Assignment

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THE TRANSTHEORETICAL MODEL &  STAGES OF CHANGE

THE CHALLENGE:

 Traditional health promotion programs have been producing minor impacts on major health issues  Why is “Just say NO” a failed campaign

 There is a need to design cost effective, successful interventions that impact entire populations at risk

THE TRANSTHEORETICAL MODEL CORE CONSTRUCTS: STAGES OF CHANGE

 Strengths  Behavior change takes time

 stage constructs represents a temporal dimension

 Change is incremental  it’s not a issue of either you do it or you don’t

 Stage‐matching of interventions

Stages of TTM 1. Precontemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance 6. Termination

Precontemplation:

Not  Ready To Act

 Have no intention to start  taking action in next 6  months

Characteristics of a Precontemplator:

 Avoid reading, talking, and thinking about the risk or the behavior.

 Feel pressured by others to take action, but have developed defenses to cope with such pressures.

 Unaware or under‐aware of their problems despite others’ awareness of problems with addictions.

 Denial or minimization of problem.

 Most resistant to public policy changes.

CHARACTERISTICS OF A PRECONTEMPLATOR:

 The least confident about ability to take action.

 Typically seek help because of pressure from others.

 Typically less than 1% of those at risk participate in traditional programs.

 About 40% of people at risk are in Precontemplation.

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Contemplation

Thinking About Taking Action

 Intend to start in next 6 months

CHARACTERISTICS OF CONTEMPLATORS:

 Substitute thinking for acting  Increasing awareness of benefits of staying drug free and the risks of using

 Costs of quitting are very clear

 Ambivalent about changing

 Often waiting for the magic moment

Characteristics of Contemplators:

When in doubt, don’t act

Not confident enough about their abilities to quit, feel unprepared

Typically less than 1% of those at risk participate in traditional programs

About 40% of people at risk are Contemplators

Preparation

Getting Ready to Take Action

Practicing the behavior

Intend to start in next 30 days

Characteristics of Preparation:

More confident & less tempted than those in earlier stages

Assess the Benefits (Pros) as higher than the Costs (Cons)

Most likely to participate in programs and most likely to benefit from those programs

Participants that health promotion programs love

Less than 20% of people at risk are in Preparation May begin taking small steps towards action (24 hour quit attempt) May leap into action prematurely

Characteristics of Preparation:

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Action

Recently Started to Change Behavior  Consistently for less than 6 months

CHARACTERISTICS OF ACTION

 Behavior change is recent  Temptation and recycling a concern  Need to use specific processes to deal with temptations

Maintenance

Has Changed Behavior

 Consistently for 6 months or more

CHARACTERISTICS OF MAINTENANCE

 Problems with atypical temptations that have not occurred before

 May be overconfident and court relapse  Not static stage ‐ Still using processes

TERMINATION

 No temptation to relapse and 100% self efficacy

 Applies only certain types of behavior  In fact, not a realistic goal for most health behaviors  receives less attention in TTM research

Decisional Balance

 Pros of Change  perceived positive consequences  the benefits of changing

 Cons of Change  perceived negative consequences  costs of changing

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PROS AND CONS OF SMOKING

40

45

50

55

60

PC C A M

Pros of Smoking

Cons of Smoking

T S

co re

s

Stage

Processes of Change

 HOW people change

 Cognitive, affective, evaluative, interpersonal, and behavioral strategies and techniques used to change behavior

 Mediate transitions between stages

 Foundation of intervention design

Processes of Change

Consciousness Raising Dramatic Relief Self Reevaluation Environmental Reevaluation Social Liberation

Helping Relationships Reinforcement Management Counterconditioning Self Liberation Stimulus Control

Experiential Processes

Doing

Behavioral Processes

Thinking, Feeling or Experiencing

PROCESSES OF CHANGE (10)

1. Consciousness Raising  Awareness

2. Dramatic Relief  Experience (or simulate) emotions connected with unhealthy behavioral risks

3. Self Reevaluation  Cognitive and affective assessments of self image with and without the unhealthy habit

4. Environmental Reevaluation  Cognitive and affective assessments of the relationship of the habit to one’s social environment

5. Self Liberation  Belief that one can change and commitment to act on that belief (Self efficacy & Behavioral intent)

PROCESSES OF CHANGE (10)

6. Helping Relationships  Social support (building psychosocial assets)

7. Counterconditioning  Learning healthier alternatives to unhealthy habits

8. Contingency Management  Operant conditioning (Punishment or incentives)  Consequences for taking steps in a particular disease

9. Stimulus Control  Remove cues for unhealthy habits

10. Social Liberation  realizing social norms are changing in a direction that supports healthy behavior change

STAGES BY PROCESSES

Precontemplation Contemplation     Preparation     Action        Maintenance 

Consciousness Raising

Dramatic Relief

Environmental Reevaluation

Social Liberation

Self‐reevaluation

Self Liberation

Helping Relationships

Stimulus Control

Reinforcement Management

Counterconditioning

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STAGE BASED INTERVENTIONS

 Moving from Pre‐Contemplative to Contemplative  Consciousness Raising (observations, confrontations, interpretations, bibliotherapy)  Dramatic Relief (psychodrama, grieving losses, role playing)  Environmental Reevaluation (empathy training, documentaries)

 Moving from Contemplative to Preparation  Self Reevaluation (value clarification, imagery, corrective emotional experience)

 Moving from Preparation to Action  Self‐Liberation (decision‐making therapy, New Year’s resolutions, Logo therapy

techniques, Commitment enhancing techniques)

 Moving from Action to Maintenance  Helping Relationships (therapeutic alliances, social support, self‐help groups)  Reinforcement Management (Contingency contracts, overt and covert reinforcement,

self‐reward)  Counter Conditioning (relaxation, desensitization, assertion, positive self‐statements)  Stimulus Control (restructuring one’s environment, avoiding high risk cues, fading

techniques)

CRITICAL ASSUMPTIONS OF THE TTM

1. No single theory can account for all the complexities of behavior change  a more comprehensive model will most likely to emerge from integration across major theories

2. Behavior change is an ongoing process that unfolds over time and through a sequence of stages.

3. Stages of change may be stable or open to change.  e.g., chronic behavioral risk factors are both stable and open to change

BASIC ASSUMPTIONS OF THE TTM

4. Most at risk populations are not prepared for action. They must be prepared by stages. (Education & Income)

5. Specific processes and principles of change should be applied at specific changes if progress through the stages is to occur(Stage Matching)  Without planned interventions, populations remain stuck in the early stages.