Sunday, November 21, 2010


Transtheoretical model is widely used to help people make and understand change. The research for the model comes from health studies, particularly focused on drug addiction (e.g. tobacco). Some researchers have tested the model outside of the realm of addiction and found it to be a broadly applicable model for change.

The model integrates several theories - hence the name - and its core is a stages of change structure.

Precontemplation - In this stage you are not thinking about change in the next six months
Contemplation - In this stage you are thinking about change in the next six months
Preparation - Making plans for change
Action - Executing the plans
Maintenance - Successful action over several month
Relapse - Reverting to old behaviours
Termination - New behaviour is natural

An important feature of this model is the open recognition of relapse. When making change there are is always the possibility of falling back into old ways, and acknowledging this gives you the opportunity to deal with it.

Many change theories have stages, Kubler-Ross's stage of grief for example, the advantage of TTM is that it you have guidance at each stage. Stages of grief for example can help you explain what is happening, but not what to do about it, TTM gives you more than "oh, I am bargaining now".

What to do...
Precontemplation - raise awareness, give someone the reason to change
Contemplation - an extremely ambivalent stage, play on this, tease out the tension, let the person make the decision
Preparation - plan small steps, you need to build on success
Action - support and encouragement, prepare for relapse - it will happen
Maintenance - support and encouragement
Relapse - this is falling back to another stage, it may be precontemplation, contemplation, use the techniques required at that stage.
Termination - pat yourself on the back and select a new goal

There a two other fundamental elements to the model (adding up to the transtheoretical name):
- Self efficacy
- Decisional balance

Self efficacy is how well someone thinks they can perform in a specific domain or circumstance. The degree of self efficacy an individual will feel across the stages of change varies and can be an indicator to where someone is within TTM.

Precontemplation - High
Contemplation - Lower
Preparation - Lower
Action - Growing
Maintenance - High
Relapse - Low
Termination - High

What I find interesting is that self-efficacy is high in precontemplation. In this stage someone is feeling good about what you do and how you do it, you have no reason for change, so you "resist" change.

Transitioning into contemplation self-efficacy is lowered because of uncertainty about the new behaviours and no longer convinced about the existing behaviours.

As you practice the change through preparation and action you will build in your self-efficacy through small successes. Eventually the change is part of who the person is and how they act, self-efficacy is once again at its peak.

Decisional balance is about weighing up the pros and cons of change. Over the stages of change this balance changes.

Decisional balance...
Precontemplation - Cons out weigh pros
Contemplation - Pros and cons are equal (near)
Preparation - Pros start to outweigh cons
Action - Pros outweigh cons
Maintenance - Pros outweigh cons
Relapse - Cons out weigh pros
Termination - Pros outweigh cons

In important implication of this is that when you are thinking resistance it may be that someone doesn't see the need to change. The cons of change outweigh the pros, they feel effective in what they are doing, there is no reason for them to change.

Brief summary (in crappy HTML table)

Transtheoretical model
Stage What to do Self-efficacyDecisional Balance
Precontemplation raise awareness HighCons outweigh pros
Contemplation work with the tension, let the person make the decision LowPros and cons equal
Preparation plan small steps, you need to build on success GrowingPros outweigh cons
Action support and encouragement, prepare for relapse HighPros outweigh cons
Maintenance support and encouragementHighPros outweigh cons
Relapse revisit other stages LowDecisional Balance
Termination party HighPros outweigh cons

Some light reading to kill off the insomnia

Velicer, W. F., C. C. DiClemente, et al. (1985). "Decisional balance measure for assessing and predicting smoking status." Journal of Personality and Social Psychology 48(5): 1279-1289.

McConnaughy, E. A., J. O. Prochaska, et al. (1983). "Stages of change in psychotherapy: Measurement and sample profiles." Psychotherapy: Theory, Research & Practice 20(3): 368-375.

Prochaska, J. O. and C. C. DiClemente (1983). "Stages and processes of self-change of smoking: Toward an integrative model of change." Journal of Consulting and Clinical Psychology 51(3): 390-395.

Prochaska, J. O. and et al. (1982). "Self-change processes, self-efficacy and self-concept in relapse and maintenance of cessation of smoking." Psychological Reports 51(3, Pt 1): 983-990.

Prochaska, J. O., W. F. Velicer, et al. (1994). "Stages of change and decisional balance for 12 problem behaviors." Health Psychology 13(1): 39-46.

Grant, A. M. (2006). An Integrative Goal-Focused Approach to Executive Coaching. Evidence based coaching handbook: Putting best practices to work for your clients. Hoboken, NJ, John Wiley & Sons Inc; US: 153-192.

Grant, A. M. and J. Franklin (2007). "The transtheoretical model and study skills." Behaviour Change 24(2): 99-113.


Jason Yip said...

From what I understand the Kubler-Ross stages of grief are not supported by evidence?

L said...

The stages of grief are based on observation. It's a useful model to help people understand grief. Not so useful for intentional change.

Jason Yip said...

That's the thing, from what I understand, the model does not reflect what grief researchers are observing. I was trying to find a book that I had on my to-read list about this but I haven't found it yet.