CH7 Transtheoretical Model (TTM) & Stages of change

Construct 4: Self-Efficacy

-Confidence >Behavior specific >Situation specific >"Here and now" >Build small steps -Important in preparation and action stages

3 principles of change

-Decisional balance: weighing of pros and cons -Self-efficacy: confidence to cope in high-risk situations without relapse -Temptation: intensity of urges to engage in a specific behavior in difficult situations

6 Constructs of TTM

1) Stages of Change (5 stages) 2) Processes of Change (10 processes) 3) Decisional Balance 4) Self-efficacy 5) Temptation 6) Levels of Change (6 levels)

TTM Limitations (4)

Applicability to children and adolescents is unclear Applied more often to risk reduction than to risk prevention Difficult to recruit individuals in precontemplation stage Poor retention rates

TTM Strengths (3)

Applied and effective with a large number of health problems Can be used in a range of settings Supported by both theoretical and applied studies

Stage 3: Preparation

Intention to take action soon (~1mo.). May have attempted to modify behavior in the past year, has a plan of action. Example: Smoker is planning to quit smoking after her birthday in two weeks. She has talked with her doctor and has a prescription for Chantix. note: -have made a commitment to make a change and motivation of "ive got to do something this is serious, something has to change what could I do" -small steps twd cessatino and gathering info of what they need to do -may call clinic for strategies -ppl often skip this stage and want to move from contemplation into action and fail bc havent researched/accepted what is going on

Six Stages of Change

Precontemplation Contemplation Preparation Action Maintenance Termination notes: -Change is a process that unfolds over time, progressing through six stages, not necessarily in a linear manner. -she leaves out termination phase bc she doesn't think we go through it -you can move back and forth btw contemplation and preparation

Practical Application of TTM: Interventions in diverse settings:

Primary care Homes Churches Schools Campuses Communities Worksites

Practical Application of TTM: Interventions with diverse health topics:

Smoking cessation Diet Exercise Stress management Medication adherence Bullying prevention Alcohol use Condom use Domestic violence Organ donation

Stage 5: Maintenance

Specific sustained modifications in lifestyle, working to prevent relapse. Example: Smoker has experienced 15 months of abstinence. She no longer needs the medication to resist cravings and avoids areas where others smoke. note: -being able to successfully avoid any temptation to return to bad habit -goal is to maintain new status quo -remind selves of how much progress uve made -constantly reformulate rules of lives and acquire new skills to deal and avoid relapse -can anticipate situation in which relapse can occur and prepare coping strategies in advance -remain aware that what they are striving for is worth it -patient w selves and recognize it takes time -even in one day you may go through several stages of change (its normal to move forwards and fall back)

4. environmental reevaluation

cognitive and affective assessment of how the presence or absence of a behavior affects one's social environment, such as the impact of one's smoking on others ex: empathy training notes: the awareness that one can serve as a pos or neg role model for others; empathy training, documentaries, and family interventions can lead to reassessments (ex: I consider the veiw that smoking can be harmful to the environment)

3. Self-reevaluation

cognitive and affective reassessment of one's self-image with or without an unhealthy behavior ex: values clarification notes: example is ones image of a couch potato or inactive person; techniques that can move people are value clarification, healthy role models, and imagery (ex: my dependency on cigs makes me disappointed in myself)

7. social liberation

increase healthy social opportunities or alternatives ex: easy access to walking paths note: requires an increase in social opportunities or alternatives, esp for ppl who are relatively deprived or oppressed; advocacy and empowerment procedures and appropriate policies can produce increased opportunities for minority/gay/impoverished health promotion; the same procedures can also be used to help all people change, such as smoke free zones, salad bars in school lunches, easy access to contraceptives (ex: I find society changing in ways that make it easier for the non smoker)

1. consciousness raising

increasing awareness about the causes, consequences, and cures for a problem behavior, ex: nutrition education notes: intervention to increase awareness=feedback, education, confrontation, interpretation, bibliotherapy?, and media campaigns; ex: recalling info given on how to stop smoking

stage 6: termination

Zero temptation and 100% self-efficacy Example: She has not smoked for 20 years and reports no cravings or desire for smoking, even in the presence of smokers Rare for smoking and many other health behaviors. note: -prof believes ppl always in maintenance to avoid relapse

History of Transtheoretical Model(TTM)

-Developed after comparative analysis of 25 psychotherapy theories >Revealed existing theories focus on why people change, not how they change behaviors >Identified 10 process of change to describe ways in which behavior change occurs notes: -explains/predicts persons success or failure at achieving behavior change (why the change stuck or why the change was not made); ex: smoking cessation, weight control, sunscreen use, quitting cocaine, condom use, and monography? Screening -certain predictors of progression through change including decisional balance, self efficacy, and the processes of change

Review notes on Eco Model

-Ecological models recognize that all levels of influence are important. It takes a combination of both individual and environmental/policy-level interactions to change and maintain health behaviors. -Ecological models provide an framework for integrating other theories into the model, including individual, interpersonal, and macro theories. They can be considered meta-models that organize other models and theories into a whole. -Multiple levels of influence impact health behaviors -Framework for integrating other theories and models -Comprehensive approach to study design and/or interventions

Pros and cons of decisional balance and its 4 components

-Pros: The benefits of changing -Cons: The costs of changing -Janis and Mann identified the following components: >Instrumental costs to self >Instrumental costs to others >Disapproval from self >Disapproval from others

Be able to answer:

