The Stages of Change

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Break a habit. Achieve a goal. Transform your life.

At one time or another, most of us have embarked on an effort to change some part of ourselves or our lives. We’ve decided to stop smoking, to start saving, to drop a few pounds, or to get a new job. As a rule, these sorts of changes don’t occur overnight. They take time and effort. And they tend to evolve through a multistage process — one that many behavior-change experts know as the Transtheoretical Model of Change, or TTM.

Conceived in the early 1980s by psychologist James O. Prochaska, PhD, this theoretical tool (sometimes referred to as the “readiness-to-change” model) has encouraged many to rethink their assumptions about the most effective, appropriate ways to support themselves in accomplishing their goals. Read on to get a sense of where you are in your own change process, and what actions and attitudes are most likely to help you create forward momentum.

Just Do It

There’s something so commanding about those three simple words that Nike was compelled to trademark them. And wisely so. What better way to invoke the appeal of go-get-’em action — and to reject all the pointless dilly-dallying that so often seems to lead up to it?

Most of us also know from hard-won experience, though, that when it comes to making significant changes, launching ourselves into action is often harder than it sounds, and less productive than we hoped.

In fact, it turns out that “just doing it” — before you are emotionally ready and properly prepared to take on a particular goal — may be one of the fastest ways to sabotage your success.

What Prochaska’s six-stage model illuminates is what many earlier models tended to gloss over — namely, that lasting change rarely occurs as the result of a single, ongoing decision to act.

More often, as Prochaska points out, change evolves from a subtle, complex and sometimes circuitous progression — one that involves thinking, hesitating, stepping forward, stumbling backward, and, quite possibly, starting all over again.

Prochaska’s Transtheoretical Model (TTM) acknowledges that lasting change generally proceeds through six key stages: from Precontemplation, to Contemplation, then to Preparationand Action. But that’s only the beginning, and we can easily coast right back into preparation or contemplation if we lose our nerve, focus or steam. For our behavior change to prove sustainable, it must enter a Maintenance phase (generally, six months or more of consistent action) until it finally becomes ingrained as a stable habit. This final, ongoing phase is known as Termination, which implies that the change is now a permanent part of our lifestyle.

Most “just do it” programs fail to embrace the reality of this complex and fluid progression. Instead, they encourage people to jump straight into action, leapfrogging over all those messy preparatory steps.

Unfortunately, those might be precisely the steps that give our change efforts the greatest chances of success. And so it happens that a great many of us who jump directly into action wind up falling right back out of it — again and again.

Once you take stock of Prochaska’s model, all of this seems self-evident. And it seems curious that these insights became part of the modern psychological canon only relatively recently.

“Thirty years ago, psychotherapy was made up of over 300 different theories,” recalls Prochaska, who now serves as director of the Cancer Prevention Research Center and professor of clinical and health psychology at the University of Rhode Island. “I was looking for a way to integrate some of these theories,” he says. “So my research team and I went out and interviewed ordinary folks who were struggling with quitting smoking. We asked them about the various processes they’d gone through, and they said, ‘Early on I did this; later I did this.’ They were talking about stages of change. But that wasn’t in any of the 300 models of therapy known at the time. We realized that was the missing link that could allow us to integrate different processes from different theories.”

Prochaska also recognized the need for stage-appropriate support systems, and eventually founded a behavior-change research and development consultancy — Pro-Change Behavior Systems — based on this area of expertise. “For a long time,” he says, “the dominant model was an action model, where people were seen as changing only when they took action.” Accordingly,  he notes, resources and support were focused exclusively in that phase. “The problem is,” he says, “action-oriented programs don’t work for the majority of people.”

At any given time, about only 20 percent of people needing to change an unhealthy behavior are actually prepared and ready to do so, says Prochaska’s collaborator and wife, Janice M. Prochaska, PhD, who serves as CEO of Pro-Change Behavior Systems. “This model works with the whole at-risk population, not just those who are ready for change right then. And research shows that if we can get someone to move just one stage forward, we double their chances of being successful six to 12 months down the road.”

