The Stages of Change Transtheoretical Model of Change

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

In this video we’re going to talk about change. And we’re going to learn a model that describes the process of change and the stages we need to go through in order to make change happen. And it’s known as the transtheoretical model of change, transtheoretical because it describes the process of change that unfolds regardless of the theory behind that change. And the part of the model that’s most well known and that we’re going to look at in this video are the stages of change.

And the stages of change model is often used in treating addiction, and for changes that involve adopting a healthier lifestyle, like getting in shape or losing weight. And the model applies to any sort of behavioral change, like changing a habit, and to almost any sort of change we might try to make for personal growth or just to improve the quality of our lives.

So there are six stages of change pre-contemplation: contemplation, preparation, action, maintenance— and then there’s relapse, which isn’t technically a stage, but a regression to an earlier stage and we move from the action or maintenance stage back to preparation contemplation or pre-contemplation—and finally termination.

And the stages of change model focuses on, how do we move from one stage of change on to the next. In other words, what needs to happen to move us from thinking about change, to actually initiating and maintaining that change.

So let’s look at these stages in more detail. In the pre-contemplation stage we’re not even contemplating change yet. Sometimes we don’t see our behavior as a problem so there’s no motivation to change anything. Or we may recognize there’s a problem but we don’t think we have any control over the problem, so we feel resigned to things staying the way they are.

We might have unsuccessfully tried to change a number of times in the past and that’s led us to believe that change isn’t even possible. Or maybe we feel like we’ve always been an angry person, there’s nothing i can do to control my anger, i was born that way, sometimes i just snap. And so again, we’re not contemplating change because we don’t even think change is possible.

In pre-contemplation, even though we’re not thinking about change, there are often other people who are urging us to change. Sometimes it’s a spouse or partner or family member who’s telling us we need to stop drinking or work on our anger issues. Or maybe a doctor is telling us to lose weight or change our diets or start exercising. Or maybe attending addictions counseling or anger management is a condition of probation. So in the pre-contemplation stage often someone else has identified an issue that they want us to change, even if we’re not on board with trying to change it and not even thinking about it.

So in order to move from pre-contemplation to contemplation there has to be some sort of shift in our perspectives. If we were to do a list of the pros and cons of changing, the pros part of the list would be pretty sparse. And we usually don’t start to contemplate change until we start to recognize more pros of changing.

But if we’re trying to encourage someone else to start contemplating change, the best thing we can do is to just listen to them be supportive and offer empathy. We can gently let them know how their behavior is affecting us, gently point out ways in which their behavior is negatively impacting them or isn’t aligned with some of their goals or values. We can offer information and encourage them to look at some of the pros of changing, and to assess the risks of their current behavior, and so on. But these are more things we would try in therapy, and could be really hard to pull off with a friend or loved one, and in the pre-contemplation stage they’re not likely to be very receptive.

And even when we do our best to be non-judgmental and gentle with them, we’re often met with defensiveness or anger. There’s no easy way to help someone move from pre-contemplation to contemplation, and it can be frustrating and aggravating to even attempt.

Now in the contemplation stage we acknowledge that there is, or might be a problem. And maybe we’ll try to do something about, it maybe we’ll try to change, and maybe we won’t. We can go back and forth, one day ready to start changing, and then having second thoughts the next.

The main strategy we use to help move us from contemplation to preparation is called decisional balance, which refers to weighing the pros and cons of change.

So we want to look at the pros and cons, or benefits versus costs, or advantages and disadvantages of changing; and the pros, benefits, advantages, and cons, costs and disadvantages of not changing.

So the pros of changing, the pros of cutting back on our drinking for example could be something like this. And then the cons of changing, the cons of cutting back on our drinking, could be something like this.

And then the pros and cons of not changing. And so the pros of not cutting back on our drinking could look something like this. And the cons of not cutting back on our drinking could look something like this.

And if the pros or benefits of changing and the costs of not changing, outweigh the costs of changing and benefits of not changing, then we may be ready to move on to the preparation stage.

But committing to change can be hard and so we can waver in our commitments to change. We can spend a lot of time contemplating change before ever deciding that we’re actually ready to start preparing to change. And sometimes we never even get out of the contemplation stage.

