Stages of Change

Step 5: Maintenance

Change for at least six months People have sustained their behavior change for a while (defined as more than 6 months) and intend to maintain the behavior change going forward. People in this stage work to prevent relapse to earlier stages.

Accordingly to TTM (Stages of change), how does change occur?

Change in behavior, especially habitual behavior, occurs continuously through a cyclical process.

Step 4: Action KEY WORDs

Commitment Direct Actions Knows and wants to change

Five processes of change

Consciousness Raising Dramatic Relief Environmental Reevaluation Social Liberation Self Reevaluation

Robert lives alone after his divorce and visits with his son for a week at a time. He has been using his son's stimulant medication to get high and has lied to the child's doctor and the child's mother about losing or spilling the pills in order to get more. Robert knows his behavior is dangerous but still takes comfort in the intoxication produced.

Contemplation - Robert is aware of the problem and recognized the risk involved with his continued use. He has not reached the next stage because he continues to use regardless of risk.

Suzy is a mother who feels the amount of Vicodin she has been consuming is interfering with her relationship with her children. She has told her husband she would speak with her doctor but consistently "forgets" to do so. C

Contemplation - Suzy has begun questioning the impact her drug use is having but is not taking it seriously enough to act.

Reinforcement management

Is the process of both rewarding and reevaluating behavior after you take action. Did you go to the gym every day this week? Offer yourself a reward. Did your partner fail to meet their word count goals during the month? Take some time to recognize the shortcoming and reassess.

Who were the developers of the Transtheoretical Model of Change?

James Prochaska and Carlo DiClemente

Step 4: Action

Lasts for 3-6 months People have recently changed their behavior (defined as within the last 6 months) and intend to keep moving forward with that behavior change. People may exhibit this by modifying their problem behavior or acquiring new healthy behaviors.

After 15 years of Opioid dependence, Earnest checked himself into a rehabilitation program. He has been sober for two years and has a large support system around him.

Maintenance - Earnest has successfully quit abusing Opioids and now lives a sober lifestyle with a large support system.

Jon was addicted to CNS Depressants for 6 years. After completing a one-month stay in an inpatient treatment center, he has remained sober for the last 11 months. He attends outpatient support groups and is celebrating one year of sobriety with a renewed vow never to use again.

Maintenance - Jon has maintained sobriety for nearly a year. He is aware of his addiction and has taken steps to avoid relapse.

Step 1: Precontemplation KEY words

No awareness Denial Minimization

TTM operates on what assumptions?

People do not change behaviors quickly and decisively.

When was the Transtheoretical Model of developed?

1970s

Roger is an Opioid addict and has been clean for 2 months. He regularly sees a therapist and attends NA meetings once a week.

Action - Roger is on the right track but remains in the action stage. This is because he has not reached the 6 month point required to enter the Maintenance Stage.

What Is the Transtheoretical Model of Change?

Decision-making of the individual and is a model of intentional change. TTM is a model NOT A theory

Step 3: Preparation

Fully ready to make a big change within the upcoming month. They understand the benefits of making the change and want to move forward. But rather than diving in headfirst, they just "test the waters" of change. Believe changing their behavior can lead to a healthier life.

Can a person change without motivation?

If a person does not see and believe the benefits of making a change, they are more likely to relapse.

Step 2: Contemplation KEY words

Increase Awareness Considering the change No Commitment

Step 1: Precontemplation

People do not intend to take action in the foreseeable future. People are often unaware that their behavior is problematic or produces negative consequences. People in this stage often underestimate the pros of changing behavior and place too much emphasis on the cons of changing behavior.

Step 6: Relapse

Person revert to previous stage of change Person revert to previous behaviors

Mike is a college student who is struggling with the stress of his coursework. He has been obtaining and nasally ingesting Ritalin to keep himself awake at night to study. Mike believes the Ritalin is not a problem and it is helping him to succeed in school.

Pre-contemplation - Mike is actively using Ritalin inappropriately and does not see any problems with the behavior.

Dramatic relief

Process of emotionally responding to information about a behavior and its consequences. If you have ever watched a powerful anti-smoking commercial and recognized your intense feelings after the commercial, you have undergone dramatic relief.

Environmental reevaluation

Process of reassessing how the behavior impacts the physical or social environment surrounding that person. Showing a friend a documentary on how plastic waste climate change can encourage them to evaluate how much plastic they use every day.

Social liberation

Process of seeing opportunities that allow for the behavior to change. When cities started to ban smoking in bars and restaurants, social liberation was taking place. More people were encouraged to quit smoking because they would have to go outside to smoke and wouldn't be tempted while eating a meal

Reba is a high school student who has begun abusing Opioid prescription drugs with some other teens after school. Her best friend tells her the behavior is dangerous but Reba insists she is having fun and the drugs are safe because they came from a pharmacy.

Precontemplation - Reba does not believe there is anything wrong with her behaviors and incorrectly views the drugs as "safe.

The TTM posits that individuals move through SIX stages of change

Precontemplation, Contemplation, Preparation, Action, Maintenance AND Relapse

Eliza decides that she is tired of constantly seeking pills and after a few days of thought, she tells her therapist that she is ready to change. The therapist then makes her an appointment with a drug and alcohol counselor

Preparation - Eliza has recognized her problem and is preparing to take action.

Page has been taking Oxycodone for three years and is addicted to the medication. He was obtaining them from anyone who would sell them to him. He has recently realized the impact it is having on his life and he has made an appointment with his doctor to discuss quitting. P

Preparation - Page recognizes that he has a problem and has taken steps to get him to the Action stage.

Counter-conditioning

Relaps to shift our perspective from "quitting" or "losing" a habit to "gaining" or "beginning" a more positive habit. Discovering more positive alternatives to your current behaviors helps to counter-condition you and set you up for success. Replacing an evening beer with an evening cup of tea is just one way you can counter-condition yourself while cutting down on booze.

After successfully quitting a severe Opioid habit, Kitty was sober for over 8 months. One afternoon she sees an old boyfriend and becomes depressed. Kitty goes to the home of her old drug dealer and obtains five Percocet pills. She immediately takes all of them.

Relapse - Kitty had entered the maintenance stage but encountered a "trigger" and then relapsed.

Step 6: Relapse KEY words

Relapses happen. They just do. When it comes to substance abuse, the relapse rate falls BETWEEN 40% and 60%

Step 3: Preparation Key WORDs

Small changes Determination

Step 5: Maintenance KEY Words

Sustained behavioral change for at least 6 months

Consciousness raising

The process of raising general awareness of a behavior and its consequences. Recalling some of the information you know about the dangers of addiction raises your consciousness on the issue.

Step 2: Contemplation

They understand that their behavior is hurting themselves or others. They can see themselves making a change within the next six months of their life. BUT SOMETHING IS Still HOLDING BACK. People are intending to start the healthy behavior in the foreseeable future (defined as within the next 6 months).

Helping relationship

This process includes building a support system through the attendance of meetings or by engaging in discussions with others. Every time you go to an AA meeting, you engage in this process.