Not all experts see TTM as a perfect tool. And there’s no guarantee that stage-appropriate interventions and support systems will prove effective for a particular individual. But if you’ve been striving to put your own change efforts into perspective, understanding your “readiness to change” may very well be a step in the right direction.

Want to be more successful in making the changes that matter to you? Here’s a detailed look at the stages of change, and how you can move through them with confidence.

Stage 1: Precontemplation

People in this stage may wish to change, but for the immediate future have no plans to do so. Why? They may not be fully aware of all the potential benefits, or they may feel disinclined to try because of past failed attempts, or a lack of available energy.

“In Precontemplation, people underestimate the benefits of changing, and overestimate the cons, or costs,” says Prochaska. “But they’re not particularly conscious of that, so it’s not a focused, rational decision-making process.”

Weighing the pros and cons of a behavior is an important component in the Transtheoretical Model. In the beginning, the apparent cons tend to outweigh the perceived pros. As a person moves through the six stages, however, that balance shifts.

“If I’m dealing with a patient in Precontemplation, I assign them the task of thinking at least once a day about all the benefits they’d expect from changing whatever behavior they’re trying to stop or start,” says Alex Lickerman, MD, a primary-care physician at the University of Chicago, who uses the stages-of-change model with his patients. “That may be enough to move an individual into Contemplation,” he notes. “Thinking about making a change is what gets people used to the idea of actually making it.”

You’re in the Precontemplation stage if: You’ve heard plenty of times (from your doctor, your spouse, your friends, or maybe your own conscience) that you should make a change — but you’re not seriously considering doing anything about it anytime soon. It may seem like too much work, or just plain not for you. When someone tries to talk to you about it (e.g., cutting back on drinking, losing weight, giving up cigarettes), you tune out, shut down or change the subject.

Moving from Precontemplation to Contemplation: It may take a scary test result or a major life event (such as the birth of a child or death of a loved one) to get you motivated to start thinking differently about your prospects for change. Meanwhile, recognize that “just thinking about it” has potential value, too, and can help open your mind to new possibilities.

Stage 2: Contemplation

Those in the Contemplation stage are thinking about taking action, but aren’t quite ready or don’t know how to get started. Contemplators often think they might make the behavior change within the next six months, and they’re open to information and feedback. In this stage, the pros and cons of potential change feel about equal.

“At this stage, identifying and amplifying a person’s internal motivators for behavior change — the things uniquely important to them as an individual — is very important to tipping the scales,” notes master certified life coach Kate Larsen, in Progress Not Perfection: Your Journey Matters (Expert Publisher, 2007).

Since contemplators are open to new information (unlike precontemplators, who tend to reject it), they can build their enthusiasm for change by connecting to these core values or motivations, gathering information, exploring new perspectives, asking others about their experiences and learning from the examples of those who have already made the change they are considering. All of these discovery processes can help shift how the contemplator is thinking — an essential step for making forward progress.

“Just as we have behavioral habits, we also have thinking habits,” says Larsen. “And generally, those mental patterns have to shift before lasting behavior change can occur.”

Larsen encourages clients to spend some time visualizing what their lives will be like after the change, asking: How will I look, act and feel when I’ve made this change? What will I be doing differently? This can turn up their enthusiasm, and also help reveal unaddressed obstacles or anxieties for which they might need support.

You’re in the Contemplation stage if: You’re no longer opposed to making a change in your life, but you’re still sitting on the fence. Your ears may perk up when you hear someone talking about related subjects. And while you’re not actively searching for information or supportive resources, when you happen to stumble across them, you take a look. You’re gaining the confidence to imagine changing, and becoming more aware that it might very well be worth the effort.

Moving from Contemplation to Preparation: This is a great time to do the low-commitment work of envisioning your better self and your better life — perhaps journaling or making a “vision board” that represents the change you’d like to accomplish. It’s also a good time to recognize that if you have been thinking about change for a while and not doing it, there’s probably a reason: You may lack some of the necessary skills, knowledge or confidence. You may be concerned about the prospect of leaving behind familiar patterns. If so, reaching out for the support of a coach, mentor or counselor could be very helpful. Hearing the first-person accounts of others who have already made this change can be inspiring and reassuring, too.

