This Guide provides a brief summary of the most established scientific model of individual change, and brief reviews of some of the more popular and potentially useful books written to guide personal change. We also provide suggestions for integrating the perspectives reviewed.

Any woman who feels that her life could be improved is in good company. There are hundreds of books aimed at women who would like to feel less burdened by problematic habits or more enhanced by insight.

Many of these books promise that if we read them, we will change for the better. Unfortunately, just reading a book that promises change does not necessarily make it happen.

We believe that self-discovery and self-directed change are important. We know the research evidence: small choices that we make, every day, have a great influence on how healthy we are in mind, body, and spirit.

We want to help women help themselves to make the choices that lead to better lives. We want to empower women to be as responsible as they can be for making the best choices, every day.

We have targeted resources for midlife and older women for several reasons. First, this Guide grows out of a grant from the Office of Women’s Health of the Illinois Department of Public Health for “Promoting Mental Health in Midlife and Older Women Using a Stages of Change Model.”

This Guide is one of the products produced under this grant. As part of the grant, we conducted focus groups and workshops on personal change with midlife and older women; we draw upon those experiences in this review.

Second, the grant project was a collaboration between researchers at the Institute of Psychology, Illinois Institute of Technology and OWL Illinois (The Older Women’s League of Illinois); the common concern is identifying ways of helping midlife and older women gain more control over their own lives.

Third, the three authors of this Guide are all midlife women, and OWL activists; we know about the special challenges and opportunities confronting women like us.

Tools for Change: The Transtheoretical or “Stages of Change” Model

We need the tools for change. There are models for understanding how we make choices and how we change to make better choices.

One of the most interesting models is one developed by studying hundreds of people who have made significant life changes that have improved their health.

The primary researcher has been James Prochaska, Ph.D., working with a number of other researchers over the last two decades. Most of the research has been funded by the National Institutes of Health (our premier federal agency that conducts and funds research).

The researchers who examined these individuals concluded that the process of change is very similar regardless of whether the person was trying to increase physical activity, modify addictive behaviors, get regular mammograms, or think more positive thoughts.

This model was called Transtheoretical because it applies regardless of whether a change is supported by a treatment that comes from a behavioral perspective (e.g., systematically rewarding desired behaviors), a humanistic perspective (assuming that the roots of wellness are within the individual), or a psychodynamic perspective (which assumes that unconscious conflicts underlie “irrational” behavior).


              

The scientists who developed the model emphasize that change is a process – often a long process. Individuals go through a series of five fairly distinct stages, beginning with the denial that anything needs to change, to contemplating some change, to preparing and taking action, and finally to maintaining the change.

The crucial point is that individuals use somewhat different strategies to accomplish their changes, depending on where they are in the process.

This model of how people change is important because it is evidence based: that means that the conclusions have come out of many scientific studies of different individuals.

What makes a study scientific has something to do with measurement: How do we know what behaviors have changed, and how much? It also has to do with sampling: Who are the people who were studied? How representative are they of other groups?

Mostly, good science has to do with good reporting: Describing accurately just what information (data) was collected, how it was analyzed, and how the scientist reached their conclusions.

In the Stages of Change model, the conclusions are based not solely on personal experiences of the authors, or the small number of people seen in clinical practice by a particular therapist or people with whom they happen to have had a conversation about their experience.

Each of the professional publications provides detailed information about what behaviors were measured, who was included in the study, and what differentiated the individuals who were successful in changing their behaviors from those who were not.

The research program has been going on for two decades, with many different researchers testing the model for how well it helps them understand the process of change, and how well they can predict who will actually change and who will not.

An excellent guide to personal change is the book on the Stages of Change model written for lay readers by three of the researchers – James Prochaska, John Norcross, and Carlo DiClemente.

We strongly recommend this book to anyone interested in personal change – for yourself, or to help others change. We will use it as the standard by which we assess the other self-help books.

James Prochaska, Ph.D., John Norcross, Ph.D., Carlo DiClemente, Ph.D. (1994) Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward.

This book describes the process of developing the model (e.g. the sciencific evidence base), the processes which individuals who were successful in making changes used to help them along, and the stages that they identified. We have summarized the strategies and stages below.

Processes Promoting Change. Prochaska and his colleagues (1994) described nine processes that people engage in when they attempt to modify their behaviors. These include both covert (less conscious) and overt (conscious) activities and experiences.

The processes were identified by asking people how they changed, what helped and what made change more difficult. Below we list the strategies, and illustrate them with statements made by midlife and older women who participated in focus groups and “Changing for Good” Workshops conducted as part of our project.

