¶ The Trans-Theoretical Model of Behavior Change
Hello everyone and welcome to our podcast at Licensure Exams . I'm Dr Linton Hutchinson and this is the incredible Stacey Frost .
Hey there everybody , and hello Linton . As part of our Theory to Therapy series , today we'll be talking about the trans theoretical model of change which is used to understand behavior change . Now , no single theory can account for all of the complexities of behavior change , but this model gives us a pretty good place to start .
So therapy is all about change and as a therapist , you're going to be working with clients who are in different stages of change .
For example , you might see an involuntary client who's mandated to therapy by an external source , like maybe a court order , and they're not the least bit interested in making changes to the way they're currently doing things because they don't have a problem .
Or perhaps you're working with a client who's contemplating what life would be like if they jumped ship and explore what life is like on other islands , but they aren't ready to fully commit to that decision yet .
Yeah , I have a friend that's thinking of going and living on a ship for a year .
Oh , that's cool . I mean change , yeah , yeah .
Well , as you know , being therapists , you can't force anybody to change . So your role as a therapist is to provide support , raise awareness and help motivate your client towards that change and understanding where your client is in the change process , and this will help you provide more effective treatment .
Exactly so . The stages of change model looks at a client's readiness and intention to change , and there are two really important concepts that affect their motivation and readiness to change .
The first is something called self-efficacy , and this is the client's belief in their ability to change , and decisional balance , which is the client's evaluation of the pros and cons of changing a behavior .
Yeah , I'm really , really , really hungry and I'm trying to decide if I should spend that extra money on sushi at Publix , even though it's not Sushi Bogo Wednesday . Wouldn't that indicate I'm focusing on decision making , since I'm really motivated , because really right now I'm starved to death ?
Well , you're headed in the right direction there , linton , but don't scarf down that wasabi just yet . Let's go through the six stages of the model . All right , so one , pre-contemplation , two , contemplation , three , preparation , four , action . Five , maintenance and six , termination .
Well , I just happen to have a way that you can remember that and it's the phrase PCP in the morning today . Oh , boy so pre-contemplation P , contemplation C , preparation P , action A , maintenance , m , termination . Today You've heard of PCP , haven't you , stacey ?
Ah , you mean Angel Dust Wet shirm Loveboat , Supergrass Ozone hog .
I'm sure you weren't around in the 60s .
Well , that was before my time , but your mnemonic is pretty memorable there , Linton .
You know , back in the 60s PCP was marketed as a surgical anesthetic for humans . It was discontinued for obvious reasons and restricted to vet fanarian use .
Ah , so you know , linton , you once told me that the stranger and work graphic that the memory device is , the better that it'll stick , and PCP in the AM today sure fits that bill . I think you have a memory device for everything , linton .
Just about . You know , when you get to be my age Stacey , you've got to keep something working .
Well , I'll take your word on that one , linton , now , while you're objective as a therapist is to help guide the client through the stages of change , you've got an ultimate goal of maintaining their new behaviors , and movement through these stages can occur in a non-linear fashion .
Right right . People may move back and forth between stages as they attempt to change their behavior . For example , someone in the action stage who has started exercising regularly may hit roadblocks like an injury or a busy schedule that causes them to miss workouts .
This can cause them to relapse into contemplation or preparation as they reconsider their commitment to exercise .
Similarly , a client in maintenance mode who has sustained behavioral change for years can unexpectedly spiral back into earlier stages if they experience a major life stressor job loss or divorce , for instance that can temporarily derail their progress and tempt people to return to their old habits .
It's really common for clients to go through cycles of progress and setbacks multiple times before any change sticks .
Well , that is a great overview so far , linton . Let's dig into each stage in more detail . We'll start with the pre-contemplation stage . This is when the person has no intention to change in the near future , typically within the next six months . They may not think there's a problem to address .
They may have limited insight into how their behavior is linked to the negative consequences in their lives . Or perhaps they've tried to change unsuccessfully in the past and they've really just become discouraged about being able to make changes . Someone in the pre-contemplation stage is typically unmotivated in denial and unwilling to make any changes .
When talking with a client in this stage , there tends to be this focus on all of the downsides to making changes , without really any regard to potential positives .
That never happens to me .
No , never , never happens to me either . There's often resistance and defensiveness when you bring up the possibility of change . If you entertain the idea of change with them , you're likely to get something an .
I can't response like I can't stop smoking because yeah , or I can't stop eating that second donut from Duncan's .
Or I can't not get that bulgo sushi .
Yeah , yeah , from Publix . Exactly Next is the contemplation stage where the client is more aware of their personal consequences of their behaviors and is seriously considering making some changes , usually within the next six months . They're more aware of the pros but are still actually aware of the cons .
This flip-flopping leads to ambivalence that can cause them to languish in this stage for long periods of time . A client in this stage may say something like I know I should start exercising for my health , but I can't seem to make the time or push myself to do it .
I remember when you were contemplating if you should stay in hot and sunny Florida Stacey , where counselors would kill to do therapy , rather than move to the frozen tundra of Michigan .
Well , true there , linton , but don't get carried away . I'm actually looking forward to an average of 110 sunny days per year , rather than being stuck in that sauna down there all year round with no escape . I don't know how you do it , all right .
So after you've contemplated wherever you might like to live and you've made a decision , it's time to cue the fireworks , because this next stage is cause for celebration . In the preparation stage , the client has made a commitment . You're familiar with Star Trek , right , linton ?
