Topic 1 Overview of Key Theory on Transtheoretical Model

The Transtheoretical Model (TTM) (also called the Stages of Change Model), developed by Prochaska and DiClemente in the late 1970s, evolved through studies examining the experiences of smokers who quit on their own. It was determined that people can quit smoking if they are actually ready to do so.

  • The TTM focuses on the decision-making of the individual.
  • The TTM is a model of intentional change.
  • The TTM posits that individuals move through six stages of change. The steps illustrate a sequence of cognitive and behavioral steps toward successful behavioral change. Specifically, for dietary interventions, they refer to the degree of readiness of an individual to adopt the proposed dietary behavior

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Stage Description
In this stage, people do not intend to take action in the foreseeable future (defined as within the next 6 months). 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.
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 (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.
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.
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.
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.

The “relapse” part of the TTM is not a stage. It is a form of regression, in which the person moves to a previous stage.

What the TTM includes?

  • When an individual is in the Precontemplation stage, the pros in favor of behavior change are outweighed by the relative cons for change and in favor of maintaining the existing behavior.
  • In the Contemplation stage, the pros and cons tend to carry equal weight, leaving the individual ambivalent toward change. If the decisional balance is tipped however, such that the pros in favor of changing outweigh the cons for maintaining the unhealthy behavior, many individuals move to the Preparation or even Action stage.
  • As individuals enter the Maintenance stage, the pros in favor of maintaining the behavior change should outweigh the cons of maintaining the change in order to decrease the risk of relapse.

Confidence individuals have in maintaining their desired behavior change in situations that often trigger relapse.

  • In Precontemplation/Contemplation stages, temptation to engage in problematic behavior is far greater than self-efficacy to abstain.
  • From Preparation to Action, the disparity between feelings of self-efficacy and temptation closes, and behavior change is attained.
  • Relapse occurs in situations where feelings of temptation trump individuals’ sense of self-efficacy to maintain the change

While the Stages of Change are useful in explaining when changes in cognition, emotion, and behavior take place, the processes of change help to explain how those changes occur.

These processes need to be implemented to successfully progress through the stages of change and attain the desired behavior change.

These processes can be divided into two groups:

  • cognitive and affective experiential processes
  • behavioral processes