The Transtheoretical Model of Behavior Change

Cynthia MH Bane, Ph.D.Professor of Psychology

Wartburg College

http://www.cdc.gov/tobacco/data_statistics/sgr/2010/clinician_sheet/pdfs/clinician.pdf

Transtheoretical Model of Behavior Change(TTM)

• Development of the Model

• Underlying Assumptions

• Elements of the Model• Stages of Change• Decisional Balance• Self-Efficacy/Temptations• Processes of Change

• Questions/Comments

Development of the Transtheoretical Model

• First proposed in 1983

• Followed individuals who were attempting to quit smoking

• Created TTM using concepts from multiple models of psychotherapy

• The TTM has been applied to many health-related behaviors

Prochaska DiClemente

Primary Assumptions

• Important to consider the process of change over time

• Necessary to tailor messages and interventions to match patient’s level of readiness to change

Stages of Change

Stages of Change

Precontemplation

• Not ready

• No intention to take action in the forseeable future (6 months)

Contemplation

• Getting ready to change

• Intends to take action in the forseeable future• Within the next 6 months

• Ambivalent about change

Preparation: Ready to Change• Intends to take action in the next 30 days• Typically have taken some action in the past year• Have a plan

Action

• Has made an overt modification in lifestyle

• Is meeting behavioral criterion• 6 months or less• High risk for relapse/recycling

Maintenance

• Has maintained behavior change for more than 6 months

• Still at risk for relapse

Recycling

• Returning to a previous stage

Termination

• Might be possible for some behaviors

• Individual has zero temptation & total self-efficacy

Stages of Change

PCPAM

Decisional BalanceThe Pros and Cons of Changing

Decisional Balance

• Pros & cons of changing

• Roughly equal during contemplation

• Important to address both

PROSCONS

Self-EfficacyConfidence in Specific Situations

Self-Efficacy

• Confidence in maintaining desired behavior in specific situations that often trigger relapse

• Temptations to return to problem behavior

Processes of ChangeTailoring Messages and Interventions to Match

Stage of Readiness to Change

Stages of Change & Processes of Change

• Precontemplation• Contemplation

• Preparation• Action• Maintenance

Cognitive & experientialprocesses

Behavioralprocesses

Cognitive & experiential processescontinue to be relevant

Processes of Change: Experiential• Consciousness Raising

• Dramatic Relief

• Self-Re-evaluation

• Increasing information about self & a behavior• Experiencing & expressing feelings about a behavior (“wake-up call”)

• Assessing how behavior fits with one’s goals and values

Processes of Change: Experiential• Environmental Re-Evaluation

• Social Liberation

• Assessing how one’s behaviors affect the environment• Noticing increasing alternatives to the undesirable behavior in society

Processes of Change: Behavioral• Self-Liberation

• Stimulus Control

• Making a choice & committing to change

• Avoiding cues that elicit the undesirable behavior• Adding cues that elicit desirable behavior

Processes of Change: Behavioral• Counterconditioning

• Reinforcement Management

• Substituting new alternative behaviors for undesirable behavior

• Rewards for positive change• Reward small steps• Rewards should be meaningful

Helping Relationships

• Support without nagging

Transtheoretical Model

Pre-contemplation

Contemplation Preparation Action Maintenance

Consciousness RaisingDramatic ReliefSelf-reevaluationEnvironmental Re-evaluationSocial liberation

Consciousness RaisingDramatic ReliefSelf-reevaluationEnvironmental Re-evaluationSocial liberation

Self-Liberation

Plans for behavioral processes

Stimulus ControlCounterconditioningReinforcement Management

Stimulus ControlCounter conditioningReinforcement management

Self-Efficacy

Pros

Cons

Which Process(es)? Which Stage?• From “Finding Your Way to a Healthier You: Based on the Dietary Guidelines for

Americans” (US Department of Health and Human Services, 2013)

• DON’T GIVE IN WHEN YOU EAT OUT AND ARE ON THE GO. It’s important to make smart food choices and watch portion sizes wherever you are—at the grocery store, at work, in your favorite restaurant, or running errands.

• Try these tips:• In a restaurant, opt for steamed, grilled, or broiled dishes instead of those that are

fried or sautéed. • On a long commute or shopping trip, pack some fresh fruit, cut-up vegetables,

string cheese sticks, or a handful of unsalted nuts—to help you avoid impulsive, less healthful snack choices.

Which Process(es)? Which Stage?• From “Blood Sugar Testing: The Power to Control Diabetes is in Your

Hands” (NIH Publication Number 00-4849)

• Why should I control my diabetes? • To feel better and stay healthy. Ask your doctor or health care

provider if regular blood sugar testing is right for you. Lowering your blood sugar by any amount reduces your chances of having eye, kidney, and nerve problems. You can avoid these problems when you control your diabetes.

Which Process(es)? Which Stage?• From “Healthy Eating & Physical Activity across Your Lifespan: Tips

for Adults” (NIH Publication No. 08-4992)

• To keep a food diary, write down all the food you eat in a day. Also write down the time you eat and your feelings at the time. Writing down your feelings may help you identify your eating triggers. For example, you may notice that you sometimes overeat when you are in a big group, simply because everyone around you is eating. The next time you find yourself in this situation, be mindful of that eating trigger and try to limit your portion sizes.

Transtheoretical ModelPre-

contemplationContemplation Preparation Action Maintenance

Consciousness RaisingDramatic ReliefSelf-reevaluationEnvironmental Re-evaluationSocial liberation

Consciousness RaisingDramatic ReliefSelf-reevaluationEnvironmental Re-evaluationSocial liberation

Self-LiberationPlans for behavioral processes

Stimulus ControlCounterconditioningReinforcement Management

Stimulus ControlCounter conditioningReinforcement management

Self-Efficacy

Pros

Cons