Stages of Change
Stages of Change: Smoking Cessation as an ExampleIt is important
to remember that behavior change does not involve a single act, but
can occur over time in stages. According to one widely-used model,
behavior change has six stages: pre-contemplation, contemplation,
preparation, action, maintenance, and termination (1). Realize that
patients may move back and forth between the stages of change in
the process of quitting smoking or other habit changes.(2)
PrecontemplationContemplationPreparationActionMaintenanceTermination
Pre-contemplation is the stage in which people, though aware of
the risks of smoking, does not intend to quit immediately. Many
smokers are afraid they will be unable to quit, may be discouraged
because they have been unsuccessful in the past, and/or have
suffered withdrawal symptoms.
Contemplation is the stage in which people intend to change
their behavior in the next six months, but are ambivalent, weighing
the benefits of quitting with the difficulties.
Preparation is the stage in which people intend to take action
in the immediate future (usually within a month). You can help move
your patient from contemplation to preparation. Use open-ended
questions (Why would you like to quit smoking?), affirming
statements (Its great that you were able to quit once before.),
reflective listening (It sounds like quitting smoking has been
frustrating for you.), and offer NRT and/or pharmacotherapy). If a
patient is not yet ready to make a quit attempt, reiterate that
quitting smoking is the most important thing you can do for your
health" at each future visit.
Preparation is the stage in which a person has a firm intention
to take action in the immediate future. They are more likely to
initiate and respond to counseling with a physician, and may have
taken other steps on their own, such as online smoking cessation
programs. Action: Once a person has quit smoking they have moved
into to the action stage.
Maintenance is the most crucial and difficult stage, where
people struggle to maintain behavior change. Support and continued
counseling from a physician can be crucial to preventing smoking
relapse.
Termination: By this stage, patients may no longer succumb to
the temptation to smoke and have confidence in their continued
ability to avoid tobacco. Use of this behavioral change model has
proven successful in smoking cessation. (3)1. Prochaska, JO &
DiClemente, CC. Stages and processes of self-change of smoking:
Toward an integrative model of change. Journal of Consulting and
Clinical Psychology. 1983; 51, 390-395
2. Stages of Change and Your Patient (Appendix E, Smoking
Cessation), 2001, AHRQ. Available at:
www.ahrq.gov/ppip/manual/appende.htm3. Prochaska, J et al,
Counselor and Stimulus Control Enhancements of a Stage-Matched
Expert System Intervention for Smokers in a Managed Care Setting.
Preventive Medicine. 2001b;32: 23-32.
