Chapter 7 — Readiness to Change

Question 1

Who developed the Transtheoretical Model of Change?

Answer 1

Dr. James O. Prochaska and collaborators

Question 2

The TTM of behavior change evaluated and measured behavior change for a wide variety of health behaviors. Name 4._{<span>93</span>}

Answer 2

• Smoking Cessation
• Alcohol
• Exercise adoption
• Mamogram engagement

Question 3

How is the TTM Model used for self-changers?_{<span>93</span>}

Answer 3

The TTM Model serves as a blueprint for self-change in health behaviors and can readily be applied to health and wellness coaching and other coaching domains. (Prochaska, Norcross, & DiClemente, 1994O)

Question 4

What does the TTM Model offer coaches?_{<strong><span>93 - 94</span></strong>}

Answer 4

TTM Model

1. Offers an understand of how and when new behaviors can be adopted and sustained, and
2. Why clients may struggle, fail, or quit.

Question 5

What does the phrase

“Self-change is a staged process,”

mean_{<span> 94</span>}

Answer 5

We move through a sequence of change.

All of us moves through each of the stages before getting to long-term sustained behavior change.

That is, we all move through

1. Pre-Contemplation→
2. Contemplation →
3. Preparation →
4. Action →
5. Maintenance →
6. Termination →

We do not skip stages.

We can recycle through stages.

We can relapse.

Question 6

Clients may be in different Stages of Change in different areas and subdomains of health and wellness. Give two examples._{<span>94</span>}

Answer 6

• Be ready to eat a healthy breakfast but not be willing to eat more vegetables with dinner.
• Might be ready to walk but not to participate in strength-training.
• May be willing to practice a self-compassion exercise but not in meditation.

Question 7

What are the 5 Stages of Change in TTM?_{<span>94</span>}

Answer 7

1. Pre-contemplation = Not ready for change
2. Contemplation = Thinking about change
3. Preparation = Preparing to change
4. Action = Taking action
5. Maintenance = Maintaining a positive behavior

Question 8

What are the two categories that Pre-Contemplators fall into?_{<span>94 - 95</span>}

Answer 8

1. I can’t
2. I won’t

Question 9

Why are I won’t Pre-contemplators not willing to change? _{<span>94 - 95</span>}

Answer 9

I won’t

1. They do not believe that they have a problem = Fail to see a need to change.
2. Refuse to acknowledge that they need to change.
3. Resist being changed by others.

Their family and friends may believe otherwise and may be nagging them about it.

Question 10

Why are the I can’t Pre-contemplators not changing? _{<span>94 - 95</span>}

Answer 10

I Can’t

Aware that issues need to be addressed and there is a need to change

Believe that change is too difficult or complicated.

May have tried and failed over and over in the past. They are acutely aware of their barriers and need help to look at the barriers in a positive and possibility minded way so they can learn from them.

Lack confidence to change.

Question 11

What do the I won’t Pre-contemplators need to hear or receive?_{<span>94 - 95</span>}

Answer 11

I Won’t

Need to hear messages that communicate an

1. Understanding of their stage of readiness to change
2. Appreciation of their full autonomy and control of choices

Question 12

What do I can’t Pre-contemplators need to hear?_{<span>94 - 95</span>}

Answer 12

I Can’t

Need to hear/receive

1. Genuine empathy + Unconditional acceptance
2. Ask: Is there an area of health and wellness where you would like to work?

How the coach conveys empathy and unconditional acceptance:

1. Perceptive Reflections: to demonstrate understanding and respect for a client’s emotions and needs
2. Recognize and accept that a client does not intend to change a particular behavior → builds trust and future possibilities.
3. Focus on understanding a client at a deeper level without judgment or fear → supports self-determination.

Question 13

What are the actions that a coach can take with the I Can’t — Precontemplator?_{<span>95 + 96</span>}

Answer 13

I Can’t

1. Acutely aware of their Barriers — Help them look at their barriers in a positive and possibility-minded way so that they can learn from them instead of being overwhelmed by negative emotions and low confidence generated by past failures or large roadblocks.

Help them sort their barriers into those that are:

• Real
• Feel large
• Need to be put aside right now → in the immediate term can lower a client’s resistance level to discussing any change. Time may have to pass before clients see these barriers as manageable.
• Excuses — that can be reframed in new, positive ways
• Those that can be overcome by tapping into the energy of deep autonomous motivation.

1. Ask them if there is an area of health and wellness where they are ready to work right now.
2. Watch for openings that emerge in coaching sessions.
3. Offer genuine empathy + unconditional acceptance.
4. Use Perceptive Reflections

Question 15

What do all pre-contemplators need from the coach?

Both

I can’t + I won’t

Answer 15

Genuine empathy + Unconditional acceptance

How the coach conveys empathy and unconditional acceptance:

1. Perceptive Reflections: to demonstrate understanding and respect for a client’s emotions and needs
2. Recognize and accept that a client does not intend to change a particular behavior → builds trust and future possibilities.
3. Focus on understanding a client at a deeper level without judgment or fear → supports self-determination.

