Assignment: Pack-Wraps
Wrap this daily cigarette count sheet around your pack of cigarettes and secure it with a rubber band. When you are
about to take a cigarette, before you actually put it in your mouth and light up, indicate the following:
Time of day
Activity you are involved in
Word/words that best describe your feeling at the time
How much do you need that particular cigarette:
Tired
Relaxed
Need
Rating
Happy
Frustrated
3 – Weakly Needed
Depressed
Bored
Other
(please
describe)
Anxious
Driving
2 – Strongly Needed
Social
Work
Relaxation
Food/Alcohol
Time
# of Cigarette
1 – Very Strongly needed
Angry
1)
2)
3)
4)
1
1
2
1
3
1
4
1
5
1
6
1
7
1
8
1
9
1
10
1
11
1
12
1
13
1
14
1
15
1
16
1
17
1
18
1
19
1
20
1
Bonnie Spring
Smoking Cessation With Weight Gain Prevention: Appendix of Forms. Copyright © 2008 by Oxford University Press
Oxford Clinical Psychology | Oxford University Press