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Stages of Change Model

The Stages of Change Model was originally developed in the late 1970's and early 1980's by James Prochaska and Carlo DiClemente at the University of Rhode Island when they were studying how smokers were able to give up their habits or addiction.

Addiction: The negative end state of a syndrome (of neurobiological and psychosocial causes) resulting in continued or increasing repetitve involvement despite consequences and conscious efforts to discontinue the behavior. Addiction to any particular substance or behavior is seen mainly as a matter of personal vulnerability, exposure and access, and the capacity to produce a desirable shift in mental state.

This definition was originally formulated by Howard J. Shaffer, Ph.D., C.A.S.Harvard Medical School, Division on Addictions.

The SCM model has been applied to a broad range of behaviors including weight loss, injury prevention, overcoming alcohol, and drug problems among others.

The idea behind the SCM is that behavior change does not happen in one step. Rather, people tend to progress through different stages on their way to successful change. Also, each of us progresses through the stages at our own rate.

So expecting behavior change by simply telling someone, for example, who is still in the "pre-contemplation" stage that he or she must go to a certain number of AA meetings in a certain time period is rather naive (and perhaps counterproductive) because they are not ready to change.

Each person must decide for himself or herself when a stage is completed and when it is time to move on to the next stage. Moreover, this decision must come from the inside you (see developing an internal locus of control) -- stable, long term change cannot be externally imposed. 

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In each of the stages, a person has to grapple with a different set of issues and tasks that relate to changing behavior. Thus, for each for each stage of change, tools are available to you through this website in The Toolbox of Change [The Self Management Tool Box section]

 
stages of change diagram
 

The Stages of Change

The stages of change are:

  • Precontemplation (Not yet acknowledging that there is a problem behavior that needs to be changed)
  • Contemplation (Acknowledging that there is a problem but not yet ready or sure of  wanting to make a change)
  • Preparation/Determination (Getting ready to change)
  • Action/Willpower (Changing behavior)
  • Maintenance (Maintaining the behavior change) and
  • Relapse (Returning to older behaviors and abandoning the new changes)

Stage One: Precontemplation

In the precontemplation stage, people are not thinking seriously about changing and are not interested in any kind of help. People in this stage tend to defend their current bad habit(s) and do not feel it is a problem. They may be defensive in the face of other people's efforts to pressure them to quit.

Are you in the precontemplation stage? No, because the fact that you are reading this shows that you are already ready to consider that you may have a problem with one or more bad habits.

(Of course, you may be reading this because you have a loved one who is still in the pre-contemplation stage. If this is the case, keep reading for suggestions about how you can help others progress through their stages of change)

Stage Two: Contemplation

In the contemplation stage people are more aware of the personal consequences of their bad habit and they spend time thinking about their problem. Although they are able to consider the possibility of changing, they tend to be ambivalent about it.

In this stage, people are on a teeter-totter, weighing the pros and cons of quitting or modifying their behavior. Although they think about the negative aspects of their bad habit and the positives associated with giving it up (or reducing), they may doubt that the long-term benefits associated with quitting will outweigh the short-term costs.

It might take as little as a couple weeks or as long as a lifetime to get through the contemplation stage. (In fact, some people think and think and think about giving up their bad habit and may die never having gotten beyond this stage)

On the plus side, people are more open to receiving information about their bad habit, and more likely to actually use educational interventions and reflect on their own feelings and thoughts concerning their bad habit.

Stage Three: Preparation/Determination

In the preparation/determination stage, people have made a commitment to make a change. Their motivation for changing is reflected by statements such as: "I've got to do something about this - this is serious. Something has to change. What can I do?"

This is sort of a research phase: people are now taking small steps toward cessation. They are trying to gather information (sometimes by reading things like this) about what they will need to do to change their behavior.