Question 16

Why is it important to take large barriers off the table when someone is in the I can’t mode (Pre-contemplation)?_{<span>96</span>}

Answer 16

I Can’t

Large Barriers

Remove from the table because

This can lower reistance to discussing any change.

Time may need to pass before they feel that the barrier is manageable.

Question 17

What is the time frame of the I May (Contemplation Stage)?_{<span>96 </span>}

Answer 17

Within the next 6 months

Question 18

How may a client present in Contemplation — I May?_{<span>96</span>}

Answer 18

1. Express a fair amount of ambivalence
2. Aware of the benefits of changing and less satisfied with their present health and well-being than precontemplators.
3. Still feel a sense of doubt and put off = procrastinate = delay the change.

Question 19

Chronic Contemplators

Why do people become chronic contemplators? What are they thinking?_{<span>96</span>}

Answer 19

1. Can’t imagine themselves behaving differently and/or
2. Do not know how to change.
3. Still weighing the benefits of change against the efforts of change + balance is pretty even between the effort it will take and the benefits of change.

Benefits of change = Effort to change

Reasons to change = Reasons not to change

Question 20

Contemplators

When are contemplators ready to move to preparation?_{<span>96</span>}

Answer 20

When the reasons to change > reasons to stay the same

Pros > Cons

Question 21

You have been coaching a client who is in contemplation, and you sense an opening for change has occurred. What might you consider? _{<strong>96</strong>}

Answer 21

An Opening has Occurred

1. Explore best experiences with change in the past and positive reasons for behaving a certain way in the future.
2. Focus on past accomplishments, values, and vision –> Help them see how change might benefit them.
3. Help them connect the dots between the changes they seek and the values and hopes for the future they hold. This sets the scene in the larger context and makes the change more meaningful and significant.
4. Help them find their personally compelling motivators to change = Supportive relationships + new reasons to change.
5. Help them identify a clear vision of what they want. This is essential.
6. ​​​Connect them to their strengths and get excited about the possibilities that emerge with change.
7. Examine the upside + downside of change. What are the benefits of change? What is the downside of giving up old behaviors for new healthier behaviors? What barriers are immovable for right now?
8. Support them to identify and accomplish small, realistic investigating and thinking goals to enhance motivation —> Empowers them to be more confident in their ability to change.
9. Benefits of Change.Ask permission before sharing important scientific facts about the benefits of a behavior. Sharing and discussing and discovering and sorting through the benefits of change can become positive and even powerful motivators.
10. Discovery work — Key change strategies

• Increase awareness of compelling reasons to change
• Get client to connect with people who have successfuly made similar changes.

Question 22

Stage Appropriate Goals

What are the stage appropriate goals for the contemplation stage?_{<span>97</span>}

Answer 22

Stage Appropriate Goals

Contemplation Stage

1. Mindset shifts — Reading, thinking, talking, listening, discovering, and deciding — often not doing the actual behavior.
2. Nike Approach — Just do it!
3. Take Tiny Behavioral Steps = Baby Steps like 5-minute walks, 10-minutes of yoga poses, or an apple a day — while sorting through ambivalence.

​Small successes breed future successes

+

Can increase Self-Efficacy

+

Can improve Readiness to Change

Question 23

I Will = Preparation Stage

When is the client planning to take action?_{<span>97</span>}

Answer 23

Within the next month

Question 24

What is happening to ambivalence when the client is in the Preparation Stage = I will?_{<span>97</span>}

Answer 24

Ambivalence

is largely overcome.

Question 25

When a client reaches the Preparation Stage, what things have happened or are in place?_{<span>97</span>}

Answer 25

Preparation = I Will

Planning to take action within the next month

1. Ambivalent feelings — have been largely overcome.
2. Motivation — has been strengthened. Have one or more motivators.
3. Barriers — know their barriers and have come up with some possible solutions (thinking tasks) that provide some hope for success.

Key. If these thinking tasks, developing strategies to navigate barriers are not accomplished, then clients will likely remain in the contemplation stage.

Question 26

What is essential for the client to achieve before they can move into Preparation = I Will?_{<span>97</span>}

Answer 26

Must Accomplish

Developing Strategies to Navigate Barriers

(Thinking Task)

or

Will Stay in Contemplation.

Key. If these thinking tasks, developing strategies to navigate barriers are not accomplished, then clients will likely remain in the contemplation stage.

Question 27

What task must be present at the start of Preparation for the client to succeed in this stage_{<span>97</span>}?

Answer 27

Barriers*

The client must know their barriers and have done thinking tasks to:

Develop strategies to overcome their barriers

*Key. Having possible strategies/solutions to overcome their barriers provide some hope.

Ambivalence

Largely overcome. Pros of changing > Cons of changing

Motivators

Tapped into deeper motivators — strengthened motivation to change

Question 28

What is the key activity during the Preparation Stage = I Will?_{<span>97</span>}

Answer 28

Clients

Experiment with possible solutions

• Discard the ones that do not work*
• +*
• Think up new approaches*

Question 29

What are the key tasks for coaching in the Preparation Stage = I Will?_{<span>97 - 98</span>}

Answer 29

Key Tasks

Preparation = I Will

1. Experiment with possible solutions. Discard the ones that don’t work. Think up new solutions.
2. Coach supports client to solidify plans for change. Example: Have client write down a formal statement of what they are committing themselves todo, containing specific details of what, when, and how.
3. Brainstorm — to identify the many small steps — as long as they are realistic.
4. If Ambivalence, Resistance, or Fear of Failure, then — Explore Challenges and identify new ways to navigate around the challenges.
5. Prevention Planning — Discuss situations clients think could be problematic when they actually start the behavior and have them develop multiple possible strategies before they begin.

