Leading Article
What is the Self-Change Model?
We prefer to
call it the Self-Change Model because we believe this makes
the concept more accessible than referring toThe Transtheoretical Model of Change as it
was named by Prochaska & DiClemente in
1983.
[1]
Originally
directed at behaviour change in connection with health issues, and
particularly as relating to the smoking habit, it gradually developed into an
effective integrative model for all forms of behaviour change.
The model describes how people modify a problem behaviour or transform
it into a positive behaviour. Central
to the model are the various stages of change.
The
Self-Change Model is less concerned – certainly less than other similar
models – with the social influences on behaviour, but focuses primarily on
decision-making behavioural patterns. It
has been found effective is such areas as nicotine addiction, exercise,
dieting, organisational change, and stress management, amongst many others.
The model's major contribution is the recognition that behaviour change unfolds through a series of stages. Individuals and organisations progress through these stages in recognising the need to change, contemplating a change, making a change, and finally sustaining the new behaviour. Most importantly, it is crucial to understand and identify the stage that has been reached in order to design and apply a successful change intervention.
Five
stages have been identified as forming the primary “building blocks” of the
Model. This is the process by
which self-change progresses.
Precontemplation
is the initial stage. People in this stage are not intending to take action in the
foreseeable future, typically regarded as the next six months. They may have
tried to change before without success, and this has depressed them, or they
are not sufficiently aware of their behaviour patterns and the possible
consequences thereof.
This stage is characterised by lack of awareness, lack of willingness, easy discouragement. Persuasion is the worst strategy. Empathy, listening, concentration on the positive effects of change is the best strategy.
Contemplation
is the stage in which people are intending to change in the next six months.
They are more aware of the pros of changing but are also acutely aware of the
cons. This ambivalence can keep them stuck in this stage for long periods of
time.
Preparation
is the stage in which people are intending to take action in the immediate
future, usually measured as the next month. They have normally already taken
some significant action in the past year, and may intend to join an exercise
class, or a therapy group, consult a doctor or a counsellor, or even simply
buy a self-help book.
At the Action stage people have already modified their behaviours within the past six months. Not all modifications of behaviour, however, count as action in this model. In the case of nicotine or drug addiction, for example, people must attain a criterion that professionals agree is sufficient to reduce risks to health. The Action stage is also the stage where vigilance against relapse is critical. At this stage reinforcement of positive behaviour and continuing emotional support are to be recommended.
Maintenance is the stage in which people are working to prevent relapse but they do not apply change processes as frequently as do people in Action. They are less tempted to backslide and increasingly more confident that they can continue their change. Emotional support should be continued while being aware of the possibility of relapse.
This major contribution to behaviour change theory has helped to clarify and explain the statistical knowledge that most people, faced with change, are not ready to take action. As an example, consider those people who have the desire but lack the ability to give up smoking; or the gap between the awareness of a physical or medical problem and the taking of specific action to deal with it.
Using the self-change model enables a far more effective treatment by moving people (or organisations) from one stage to the next rather than trying to move them directly to Action.
Questions that might be asked to determine intervention procedures include:
What? What needs to change? This enables behaviour patterns to be portrayed so that issues faced may be targeted in individuals and organisations.
When? Transtheoretical awareness helps to identify the stage reached and thus the individual's or organisation's readiness to take and sustain action.
How? The processes of change may not be revealed by individuals or organisations, but their activities provide a clue to how changes are occurring from one stage to the next.
Why? Identification of the pros and cons of changing helps in maintaining a balance and can provide the link between knowledge and action.
Decisional Balance and Self-Efficacy
Before leaving the subject of the self-change model, two other components need to be mentioned. First is the decisional balance. This states simply that before change can occur from an unhealthy to a healthy behaviour, the pros must outweigh the cons. In precontemplation there are more cons (more reasons not to change) than there are pros (reasons to change). In precontemplation, therefore, the emphasis should be on increasing the pros. When moving onward, for instance from contemplation to preparation and action, the emphasis needs to reinforce the decreasing of the cons.
Self-Efficacy is the belief that the challenge of making a change can be met and maintained. Using the Self-Change Model as a therapeutic tool, we need to reinforce that belief and encourage people to move from one stage to the next rather than put pressure on them to move too far ahead, or to take action too preciptately.
[1] Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390-395.