Stage 3: Preparation

People in the Preparation stage are getting ready to take action. They are more decisive, confident and committed; they’re developing a plan and may have already taken small steps. At this point, the pros of making the change clearly outweigh the cons — but there’s some work to be done before meaningful action can take place.

The Preparation stage is all about building confidence — and troubleshooting against the obstacles or weaknesses that stand the greatest chance of undermining it. This is the time to develop an “if-then” plan for the various challenges and temptations you are likely to face when you make the change, says Lickerman. It is much harder to think of success strategies and temptation-management techniques on the fly than it is to prepare for them in advance.

People tend to get stuck in Preparation (or ricochet back and forth between it and Contemplation) when they misjudge their level of readiness or impatiently jump straight to Action. That can undermine their confidence and make them wary about trying again.

At this stage, Lickerman says, “I encourage people to pick a specific day on which they’ll officially begin their planned change. I ask them to make key adjustments to their environment and schedule, and rally the support of friends and family.”

This is also a great time to hire a coach, if you choose to, or to join a support group that focuses on your desired change. And now is when you want to make any other necessary arrangements: If your goal is to start a fitness plan, for example, mark your calendar with a firm date and time when you plan to begin working out, sign up for a fitness class, arrange childcare, and buy the proper shoes and workout clothes for your chosen activity.

You’re in the Preparation stage if: You’re actively gathering information, support, maybe even gear and supplies — and feel nearly ready to take your first steps. You’re feeling motivated to learn the skills that will help you be successful in making this change. You’re inclined to accept appropriate support, and you welcome invitations and incentives to participate in activities that will move you forward.

Moving from Preparation to Action: This is when you sign up for that class, attend a support group, buy a health-club or yoga-studio membership, or bring home a pamphlet for services that will help you make the change you desire. If you’re determined to eat healthier, this might be when you start clearing the junk food out of your pantry and stocking up on wholesome stuff. Any initial steps — even if they are experimental — move you that much closer to Action and the sense of momentum that comes with it. Ask yourself: What, if anything, do I need to do to embrace this change in my life and be prepared for the obstacles I’m most likely to encounter?

Stage 4: Action

Beyond just thinking about it or preparing to act, a person in this phase has actually begun doing something (or a lot of things) differently, and may be experimenting with expanding his or her efforts. Even if the changes are small so far, he or she is building momentum, knowledge and self-confidence, all of which encourage continued action. “This stage is where all those small steps, small choices, and mini sacrifices make a huge difference,” notes Larsen.

During the Action stage, when people are working to strengthen their commitment to the change, external support is critical, says Prochaska. Even though they may not be inclined to ask for it, people in this stage benefit from offers of emotional and physical support, and from having people around them recognize their progress and help keep them accountable.

Because encountering situations that trigger old, unhealthy behaviors is a real risk at this point, Prochaska advises people in Action to consciously focus on substituting their “old ways” with healthier environments, situations and people. You might post visual reminders or inspirations on your fridge or in your cube at work to keep you focused on your goal.

But Action is an ongoing process, notes Larsen, so the focus here needs to be on progress, not perfection. “You don’t have to do everything flawlessly,” she says. “You just have to keep cultivating the willingness and positive momentum that brought you this far.” Look for ways to acknowledge your ongoing efforts, to address new obstacles as they emerge, and to reward yourself for even small successes, she advises. Quick course corrections and positive reinforcement will help you stay committed and motivated.

You’re in the Action stage if: You’re implementing your action plan. Perhaps you ate your first healthy meal, completed your first round of workouts, or got through your first few days or weeks as a nonsmoker. Congrats! Now you just have to keep going.

Moving from Action to Maintenance: Prochaska’s model specifies that after six months of consistent action, you transition into Maintenance. Getting to that point mostly involves doing whatever keeps you strong, motivated and focused. Finding ways to integrate your chosen behavior change into your social life and sense of identity can be a big help.

