Transtheoretical Model Of Behavior Change Acetate

Transtheoretical Model of Behavior Change (Prochaska & DiClemente, 1983; Prochaska, DiClemente, & Norcross, 1992; Prochaska & Velicer, 1997) The Transtheoretical Model of Change, a theoretical model of behavior change, which has been the basis for developing effective interventions to promote health behavior change.. The model describes how people modify a problem behavior or acquire a positive behavior. The central organizing construct of the model is the Stages of Change. The model also includes a series of independent variables, the Processes of Change, and a series of outcome measures, including the Decisional Balance and the Temptation scales. The Processes of Change are ten cognitive and behavior activities that facilitate change. The Transtheoretical Model is a model of intentional change. It is a model that focuses on the decision making of the individual Stages of Change: The Temporal Dimension Precontemplation is the stage in which people are not intending to take action in the foreseeable future, usually measured as the next six months Contemplation is the stage in which people are intending to change in the next six months. They are more aware of the pros of changing but are also acutely aware of the cons. Preparation is the stage in which people are intending to take action in the immediate future, usually measured as the next month. They have typically taken some significant action in the past year. These individuals have a plan of action. Action is the stage in which people have made specific overt modifications in their life-styles within the past six months. Since action is observable, behavior change often has been equated with action Maintenance is the stage in which people are working to prevent relapse but they do not apply change processes as frequently as do people in action. They are less tempted to relapse and increasingly more confident that they can continue their change.

Figure 1. The Temporal Dimension as the Basis for the Stages of Change *Regression occurs when individuals revert to an earlier stage of change. Relapse is one form of regression, involving regression from Action or Maintenance to an earlier stage.

Stages (uses Tobacco Cessation as example) Precontemplation stage  Smoking is not a problem. I do not want to quit.  Consider brief interventions  Educate on the negative effects of Tobacco  Recommend quitting smoking  List cessation options (e.g. Nicotine Replacement)  Discuss patient's reaction to recommendations  Reinforce at follow-up visits  Physician example  Most people agree that Tobacco use is a harmful  What do you think about this?  I am concerned about your health  How can I help you quit? Contemplation stage  Smoking is a problem. I want to quit.  Continue to discuss benefits of quitting smoking  Avoid negative long-term effects of Tobacco use  Improved health and positive self-image  Financial cost savings  Physician example (Your morning cough will improve off Tobacco ) Preparation stage  Set a definite quit date (I will quit smoking on January 1)  Facilitation measures  Encourage social support  Tobacco Cessation program  Friends and relatives provide support  Provide a no-fail environment  Remove Tobacco, ashtrays and other related items  Others should not smoke around patient  Be aware of Tobacco use triggers (rituals)  Consider habit substitutions in place of Tobacco  Avoid provocative behaviors (e.g. alcohol use)  Offer Tobacco Cessation pharmacologic measures  Nicotine Replacement Action stage  I stopped smoking today.  Provide behavior support  Smoking Cessation program  Follow-up contact (e.g. Troubleshoot triggers)  Weekly during first month of cessation  At time of stopping pharmacologic measures Maintenance stage

 I only smoked on one stressful day in the last month.  Continue behavior support  Offer additional interventions if relapse occurs Series of Intermediate/Outcome Measures. - measures that are sensitive to progress through all stages. These constructs include the Pros and Cons from the Decisional Balance Scale, Self-efficacy or Temptation, and the target behavior. Decisional Balance The Decisional Balance construct reflects the individual's relative weighing of the pros and cons of changing. The Decisional Balance scale involves weighting the importance of the Pros and Cons.

Figure 2. The Relationship between Stage and the Decisional Balance for an Unhealthy Behavior

Figure 3. The Relationship between Stage and the Decisional Balance for a Healthy Behavior

Self-efficacy/Temptations - represents the situation specific confidence that people have that they can cope with high-risk situations without relapsing to their unhealthy or high-risk habit. The Situational Temptation Measure reflects the intensity of urges to engage in a specific behavior when in the midst of difficult situations. The Situational Self-efficacy Measure reflects the confidence of the individual not to engage in a specific behavior across a series of difficult situations.

