Stages of Change

The Transtheoretical Model (i.e. the Stages of Change) views change as a process rather than an event, and the process has several stages:

The first stage is called precontemplation (what some folks might refer to as “denial”). When I’m in this stage, I don’t intend to make a behavior change. In fact, I might not even be aware that my behavior is self-defeating. I might underestimate the advantages of changing and overestimate the disadvantages of changing, and I probably am not aware of this skew in my perspective.

The next stage is called contemplation. When I’m in this stage, I am just starting to think about changing my behavior. Likely, I have ambivalence* about changing. While I might be aware of the advantages of changing, the disadvantages seem to be about equal to those advantages. This ambivalence can cause me to keep putting off taking action.
(* ambi = both; valence = strength, so ambivalence is feeling strongly both about changing and not changing)

The next stage is called preparation. When I’m in this stage, I have decided to make a behavior change and I preparing to do so because I soon will be ready to take action. I take small steps that I believe can help make the constructive behavior a part of my life. For example, I might seek support from friends I trust, tell people about my plan to change, and imagine how I would feel if I were making the change.

The next stage is called action. When Im in this stage, I have just begun to take action to change my behavior and I need to continue to work hard, practicing my new behavior. Part of this practice often includes substituting activities related to the self-defeating behavior with constructive activities, rewarding myself for taking steps toward positive change, and avoiding people and situations that tempt me to behave in the old, self-defeating ways.

Ideally, the last stage is what is called maintenance. When I’m in this stage, I have made a change and am working to keep it up (i.e. maintain it). It is important to be aware of situations (particularly stressful situations) that could tempt me to slip back into the self-defeating behavior. It helps to seek support from and talk with people I trust, to spend time with people who behave in ways that promote my  change, and to remember to engage in alternative activities to cope with stress instead of relying on self-defeating behavior.

I mentioned that maintenance is ideally the last stage. However, in reality often we recycle (or relapse)—we slip back into the old self-defeating behavior, if only temporarily. Contrary to the messages about relapse often received from 12-step programs and from the legal system, recycling is part-and-parcel to the change process—it’s not inevitable, but it is very common. And it doesn’t mean I am back to square one. After all, I had that time of change under my belt, so I know I can do it and I even have some idea how. In fact, research shows that the more periods of positive change we maintain—even if those periods end in recycling—the more likely we are to change for good!

What do we need to move from one stage to another?

In general, for us to progress through the changes we need the following:

  • A growing awareness that the advantages of changing outweigh the disadvantages.
    The Transtheorital Model calls this awareness the decisional balance.
  • Confidence that we can make and maintain changes in situations that tempt us to return to our old, self-defeating behavior.
    The Transtheoretical Model calls this self-efficacy.
  • Strategies that can help us make and maintain change.
    The Transtheoretical Model calls these processes of change and identifies nine of them:
  1. consciousness raising—increasing awareness via information about ourselves, about the consequences of our self-defeating behavior, and about prospective strategies for change; for example, learning about the body’s natural response (lowering the metabolism and burning fewer calories) to dieting so that I can make adjustments to my weight-loss approach to increase the likelihood of its success
  2. social liberation—identifying and taking advantage of our social environment provides to encourage our change; for example, I order from the healthy choices section of the menu
  3. dramatic release—feeling fear, anxiety, or worry because of the self-defeating behavior; for example, I respond to the news of a family member being diagnosed with cancer by deciding to quit smoking
  4. self-reevaluation—seeing when and how our self-defeating behavior conflicts with our personal values; for example, I realize that—given my declaration that my children are the most important thing to me—getting drunk even when the grandparents are taking care of my children could prevent me from getting to them in an emergency
  5. self-liberation—accepting responsibility for changing and acknowledging that I am the only one who is able to respond, speak, and act for myself; for example, I announce to my partner that I have decided to stop gambling
  6. countering—substituting positive ways of acting and thinking for self-defeating ways; for example, instead of drinking because I’m bored, I go to the gym
  7. environment control—restructuring our environment so that the likelihood of problem-causing event is reduced; for example, I flush all my weed down the toilet so that it isn’t around to tempt me
  8. rewards—increasing the rewards that come from positive behavior and reducing those that come from negative behavior; for example, I purchase a bicycle with the money I otherwise would have spent on cocaine
  9. helping relationships—requesting and enlisting the support of people who are supportive of our change; for example, I call my friend who’s also in recovery when I have the urge to drink

Some strategies are more effective for certain stages of change. For example, counter conditioning and stimulus control can be very helpful in the action and maintenance stages but less so in the precontemplation stage. On the other hand, consciousness raising and dramatic relief can work well in precontemplation to move us into the contemplation stage.

For more information about the stages of change, you can read this paper written by the folks who originally developed the model or read their book, Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward by Prochaska, Norcross, and DiClemente.

For a quick summary of how the stages of change work, you can read this article from the New York Times.