The Transtheoretical Model
Tara Walton

 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

 A model used to explain individual behavior change
 Consists of 4 main constructs:
Stages of Change
Processes of Change
Decisional Balance
Self-efficacy

Pre contemplation
• “ignorance is bliss”
Termination
Relapse
•“Fall from grace”
Contemplation
•“fence sitting”
Maintenance
• “steady as she goes”
Action
•“go for it”
Preparation
•“testing the waters”

 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

 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

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

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

Precontemplation Contemplation Preparation
Consciousness Raising
Dramatic Relief
Environmental Re-evaluation
Self-Re-evaluation
Action Maintenance
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

Goal:
• increase the pro’s of changing
Process:
• Consciousness raising (increase awareness)
• Dramatic Relief (emotional arousal)
• Environmental Re-evaluation

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

Goal:
• decrease the con’s of changing
Process:
• Self re-evaluation (self-reappraisal)

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

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

Goal:
• Increase self-efficacy
Process:
• Counter-conditioning (substituting)
• Helping relationships (supporting)
• Reinforcement Management (rewarding)
• Stimulus Control (re-engineering)

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

 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

 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

 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

 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.