Five Stages of Change in the Transtheoretical Model (TTM)

December 30, 2014


An article in Harvard Women’s Health Watch titled “Why it’s hard to change unhealthy behavior — and why you should keep trying,” states that a certain model applied to various health behaviors can help lead people through the changes. First developed in the 1980s by alcoholism researchers James O. Prochaska and Carlo C. DiClemente, the transtheoretical model (TTM) of behavior change assesses an individual’s readiness to act on a new healthier behavior, and provides strategies, or processes of change to guide the individual through the stages of change. Health providers and health educators utilize TTM to advise patients, but one doesn’t need to be a professional to try this methodology. Anyone motivated to change can use it to assess his or her situation and formulate strategies. The author explains the five stages of change:

Precontemplation

At this stage, you have no conscious intention of making a change, whether through lack of awareness or information (“Overweight in my family is genetic; it’s just the way we are”) or because you have failed in the past and feel demoralized (“I’ve tried so many times to lose weight; it’s hopeless”). You tend to avoid reading, talking, or thinking about the unhealthy behavior, but your awareness and interest may be sparked by outside influences, such as public information campaigns, stories in the media, emotional experiences, illness, or a clinician’s or family member’s concern. To move past precontemplation, you must sense that the unhealthy behavior is at odds with important personal goals, for example, being healthy enough to travel or to enjoy your children or grandchildren.

Contemplation

In some programs and studies that employ TTM, people who say they’re considering a change in the next six months are classified as contemplators. In reality, people often waver for much longer than that. In this stage, you are aware that the behavior is a problem and are considering doing something about it, but you still aren’t committed to taking any action. Ambivalence may lead you to weigh and re-weigh the benefits and costs: “If I stop smoking, I’ll lose that hacking cough, but I know I’ll gain weight,” or “I know smoking could give me lung cancer, but it helps me relax; if I quit, stress could kill me, too!Health educators use several techniques to help people pry themselves and move on to the next stage. One is to make a list of the pros and cons of making a change, then examine the barriers — the “cons” — and think about ways to overcome them. For example, many women find it difficult to get regular exercise because it’s inconvenient or they have too little time. If finding a 30-minute block of time to exercise is a barrier, how about two separate 15-minute sessions? Could someone else cook dinner so you can take a walk after work? If you feel too self-conscious to take an exercise class, how about buying an exercise tape to use at home?

Preparation

At this stage, you know you must change, believe you can, and are making plans to change soon — say, next month. You’ve joined a health club, purchased a supply of nicotine patches, or added a calorie-counting book to the kitchen shelf. At this stage, it’s important to anticipate potential obstacles. If you’re preparing to cut down on alcohol, for example, be aware of situations that provoke unhealthy drinking, and plan ways around them. If work stress triggers end-of-day drinking, plan to take a walk when you get home. If preparing dinner makes you want a drink, plan to have seltzer water instead of wine. If social situations are a problem, make a list of alternatives, such as going to the movies instead of having drinks or dinner with friends. At the same time, create a realistic action plan with achievable goals. If you’ve been sedentary and want to exercise more, start by making it your goal to avoid using the elevator for two-, three-, or four-story trips. Or plan to walk 15 minutes every day. This can help you work your way up to more ambitious goals.

Action

At this stage, you’ve changed — stopped smoking, for example (according to Prochaska, cutting down would not be “action” but preparation for action) — and you’ve begun to experience the challenges of life without the old behavior. You’ll need to practice the alternatives you identified during the preparation stage. For example, if stress tempts you to eat, you can use healthy coping strategies such as yoga, deep breathing, or exercise. At this stage, it’s important to be clear about your motivation; if necessary, write down your reasons for making the change and read them every day. Engage in “self-talk” to bolster your resolve. Get support. Let others know you’re making a change.

Maintenance

Once you’ve practiced the new behavior change for at least six months, you’re in the maintenance stage. Now you’re working to prevent relapse and integrate the change into your life. That may require other changes, especially avoiding situations or triggers associated with the old habit. It can be tough, especially if it means steering clear of certain activities or friends while you work to fully assimilate your new, healthier habit.

Source: “Why it’s hard to change unhealthy behavior – and why you should keep trying.” Harvard Women’s Health Watch, January 2007 (link: http://www.health.harvard.edu/newsweek/Why-its-hard-to-change-unhealthy-behavior.htm)

Ready to make a lifestyle change in 2015? Check out: Evolving Through the Journey of Lifestyle Changes