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Curr Top Neurol Psychiatr Relat Discip. Vol 19, No. 1, March 2011
Kolundija K. et al..
INTRODUCTION
The Transtheoretical Model of Behavior Change
is an integrative and multidimensional framework
for understanding how people decide to change
and how they act on and maintain change. The
model was developed in the late eighties of the
last century as a result of integration of the leading psychotherapeutic systems. Authors credited
with the development of the model are Prochaska,
DiClemente, Norcross, and Velicer. The core constructs of the model include processes of change,
stages of change, decisional balance and self-efficacy, and resistance to temptation. Change is defined as the relationship between the core constructs (1, 2, 3).
PROCESSES OF CHANGE
Processes of change are covert or overt activities or experience that help people change their
thoughts, feelings, behaviors, or relationships (1,
3, 4). Each of the processes is a wide category that
encompasses various techniques, methods and interventions used to make a change in a counseling session, in between the sessions, as well as outside the counseling process. On the basis of a great
number of empirical tests and factorial analyses,
the following list of ten basic processes has been
defined:
Consciousness raising encompasses interventions or activities aimed at raising the clients consciousness about the problem, its causes, consequences and possible ways of overcoming it. It includes interventions such as interpretation, clarification, confrontation, education, feedback, bibliotherapy, media campaigns, etc.
Dramatic relief refers to techniques that enable
the client to feel and express emotions associated
with the problem and its solution, which leads to
lightening the emotional load. It includes psychodrama, visualization, role-playing, and grieving.
Self-reevaluation combines cognitive and affective assessments of ones self-image in relation to
both the problem behavior and the new behavior.
It includes various rational emotive behavior ther-
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Kolundija K. et al.
STAGES OF CHANGE
By postulating the processes of change, the authors of the Transtheoretical Model answered the
question how a change in thinking, feeling or behavior is encouraged and carried out. However, it
was early recognized that in order to discover the
structure of behavior change it is necessary to answer when the change takes place, which resulted in the conceptualization of the stages of change
as a temporal dimension of the model. Time is
the very construct that makes the Transtheoretical Model unique, since no other relevant therapeutic system includes a construct that represents time. In contrast to the previous definitions
of change as an event, the Transtheoretical Model defines change as a process, a phenomenon that
takes place in a period of time and involves progress through a series of five stages. The stages of
change entail a specific constellation of attitudes,
intentions and behaviors related to ones readiness
to change, change being a phenomenon that develops over time (1). Each of the stages is not only
a period, but also a set of specific tasks necessary
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Curr Top Neurol Psychiatr Relat Discip. Vol 19, No. 1, March 2011
Kolundija K. et al.
DECISIONAL BALANCE
Decisional balance is a concept originally developed within the conflict model of decision-making by Janis and Mann (10). According to the
model, decision making involves constant and
careful weighing of the pros and cons of a new behavior (10, 11)
By analyzing the association between decisional
balance and the stages of change, researchers have
concluded that the two constructs have a characteristic relationship (10). Anticipated benefits related to changing a problem behavior or adopting
a new one are low in the early stages and as they
increase, progress to the next stage is made. Conversely, the cons are high in the early stages and
decrease in the later stages.
SELF-EFFICACY/TEMPTATIONS
The self-efficacy construct, adapted from Banduras self-efficacy theory (12), is frequently used in
the Transtheoretical Model, either independently or together with the temptation measure, in order to better describe a behavioral change. The
self-efficacy measure represents the situation-specific confidence that people have that they can
cope with high-risk situations without relapsing
to their old, unhealthy or high-risk habit. The situational temptation measure reflects the intensity of urges to engage in the problem behavior that
is being changed. Self-efficacy and temptations are
usually negatively correlated. However, this is not
a rule, since these two are not mirror images (5).
During therapy, the client may be strongly tempted to relapse in certain situations and simultaneously be convinced in own ability to avoid relapse.
Their relationship with the stages of change shows
a specific pattern, with self-efficacy being the lowest in the early stages and increasing as the client
progresses toward the maintenance stage, whereas
with temptations the converse applies (13).
CONCLUSION
The Transtheoretical Model of Behavior Change
provides a new perspective on human motivation,
facilitates assessment of ones readiness to change,
and harmonizes therapeutic interventions with
the clients stage of change. The latter is important
since people seeking professional help present in
various stages of change. Action-oriented treatments may be efficient for people in the preparation and action stages, whereas the same programs
may be harmful for those in the precontemplation
and contemplation stages. The Transtheoretical
Model offers a global concept of change and encourages creation of new approaches in the treatment of various problem behaviors.
REFERENCES
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Thomson Brooks/Cole; 2006.
2. Prochaska J, Johnson S, Lee P. The Transtheoretical Model of Behavior Change. In: Schron
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Prochaska J, Velicer W, DiClemente C, Fawa J.
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DiClemente C. Addiction and Change: How
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