Question 31

How long does the Action Stage = I AM last?_{<span>98</span>}

Answer 31

6 months or longer

Question 32

What are clients working on in the Action Stage = I Am?_{<strong><span>98</span></strong>}

Answer 32

1. Building new relationships
2. Practicing new behaviors
3. Establishing new habits

Question 33

1. When coaching a client in the Action Stage = I AM on a particular behavior, what actions does the coach do?_{<span>98</span>}

Answer 33

Coaching Topics and/or Tasks Include

Helping/Supporting the Client to

1. Keep their strengths and values at the top of their minds to get on and stay on track.
2. Engage social connections or develop new relationships with people who share their interests and behavioral goals. The more modes of support they identify, the better.
3. Prevention Planning: Anticipate situations that could be problematic and encourage clients to develop multiple possible strategies to handle these situations before they arise.
4. Lapses — Anticipate and be prepared for lapses in behavior. Reframe lapses as temporary setbacks. These are important learning opportunities rather than failures.
5. Consider a planned lapse — as a way to develop new mental skills, perspective, and resilience in a controlled situation. Example: Plan to go a day without exercise or skip a meal or eat anything you want.
6. Discuss learning from setbacks and reframe setbacks as sources of valuable learning.
7. Be a role model to the client.

Question 34

There is a high risk of returning to Preparation in the Action Stage = I AM due to setbacks/lapses. What might you do, as a coach, to prevent this from happening?_{<strong><span>99</span></strong>}

Answer 34

Have discussions with the client to

• Process learning from setbacks
• Reframe setbacks as sources of valuable learning

These situations allow you to explore a client’s ___________. These are learning opportunities.

• Response to the situation
• Perceived loss of control
• Help or hindrance of social connections

Be a role model. Be supportive.

Help the client develop a supportive network.

Question 35

When is a client in the Maintenance Stage = I Still Am?_{<span>99</span>}

Answer 35

The new behavior change has become a habit and is done automatically —

usually at least six months after the initial behavior has changed.

Question 36

What are the behaviors do we see clients doing when they reach the

Maintenance Stage = I Still Am?_{<span>99</span>}

Answer 36

Reach Maintenance Stage = I Still AM

Client Behaviors

1. Confident that they can maintain the new behavior. Confidence Level = 8 or 9 out of 10.
2. Self-efficacy is high and self-reinforcing.

Question 37

Ture or False. Once a client has reached maintenance, they can relax and stop working diligently to maintain the new behavior and prevent relapse.

Answer 37

False.

Question 38

What are the risks in the Maintenance Stage = I Still Am?_{<span>99</span>}

Answer 38

Maintenance Stage = I Still AM

Risks

1. Boredom.
2. Danger of gradually slipping back into old, less healthful habits.
3. Lapses
4. Relapses

Question 39

Lapses

What is a lapse?

In what stage(s) do lapses occur?_{<span>99</span>}

Answer 39

Lapse

A time when the client temporarily abandons new behaviors.

Lapses can occur during the Action or Maintenance Stages.

Question 40

What is the impact of a lapse in the Maintenance Stage = I Still Am?_{<span>99</span>}

What is the impact or risk of a lapse in the Action Stage = I Am?98 - 99

Answer 40

Maintenance Stage + I Still Am

Lapses — Impact of

1. Clients often need assistance to set new goals and get refocused. They might benefit from signing up for an event related to the goal, take up a new type of exercise, try a new but related skill, or help others who are just getting started.
2. Getting refocused can be easier in Maintenance because the client’s have already come to experience the value and benefits of their new behavioral patterns.
3. People can quickly get back on track — Do not produce any significant alteration in health and fitness benefits of the behavior change.
4. Learning to make adjustments to get back on track = Sign of being in the Maintenance Stage.

Action Stage = I Am

Risks

1. The risks of relapse into the Preparation Stage is greater here.
2. Clients have not had the experience of Lapsing and then moving out of it.

Question 41

What are the tasks of the coach to prepare a client in the Action Stage = I AM for lapses? That is, what does a coach do to prepare a client for a lapse?_{<span> 98</span>}

Answer 41

Action Stage = I Am

Preparation for Lapses

1. Reframe Lapses as temporary setbacks.
2. Plan a Lapse — to develop new mental skills, perspective, and resilience in a controlled situation. Example: A day without exercise, skip a meal, or have a day where she can eat anything all day long.
3. Discuss the Lapse or Planned Lapse:

• ​Process the learning from setbacks
• Reframe setbacks as sources of valuable learning
• Explore the Client’s
  
  • Response to the situation
  • Their perceived loss of control
  • The help or hindrance of Social Connections