Transtheoretical Model of Behaviour Change
The TTM was developed as a comprehensive model of behaviourÂ change and was initially applied to smoking cessationÂ (Prochaska and DiClemente 1983). It incorporates cognitive,Â behavioural and temporal aspects of changing behaviour. TheÂ TTM consists of the stages of change, the processes of change,Â decisional balance and self-efficacy. The stage of change is theÂ time dimension along which behaviour change occurs (theÂ whenâ), and the other elements are the âhowâ and âwhyâ. TheÂ stages are:
- Precontemplation- no intention of change
- Contemplation – intention to make a change, usually
within 6 months
- Preparation – immediate intention (within 30 days)Â and commitment to change (sometimesÂ accompanied by small behavioural changes inÂ preparation)
- Action – making the change.
- Maintenance- maintaining the change long term.
It is important that the change is clearly defined and concise.Â Many people have relapses when attempting behaviourÂ change and methods for coping with this should be built into allÂ interventions. Learning from failure can be a beneficial processÂ for long term success.
The processes of change are the strategies used to progressÂ along the stages of change. The processes are divided intoÂ experiential (where information is gathered through experiences)Â and behavioural (where information is gathered through theÂ environment and actions. The experiential processes are moreÂ important in the early stages and behavioural more importantÂ later. These processes can be subdivided:
Experiential (thinking) processes
1. Consciousness raising- seeking new information
2. Dramatic relief – experiencing and expressingÂ intense feelings and emotions about NOTÂ making the change
3. Environmental re-evaluation – assessing howÂ the change will affect physical andÂ social environments
4. Self re-evaluation – cognitive and emotionalÂ reappraisal of values
5. Social liberation – developing an awarenessÂ and acceptance of new lifestyle
Behavioural (doing) processes
1. Counter-conditioning – substitute alternativesÂ for current behaviour
2. Helping relationships – use support from othersÂ to make and sustain change
3. Reinforcement management – changeÂ contingencies and reward new behaviours
4. Self liberation – choose and commit to change,Â believe that one can change
5. Stimulus control – control situations and cuesÂ that interfere with new behaviours
Decisional balance is the evaluation of the costs and benefits (orÂ 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 toÂ increase, linearly, through the stages.