Changing Behavior Using the Transtheoretical Model

This chapter describes how the transtheoretical model of behavior change (TTM) provides a framework to guide the development of tailored behavior change interventions. The TTM includes four critical concepts: stages of change to delineate critical motivational and behavior change tasks; processes of change to identify a multidimensional set of mechanisms individuals use to accomplish stage tasks and make change happen; context of change to identify contextual resources and problems that promote or hinder personal change; and markers of change that are used to track important decisional and self-efficacy dimensions related to movement through the process of change. The TTM has been used to develop interventions for pre-action and action-oriented stage tasks and offers a unique perspective for understanding how behavior changes. TTM constructs have been used and evaluated in diverse clinical and cultural settings with both mental and physical health conditions. There is substantial support for the constructs and for tailoring interventions using these constructs across multiple studies. This chapter offers concrete strategies from diverse intervention approaches that can be used to address the varied motivation and behavior change tasks represented by the stages of change. Finally, implications for prevention, treatment, and training are discussed.

Keywords

stages of change processes of change context of change markers of change pre-contemplation contemplation preparation action maintenance self-efficacy

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Type: Chapter
Information: The Handbook of Behavior Change , pp. 136 - 149
DOI: https://doi.org/10.1017/9781108677318.010 [Opens in a new window]
Publisher: Cambridge University Press
Print publication year: 2020

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References

Bandura, A. (1997). Self-Efficacy: The Exercise of Control. New York: Freeman. https://doi.org/10.1891/0889-8391.13.2.158 Google Scholar

Brogan, M. M., Prochaska, J. O., & Prochaska, J. M. (1999). Predicting termination and continuation status in psychotherapy by using the transtheoretical model. Psychotherapy, 36, 105–113. https://doi.org/10.1037/h0087773 CrossRef Google Scholar

Carbonari, J. P., & DiClemente, C. C. (2000). Using transtheoretical model profiles to differentiate levels of alcohol abstinence success. Journal of Consulting and Clinical Psychology, 68, 810–817. https://doi.org/10.1037/0022-006X.68.5.810 CrossRef Google Scholar PubMed

Connors, G. J., DiClemente, C. C., Dermen, K. H., Kadden, R., Carroll, K. M., & Frone, M. R. (2000). Predicting the therapeutic alliance in alcoholism treatment. Journal of Studies on Alcohol, 61, 139–149. https://doi.org/10.15288/jsa.2000.61.139 Google Scholar

Connors, G. J., DiClemente, C. C., Velasquez, M., & Donovan, D. (2013). Substance Abuse Treatment and the Stages of Change (2nd ed.). New York: Guilford Press.Google Scholar

DiClemente, C. C. (1978). Perceived processes of change on the cessation of smoking and the maintenance of that change. Unpublished PhD dissertation, University of Rhode Island.Google Scholar

DiClemente, C. C. (2006). Natural change and the troublesome use of substances. In Miller, W. R. & Carroll, K. M. (Eds.), Rethinking Substance Abuse: What the Science Shows and What We Should Do About It (pp. 81–96). New York: Guilford Press.Google Scholar

DiClemente, C. C. (2018). Addiction and Change: How Addictions Develop and Addicted People Recover. New York: Guilford Press.Google Scholar

DiClemente, C. C., Carbonari, J. P., Montgomery, R. P., & Hughes, S. O. (1994). The alcohol abstinence self-efficacy scale. Journal of Studies on Alcohol, 55, 141–148. https://doi.org/10.15288/jsa.1994.55.141 CrossRef Google Scholar PubMed

DiClemente, C. C., Carbonari, J., Zweben, A., Morrel, T., & Lee, R. E. (2001). Motivation hypothesis causal chain analysis. In Longabaugh, R. & Wirtz, P. W. (Eds.), Project MATCH : A Priori Matching hypotheses, Results, and Mediating Mechanisms (National Institute on Alcohol Abuse and Alcoholism Project MATCH Monograph Series) Vol. 8 (pp. 206–222). Rockville, MD: National Institute on Alcohol Abuse and Alcoholism.Google Scholar

DiClemente, C. C., Carroll, K. M., Miller, W. R., Connors, G. J., & Donovan, D. M. (2002). A look inside treatment: Therapist effects, the therapeutic alliance, and the process of intentional behavior change. In Babor, T. F. & DelBoca, F. K. (Eds.), Treatment Matching in Alcoholism (pp. 166–183). London: Cambridge University Press.Google Scholar

DiClemente, C. C., Delahanty, J. C., Havas, S. W., & Van Orden, O. R. (2015). Understanding self-reported staging of dietary behavior in low-income women. Journal of Health Psychology, 20, 741–753. https://doi.org/10.1177/1359105315580213 Google Scholar

