December 13, 2008

ENTER STAGE RIGHT

"Stages of change" co-creator Carlo DiClemente discusses practical applications of his Transtheoretical Model for health, wellness and recovery

—by Paul M. Kubek and Matthew K. Weiland

Baltimore, MD—Ask Psychologist Carlo DiClemente, PhD, co-creator of the Transtheoretical Model of Change (TTM), how you might achieve and maintain a meaningful personal change in your life—such as diet, exercise, sobriety, mental health recovery—and he'll tell you what he's found from almost 30 years of research on the subject. Expect to go through five "stages of change" and to work through specific tasks associated with each stage (see below). He'll also tell you that it helps to have ongoing emotional support from someone who uses the stages to guide and to pace their working relationship with you.

Dr. DiClemente is professor of psychology and director of The Habits Lab at the University of Maryland-Baltimore County (see sidebar). He has written and co-authored several books, as well as numerous articles and book chapters about the stages of change.

 THE STAGES OF CHANGE
 Sample of tasks to complete
  •  Pre-contemplation (not interested)
  • Acknowledge problem
  • Evaluate self-regulation of feelings, thoughts, behavior
  • Contemplation (considering pros and cons of change)
  • Conduct risk-reward analysis
  • Decide to act
  • Preparation (beginning to increase self-regulation)
  • Set goals and priorities
  • Develop change-plan
  • Action (modifying problem behavior)
  • Implement plan and revise as needed
  • Behavior change for 6 months
  • Maintenance (sustaining accomplishments)
  • Consolidate change into lifestyle

(For more information about TTM and the stages of change, see "Sources" at the bottom of this page.) 


THE CONVERSATION

Dr. DiClemente was a keynote speaker at the 2008 Annual Ohio SAMI CCOE/ IDDT Conference, which took place in Columbus, Ohio, on September 16 & 17. The event was sponsored by the Center for Evidence-Based Practices at Case Western Reserve University. Dr. DiClemente sat down with us to recap his plenary and workshop presentations and to provide a tutorial on the origins and ongoing evolution of TTM, as well as its utility worldwide for healthcare and behavioral healthcare research and interventions, including the following:

  • Integrated Dual Disorder Treatment (IDDT), the evidence-based practice
  • Supported Employment (SE), the evidence-based practice
  • Motivational Interviewing (MI), the evidence-based treatment
  • Tobacco-cessation initiatives
  • Tobacco and Recovery (TR), a stages-of-change model for people with severe mental illness and substance use disorders
  • Cancer prevention, HIV risk reduction, dietary change, exercise, occupational safety

1.) The Stages of Change (1m 26s)
The five stages of change represent different emotional, cognitive, and behavioral tasks of recovery, helping people pace the process of transformation.
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2.) The Tasks of Change (1m 15s)
Completing the tasks in each stage of change is often not linear. There is often a cycling back to (or a "recycling" through) earlier tasks.
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3.) Two Sets of Stages (1m 37s)
If five stages are too many to remember, chunk them into two: pre-action and action/maintenance.
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4.) Behavior Specific (54s)
"Staging" is a process of figuring out in which stage of change a person is. "Staging" is behavior specific, so people who are cutting down on the use of tobacco and other drugs are in a different phase of action than those who are quitting altogether.
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5.) Complicating Factors (1m 52s)
Situations and circumstances from peoples' lives will influence (or complicate) their ability to focus on the tasks of change. For instance, symptoms of severe anxiety and depression may complicate a person's effort to reduce and quit cocaine use.
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6.) Scaffolding (1m 40s)
Assertive outreach and case-management services for people with severe mental illness provide a form of emotional support known as "scaffolding"—an essential component of human development, personal change, and recovery.
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7.) The Origin of Stages (3m 23s)
The Transtheoretical Model of Change (TTM) got its start in the mid 1970s and 1980s during studies of smoking-cessation initiatives that also included people who quit by themselves.
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8.) The Early Days (3m 5s)
It was the smokers who quit on their own who asked the researchers important questions and, thus, helped identify the stages of change and the tasks associated with success in those stages.
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9.) Motivational Interviewing and the Stages of Change, Part 1 (2m 20s)
Motivational Interviewing (MI) and TTM emerged separately in the 1980s in an unpredictable synergy that coalesced in Albuquerque, NM.
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10.) Motivational Interviewing and the Stages of Change, Part 2 (1m 25s)
MI helps with the emotional and cognitive tasks of the pre-contemplation and contemplation stages.
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11.) Motivational Interviewing and the Stages of Change, Part 3 (2m 19s)
MI prepares you for change and the stages help people facilitate and maintain that change.
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12.) Transtheoretical Model of Change (TTM), Part 1 (2m 11s)
TTM synthesizes theories and practices from many different disciplines and systems of psychotherapy. It includes decision-making theory, cognitive therapy, behavioral therapy, gestalt, and psychoanalysis, among others.
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13.) Transtheoretical Model of Change (TTM), Part 2 (2m 19s)
The context of a person's life—circumstances, situations, problems—complicate the process of change. Do you address these multiple factors sequentially or simultaneously?
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14.) Transtheoretical Model of Change (TTM), Part 3 (1m 30s)
"Markers of change" include decisional balance, decision making, and self-efficacy.
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15.) Supervision and the Stages (2m 48s)
What supervisors can do to use Motivational Interviewing and Stages of Change during the supervision process.
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16.) Tobacco Cessation and the Stages (3m 55s)
Listen to consumers first. Find what is important to each person who is trying to quit smoking, identify what might interfere with the process of change, and provide "scaffolding".
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17.) Forces of Resistance (3m 55s)
Service providers who have historically been dogmatic about their treatment approaches are beginning to open up to TTM.
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18.) People Get It (1m 23s)
TTM and its stages of change seem to speak to people on an intuitive level, which is why so many seem to gravitate toward it.
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19.) A Worldwide Movement (3m 13s)
TTM and MI have become one of the most popular U.S. exports of behavioral healthcare technology, having found their way to communities throughout Europe, Asia, and Africa.
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20.) A Universal Process (2m 51s)
We all have stories of change and the processes we undertake have a universal similarity.
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SOURCES

A more detailed description of the Transtheoretical Model's (TTM) stages of change, and the tasks associated with each, may be found in the following sources:

• James O. Prochaska, John C. Norcross, Carlo O. DiClemente (1995). Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward. New York, NY: Harper Collins (click here).

• Gerard J. Connors, Dennis M. Donovan, Carlo C. DiClemente (2001). Substance Abuse Treatment and the Stages of Change. New York: The Guilford Press, p7, (click here).

• Carlo C. DiClemente (2003). Addiction and Change: How Addictions Develop and Addicted People Recover. New York: The Guilford Press (click here).


Paul M. Kubek, MA, is director of communications and Matthew K. Weiland, MA, is senior writer, producer, and new-media specialist at the Center for Evidence-Based Practices at Case Western Reserve University.
 

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