This week we'll return to longstanding theories of change, this time to explain the most cited and relevant scientific model of the process of change: The Transtheoretical Model developed by Prochaska and DiClemente in the late 1970s.
The transtheoretical model states that regardless of outside influences such as new information or peer pressure, people don’t make change until they are personally ready. It also recognises that people learn from each part of their change and use this knowledge to revive previously failed attempts at change or to kickstart new efforts.
We’ll use the smoking example again and this time we'll follow it through with more detail.
Joyce was a 45 year old smoker with 4 children aged between 25 – 35 who, along with their partners, also smoked. Each time any of the children or their partners stopped smoking Joyce would stop with them, only to fall back into the habit shortly afterwards. Joyce stopped smoking at least 8 times over a 15 year period.
During those years, the children gave Joyce grandchildren. She loved spending time with them and became concerned about the news that her smoking was a threat to their health. In addition, the activities she enjoyed the most, like taking the children to the swimming pool or cinema, excluded smokers.
Eventually the grandchildren told Joyce that they didn’t like the smell.
She consulted a pharmacist for help and with the help of nicotine gum and knitting she found she was able to stop for good. Even in the ensuing years when some of her family admitted to secretly smoking, she was confident that she had finally kicked the habit.
Compare this story to the transtheoretical model:
1. Regardless of outside influences such as new information or peer pressure, people don’t make change until they are personally ready. Joyce wasn't ready at the same time as her family.
2. People learn from each part of their change. Joyce knew she could quit, just not how long she could stop for.
3. People use knowledge to revive previously failed attempts at change or to kickstart new efforts. Joyce had a wealth of quitting knowledge she could draw on when she was finally ready.
It’s clear to see how this fits with our aim to sharpen our change-making skills.
This model includes 6 stages of change:
Precontemplation: where people have no intention of changing their behaviour and believe the effort required to make the change as being worse than the benefit. Picture Joyce smoking quite happily without considering ever quitting.
Contemplation: where people think there may be equal advantage to making or not making change. People at this stage may become more aware of poor habits and more thoughtful about the positive aspects of making a change. This stage will not necessarily lead to action. At this point, some of Joyce’s family may be thinking of stopping smoking and she feels she would like to support them.
Preparation: people start to take small steps toward the behaviour change, and they believe changing their behaviour can lead to a healthier life. Joyce may try to cut down on her smoking or buy a lighter brand of cigarettes.
Action: this is where people have recently changed their behaviour and intend to continue by either limiting their poor health habits or seeking to start good health habits. One of Joyce’s many, many attempts to stop.
Maintenance: those who have taken action previously work hard to maintain their change and take further efforts not to slide back into poor health habits. This could be either an occasion where Joyce has quit for a long period of time or her last and fully successful attempt which leads to a smoke free life.
Termination: people have no desire to return to their unhealthy behaviours and are confident they will not relapse. When considering addiction such as smoking or alcohol abuse, few will reach this stage and most people will remain at the maintenance stage indefinitely. Joyce was fortunate enough to reach this point even though some of her family continued to occasionally smoke.
Prochaska and DiClimente theorise that people use a variety of different thinking and support methods throughout the life cycle of each change undertaken. While reading these through, consider Joyce's feelings at each stage and see if you can find a situation where you can draw on personal experience. Joyce used many of these in her journey to change. These include:
Becoming more aware of the healthy habit or change: Joyce listened to her children when they told her that smoking was unhealthy.
Experiencing stronger emotions about a poor health habit. Interestingly enough, during the contemplation stage this can be both for or against: Joyce became concerned for her health and the health of her family.
Realising this healthy habit is preferable to the previous bad habit: Joyce’s grandchildren preferred a smoke free environment.
Considering the effects of their poor health habit on other people: Joyce was worried that her grandchildren would inhale second hand smoke.
Paying attention to ways in which the world in general supports the healthier habit: Over time, smoking became less tolerated in public spaces so Joyce could not smoke at the cinema.
Believing that a change is manageable for them: previous attempts gave Joyce more confidence to quit.
Seeking people to support with this change: Joyce asked her pharmacist to help
Swapping out poor health habits with alternatives: Joyce used gum to kick the cravings and kept her hands busy with her knitting.
Rewarding themselves for good health habits and paying less attention to the perceived rewards of the poor health habit: as Joyce’s lifestyle was child centred she found herself less in smokey situations.
Changing their environment to remove anything which could lead back to the poor health habit: for Joyce this happened naturally as her family grew.
Many of these thought processes have been discussed already in the previous blog posts.
Understanding the many procedures involved in Joyce’s change illustrates why good planning is essential to move smoothly from the preparation to the action stage. Planning could have bypassed all Joyce’s failed attempts and let her focus on all the benefits of stopping smoking.
Our goal is to remain for long enough in the maintenance stage that it becomes our new norm and our old habits seem unattractive. By taking time to plan our expected habit change we can anticipate many of these steps, be clear about the reasons for our efforts and smooth our path to easier and longer lasting change. Note how Joyce was able to stop smoking on countless occasions. Her willpower never waned in the short term however the preparation and planning that would have let her reach that maintenance stage never took place because she was helping her family rather than truly doing it for her own health reasons.
Next week we'll look more at willpower and its usefulness as a support for change.