Overview of the Model
The Transtheoretical Model (Prochaska & DiClemente, 1983; Prochaska, DiClemente, & Norcross, 1992) is an integrative theory of therapy that assesses an individual’s readiness to act on a new healthier behaviour, and provides strategies, or processes of change to guide the individual. The model is composed of constructs such as: stages of change, processes of change, levels of change, self-efficacy, and decisional balance.
The Stages of Change
This construct refers to the temporal dimension of behavioural change. In the transtheoretical model, change is a “process involving progress through a series of stages”:
- Precontemplation (“not ready”) – “People are not intending to take action in the foreseeable future, and can be unaware that their behaviour is problematic”
- Contemplation (“getting ready”) – “People are beginning to recognize that their behaviour is problematic, and start to look at the pros and cons of their continued actions”
- Preparation (“ready”) – “People are intending to take action in the immediate future, and may begin taking small steps toward behaviour change”
- Action – “People have made specific overt modifications in modifying their problem behaviour or in acquiring new healthy behaviours”
- Maintenance – “People have been able to sustain action for at least six months and are working to prevent relapse”
- Termination – “Individuals have zero temptation and they are sure they will not return to their old unhealthy habit as a way of coping”
In addition, the researchers conceptualised “Relapse” (recycling) which is not a stage in itself but rather the “return from Action or Maintenance to an earlier stage”.
Pre-contemplation (Not Ready)
People at this stage do not intend to start the healthy behaviour in the near future (within 6 months), and may be unaware of the need to change. People here learn more about healthy behaviour: they are encouraged to think about the pros of changing their behaviour and to feel emotions about the effects of their negative behaviour on others.
Precontemplators typically underestimate the pros of changing, overestimate the cons, and often are not aware of making such mistakes.
One of the most effective steps that others can help with at this stage is to encourage them to become more mindful of their decision making and more conscious of the multiple benefits of changing an unhealthy behaviour.
Contemplation (Getting Ready)
At this stage, participants are intending to start the healthy behaviour within the next 6 months. While they are usually now more aware of the pros of changing, their cons are about equal to their Pros. This ambivalence about changing can cause them to keep putting off taking action.
People here learn about the kind of person they could be if they changed their behaviour and learn more from people who behave in healthy ways.
Others can influence and help effectively at this stage by encouraging them to work at reducing the cons of changing their behaviour.
People at this stage are ready to start taking action within the next 30 days. They take small steps that they believe can help them make the healthy behaviour a part of their lives. For example, they tell their friends and family that they want to change their behaviour.
People in this stage should be encouraged to seek support from friends they trust, tell people about their plan to change the way they act, and think about how they would feel if they behaved in a healthier way. Their number one concern is: when they act, will they fail? They learn that the better prepared they are, the more likely they are to keep progressing.
People at this stage have changed their behaviour within the last 6 months and need to work hard to keep moving ahead. These participants need to learn how to strengthen their commitments to change and to fight urges to slip back.
People in this stage progress by being taught techniques for keeping up their commitments such as substituting activities related to the unhealthy behaviour with positive ones, rewarding themselves for taking steps toward changing, and avoiding people and situations that tempt them to behave in unhealthy ways.
People at this stage changed their behaviour more than 6 months ago. It is important for people in this stage to be aware of situations that may tempt them to slip back into doing the unhealthy behaviour—particularly stressful situations.
It is recommended that people in this stage seek support from and talk with people whom they trust, spend time with people who behave in healthy ways, and remember to engage in healthy activities to cope with stress instead of relying on unhealthy behaviour.
Relapse in the TTM specifically applies to individuals who successfully quit smoking or using drugs or alcohol, only to resume these unhealthy behaviours. Individuals who attempt to quit highly addictive behaviours such as drug, alcohol, and tobacco use are at particularly high risk of a relapse. Achieving a long-term behaviour change often requires ongoing support from family members, a health coach, a physician, or another motivational source. Supportive literature and other resources can also be helpful to avoid a relapse from happening.
his core construct is “the situation-specific confidence people have that they can cope with high-risk situations without relapsing to their unhealthy or high risk-habit”. The construct is based on Bandura’s self-efficacy theory and conceptualizes a person’s perceived ability to perform on a task as a mediator of performance on future tasks. In his research Bandura already established that greater levels of perceived self-efficacy leads to greater changes in behaviour. This underlines the integrative nature of the transtheoretical model which combines various behaviour theories. A change in the level of self-efficacy can predict a lasting change in behaviour if there are adequate incentives and skills. The transtheoretical model employs an overall confidence score to assess an individual’s self-efficacy. Situational temptations assess how tempted people are to engage in a problem behaviour in a certain situation.
Processes of Change
The 10 processes of change are “covert and overt activities that people use to progress through the stages”.
To progress through the early stages, people apply cognitive, affective, and evaluative processes. As people move toward Action and Maintenance, they rely more on commitments, conditioning, contingencies, environmental controls, and support.
Prochaska and colleagues state that their research related to the transtheoretical model shows that interventions to change behaviour are more effective if they are “stage-matched”, that is, “matched to each individual’s stage of change”.
In general, for people to progress they need:
A growing awareness that the advantages (the “pros”) of changing outweigh the disadvantages (the “cons”)—the TTM calls this decisional balance.
Confidence that they can make and maintain changes in situations that tempt them to return to their old, unhealthy behaviour—the TTM calls this self-efficacy.
Strategies that can help them make and maintain change—the TTM calls these processes of change.
The ten processes of change include:
- Consciousness-raising (Get the facts) — increasing awareness via information, education, and personal feedback about the healthy behaviour.
- Dramatic relief (Pay attention to feelings) — feeling fear, anxiety, or worry because of the unhealthy behaviour, or feeling inspiration and hope when they hear about how people are able to change to healthy behaviours.
- Self-reevaluation (Create a new self-image) — realizing that the healthy behaviour is an important part of who they are and want to be.
- Environmental reevaluation (Notice your effect on others) — realizing how their unhealthy behaviour affects others and how they could have more positive effects by changing.
- Social liberation (Notice public support) — realizing that society is more supportive of the healthy behaviour.
- Self-liberation (Make a commitment) — believing in one’s ability to change and making commitments and re-commitments to act on that belief.
- Helping relationships (Get support) — finding people who are supportive of their change.
- Counter-conditioning (Use substitutes) — substituting healthy ways of acting and thinking for unhealthy ways.
- Reinforcement management (Use rewards) — increasing the rewards that come from positive behaviour and reducing those that come from negative behaviour.
- Stimulus control (Manage your environment) — using reminders and cues that encourage healthy behaviour as substitutes for those that encourage the unhealthy behaviour.
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