1.4: Behavior Change and Goal Setting
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Transtheoretical Model (Stages of Change)
The transtheoretical model of behavior change, developed by Prochaska and DiClemente, assesses an individual’s readiness to implement a healthier behavior and provides insight into the decision making process that leads to action. For many people, changing or modifying a behavior that is unhealthy or potentially harmful can be quite challenging. Here are the stages that lead to behavior change:
- Precontemplation (Not Ready) – You are not intending to take action in the foreseeable future, and can be unaware that your behavior is problematic
- Contemplation (Getting Ready) – You are beginning to recognize that your behavior is problematic, and start to look at the pros and cons of your continued actions
- Preparation (Ready) – You are intending to take action in the immediate future, and may begin taking small steps toward behavior change
- Action – You are making actual changes to your problem behavior by incorporating healthy choices/behaviors into your life
- Maintenance – You have been able to sustain action for at least six months and are working to prevent relapse into previous unhealthy behaviors
Stage 1: Precontemplation (not ready)
People at this stage do not intend to start the healthy behavior in the near future (within 6 months), and may be unaware of the need to change. People here learn more about healthy behavior: they are encouraged to think about the pros of changing their behavior and to feel emotions about the effects of their negative behavior 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 behavior.
Stage 2: Contemplation (getting ready)
At this stage, participants are intending to start the healthy behavior 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 behavior 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 behavior.
Stage 3: Preparation (ready)
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 behavior a part of their lives. For example, they tell their friends and family that they want to change their behavior.
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.
Stage 4: Action (current action)
People at this stage have changed their behavior 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 behavior with positive ones, rewarding themselves for taking steps toward changing, and avoiding people and situations that tempt them to behave in unhealthy ways.
Stage 5: Maintenance (monitoring)
People at this stage changed their behavior 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 behavior—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 behavior.
Relapse (recycling):
Relapse in the TTM specifically applies to individuals who successfully quit smoking or using drugs or alcohol, only to resume these unhealthy behaviors. Individuals who attempt to quit highly addictive behaviors such as drug, alcohol, and tobacco use are at particularly high risk of a relapse. Achieving a long-term behavior 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.