September 11, 2011

Stages of Change

Change is a process and most people don't make big behaviour changes in one shot. The Stages of Change model describes the processes involved in quitting a habit or implementing a new behaviour. Originally developed to explain the behaviour of smokers attempting to quit, the model can be used to explain any behaviour change, from changing your diet to leaving your partner to learning a new language.

There are six stages:

Precontemplation: People in this stage don't intend to take action in the forseeable future. They may be uninformed, unaware, in denial, or not ready to deal with the problematic behaviour or situation or its consequences. For example, someone in this stage might not realize the direct relationship between his knee pain and the extra twenty pounds he's carrying, or may have already tried to quit smoking three times without success and not feel like trying again. Another person in the precontemplation stage may not be ready to admit that her partner is emotionally abusive or to consider leaving the relationship. People in this stage avoid talking or thinking about the problem, and don't want help.

Contemplation: People in this stage are aware of the problem and are thinking about making change in the next six months or so. Although they can see the advantages of making the change, they also see the disadvantages and aren't sure that the benefits will outweigh the costs. For example, someone contemplating quitting smoking wonders if the irritability, possible weight gain, and loss of pleasure is worth the long-term health gains. The woman with the abusive partner isn't sure that the emotional pain and financial instability inherent in ending the relationship is worth it. Someone contemplating learning a new language weighs being able to communicate more easily in her new city against the time and cost of committing to learning a second language. People in the contemplation stage are open to talking about the potential change and to receiving information and advice.

Preparation: People in this stage are committed to taking action in the next month or so, and have started preparing. The person who intends to quit smoking researches different smoking cessation methods and chooses one. The person who plans to become a vegetarian discusses it with his partner and buys a couple vegetarian cookbooks. The woman with the abusive partner starts looking for apartments and asks a friend for a therapist referral, and the person in the new city purchases language software and sets up a weekly language exchange with a native speaker.

Action: People in this stage make specific and observable changes; they are very open to talking about the change and receiving support from others. The person in the abusive relationship ends the relationship and moves out. The new vegetarian no longer eats meat, and the smoker stops smoking and starts sporting a patch. The person in the new city is meeting weekly with her language exchange partner and studying on her own a predetermined number of hours per week.

Maintenance: In this stage, people can successfully avoid temptation, and are increasingly confident that they can maintain the change. The vegetarian rarely craves meat and the person who quit smoking is able to enjoy a glass of wine or cup of coffee just as much without a cigarette. The woman who left her abusive partner feels empowered in her independent life, and the person in the new city finds herself looking forward to her weekly language exchange and using her new language regularly.

Relapse: Even people who eventually successfully change their behaviour don't follow a straight path to change, and usually relapse at some point. The vegetarian may cave at a barbeque and the smoker may give in to a craving during a stressful period. In a moment of loneliness, the woman who left her partner may give in to his pleas for a second chance, and the person in the new city may get busy at work and discontinue the language-exchange or let the software gather dust. The key to managing relapse is to analyze how and why it happened (e.g., you were busy; you were stressed; you were drinking; you were isolated), put a plan in place for next time, and start again at the preparation or action stage (i.e., don't go back to precontemplation or contemplation).

How is the Stages of Change model helpful?

For therapists, the Stages of Change model helps pace therapy appropriately. It's easy to assume that because a client came to therapy, he or she is ready to change. For example, if a client shares that she's considering leaving her abusive partner, her therapist could easily jump ahead and start trying to help the client deal with loneliness and financial insecurity. But if the client is only at the contemplation stage, what she needs is to have her experience validated and to explore her ambivalence about her relationship.

Similarly, a doctor whose patient vaguely mentions quitting smoking at some point might inundate the patient with pamphlets about smoking cessation programs. If the patient is in precontemplation, the pamphlets will end up in the recycling and may even decrease the likelihood that the patient will bring it up again. The therapist and doctor would both be better off acknowledging the client/patient's control over the decision, encouraging further exploration, and leaving the door open for a move to the preparation stage.

The Stages of Change model isn't just for professionals! You can use it on yourself or on the people around you. If in November, your partner mentioned joining the gym after the holidays, and you wonder why he never uses the six-month gym membership you got him for Christmas, it's probably because he was only in the precontemplation or contemplation stage, and your gift was more appropriate for someone in the preparation or action stage.

If you're having a hard time following through with your new plan to limit your Internet use to one hour in the evenings, maybe it's because you leapt from precontemplation to action without stopping in the contemplation stage to deal with your ambivalence ("What if I miss important emails or information?") or without stopping in the preparation stage to make a concrete plan ("Am I going to just put away the laptop or will I turn off the modem altogether? What if my partner wants to show me something online?"). It's easy to relapse and get discouraged if you move too quickly or misjudge your stage.

NB: As with any stage model, not everyone goes through every stage for every change, and not necessarily in this order.

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