1. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Systems of Psychotherapy: A Transtheoretical Analysis 16. Comparative Conclusions: Toward a Transtheoretical Therapy

2. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Developmental Model I Perry’s stages of ethical development Dualists: true believers who view world in polar, dichotomous terms Multiplists: true bettors who accept diversity & uncertainly, but favor a single theory Relativists: true eclectics who embrace pluralism and see validity as issue-specific Committed: accept relativism but committed to mastering and improving a particular theory

3. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Developmental Model II Werner’s organismic-developmental model Stage 1: Experiences global whole with no distinctions among the component parts Stage 2: Experiences differentiation of the whole into parts, but loses the big picture Stage 3: Differentiated parts are organized & integrated into whole at a higher level; appreciation of unity and complexity

4. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Transtheoretical Model: 3 Core Dimensions 1.Processes of change (how people change) 2.Stages of change (when people change) 3.Levels of change (what people change)

5. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Processes of Change Covert or overt activities that people engage in to alter emotion, cognition, behavior, or relationships Systems of psychotherapy differ on what to change (content), but tend to agree on how to change (processes) Change processes with most use/ agreement are consciousness raising and therapeutic relationship

6. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Experiential Processes Consciousness raising: increasing awareness Dramatic relief: emotional arousal Self reevaluation: self reappraisal Environmental reevaluation: social reappraisal Social liberation: environmental opportunities and advocacy

7. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Behavioral Processes Reinforcement management: rewarding Counterconditioning: substituting healthier alternatives for problem behavior Self liberation: committing Stimulus control: re-engineering

8. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Consciousness Raising Dramatic Relief Self Reevaluation Environmental Reevaluation Social Liberation Reinforcement Management Counterconditioning Self Liberation Stimulus Control Experiential Processes Doing Behavioral Processes Thinking, Feeling or Experiencing

9. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Stages of Change Constellation of individual’s attitudes, intentions, & behaviors related to readiness to change problem A temporal dimension unfolding over time 5 stages: precontemplation, contemplation, preparation, action, maintenance If change is unsuccessful, then recycle (relapse) back into stages If change is complete and stable, then termination

10. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Stages of Change Maintenance Action Action Preparation Preparation Contemplation ContemplationPrecontemplation

11. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Spiral Pattern of Change

12. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Precontemplators Avoid reading, talking, and thinking about the behavior that needs to be changed The least confident about ability to take action Most resistant to public policy changes Feel pressured by others to take action, but have developed defenses About 40% of people are in Precontemplation

13. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Contemplators Substitute thinking for acting Often waiting for magic moment Not confident about their abilities to change, feel unprepared or ambivalent Typically less than 1% of those at risk participate in traditional programs About 40% of people are contemplators

14. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Preparation More confident & less tempted Assess the pros as higher than the cons Most likely to participate in programs and most likely to benefit Less than 20% of people are in preparation

15. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Action Recently started to change overt problem Consistent for less than 6 months “Here I go!” Apply behavioral process Loved by psychotherapists as the most successful in tx

16. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Maintenance Has overtly changed behavior Consistent success for ≥ 6 months “Keep moving forward!” Reaping rewards of change, but also realize relapse is common

17. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Processes X Stages

18. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Levels of Change 1.Symptom/situational problems 2.Maladaptive cognitions 3.Current interpersonal conflicts 4.Family/systems conflicts 5.Intrapersonal conflicts

19. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Putting It All Together

20. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Transtheoretical Relationship Therapist is expert on process of change Empathic, warm, and supportive Relationship tailored to patient’s stage with procontemplators, a nurturing parent with contemplators, a Socratic teacher with preparation, experienced coach with action & maintenance, a consultant

21. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Effectiveness of Transtheoretical Model (TTM) Hundreds of studies on stages of change and processes of change Early research conducted on addictions; now applied to dozens of behavioral disorders RCTs on smoking cessation, stress, bullying, multiple health behaviors Stage-matched txs outperform conventional treatments

22. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. A Paradigm Shift Moving from action-oriented programs to a stage paradigm to more effectively help people change their behavior.

23. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Action-Oriented Programs 1 - 5% participation rates ≥ 20% of people are ready for action High drop out rates Small impact on populations with unhealthy behaviors

24. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Stage-Matched Programs Recognize behavior change occurs in stages Are tailored to the needs of all participants, not just those in action Can generate 80% participation Can produce 10 times more impact than action-oriented programs

25. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Efficacy vs. Impact Efficacy X Participation = Impact Individual/Clinic: 50% X 5% = 2.5% Public Health/Community: 6% X 75% = 4.5% Stage-Matched Proactive: 20% X 75% = 15%

26. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Criticisms of Transtheoretical Model From a Psychoanalytic Perspective From a Behavioral Perspective From a Humanistic Perspective From a Cultural Perspective

27. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. iatrogenic key levels strategy levels of change maintenance stage maximum impact strategy multiplism precontemplation stage preparation processes of change relativism action stage consciousness raising contemplation stage contingency management counterconditioning dramatic relief dualism efficacy vs. impact environmental reevaluation Key Terms

28. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. self-efficacy self-liberation self-reevaluation shifting levels strategy stages of change stimulus control theoretical complimentarity transtheoretical Key Terms (cont.)

29. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Recommended Websites APA Division of Psychotherapy: www.divisionofpsychotherapy.org/ www.divisionofpsychotherapy.org/ HABITS – Health & Addictive Behaviors: Investigating Transtheoretical Solutions www.umbc.edu/psyc/habits/ www.umbc.edu/psyc/habits/ Home of the Transtheoretical Model: www.uri.edu/research/cprc/ www.uri.edu/research/cprc/ Relapse Prevention: www.niaaa.nih.gov/ publications/arh23-2/151-160.pdfwww.niaaa.nih.gov/ publications/arh23-2/151-160.pdf

30. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc.

31. Chapter 16 Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc.