-smoker phrase;
  - a short urge-passing image;
  - re-alerting.
2. Have the client practise it once in session while you watch.
3. Agree how often to practise (for example several short practices a day plus one when an urge comes). The exact frequency used by Spiegel and by Green & Lynn is not drawn on here [uncertain].
4. Optionally give a recording of the session made in-house or by the clinician. Stanford's trial used professionally produced audio for self-hypnosis. Do not use recordings while driving.
Example language (illustrative): "This is yours to take away: three slow breaths, eyes close, bring up your reasons and your phrase, picture the urge passing, then count yourself back. About a minute. Show me now."
Watch for: Practice dropping off after the first week. Check it at every call and link practice to existing routines.

4.21 Coping-model interview (Winning Edge)

Purpose: Winning Edge includes an interview with a coping model, someone who quit successfully, alongside self-hypnosis script 1. [source: Green & Lynn 2018 contents]
Steps: The format is not drawn on here [uncertain]. A practical adaptation [synthesis]:
1. Play, or invite (with consent), an ex-smoker who describes their own struggles, the strategies that worked, and how they recovered from lapses.
2. Ask the client which strategies they will borrow.
Example language (illustrative): "Listen for one thing they did that you could try this week."
Watch for: The client comparing themselves unfavourably. Choose a model who struggled and coped, not one who found it effortless.

4.22 Cognitive-behavioural and mindfulness components

Purpose: Winning Edge combines CBT, mindfulness and hypnosis in two sessions with handouts and worksheets. Carmody 2017 compared hypnosis with behavioural relapse-prevention counselling of equal length. [source: Green & Lynn 2018 contents; Carmody 2017 abstract]
Steps: The handouts and specific exercises are not drawn on here [uncertain]. Standard cessation behavioural content to include [synthesis]:
1. Self-monitoring of urges and situations.
2. Avoiding triggers early on, or changing them.
3. Planning substitute behaviours.
4. Preparing for alcohol and social situations.
5. Coping with stress without smoking.
6. Mindful, non-judgemental noticing of urges.
7. Rewards for milestones.
Example language (illustrative): "Let's plan the three riskiest moments this week and what you'll do instead in each."
Watch for: Plans that are vague. Each high-risk situation needs a specific, rehearsed response.

4.23 Session 2: consolidation and relapse prevention

Purpose: Strengthen abstinence and target the triggers that proved hard. In Carmody 2017, hypnosis was used specifically for relapse prevention in people who had already stopped for at least 3 days. [source: Carmody 2017 abstract; Green & Lynn 2018 contents; synthesis for steps]
Steps [synthesis]:
1. Review smoking status (CO reading if available), urges, self-hypnosis practice, medication use and mood.
2. Go through any lapse in detail without blame.
3. Hypnosis: a brief induction, renewed motivational and identity suggestions, rehearsal (4.12–4.13) focused on the triggers that proved hard, and suggestions for recovering straight away from a slip.
4. Update the self-hypnosis routine and the plan for high-risk situations.
Example language (illustrative): "Which moment this week was hardest? Let's take that one into the rehearsal today."
Watch for: Abstinence-violation thinking ("I had one, so I've failed"). Recast a slip as information and put a recovery plan in place.

4.24 Telephone follow-up and boosters

Purpose: Support people through the early high-risk weeks. Carmody's trials used three calls (2008) and four 20-minute calls, twice weekly (2017). Kraft phoned at one week and offered booster sessions. [source: Carmody 2008 UCSF page; Carmody 2017 abstract; Kraft 2012]
Steps:
1. On each call, check status, urges, practice, medication adherence (referring medication questions to the prescriber) and mood.
2. Solve one problem.
3. Do a brief self-hypnosis practice over the phone if useful [synthesis].
4. Offer a booster session after a lapse or before a known high-risk event [synthesis].
Example language (illustrative): "Quick check-in: any cigarettes since we last spoke? What's been the hardest moment, and how did you handle it?"
Watch for: Missed calls often signal a lapse plus shame. Leave a warm, non-judgemental message and re-offer contact.

4.25 Mobilising social support and lifestyle adjuncts

Purpose: Living with a significant other predicted lasting abstinence. Kraft recommends telling friends and family, healthy eating and physical activity. [source: Spiegel et al. 1993 abstract; Kraft 2012]
Steps:
1. Help the client tell key people and ask for specific support.
2. Agree smoke-free rules at home and in the car [synthesis].
3. Encourage general healthy eating and activity, without weight or exercise targets.
4. If a partner smokes, offer them a referral to cessation support [synthesis].
Example language (illustrative): "Who's one person you'll tell today, and what would you like them to do if they see you struggling?"
Watch for: Unsupportive or smoking household members. Plan responses to them explicitly.

4.26 Outcome monitoring

Purpose: Track abstinence honestly and adjust care. [source: Kraft 2012; Carmody 2008/2017 (validated point-prevalence outcomes)]
Steps:
1. Record self-reported abstinence (for example 7-day point prevalence) at 1 week, 1, 3, 6 and 12 months [synthesis for schedule].
2. Confirm with CO testing where available. Kraft notes that cotinine only detects recent use [source: Kraft 2012].
3. Record lapses, medication use and mood.
Watch for: Over-reporting of abstinence by clients who want to please. Measure without judgement.

