Transtheoretical Model Of Change

Question 1

Five stages of change

Answer 1

1. Pre contemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance/relapse prevention

Question 2

Each stage contains two processes

Answer 2

1. Decisional balance: strike balance between where they are and how motivated they are to move forward
2. Self-efficacy/situational temptation judgements: how confident that they can resist temptation/avoid or navigate situations and move forward

Question 3

Pre contemplation

Answer 3

• no intention to take action in foreseeable future
• don’t realize there is a problem
• don’t contemplate doing anything
• lazy, don’t want to do anything or
• don’t believe they can do anything or
• have attempted before and failed
• oblivious to impact of behavior or
• demoralized from previous attempts

Question 4

Client in Precontemplation

Answer 4

Doesn’t try
Cons for changing are high, Pros are low
There due to family pressure, ultimatum, court mandate. Typically not voluntary

Question 5

Contemplation

Answer 5

• intend to make change within next six months
• sees reason to engage but not quite ready to do it
• Recognizes advantages and aware of disadvantages
• ambivalent

Question 6

Client in contemplation

Answer 6

• ambivalent
• “yeah, but…”
• know there is a problem, referred, compliant
• not necessarily up for a lot of work
• biggest challenge: not motivated to work on problem, challenger to get into next stage

Question 7

Preparation

Answer 7

• ready to initiate change in next month
• many clients arrive at this point
• rudiment plan of action (usually therapy)
• pros for change are slightly higher than cons

Question 8

Client in preparation

Answer 8

Eager to make change
Disappointed w setbacks and challenges
Frustration w slow progress
Cons may be bigger than anticipated 
Risk-matching enthusiasm, eagerness, challenge too much/too lofty goals, slip back into contemplation

Question 9

Action

Answer 9

• bolster self-efficacy*
• actively involved in provided interventions
• good balance of challenge, recognizable success; support, validation, progress making
• Doing good work

Question 10

Purpose of Transtheoretical Model of Change

Answer 10

• Means of conceptualizing change
• Process & different levels of readiness to change
• Can conceptualize individuals or populations

Question 11

Relapse Prevention Starts in this Phase

Answer 11

Action

• Not fully integrated, might slip up
• Can plateau in action stageget discouraged, lapse
• Go all in on the mistake, cash in; donut example

Question 12

Role of Therapist in Action Stage

Answer 12

Check in about progress, support, keep on task, keep grounded, normal expectations, recalibrate expectations

Question 13

Role of Self-Efficacy in Action Stage

Answer 13

• Increase confidence in whatthey can do independently

- Raise scaffolding

Question 14

Self-efficacy

Answer 14

Belief in ability to do something

Question 15

Maintenance

Answer 15

• Working to prevent relapse
• Stage sometimes called Relapse Prevention
• Temptation is lessened but typically not eliminated
• Pros of making change outweigh the Cons

Question 16

Lapse

Answer 16

—deviating from plan

Question 17

Relapse

Answer 17

—baseline/moving back to different stage

Question 18

Why is Maintenance so challenging for the clients?

Answer 18

Temptations never entirely goes away
Becomes normal, less excited, abnormal/stressful situations
When therapy goes away, maintenance goes away, easier to slip up
Even while making good progress, may hit plateau
Reinforcement fade > must extend power of maintenance

Question 19

How can therapists help clients in maintenance stage?

Answer 19

Cuing a memory
Regular support of therapy
Fading sessions over time
Reinforcement fade > must extend power of maintenance 
Accountability

Question 20

Decisional Balance

Answer 20

Weighing the pros and cons of changing;

Helps the client recognize/uncover some of the consequences of behavior and of changing

Question 21

Decision Balance Format

Answer 21

Pros
-Gains for self and others
-Approval for self and others
Cons
-Costs to self and others
-Disapproval from self and others

Question 22

Self-Efficacy and Situational Temptation

Answer 22

Measure of confidence clients have in ability to avoid relapse in high-risk situations

Question 23

Three factors Influence judgment

Answer 23

Negative affect/emotional distress—Bob who stopped smoking until stressful situation in Italy example
Positive social situations–Social situations that encourage the behavior; situation encourages situation
Gained confidence from successfully managing one situaiton
Craving—used to having a cig after each meal

Question 24

Temptation

Answer 24

cold turkey makes all the harder to resist; moderation reaps greater success

Question 25

Self-Efficacy/Temptation vary in reasonably predictable ways across stages

Answer 25

Temptation is usually situational and/or induced by stress; consistent cues; usually can be anticipated

Question 26

When do Self-Efficacy and Temptation shift places?

Answer 26

• Just before or during Action stage
• Shift places, notice more self-control, feel more capable->temptation decreases
• More temptation decreases, more successful one feels

Question 27

Five processes typically associated with the earlier stages in the model

Answer 27

1. Increasing Awareness-increase understanding of problem, increase likelihood they will do something about it
2. Emotional Arousal-increase emotion around problem, increase them to take action; rec problem
3. Social Reappraisal-recognize impact behavior has on social environments; implications of being a smoker in this environment; how do ppl perceive those who smokes, etc. impact behav has in that way
4. Environmental Opportunities-things happen in environment that make change easier e.g. outlaw smoking in bars and restaurants, make change easier
5. Self Reappraisal-reappraise what would mean to them

Question 28

How is knowing these processes useful to therapists?

Answer 28

Intend to take resistant and ambivalent clients from early stages and move into latter three stages
These are things we can do to help move people forward, concrete things we can do to help [people recognize the problem]

Question 29

Five processes associated with final three stages

Answer 29

1. Re-engineering-classical condition, stimulus control; e.g., Client lose weight, clean out junk food from pantry. Not keep at home; control environment
2. Supporting-typical therapeutic relationsihp, contin help move forward
3. Substituting-counterconditioning, sub neg behavior for more positive behavior; E.g. exchange smoking for drinking and/or sub exercise for addiction use energy for something else
4. Rewarding-Premack Principle, move forward using contingency principle
5. Committing-making promise to self, therapist, do homeowrk; encouarges to stick to plans; tell someone about behviaor change, sharing creates accountabilitysocial consequence

Question 30

How do therapists capitalize on these processes?

Answer 30

1. Figure out if your intervention is consistent with their stage of change, willingness
2. Stronger therapeutic relationship if meet client where they are at
3. Clients slip backwards utilize first five processes