Transtheoretical Model: Six Stages of Change

Stage 1: Precontemplation. In this stage, people do not intend to take action in the foreseeable future (defined as within the next 6 months). People are often unaware that their behaviour is problematic or produces negative consequences. People in this stage often underestimate the pros of changing behaviour and place too much emphasis on the cons of changing behaviour.

Stage 2: Contemplation. In this stage, people are intending to start the healthy behaviour in the foreseeable future. People recognize that their behaviour may be problematic, and a more thoughtful and practical consideration of the pros and cons of changing the behaviour takes place, with equal emphasis placed on both. Even with this recognition, people may still feel ambivalent toward changing their behaviour.

Stage 3: Preparation (Determination). In this stage, people are ready to take action within the next 30 days. People start to take small steps toward the behaviour change, and they believe changing their behaviour can lead to a healthier life.

Stage 4: Action. In this stage, people have recently changed their behaviour and intend to keep moving forward with that behaviour change. People may exhibit this by modifying their problem behaviour or acquiring new healthy behaviours.

Stage 5: Maintenance. In this stage, people have sustained their behaviour change for a while and intend to maintain the behaviour change going forward. People in this stage work to prevent relapse to earlier stages.

Stage 6: Termination. In this stage, people have no desire to return to their unhealthy behaviours and are sure they will not relapse. Since this is rarely reached, and people tend to stay in the maintenance stage, this stage is often not considered in health promotion programs.

Figure 1.1.3.1 Transtheoretical Model: Stages of Change.

To progress through the stages of change, people apply cognitive, affective, and evaluative processes. Ten processes of change have been identified, with some processes being more relevant to a specific stage of change than other processes. These processes result in strategies that help people make and maintain change. Source: Wellness

Ten Processes of Change

• consciousness raising: Increasing awareness about the healthy behaviour.
• dramatic relief: Emotional arousal about the health behaviour, whether positive or negative arousal.
• self-reevaluation: Self-reappraisal to realize the healthy behaviour is part of who they want to be.
• environmental reevaluation: Social reappraisal to realize how their unhealthy behaviour affects others.
• social liberation: Environmental opportunities that exist to show society is supportive of the healthy behaviour.
• self-liberation: Commitment to change behaviour based on the belief that achievement of the healthy behaviour is possible.
• helping relationships: Finding supportive relationships that encourage the desired change.
• counter-conditioning: Substituting healthy behaviours and thoughts for unhealthy behaviours and thoughts.
• reinforcement management: Rewarding the positive behaviour and reducing the rewards that come from negative behaviour.
• stimulus control: Re-engineering the environment to have reminders and cues that support and encourage the healthy behaviour and remove those that encourage the unhealthy behaviour.

Limitations of the Transtheoretical Model

Limitations of the model include the following:

• The theory ignores the social context in which change occurs, such as socioeconomic status and income.
• The lines between the stages can be arbitrary with no set criteria of how to determine a person’s stage of change. The questionnaires that have been developed to assign a person to a stage of change are not always standardized or validated.
• No clear sense exists for how much time is needed for each stage, or how long a person can remain in a stage.
• The model assumes that individuals make coherent and logical plans in their decision-making process when this is not always true.

The Transtheoretical Model provides suggested strategies for public health interventions to address people at various stages of the decision-making process. Using strategies suggested by TTM can result in interventions that are more effective because they are tailored for a specific group of people. In other words, the interventions involve a message or program component that has been specifically created for a target population’s level of knowledge and motivation. The TTM encourages an assessment of an individual’s current stage of change and accounts for relapse in people’s decision-making process.

For more information about the TTM, especially as it relates to exercise, click on the link below:

TTM for Behaviour Change

One of the most effective tools for changing behaviour is goal setting. The links below provide information on how to set goals effectively to achieve greater success in goal attainment.

Goal Setting Info from Oregon State

One Step at a Time Goal Achievement

Video on S.M.A.R.T. Goals

Making S.M.A.R.T. Goals

You can use the S.M.A.R.T. acronym to guide your goal setting. According to this acronym goals should be:

Lifestyle Modification Barriers

Dr. James M. Olson, a psychology professor at the University of Western Ontario, London, has identified several psychological barriers that commonly prevent people from taking action, even when inaction poses a threat to their health.

These barriers occur during 3 stages of behaviour modification: admission of the problem, initial attempts to change, and long-term change as outlined below.

Barriers to Admission of the Problem. The first step in lasting change is admitting a problem exists. People often fail to change behaviour that poses a risk to their health because they deny a risk exists, trivialize their personal risk, feel invulnerable, make a faulty conceptualization, (i.e., they attribute early warning signs to a benign cause), or experience debilitating emotions when contemplating preventative measures.

Barriers to Initial Attempts To Change. At this stage, people acknowledge the need to change but struggle to accomplish their goals. This failure is a result of lack of knowledge, low self-efficacy (the belief in one’s own ability to succeed at change), and dysfunctional attitudes.

Barriers to Long-Term Change. Just because a person has experienced success in changing a behaviour, that doesn’t mean the change is permanent. Barriers to long-term change include cognitive and motivational drift (diminishing enthusiasm for the need to change), lack of perceived improvement, lack of social support, and lapses.

To read more about these barriers to change, including strategies for overcoming these barriers, read Dr. Olson’s entire article linked below:

Psychological Barriers to Behaviour Change

A presentation on overcoming barriers to change by the National Institute for Health and Clinical Excellence (NHS) is linked below:

Overcoming Barriers to Change