Transtheoretical Model

Stages of Change
Prochaska and DiClemente
Introduction
TTM represents major change in how treat
addiction
Provides way of understanding, measuring and
intervening in behavior.
Sees motivation for tx as something that we can
facilitate
Researchers found that most people go through
specific process when changing behaviors.
Broke this process into 6 stages
1. Pre-contemplation
Not currently considering change
What to do:
Accept lack of readiness
Remind them that the decision is theirs
Encourage them to think about their
behavior and the consequences to self and
others
Explain risk, make it specific to them
2. Contemplation
Ambivalent about change
What to do:
Remind them that decision is still theirs
Encourage them to evaluate pros and cons of
behavior change
Identify and promote new, positive changes
in behavior
3. Preparation
Experimenting with change
What to do:
Identify problems
Help with problem solving
Help patient identify social support
Remind patient that they have the skills for
behavior change
Encourage small initial steps
4. Action
Implementing and practicing new behavior
for 3-6 months
What to do:
Focus on social support
Reinforce clients ability to deal with obstacles
Validate feelings of loss and reiterate long-
term benefits
5. Maintenance
Continued commitment to sustaining
new behavior, 6 months to 5 years
What to do:
Plan for follow-up support
Reinforce positive results
Discuss coping with relapse
6. Relapse
Resumes old behaviors
What to do:
Identify triggers for relapse
Reassess motivation and barriers
Implement stronger/more appropriate
coping strategies
10 Processes of Change
Experiential Processes
Internal processes; Perception based
Behavioral Processes
External processes; Action based
Experiential Processes
1. Consciousness raising
Gain knowledge about self and own behavior
2. Dramatic relief
Significant experience related to the problem
3. Self reevaluation
Seeing how current behavior conflicts with values and
goals
4. Environmental reevaluation
Recognizing the effects of own behavior on others
5. Social liberation
Creating alternatives in social environment that promote
change
Behavioral Processes
1.Stimulus control
Avoiding certain cues to prevent engaging in the
behavior
2. Counterconditioning
Substituting healthy behaviors for unhealthy ones
3. Reinforcement management
Rewarding positive behavior changes
4. Self-liberation
Belief in ones ability to change
5. Helping relationships
Relationships that provide support and
acceptance
New Terms
Decisional Balance
Weighing the pros and cons of a behavior
Indicates movement through the stages
Self Efficacy
Sense of how well one can succeed at change
Examines how tempted one is to engage in
problem behavior and how confident one is
that they wont engage in the behavior