Figure 4. The Relationship between Stage and both Self-efficacy and Temptation Independent Measures: How Change Occurs Processes of Change Processes of Change are the covert and overt activities that people use to progress through the stages. Efficient self-change thus depends on doing the right thing (processes) at the right time (stages). I. Processes of Change: Experiential  Consciousness Raising [Increasing awareness] Feedback, education, confrontation, interpretation, bibliotherapy and media campaigns. eg. I recall information people had given me on how to stop smoking  Dramatic Relief [Emotional arousal] Psychodrama, role playing, grieving, personal testimonies and media campaigns are examples of techniques that can move people emotionally. eg. I react emotionally to warnings about smoking cigarettes  Environmental Reevaluation [Social reappraisal] Empathy training, documentaries, and family interventions can lead to such reassessments. eg. I consider the view that smoking can be harmful to the environment  Social Liberation [Environmental opportunities] Advocacy, empowerment procedures, and appropriate policies can produce increased opportunities for minority health promotion, gay health promotion, and health promotion for impoverished people. eg. I find society changing in ways that make it easier for the nonsmoker  Self Reevaluation [Self reappraisal]

Value clarification, healthy role models, and imagery are techniques that can move people evaluatively. eg. My dependency on cigarettes makes me feel disappointed in myself

II. Processes of Change: Behavioral  Stimulus Control [Re-engineering] Avoidance, environmental re-engineering, and self-help groups can provide stimuli that support change and reduce risks for relapse. eg. I remove things from my home that remind me of smoking  Helping Relationship [Supporting] Rapport building, a therapeutic alliance, counselor calls and buddy systems can be sources of social support. eg. I have someone who listens when I need to talk about my smoking  Counter Conditioning [Substituting] Relaxation can counter stress; assertion can counter peer pressure; nicotine replacement can substitute for cigarettes, and fat free foods can be safer substitutes. eg. I find that doing other things with my hands is a good substitute for smoking  Reinforcement Management [Rewarding] Contingency contracts, overt and covert reinforcements, positive self-statements and group recognition are procedures for increasing reinforcement and the probability that healthier responses will be repeated. eg. I reward myself when I don’t smoke  Self Liberation [Committing] New Year's resolutions, public testimonies, and multiple rather than single choices can enhance self-liberation or what the public calls willpower. eg. I make commitments not to smoke

Figure 5. The Relationship between Stage and two sample Processes, Consciousness Raising and Stimulus Control

The Behavior Modification Method REMEMBER behavior modification is a process. Some behaviors are deeply engraved and will require a lot of time and effort to change. Steps to success are: 1) Determine which behaviors promote personal wellness. (knowledge) 2) Problem Identification - Problem behaviors must first be identified. What is the target behavior ? 2) Discover patterns of behavior - identify and record the circumstances which promote the target behavior. This step requires you to keep careful records of your behavior patterns. Why, When, Where, and How does the target behavior occur? 3) Establish goal(s) to change behavior patterns - address the target behavior These goals should be both long term (up to 1 year) and short term (present to 3-6 months)goals. Goals should be as specific as possible. Goals should be S.M.A.R.T. S = Sensible; M = Measurable; A = Attainable; R = Responsibility; T = Time: Example : To improve my aerobic fitness, I will walk three times a week outside of my apartment complex on the exercise trail in the morning between 7 and 8:00 am for the next three months. I will exercise for 30 minutes at my training heart rate. 4) Make a personal plan/contract - detailed plan needed to achieve the goals you have established. 5) Monitor progress, maintain new behavior and/or revise plan - monitoring progress will allow for an objective review of the effectiveness of the personal plan. If the personal plan is ineffective, program revision may be indicated. ** Helpful Hints: 1) Build a support 2) Keep to your routine 3) Try to avoid product related goals. 4) Focus on the process of your behavior change 5) Build rewards into your plan