-What are the five principles of ecological models? Name and explain? -What are the strengths and limitations of ecological models? -What are the strengths and limits of the HBM? its 6 constructs? -Key constructs of TRA? strengths and limits? Difference between TRA and TPB? be able to fill in chart -TTM and Staes of Change: see slide for answer and be able to fill in blanks 1-6 (including 5 stages, 10 processes, and know #6 is 6 levels of change but do NOT need to memorize these 6 levels); strengths and limits?

review

-activities; like the ones we did in class before the test

6. helping relationships

-caring, trust, openness, and acceptance and support from others for healthy behavior change ex: positive social network note: repor building, therapeutic alliance, counser calls?, and buddy system are all sources of social support ("I have someone who listens when I need to talk about my smoking")

Assumption that people apply change processes across common set of behaviors: -10 _____ -3 _______

-processes of change -principles of change

notes on processes of change

-processes of change=over and over activities that people use to progress at these stages; give important guide for intervention programs since the processes are the indep variables that people need to apply to move from stage to stage -10 processes have received most empirical support in research today around health behavior change -first 5 processes are EXPERIENTIAL? Processes used primarily for their early stage transitions -last 5 are BEHAVIORAL processes used primarily for later stage transitions

Construct 6: 5 Levels of Change (not as important to focus on bc limited utility for designing health behavior change interventions; only listed so we have a complete picture of the TTM)

1. Symptom/situational problems 2. Maladaptive conditions 3. Current interpersonal conflict 4. Family/system conflicts 5. Intrapersonal conflicts

Stage 2: Contemplation

No intention to change in the near future (~6 mo.) Considering pros and the cons of modifying behavior Example: Smoker is thinking about quitting. She knows it is bad for her health and causes severe cough. note: -more aware of consequences of habit and spend more time thinking about problem; in the middle between deciding to change or not change -could take weeks to a lifetime -more open to receiving info about bad habit and more likely to actually see educational interventions and reflect on own feelings and thoughts

Stage 1 Precontemplation

No intention to take action in the near future (~6 mo.) Example: A current smoker is not considering or planning to quit smoking in the next sixth months note: -not thinking about changing nor interested in any kind of help -defend bad habits and don't think it's a problem -intend to not discuss bad habits w others

Stage 4: Action

Recent specific overt modifications to change behavior (~6 mo.). Example: She has not smoked in three months. She is taking her medication as prescribed and practicing yoga to manage stress. note: -believe ability to change behavior and actively involved; shortest of all stages usually 6 months but can be just an hour -depends on own willpower -at greatest risk for relapse -review commitment to selves and plans to deal w personal and external pressures that may lead to slips -may use short term rewards to keep motivated -analyze behavior change efforts in a way that enhances self confidence -open to receiving help and seek support from others

Construct 3: Decisional Balance

This reflects the pros and cons of changing. The balance between the pros and cons varies depending on the current stage of change of the individual. Behavior changes when the pros of behavior change are viewed as more important than the cons of change. notes: -This is the individual's cost benefit analysis of taking the positive behavior. -Perceptions of pros and cons will change as an individual goes through the stages of changes. For example, the cons of changing will be more prominent in the precontemplation and contemplation stage and the pros of changing will usually be perceived as more important in the preparation and following stages of action, maintenance and termination. -Refer participants to: Exercise: Decisional Balance - Alcohol & Drug Use. This is an example of a measure of the pros and cons of drinking and or using drugs.

5. self-liberation

belief that one can change and the commitment and re-commitment to act on that belief ex: New Year's resolutions notes: public testomonies, and multiple rather than single choices can enhance self-liberation or what the public calls "willpower"; motivation research indicates that people with 2 choices have greater commitment than people with one choice, those with 3 choices have even better commitment, however 4 choices do not further enhance willpower (ex: given 3 choices to take action to quit, "I make commitments to not smoke")

10 processes of change

covert and overt activities used to progress through stages

Construct 5: Temptation

goes hand-in-hand with self-efficacy. Temptation is the urge to engage in unhealthy behavior when confronted with a difficult situation. Methods: >Counteract stress >Avoid negative social occasions >Control cravings

2. Dramatic relief

increasing negative or positive emotions (ex: fear or inspiration) to motivate taking appropriate action ex: personal testimonials notes: initial increase in emotions followed by reduced effect if aprop action can be taken; examples of techinques that can move ppl emotionally are role play, grieving, personal testimonies, and media campaigns (ex: react emotionally to warnings about cigs)

9. stimulus control

removes cues for unhealthy habits and add prompts for healthier alternatives, ex: remove all ashtrays from house and car notes: avoidance, envir reengineering, and self-help groups can provide stimuli that support change and reduce risk fro relapse; planning parking lots w a 2 min walk to the office or putting art in stairways are examples of reengineering that can encourage more exercise ("I can remove things from my home that remind me from smoking")

8. counterconditioning

requires learning healthier behaviors that can substitute for problem behaviors, ex: relaxation replacing alcohol notes: relaxation can counter stress, assertion can counter peer pressure, nicotine replacement can substitute for cigs and fat free foods can be safer substitutes ("I find that doing other things w my hands is a good sub for smoking")

10. reinforcement management

rewarding oneself or being rewarded by others for making progress ex: incentives notes: provides consequences for taking steps in a particular direction while reinf managm can include the use of punishments, we found that self changers rely much more on rewards than punishment, so reinforcements are emphasized since a philosophy of the stage model is to work in harmony with how ppl change naturally; contingency contracts, overt and covert reinf, positive self statements, and group recognition are procedures for increasing reinf and the probability that healthier responses will be repeated ("I reward myself when I don't smoke")