Six-stage model of behaviour change Flashcards
Model proposed by:
Prochaska and DiClemente (1983), who noticed that smokers’ behaviour changed during the time that they were trying to quit.
The model recognises that…
Overcoming addiction doesn’t happen quickly but a cyclical process: client progress through stages but they also return to previous ones, and some stages may even be missed altogether.
First insight.
People who are addicted differ in how ready they are to change their behaviour.
Some are thinking about it, some are already doing something about it and others have decided to do nothing.
Second insight.
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.
Precontemplation.
Not thinking about their addiction-related behaviour in the near future; may be because of denial - person has never considered changing because they don’t believe they have a problem.
May also be due to demotivation - person may have unsuccessfully tried many times, so is now demoralised and doesn’t currently intend to change.
Intervention at stage should focus on helping person to consider the need for change.
Contemplation.
Thinking about making a change to their behaviour in the next 6 months = does not mean they decided to change.
Increasingly aware of the need for change but also aware of costs.
People remain in a chronic state of contemplation for a long time, most useful intervention = to help person finally see pros of overcoming addiction outweigh the cons.
Preparation.
Individual believes benefits are greater than costs, he/she decides to change addiction-related behaviour some time within the next month.
However, have not yet decided exactly how and when to change.
Most useful form of intervention = support in constructing plan or presenting them with some options.
Action.
People at stage have done something to change behaviour in last 6 months.
Action person takes must substantially reduce their risk.
Effective intervention at stage focuses on developing coping skills the client will need to quit and maintain their change of behaviour into the next stage.
Maintenance.
Person maintained some change of behaviour for more than 6 months.
Focus on relapse prevention - avoiding situations where cues might trigger addiction.
Person becomes more confident that abstaining can be continued in longer term because it is becoming way of life.
Aims to help client to apply coping skills they have learned and uses sources of support available to them.
Termination.
Newly acquired behaviours become automatic.
Person no longer returns to addictive behaviours to cope with anxiety, stress, loneliness.
Stage may not be possible or realistic for some people to achieve.
Most appropriate goal for many - to prolong maintenance for as long as they can, accepting relapse = inevitable but providing the person with skills to work through the earlier stages of process quickly.
No intervention required.
Strength.
P: The model views relapse realistically.
E: According to DiClemente et al (2004), ‘relapse is the rule rather than the exception’. The 6-stage model doesn’t view relapse as failure, but as an inevitable aspect of the process of behaviour change. Even so, relapse is a more than just a slip, so the model also takes it seriously and doesn’t understimate its potential to blow change entirely off course.
E: Recovering from addiction may require several attempts to get it right, to make it last, or to reach the maintenance or termination stages.
L: This means the model has face validity with clients and is more acceptable because they can see it is realistic about relapse.
Limitation.
P: There is evidence challenging the model.
E: Taylor et al (2006) conducted a major review for the National Institute for Health and Care Excellence (NICE), analysing 24 reviews and meta-analyses of the 6-stage model.
E: 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 defined stages in behaviour change could not be validated by available data.
L: It suggests that overall research picture is negative, despite optimistic claims made for the model by some.
Strength and Limitation.
P: The model reviews recovery as a dynamic process.
E: Earlier theories have considered recovery from addiction as a single ‘all-or-nothing’ event. In contrast, the 6-stage model emphasises the importance of time, overcoming an addiction such as smoking is a continuing process.
E: This is why the model proposes that behaviour change occurs through 6 stages of varying duration for each person. Although progress through the stages is always in the same order for everyone, there is also recycling backwards to different degrees and stages can be missed out. This suggests that this stage model provides a realistic view of the complex and active nature of recovery from addiction.
P: However, the stages themselves have been criticised for being arbitrary.
E: This means there is no research evidence to distinguish one stage from another. Kraft et al (1999) argues that the 6 stages can be reduced to just 2 useful ones: precontemplation, plus all the others grouped together.
E: This has important implications because according to the model, each stage is matched with a particular type of intervention.
L: This suggests that Prochaska’s stage model has little usefulness both for understanding changes over time and for treatment recommendations.
