Stages of Change
Model/Transtheoretical Model (TTM)
Prochaska and DiClemente
- Transtheoretical Model of Change, a theoretical model of
behavior change was originally explained by Prochaska &
- Transtheoretical model of change has been the basis for
developing effective interventions to promote health behavior
- The model describes how people modify a problem behavior or
acquire a positive behavior.
- The TTM is a model of intentional change. This model
focuses on the decision making of the individual.
- The transtheoretical model may help to explain differences
in persons’ success during treatment for a range of
psychological and physical health problems.
- This model has been widely applied in behaviour
The core constructs of the TTM are
- the processes of change
- decisional balance
- self-effi cacy, and
Processes of change
- Processes of change are the covert and overt activities
that people use to progress through the stages.
- There are ten such processes as explained by Prochaska:
- Consciousness Raising (Increasing awareness)
- Dramatic Relief (Emotional arousal)
- Environmental Reevaluation (Social reappraisal)
- Social Liberation (Environmental opportunities)
- Self Reevaluation (Self reappraisal)
- Stimulus Control (Re-engineering)
- Helping Relationship (Supporting)
- Counter Conditioning (Substituting)
- Reinforcement Management (Rewarding)
- Self Liberation (Committing)
- The first five are classified as Experiential
Processes and are used primarily for the early stage
- The last five are labeled Behavioral Processes
and are used primarily for later stage transitions.
- Decisional Balance reflects the individual's relative
weighing of the pros and cons of changing.
- The Decisional Balance scale involves weighting the importance
of the Pros and Cons.
- Self-efficacy represents the situation specific confidence
that people have that they can cope with high-risk situations
without relapsing to their unhealthy or high-risk habit.
- This concept was adapted wfrom Bandura's self-efficacy
- reflects the intensity of urges to engage in a specific
behavior when in the midst of difficult situations.
- Temptation is the converse of self-efficacy.
- The most common types of tempting situations are;
- negative affect or emotional distress
- positive social situations, and
- People pass through a series of stages when change occurs.
- The stages discussed in their change theory are:
- action, and
PRECONTEMPLATION (Not ready to change)
- The individual is not currently considering change:
"Ignorance is bliss"
- People are not intending to take action in the foreseeable
future, usually in the next six months.
- Validate lack of readiness
- Encourage re-evaluation of current behavior
- Encourage self-exploration, not action
- Explain and personalize the risk
- Traditional health promotion programs are often not
designed for such individuals and are not matched to their
CONTEMPLATION (Thinking of changing)
- Ambivalent about change: "Sitting on the fence"
- Not considering change within the next month.
- Encourage evaluation of pros and cons of behavior
- Re-evaluation of group image through group activities.
- Identify and promote new, positive outcome expectations
PREPARATION (Ready to change)
- Some experience with change and are trying to change:
"Testing the waters"
- Planning to act within 1month.
- The individual needs encouragement to evaluate pros and
cons of behavior change.
- The therapist needs to identify and promote new,
positive outcome expectations in the individual.
- Encourage small initial steps .
- These individuals ahve taken some actions in the past
year such as joining a health education class, consulting
a counselor, talking to their physician, buying a
self-help book or relying on a self-change approach.
- These group of individuals ar suitablefor action-
oriented programs for smoking cessation, weight loss, or
ACTION (Making change)
- The active work toward desired behavioral change including
modifi cation of environment, experiences, or behavior have
- At this stage people have made specific overt modifications
in their life-styles within the past six months.
- At this stage measures should be taken against relapse.
- Help the individual on restructuring cues and social
- Enhance self-efficacy for dealing with obstacles.
- Help to guard against feelings of loss and frustration.
MAITANANCE (Staying on track)
- Here, the focus is on ongoing, active work to maintain
changes made and relapse prevention.
- At this stage people are are less tempted to relapse and
increasingly more confident that they can continue their
- lan for follow-up support
- Reinforce internal rewards
- Discuss coping with relapse
RELAPSE (Fall from grace)
- This stage is not explained in the original article. It is
a form of regression to previous stages.
- It refers to falling back to the old behaviors after going
through other stages.
- Regression occurs when individuals revert to an earlier
stage of change.
- Evaluate trigger for relapse
- Reassess motivation and barriers
- Plan stronger coping strategies
- The model has been applied to a wide variety of problem
- smoking cessation
- low fat diet
- radon testing
- alcohol abuse
- weight control
- condom use for HIV protection
- organizational change
- use of sunscreens to prevent skin cancer
- drug abuse
- medical compliance
- mammography screening, and
- stress management.
- Rhode Island Change Assessment Scale (URICA) is a 32-item
questionnaire designed to measure the stages of change across
diverse problem behaviors.
- Motivational Enhancement Therapy (MET) is based on the
Prochaska and DiClemente’s stages of change model, which is
applicable in smocking sessation and alcohol abuse.
- Prochaska JO, DiClemente CC, Norcross JC (1992). In search
of how people change. Applications to addictive behaviours. Am
- Velicer, W. F, Prochaska, J. O., Fava, J. L., Norman, G.
J., & Redding, C. A. (1998) Smoking cessation and stress
management: Applications of the Transtheoretical Model of
behavior change. Homeostasis, 38, 216-233.
- Prochaska JO , Velicer WF , Rossi JS , et al. ( 1994 )
Stages of change and decisional balance for 12 problem
behaviors . Health Psychology 13, 39 – 46 .
- Prochaska JO and DiClemente CC ( 1984 ) The
Transtheoretical Approach: Towards a Systematic Eclectic
Framework . Dow Jones Irwin , Homewood, IL, USA .
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