Understanding of the model (TTM) Flashcards
Draw and label the Transtheoretical model.
Provide an introductory overview of the TTM.
- The Transtheoretical/stages of change model was originally developed in 1982 by Prochaska and DiClemente as a synthesis of 18 therapies to describe the processes involved in eliciting and maintaining behavioural change. The stages of change were devised from an empirical study by Prochaska and DiClemente which looked at a sample of smokers who reported that they used difference change processes at different times.
- It addresses criticisms of previous models that attempted to explain behavioural change (the health belief model, and the theory of planned behaviour), and takes into account that the majority of at risk people are not yet ready to change their behaviour, acknowledging the failure of action-based models/programmes of change.
- Prochaska and DiClemente argued that no single approach could address the complexities of behavioural change, as they were influenced by different factors. They suggested that behaviour change is complex, but it unfolds in a stable sequence of stages, and that people apply different processes of change according to the progress they have made.
Why is it called the Transtheoretical model, and what theories/theorists have influenced it?
- It is called “transtheoretical” as it draws upon works by multiple theorists.
- The TTM is influenced by Freud’s work on defence mechanisms and the reasoning people use to defend their decisions to not want to change their behaviour.
- It is influenced by Skinner’s theories on conditioning, counter conditioning and social learning theory.
- It is influenced by Carl Rogers’ and Bandura’s theories of self-esteem and self-efficacy.
What are the 4 main constructs of the TTM?
1) The sequential stages of change - pre-contemplation, contemplation, preparation and planning, action, maintenance, termination or relapse.
2) The ‘processes of change’ - self-change strategies which people utilise to move through the stages.
3) Decisional balance - weighing up the pros and cons of a particular behaviour which predicts behavioural change.
4) Self-efficacy – the person’s confidence that they can make changes, often in relation to avoid temptation which arises in times of emotional distress/particular social situations or as a result of cravings.
What are the stages of change?
1) Pre-contemplation - not intending or not ready to make any changes to behaviour.
2) Contemplation - considering/thinking about change.
3) Preparation and planning - deciding to change, making small changes.
4) Action - making the change, actively engaging in new behaviour.
5) Maintenance - new behaviour adopted, sustaining the change over time.
6) Termination - previous behaviour terminated.
OR
7) Relapse - return to pre-change behaviour.
What are the characteristics of the pre-contemplation stage?
Pre-contemplation - ‘not ready’ - the person has no intention of changing the behaviour, maybe due to lifestyle choice or a lack of information, or a lack of confidence or self-esteem. The person is typically unmotivated, will resist discussing or thinking about making the change and is not ready for traditional health-promotion interventions. They may also become defensive when encouraged to adopt healthier behaviours.
What are the characteristics of the contemplation stage?
Contemplation - ‘getting ready/thinking about change’. The person expresses an intention to take action within usually six months, but many individuals remain in this stage for up to 2 years or longer. They are aware of both the benefits and costs of making the change and appreciate the positives of behavioural change, however this decisional balance where the pros and cons outweigh each other may keep them at this stage for a very long time - chronic contemplation/ behavioural procrastination. At this point the person is not ready for an intervention which expects immediate action.
What are the characteristics of the preparation stage?
Preparation and planning - the person intends to take action in the immediate future (commonly defined as 30 days). They typically have a plan of action (e.g. contacting a support groups, joining a gym etc.), and have taken some preparatory action/gradual steps to incorporate new behaviour into their everyday life, such as obtaining additional information. At this stage the person is ready for traditional action-based health promotion interventions.
What are the characteristics of the action stage?
Action - at this stage the person has made specified changes to their lifestyle/addressed their health behaviour in the past six months, using active strategies, existing plans as well as developing new plans. This is the stage where the potential for relapse is the highest and where individuals need to put in the most effort to keep the behavioural change as part of their life. Strategies employed to maintain behavioural change include counter-conditioning, which aims to substitute healthy alternatives for unhealthy behaviours, and reinforcement management - increasing the rewards for positive behaviour and decreasing the rewards for negative behaviour.
What are the characteristics of the maintenance stage?
Maintenance - at this stage the person will have successfully changed their behaviour several months ago, and continues to work hard to prevent relapse, confidence increases that they can maintain a new lifestyle. The duration of this phase may be variable e.g. for smoking it is generally defined as 5 years, for alcohol it is defined as lifelong. Individuals need to continue to use reinforcement management and stimulant control to ensure the behavioural change continues, which includes reminders to keep up with the change e.g. for weight management - weighing themselves weekly to make sure they stay within a healthy weight.
What are the characteristics of the termination stage?
Termination - in theory the maintenance stage will lead to a phase in which the person is no longer tempted by their previous health behaviours, and no reversal to former behaviour occurs. The behaviour change is therefore classified as complete, but there may be classic “addiction-transfer”.
How did Prochaska and DiClemente argue/describe how movement through the stages occurs?
- Movement does not always occur in a linear fashion, and the model describes behaviour change as dynamic/cyclical as people often don’t succeed in changing behaviour the first time, e.g. individual may move from preparation then back to contemplation stage many times before moving to action stage. Similarly, individual may move linearly through to maintenance stage then relapse to contemplation stage.
- Movement across the stages is dependent on decisional balance and perceived self-efficacy. (Decisional balance - a cognitive assessment of the relative merits of the pros and cons of a particular behaviour, self-efficacy - the belief in one’s ability to enact behaviour change).
How does decisional balance differ in the stages?
Individuals at different stages of change will weigh up the pros and cons differently, for example, a smoker in pre-contemplation stage will focus more on the negative effects of giving up compared to the positives, e.g. giving up smoking will make me feel anxious/stressed, whereas smokers in the action and maintenance stages will place more importance on the benefits of giving up, such as the positive effects on health, than the negatives.
What are the 10 processes of change?
- *1) Consciousness raising** - increasing information about self and the problem.
- *2) Self-re-evaluation** - assessing how one feels and thinks about oneself with respect to the problem behaviours.
- *3) Self-liberation** - choosing and committing to act or believing in ability to change.
- *4) Counter-conditioning** - substituting alternatives for anxiety related to addictive behaviours.
- *5) Stimulus control** - avoiding or countering stimuli that elicit problem behaviours.
- *6) Reinforcement management** - rewarding oneself or being rewarded by others for making changes.
- *7) Helping relationships** - being open and trusting about problems with people who care.
- *8) Emotional arousal** - experiencing and expressing feelings about one’s problems and solutions.
- *9) Environmental re-evaluation** - assessing how one’s problems affect the personal and physical environment.
- *10) Social liberation** - increasing alternatives for non-probme behaviours available in society.
