Transtheoretical Model (TTM)

Question 1

Transtheoretical Model (TTM)

• aka?
• originally developed to?

Answer 1

“Stages of Change” Model

to treat addictive disorders

Question 2

TTM

• includes several different constructs (4)

Answer 2

• assesses individual’s readiness to act on healthier behavior & provides strategies (processes of change) to guide them through stages of change
  1) Stages of Change - dependent variable
  2) Decisional Balance
  3) Confidence vs. Temptation
  4) Processes of Change

Question 3

1) Stages of Change

Answer 3

specifies that individuals move through (5) stages of change

1-3 → pre-action

4-5 → post-action

• people are assumed to move through stages in order but may relapse to earlier stage*
• this stage model is conceptualized as a spiral since relapse is a rule rather than an exception*
• may cycle through stages several times before achieving long-term behavior change

Question 4

2) Decisional Balance

Answer 4

aka pros & cons

• percieved advantages & disadvantages of changes one’s behavior
• decisional balance shifts in critical ways as individuals progress through stages of change*

Question 5

3) Confidence

• define
• similar to?
• related construct?

Answer 5

similar to Bandura’s construct → self-efficacy (SE)

refers to confidence that one can carry out recommended behavior across range of potentially difficult situations

related construct = temptation

Question 6

3) Confidence

• related construct → Temptation
  
  • ​refers to?

Answer 6

refers to temptation to engage in unhealthy behavior across range of difficult situations

Question 7

4) Processes of Change

Answer 7

covert & overt activities that people engage in to progress through stages of change

• result in strategies that help people make & maintain change

Question 8

4) Processes of Change
* divided into (2) groups

Answer 8

Experiential

Behavioral

Question 9

4) Processes of Change → Experiential (5)

Answer 9

cognitive-affective processes

a) Consciousness raising
b) Dramatic Relief
c) Environmental Reevaluation
d) Social Liberation
e) Self Reevaluation

Question 10

4) Processes of Change → Experiential

a) Consciousness raising

Answer 10

increasing awareness of facts/ideas/tips that support healthy behavior change

& of causes/consequences/cures for problem behavior

Interventions: feedback, information/education

1-2

Question 11

4) Processes of Change → Experiential

b) Dramatic Relief

Answer 11

experiencing negative emotions that accompany unhealthy behavioral risks

Intervention(s): provide fear-arousing feedback on risks & success stories to move people emotionally

1-2

Question 12

4) Processes of Change → Experiental

c) Environmental Reevaluation

Answer 12

Assessing positive/negative impact of healthy/unhealthy behavior on one’s social/physical environment

• realizing negative effect of behavior & positive impact of change on others

1-2

Question 13

4) Processes of Change → Experiential

d) Social Liberation

Answer 13

Realizing that social norms are supportive of healthy behavior change

• requires existing environmental opportunities that show society is supportive of healthy behavior change

1-2

Question 14

4) Processes of Change → Experiential

e) Self Reevaluation

Answer 14

Realizing behavior change is important part of one’s identity (who they want to be)

• cognitive & affective assessments of self-image with & without unhealthy behavior

Intervention: identify healthy role models, imagery

2-3

Question 15

Process of Change → Behavioral (5)

Answer 15

a) Stimulus Control
b) Helping Relationships
c) Counter Conditioning
d) Reinforcement Management
e) Self Liberation

Question 16

Process of Change → Behavioral

a) Stimulus Control

Answer 16

removing cues for unhealthy habits & adding prompts for healthier alternatives

• changing environment to support healthy behavior

Intervention(s): provide recommendations

4-5

Question 17

Process of Change → Behavioral

b) Helping Relationships

Answer 17

Seeking & using social support for healthy behavior change

Intervention(s): buddy system, supportive calls, rapport building

3-5

Question 18

Process of Change → Behavioral

c) Counter Conditioning

Answer 18

learning healthier alternative behaviors & cognitions as substitutes for unhealthy behavior

3-5

Question 19

Process of Change → Behavioral

d) Reinforcement Management

Answer 19

Increase rewards for healthy behavior changes & decrease rewards for unhealthy behaviors

4-5

Question 20

Process of Change → Behavioral

e) Self Liberation

Answer 20

making firm commitment to change & beleiving that one can change

3-4

Question 21

Strategies (Processes of Change) most effective at which stages of change?

