Transtheoretical Model (TTM)

TTM Decisional balance

"pros and cons" - The pros and cons can change drastically as a person passes through the stages of change. - Changes to the decisional balance are motivating factors to progress through stages of change. Decisional Balance related to stages: - During the Precontemplation Stage, whether consciously or not, an addict decides that the cons of quitting their substance of choice outweigh the pros of quitting it. - During the Contemplation Stage, the balance between pros and cons is about even. - As the pros start to outweigh the cons, the addict begins to recognize that they have a problem that must be addressed and they move on to the Preparation and Action stages. - During the Maintenance Stage, the pros must continue to outweigh the cons in order to prevent a relapse.

4 Constructs

1.Stages of Change (key construct of model) 2.Processes of Change 3.Decisional Balance 4.Self-Efficacy

Another way to see it

•Pre-contemplation: ignorance is bliss, individuals don't see a problem and are not interested in changing behavior •Contemplation: on the fence, individual acknowledges a problem exists but aren't sure if the benefits of changing outweigh the benefits of staying the same •Preparation: testing the waters, individuals recognize the problem and are taking small steps toward change, •Action: implementation, individual has identified a plan for changing the behavior and has started it •Maintenance: doing it, individual has been engaging in the new behavior for at least 6 months •Relapse: fallen off the wagon, individual is engaging old behaviors

Summary

- TTM - an approach to contemplate how behavior change is made - 5 Stages of change: 1.Pre-contemplation 2.Contemplation 3.Preparation 4.Action 5.Maintenance Relapse (unofficial stage) TTM assumptions: - Change takes time - There are common tasks in each stage - Tailoring your intervention to match the stage of change client is in will increase client's success in making lasting change

10 Processes

1.Consciousness raising: Increasing awareness about the behavior 2. Dramatic relief: Attention to positive & negative feelings about the behavior 3. Environmental reevaluation: Noticing how behavior effects others (family, work, etc.) 4. Self reevaluation: Creating new self image where healthy behavior is a part of self 5. Social Liberation: Notice public support processes/opportunities 6. Self Liberation: Making commitment to change behavior with belief its possible 7. Counter Conditioning: Substituting healthy behaviors & thoughts for unhealthy ones 8. Helping Relationships: Getting support 9. Reinforcement Management: Rewarding positive behavior & reducing rewards for negative behavior 10. Stimulus Control: Re-engineering environment - incorporating cues that support & encourage healthy behavior - removing cues that encourage unhealthy behavior

TTM: Stages of Changes

Pre-contemplation - no need to make a change Contemplation - In this stage, people are intending to start the healthy behavior in the foreseeable future (defined as within the next 6 months). People recognize that their behavior may be problematic, and a more thoughtful and practical consideration of the pros and cons of changing the behavior takes place, with equal emphasis placed on both. Even with this recognition, people may still feel ambivalent toward changing their behavior. Preparation - think of it as determination; In this stage, people are ready to take action within the next 30 days. People start to take small steps toward the behavior change, and they believe changing their behavior can lead to a healthier life. Action - In this stage, 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. Maintenance - In this stage, 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. Termination (relapse) - In this stage, people have no desire to return to their unhealthy behaviors and are sure they will not relapse. Since this is rarely reached, and people tend to stay in the maintenance stage, this stage is often not considered in health promotion programs.

TTM and self efficacy

Self-efficacy: ability or degree of confidence in producing or maintaining behavior change Self-efficacy related to stages: Precontemplation and - Contemplation stages - temptation to engage in the unhealthy behavior is far greater than self-efficacy to abstain. From Preparation to Action - disparity between feelings of self-efficacy and temptation closes, and behavior change is attained. Relapse - occurs when feelings of temptation trump the sense of self-efficacy to maintain the desired behavior change. ** High level of self-efficacy can predict a lasting change in behavior **