In What Stage Of The Transtheoretical Model Does A Person Actively Plan Change

Ch. 3: Theory Integration in the Transtheoretical Model of Behavioral Change

A great bargain of effort both in our course and in inquiry has been directed toward understanding the processes involved in substance utilize initiation and the progression from utilize to misuse and substance employ disorder. At this signal, we examine a model concerned with processes of modify and recovery—moving back from problematic and disordered substance employ into recovery. The model nosotros focus on in this chapter is known as the transtheoretical model of behavior changdue east (the TTM for transtheoretical model, or sometimes the TMBC for the transtheoretical model of behavior change). The model originally emerged in transtheoretical assay of psychotherapies (Prochaska, 1979; Prochaska & DiClemente, 1982) and continued to evolve during the 1980s and 1990s based on inquiry concerning the process of alter in smoking behavior (Prochaska & DiClemente, 1983) and expanded to include other addictive behaviors (Prochaska, DiClemente, & Norcross, 1992). Information technology has been applied across disciplines (social piece of work, psychology, medicine, nursing, physical therapy, occupational therapy, and others) and beyond a wide array of behaviors, including but not limited to individuals making changes in their smoking (tobacco), alcohol use, adhering to a medication or medical treatment regimen, dieting, exercising, safety-sex, and intimate partner violence behaviors.

Use of the word "transtheoretical" in the model proper noun reflects its theoretical inclusiveness and that it integrates and applies across theories. The transtheoretical approach represented an important shift in emphasis abroad from "horse race" research to detect "the winner" amongst intervention options towards identifying mechanisms of change and the elements or factors common across a diverseness of intervention approaches. The TTM's developers distilled from inquiry and clinical ascertainment a set of principles describing behavior change processes and factors that facilitate or pose barriers to achieving modify goals. The TTM identified a series of five stages in the typical cycle of change, common processes involved in intentional behavior change, and implications for intervening to back up individuals' intentional beliefs change efforts.

While yous review the balance of this chapter, consider a specific beliefs that you have wished or tried to modify in the past. Encounter how the model seems to fit your own experience with intentional beliefs alter (something like getting more sleep, drinking more water, using less electricity, praising your partner or kids more than often, spending less money on coffee, stop biting your fingernails, expressing gratitude for small favors others practice for united states—information technology does not have to be well-nigh an addictive behavior).

Stages of Change

Like most stage theories, the TTM identified a serial of progressive stages that are qualitatively distinct from each other. Originally, the TTM specified 4 stages: Precontemplation, Contemplation, Activity, and Maintenance; data reanalysis led to specification of a fifth stage, Preparation, between Contemplation and Activity. An of import difference from many other stage theories is acknowledgement that individuals exercise not move through the stages in a linear "up" fashion but that they oftentimes cycle upwards and downwards through stages as they piece of work to achieve their alter goals (Prochaska, DiClemente, & Norcross, 1992). For instance, a person perhaps kickoff in Precontemplation may progress through some of the other stages, return to prior stages (including back to Precontemplation), and progress again over fourth dimension, and that this cycle may repeat multiple times earlier the desired change goal is ultimately achieved. In enquiry concerning smoking cessation, iii to four Action attempts occurred earlier individuals were able to quit smoking for the long-term (Prochaska, DiClemente, & Norcross, 1992)—in other words, relapsing and falling dorsum to earlier stages is normative, not singular. A determining cistron in how quickly someone is able to again move forward in the process concerns how relapse is handled: if seen as a failed attempt, the person may return to precontemplation and remain there for a lengthy menstruum; if seen as an opportunity to acquire from one's mistakes, identify potential pitfalls and solutions, the person may move more quickly back into action instead. In fact, one criticism of the TTM is that individuals may move betwixt stages then quickly that assessment tools are rendered inaccurate, and that a person may exist situated betwixt stages rather than in a single stage.

Another ascertainment made by the model'due south developers was that what a person learns about irresolute one type of behavior may assist them learn what will or will not help them change a unlike type of behavior. Even so, if someone is concerned about changing two or more behaviors at the same time, the change process for each will nigh likely differ—in other words, a person may exist in i stage for one behavior change endeavor and a different stage for another. Consider, for example, that someone wishes both to quit smoking cigarettes and to quit drinking alcohol to excess. Each of these change attempts, although occurring at the same fourth dimension, will progress on its own trajectory (Velasquez, Crouch, Stephens, & DiClemente, 2016). The individual may move through the cycle more than quickly with 1 behavior compared to the other and may spiral back and forward more times. It is difficult enough to change an addictive beliefs; information technology is far more hard to alter more than than one at a fourth dimension.

