An Overview of Prochaska and DiClemente s Stages of Change Model
Transcript of An Overview of Prochaska and DiClemente s Stages of Change Model
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An Overview of
Prochaska and DiClemente’s Stages of Change Model
Developed by Catherine Segan
for the Victorian Smoking and Health Program
September, 1999
The Victorian Smoking and Health Program is a joint initiative of the Anti-Cancer Council of Victoria, the Department of Human Services,
the National Heart Foundation and the Victorian Health Promotion Foundation.
The Quit logo is a registered trademark of the Anti-Cancer Council of Victoria.
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Key Features of the Stages of Change
Model
• Deals with intentional behaviour change
• Views change as a process rather than an event
• The change process is characterised by a series of stages of change
• In attempting to change a behaviour a person
typically cycles through these stages of change
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What are the Stages of Change?
The stages describe a person’s motivational readiness
or progress towards modifying the problem behaviour
Precontemplation: not considering quitting in the
next 6 months
Contemplation: seriously considering quitting
in the next 6 months
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What are the Stages of Change?(Cont’d)
Preparation: planning to quit in the next 30
days
Action: the first 6 months of staying quit
Maintenance: quit for more than 6 months
Relapse: transition to an earlier stage
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Maintenance Relapse
Contemplation Action
Preparation
Termination
Precontemplation
Figure 1: Prochaska and DiClemente’s
Wheel of Change
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Figure 2. Spiral of change
From Prochaska, DiClemente & Norcross, 1992, p1104
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What helps people move forward
through the Stages of Change?
• Processes of Change
• Decisional balance
• Self-efficacy
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10 Processes of Change
• Coping activities or strategies used by people in
their attempts to change
• Each change process is a broad category of
coping activities which encompasses multiple
techniques, methods and interventions
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Two Main Types of Change
Processes
Cognitive change processes
Involve changes in the way people think and feel
about their smoking
Behavioural change processes
Involve people making changes to their smoking
behaviour
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5 Cognitive Processes
Consciousness raising
Increasing information about yourself and smoking
e.g. - thinking about health effects of smoking
- a doctor asking whether you smoke- thinking about how you’re running out of
breath
- reading the Quit book
- watching the Quit TV ads
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5 Cognitive Processes
Dramatic relief Experiencing strong emotional reactions to events
associated with smoking
e.g. - deciding to do something about your smoking after your grand mother is diagnosed with lung cancer
- seeing the effect of blowing smoke through a white
handkerchief
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5 Cognitive Processes (Cont’d)
Environmental reevaluation
Becoming aware of the impact of the problem
behaviour on others
e.g. - thinking about the effects of smoking
around the kids
- noticing cigarette butts on the street
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5 Cognitive Processes (Cont’d)
Self-reevaluation
Affective and cognitive reexperiencing of one’s self
and problems
e.g. - thinking that you’re no longer happy
being a smoker
- imagining yourself as a non-smoker
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5 Cognitive Processes (Cont’d)
Social liberation
Noticing and using social conditions that support
personal changes
e.g. - noticing the non-smoking areas around
you
- joining a quit smoking course
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5 Behavioural Processes
Self-liberation
Belief in your ability to change and commitment to
act on that belief
e.g. - telling yourself that you can quit
smoking
- setting a quit day
- telling others you’re quitting
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5 Behavioural Processes (Cont’d)
Helping relationships
Trusting others and accepting their support in
quitting
e.g. - asking a friend who used to smoke for
help
- calling the Quitline
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5 Behavioural Processes (Cont’d)
Counter conditioning
Replacing smoking with more positive
behaviours and experiences
e.g. - “Do something else”
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5 Behavioural Processes (Cont’d)
Reinforcement managementRewards for staying quit
e.g. - the family showering you with praise- buying yourself a magazine, CD,
flowers
- telling yourself how wonderful you are
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5 Behavioural Processes (Cont’d)
Stimulus control
Avoiding or countering stimuli that elicit the
problem behaviour
e.g. - cleaning up ashtrays before your quitday
- not going to the pub the day after you
quit
- putting up no smoking signs
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Relationship between Processes and
Stages of Change
Cognitive change processes help people to movethrough the early stages of change
i.e. from not thinking about quitting to
deciding to quit
Behavioural change processes help people to move
through the later stages of change
i.e. from making a quit attempt to staying quit
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Decisional Balance
• Decisional balance is the importance a person
gives to the perceived advantages (pros) and
disadvantages (cons) of smoking, and of quitting
• An individual’s motivation to change is affected
by his/her decisional balance
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Decisional Balance (Cont’d)
• Decisional balance changes across the stages of
change
• Use of cognitive change processes can help tip the
decisional balance in favour of quitting
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Figure 3. Decisional Balance Across the Stages of Change
From Prochaska, Velicer, Rossi et al. 1994 pg.43
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Self-efficacy
• Self-efficacy is a person’s confidence in his/her
ability to quit, and to resist temptations
• Confidence to resist temptations to smoke varies
across the stages of change, being lowest in
Precontemplation and highest in Maintenance
• Self-efficacy is a strong predictor of success in
the Action and Maintenance stages
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How is the Model Useful?
• Provides a framework for understanding the process of how people change
• Recognises that people in different stages of
change need different types of interventions to
help them progress.
• Quit Victoria has developed goals and strategies
for counselling clients at each of the stages of
change
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References
• Prochaska, J.O., DiClemente, C.C. & Norcross, J.C. (1992). In
search of how people change: Applications to addictive behaviors.
American Psychologist, 47 (9), 1102-1114.
• Prochaska, J.O., Velicer, W.F., Rossi, J.S., Goldstein, M.G.,
Marcus, B.H., Rakowski, W., Fiore, C., Harlow, L.L., Redding,
C.A., Rosenbloom, D., & Rossi, S.R. (1994). Stages of change
and decisional balance for twelve problem behaviors. Health
Psychology, 13(1), 39-46.