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.
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How to use the stages of change