DiClemente, C. C., & Hughes, S. O. (1990). Stages of change profiles in outpatient alcoholism treatment. Journal of Substance Abuse, 2, 217–235. https://doi.org/10.1016/S0899-3289(05)80057-4 Google Scholar

DiClemente, C. C., Prochaska, J. O., Fairhurst, S. K., Velicer, W. F., Velasquez, M. M., & Rossi, J. S. (1991). The process of smoking cessation: An analysis of precontemplation, contemplation, and preparation stages of change. Journal of Consulting and Clinical Psychology, 59, 295–304. https://doi.org/10.1037/0022-006X.59.2.295 Google Scholar

Dijkstra, A., Conijn, B., & De Vries, H. (2006). A match–mismatch test of a stage model of behaviour change in tobacco smoking. Addiction, 101, 1035–1043. https://doi.org/10.1111/j.1360-0443.2006.01419.x CrossRef Google Scholar PubMed

Goldfried, M. (1980). Toward the delineation of therapeutic change principles. American Psychologist, 35, 931–950. https://doi.org/10.1037/0003-066X.35.11.991 CrossRef Google Scholar PubMed

Griffin-Blake, C. S., & DeJoy, D. M. (2006). Evaluation of social-cognitive versus stage-matched, self-help physical activity interventions at the workplace. American Journal of Health Promotion, 20, 200–209. https://doi.org/10.4278/0890-1171-20.3.200 Google Scholar

Hartzler, B., Witkiewitz, K., Villarroel, N., & Donovan, D. (2011). Self-efficacy change as a mediator of associations between therapeutic bond and one-year outcomes in treatments for alcohol dependence. Psychology of Addictive Behaviors, 25, 269. https://doi.org/10.1037/a0022869 Google Scholar

Heather, N., Hönekopp, J., & Smailes, D. (2009). Progressive stage transition does mean getting better: A further test of the transtheoretical model in recovery from alcohol problems. Addiction, 104, 949–958. https://doi.org/10.1111/j.1360-0443.2009.02578.x Google Scholar

Ilgen, M. A., McKellar, J., Moos, R., & Finney, J. W. (2006). Therapeutic alliance and the relationship between motivation and treatment outcomes in patients with alcohol use disorder. Journal of Substance Abuse Treatment, 31, 157–162. https://doi.org/10.1016/j.jsat.2006.04.001 CrossRef Google Scholar PubMed

Ilgen, M., Tiet, Q., Finney, J., & Moos, R. H. (2006). Self-efficacy, therapeutic alliance, and alcohol-use disorder treatment outcomes. Journal of Studies on Alcohol, 67, 465–472. https://doi.org/10.15288/jsa.2006.67.465 CrossRef Google Scholar PubMed

Janis, I. L., & Mann, L. (1977). Decision Making. New York: Free Press.Google Scholar PubMed

Krebs, P., Norcross, J. C., Nicholson, J. M., & Prochaska, J. O. (2018). Stages of change and psychotherapy outcomes: A review and meta‐analysis. Journal of Clinical Psychology, 74, 1964–1979. https://doi.org/10.1002/jclp.22683 CrossRef Google Scholar PubMed

Marcus, B. H., Rossi, J. S., Selby, V. C., Niaura, R. S., & Abrams, D. B. (1992). The stages and processes of exercise adoption and maintenance in a worksite sample. Health Psychology, 11, 386–395. https://doi.org/10.1037//0278-6133.11.6.386 Google Scholar

Mee-Lee, D. (Ed.). (2013). The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-occurring Conditions. Bethesda, MD: American Society of Addiction Medicine.Google Scholar

Miller, W. R. (1999). Enhancing Motivation to Change in Substance Abuse Treatment. Treatment Improvement Protocol Series, Vol. 35. Rockville, MD: US Department of Health and Human Services.Google Scholar

Norcross, J. C., Krebs, P. M., & Prochaska, J. O. (2010). Stages of change. Journal of Clinical Psychology: In Session, 67, 143–154. https://doi.org/10.1002/jclp.20758 Google Scholar

Penberthy, J. K., Hook, J. N., Vaughan, M. D. et al. (2011). Impact of motivational changes on drinking outcomes in pharmacobehavioral treatment for alcohol dependence. Alcoholism: Clinical and Experimental Research, 35, 1694–1704. https://doi.org/10.1111/j.1530-0277.2011.01516.x Google Scholar

Prochaska, J. O. (1979). Systems of Psychotherapy: A Transtheoretical Analysis. Homewood, IL: Dorsey Press.Google Scholar

Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research and Practice, 19, 276–288. https://doi.org/10.1037/h0088437 Google Scholar

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. https://doi.org/10.1037/0022-006X.51.3.390 Google Scholar

Prochaska, J. O., & DiClemente, C. C. (1984). The Transtheoretical Approach: Crossing the Traditional Boundaries of Therapy. Malabar, FL: Krieger.Google Scholar

