Transtheoretical model of behavior change

'The Transtheoretical Model of Behavior Change'

Though addiction has long been a significant problem across the world, only recently have studies investigated how individuals are able to make the changes necessary to overcome it. Prochaska, DiClemente, and Norcross (1992) have developed a paradigm to approach this problem, known as the transtheoretical model (TTM) of behavior change. Individuals are able to achieve lasting behavior change without treatment as well as with professional help and it is theorized that there is a similar structure underlying behavior change in general. A wide range of health behaviors have been investigated using this paradigm, including smoking, drinking, eating disorders, and illicit drug use (Belding, Iguchi, & Lamb, 1996; DiClemente, 1990; Etter & Perneger, 1999; Pantalon, Nich, Frankforter, & Carroll, 2002; Prochaska, DiClemente, Velicer, Ginpil, & Norcross, 1985; Prochaska, Norcross, Fowler, Follick, & Abrams, 1992; Prochaska, Velicer, DiClemente, & Fava, 1988; Willoughby and Edens, 1996). There is evidence of a systematic series of phenomena behind successful change of these behaviors.

The TTM has three primary components: stages of change, processes of change, and levels of change (Prochaska, DiClemente, & Norcross, 1992). According to the model, individuals pass through five stages of change when modifying a behavior: precontemplation, contemplation, preparation, action, and maintenance. At first, during precontemplation, the individual does not recognize the behavior as a problem. As the individual begins to realize that the behavior is problematic, he or she moves into the contemplation stage. However, at this point, the individual is not ready to make any changes. When the individual is ready to initiate change in the immediate future, operationalized as within the next month, he or she is said to be in the preparation stage. In the next stage, action, changes are made in the individual’s behavior, experiences, and environment. Finally, during the maintenance stage, the individual works to prevent relapse and endeavors to integrate the changes made during the previous phases into his or her life.

It should be noted, however, that these phases do not follow a simple linear progression. Relapse is a common and expected occurrence in addiction recovery (Gerwe, 2000; Hunt, Barnett, & Branch, 1971; Milkman, Weiner, & Sunderwirth, 1983). Therefore, the stages are seen as a set of dynamically interacting components through which the individual will likely cycle a number of times before achieving sustained behavior change (DiClemente et al., 1991). This is known as the spiral model of the stages of change, which suggests that when an individual regresses to previous stages, he or she does not typically completely fall back to where they started. The individual advances through the stages, making progress and losing ground, learning from mistakes made over time, and using those gains to move forward.

Progress is made through the stages by implementing a series of 10 processes of change, as first identified by Prochaska (1979) in an analysis of different methods of psychotherapy. However, these processes appear to occur in successful change whether it is change aided by professional therapy or not. The advancement through each stage is facilitated by engaging in a particular set of processes; i. e., movement through the stages is facilitated by different processes depending on the given stage (Prochaska, DiClemente, & Norcross, 1992). Therefore, it has been proposed that treatment is most effective when it is tailored to the particular stage of the individual.

For example, a study of a smoking cessation program for cardiac patients found that an intensive action- and maintenance-oriented approach was highly successful for patients in the action stage, but failed with those in the precontemplation and contemplation stages (Ockene, Ockene, & Kristellar, 1988). The amount of progress made in a treatment program tends to be correlated with the patient’s pretreatment state of change (Prochaska & DiClemente, 1992; Prochaska et al., 1992). Unfortunately, treatment programs tend to be action-oriented (Orleans et al., 1988; Schmid, Jeffrey, & Hellerstedt, 1989), even though most addicts are not in the action stage (Abrams, Follick, & Biener, 1988; Gottleib, Galvotti, McCuan, & McAlister, 1990; Prochaska & DiClemente, 1992).