Or they will call a lot of clinics, trying to find out what strategies and resources are available to help them in their attempt. Too often, people skip this stage: they try to move directly from contemplation into action and fall flat on their faces because they haven't adequately researched or accepted what it is going to take to make this major lifestyle change.

Stage Four: Action/Willpower

This is the stage where people believe they have the ability to change their behavior and are actively involved in taking steps to change their bad behavior by using a variety of different techniques.

This is the shortest of all the stages. The amount of time people spend in action varies. It generally lasts about 6 months, but it can literally be as short as one hour! This is a stage when people most depend on their own willpower. They are making overt efforts to quit or change the behavior and are at greatest risk for relapse.

Mentally, they review their commitment to themselves and develop plans to deal with both personal and external pressures that may lead to slips. They may use short-term rewards to sustain their motivation, and analyze their behavior change efforts in a way that enhances their self-confidence. People in this stage also tend to be open to receiving help and are also likely to seek support from others (a very important element).

Hopefully, people will then move to:

Stage Five: Maintenance

Maintenance involves being able to successfully avoid any temptations to return to the bad habit. The goal of the maintenance stage is to maintain the new status quo. People in this stage tend to remind themselves of how much progress they have made.

People in maintenance constantly reformulate the rules of their lives and are acquiring new skills to deal with life and avoid relapse. They are able to anticipate the situations in which a relapse could occur and prepare coping strategies in advance.

They remain aware that what they are striving for is personally worthwhile and meaningful. They are patient with themselves and recognize that it often takes a while to let go of old behavior patterns and practice new ones until they are second nature to them. Even though they may have thoughts of returning to their old bad habits, they resist the temptation and stay on track.

As you progress through your own stages of change, it can be helpful to re-evaluate your progress in moving up and down through these stages.

(Even in the course of one day, you may go through several different stages of change).

And remember: it is normal and natural to regress, to attain one stage only to fall back to a previous stage. This is just a normal part of making changes in your behavior.

Relapse

Along the way to permanent cessation or stable reduction of a bad habit, most people experience relapse. In fact, it is much more common to have at least one relapse than not. Relapse is often accompanied by feelings of discouragement and seeing oneself as a failure.

While relapse can be discouraging, the majority of people who successfully quit do not follow a straight path to a life time free of self-destructive bad habits. Rather, they cycle through the five stages several times before achieving a stable life style change. Consequently, the Stages of Change Model considers relapse to be normal.

There is a real risk that people who relapse will experience an immediate sense of failure that can seriously undermine their self-confidence. The important thing is that if they do slip and say, have a cigarette or a drink, they shouldn't see themselves as having failed.

Rather, they should analyze how the slip happened and use it as an opportunity to learn how to cope differently. In fact, relapses can be important opportunities for learning and becoming stronger.

Relapsing is like falling off a horse - the best thing you can do is get right back on again. However, if you do "fall off the horse" and relapse, it is important that you do not fall back to the precontemplation or contemplation stages. Rather, restart the process again at preparation, action or even the maintenance stages.

People who have relapsed may need to learn to anticipate high-risk situations (such as being with their family) more effectively, control environmental cues that tempt them to engage in their bad habits (such as being around drinking buddies), and learn how to handle unexpected episodes of stress without returning to the bad habit. This gives them a stronger sense of self control and the ability to get back on track.

In addition, there is one more stage, Dr. Kern has added which is not part of the Prochaska-DiClemente Stages of Change model:

Transcendence

Eventually, if you "maintain maintenance" long enough, you will reach a point where you will be able to work with your emotions and understand your own behavior and view it in a new light. This is the stage of "transcendence," a transcendence to a new life. In this stage, not only is your bad habit no longer an integral part of your life but to return to it would seem atypical, abnormal, even weird to you.

When you reach this point in your process of change, you will know that you have transcended the old bad habits and that you are truly becoming a new "you", who no longer needs the old behaviors to sustain yourself.

From "Optimal Stress," Carol J. Scott, M.D.