The Transtheoretical or Stages of Change Model
Anyone who has ever made and broken a resolution or wanting to break a habit or even to achieve a wellness goal can appreciate the difficulty of behaviour change. Making a lasting change in behaviour is rarely a simple process. It usually involves a substantial commitment of time, effort, and emotion.
How to Get Started
Whether you want to lose weight, stop smoking, or accomplish another goal, there is no single solution that works for everyone. You may have to try several different techniques, often through a process of trial and error, to achieve your goal.
It's during this period that many people become discouraged and give up on their behaviour change goals. The keys to achieving and maintaining your goals are to try new techniques and find ways to stay motivated.
Change might not come easily, but we have found an effective way to help people change their behaviour. And as Naturopathic Pracitioner Researchers we have also proposed theories to explain how change occurs.
Understanding the elements of change, the stages of change, and ways to work through each stage can help you achieve your goals.
The Elements of Change
To succeed, you need to understand the three most important elements in changing a behaviour:
Readiness to change: Do you have the resources and knowledge to make a lasting change successfully?
Barriers to change: Is there anything preventing you from changing?
Likelihood of relapse: What might trigger a return to a former behaviour?
Stages of Change Model
One of the best-known approaches to change is the Stages of Change or Transtheoretical Model, introduced in the late 1970s by James Prochaska and Carlo DiClemente. They were studying ways to help people quit smoking (1). The Stages of Change model has been found to be an effective aid in understanding how people go through a change in behaviour. And want and try as we might for a love one to want to change - it just isn't happening. So we are here to help you end the stress, constant fight and desire - to be informed and empowered with this knowledge too.
In the stages of change model, change occurs gradually and relapses are an inevitable part of the process. People are often unwilling or resistant to change during the early stages, but they eventually develop a proactive and committed approach to changing a behaviour. Never giving up is the best state of mind to have for you or a loved one (no matter how much they or you kick and scream). So this model demonstrates that change is rarely easy. It often requires a gradual progression of small steps toward a goal that we always develop in the initial consultation. But often people can give up after one try and so enter the stages of change.
Stage 1: Precontemplation
Characteristics
Denial
Ignorance of the problem
Strategies
Rethink your behaviour
Analyse yourself and your actions
Assess risks of current behaviour
The earliest stage of change is known as precontemplation (1). During the precontemplation stage, people are not considering a change. People in this stage are often described as "in denial," because they claim that their behaviour is not a problem. In some cases, people in this stage do not understand that their behaviour is damaging, or they are under-informed about the consequences of their actions.
If you are in this stage, you may feel resigned to your current state or believe that you have no control over your behaviour.
If you are in this stage, begin by asking yourself some questions. Have you ever tried to change this behaviour in the past? How do you recognise that you have a problem? What would have to happen for you to consider your behaviour a problem?
Stage 2: Contemplation
Characteristics
Ambivalence
Conflicted emotions
Strategies
Weigh pros and cons of behaviour change
Confirm readiness and ability to change
Identify barriers to change
During this stage, people become more and more aware of the potential benefits of making a change, but the costs tend to stand out even more. This conflict creates a strong sense of ambivalence about changing. Because of this uncertainty, the contemplation stage of change can last months or even years (1).
IMPORTANT - Many people never make it past the contemplation phase.
You may view change as a process of giving something up rather than a means of gaining emotional, mental, or physical benefits. If you are contemplating a behaviour change, there are some important questions to ask yourself: Why do you want to change? Is there anything preventing you from changing? What are some things that could help you make this change?
Stage 3: Preparation
Characteristics
Experimenting with small changes
Collecting information about change
Strategies
Write down your goals
Prepare a plan of action
Make a list of motivating statements
During the preparation stage, you might begin making small changes to prepare for a larger life change. For example, if losing weight is your goal, you might switch to whole foods with a TDEE naturopathic report (2). If your goal is to quit smoking, you might switch brands or smoke less each day or even switch to a herbal made blend with no nasties. You might also take some sort of direct action such as consulting a therapist, joining a gym, or reading self-help books.
If you are in the preparation stage, there are some steps you can take to improve your chances of successfully making a lasting life change. Gather as much information as you can about ways to change your behaviour. Prepare a list of motivating statements. Write down your goals. Find resources such as support groups, accountability partner like us here at The Feel Good Society, or seek friends who can offer advice and encouragement.
Stage 4: Action
Characteristics
Direct action toward a goal
Strategies
Reward your successes
Seek out social support
During the fourth stage of change, people begin taking direct action in order to accomplish their goals (1). Oftentimes, goals fail because the previous steps have not been given enough thought or time.
