An Overview of Prochaska and DiClemente’s

Stages of Change Model

Developed by Catherine Segan

for the Victorian Smoking and Health Program

September, 1999

The Victorian Smoking and Health Program is a joint initiative of the Anti-Cancer Council of Victoria, the Department of Human Services, the National Heart Foundation and the Victorian Health Promotion Foundation. The Quit logo is a registered trademark of the Anti-Cancer Council of Victoria.

Key Features of the Stages of Change Model

• Deals with intentional behaviour change

• Views change as a process rather than an event

• The change process is characterised by a series of stages of change

• In attempting to change a behaviour a person typically cycles through these stages of change

What are the Stages of Change?

The stages describe a person’s motivational readiness or progress towards modifying the problem behaviour

Precontemplation: not considering quitting in the next 6 months

Contemplation: seriously considering quitting in the next 6 months

What are the Stages of Change? (Cont’d)

Preparation: planning to quit in the next 30 days

Action: the first 6 months of staying quit

Maintenance: quit for more than 6 months

Relapse: transition to an earlier stage

Maintenance Relapse

ContemplationAction

Preparation

Termination

Precontemplation

Figure 1: Prochaska and DiClemente’s Wheel of Change

Figure 2. Spiral of change

From Prochaska, DiClemente & Norcross, 1992, p1104

What helps people move forward through the Stages of Change?

• Processes of Change

• Decisional balance

• Self-efficacy

10 Processes of Change

• Coping activities or strategies used by people in their attempts to change

• Each change process is a broad category of coping activities which encompasses multiple techniques, methods and interventions

Two Main Types of Change Processes

Cognitive change processesInvolve changes in the way people think and feel about their smoking

Behavioural change processesInvolve people making changes to their smoking behaviour

5 Cognitive ProcessesConsciousness raisingIncreasing information about yourself and smoking

e.g. - thinking about health effects of smoking- a doctor asking whether you smoke- thinking about how you’re running out of breath- reading the Quit book- watching the Quit TV ads

5 Cognitive Processes

Dramatic reliefExperiencing strong emotional reactions to events associated with smoking

e.g. -deciding to do something about your smoking after your grand mother is diagnosed with lung cancer

-seeing the effect of blowing smoke through a white handkerchief

5 Cognitive Processes (Cont’d)

Environmental reevaluationBecoming aware of the impact of the problem behaviour on others

e.g. - thinking about the effects of smoking around the kids- noticing cigarette butts on the street

5 Cognitive Processes (Cont’d)

Self-reevaluationAffective and cognitive reexperiencing of one’s self and problems

e.g. - thinking that you’re no longer happy being a smoker- imagining yourself as a non-smoker

5 Cognitive Processes (Cont’d)

Social liberationNoticing and using social conditions that support personal changes

e.g. - noticing the non-smoking areas around you- joining a quit smoking course

5 Behavioural Processes

Self-liberationBelief in your ability to change and commitment to act on that belief

e.g. - telling yourself that you can quit smoking- setting a quit day- telling others you’re quitting

5 Behavioural Processes (Cont’d)

Helping relationshipsTrusting others and accepting their support in quitting

e.g. - asking a friend who used to smoke for help

- calling the Quitline

5 Behavioural Processes (Cont’d)

Counter conditioningReplacing smoking with more positive behaviours and experiences

e.g. - “Do something else”

5 Behavioural Processes (Cont’d)

Reinforcement managementRewards for staying quit

e.g. - the family showering you with praise- buying yourself a magazine, CD,

flowers- telling yourself how wonderful you are

5 Behavioural Processes (Cont’d)

Stimulus controlAvoiding or countering stimuli that elicit the problem behaviour

e.g. - cleaning up ashtrays before your quit day - not going to the pub the day after you quit- putting up no smoking signs

Relationship between Processes and Stages of Change

Cognitive change processes help people to move through the early stages of change

i.e. from not thinking about quitting to deciding to quit

Behavioural change processes help people to move through the later stages of change

i.e. from making a quit attempt to staying quit

Decisional Balance

• Decisional balance is the importance a person gives to the perceived advantages (pros) and disadvantages (cons) of smoking, and of quitting

• An individual’s motivation to change is affected by his/her decisional balance

Decisional Balance (Cont’d)

• Decisional balance changes across the stages of change

• Use of cognitive change processes can help tip the decisional balance in favour of quitting

Figure 3. Decisional Balance Across the Stages of Change From Prochaska, Velicer, Rossi et al. 1994 pg.43

Self-efficacy• Self-efficacy is a person’s confidence in his/her ability

to quit, and to resist temptations

• Confidence to resist temptations to smoke varies across the stages of change, being lowest in Precontemplation and highest in Maintenance

• Self-efficacy is a strong predictor of success in the Action and Maintenance stages

How is the Model Useful?

• Provides a framework for understanding the process of how people change

• Recognises that people in different stages of change need different types of interventions to help them progress.

• Quit Victoria has developed goals and strategies for counselling clients at each of the stages of change

References

• Prochaska, J.O., DiClemente, C.C. & Norcross, J.C. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47(9), 1102-1114.

• Prochaska, J.O., Velicer, W.F., Rossi, J.S., Goldstein, M.G., Marcus, B.H., Rakowski, W., Fiore, C., Harlow, L.L., Redding, C.A., Rosenbloom, D., & Rossi, S.R. (1994). Stages of change and decisional balance for twelve problem behaviors. Health

Psychology, 13(1), 39-46.