Transtheoretical Model Of Change Flashcards
Five stages of change
- Pre contemplation
- Contemplation
- Preparation
- Action
- Maintenance/relapse prevention
Each stage contains two processes
- Decisional balance: strike balance between where they are and how motivated they are to move forward
- Self-efficacy/situational temptation judgements: how confident that they can resist temptation/avoid or navigate situations and move forward
Pre contemplation
- no intention to take action in foreseeable future
- don’t realize there is a problem
- don’t contemplate doing anything
- lazy, don’t want to do anything or
- don’t believe they can do anything or
- have attempted before and failed
- oblivious to impact of behavior or
- demoralized from previous attempts
Client in Precontemplation
Doesn’t try
Cons for changing are high, Pros are low
There due to family pressure, ultimatum, court mandate. Typically not voluntary
Contemplation
- intend to make change within next six months
- sees reason to engage but not quite ready to do it
- Recognizes advantages and aware of disadvantages
- ambivalent
Client in contemplation
- ambivalent
- “yeah, but…”
- know there is a problem, referred, compliant
- not necessarily up for a lot of work
- biggest challenge: not motivated to work on problem, challenger to get into next stage
Preparation
- ready to initiate change in next month
- many clients arrive at this point
- rudiment plan of action (usually therapy)
- pros for change are slightly higher than cons
Client in preparation
Eager to make change Disappointed w setbacks and challenges Frustration w slow progress Cons may be bigger than anticipated Risk-matching enthusiasm, eagerness, challenge too much/too lofty goals, slip back into contemplation
Action
- bolster self-efficacy*
- actively involved in provided interventions
- good balance of challenge, recognizable success; support, validation, progress making
- Doing good work
Purpose of Transtheoretical Model of Change
- Means of conceptualizing change
- Process & different levels of readiness to change
- Can conceptualize individuals or populations
Relapse Prevention Starts in this Phase
Action
- Not fully integrated, might slip up
- Can plateau in action stageget discouraged, lapse
- Go all in on the mistake, cash in; donut example
Role of Therapist in Action Stage
Check in about progress, support, keep on task, keep grounded, normal expectations, recalibrate expectations
Role of Self-Efficacy in Action Stage
- Increase confidence in whatthey can do independently
- Raise scaffolding
Self-efficacy
Belief in ability to do something
Maintenance
- Working to prevent relapse
- Stage sometimes called Relapse Prevention
- Temptation is lessened but typically not eliminated
- Pros of making change outweigh the Cons
Lapse
—deviating from plan
Relapse
—baseline/moving back to different stage
Why is Maintenance so challenging for the clients?
Temptations never entirely goes away
Becomes normal, less excited, abnormal/stressful situations
When therapy goes away, maintenance goes away, easier to slip up
Even while making good progress, may hit plateau
Reinforcement fade > must extend power of maintenance
How can therapists help clients in maintenance stage?
Cuing a memory Regular support of therapy Fading sessions over time Reinforcement fade > must extend power of maintenance Accountability
Decisional Balance
Weighing the pros and cons of changing;
Helps the client recognize/uncover some of the consequences of behavior and of changing
Decision Balance Format
Pros -Gains for self and others -Approval for self and others Cons -Costs to self and others -Disapproval from self and others
Self-Efficacy and Situational Temptation
Measure of confidence clients have in ability to avoid relapse in high-risk situations
Three factors Influence judgment
Negative affect/emotional distress—Bob who stopped smoking until stressful situation in Italy example
Positive social situations–Social situations that encourage the behavior; situation encourages situation
Gained confidence from successfully managing one situaiton
Craving—used to having a cig after each meal
Temptation
cold turkey makes all the harder to resist; moderation reaps greater success
Self-Efficacy/Temptation vary in reasonably predictable ways across stages
Temptation is usually situational and/or induced by stress; consistent cues; usually can be anticipated
When do Self-Efficacy and Temptation shift places?
- Just before or during Action stage
- Shift places, notice more self-control, feel more capable->temptation decreases
- More temptation decreases, more successful one feels
Five processes typically associated with the earlier stages in the model
- Increasing Awareness-increase understanding of problem, increase likelihood they will do something about it
- Emotional Arousal-increase emotion around problem, increase them to take action; rec problem
- Social Reappraisal-recognize impact behavior has on social environments; implications of being a smoker in this environment; how do ppl perceive those who smokes, etc. impact behav has in that way
- Environmental Opportunities-things happen in environment that make change easier e.g. outlaw smoking in bars and restaurants, make change easier
- Self Reappraisal-reappraise what would mean to them
How is knowing these processes useful to therapists?
Intend to take resistant and ambivalent clients from early stages and move into latter three stages
These are things we can do to help move people forward, concrete things we can do to help [people recognize the problem]
Five processes associated with final three stages
- Re-engineering-classical condition, stimulus control; e.g., Client lose weight, clean out junk food from pantry. Not keep at home; control environment
- Supporting-typical therapeutic relationsihp, contin help move forward
- Substituting-counterconditioning, sub neg behavior for more positive behavior; E.g. exchange smoking for drinking and/or sub exercise for addiction use energy for something else
- Rewarding-Premack Principle, move forward using contingency principle
- Committing-making promise to self, therapist, do homeowrk; encouarges to stick to plans; tell someone about behviaor change, sharing creates accountabilitysocial consequence
How do therapists capitalize on these processes?
- Figure out if your intervention is consistent with their stage of change, willingness
- Stronger therapeutic relationship if meet client where they are at
- Clients slip backwards utilize first five processes
