The Transtheoretical Model of Behavior Change Cynthia MH Bane, Ph.D. Professor of Psychology Wartburg College

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Transtheoretical Model of Behavior Change (TTM) Development of the Model Underlying Assumptions Elements of the Model Stages of Change Decisional Balance Self-Efficacy/Temptations Processes of Change Questions/Comments

Development of the Transtheoretical Model First proposed in 1983 Followed individuals who were attempting to quit smoking Created TTM using concepts from multiple models of psychotherapy The TTM has been applied to many health-related behaviors Prochaska DiClemente

Primary Assumptions Important to consider the process of change over time Necessary to tailor messages and interventions to match patient’s level of readiness to change

Stages of Change

Precontemplati on Not ready No intention to take action in the forseeable future (6 months)

Contemplation Getting ready to change Intends to take action in the forseeable future Within the next 6 months Ambivalent about change

Preparation: Ready to Change Intends to take action in the next 30 days Typically have taken some action in the past year Have a plan

Action Has made an overt modification in lifestyle Is meeting behavioral criterion 6 months or less High risk for relapse/recycling

Maintenance Has maintained behavior change for more than 6 months Still at risk for relapse

Recyclin g Returning to a previous stage

Terminatio n Might be possible for some behaviors Individual has zero temptation & total self-efficacy

Stages of Change PCPAMPCPAM

Decisional Balance The Pros and Cons of Changing

Decisional Balance Pros & cons of changing Roughly equal during contemplation Important to address both PROS CONS

Self-Efficacy Confidence in Specific Situations

Self-Efficacy Confidence in maintaining desired behavior in specific situations that often trigger relapse Temptations to return to problem behavior

Processes of Change Tailoring Messages and Interventions to Match Stage of Readiness to Change

Stages of Change & Processes of Change Precontemplation Contemplation Preparation Action Maintenance Cognitive & experiential processes Behavioral processes Cognitive & experiential processes continue to be relevant

Processes of Change: Experiential Consciousness Raising Dramatic Relief Self-Re-evaluation Increasing information about self & a behavior Experiencing & expressing feelings about a behavior (“wake-up call”) Assessing how behavior fits with one’s goals and values

Processes of Change: Experiential Environmental Re-Evaluation Social Liberation Assessing how one’s behaviors affect the environment Noticing increasing alternatives to the undesirable behavior in society

Processes of Change: Behavioral Self-Liberation Stimulus Control Making a choice & committing to change Avoiding cues that elicit the undesirable behavior Adding cues that elicit desirable behavior

Processes of Change: Behavioral Counterconditioning Reinforcement Management Substituting new alternative behaviors for undesirable behavior Rewards for positive change Reward small steps Rewards should be meaningful

Helping Relationships Support without nagging

Transtheoretical Model Pre- contemplation ContemplationPreparationActionMaintenance Consciousness Raising Dramatic Relief Self- reevaluation Environmental Re-evaluation Social liberation Consciousness Raising Dramatic Relief Self-reevaluation Environmental Re-evaluation Social liberation Self-Liberation Plans for behavioral processes Stimulus Control Counter conditioning Reinforcement Management Stimulus Control Counter conditioning Reinforcement management Self-Efficacy Pros Cons

Which Process(es)? Which Stage? From “Finding Your Way to a Healthier You: Based on the Dietary Guidelines for Americans” (US Department of Health and Human Services, 2013) DON’T GIVE IN WHEN YOU EAT OUT AND ARE ON THE GO. It’s important to make smart food choices and watch portion sizes wherever you are—at the grocery store, at work, in your favorite restaurant, or running errands. Try these tips: In a restaurant, opt for steamed, grilled, or broiled dishes instead of those that are fried or sautéed. On a long commute or shopping trip, pack some fresh fruit, cut-up vegetables, string cheese sticks, or a handful of unsalted nuts—to help you avoid impulsive, less healthful snack choices.

Which Process(es)? Which Stage? From “Blood Sugar Testing: The Power to Control Diabetes is in Your Hands” (NIH Publication Number ) Why should I control my diabetes? To feel better and stay healthy. Ask your doctor or health care provider if regular blood sugar testing is right for you. Lowering your blood sugar by any amount reduces your chances of having eye, kidney, and nerve problems. You can avoid these problems when you control your diabetes.

Which Process(es)? Which Stage? From “Healthy Eating & Physical Activity across Your Lifespan: Tips for Adults” (NIH Publication No ) To keep a food diary, write down all the food you eat in a day. Also write down the time you eat and your feelings at the time. Writing down your feelings may help you identify your eating triggers. For example, you may notice that you sometimes overeat when you are in a big group, simply because everyone around you is eating. The next time you find yourself in this situation, be mindful of that eating trigger and try to limit your portion sizes.

Transtheoretical Model Pre- contemplation ContemplationPreparationActionMaintenance Consciousness Raising Dramatic Relief Self- reevaluation Environmental Re-evaluation Social liberation Consciousness Raising Dramatic Relief Self-reevaluation Environmental Re-evaluation Social liberation Self-Liberation Plans for behavioral processes Stimulus Control Counter conditioning Reinforcement Management Stimulus Control Counter conditioning Reinforcement management Self-Efficacy Pros Cons