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Which stage of change is the person in?
More, if you want it
Has the patient changed the behaviour yet?Tap a term: its definition, what you can do with it, and how often the exam asks it.
Definition: the person sees no problem and is not considering change.
You can: Tell precontemplation from contemplation by whether the person sees a problem.
Definition: the person accepts the problem and has not decided to act.
You can: Tell contemplation from preparation by whether the person has decided to act.
Definition: the person has decided to change and plans to act soon.
You can: Tell preparation from action by whether the behaviour has already changed.
Definition: the person is changing the behaviour now.
You can: Tell action from maintenance by how long the change has lasted.
Definition: the person has kept up the change for a long time.
You can: Tell action from maintenance by how long the change has lasted.
Definition: a return to old behaviour that can follow any stage.
You can: Name relapse when a person returns to old behaviour after any stage.
Each card is one term. The grey line is what the patient says, which is what the question stem gives.
Summary
Precontemplation is the stage where the person is not considering change and sees no problem.
Precontemplation is the stage where the person is not considering change and sees no problem. The person or denies the harm.
A person can openly admit the behaviour and still deny that the behaviour is a problem. Admitting use does not mean the person sees harm. Asked about control, one patient defensively said he could stop. He had never tried, because he saw no problem. The person also avoids contrary information that shows the harm. Contemplation looks like precontemplation at first. In contemplation, the person accepts that there is a problem. Sean sees his GP after a fall at home.
A person who sees no problem and makes no attempt to change is in precontemplation.
Precontemplation is the stage where the person is not considering change and sees no problem.
Contemplation is the stage where the person accepts a problem and has not yet decided to act.
Contemplation is the stage where the person accepts a problem and has not yet decided to act. Preparation is the stage where the person has decided to change. In preparation, the person typically acknowledges the harm, accepts help and plans to act.
A person in preparation often tests the waters before the full change begins. The person has decided to change and takes small steps, such as asking about help. The plan is usually to start within the next month. Candidates see a person who knows the harm and wants to stop, and choose preparation. Wanting to stop without a firm decision is still contemplation. Look in the stem for a start date or a request for help. Kevin Doyle, a delivery driver, attends a community alcohol service in Leeds.
In March, Kevin says, "I know the drink is hurting my liver, but I am not sure." In April, Kevin says, "I will start next month, and I want your help."
Preparation needs a firm decision, accepted help and a plan to act soon.
Mnemonic
Deny, weigh, plan the day, do, stay, slip anywhere. Cue: has decided to stop
Deny is precontemplation, where the person sees no problem. Weigh is contemplation, where the person admits the problem and weighs pros and cons without yet choosing to act. Plan the day is preparation, where the person commits to change, accepts help and sets a start date. Do is action, where the person is cutting down now. Stay is maintenance, where the change lasts for years. Slip anywhere is relapse, which can follow any stage.
Analogy
The stages are a trip to a hospital appointment. Seeing no need to go is precontemplation. Wondering whether to go is contemplation. Booking the taxi and packing a bag is preparation. Being on the road is action. Keeping the habit of attending is maintenance.
Where the analogy breaks: a trip has one fixed route, and a person can relapse after any stage and go round more than once.
Contemplation is the stage where the person accepts a problem and has not yet decided to act.
Action is the stage where the person is actively changing the behaviour.
Action is the stage where the person is actively changing the behaviour. The action stage is practised for roughly 3 to 6 months. Maintenance is the stage where the person has sustained the new behaviour over a long period.
Priya attends an alcohol clinic review and says, "I have cut down every week since January."
A person whose drinking has already started to fall is in action.
One example is steadily cutting down drinking. In maintenance, the person works to prevent relapse, for example by staying within drinking limits for years. Preparation looks like action at first. In preparation, the person has a plan, and the drinking has not yet changed. Maintenance differs from action by time, with the new behaviour kept up for years. Tom attends the same clinic and says, "I have stayed within my limits for six years."
Action is the stage where the person is actively changing the behaviour.
Relapse is a return to old behaviour, and relapse can follow any stage.
Relapse is a return to old behaviour, and relapse can follow any stage. Maintenance is the last stage of the .
Marcus says, "I was doing well, and then I drank all weekend."
Relapse can follow any stage, and maintenance stays the last stage.
The person can learn strategies from a relapse for the next attempt. Candidates place relapse at the end of the cycle, after maintenance. Marcus can use what he learned from the weekend in his next attempt. Marcus cut down his drinking for a year with help from his key worker.
Relapse is a return to old behaviour, and relapse can follow any stage.
A firm decision separates preparation from contemplation.
| Stage | Patient says | Often mistaken for | Deciding feature |
|---|---|---|---|
| Contemplation | "It harms me, but I am not sure" | Preparation | Accepts problem, no decision |
| Preparation | "I start next month, I want help" | Action | Decided, behaviour unchanged |
| Action | "I cut down every week" | Preparation | Behaviour changing, 3 to 6 months |
| Precontemplation | "My drinking is fine" | Contemplation | Sees no problem |
| Maintenance | "Within limits for years" | Action | Change sustained long term |
| Relapse | "I drank all weekend again" | A final stage | Can follow any stage |
A firm decision separates preparation from contemplation. Changed behaviour separates action from preparation.
A firm decision separates preparation from contemplation.
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