Applying theories of behaviour change to addiction: Prochaska's model

Question 1

prochaska’s six-stage model

Answer 1

this explains the stages people go through to change their behaviour. it identifies six stages of change (sometimes referred to as the stages of change model), from not considering it at all to making permanent changes. the stages are not necessarily followed in a linear order

Question 2

what are the six stages of Prochaska’s model

Answer 2

-precontemplation
-contemplation
-preparation
-action
-maintenance
-termination

Question 3

who noticed behaviour in change in smokers why trying to quit

Answer 3

Prochaska and DiClemente (1983)

Question 4

what does Prochaska’s model recognise

Answer 4

overcoming addiction does not happen quickly or in a tidy linear order from start to finish. it is not a single event but a cyclical process. clients progress through stages but they also return to the previous ones, and some stages may be skipped out altogether

Question 5

what is Prochaska’s model based off

Answer 5

two major insights, first people who are addicted differ and how ready there are to change their behaviour, as some are thinking about it, some are already doing something about it and others have decided to do nothing
-the second the usefulness of treatment intervention depends on the stage the person is currently in. some interventions will be most effective at an early stage of the recovery process but less useful later on

Question 6

what are people thinking about in the precontemplation stage

Answer 6

not thinking about changing their addiction related behaviour in the near future (typically defined as the next 6 months)

Question 7

why might someone not be thinking about changing their behaviour in the precontemplation stage

Answer 7

-may be in denial so don’t consider changing as don’t believe they have a problem
-demotivated as the person has tried many times unsuccessfully to abstain

Question 8

what should intervention focus in the precontemplation stage

Answer 8

focus on helping the person to consider the need for change

Question 9

what are they thinking about in contemplation stage

Answer 9

thinking about making a change in behaviour in the next 6 months. this does not mean they have decided to change, but they are increasingly aware of the need for change but are also aware of the costs

Question 10

contemplation stage intervention

Answer 10

as people can remain in a chronic contemplation stage for a long time, the best intervention is to help the person finally see how the pros of overcoming addiction outweigh the cons

Question 11

what does the individual believe in the preparation stage

Answer 11

believes the benefits are greater than the costs. so decide to change addiction related behaviour some time within the next month. however, they have not decided exactly how and when to change

Question 12

intervention in the preparation stage

Answer 12

support in constructing a plan, or presenting them with some options such as seeing a drug counsellor or calling a helpline or GP

Question 13

individuals thoughts in the action stage

Answer 13

done something to change their behaviour in the last 6 months. the action will reduce risk

Question 14

example of what someone might have done at the action stage

Answer 14

-cognitive therapies
-behaviour therapies
-something less meaningful such as cutting up cigarettes or pouring alcohol down the sink

Question 15

what does intervention focus on in the action stage

Answer 15

focuses on developing coping skills the client will need to quit and maintain their change of behaviour into the next stage

Question 16

what has the individual done in the maintenance stage

Answer 16

maintained some change of behaviour for more than 6 months. the person becomes more confident that abstaining can be continued in the longer term as it is becoming a way of life

Question 17

what is the focus on in the maintenance stage

Answer 17

relapse prevention (avoiding situations where cues might trigger addiction)`

Question 18

what is intervention for the maintenance stage

Answer 18

focuses on relapse prevention, and aims to help the client to apply the coping skills they have learned and use of the sources of support available to them

Question 19

what happens at the termination stage

Answer 19

newly acquired behaviours such as abstinence become automatic. the person no longer returns to addictive behaviours to cope with stress, anxiety or loneliness.

Question 20

is termination stage realistic

Answer 20

may not be possible or realistic for some to achieve. it may be that the most appropriate goal for many is to prolong maintenance for as long as they can, accepting that relapse if inevitable but providing the person with the skills to work through the earlier stages of the process quickly

Question 21

intervention for termination stage

Answer 21

no intervention needed

Question 22

strength of Prochaska’s model as a theory of behaviour change to addiction - dynamic process

Answer 22

-views recovery as a dynamic process
-earlier theories have considered recovery from addiction as a single ‘all or nothing’ event. in contrast, this model emphasises the importance of time, overcoming an addiction is a continuing process. this is why the model proposes that behaviour change occurs through six stages of varying duration per person. although progress through the stages is the same order, there is also recycling backwards to different degrees and stages can be missed –> provides a realistic view of the complex and active nature of recovery from addiction

Question 23

limitation of Prochaska’s model as a theory of behaviour change to addiction - counterpoint to dynamic process

Answer 23

-stages have been criticised for being arbitrary
-no research to evidence to distinguish one stage from another. Kraft et al (1999) argue that the six stages can be reduced to just 2 useful ones of precontemplation and all the other ones grouped together. this has important implications because according to the model, each stage is matched with a particular type of intervention –> suggests Prochaska’s stage model has little usefulness both for understanding changes over time and for treatment recommendations

Question 24

strength of Prochaska’s model as a theory of behaviour change to addiction - positive view of relapse

Answer 24

-model views relapse positively
-relapse is the rule rather than the exception according to DiClemente et al (2004). it does not view relapse as failure rather as an inevitable part of the untidy, non-linear, dynamic process of behaviour change. even so, relapse is more than just a slip so model also takes it seriously and does not underestimate ability to blow change off course. recovering from addiction may require several attempts to get it right, to make it last, or to reach the maintenance of termination stages –> means model has face validity with clients and is more acceptable because they can see it is realistic about relapse

Question 25

limitation of Prochaska’s model as a theory of behaviour change to addiction - contradictory research

Answer 25

-evidence challenging the model
-Taylor et al (2006) conducted a major review for the national institute for health and care excellence, analysing 24 reviews and meta-analyses of the 6 stage model. they concluded that the model was no more effective than appropriate alternatives in changing nicotine addiction-related behaviours. perhaps, even more critically, they also concluded that the key concept of the defined stages in behaviour change could not be validated by available data –> suggests the overall research picture is negative, despite optimistic claims made for the model by some

Question 26

evaluation of Prochaska’s model as a theory of behaviour change to addiction - model of behaviour change?

Answer 26

-Prochaska’s model is a model of behaviour change. this is because it emphasises that change unfolds over time and depends on whether someone is ready to change. also, the model assumes that an effective intervention will move a client on to the next stage by motivating them to change their behaviour
-on the other hand Prochaska’s model is arguably not really a model of behaviour change. this is because clients move between stage (and can go backwards) regardless of whether their behaviour changes or not