Harvey's Garden

Transtheoretical model of change

2 min read

Defense mechanisms are often used in the precontemplation or contemplation phases to avoid acknowledging the problem or making behavioral changes.

  • Stages of Change
    1. Precontemplation
      • Description: Patient does not recognize the problem and has no intention of changing behavior in the near future (< 6 months).
      • Key Feature: Denial or ignorance of the consequences. “I don’t have a problem.”
    2. Contemplation
      • Description: Patient acknowledges the problem and is considering change within the next 6 months but is ambivalent t .
      • Key Feature: Weighing pros and cons. “I know smoking is bad, but it relaxes me.”
    3. Preparation
      • Description: Patient intends to take action in the immediate future (< 1 month) and has taken some small steps toward behavior change.
      • Key Feature: Making plans (e.g., buying nicotine patches, signing up for a gym).
    4. Action
      • Description: Patient has actively modified the behavior.
      • Key Feature: Overt lifestyle changes have occurred but have lasted < 6 months.
    5. Maintenance
      • Description: Patient has sustained the behavior change for > 6 months.
      • Key Feature: Focus shifts to preventing relapse.
    6. Relapse
      • Description: Return to previous problem behavior.
      • Key Feature: Accepted as a normal part of the cycle; not a failure. Patient re-enters the cycle (usually at Contemplation or Preparation).
  • Physician Management Strategies
    • Precontemplation:
      • Do not argue or lecture.
      • Build rapport and encourage re-evaluation.
      • Ask permission to discuss the issue next visit.
    • Contemplation:
      • Elicit the patient’s perspective on pros/cons (Motivational Interviewing).
      • Emphasize benefits of change.
    • Preparation:
      • Assist in developing a concrete plan (e.g., set a quit date).
      • Discuss potential barriers and solutions.
    • Action:
      • Provide positive reinforcement and encouragement.
      • Discuss relapse prevention techniques.
    • Maintenance:
      • Continue monitoring and support.
      • Reinforce internal rewards.
    • Relapse:
      • Reassess motivation and barriers.
      • Encourage the patient to try again; frame as a learning opportunity.

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