Star Trek ? Do you mean Star Wars ? Hmm , no , I've never heard of it there . Just kidding , I grew up in the 60s , didn't I ?
Hey , I'm no stranger to sarcasm . Well , I remember your Star Trek-themed Christmas party a few years back , when you dressed up as Q and CJ and I had a lot of fun with that one . Well , I think that the immortal words of Spock summarize the contemplation stage the best . I believe we can attempt the course correction .
Captain , during the contemplation stage , the client is ready to alter their current course and make some changes to their behavior . After logically weighing the pros and cons of making changes , the scale has tipped toward the pros side and the client has the intention of taking action within the next 30 days or so .
And moving right along at warp speed . Next is the action stage , which involves the client actively modifying their behavior . They use specific techniques to rewrite habits and environmental cues to support their change . You can see how preparation leads directly to actions . Right Stacy .
Makes sense to me . So next up is the maintenance stage , and here the client works to prevent relapse and consolidate their gains . The new behavior becomes habitual and they use fewer change processes , but relapse is still possible , sending them backward to earlier stages .
And finally , the termination stage , where the client has zero temptation to return to their old behaviors and 100% self-efficacy . They feel completely confident that they can continue their new patterns or behaviors moving forward without any difficulties . At this stage they may feel they don't need you any longer or therapy to maintain their changes .
Exactly so . There you have it , six stages of the trans theoretical model Precontemplation , Contemplation , preparation , action , maintenance and termination .
Okay , Stacey , I seem to understand the different stages and I can remember them using the mnemonic , but using the model with the client seems clear as mud to me right now .
Guess someone didn't take their PCP this morning today there , linton . Well , here is an example that will make the stages crystal clear when working with a client . So you've got a client , let's say they're a smoker . In the preparation stage they might be smoking one pack of cigarettes per day with no desire to quit smoking .
So their thoughts might include you know , smoking relaxes me . The risks of smoking are exaggerated , basically rationalizing right that smoking's okay .
All right .
So if the client were in the contemplation stage , they might be smoking one pack a day still and they're thinking about quitting , though . So when talking with them , you might hear comments like smoking's probably bad for my health , or I should quit to set a good example for my kids , or maybe , but it's gonna be really difficult to stop .
God , I remember seeing this mother that was smoking with a baby in her arms . She whipped her head around fast and the cigarette just went right into the kid's arm .
Oh I know , Boy . Yeah , that might make you want to make some changes then at that point .
Really that would be a motivator .
Exactly so . In the preparation stage remember , this is the commitment stage , preparation . Our hypothetical client here has made a commitment to cut back on smoking to about a half a pack per day and they're setting an eventual quit date .
Thoughts include I'm ready to do this , I'm going to stop smoking for good , or I'm gonna need to remove the ashtrays from my house , or what medication might be able to help me , all right . And then in the action stage , the client has quit smoking completely , using nicotine gum . They're thinking I'm so glad I stopped .
Food tastes better all of a sudden , but I still get cravings when I'm stressed . Well , let me ask you this Stacy .
I had a friend that was a smoker and he used to go to the store to get those nicotine gums so he could increase the amount of nicotine he was getting .
Oh , okay . Well , that seems a bit contrary to the purpose of nicotine gum , huh .
So what stage would he be in ?
Oh gosh , I'm almost thinking he's in the very beginning , thinking he doesn't have a problem . Exactly , yeah , he's pre-contemplation all the way , baby , all right . So if the client sticks to the linear course , after action they'd be moving into the maintenance stage . Next , and this is where they've been nicotine free for , let's say , six months .
Okay , thoughts could be not , smoking is my new normal now , or I barely think about smoking anymore , but I better not get too confident . And finally we've got the termination stage .
If our client quit smoking two years ago and they have no temptation to smoke , they're likely in this stage , thoughts are I'm now a non-smoker for life , or ugh , just the smell of cigarettes makes me nauseous . Quitting was the best decision I ever made . So how's that for you , lenten ? Have I cleared up the muddy waters ?
Yes , it sure does . It's like the spring's wiki watch here down here in hot and sunny Florida . Now a few takeaways before we wrap it up today . The trans theoretical model views behavioral change as an evolving process rather than a single event .
Progress through the stages is impacted by the client's level of readiness and confidence to enact and sustain the new behavior . Self-efficacy or the person's belief in their ability to change varies across the stages and influences that the change progresses . Movement through the stages is often non-linear Clients may progress and then regress .
Relapse involves reverting back to the old behavior and is seen as a natural process of the change process . Old behaviors meet a need and when the client drops the old behavior , the need is still there . Substituting a new behavior for the old one rather than just ditching the old behavior can be an effective way to avoid relapse .
¶ Decisional Balance and Trans Theoretical Model
Decisional balance refers to weighing the pros and cons of changing a behavior . For example , a pro versus con list for starting an exercise regime may include pros like will improve my health and will feel more energetic . Balance against cons , such as will have to give up some leisure time now or will be tired at first .
If you see any of these terms on an exam . You might want to consider that you are being asked about the trans theoretical model .
Alright , great Thanks , linton . Well , we've covered a lot of ground explaining the trans theoretical model as just one theory about behavior change . So good luck to all of you therapists out there as you continue to prepare for your exam . Until next time , remember it's in there .