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Understanding the Process of Change

Change is a spiraling process, rather than a singular event.

Key points

  • Change is a process involving five stages: pre-contemplation, contemplation, preparation, action, and maintenance.
  • The needs of an individual in one stage of change are different from the needs of an individual in another stage.
  • Recycling through stages is the rule rather than the exception.
  • It's imperative to recognize and celebrate progression through the stages rather than waiting until maintenance is achieved.

Wouldn’t it be wonderful if change happened in an instant? Wouldn't it be great to wake up in the morning and think: “I want to start eating better.” And then we do. Or decide, “I am going to stop smoking” and never pick up another cigarette?

But we all know that’s not how change works. It isn’t a one-time event or singular action—instead, it is a process. And the more we understand the process of change, the more we can empathize, support, and demonstrate compassion for ourselves and those around us who seek to alter their behavior. What is the process of change?

The Transtheoretical Model of Behavior Change

The Transtheoretical Model (TTM), also commonly referred to as the Stages of Change Model, provides us with an understanding of how change occurs (Prochaska et al., 1992). Developed in the early '80s out of research with former smokers, Prochaska and DiClemente found that individuals who successfully make changes go through a series of stages over time (Prochaska & DiClemente, 2005). In contrast to the assumption that change begins with behavior modification, Prochaska and DiClemente discovered several stages prior to taking action.

The Five Stages of Change

The first stage of the change process is marked by a lack of awareness of a problem. This stage, known as pre-contemplation, is when individuals fail to see their behavior as an issue. Others in their life may be telling them they need change, but they do not agree and have no intention of making a change in the next six months. A person in pre-contemplation may say, “It’s not my drinking that needs to change, it’s my job that is causing all my problems.” Pre-contemplation is a common starting place for many who embark upon the journey of change.

The second stage of change, contemplation, is when an individual becomes aware of the problem, but is ambivalent about making a change. They perceive the pros and cons of changing as approximately equal and thus have not committed to change. They may be considering making a change in the next six months, but currently are not ready to act. A person in contemplation may say, “I know I need to eat better, but it’s so expensive to buy fruit and vegetables. I don’t know how I would make it work.” The contemplation stage is marked by ambivalence and people can get stuck in this stage for months or years.

The third stage of change, preparation, is characterized by making a commitment to change. The individual intends to take action within the next month and may already be making small changes (e.g., reducing their pornography use). A person in preparation may say, “I’m ready to stop smoking. I’ve already purchased a nicotine patch and haven’t bought any more cigarettes.” Individuals in preparation are on the brink of taking action.

After the preparation stage comes action, in which individuals modify their problem behavior and make the change. In this stage, there is a strong commitment to change, and the change is intentional (i.e., self-directed) rather than imposed by others or the environment. A person in action may say, “I did it. I filled my prescription for Depakote and I have been taking it consistently for the past week.” The action stage lasts for approximately six months as the new behavior modifications are solidified.

Finally, the fifth stage of change is maintenance, in which individuals sustain their behavioral change indefinitely. During this stage, the focus is on avoiding relapse and fully integrating the behavioral change into their lives. A person in maintenance may say, “It’s been almost a year since I last used cocaine. I’ve learned how to control cravings and find support when I need it.” In maintenance, individuals learn to sustain their behavior change through various seasons of life.

The Process of Change as a Spiral

Although the five stages of change sound like a natural forward progression, this often is not the case. Anyone who has made a New Year’s Resolution that lasted until February knows that relapse (or the return to prior behavior patterns) is the rule rather than the exception. The TTM recognizes that recycling through stages is likely before individuals reach sustained maintenance (DiClemente, 2015), thus the change process is better understood as a spiral rather than a straight line.

In addition, individuals can spend varying amounts of time in each stage, thus the process of change looks different for different people (Prochaska & DiClemente, 2005). When conceptualizing change as a process, the goal is for an individual to move from whatever stage they currently find themselves in (e.g., contemplation) to the next stage (e.g., preparation). In this way, people can acknowledge and affirm the small steps leading up to change (e.g., moving from one stage to the next), rather than waiting for the maintenance stage to celebrate.

Meeting People Where They Are

The genius of the TTM is the acknowledgment that people in one stage of change are addressing different tasks than those in another stage (Prochaska & DiClemente, 2005). For example, a person in pre-contemplation benefits from gaining insight, information, and feedback to raise awareness about their problem behavior, while a person in contemplation benefits from exploring the impact of their behavior on others, examining their emotions, and working through ambivalence. The person in preparation benefits from creating an action plan and troubleshooting, while a person in action benefits from restructuring their environment to avoid triggers and implementing replacement behaviors. Finally, a person in maintenance benefits from relapse prevention strategies and increasing overall wellness (Prochaska & DiClemente, 2005).

As we learn to conceptualize change as a process, we can identify an individual’s current stage of change, meet them where they are, and help them attend to their current needs. Reaching sustained behavioral change is a journey and the more we know about the process, the more we can support one another along the way.

References

DiClemente, C. C. (2015). Change is a process not a product: Reflections on pieces to the puzzle. Substance Use & Misuse, 50, 1225-1228.

Prochaska, J. O., & DiClemente, C. C. (2005). The transtheoretical approach. In J. C. Norcross & M. R. Goldfield (Eds.). Handbook of Psychotherapy Integration (pp. 147-170). Oxford University Press.

Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47, 1102-1114.

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