Transtheoretical model on change

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Real change is sometimes very difficult, especially when we refer to habits such as over eating, smoking and alcohol or drug use. This is due to the time span of the contingencies associated with such activities. Immediate pleasure and satisfaction is a strong reforcer for continuing with unhealthy behavior, whereas any benefits derived from stopping or changing behavior are at best mid- term or usually long term.

In 1983 Prochaska & DiClemente developed a Transtheoretical model outlining the basic process of change and has become known as the Stages of Change Model.

The Stages of Change model shows that, for most persons, a change in behavior occurs gradually, with people moving from being uninterested, unaware or unwilling to make a change (precontemplation), to considering a change (contemplation), to deciding and preparing to make a change. Genuine, determined action is then taken and, over time, attempts to maintain the new behavior occur. Relapses are almost inevitable and become part of the process of working toward life-long change. 

Precontemplation Stage
During the precontemplation stage, people do not even consider changing. Smokers who are "in denial" may not see that the advice applies to them personally. People who have high cholesterol levels may feel "immune" to the health problems that strike others. Obese patients may have tried unsuccessfully so many times to lose weight that they have simply given up.

Contemplation Stage
During the contemplation stage, people are ambivalent about changing. Giving up an enjoyed behavior causes them to feel a sense of loss despite the perceived gain. During this stage, patients assess barriers (e.g., time, expense, hassle, fear, "I know I need to, doc, but ...") as well as the benefits of change. 

Preparation Stage
During the preparation stage, people prepare to make a specific change. They may experiment with small changes as their determination to change increases. For example, sampling low-fat foods may be an experimentation with or a move toward greater dietary modification. Switching to a different brand of cigarettes or decreasing their drinking may signal that they have decided a change is needed.

Action Stage
When people have decided to make a commitment to change they enter the action stage. Many failed New Year's resolutions provide evidence that if the prior stages have been glossed over, action itself is often not enough. Any change behaviour, no matter how small is recognized as action and moving in a desired direction.

  

Maintenance and Relapse Prevention
Maintenance and relapse prevention involve incorporating the new behavior "over the long haul." Discouragement over occasional "slips" may halt the change process and result in the patient giving up. However, most patients find themselves "recycling" through the stages of change several times before the change becomes truly established. 

Most people find themselves "recycling" through the stages of change several times ("relapsing") before the change becomes truly established. On average smokers try 4 times before finally stopping smoking.