1. Model of Change James Prochaska and Carlo Diclemente (1982) Briony Williams

2. Who Made Resolutions on New Years Eve? Intention to change Willingness to change Barriers to change Process of change

3. Stages of Change Change is not an event, it is a process There are 5 stages which form a predicable motivational route from the position of not recognising a problem to recognition and change, to a point at which the problem no longer exists. Relapse and recycling throughout stages is common. Relapse is the rule rather than the exception. (Prochaska; DiClemente and Norcross (1992)

4. The Spiral Of Change Pre-contemplation Contemplation Preparation Action Maintenance Leading to sustained change Adapted from the work of Prochaska & DiclementeNorman Rogers Lapse & Relapse are part of this process

5. Precontemplation Stage Where there is no intention to change the behaviour in the foreseeable future. People are unaware of or are unconcerned by their behaviour. They may express a wish to change, but this is different from a serious intention to change in the near future. Discuss denial

6. The Spiral Of Change Pre-contemplation Contemplation Preparation Action Maintenance Leading to sustained change Adapted from the work of Prochaska & DiclementeNorman Rogers Lapse & Relapse are part of this process

7. Contemplation Where people are aware that problem exists and are seriously thinking about change. They are weighing up the pros and cons of changing. They struggle with their behaviour and the amount of effort and loss it will cost to overcome the behaviour.

8. The Spiral Of Change Pre-contemplation Contemplation Preparation Action Maintenance Leading to sustained change Adapted from the work of Prochaska & DiclementeNorman Rogers Lapse & Relapse are part of this process

9. Preparation This is a transition period between shifting the balance in favour of change and getting things moving in the that direction. Many people have fleeting moments of determination that swiftly vanish when all of the horrors involved come back into awareness. What issues may push people back to the behaviour?

10. The Spiral Of Change Pre-contemplation Contemplation Preparation Action Maintenance Leading to sustained change Adapted from the work of Prochaska & DiclementeNorman Rogers Lapse & Relapse are part of this process

11. Action Where people modify their behaviour, experiences and environment in order to change the addictive behaviour.

12. The Spiral Of Change Pre-contemplation Contemplation Preparation Action Maintenance Leading to sustained change Adapted from the work of Prochaska & DiclementeNorman Rogers Lapse & Relapse are part of this process

13. Maintenance: Where people work to avoid relapse and consolidate gains. This is a continuance, not an absence of change

14. Transtheoretical Model and Stages of Change Norman Rogers

15. Transtheoretical Model: The Transtheoretical Model uses stages of change to integrate processes and principles of change from across major theories of intervention. It was labeled transtheoretical because concepts come from different theories of human behavior and views of how to change people Comparative analysis of leading theories of psychotherapy and behavioral change identified only ten processes of change among them, which unfold through a series of stages

16. Processes of Change: Experiential 1. Consciousness Raising [Increasing Awareness]  I recall information people had given me on how to stop using. 2. Dramatic Relief [Emotional Arousal]  I react emotionally to warnings about using. 3. Environmental Reevaluation [Social Reappraisal]  I consider the view that using can be harmful to the people around me. 4. Social Liberation [Environmental Opportunities]  I find society changing in ways that make it easier for the nonuser. 5. Self Reevaluation [Self Reappraisal]  My dependency on substances makes me feel disappointed in myself.

17. Processes of Change: Behavioral 1. Stimulus Control [Re-Engineering]  I remove things from my home that remind me of using. 2. Helping Relationships [Supporting]  I have someone who listens to me when I need to talk about my using. 3. Counter Conditioning [Substituting]  I find that doing other things with my hands is a good substitute for not using. 4. Contingency Management [Holding ones self Responsible]  Changing the consequence of behavior I reward myself when I don’t use. 5. Self liberation [Committing]  I make commitments not to use.

18. Stages of Change in Which Change Processes Are Most Emphasized Stages of Change Pre-contemplationContemplationPreparationActionMaintenance Consciousness Raising Dramatic relief Environmental reevaluation Self-reevaluation Self-liberation Contingency Management Helping relationships Counterconditioning Stimulus Control

19. Decisional Balance Decisional balance is derived via a comparison of the strength of perceived pros of the target behavior with the perceived cons. The relative weight people assign to the pros and cons of a behavior influences their decisions about behavior changes

20. Self-Efficacy Confidence: situation-specific confidence people have that they can cope with high-risk situations without relapsing to their unhealthy or high-risk habits Temptation: the intensity of urges to engage in a specific habit when in the midst of difficult situations, including: Negative affect or emotional distress Positive social occasions Cravings

21. Critical Assumptions No single theory can account for all the complexities of behavioral change. Behavioral change is a process that unfolds over time through a sequence of stages. Stages are both stable and open to change just as chronic behavioral risk factors are both stable and open to change. There are a common set of change processes that people apply across a broad range of behaviors.

