WBR0512

Author	[[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Serge Korjian)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Behavioral Science/Psychiatry
Sub Category	SubCategory::General Principles
Prompt	[[Prompt::A 52-year-old man, with a past medical history of myocardial infarction and heavy tobacco use, presents to the physician's office for his annual check-up. Upon further questioning, the physician notes that the patient still hasn't stopped smoking despite receiving multiple recommendations to do so. The patient explains that he is aware that smoking has been a problem for him, and he knows he needs help. However, he states that he does not feel like he is quite ready to stop smoking. Which of the following stages of change is the patient currently in?]]
Answer A	AnswerA::Precontemplation
Answer A Explanation	AnswerAExp::During the precontemplation stage, individuals do not acknowledge the problem they have and are not considering change.
Answer B	AnswerB::Contemplation
Answer B Explanation	AnswerBExp::During the contemplation stage, individuals acknowledge their problem, with or without seeking help, without any real commitment to change.
Answer C	AnswerC::Determination/Preparation
Answer C Explanation	AnswerCExp::During the determination/preparation stage, individuals show a commitment to making necessary changes, with a clear plan in mind. However, these individuals have not made any changes yet.
Answer D	AnswerD::Action
Answer D Explanation	AnswerDExp::The action stage is defined as an active state of change whereby the patient modifies his behaviors and environment to overcome an addictive behavior.
Answer E	AnswerE::Relapse
Answer E Explanation	AnswerEExp::Relapse is characterized by a reinstatement of the addictive behavior after a period of non-use or abstinence.
Right Answer	RightAnswer::B
Explanation	[[Explanation::The transtheoretical model (TTM) describes the stages most individuals go through in the process of change. These 6 stages are important to identify before implementing a plan to curb an addictive behavior. The model was initially established by observing patterns in alcoholics before, during, and after they attempted to modify their addiction. The patient in this vignette is in a stage of contemplation. Contemplation is a stage characterized by acknowledgement of the problem, with or without seeking help, without any real commitment to change. People who are in the contemplation stage are often very ambivalent. Tailoring therapy to the the stage of change an individual is in has been associated will improved overall outcomes and higher likelihood of success. The stages of change in order are as follows: 1- Precontemplation 2- Contemplation 3- Preparation/Determination 4- Action/Will power 5- Maintenance 6- Relapse Educational Objective: Contemplation is a stage of the stages of change model whereby individuals acknowledge the presence of a problem and may seek help, but have not yet made a commitment to take action or change. References: Norcross JC, Krebs PM, Prochaska JO. Stages of change. J Clin Psychol. 2011;67(2):143-54. First Aid 2014 page 513]]
Approved	Approved::Yes
Keyword	WBRKeyword::Stages of change, WBRKeyword::Transtheoretical model, WBRKeyword::Smoking, WBRKeyword::Substance abuse, WBRKeyword::Addiction, WBRKeyword::Precontemplation, WBRKeyword::Contemplation, WBRKeyword::Preparation, WBRKeyword::Determination, WBRKeyword::Action, WBRKeyword::Maintenance, WBRKeyword::Relapse
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