Chapter 7 — Readiness to Change Flashcards
Who developed the Transtheoretical Model of Change?
Dr. James O. Prochaska and collaborators
The TTM of behavior change evaluated and measured behavior change for a wide variety of health behaviors. Name 4.<span>93</span>
- Smoking Cessation
- Alcohol
- Exercise adoption
- Mamogram engagement
How is the TTM Model used for self-changers?<span>93</span>
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)
What does the TTM Model offer coaches?<strong><span>93 - 94</span></strong>
TTM Model
- Offers an understand of how and when new behaviors can be adopted and sustained, and
- Why clients may struggle, fail, or quit.
What does the phrase
“Self-change is a staged process,”
mean<span> 94</span>
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
- Pre-Contemplation→
- Contemplation →
- Preparation →
- Action →
- Maintenance →
- Termination →
We do not skip stages.
We can recycle through stages.
We can relapse.
Clients may be in different Stages of Change in different areas and subdomains of health and wellness. Give two examples.<span>94</span>
- 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.
What are the 5 Stages of Change in TTM?<span>94</span>
- Pre-contemplation = Not ready for change
- Contemplation = Thinking about change
- Preparation = Preparing to change
- Action = Taking action
- Maintenance = Maintaining a positive behavior
What are the two categories that Pre-Contemplators fall into?<span>94 - 95</span>
- I can’t
- I won’t
Why are I won’t Pre-contemplators not willing to change? <span>94 - 95</span>
I won’t
- They do not believe that they have a problem = Fail to see a need to change.
- Refuse to acknowledge that they need to change.
- Resist being changed by others.
Their family and friends may believe otherwise and may be nagging them about it.
Why are the I can’t Pre-contemplators not changing? <span>94 - 95</span>
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.
What do the I won’t Pre-contemplators need to hear or receive?<span>94 - 95</span>
I Won’t
Need to hear messages that communicate an
- Understanding of their stage of readiness to change
- Appreciation of their full autonomy and control of choices
What do I can’t Pre-contemplators need to hear?<span>94 - 95</span>
I Can’t
Need to hear/receive
- Genuine empathy + Unconditional acceptance
- Ask: Is there an area of health and wellness where you would like to work?
How the coach conveys empathy and unconditional acceptance:
- Perceptive Reflections: to demonstrate understanding and respect for a client’s emotions and needs
- Recognize and accept that a client does not intend to change a particular behavior → builds trust and future possibilities.
- Focus on understanding a client at a deeper level without judgment or fear → supports self-determination.
What are the actions that a coach can take with the I Can’t — Precontemplator?<span>95 + 96</span>
I Can’t
- 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.
- Ask them if there is an area of health and wellness where they are ready to work right now.
- Watch for openings that emerge in coaching sessions.
- Offer genuine empathy + unconditional acceptance.
- Use Perceptive Reflections
What do all pre-contemplators need from the coach?
Both
I can’t + I won’t
Genuine empathy + Unconditional acceptance
How the coach conveys empathy and unconditional acceptance:
- Perceptive Reflections: to demonstrate understanding and respect for a client’s emotions and needs
- Recognize and accept that a client does not intend to change a particular behavior → builds trust and future possibilities.
- Focus on understanding a client at a deeper level without judgment or fear → supports self-determination.
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>
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.
What is the time frame of the I May (Contemplation Stage)?<span>96 </span>
Within the next 6 months
How may a client present in Contemplation — I May?<span>96</span>
- Express a fair amount of ambivalence
- Aware of the benefits of changing and less satisfied with their present health and well-being than precontemplators.
- Still feel a sense of doubt and put off = procrastinate = delay the change.
Chronic Contemplators
Why do people become chronic contemplators? What are they thinking?<span>96</span>
- Can’t imagine themselves behaving differently and/or
- Do not know how to change.
- 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
Contemplators
When are contemplators ready to move to preparation?<span>96</span>
When the reasons to change > reasons to stay the same
Pros > Cons
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>
An Opening has Occurred
- Explore best experiences with change in the past and positive reasons for behaving a certain way in the future.
- Focus on past accomplishments, values, and vision –> Help them see how change might benefit them.
- 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.
- Help them find their personally compelling motivators to change = Supportive relationships + new reasons to change.
- Help them identify a clear vision of what they want. This is essential.
- Connect them to their strengths and get excited about the possibilities that emerge with change.
- 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?
- 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.
- 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.
- Discovery work — Key change strategies
- Increase awareness of compelling reasons to change
- Get client to connect with people who have successfuly made similar changes.
Stage Appropriate Goals
What are the stage appropriate goals for the contemplation stage?<span>97</span>
Stage Appropriate Goals
Contemplation Stage
- Mindset shifts — Reading, thinking, talking, listening, discovering, and deciding — often not doing the actual behavior.
- Nike Approach — Just do it!
- 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
I Will = Preparation Stage
When is the client planning to take action?<span>97</span>
Within the next month
What is happening to ambivalence when the client is in the Preparation Stage = I will?<span>97</span>
Ambivalence
is largely overcome.