→ Experiential

a) Consciousness raising
b) Dramatic Relief
c) Environmental Reevaluation
d) Social Liberation
e) Self Reevaluation

Answer 21

a, b, c, d → 1-2

• consciousness raising, dramatic relief, env reeval, social lib

e → 2-3

• self-reeval

Question 22

Strategies (Processes of Change) most effective at which stages of change?

→ Behavioral

a) Stimulus Control
b) Helping Relationships
c) Counter Conditioning
d) Reinforcement Management
e) Self-Liberation

Answer 22

e → 3-4

b, c → 3-5

a, d → 4-5

Question 23

Stages of Change (5)

Answer 23

1) Pre-Contemplation
2) Contemplation
3) Preparation
4) Action
5) Maintenance

Question 24

1) Pre-Contemplation
* (4)

Answer 24

NO intention to change behavior

may be unaware they have a problem

may seek help

• usually only if pressured by others or feel coerced into changing behavior

Poor targets for intervention

Question 25

2) Contemplation * **(3)**

Answer 25

→ *this stage can last years* **aware** problem exists *but not yet committed to take action* still weighing **pros & cons** those who decide to change behavior have typicially formed favorable expectations about ability to do so & rewards that will result *(SE & outcome expectancies)*

Question 26

3) Preparation * **(2)**

Answer 26

individuals **intend** to change behavior *but haven't done so* may have already **modifed** target behavior *but not yet committed to eliminate behavior completely*

Question 27

4) Action * (3)

Answer 27

stage in which individuals **modify** behavior to overcome problem requires **commitment** of **time** & **energy** includes **stopping** behavior & **modifying lifestyle/environment** to **eliminate cues** associated with unhealthy behavior

Question 28

5) Maintenance * **(2)**

Answer 28

working to **prevent relapse** & consolidate gains made In this phase if **6+ months** free of addictive unhealthy behavior

Question 29

Stage Model conceptualized as a **Spiral** * explain?

Answer 29

because **relapse** is the rule rather than the exception may cycle through stages several times before achieving long-term behavior change

Question 30

**Application** of TTM

Answer 30

TTM suggests that particular interventions are more valuable during certain stages in helping them move to next stage ## Footnote **#1 - Pre-contemplation:** providing info about problem (**consciousness raising**) **#2 - Contemplation:** induce assessment of feelings & thoughts about problem (**dramatic relief**) **#3 - Preparation:** get people to make explicit commitment to when/how they will change behavior (**self-liberation**) **#4 - Action:** self-reinforcement (**reinforcement management**), social support (**helping relationships**), **stimulus control** & coping skills (**counter conditioning**)

Question 31

Stages of Change → **1) Pre-Contemplation** * Intervention Techniques **(4)**

Answer 31

* validate **lack of readiness** * **clarify**: decision is theirs * encourage **re-evaluation** of current behavior & **self-exploration** * explain & personalize **risk**

Question 32

Stages of Change → 2) Contemplation * **Intervention Techniques (4)**

Answer 32

* validate **lack of readiness** * **clarify**: decision is theirs * encourage evaluation of **pros & cons** of behavior change * **identify & promote** positive **outcome expectations**

Question 33

Stages of Change → **3) Preparation** * Intervention Techniques **(4)**

Answer 33

* identify & assist in **problem-solving** (obstacles) * help identify **social support** * verifyt individual has underlying **skills** for behavior change * encourage **small initial steps**

Question 34

Stages of Change → **4) Action** Intervention Techniques **(3)**

Answer 34

focus on **restructuring cues & social support** **strengthen SE** for dealing with obstacles **resist feelings** of **loss** & **reiterate** long-term **benefits**