For example, many people make a resolution to lose weight and immediately start a new exercise regimen, embark on a healthier diet, and cut back on snacks. These definitive steps are vital to success, but these efforts are often abandoned in a matter of weeks because the previous steps have been overlooked.
If you are currently taking action towards achieving a goal, congratulate and reward yourself for any positive steps you take. Reinforcement and support are extremely important in helping maintain positive steps toward change. Along with assessment in where you were and to where you are going.
Take the time to periodically review your motivations, resources, and progress in order to refresh your commitment and belief in your abilities.
Stage 5: Maintenance
Characteristics
Maintenance of the new behaviour
Avoiding temptation
Strategies
Develop coping strategies for temptation
Remember to reward yourself
The maintenance phase of the Stages of Change model involves successfully avoiding former behaviours and keeping up new behaviours (2). If you are trying to maintain a new behaviour, look for ways to avoid temptation. Try replacing old habits with more positive and helpful actions. Reward yourself when you are able to successfully avoid a relapse.
If you do falter, don’t be too hard on yourself or give up. Instead, remind yourself that it was just a minor setback, a lesson or a reminder of what you do not want. As you will learn in the next stage, relapses are common and are a part of the process of making a lifelong change.
During this stage, people become more assured that they will be able to continue their change.
Stage 6: Relapse
Characteristics
Disappointment
Frustration
Feelings of failure
Strategies
Identify triggers that lead to relapse
Recognise barriers to success
Reaffirm your goal and commitment to change
In any behaviour change, relapses are a common occurrence (3). When you go through a relapse, you might experience feelings of failure, disappointment, and frustration.
The key to success is to not let these setbacks undermine your self-confidence or belief in the desired goal you want. If you lapse back to an old behaviour, take a good look at why it happened. What triggered the relapse? What can you do to avoid these triggers in the future? Is it because it feels more 'comfortable' and has a false sense of safety? Are you getting other gains from the habits? Like smoking means you get more breaks, means all your friends do it so you are worried you'll loose them as friends. That you can't image life without this habit because you've not fully allowed yourself permission to think of what is actually possible and more beneficial.
While relapses can be difficult, the best solution is to start again with the preparation, action, or maintenance stages of behaviour change.
You might want to reassess your habits and techniques. Reaffirm your motivation, plan of action, and commitment to your goals. Also, make plans for how you will deal with any future temptations and always disclose to your naturopath cause it is always a judgement free zone.
Goals, changes in habits, resolutions fail when the proper preparation and actions are not taken. By approaching a goal or change with an understanding of how to best prepare, act, and maintain a new behaviour, you will be more likely to succeed.
Let’s say your doctor tells you that you're at risk of developing heart disease unless you make healthier choices, like daily walks and a better diet. Here’s what the stages may look like for you:
Precontemplation: You may initially think there’s nothing wrong, and that their doctor is overreacting to one bad test result.
Contemplation: You start asking folks close to you, who have tried overhauling their own health habits before, for advice. you might also start making a pros and cons list about switching to a nutritious diet and exercising daily and start thinking who can help you on this new journey (HINT: you'd be thinking about seeing us).
Preparation: You start looking up specific heart-healthy diets and researching exercise programs that would work for you. And booking in an initial consultation to have us as your Naturopath to help too.
Action: You begin a new nutritious meal plan and a daily workout. Plus have supportive herbs and nutrients too.
Maintenance: As unhealthy behaviours are incrementally replaced with healthier ones, you may join a support group to discuss keeping up your efforts long term and sticking to your follow-up wellness check-in appointments too.
Termination: (Cause you don't have any relapse) Finally, you're able to experiment with other nutritious diets and dive even deeper into more rigorous workout plans because you have achieved your goal and have new ones insight. Your fully committed to living with these changes.
A Word From The Feel Good Society
It's not easy to make a major change and make it stick. You may be more successful in keeping your wellness desires by using these steps. Your clinical initial consolation helps us assess where in the behaviour change cycle you are and in your follow-up we use these steps, from smoking cessation to addiction recovery to empower you to achieve step 5. If you decide you need a structured program to support your change, you can start to recognise the steps you are using and we can talk about it and provide strategies and resources at your consultation.
In good health,
Suzzi Hartery
BHSc Naturopath (Distinction) The Feel Good Society Founder & Head Practitioner
References
Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12(1):38-48. doi:10.4278/0890-1171-12.1.38
Mastellos N, Gunn LH, Felix LM, Car J, Majeed A. Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults.
Cochrane Database Syst Rev. 2014;(2):CD008066. doi:10.1002/14651858.CD008066.pub3LaMorte WW. The transtheoretical model (Stages of Change). Boston University School of Public Health.