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Transtheoretical Model and Stages of Change


1. Transtheoretical Model and Stages of Change. 2. Who Made Resolutions on News Years Eve? ... New Directions: A Third Dimension in TTM ... – PowerPoint PPT presentation

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Title: Transtheoretical Model and Stages of Change

Transtheoretical Model and Stages of Change
Who Made Resolutions on News Years Eve?
  • Intention to change
  • Willingness to change
  • Barriers to change
  • Process of change

Transtheoretical Model
  • The Transtheoretical Model uses stages of change
    to integrate processes and principles of change
    from across major theories of intervention.
  • It was labeled transtheoretical because concepts
    come from different theories of human behavior
    and views of how to change people
  • Comparative analysis of leading theories of
    psychotherapy and behavioral change identified
    only ten processes of change among them, which
    unfold through a series of stages

Core Constructs
  • Stages of Change temporal dimension
  • Processes of Change covert and overt activities
    people use to progress through the stages
  • Decisional Balance weighing pros and cons of
  • Self-Efficacy

Stages of Change
  • Precontemplation no intention to act in the near
    future (six months), due to lack of information
    or demoralization from past attempts
  • Contemplation intention to change in the near
    future aware of pros and cons of changing
  • Preparation intention to take action in the
    immediate future (1 month) have a plan of action
  • Action overt action taken within the last 6
  • Maintenance work to prevent relapse less
    temptation and more confidence
  • Termination no temptation and 100 self efficacy

Stages of Change Smoking
Different Mechanisms Hypothesized to Drive
Movement Through Stages
Processes of Change Experiential
  • Consciousness Raising Increasing Awareness
  • I recall information people had given me on how
    to stop smoking.
  • Dramatic Relief Emotional Arousal
  • I react emotionally to warnings about smoking
  • Environmental Reevaluation Social Reappraisal
  • I consider the view that smoking can be harmful
    to the people around me.
  • Social Liberation Environmental Opportunities
  • I find society changing in ways that make it
    easier for the nonsmoker.
  • Self Reevaluation Self Reappraisal
  • My dependency on cigarettes makes me feel
    disappointed in myself.

Processes of Change Behavioral
  • Stimulus Control Re-Engineering
  • I remove things from my home that remind me of
  • Helping Relationships Supporting
  • I have someone who listens to me when I need to
    talk about my smoking.
  • Counter Conditioning Substituting
  • I find that doing other things with my hands is a
    good substitute for smoking.
  • Reinforcement Management Rewarding
  • I reward myself when I dont smoke.
  • Self liberation Committing
  • I make commitments not to smoke.

Stages of Change in Which Change Processes Are
Most Emphasized
To Motivate an Individual to Change Requires
Different Information At Different Stages
  • How would you do this for rest breaks when
    working on a computer?
  • How about cleaning in a house with a child with
  • Stage-matched interventions accelerates change

Decisional Balance
  • Decisional balance is derived via a comparison of
    the strength of perceived pros of the target
    behavior with the perceived cons.
  • Derived from Janis Manns model of
    decision-making which says
  • The relative weight people assign to the pros and
    cons of a behavior influences their decisions
    about behavior changes

Examples of Pros Cons for Mammogram Screening
  • Mammograms have a high risk of leading to
    unnecessary surgery
  • If a mammogram finds something, then whatever is
    there will be too far along to do anything about
  • My family will benefit if I have a mammogram
  • Having a yearly mammogram will give me a feeling
    of control over my health

Decisional Balance Leads to Individual Behavioral
  • Confidence situation-specific confidence people
    have that they can cope with high-risk situations
    without relapsing to their unhealthy or high-risk
  • Temptation the intensity of urges to engage in a
    specific habit when in the midst of difficult
    situations, including
  • Negative affect or emotional distress
  • Positive social occasions
  • Cravings

Self-Efficacy (or lack thereof) Leads to Directed
Individual Acts
Critical Assumptions
  • No single theory can account for all the
    complexities of behavioral change.
  • Behavioral change is a process that unfolds over
    time through a sequence of stages.
  • Stages are both stable and open to change just as
    chronic behavioral risk factors are both stable
    and open to change.
  • There are a common set of change processes that
    people apply across a broad range of behaviors.
  • Without planned interventions, populations will
    remain stuck in the early stages. There is no
    inherent motivation to progress through the
    stages of change.

Critical Assumptions
  • The majority of at-risk populations are not
    prepared for action and will not be served by
    traditional action-oriented prevention programs.
  • Specific processes and principles of change need
    to be applied at specific stages if progress
    through the stages is to occur. In the stage
    paradigm, intervention programs must be matched
    to each individuals stage of change.
  • Chronic behavioral patterns are under some
    combination of biological, social, and
    self-control. Stage-matched interventions have
    been designed primarily to enhance self-control.

Limitations or Problems
  • Literacy level and sociodemographic
    characteristics may impacts the types of
    resources individuals need.
  • When behaviors are strongly associated with
    socioeconomic and educational status in may also
    be important to address the behaviors role in
    the broader social and physical context.
  • Single parent and smoking cessation stressors
    related to smoking
  • Stress management programs
  • Work/rest breaks and productivity
  • Model may be of limited utility in populations
    where behaviors are contingent on severe external

Limitations or Problems
  • TTM is primarily self-change/self-help
  • From a stage perspective an individual may be
    asked to think about some of the reasons why s/he
    wants to quit smoking and to reconsider the
    health risks
  • BUT . If s/he lives in an unsafe environment, is
    unemployed or having difficulty caring for
    children the concerns about future health
    problems are likely to have little impact
  • The models emphasis on organizational, cultural
    and social factors that may impact behavior
    change is weak.
  • Addictive behaviors not adaptive behaviors

Limitations or Problems
  • The behavioral criterion are often difficult to
    measure for each stage
  • How do you know when people change?
  • People often use a piece of the model
  • Model is not linear and there is no sense of how
    much time is reasonable within each stage
  • Smokers hospitalized for MI quit smoking (60),
    so go directly form precontemplation to action
  • The 6 month window for contemplation
  • Intention to change (decisional balance) is a
    good predictor of change, BUT past behavior
    better predictor of future behavior

New DirectionsA Third Dimension in TTM
  • Stages of Change recognizes the temporal and
    developmental nature of the process of change
  • Process of Change the critical activities needed
    to move an individual through the stages
  • Levels of Change interactive areas of an
    individuals life that influence and are
    influenced by changes at any one of five levels
  • symptom/situational
  • maladaptive cognition
  • interpersonal problems
  • family and system conflicts
  • intrapersonal conflicts

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