Transtheoretical Model of Behaviour Change
The TTM was developed as a comprehensive model of behaviour change and was initially applied to smoking cessation (Prochaska and DiClemente 1983). It incorporates cognitive, behavioural and temporal aspects of changing behaviour. The TTM consists of the stages of change, the processes of change, decisional balance and self-efficacy. The stage of change is the time dimension along which behaviour change occurs (the whenâ), and the other elements are the âhowâ and âwhyâ. The stages are:
- Precontemplation- no intention of change
- Contemplation – intention to make a change, usually
within 6 months - Preparation – immediate intention (within 30 days) and commitment to change (sometimes accompanied by small behavioural changes in preparation)
- Action – making the change.
- Maintenance- maintaining the change long term.
It is important that the change is clearly defined and concise. Many people have relapses when attempting behaviour change and methods for coping with this should be built into all interventions. Learning from failure can be a beneficial process for long term success.
The processes of change are the strategies used to progress along the stages of change. The processes are divided into experiential (where information is gathered through experiences) and behavioural (where information is gathered through the environment and actions. The experiential processes are more important in the early stages and behavioural more important later. These processes can be subdivided:
Experiential (thinking) processes
1. Consciousness raising- seeking new information
2. Dramatic relief – experiencing and expressing intense feelings and emotions about NOT making the change
3. Environmental re-evaluation – assessing how the change will affect physical and social environments
4. Self re-evaluation – cognitive and emotional reappraisal of values
5. Social liberation – developing an awareness and acceptance of new lifestyle
Behavioural (doing) processes
1. Counter-conditioning – substitute alternatives for current behaviour
2. Helping relationships – use support from others to make and sustain change
3. Reinforcement management – change contingencies and reward new behaviours
4. Self liberation – choose and commit to change, believe that one can change
5. Stimulus control – control situations and cues that interfere with new behaviours
Decisional balance is the evaluation of the costs and benefits (or pros and cons) of engaging in a behaviour or making a change.Each consists of four categories:
- Approval and instrumental gains by self
- Approval and instrumental gains by others
- Disapproval and losses by self
- Disapproval and losses by others
Self-efficacy is also a factor of the TTM and has been found to increase, linearly, through the stages.