5. Handling problems

Unless tagged otherwise, the guidance in this section is the author's own [synthesis]. The sources say little about handling problems. Green & Lynn's book has a chapter on common questions, tailoring treatment, and ambivalence and resistance, but it is not drawn on here [uncertain].

Ambivalence or "not really ready": Postpone the hypnosis. Use motivational interviewing: discuss the pros and cons of smoking, the client's own change talk, and confidence and importance ratings. Offer hypnosis once the client chooses a quit date. Green & Lynn present motivation as the central obstacle to treatment adherence [source: Green & Lynn 2017 abstract].
Expecting a one-session "cure": Agree up front that hypnosis is one tool. Plan session 2 and the calls before the first induction.
"It didn't work, I wasn't hypnotised": Point out that responses vary and that hypnotisability is one factor among several [source: Spiegel et al. 1993]. Shift the emphasis to self-hypnosis as a practice routine, the behavioural plan and medication. Try an eyes-open, more active induction.
Lapse in the first days: Review it straight away and without blame. Was it a trigger that was not rehearsed? Was medication not taken? Re-rehearse that trigger in a booster. Re-set the quit date if the client is smoking regularly again. Tell the prescriber.
Strong cravings or withdrawal: Check medication adherence and suitability with the prescriber. Increase urge-passing self-hypnosis to short, frequent practices. Add behavioural substitutes.
Low mood or anxiety during withdrawal: Screen for depression at each contact. Clients with a history of depression did comparatively well with hypnosis in Carmody's trials, but withdrawal can worsen mood [source: Carmody NCTOH 2012 abstract]. Do a suicide-risk assessment if mood drops sharply, and liaise with the GP or psychiatrist.
Not practising self-hypnosis: Shorten the routine to about a minute. Tie it to existing habits (after meals, on arriving home). Ask what got in the way, and use a recording if the client prefers.
Abreaction or distress in trance (for example from health imagery, aversion or the safe place): Stop the suggestion. Move to neutral breathing and grounding in the present (feet on the floor, the room's sounds), re-alert gently, and debrief. Remove or replace that imagery in future sessions.
Dissociative responses (lost time, depersonalisation, difficulty re-alerting): Re-alert slowly with orienting questions. Keep the client until they are fully oriented. Stop hypnosis and review screening. If symptoms persist, refer for assessment.
Fear of losing control or past stage-hypnosis experience: Spend extra time on consent and demonstrations, use an eyes-open approach and a stop signal, and give the client control of the pace.
Rupture after relapse (shame, missed appointments): Name it and normalise it. Take responsibility for anything the plan missed. Re-engage the client on their terms. Never blame the client's "resistance" to hypnosis.
Refusing medication: Respect the choice. Give balanced information and point the client to the prescriber, and record that the medication option was discussed.
Weight-gain worries: Acknowledge them. Encourage general healthy eating and activity without targets, and refer to the GP or a dietitian if the worry is significant.
E-cigarettes or other nicotine products: Agree with the client and prescriber whether these are part of the plan. Tailor identity suggestions to fit. For example, "non-smoker" may coexist with a supervised NRT course.
Smoking household or partner: Plan responses to offers of cigarettes. Rehearse them in trance (4.12). Offer the partner a referral.
Pregnant clients: Work only alongside maternity cessation services. Avoid aversive nausea suggestions.
Emerging psychosis, mania or severe dissociation: Stop hypnosis and refer for psychiatric assessment [source: Stanford NCT03931772 exclusion of severe psychiatric disease].

Sources

Sources:

Further reading (not drawn on) [uncertain where relied on]:

Green JP, Lynn SJ (2018). Cognitive-Behavioral Therapy, Mindfulness, and Hypnosis for Smoking Cessation: A Scientifically Informed Intervention. Wiley.
Spiegel H (1970). A single-treatment method to stop smoking using ancillary self-hypnosis. IJCEH 18.
Spiegel H, Spiegel D. Trance and Treatment: Clinical Uses of Hypnosis (2nd ed., 2004). American Psychiatric Publishing.
Carmody TP, Duncan C, Simon JA, et al. (2008). Hypnosis for smoking cessation: a randomized trial. Nicotine & Tobacco Research 10(5).
Elkins GR, Rajab MH (2004). Clinical hypnosis for smoking cessation: preliminary results of a three-session intervention. IJCEH 52(1).
Elkins G, Marcus J, Bates J, Rajab MH, Cook T (2006). Intensive hypnotherapy for smoking cessation: a prospective study. IJCEH 54(3), 303–315.
Hasan FM, Zagarins SE, Pischke KM, et al. (2014). Hypnotherapy is more effective than nicotine replacement therapy for smoking cessation. Complementary Therapies in Medicine 22(1).
Ekanayake V, Elkins G (2025). Review of hypnosis for smoking cessation. IJCEH (cited via Green 2026).

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