The five stages identified in the TTM distinguish between the dissimilar behaviors, attitudes, experiences, and motivations representing each stage.

Precontemplation. The hallmark of Precontemplation is the absence of an intent to modify the identified behavior, at least non in the foreseeable future. This includes individuals who are un- or under-aware of a need to make changes. It also may include someone who wishes they could change just does not seriously intend to brand the changes wished for. This phase likewise may involve resistance to change in response to pressure level from others. For example, if a person is compelled to quit smoking while incarcerated in jail or prison, that individual may only comply equally long equally extrinsic (external) pressure is applied. There may be no intention to extend the modify in beliefs to the post-release period. The kinds of statements endorsed by someone in this stage include denial that a problem exists, that the behavior is non problematic, or that it is "their" business and no ane else'south business—similar the proverbial ostrich with its head cached in the sand. On the other paw, they may engage in blame about the problem ("If I drink likewise much, it is considering yous are ever nagging me") or focus on an inability to change ("I have tried to quit smoking too many times, face it—I am just a failure" or "Information technology is in my genes, I am destined to dice this style.")

Contemplation. A person in the Contemplation stage demonstrates sensation of a trouble and serious consideration of making a change without making a specific alter commitment. Ane feature of the Contemplation stage is the person struggling with the "pros and cons" dilemma—the advantages of making the modify versus the disadvantages. For example, someone might realize the health benefits of changing their rampage drinking and appreciate the corporeality of coin that could be saved by making a change, just at the aforementioned time recognize that they like drinking, would be lonely without binge drinking with "buddies," and that it will take a great deal of effort to make this modify (see discussion of decisional residuum below). An intention to make meaning alter inside the next six months is considered a feature of Contemplation. However, individuals may remain in Contemplation for lengthy periods (despite the "inside six months" intent) without moving further in the process—for two years or more amid a group of participants in a smoking study (Prochaska, DiClemente, & Norcross, 1992). Examples of statements that a person in Contemplation might endorse generally include awareness of a trouble and a desire to make a modify: "I think I may take a problem with my drinking," "I am really starting to feel the furnishings of my smoking when I try to walk upstairs," "I am getting to the point where I can't keep doing this to myself anymore." A person in Contemplation might engage in information-gathering, exploring options for how to brand the desired alter (even looking into formal intervention/handling options), but not actually engage with or commit to whatsoever of them.

Preparation. The Preparation stage extends beyond an intent to change to include early alter behaviors toward the goal of taking serious action inside the next xxx days. They will take prepare a plan in motion, even if non actively engaged in it still, and have prepare a target day/date for the action to brainstorm. For example, the person may enroll in a alter-focused program, identify a specific change strategy or plan, and may begin taking "babe-steps" toward the alter goal. For example, a person preparing to quit smoking may purchase supply of nicotine replacement "patches" or glue, schedule an appointment for prescription smoking cessation medication, register with a smoking cessation plan. In addition, they may break their cigarettes in half to smoke less when they practise smoke and gather together all their "stashed" cigarettes into one, visible drove. They may tell friends and family unit to pass up their requests to "bum" cigarettes and not invite them to share a smoking session.

Activeness. The Activity phase is characterized by a person actively taking very specific, concrete steps to change the target behavior and go along the change momentum going. For a beliefs as complex as quitting drinking, for case, the person may appoint in a host of strategic alternative behaviors: avoiding the people, places, and situations that tempt them to drink; applying strategies for controlling their mood (eastward.thou., mindfulness practices) and stress management (east.yard., exercise); grocery shopping online to avoid impulse booze purchases in the store. Additionally, they may take new ways of rewarding themselves for each positive step taken (e.g., putting money that would have been spent on alcohol into an account toward a positive goal; celebrating their "sobriety birthday" each week, and so month, then year), and reminding themselves of their accomplishments (e.m., journaling their efforts, experiences, and progress). Action is very often the emphasis in handling programs—didactics, training, and practicing the new skills. A person in Activity has specific skills and behaviors to substitute for and manage the onetime, problematic behaviors and they consciously act to implement these new behaviors. Activeness, by definition, lasts for at least vi months and may last much longer for some individuals and some behaviors. Big changes in complex behaviors do not happen overnight. This is a person engaged in multiple, sometimes heroic, activeness efforts as they are fighting to achieve their change goals.

