We all know that change doesn’t just happen.  Changing behaviors is not easy. And when we aren’t successful, we can feel like we’ve failed and didn’t have the will-power to make changes.  It can be frustrating, not only personally but also for family members and health care professionals who are rooting for and encouraging our change.  It can even become somewhat confrontational,  appearing that people are critical of us, instead of supportive.

Understanding change behavior can help – both for the person trying to change, and their family.

Behavior change has come to be recognised as, not a single event, but a process of identifiable stages through which we pass. We go through different stages in our thinking and actions before we actually make a change. And knowing what stage we are in can help up understand why we haven’t quite made the change we want.

The ‘stages of change’ model [1] shows that for most of us, change is gradual, progressing from uninterested or unaware, to considering a change, to deciding and preparing to make a change. Then determined action begins to try to maintain the new behavior.  Relapses are almost inevitable and become part of the process to achieve lifelong change.

There are six stages of change described in the work of Prochaska and DiClemente [1]:

  1. Precontemplation – no intention to change in the unforeseeable future; unaware a problem exists
  2. Contemplation – aware a problem exists; seriously thinking of change; some ambivalence
  3. Preparation – intending to act in the next month; reduced ambivalence and exploration of options
  4. Action – taking action through modification of behavior, experiences or environment
  5. Maintenance – work to prevent relapse and consolidate gain
  6. Relapse – a recurrence of the undesired behavior or elimination of the desired behavior.

Stages of change

The relapse stage does not happen for everyone, but if you do relapse, the goal is to move back through the stages again until the change becomes permanent.

It’s useful to consider these stages for ourselves and for others who we may be encouraging to make changes. Based on this model, the goal now becomes, not to convince someone to change a behavior, but to help them move through the stages of change.  And different approaches help at different stages. For example, what you say to someone when they are in ‘pre-contemplation’ is different from what to say when they are in ‘preparation.’ Here are a couple of examples of questions we can ask ourselves or others who haven’t yet started making changes:

Pre-contemplation stage – Goal: begin thinking about change.

Example questions:  How will you know when it is time is quit? What would have to happen for you to know this is a problem? Have you thought about…?

Contemplation stage – Goal: example beliefs and barriers to change

Example questions: Why do you want to change at this time? What would keep you from changing? What would help you at this time?

These are not stages when trying to convince someone to change is a good approach as it tends to be met with resistance.  At other stages, more practical ideas are useful, or acknowledgement of how well someone has done already.

Is there a behavior that you are struggling to change at the moment?  Can you identify your stage of change?  What do you need to move into the next stage – Information? Support? Encouragement? Or no input from others?  Spend some time thinking about not the big goal, but just how to get to the next stage. What will it take to move forward into the next stage of change?
[1] Prochaska JO, DiClemente CC, & Norcross JC (1992). In search of how people change. Applications to addictive behaviors. The American psychologist, 47 (9), 1102-14 PMID: 1329589

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