22. Critical Assumptions The majority of at-risk populations are not prepared for action and will not be served by traditional action-oriented prevention programs. Specific processes and principles of change need to be applied at specific stages if progress through the stages is to occur. Intervention programs must be matched to each individual’s stage of change. Chronic behavioral patterns are under some combination of biological, social, and self-control. Stage-matched interventions have been designed primarily to enhance self-control.

23. New Directions: A Third Dimension in TTM Stages of Change: recognizes the temporal and developmental nature of the process of change Process of Change: the critical activities needed to move an individual through the stages Levels of Change: interactive areas of an individuals life that influence and are influenced by changes at any one of five levels: symptom/situational maladaptive cognition interpersonal problems family and system conflicts intrapersonal conflicts Therefore this model deals with where the client is, which level of intervention is sought, and the elements necessary to bring about meaningful change

24. Relapse While relapse can be discouraging, the majority of people who successfully quit do not follow a straight path to a life time free of self-destructive habits, they cycle through the five stages several times before achieving a stable life style change. The Stages of Change Model considers relapse to be normal People should analyse how the slip happened and use it as an opportunity to learn how to cope differently. Relapses can be important opportunities for learning and becoming stronger. What are the possible triggers?

25. Relapse People who have relapsed may need to learn to anticipate high-risk situations (such as being with their family) more effectively. Control environmental cues that tempt them to engage in their old habits and learn how to handle unexpected episodes of stress without returning to the bad habit. This gives them a stronger sense of self control and the ability to get back on track.

26. REFERENCES DiClemenete, C.C., & Prochaska, J.O. (1982). Self change and therapy change of smoking behavior: A comparison of processes of change in cessation and maintenance. Addictive Behavior. &: 133-142. Marlatt, G.A. (1985). Cognitive factors in the relapse process. In G. A. Marital & J.R. Gordon, Relapse Prevention. New York: Guilford Publications. Marlatt, G.A. (1985). Lifestyle Modification. In G.A. Marlatt & J.R. Gordon, Relapse Prevention. New York: Guilford Publications.

27. References Marlatt, G.A. (1985). Lifestyle Modification. In G.A. Marlatt & J.R. Gordon, Relapse Prevention. New York: Guilford Publications. Miller, W.R., Gribskov, C.J., & Mortell, R.L. (1981). Effectiveness of a self-control manual for problem drinkers with and without therapist contact. International journal of addictions, 16, 1247-1254. Miller, W.R., Taylor, C.A., & West, J.C. (1980). Relative effectiveness of bibiotherapy, individual and group self- control training in the treatment of problem drinkers. Addictive Behaviors, 5, 13-24. Miller, W.R., & Rollnick, S. (1991). Motivational Interviewing: Preparing People to Change Addictive Behavior. New York: Guilford Publications.

28. References Prochaska, J.O. & DiClemente, C.C. (1982) Transtheoretical therapy: Toward a more integrative model of change. Pscychotherapy: theory, research and practice, 19: 276-288. Sanchez-Craig, M., Annis, H.M., Bornet, A.R., & MacDonald, K.R. (1984). Random assignment to abstinence and controlled drinking: Evaluation of a cognitive- behavioral program for problem drinkers. Journal of Consulting and Clinical Psychology, 52, 390- 403.

29. References Skutle, A., & Berg, G. (1987). Training in controlled drinking for early stage problem drinkers. British Journal of Addiction, 82, 493-501. Sobell, M.B., & Sobell, L.C. (1993). Problem Drinkers: Guided Self-Change Treatment. New York: Guilford Publications. Sobell, M.B., Sobell, L.C., Bogardis, J., Leo, G.I., & Skinner, W. (1992). Problem drinkers' perceptions of whether treatment goals should be self-selected or therapist selected. Behavior Therapy, 23, 43-52 Westermeyer, R. A USER-FRIENDLY MODEL OF CHANGE www.habitsmart.com/motivate.htm