Maintenance. Once a person has engaged in activity behaviors for at least 6 months, they may move into a M aintenance stage—a period of connected vigilance against relapsing to the past behavior. Individuals continue to engage in relapse prevention activities, but information technology differs from the Activeness flow in that the new inverse/alternative behaviors, attitudes, and experiences are becoming routine and experience relatively natural. They require less endeavour to maintain. During maintenance, a person continues to be aware that information technology would accept only one "slip up" action to disengage their difficult work simply takes many daily "non-deportment" to avoid relapse—consistently avoiding temptations and relapse triggers, engaging in competing culling behaviors, and managing temptations and relapse triggers when they practice appear. A person in maintenance is not "cured" as long as there are temptations or craving experiences—the maintenance period may persist for a very long period, possibly indefinitely for some individuals. However, a person who managed to quit smoking cigarettes (for case) may reach a point when there is no longer any desire to pick it upwardly again, none of their old cues trigger a temptation or desire to smoke, and they self-identify equally a non-fume (rather than an ex-smoker), even in periods of stress/distress. At the point where the changed behavior is relatively effortless, the person may be considered to accept moved beyond maintenance.

Relapse. Agreement the modify procedure is incomplete without recognizing what relapse is and how information technology might be addressed. Ideally, we desire to prevent relapse to the "onetime" behavior whenever possible; only as the evidence indicates, relapse happens (may even be a "norm" rather than an exception) and what happens in response to relapse matters very much in the future of a change effort. Showtime, a distinction is made betwixt a recurrence ("slip") and a full-diddled relapse event. A lapse or "slip" is time/event limited—doing it in one case or more times for a brusk period, quickly regretting the lapse, and getting dorsum to renewed action. The circumstances surrounding a lapse can exist effectively used equally a learning feel to strengthen the ongoing modify endeavour for the future. Relapse refers to a return to the former design of behavior with no intention of changing once again—spiraling dorsum to Precontemplation, especially if the person despairs of ever being able to successfully change. A lapse, relapse, or impending relapse can happen at any point in the alter process.

Relapse is a procedure (rather than an event) that starts earlier substance use occurs again—information technology is "a gradual process with distinct stages" (Melemis, 2015). The relapse process may begin days or even months earlier the actual substance apply relapse behavior occurs and can be conceptualized in 3 parts.

• The "emotional" process of relapse is characterized past a lack of emotional, psychological, and physical intendance (Melamis, 2015). This includes basic physical care (diet, sleep, exercise, hygiene), also as emotional and social "care" activities. This contributes to the kinds of negative emotional states involved in substance misuse—stress, tension, restlessness, anxiety, fatigue, irritability, and discontent.
• The "mental" relapse procedure concerns failing cognitive resistance to relapse, increased sensitivity to "utilize" messages, framing past employ more than positively ("glamorizing") and minimizing consequences, entering into bargaining virtually use ("I'll only practice X and nothing more" or "It volition be okay on holiday, just not in my regular life" or "if I stick to beer and avoid "hard" liquor, it will exist okay"), scheming/lying, and actually planning a relapse/looking for relapse opportunities (Melamis, 2015). While occasionally thinking about using substances again is a common experience during recovery, a warning sign is when these thoughts get frequent, detailed/specific, and intrusive/insistent in nature.

• "physical" relapse involves actual substance utilize/misuse—a return to uncontrolled substance utilise. One-fourth dimension substance use may not atomic number 82 to further uncontrolled utilise or it may contribute to the emotional and mental relapse processes that, in turn, lead to concrete relapse. Relapse prevention involves anticipating and addressing all three parts—emotional, mental, and physical—and having in identify plans for identifying/assessing and developing exit strategies for the unlike threats. This probable includes engaging supportive significant others (asking for help from trusted family/friends; participating actively in recovery-oriented or mutual support groups) and engaging in treatment interventions designed specifically around relapse prevention (e.yard., cerebral behavioral interventions and skill building).

