Transtheoretical Model (Stages of Change):
The Transtheoretical Model is currently conceptualized in terms of
several major dimensions. The core constructs, around which the other
dimensions are organized, are the five stages of change. These
represent ordered categories along a continuum of motivational
readiness to change a problem behavior. Transitions between the stages
of change are effected by a set of independent variables known as the
processes of change. The five stages are:
- Precontemplation: Individual has the problem (whether he/she recognizes it or not) and has no intention of changing.
- Contemplation: Individual recognizes the problem and is seriously thinking about changing.
- Preparation for Action: Individual recognizes the problem and intends to change the behavior within the next month. Some behavior change efforts may be reported, such as inconsistent condom usage. However, the defined behavior change criterion has not been reached (i.e., consistent condom usage).
- Action: Individual has enacted consistent behavior change (i.e., consistent condom usage) for less than six months.
- Maintenance: Individual maintains new behavior for six months or more.
Processes of Change are the covert and overt activities that people use to progress through the stages. Processes of change provide important guides for intervention programs, since the processes are the independent variables that people need to apply, or be engaged in, to move from stage to stage. The ten processes are:
- Consciousness Raising involves increased awareness about the causes, consequences and cures for a particular problem behavior. Interventions that can increase awareness include feedback, education, confrontation, interpretation, bibliotherapy and media campaigns.
- Dramatic Relief initially produces increased emotional experiences followed by reduced affect if appropriate action can be taken. Psychodrama, role-playing, grieving, personal testimonies and media campaigns are examples of techniques that can move people emotionally.
- Environmental Reevaluation combines both affective and cognitive assessments of how the presence or absence of a personal habit affects one's social environment. It can also include the awareness that one can serve as a positive or negative role model for others. Empathy training, documentaries, and family interventions can lead to such re-assessments.
- Social Liberation requires an increase in social opportunities or alternatives especially for people who are relatively deprived or oppressed. Advocacy, empowerment procedures, and appropriate policies can produce increased opportunities.
- Self-reevaluation combines both cognitive and affective assessments of one's self-image with and without a particular unhealthy habit, such as one's image as a couch potato or an active person. Value clarification, healthy role models, and imagery are techniques that can move people evaluatively.
- Stimulus Control removes cues for unhealthy habits and adds prompts for healthier alternatives. Avoidance, environmental re-engineering, and self-help groups can provide stimuli that support change and reduce risks for relapse.
- Helping Relationships combine caring, trust, openness and acceptance as well as support for the healthy behavior change. Rapport building, a therapeutic alliance, counselor calls and buddy systems can be sources of social support.
- Counter Conditioning requires the learning of healthier behaviors that can substitute for problem behaviors. Relaxation can counter stress; assertion can counter peer pressure; nicotine replacement can substitute for cigarettes, and fat free foods can be safer substitutes.
- Reinforcement Management provides consequences for taking steps in a particular direction. While reinforcement management can include the use of punishments, self-changers can rely on rewards much more than punishments.
- Self-liberation is both the belief that one can change and the commitment and recommitment to act on that belief. New Year's resolutions, public testimonies, and multiple rather than single choices can enhance self-liberation or what the public calls willpower.
The model also incorporates a series of intervening or outcome variables. These include decisional balance (the pros and cons of change), self-efficacy (confidence in the ability to change across problem situations), situational temptations to engage in the problem behavior, and behaviors that are specific to the problem area. Also included among these intermediate or dependent variables would be any other psychological, environmental, cultural, socioeconomic, physiological, biochemical, or even genetic variables or behavior specific to the problem being studied.
References:
Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change. American Psychologist, 47, 1102-1114.
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390-395.
Prochaska, J. O., & Velicer, W.F. (1997). The Transtheoretical Model of health behavior change. American Journal of Health Promotion, 12, 38-48.
Health Belief Model Social Cognitive Theory Motivational Interviewing