Action – Turning Plans Into Action Without Burning Out the Patient

Helping Prescribers Reinforce Effort, Prevent Overwhelm, and Sustain Momentum

Clinical Vignette

Mr. B is a 63-year-old man with a history of alcohol use disorder and chronic insomnia.
After months of contemplation and planning, he has now stopped drinking for two weeks.

“It’s been hard, but I’m hanging in.”

But he’s also struggling, for he’s having cravings, he hasn’t told his friends, and he’s exhausted.
He’s in Action—the most visible stage, but also one of the most vulnerable.

What is the Action Stage?

The Action stage is where change is happening.
The patient is:

• Actively modifying their behavior

• Committed to their new path

• Facing real-world barriers and fatigue

• Needing validation, structure, and reinforcement

Success here depends less on motivation and more on systems, support, and staying power.

Clinical Markers of Action

 Goal for the Prescriber: Support, Normalize, Reinforce

Your job now is to reinforce effort, normalize struggle, and prevent burnout by helping the patient:
- Stay connected to their “why”
- Build structure and community
- Monitor progress and reward small wins
- Prepare for lapses without shame

Tool: Weekly Behavior Tracker + Support Scaffold

Help the patient create a simple 3-part Action Plan:
1. Behavior Tracker
What specific action are they taking daily or weekly?
e.g., “Walk 10 minutes a day,” “Skip alcohol at dinner,” “Take meds at 8 p.m.”

2. Support System
Who knows about this goal? Who’s checking in?
e.g., sponsor, peer, friend, prescriber, journal, app

3. Reward Ritual
What feels affirming after sticking to it?
e.g., gold star, calendar streak, prayer, affirmation, text to a loved one

Script:

“What’s one small way you can keep track—and one small way to reward yourself?”

Go-To Scripts for Busy Prescribers: From Action to Maintenance

 Common Pitfalls to Avoid

🚫 Don’t assume progress = stability
🚫 Don’t overfocus on outcome instead of effort
🚫 Don’t ignore the emotional strain of behavior change

Instead, meet effort with empathy, and anchor change in consistency, not perfection.

Scientific Citations

• Marlatt, G. A., & Gordon, J. R. (1985). Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors. Guilford Press.

• Bandura, A. (1997). Self-Efficacy: The Exercise of Control. Freeman.

• Deci, E. L., & Ryan, R. M. (2000). The “What” and “Why” of Goal Pursuits: Human Needs and the Self-Determination of Behavior. Psychological Inquiry, 11(4), 227–268.

• Fogg, B. J. (2019). Tiny Habits: The Small Changes That Change Everything. Houghton Mifflin Harcourt.

Reflection Prompt

“How do I acknowledge effort more than outcome?”
“What scaffolding do my patients need to sustain change beyond motivation?”
“Do I treat relapses as failure—or as feedback and redirection?”