Stage Based Interventions for Tobacco Cessation
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1 Precontemplation Stage Based Interventions for Tobacco Cessation Relapse Contemplation Preparation Action Maintenance
2 Theoretical and practical considerations related to Movement through the Stages of Change Motivation Decision-Making Self-Efficacy Precontemplation Contemplation Preparation Action Maintenance Personal Concerns Environmental Pressure Decisional Balance (Pros & Cons) Cognitive & Experiential Processes Behavioral Processes Recycling Relapse
3 Precontemplation Not Considering Change & Not Ready for Change Increase awareness of need for change and concern about current behavior See possibility of change Move to next Stage of Change Assess awareness and knowledge Discuss pro s and con s Acknowledge their concerns Learn benefits of abstinence Identify reasons for usage Introduce ambivalence Spotlight successful quitters Suggest talking with a positive ex-smoker or ex-dipper Advise of need to quit and personalize the message Provide personalized feedback Seek out a supportive, trusted person to explore issue Discuss possibility of change Give self-help materials
4 Contemplation Considering and Thinking & about Change Analyze the pro s and con s of current tobacco behavior Review benefits and cost of change Make a decision Discuss reasons for wanting to quit tobacco Explore good/bad reasons for using Discuss reasons and benefits for quitting tobacco Elicit reasons for change Review barriers to quitting Evaluate obstacles to success and resistance to change Review resources and supports for quitting Discuss negative consequences of tobacco use Review coping skills Discuss strategies for quitting Set a date to think about quitting Give self-help materials
5 Preparation Getting Ready for Change Increase commitment for change Develop a plan for change Implement an action plan in near future Review reasons for quitting Counter ambivalence Resolve ambivalence Develop a QUIT PLAN (which is acceptable, accessible and effective!) Discuss past quit attempts Set a date for quitting Support commitment Encourage motivation and efforts for change Give direct and positive message for quitting Give self-help materials
6 Action Making the Change Implementing change strategies Maintaining commitment Revising plan Sustaining new behavior patterns Review and affirm reasons for quitting Explore relationship with tobacco Plan for quit day & days thereafter Review relapse triggers (people, situations, feelings, thoughts, places) Troubleshoot problem areas Discuss obstacles to quitting Review coping strategies for urges, cravings and withdrawal Explore support system & other resources Encourage cessation efforts Focus on progress Follow-up Give self-help materials
7 Maintenance Sustaining behavior change as part of new lifestyle Support self efficacy Reaffirm commitment Support change efforts Highlight positive benefits Identify risks and temptations Maintaining change overtime Avoiding and coping with slips Sustaining long term behavior change Review and practice coping skills Relapse Prevention Skills Provide resources
8 Relapse Return to tobacco usage Identify barriers to success Review and explore negative feelings (i.e., shame, guilt, discouragement and thoughts about failure) Slipping and sliding are normal and can be overcome Reframe slips as a learning experience Help with discouragement, shame Assist with renewal preparation, and determination for change Encourage change efforts! Explore successful quitting strategies Review relapse events, and triggers and learn from them! Encourage to try again Discuss available resources
9 References 1. DiClemente, C. & Prochaska, J. etal (1991). The Process of Smoking Cessation: An Analysis of Precontemplation, Contemplation and Preparation Stages of Change. Journal of Consulting and Clinical Psychology 59: DiClemente, C. (2001). Seminar-Matching Interventions to the Process of Change. 3. Mayo Clinic Nicotine Dependence Seminar, May, Rustin T. A. (1998). Facilitating Behavior Change. NEHC, Health Promotion Conference, San Diego. 5. Prochaska, J.O., J.C. Norcross, C.C. DiClemente (1994). Changing for Good. Avon: New York.
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