HOW TO USE THE STAGES OF CHANGE The Transtheoretical Model Tara Walton OBJECTIVES 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 STAGES OF CHANGE/ TRANSTHEORETICAL MODEL (TTM) A model used to explain individual behavior change Consists of 4 main constructs: Stages of Change Processes of Change Decisional Balance Self-efficacy 1. THE STAGES OF CHANGE Pre contemplation • “ignorance is bliss” Relapse Contemplation •“Fall from grace” •“fence sitting” Termination Maintenance Preparation • “steady as she goes” •“testing the waters” Action •“go for it” 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: Cognitive Affective 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 HOW Self Efficacy Decisional Balance Processes of change WHEN Stages of Change 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-conditioning Helping 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 Goal: • increase the pro’s of changing Process: • Consciousness raising (increase awareness) • Dramatic Relief (emotional arousal) • Environmental Re-evaluation PRECONTEMPLATION TO CONTEMPLATION This illustration can be used as educational material to help an CONTEMPLATION TO PREPARATION Goal: • decrease the con’s of changing Process: • Self re-evaluation (self-reappraisal) CONTEMPLATION TO PREPARATION - Con’s Less time for friends Can’t watch as much tv Less time to study Might miss deadlines - Pro’s Helps repair the body Reduce stress Improve memory Control body weight Reduce mood disorders PREPARATION TO ACTION Goal: • Pro’s of changing must outweigh con’s • Increase self-efficacy Process: • 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 ACTION TO MAINTENANCE Goal: • Increase self-efficacy Process: • Counter-conditioning (substituting) • Helping relationships (supporting) • Reinforcement Management (rewarding) • Stimulus Control (re-engineering) STIMULUS CONTROL This process includes using avoidance, environmental reengineering, and self -help groups Example: Tips to help you sleep Keep a regular sleep/wake schedule Avoid caffeine 4-6 hrs before bed Minimize daytime use Avoid alcohol/heavy meals before bed Get regular exercise Minimize 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 factors social determinants Focuses on primary prevention Reducing risks vs preventing risks May not be applicable to: Specific populations Complex health behaviors Population 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 Behavior s. 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.