Stage 5: Maintenance

Individuals in the Maintenance stage have managed to stay in Action mode for at least six months. That means they’ve successfully avoided or overcome the obstacles that could have caused them to slip back into old behaviors. Through practice, they’ve attained a greater level of confidence and capacity. Their new behaviors have started to become a more integrated part of their lifestyle and identity, and their risk of relapse is much lower than when they began.

Yet several things can trigger people in Maintenance to relapse: stress, crisis, apathy, boredom, a loss of environmental or emotional support, or a frustrating plateau in progress. Major life events — like a job change, romantic breakup, location change, birth or death in the family — can also trigger a relapse.

What constitutes a lapse in maintenance depends on the behavior change in question. For an alcoholic who has committed to total sobriety, it may be a single drink. For those who have embarked on a fitness routine, it may mean missing a few workouts in a row.

Whenever you fall out of Action for long enough that there’s a question about whether or not you’ll be back on track tomorrow, you’re probably stepping out of Maintenance and back into Action, Preparation, or even Contemplation. The thing to keep in mind, says Prochaska, is that “the only real mistake you can make in changing is to give up on your ability to change.”

You’re in the Maintenance stage if: For at least the past six months, you’ve been diligent and consistent in performing the actions you committed to as part of your desired behavior to change. They now seem fairly routine.

Moving from Maintenance to Termination: Treat obstacles and unanticipated challenges as opportunities to develop new strengths. Ward off boredom by taking on new challenges and expanding your skills. Stay on the maintenance path for two years or more, rallying even through stresses and setbacks, and you’ll reach a point where you can’t really imagine ever going back to the way things were before.

Stage 6: Termination

When people in the Maintenance stage continue their healthier behavior for at least two years, they enter into Termination (sometimes also referred to as “Adoption”). In Termination, the behavior change is completely integrated, and the temptation to revert to the former behavior is entirely gone. This element of behavior change is no longer something you have to “do” — it’s just who you are.

But this doesn’t necessarily mean that the evolution is complete. People in Termination often opt to keep building on their initial change, adding bigger and broader goals and achieving even more success.

According to Prochaska, about only 15 to 20 percent of people ever make it to Termination. Still, he notes, any significant forward progress you make between the stages brings real and important rewards, such as confidence, knowledge, momentum and growth.

Until you enter Termination, hitting a wall or falling back into an earlier stage is very common. So don’t be too hard on yourself. As long as you can identify the stage you are at within TTM, you will always know what you need to do to get back on track, recommit to your goal and make forward progress. And you’ll have a clear sense of where you’re headed next.

You’re in the Termination stage if: After two years or more in Maintenance, you’ve been at this long enough that it now doesn’t seem like “behavior change” at all. It’s just the way you live — an integrated, almost effortless part of who you are. You’ve likely become adept enough at the required skills and awarenesses that you’ve learned how to apply them in new ways, perhaps to new goals in other parts of your life. You’re confident enough now in this realm that you may even coach or mentor others in making the changes you’ve mastered.

Enjoying Termination: The whole point of mastering the art of behavior change is to create the life of your highest choosing. Successfully integrating a chosen lifestyle change is a clear indication that you have the skills to do that. Look for new ways you can leverage those skills. Explore how you might use the strength, self-knowledge and wisdom you’ve gained to undertake new areas of challenge or learning, and to be of service and support to others.

You now know a secret that few fully appreciate — that there’s more to creating change than meets the eye, more than those who like to invoke the “just do it” imperative may care to admit.

“Too often,” says Prochaska, “we’ve presented people with a false choice: Take immediate action, or do nothing. And those are bad choices for most people. If they take action and they aren’t ready, half will fail. And if they don’t take action, they’ll continue with their unhealthy lifestyle.” The better choice? Start where you are, take the steps forward that are appropriate for you now, and then just keep on going.

Jessie Sholl is the author of Dirty Secret: A Daughter Comes Clean About Her Mother’s Compulsive Hoarding (Simon & Schusgter, 2010).

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