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Medicine LibreTexts

1.5: Behavior Modification

  • Page ID
    11122
  • Making permanent lifestyle changes is one of the greatest challenges a person can face. This section will explore how changes to behavior occur, the psychological barriers that hamper efforts to change, and tips for making lasting change.

    How Changes in Behavior Occur

    The Transtheoretical Model, also called the Stages of Change Model, was developed by James Prochaska and Carlo DiClemente in the late 1970s. Considered the dominant model for describing how behavior changes occur, it evolved through studies examining the experiences of smokers who quit on their own and comparing them with the experiences of those requiring further treatment. The goal of those studies was to understand why some people were capable of quitting on their own. It was determined that people quit smoking if they were ready to do so. Thus, the Transtheoretical Model (TTM) focuses on the decision-making of the individual and is a model of intentional change. The TTM operates on the assumption that people do not change behaviors quickly and decisively. Rather, change in behavior, especially habitual behavior, occurs continuously through a cyclical process. The TTM is not a theory but a model; different behavioral theories and constructs can be applied to various stages of the model where they may be most effective.

    The TTM posits that individuals move through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. Termination was not part of the original model and is less often used in application of stages of change for health- related behaviors. For each stage of change, different intervention strategies are most effective at moving the person to the next stage of change and subsequently through the model to maintenance, the ideal stage of behavior.

    Six Stages of Change:

    • Stage 1: Precontemplation
      In this stage, people do not intend to take action in the foreseeable future (defined as within the next 6 months). People are often unaware that their behavior is problematic or produces negative consequences. People in this stage often underestimate the pros of changing behavior and place too much emphasis on the cons of changing behavior.

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    • Stage 2: Contemplation
      In this stage, people are intending to start the healthy behavior in the foreseeable future (defined as within the next 6 months). People recognize that their behavior may be problematic, and a more thoughtful and practical consideration of the pros and cons of changing the behavior takes place, with equal emphasis placed on both. Even with this recognition, people may still feel ambivalent toward changing their behavior.

    • Stage 3: Preparation (Determination)
      In this stage, people are ready to take action within the next 30 days. People start to take small steps toward the behavior change, and they believe changing their behavior can lead to a healthier life.

    • Stage 4: Action
      In this stage, people have recently changed their behavior (defined as within the last 6 months) and intend to keep moving forward with that behavior change. People may exhibit this by modifying their problem behavior or acquiring new healthy behaviors.

    • Stage 5: Maintenance
      In this stage, people have sustained their behavior change for a while (defined as more than 6 months) and intend to maintain the behavior change going forward. People in this stage work to prevent relapse to earlier stages.

    • Stage 6: Termination
      In this stage, people have no desire to return to their unhealthy behaviors and are sure they will not relapse. Since this is rarely reached, and people tend to stay in the maintenance stage, this stage is often not considered in health promotion programs.

    To progress through the stages of change, people apply cognitive, affective, and evaluative processes. Ten processes of change have been identified, with some processes being more relevant to a specific stage of change than other processes. These processes result in strategies that help people make and maintain change.

    Ten Processes of Change:

    1. Consciousness RaisingIncreasing awareness about the healthy behavior.

    2. Dramatic Relief
      Emotional arousal about the health behavior, whether positive or negative arousal.

    3. Self-Reevaluation
      Self-reappraisal to realize the healthy behavior is part of who they want to be.

    4. Environmental Reevaluation
      Social reappraisal to realize how their unhealthy behavior affects others.

    5. Social Liberation
      Environmental opportunities that exist to show society is supportive of the healthy behavior.

    6. Self-Liberation
      Commitment to change behavior based on the belief that achievement of the healthy behavior is possible.

    7. Helping Relationships
      Finding supportive relationships that encourage the desired change.

    8. Counter-Conditioning
      Substituting healthy behaviors and thoughts for unhealthy behaviors and thoughts.

    9. Reinforcement ManagementRewarding the positive behavior and reducing the rewards that come from negative behavior.

    10. Stimulus Control
      Re-engineering the environment to have reminders and cues that support and encourage the healthy behavior and remove those that encourage the unhealthy behavior.

    Limitations of the Transtheoretical Model

    Limitations of the model include the following:

    • The theory ignores the social context in which change occurs, such as socioeconomic status and income.
    • The lines between the stages can be arbitrary with no set criteria of how to determine a person's stage of change. The questionnaires that have been developed to assign a person to a stage of change are not always standardized or validated.

    • No clear sense exists for how much time is needed for each stage, or how long a person can remain in a stage.

    • The model assumes that individuals make coherent and logical plans in their decision-making process when this is not always true.

    The Transtheoretical Model provides suggested strategies for public health interventions to address people at various stages of the decision-making process. Using strategies suggested by TTM can result in interventions that are more effective because they are tailored for a specific group of people. In other words, the interventions involve a message or program component that has been specifically created for a target population's level of knowledge and motivation. The TTM encourages an assessment of an individual's current stage of change and accounts for relapse in people's decision- making process.2

    For more information about TTM, especially as it relates to exercise, click on the link below:

    TTM for Behavior Change

    One of the most effective tools for changing behavior is goal setting. The links below provide information on how to set goals effectively to achieve greater success in goal attainment.

    Goal Setting Info from Oregon State University's Academic Success Center

    One Step at a Time Goal Achievement

    Video on S.M.A.R.T. Goals

    Making S.M.A.R.T. Goals Activity