1. Consciousness Raising: Increase in knowledge about the self or the problem. Effort by the individual to seek new information and to gain understanding and feedback about the problem behavior. May include becoming aware of self-defeating defenses that get in our way of making change, and/or developing an awareness of positive possibilities.

2. Emotional arousal: Experiencing and expressing feeling about the problem behavior and potential solution. Often sudden emotional experience related to the problem. As one woman reported, “When I realized my mother and my brother died of a condition I have, it was a real wake-up call to do something different.”

3. Social Liberation: Any new alternatives that the external environment can give which will help to begin or continue the change. Many of the women identified the focus groups and workshops as providing support for exploring personal change in an accepting, supportive environment.

4. Helping Relationships: Trusting, accepting and utilizing the support of caring others during attempts to change. These are crucial to most self-changers. The most helpful relationships vary with the stage of change the potential “changer” is in. Walking with a friend, exploring desired changes with other women, and making a pact to work on a particular change with someone else were all mentioned as helpful actions.

5. Self-reevaluation: Emotional and cognitive reappraisal of values by the individual with respect to the problem behavior. . “I think I would feel more in control of my life and better about myself if I could clean up the clutter on my desk” is a good example of a seeing the link between a “trivial” problem and an underlying important sense of self.

6. Commitment: Choice and commitment to change, including belief in the ability to change Some women reported, “I’m too old to change” and they probably will not change.

7. Countering: Substitution of alternatives (e.g, more healthy responses) for the problem behavior. The woman who reported that she had begun to substitute a piece of fruit for a brownie when she was feeling tired and depleted was using countering.

8. Environmental control: Restructuring the external environment or control of situations and other causes that trigger the problem behavior. Some women learned to avoid friends who indulged in negative, hopeless thinking and seek out those who were more optimistic.

9. Reinforcement Management: Rewarding oneself or being rewarded by others for making changes.

For each stage, the researchers identified the kinds of behaviors of others that are helpful – and those which are well-intentioned but ineffective.

For example, nagging someone to change before they are interested in considering change actually increases resistance!

The more helpful approach for someone who is considering change is to emphathize with the difficulty of changing, and to applaud the fact that they are even thinking about such a challenging action.

Stages of Change. Prochaska and his colleagues identified separate stages individuals go through as they change. Their 1994 book lists six stages; since then they usually condense the last two stages into a general Maintenance stage. Some models use four stages, condensing the Contemplation and Preparation stages.

1. Precontemplation - Resisting Change

a. Rarely take responsibility for negative consequences of their actions

b. Change sponsored by social/environmental pressures, consciousness raising, becoming aware of defenses

c. Support: NOT pushing into action, nagging, giving up, enabling (making excuses for person, and helping person avoid consequences of actions)

d. Support: YES to listening about problem, accurate feedback on defenses, self-help groups, making allies with those also interested in change

2. Contemplation - Change on the Horizon

a. Want to change - but ambivalent; prefer familiar to better

b. Defenses: search for absolute certainty; waiting for magic moment; wishful thinking; premature action (leading to failure)

c. Change sponsored by emotional arousal - including focus on negative aspects of undesirable behavior; getting informed about consequences of behavior; defining personal goals; identifying sequences leading to undesirable behaviors; balancing negative views of present self and positive images of future self

d. Support: YES for empathy (about difficulty of change and desire to change) and warmth (like you no matter how you do)

e. NOT Helpful: Push to premature action; false confidence (about change); attaching conditions to support (change or else)

3. Preparation - Getting Ready

a. Continue reevaluation of self and problem; look increasingly toward future self; focus on finding most suitable action

b. Useful techniques: Turn away from old behavior; Make Change a priority

c. Positive consequences of change must outweigh negative to proceed

d. Support: Provide help and give specific tips on what is helpful; support Pros of change

4. Action - Time to Move  

a. Focus on control, countering and reward - substituting healthy responses for problem behaviors, changing the environmental situations, rewarding change; contracting

b. Gradually shape behavior toward desired direction - reinforce each step

c. Helping Relationships Crucial: ask for support, put it in writing, elicit praise

5. Maintenance - Staying There

a. Requires: sustained long-term effort & revised lifestyle

b. Internal challenges related to lapses: overconfidence, daily temptation, self-blame

c. Helping relationships crucial - especially in crisis that can lead to relapse

Excepted from longer article
http://owlill.wnkcommunity.com/change_selfhelp.html