Preparation – The Hidden Stage That Predicts Success or Failure
Helping Prescribers Lay the Foundation for Sustainable Change
Clinical Vignette
Ms. L is a 24-year-old woman with binge eating episodes, insomnia, and untreated depression.
She says:
“I’m ready to stop. I’m tired of feeling this way.”
But when you ask about her plan, she says:
“I guess I’ll just try harder.”
She's in preparation, but without a clear plan, she's at risk of failure.
What is the Preparation Stage?
Preparation is the third stage of the Stages of Change model. The person is:
Committed to change
Taking small steps
Gathering tools and support
Not quite fully in action
Without structure, this stage can backslide into contemplation. Without support, it can lead to burnout or relapse.
Goal for the Prescriber: Help Plan the First Small Steps
Your role here is to move them from intention to execution—but not by rushing.
Focus on:
Defining a specific first step
Identifying obstacles and supports
Reinforcing confidence
Highlighting tiny habits that are sustainable
Tool: The SMART + Tiny Habits Plan
+ Tiny Habit Addition (BJ Fogg Model)
“After I [existing routine], I will [tiny new action].”
Example:
“After I brush my teeth at night, I will write down one thing I’m proud of.”
Common Pitfalls to Avoid
🚫 Don’t skip this stage and jump to action
🚫 Don’t overplan to the point of paralysis
🚫 Don’t assume motivation will carry them through
Instead, set up small wins that build momentum.
Scientific Citations
Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12(1), 38–48.
Fogg, B. J. (2019). Tiny Habits: The Small Changes That Change Everything. Houghton Mifflin Harcourt.
Gollwitzer, P. M., & Sheeran, P. (2006). Implementation intentions and goal achievement: A meta-analysis of effects and processes. Advances in Experimental Social Psychology, 38, 69–119.
Bandura, A. (1997). Self-efficacy: The exercise of control. Freeman.
Reflection Prompt
“Do I slow down enough to support planning—or do I leap ahead into action?”
“What barriers does the patient anticipate—and how can I help remove them?”
“What’s one ‘tiny habit’ I can introduce today that makes change easier, not harder?”