Résternon-fumeur

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Accueil>

Accueil Rester non- fumeur

Feuilles de travail Pour obtenir de l'aide

Envoyez. cette .

Canada Canada

Canada

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1 J'arrête Site du Canada Recherches Politiqoo Législation Jeunesse

Bienvenue au site Rester non-fumeur. Les sujets

suivants vous permettront de mieux vous préparer

à

vivre sans fumée pour la vie.

A. CréEH un plande renoncement B. Contrôler les envies de fumer C. Confronter les situations difficiles D. Préveniret surmonter les rechutes

E. Résister aux symptômes du sevrage F. Faire face à un manque de soutien G. Demeurer non-fumeur

Feuilles de travail

• Questionnaire sur la confiance (pour créer votre échelle de difficulté)

Santé environnementale et sécurité des consommateurs Programme de la lutte au tabagisme

Quitting > La prévention de la récidive>

English 1 Contactez-nous 1 Aide 1 Recherche 1 Site du Canada Recherches ¹Politique ¹ Législation ¹Jeunesse ¹J'arrête

http://www.hc-sc.gc.ca/hecs-sesc/tabac/ cesser/relapselindex.html 2/1/2005

1

Advantages of Quitting

1

Short-Terrn Advantages Long- Terrn Advantages

of Quitting of Quitting

1. 1.

2. 2.

3. 3.

4. 4.

5. 5. ^,

1

Try to list the benefits to your health, family, friends, finances, self-esteem, emotional weil being, etc.

1

Disadvantages of Quitting

1

Short- Terrn Disadvantages Long- Terrn Disadvantages

of Oulttlnq of QuittinQ

1. 1.

2. 2.

3. 3.

4. 4.

5. 5.

1 1 1 1

1

Try to list the disadvantages to your health, family, friends, finances, self-esteem, emotional weil being, etc.

1 1 1

1 1 1 1 1 1 1 1 1 1 1

1 1 1 1

1

Good Things about Smoking

Short-Terrn (Every Day) Long-Terrn (Many Years)

1. 1.

2. 2.

3. 3.

4. 4.

5. 5.

Bad Things about Smoking

Short-Terrn (Every Day) Lonq-Terrn (Many Years)

1. 1.

2. 2.

3. 3.

4. 4.

5. 5.

1 1 1

1 1 1 1 1 1 1

1 1 1 1

1 1 1

_"-_

,

Positive Associations Worksheet

Positive Associations with Positive Associations with

Smoking Quitting

1. 1.

2. 2.

3. 3.

4. 4.

5. 5.

Negative Associations Worksheet

Negative Associations with Negative Associations with

Smokinq Quitting

1. 1.

2. 2.

3. 3.

4. 4.

5. 5.

1 ~

1

Daily Record

1

Use this form to write down:

1) what happens to you around cigarettes 2) what makes you crave a cigarette 3) what you do to follow your quitting plan.

1

Tips for Keeping Track:

Write things down when they happen, not later.

Be accu rate. Try to write down the details every time a situation happens.

Keep your notes simple. Filling the form out has to fit in with your usual habits.

1

Here's an example of the information you can collect to help you with your plan.

1

Trigger 8ehaviourl ActionsfThoughtsl Consequence Emotions

When did it happen? Did you resist the urge to smoke? What happened as a result?

What did you do? Did one of your strategies work?

Who was there? If you gave into the urge, describe Was it pleasant or what happened. Did you have more unpleasant?

than one?

What were you doinq? How did you feel?

What were you saying What did you say to yourself? What did you say to yourself?

to yourself?

What were you What were you thinking? What did you think after? How

thinking? do you feel about what you

did?

What mood were you What were you feeling?

in?

What did you do?

1 1 1 1 1

1 1 1

1

^"{ ^, ¹

1 1 1 1

1 1 1 1 1 1 1 1 1 1

1 1 1

Daily Record

Date: _

Trigger Behaviourl ActionsIThoughtsl Result Emotions

1

ⁱ

1

Tracking Form

1 1

Instructions:

1) Print this form.

2) eut it out and carry it with you.

3) Record every cigarette you have for the next few days.

4) ^Printoff the questions below and answer them.

1

Cig lime Place With whom Mood Rate

# (G/S/?) (1-5)

1 1 1 1

1 1

1 1 1

G: If your mood was good or happy before you smoked B: If you were in a bad mood, angry or sad before you smoked

?: If you're not sure how you felt before you smoked

1 1

=

1 could have done without this smoke 5= 1 really had to have this cigarette

1 ^,

^,^.

1 1 1 1

1 1 1 1 1

1 1

1 1 1 1 1 1

1

Tracking Form

After you have filled in the tracking form, answer these questions. They will help you understand what you need to know to make your quitting plan.

Questions about Smoking Answers

How much do you smoke each day? Print off the Graph and plot the number of cigarettes you have each dav.

When do you usually smoke your first cigarette of the dav?

What time of day do you smoke the most cioarettes?

Where do you usually smoke?

Who do you smoke with?

What mood are you in wh en you smoke?

What are you thinking about when you smoke?

What are you doing wh en you smoke? What's happening when vou smoke?

How strong is your urge or craving usually?

Are there any cigarettes you crave more than others?

Are there any cigarettes you don't crave much or at ail? Do you just have these cigarettes out of habit?

Are there any patterns to when, why, or with whom you smoke?

How does it feel when you smoke a cigarette?

How does it feel after you smoke a cigarette?

Other observations:

1 1 1

1 1

Graph

Week of:

---~---

Instructions:

1) Print this graph.

2) . Mark the number of cigarettes or cravings you have each day of the week.

3) Use the graph to identify patterns in your smoking or cravings.

50- 45-'"

40-'"

35-'"

30-~

25-'"

20 ^_1/

15 _'"

1 0-'"

5-'"

0 ^,^...^~¹

f

f 1

'Si" ~ ..• =

1 1

f

:::J ^~^'C:LI..

,:

1 1 1

1

Relapse Prevention - Health Canada's Tobacco Control Programme

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Canada Canada

Canada

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¹^QUftlingCanada Site Rcsearch POlicy Legislation Youth

StayingOuit

Staying Quit

Confidence Questionnaire

Here are the most common situations that trigger people to smoke. Use this form in the following way:

• Rate your confidence to resist the urge to smoke in each situation (Le. type in 20 if you are 20% confident that you can resist the urge to smoke when you feel bored or depressed) .

• Add your own situations to the list using the space below.

This form will automatically generate your Difficulty Ladder.

Use your Difficulty Ladder to guide your quit plan or to help with your smoke-free strategies. .

Rate your confidence:

How confident are you that you can resist the urge to smoke in each of the situations below?

0% 10% 20% 30%

When you feel bored or depressed?

When you see others smoking?

When you want to relax or rest?

When you just want to sit back and enjoy a cigarette?

When you are watching TV?

http://www2.gosmokefree.ca/tob/ quitting/relapse/index. asp

Page 1 of2

1/31/2005

Dans le document Health Canada Smoking Cessation Study: (Page 78-87)