But if we’ve decided we’re ready to change we move into the preparation stage. So we sometimes start this stage by talking to people and getting advice, doing some research, maybe even watching a self-help video or reading a self-help book or working with a personal trainer or therapist, and eventually setting a goal for our change and coming up with a plan of action to make it happen.

Now sometimes the reason we find it difficult to change is that our goals are poorly formed. Maybe they’re too vague, like I’m going to get into shape. Or our goals are unrealistic, I’m never going to lose my temper again. Or our plans are poorly formed and unrealistic. I’m going to quit drinking by still going to the bar with my friends every weekend but I’m just going to order cranberry juice. I’m going to get in shape and lose weight by going to the gym seven days a week and not eating any junk food or fast food for the next three months.

So if we enter the action stage with unrealistic goals and poorly formed plans, our attempts to take action will usually not be successful. So the best thing we can do is to just accept and acknowledge that our goals and plans need some adjusting, go back to the preparation stage, and come up with more achievable goals and more actionable plans, and only then move back to the action stage and start initiating these plans. And I’ve got videos in the works on creating action plans and setting goals that I’ll link to in the description that go into a lot more detail than we have time for here.

And then once we’ve come up with a good plan of action in the preparation stage, the action stage is where we put our plans into action, and start initiating change. And so what we do at this stage will depend on our plans, but whatever the plan we need to realize that change is usually incremental and might not always happen as quickly as we’d like. So we need to be patient and compassionate towards ourselves reward our successes, but not beat up on ourselves if sometimes we take a step or two back.

And if we get a little stuck, we can see if we can revise our plans a bit to help us keep making progress, or strategize how to overcome any obstacles or difficulties we face, while still continuing to take some action, rather than completely withdrawing from the action stage and going back into preparation again.

And the first few times we get to the action stage and start trying to implement changes, it’s likely we won’t be completely successful. Most of the time it takes multiple attempts to be able to affect stable enough change to move on to the maintenance stage, so it’s not unlikely that we’ll relapse. Which in this model refers to regressing to an earlier stage, so moving from the action or maintenance stages, back to preparation or contemplation or even pre-contemplation.

So maybe we quit drinking for a couple of weeks but then we get drunk one weekend and then also the next. Or we start eating well and losing weight but then we have a bad day and binge junk food and then feel bad about that and binge the next day as well. Or we go a few weeks without losing our tempers but then one day we just explode.

And sometimes we can have a little slip up and continue taking action without actually relapsing and regressing to an earlier stage. But if we do relapse and aren’t able to just pick up from where we left off and continue with the change that we’ve started, again it’s important to try to practice self-compassion, as feeling guilt or shame about relapsing will only make it more difficult to recover from that relapse. So it’s great if we can give ourselves some credit for any progress we did make. And the more we’re able to do this the more likely it is we only regress to the preparation stage. And then maybe we’re ready to get back on that horse and start working on a new plan relatively quickly. But often we’ll regress back to the contemplation or pre-contemplation stages, and then need to find a way to recommit the change before we’re ready to enter the preparation stage again.

And in the stages of change model, relapse is seen as an upward spiral, which means that we learn from each relapse. So having relapsed, we can incorporate what we’ve learned from this attempt to change into our next attempts, making it more likely that they’ll be successful.

And if we do implement the changes in the action stage that we set out to make, we’re ready to move on to the maintenance stage, where we work on sustaining these changes and resist temptations that could lead to relapse or any gradual resumption of the behaviors we’ve changed and moved away from.

If we’ve lost some weight and developed some healthier habits we want to keep that weight off and continue with whatever habits helped us get to this stage keep doing what we’ve been doing that’s been working for us.

And in the maintenance stage we reaffirm our goals and commitments to change. And want to identify any triggers that could lead to relapse. And have plans in place to manage any barriers or obstacles that could make it hard for us to sustain our change.

And often maintenance is the final stage of change, because for many changes in behaviors complete termination of the old behaviors, where there’s never any temptation to resume those behaviors and absolutely no possibility of backsliding or relapse isn’t really that viable. And so it’s more about continuing with the maintenance stage indefinitely.

But sometimes we can reach the termination stage. If we used to be a smoker, it’s now like we never developed the habit in the first place. And there’s not really much to say about the termination stage, because here whatever problem we’ve identified that we wanted to change is no longer a problem, and it’s not going to be a problem again, and so there’s nothing left to do.

Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research & Practice, 19(3), 276–288. https://doi.org/10.1037/h0088437