Stages of Change

Prochaska and DiClemente's (1982) transtheoretical model of behaviour change is a way of understanding an individual's readiness for making behavioural change. The model is helpful for conceptualizing the mental states of individuals at different stages of their change journey and tailoring treatment accordingly. The Stages of Change model below illustrates the stages of this model (precontemplation, contemplation, preparation, action, maintenance). 

While many people will experience a relapse, it is possible for a person to sustain change at the maintenance phase. By using this model the therapist can normalise relapse. When someone relapses it is important to help them to pick up the change process at the preparation, action or maintenance phase rather than going all the way back to pre-contemplative or contemplative phase. 

The person learns from each relapse every time they move through the cycle, and (hopefully) grows stronger so the relapse is shorter and less distressing. 

Stages of Change

Pre-contemplation

• Characteristics

• • No intention of changing behaviour.

  • Denial/lack of awareness that there is a problem: "Weight is not a concern for me" 

• Goals

• • Help the individual develop a reason for changing

  • Validate the individual’s experience 

  • Encourage further self- exploration 

  • Leave the door open for future conversations 

• Techniques

• • Validate lack of readiness 

  • Clarify that the decision is theirs 

  • Explain and personalize the risk 

  • Explore potential concerns and re- evaluation of current behaviour 

  • Encourage possibility of change 

• Useful Scripts

• • "I can understand why you feel that way" 

  • “I know you’re an adult and you will be the one to decide if and when you’re ready to gain weight” 

  • “I believe, based on my training and experience that this weight loss is putting you at risk for physical and psychological complications” 

  • “Has your weight loss ever caused you a problem?” 

  • “Everyone who’s addressed an eating issue starts where you are now, by seeing reasons why weight gain might be beneficial to your health and wellbeing.” 

Contemplation

• Characteristics

• • Awareness of problem 

  • Willing to think about change 

  • Ambivalent about change within the next month: ‘Sitting on the fence’ 

• Goals

• • Validate the individual’s experience 

  • Encourage evaluation of pros and cons of change 

  • Encourage further self- exploration 

  • Identify and promote new positive outcome expectations 

• Techniques

• • Validate lack of readiness 

  • Encourage evaluation of pros and cons of change 

  • Encourage further self-exploration 

  • Leave the door open for future conversations 

• Useful Scripts

• • "I ‘m hearing you’re thinking about weight gain but are not ready to take action now” 

  • “What is one benefit of gaining weight? What is one drawback of gaining weight?”

  • “Can you have a think about these questions at home and talk to me about it at our next visit?” 

  • “If you feel you’d like to make some changes, we can begin some preparation work” 

Preparation

• Characteristics

• • The individual has had some experience with change: ‘Testing the waters’ 

  • Planning to take action to change within the next month 

• Goals

• • Praise the decision to change behaviour 

  • Prioritize behaviour change opportunities

  • Identify and assist in problem solving 

  • Encourage small initial steps 

  • Encourage identification of social supports 

• Techniques

• • Praise the decision to change 

  • Prioritize behaviour change opportunities 

  • Identify obstacles 

  • Encourage small initial steps with a focus on building self-efficacy for change

  • Identify social support 

• Useful Scripts

• • "It’s great you feel good about your decision to make some changes” 

  • “Looking at your eating habits, I think a benefit could come from switching from non- fat milk to whole milk” 

  • “What kind of problems would you expect? How might you deal with them?” 

  • “Which family members or friends can support you as you make this change? How can they support?” 

Action

• Characteristics

• • Actively attempting to change behaviour 

  • These behaviours changes may occur over a 3-6 month period

• Goals

• • Validate all efforts at behaviour change 

  • Focus on restructuring behavioural cues and social situations supportive of the change process 

  • Bolster self-efficacy for dealing with obstacles 

  • Combat feelings of loss 

• Techniques

• • Restructure cues and social support 

  • Bolster self-efficacy for dealing with obstacles, normalise trial and error during the action phase 

  • Reiterate long-term benefits 

  • Acknowledge any distress relating to loss associated with change, and work collaboratively to see if there is an alternative way to meet that need in recovery 

• Useful Scripts

• • "Have you successfully altered the behaviour for 1 day to 6 months?” 

Maintenance

• Characteristics

• • Continued commitment to sustaining new behaviour 

  • New behaviours replace old ones 

  • Post 6 months to 5 years 

• Goals

• • Validate progress so far and the potential for sustained change 

  • Plan for follow-up support Reinforce internal rewards 

  • Discuss the potential for relapse as a normal part of the change process and make a plan to address relapse situations and feelings around relapse 

• Techniques

• • Plan follow-up support

  • Reinforce internal rewards 

  • Actively discuss high risk scenarios for slips or relapses 

  • Discuss strategies to respond to and cope with relapse 

• Useful Scripts

• • "Have you maintained change for a period of 6 months or more?” 

Relapse

• Characteristics

• • Fall back into old patterns of behaviour 

• Goals

• • Validate efforts to resume ʻchangedʼ behaviour 

  • Evaluate trigger for relapse – treat the relapse as a learning experience 

  • Reassess motivation and barriers to sustained change 

  • Identify additional coping strategies/support which may be required 

• Techniques

• • Evaluate triggers for relapse 

  • Reassess motivation and barriers 

  • Plan effective coping strategies 

Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research & Practice, 19(3), 276–288. 

 Adapted: UCLA Centre for Human Nutrition: http://www.cellinteractive.com/ucla/physcian_ed/