Concerted intervention effort might be directed toward relapse prevention, especially during the maintenance phase.

Change Factors

Threaded throughout the modify procedure are a trio of factors: decisional balance, self-efficacy for change, and timing of dissimilar intervention/change promoting strategies.

Decisional balance. Relevant throughout the alter process, but specially in the Precontemplation and Contemplation stages, is the concept of decision al balance . The TTM relates to motivation for engaging in the change process. It recognizes that a person who is motivated to make an intentional beliefs change may also be motivated Not to make the change. There exist costs and benefits on all sides of the decision and a person may run into-saw back up and downwardly as the balance shifts toward or away from making the modify endeavour. There are 4 dimensions of which the person is aware and that have implications for the likelihood of embarking on a modify try:

No t Chang ing	Chang ing
		Pros	Cons
	Pros	ambiguity	no modify
	Cons	yes modify	ambivalence

Decisional rest underlies the ambiguity identified and addressed in motivational interviewing (MI). Eliciting and sustaining motivation for alter often requires addressing ambiguity, not just emphasizing the advantages of changing and disadvantages of not changing the behavior. Decisional balance is specially impactful in the Precontemplation, Contemplation, and Grooming stages, just continues to accept a role across the process.

Self-efficacy for change. Some other cognitive procedure involved in each stage of the intentional behavior change process concerns a person'southward conventionalities that change (or maintaining change) is possible: their self-efficacy for making or sustaining the modify goal. Like The Little Engine that Could, self-efficacy ranges from "I tin't" to "I think I can" to "I know I can" and makes a departure in motivation at all stages of the change procedure. Someone might exist in the Precontemplation stage (no program to change) because they exercise non believe it is possible, despite beingness aware of that their behavior is problematic. This may be because they accept made unsuccessful change attempts in the past and experience it is a hopeless goal. Two strategies for profitable with motivation in this state of affairs are (ane) focus on ways that they have succeeded in the past, including any positive steps they may take fabricated in irresolute this behavior or any other behaviors they may take been able to change in the past, and (two) examining how others about similar themselves have managed the alter procedure. A chat that might elicit self-efficacy involves a "change ruler" whereby a person indicates on a calibration from 1-10 how confident they are in their ability to make the desired alter in a situation of temptation. Rather than focusing on how far from 10 they are, the value lies instead on exploring why the rating is greater than 0—what the person may have going for them.

Intervention timing . Matching intervention strategies to "where the person is" with their change process, achieving the correct timing, is an important consideration related to the TTM (Velasquez et al., 2016). "Action-oriented therapies may be quite constructive with individuals who are in the grooming or action stages. These same programs may be ineffective or detrimental, however, with individuals in precontemplation or contemplation stages" (Prochaska, DiClemente, & Norcross, 1992, p. 1106). Similarly, individuals gear up for action and learning modify-based skills may get frustrated and drib out of interventions aimed at raising their awareness of the problem and why they might need to make change—they are already past that bespeak and ready to engage actively in change efforts. In other words, intervention efforts should be timed so as to connect to the relevant modify goals at whatever point in time. Ideally, these fit together like puzzle pieces, and are adapted as the situation changes over time. For case, in efforts to move from Precontemplation to Contemplation, consciousness raising might exist appropriate, whereas Action-oriented efforts might include creating a arrangement of positive reinforcement for changed behavior and other change skill sets (Prochaska, DiClemente, & Norcross, 1992; Velasquez et al., 2016). While much of the TTM approach and motivational interviewing reflect the individual's thoughts, feelings, experiences, and behaviors, information technology can effectively be practical in group work settings (Velasquez et al., 2016).

Thinking almost the material you read in this chapter and the specific change try instance y'all were because:

• What did you conclude almost how the model seems to fit your own experience with intentional behavior alter?
• How did yous experience the stages of change and did you follow a unmarried progression or spiral up/down the wheel?
• How did decisional balance, ambivalence, and self-efficacy for change look in your chosen case?
• What did or could have helped and what might accept gotten in the way of your modify effort?
• What does this tell you about possibly supporting others in their efforts to alter, even to change addictive behaviors?

Source: https://ohiostate.pressbooks.pub/substancemisusepart1/chapter/ch-3-name-5/

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