Behavior Modification

Aka: Behavior Modification, Transtheoretical Model, Trans-theoretical Model, Stages of Behavior Change, Behavior Change Model

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II. Indications: Behavior Modification counseling

  1. Chemical Dependency (e.g. Tobacco Abuse)
  2. BATHE Technique

III. Background

  1. Example uses Tobacco Cessation

IV. Stage: Precontemplation

  1. Smoking is not a problem. I do not want to quit.
  2. Consider brief interventions
    1. Educate on the negative effects of Tobacco
    2. Recommend quitting smoking
    3. List cessation options (e.g. Nicotine Replacement)
    4. Discuss patient's reaction to recommendations
    5. Reinforce at follow-up visits
  3. Physician example
    1. Most people agree that Tobacco use is a harmful
      1. What do you think about this?
    2. I am concerned about your health
      1. How can I help you quit?

V. Stage: Contemplation

  1. Smoking is a problem. I want to quit.
  2. Continue to discuss benefits of quitting smoking
    1. Avoid negative long-term effects of Tobacco use
    2. Improved health and positive self-image
    3. Financial cost savings
  3. Physician example
    1. Your morning cough will improve off Tobacco

VI. Stage: Preparation

  1. I will quit smoking on January 1.
  2. Facilitation measures
    1. Set a definite quit date
    2. Encourage social support
      1. Tobacco Cessation program
      2. Friends and relatives provide support
    3. Provide a no-fail environment
      1. Remove Tobacco, ashtrays and other related items
      2. Others should not smoke around patient
    4. Set contingency plans
      1. Be aware of Tobacco use triggers (rituals)
      2. Consider habit substitutions in place of Tobacco
      3. Avoid provocative behaviors (e.g. Alcohol use)
    5. Offer Tobacco Cessation pharmacologic measures
      1. Nicotine Replacement
      2. Bupropion (start 2 weeks before cessation)

VII. Stage: Action

  1. I stopped smoking today.
  2. Provide behavior support
    1. Smoking Cessation program
    2. Follow-up contact (e.g. Troubleshoot triggers)
      1. Weekly during first month of cessation
      2. At time of stopping pharmacologic measures

VIII. Stage: Maintenance

  1. I only smoked on one stressful day in the last month.
  2. Continue behavior support
  3. Offer additional interventions if relapse occurs

IX. References

  1. Mallin (2002) Am Fam Physician 65(6):1107-14 [PubMed]
  2. Prochaska (1992) Am Psychol 47:1102-14 [PubMed]

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