Prochaska, J. O., & DiClemente, C. C. (1986). Toward a comprehensive model of change. In Miller, W. R. & Heather, N. (Eds.), Treating Addictive Behaviors (pp. 3–27). Boston: Springer.CrossRef Google Scholar

Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to the addictive behaviors. American Psychologist, 47, 1102–1114. https://doi.org/10.1037/0003-066X.47.9.1102 Google Scholar

Prochaska, J. O., DiClemente, C. C., & Velicer, W. F. (1985). Predicting change in smoking status for self-changers. Addictive Behaviors, 10, 395–406. https://doi.org/10.1016/0306-4603(85)90036-X Google Scholar

Prochaska, J. O., DiClemente, C. C., Velicer, W. F., & Rossi, J. S. (1993). Standardized, individualized, interactive and personalized self-help programs for smoking cessation. Health Psychology, 12, 399–405. https://doi.org/10.1037//0278-6133.12.5.399 Google Scholar

Prochaska, J. O. & Norcross, J. (2016). Systems of Psychotherapy: A transtheoretical analysis (8th ed.). New York: Brooks Cole.Google Scholar

Prochaska, J. O., Norcross, J. C., & DiClemente, C. C. (1994). Changing for Good. New York: Morrow.Google Scholar

Prochaska, J. O., Norcross, J. C., Fowler, J. L., Follick, M. J., & Abrams, D. B. (1992). Attendance and outcome in a work site weight control program: Processes and stages of change as process and predictor variables. Addictive Behaviors, 17, 35–45. https://doi.org/10.1016/0306-4603(92)90051-V CrossRef Google Scholar

Prochaska, J. O., Velicer, W. F., DiClemente, C. C., & Fava, J. L. (1988). Measuring the processes of change: Applications to the cessation of smoking. Journal of Consulting and Clinical Psychology, 56, 520–528. https://doi.org/0022-006 X/88/S00.75 Google Scholar

Prochaska, J. O., Velicer, W. F., Redding, C. et al. (2005). Stage-based expert systems to guide a population of primary care patients to quit smoking, eat healthier, prevent skin cancer, and receive regular mammograms. Preventive Medicine, 41, 406–416. https://doi.org/10.1016/j.ypmed.2004.09.050 Google Scholar

Prochaska, J. O., Velicer, W. F., Rossi, J. S. et al. (1994). Stages of change and decisional balance for 12 problem behaviors. Health Psychology, 13, 39–46. https://doi.org/10.1037/0278-6133.13.1.39 Google Scholar

Project MATCH Research Group. (1997). Matching alcoholism treatments to client heterogeneity: Project MATCH post-treatment drinking outcomes. Journal of Studies on Alcohol, 58, 7–29. https://doi.org/10.15288/jsa.1997.58.7 Google Scholar

Quinlan, K. B., & McCaul, K. D. (2000). Matched and mismatched interventions with young adult smokers: Testing a stage theory. Health Psychology, 19, 165–171. https://doi.org/10.1037/0278-6133.19.2.165 Google Scholar

Rosen, C. S. (2000). Is the sequencing of change processes by stage consistent across health problems? A meta-analysis. Health Psychology, 19, 593–604. https://doi.org/10.1037/0278-6133.19.6.593 CrossRef Google Scholar PubMed

Shaw, M. A. & DiClemente, C. C. (2016). Relapse vulnerability measure of the alcohol abstinence self-efficacy scale predicting time to first drink and amount of drinking. Journal of Studies on Alcohol and Drugs. 77, 521–525. https://doi.org/10.15288/jsad.2016.77.521 CrossRef Google Scholar

Sloane, R. B., Staples, F. R., Cristol, A. H., Yorkston, N. J., & Whipple, K. (1975). Psychotherapy Versus Behavior Therapy. Cambridge, MA: Harvard University Press.CrossRef Google Scholar PubMed

Substance Abuse and Mental Health Services Administration (2013). Systems-Level Implementation of Screening, Brief Intervention, and Referral to Treatment. Technical Assistance Publication (TAP) Series 33, HHS Publication No. (SMA) 13–4741. Rockville, MD: USDHHS Center for Substance Abuse Treatment.Google Scholar

Sutton, S. (2001). Back to the drawing board? A review of applications of the transtheoretical model to substance use. Addiction, 96, 175–186. https://doi.org/10.1080/09652140020017049 CrossRef Google Scholar

Velasquez, M., Crouch, C., Stephens, N., & DiClemente, C. C. (2015). Group Treatment for Substance Abuse: Stages of Change Therapy Manual (2nd ed.). New York: Guilford Press.Google Scholar

West, R. (2005). Time for a change: Putting the transtheoretical (stages of change) model to rest. Addiction, 100, 1036–1039.CrossRef Google Scholar PubMed

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