The Process of Change

Because health psychology is interested in the psychology behind health-related behaviors, it also concerns itself with how people can learn to change their behaviors. The transtheoretical model of behavior change assesses an individual’s readiness to act on a new healthier behavior, and provides strategies to guide the individual through each stage of the behavior-change process.

Created by Prochaska and DiClemente in the 1970s, the model proposes that change is a process rather than a discrete decision. People must build up the motivation to change and this motivation is dependent on a number of personal and environmental factors. According to the transtheoretical model, behavioral change is a five-step process, consisting of precontemplation, contemplation, preparation, action, and maintenance.

Precontemplation

At the precontemplation stage, an individual may or may not be aware of a problematic behavior, and generally has no desire to change their behavior. People in this stage learn more about healthy behavior: they are encouraged to think about the benefits of changing their behavior and to feel emotions about the effects of their negative behavior on others. Precontemplators typically underestimate the pros of changing and overestimate the cons. One of the most effective steps that others can help with at this stage is to encourage them to become more mindful of their decision making and more conscious of the multiple benefits of changing an unhealthy behavior.

Contemplation

At this stage, participants are intending to start the healthy behavior, often within the next six months. While they are usually more aware of the pros of changing, their cons are about equal to their pros. This ambivalence about changing can cause them to keep putting off taking action. People in this stage learn about the kind of people they could be if they changed their behavior and learn more from people who behave in healthy ways. Others can help people at this stage by encouraging them to work on reducing the cons of changing their behavior.

Preparation

People at this stage are ready to start taking action, generally within the next 30 days. They take small steps that they believe can help them make the healthy behavior a part of their lives, such as telling their friends and family. People in this stage should be encouraged to seek support, tell people about their plan to change, and think about how they would feel if they behaved in a healthier way. Their main concern is this: When they act, will they fail? They learn that the better prepared they are, the more likely they are to keep progressing.

Action

In the action stage, people have changed their behavior and need to work hard to keep moving ahead. These participants need to learn how to strengthen their commitments to change and to fight urges to slip back. Useful techniques at this stage can include substituting activities related to the unhealthy behavior with positive ones, rewarding themselves for taking steps toward changing, and avoiding people and situations that tempt them to behave in unhealthy ways.

Maintenance

An individual finally enters the maintenance stage once they exhibit the new behavior consistently for over six months. It is important for people in this stage to be aware of situations that may tempt them to slip back into doing the unhealthy behavior—particularly stressful situations. It is recommended that people in this stage seek support from and talk with people they trust, spend time with people who behave in healthy ways, and remember to engage in healthy activities to cope with stress instead of relying on unhealthy behavior.

Some theorists suggest a sixth phase called termination, in which individuals have no temptation to return to old unhealthy behaviors as a way of coping. Importantly, the progression through these stages is not strictly linear. People may move back and forth between the stages as their motivation changes. Often people relapse in their behavior multiple times before finally achieving maintenance. In this way, relapse is conceptualized as a return from the action or maintenance stage to an earlier stage.

Applying the Stages of Change

The stages-of-change model has been widely utilized in the treatment of health-related behaviors such as substance use, obesity, diabetes, and other problem behaviors. Change is a difficult process that requires close analysis of the benefits and costs of the behavior. For instance, a smoker must come to the conclusion that the health risks associated with their smoking are more important to them than the benefits, which may include taste, stress relief, social aspects, or other factors. Coming to this decision is no easy task; despite the stress caused by their problem behavior, many people simply are not ready to initiate change. This model helps assess where on the spectrum a person falls and helps guide treatment efforts accordingly.