Tara Walton

HOW TO USE THE STAGES OF CHANGE

The Transtheoretical Model

Review the 4 constructs of the TTM

Review the 5 stages of behavior change

Learn how to apply TTM to change a

behavior

Review strengths and limitations of TTM

OBJECTIVES

A model used to explain individual behavior change

Consists of 4 main constructs:

STAGES OF CHANGE/TRANSTHEORETICAL MODEL

(TTM)

Stages of Change

Processes of Change

Decisional Balance

Self-efficacy

Pre contemplation• “ignorance is

bliss”

Contemplation• “fence sitting”

Preparation• “testing the

waters”

Action• “go for it”

Maintenance• “steady as she

goes”

Relapse• “Fall from

grace”

1. THE STAGES OF CHANGE

Termination

2. THE PROCESSES OF CHANGE

The covert and overt activities that people use to progress through stages (Prochaska et al., 2002)

These strategies can be: CognitiveAffective Behavioural

Application to specific stages can facilitate movement

Processes can help guide development of stage-specific interventions

3. DECISIONAL BALANCE

Relative weighing of the costs and benefits of changing the behaviour

motivation/readiness to change varies with each stage, relative to the balance of pro’s versus con’s of changing

4. SELF-EFFICACY

The situation-specific confidence that you have in your ability to change the behaviour

APPLYING THE STAGES OF CHANGE

Self EfficacyDecisional Balance

Processes of change

Stages of Change

HOW WHEN

The stages of change help identify WHEN a person is ready to change

Self efficacy, decisional balance, & process of change help to explain HOW

to facilitate movement through the stages of change

APPLYING THE STAGES OF CHANGE

Precontemplation

Contemplation

Preparation Action Maintenance

Consciousness Raising Dramatic Relief Environmental Re-evaluation

Self-Re-evaluation

Self-liberation

Counter-conditioningHelping Relationships

Reinforcement Management

Stimulus Control

Pro’s of changing increasing

Pro’s of changing increasing

Self-efficacy increasing

HOW TO USE STAGES OF CHANGE TO INCREASE SLEEP

PRECONTEMPLATION TO CONTEMPLATION

• increase the pro’s of changing

Goal:

• Consciousness raising (increase awareness)

• Dramatic Relief (emotional arousal)

• Environmental Re-evaluation

Process:

PRECONTEMPLATION TO CONTEMPLATION

This illustration can be used as educational material to help an individual understand some of the costs of sleep deprivation

CONTEMPLATION TO PREPARATION

• decrease the con’s of changing

Goal:

• Self re-evaluation (self-reappraisal)

Process:

CONTEMPLATION TO PREPARATION

Con’s Pro’s- Less time for

friends- Can’t watch as

much tv- Less time to study- Might miss

deadlines

- Helps repair the body

- Reduce stress- Improve memory- Control body weight- Reduce mood

disorders

PREPARATION TO ACTION

• Pro’s of changing must outweigh con’s

• Increase self-efficacy

Goal:

• Self-liberation (committing)• New Year’s resolutions• Provide several options vs one choice

• ie: 8 hrs of sleep 3 nights a week, 1 extra hr of sleep each night going to bed by midnight 5 nights/week

Process:

ACTION TO MAINTENANCE

• Increase self-efficacy

Goal:

• Counter-conditioning (substituting)

• Helping relationships (supporting)

• Reinforcement Management (rewarding)

• Stimulus Control (re-engineering)

Process:

STIMULUS CONTROL

This process includes using avoidance, environmental reengineering, and self-help groups

Example: Tips to help you sleepKeep a regular sleep/wake scheduleAvoid caffeine 4-6 hrs before bed

Minimize daytime useAvoid alcohol/heavy meals before bedGet regular exerciseMinimize noise, light & excess temperatures

where you sleep

STRENGTHS OF TTM

Individual focus: can be personally tailored

Recognizes behaviour change as dynamic and non-linear

Can help identify readiness to change

Link between stages & processes allows for targeted interventions

LIMITATIONS OF TTM

Does not consider:environmental factorssocial determinants

Focuses on primary preventionReducing risks vs preventing risks

May not be applicable to:Specific populations Complex health behaviorsPopulation health interventions

SUMMARY OF THE TTM

People move through different stages over time

Movement depends on:

the balance of pro’s and con’s

a person’s self-efficacy

Processes of change help move through stages

The model can be:

useful for facilitating individual behavior change

difficult to apply at the population health level

RESOURCES

Cancer prevention research center: http://www.uri.edu/research/cprc/TTM/detailedoverview.htm

Mississippi State University: http://www2.msstate.edu/%7Ebhunt/Stages_of_Change_Theory/

transtheoretical.html

Prochaska, J. O. & DiClemente, C. C. (1984). The transtheoretical

approach: Crossing traditional boundaries of treatment. Melbourne,

Florida: Krieger Publishing Company.

Prochaska, J.O., DiClemente, C.C., and Norcross, J.C. 1992. In

Search of How People Change: Applications to Addictive Behaviors.

American Psychologist 47(9): 1102-1114.

Prochaska, J.O., Johnson, S., and Lee, P. The Transtheoretical Model

of Behavior Change. In: Shumaker, S.A., Schron, E.B., Ockene, J.K.,

and McBee, W.L. [Editors]. 1998. The Handbook of Health Behavior

Change, 2nd Ed. Springer Publishing Company.