Stages of Change

This fact sheet outlines the stages of behavioural change and how to best work with an individual in each stage.

Stages of Change Model

Prochaska and DiClemente's 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.

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

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

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

Identify social support

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

Reiterate long-term benefits

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

Discuss strategies to cope with relapse

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