Applying theories of behaviour change to addiction: Prochaska's model Flashcards
prochaska’s six-stage model
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
what are the six stages of Prochaska’s model
-precontemplation
-contemplation
-preparation
-action
-maintenance
-termination
who noticed behaviour in change in smokers why trying to quit
Prochaska and DiClemente (1983)
what does Prochaska’s model recognise
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
what is Prochaska’s model based off
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
what are people thinking about in the precontemplation stage
not thinking about changing their addiction related behaviour in the near future (typically defined as the next 6 months)
why might someone not be thinking about changing their behaviour in the precontemplation stage
-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
what should intervention focus in the precontemplation stage
focus on helping the person to consider the need for change
what are they thinking about in contemplation stage
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
contemplation stage intervention
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
what does the individual believe in the preparation stage
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
intervention in the preparation stage
support in constructing a plan, or presenting them with some options such as seeing a drug counsellor or calling a helpline or GP
individuals thoughts in the action stage
done something to change their behaviour in the last 6 months. the action will reduce risk
example of what someone might have done at the action stage
-cognitive therapies
-behaviour therapies
-something less meaningful such as cutting up cigarettes or pouring alcohol down the sink
what does intervention focus on in the action stage
focuses on developing coping skills the client will need to quit and maintain their change of behaviour into the next stage
what has the individual done in the maintenance stage
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
what is the focus on in the maintenance stage
relapse prevention (avoiding situations where cues might trigger addiction)`
what is intervention for the maintenance stage
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
what happens at the termination stage
newly acquired behaviours such as abstinence become automatic. the person no longer returns to addictive behaviours to cope with stress, anxiety or loneliness.
is termination stage realistic
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
intervention for termination stage
no intervention needed
strength of Prochaska’s model as a theory of behaviour change to addiction - dynamic process
-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
limitation of Prochaska’s model as a theory of behaviour change to addiction - counterpoint to dynamic process
-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
strength of Prochaska’s model as a theory of behaviour change to addiction - positive view of relapse
-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
limitation of Prochaska’s model as a theory of behaviour change to addiction - contradictory research
-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
evaluation of Prochaska’s model as a theory of behaviour change to addiction - model of behaviour change?
-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
