trans theoretical model

8/6/2019 Trans Theoretical Model

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Transtheoretical Model andStages of Change



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Who Made Resolutions on

News Years Eve?

Intention to changeWillingness to change

Barriers to change Process of change



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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 behaviorand views of how to change people

Comparative analysis of leading theories of psychotherapy and behavioral change identifiedonly ten processes of change among them, which

unfold through a series of stages



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Core Constructs: Stages of Change: temporal dimension

Processes of Change: covert and overt activities people use to progress through thestages

Decisional Balance: weighing pros and consof changing

Self-Efficacy



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Stages of Change: SmokingPrecontemplation

Termination



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Different Mechanisms Hypothesized

to Drive Movement Through StagesPrecontemplation

Termination



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Processes of Change:

Experiential1. Consciousness Raising [Increasing Awareness]

I recall information people had given me on how to stop smoking.

2. Dramatic Relief [Emotional Arousal] I react emotionally to warnings about smoking cigarettes.

3. Environmental Reevaluation [Social Reappraisal] I consider the view that smoking can be harmful to the people around

me.

4. Social Liberation [Environmental Opportunities] I find society changing in ways that make it easier for the nonsmoker.

5. Self Reevaluation [Self Reappraisal] My dependency on cigarettes makes me feel disappointed in myself.



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Processes of Change:

Behavioral1. Stimulus Control [Re-Engineering]

I remove things from my home that remind me of smoking.

2. Helping Relationships [Supporting] I have someone who listens to me when I need to talk about my

smoking.

3. Counter Conditioning [Substituting] I find that doing other things with my hands is a good substitute for

smoking.

4. Reinforcement Management [Rewarding] I reward myself when I dont smoke.

5. Self liberation [Committing] I make commitments not to smoke.



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Stages of Change in Which Change

Processes Are Most Emphasized

Stages of Change

Precontemplation Contemplation Preparation Action Maintenance

Consciousness Raising

Dramatic relief

Environmental reevaluation

Self-reevaluation

Self-liberation

Reinforcement Management

Helping relationships

Counterconditioning

Stimulus Control



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To Motivate an Individual toChange Requires Different

Information At Different Stages

How would you do this for rest

breaks when working on acomputer?

How about cleaning in a house with

a child with asthma? Stage-matched interventions

accelerates change



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Decisional Balance Decisional balance is derived via a

comparison of the strength of perceived prosof the target behavior with the perceivedcons.

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 decisionsabout behavior changes



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Examples of Pros & Cons for

Mammogram Screening Mammograms have a high risk of leading to

unnecessary surgery

If a mammogram finds something, thenwhatever is there will be too far along to doanything about anyway

My family will benefit if I have amammogram

Having a yearly mammogram will give me afeeling of control over my health



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Decisional Balance Leads to

Individual Behavioral ActsPrecontemplation

Termination



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Self-Efficacy Confidence: situation-specific confidence people

have that they can cope with high-risk situations

without relapsing to their unhealthy or high-riskhabits

Temptation: the intensity of urges to engage in aspecific habit when in the midst of difficult

situations, including: Negative affect or emotional distress

Positive social occasions

Cravings



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Critical Assumptions No single theory can account for all the complexities of

behavioral change.

Behavioral change is a process that unfolds over timethrough a sequence of stages.

Stages are both stable and open to change just as chronicbehavioral risk factors are both stable and open to change.

There are a common set of change processes that peopleapply across a broad range of behaviors.

Without planned interventions, populations will remain stuckin the early stages. There is no inherent motivation toprogress through the stages of change.



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Critical Assumptions The majority of at-risk populations are not prepared for

action and will not be served by traditional action-orientedprevention programs.

Specific processes and principles of change need to beapplied at specific stages if progress through the stages is tooccur. 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-matchedinterventions have been designed primarily to enhance self-control.



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Limitations or Problems Literacy level and sociodemographic characteristics may

impacts the types of resources individuals need.

When behaviors are strongly associated with socioeconomicand educational status in may also be important to addressthe behaviors role in the broader social and physicalcontext. 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 wherebehaviors are contingent on severe external restrictions



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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, isunemployed or having difficulty caring for children theconcerns about future health problems are likely to havelittle impact

The models emphasis on organizational, cultural and socialfactors that may impact behavior change is weak.

Addictive behaviors not adaptive behaviors



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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 goodpredictor of change, BUT past behavior betterpredictor of future behavior

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