Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-04T21:49:35.912Z Has data issue: false hasContentIssue false

10 - Changing Behavior Using the Transtheoretical Model

from Part I - Theory and Behavior Change

Published online by Cambridge University Press:  04 July 2020

By
Carlo C. DiClemente  and
Meagan M. Graydon
Edited by
Martin S. Hagger ,
Linda D. Cameron ,
Kyra Hamilton ,
Nelli Hankonen  and
Taru Lintunen
Martin S. Hagger
Affiliation:
University of California, Merced
Linda D. Cameron
Affiliation:
University of California, Merced
Kyra Hamilton
Affiliation:
Griffith University
Nelli Hankonen
Affiliation:
University of Helsinki
Taru Lintunen
Affiliation:
University of Jyväskylä
Get access

Summary

This chapter describes how the transtheoretical model of behavior change (TTM) provides a framework to guide the development of tailored behavior change interventions. The TTM includes four critical concepts: stages of change to delineate critical motivational and behavior change tasks; processes of change to identify a multidimensional set of mechanisms individuals use to accomplish stage tasks and make change happen; context of change to identify contextual resources and problems that promote or hinder personal change; and markers of change that are used to track important decisional and self-efficacy dimensions related to movement through the process of change. The TTM has been used to develop interventions for pre-action and action-oriented stage tasks and offers a unique perspective for understanding how behavior changes. TTM constructs have been used and evaluated in diverse clinical and cultural settings with both mental and physical health conditions. There is substantial support for the constructs and for tailoring interventions using these constructs across multiple studies. This chapter offers concrete strategies from diverse intervention approaches that can be used to address the varied motivation and behavior change tasks represented by the stages of change. Finally, implications for prevention, treatment, and training are discussed.

Keywords

stages of changeprocesses of changecontext of changemarkers of changepre-contemplationcontemplationpreparationactionmaintenanceself-efficacy
Type
Chapter
Information
The Handbook of Behavior Change , pp. 136 - 149
Publisher: Cambridge University Press
Print publication year: 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bandura, A. (1997). Self-Efficacy: The Exercise of Control. New York: Freeman. https://doi.org/10.1891/0889-8391.13.2.158Google Scholar
Brogan, M. M., Prochaska, J. O., & Prochaska, J. M. (1999). Predicting termination and continuation status in psychotherapy by using the transtheoretical model. Psychotherapy, 36, 105–113. https://doi.org/10.1037/h0087773CrossRefGoogle Scholar
Carbonari, J. P., & DiClemente, C. C. (2000). Using transtheoretical model profiles to differentiate levels of alcohol abstinence success. Journal of Consulting and Clinical Psychology, 68, 810–817. https://doi.org/10.1037/0022-006X.68.5.810CrossRefGoogle ScholarPubMed
Connors, G. J., DiClemente, C. C., Dermen, K. H., Kadden, R., Carroll, K. M., & Frone, M. R. (2000). Predicting the therapeutic alliance in alcoholism treatment. Journal of Studies on Alcohol, 61, 139–149. https://doi.org/10.15288/jsa.2000.61.139Google Scholar
Connors, G. J., DiClemente, C. C., Velasquez, M., & Donovan, D. (2013). Substance Abuse Treatment and the Stages of Change (2nd ed.). New York: Guilford Press.Google Scholar
DiClemente, C. C. (1978). Perceived processes of change on the cessation of smoking and the maintenance of that change. Unpublished PhD dissertation, University of Rhode Island.Google Scholar
DiClemente, C. C. (2006). Natural change and the troublesome use of substances. In Miller, W. R. & Carroll, K. M. (Eds.), Rethinking Substance Abuse: What the Science Shows and What We Should Do About It (pp. 81–96). New York: Guilford Press.Google Scholar
DiClemente, C. C. (2018). Addiction and Change: How Addictions Develop and Addicted People Recover. New York: Guilford Press.Google Scholar
DiClemente, C. C., Carbonari, J. P., Montgomery, R. P., & Hughes, S. O. (1994). The alcohol abstinence self-efficacy scale. Journal of Studies on Alcohol, 55, 141–148. https://doi.org/10.15288/jsa.1994.55.141CrossRefGoogle ScholarPubMed
DiClemente, C. C., Carbonari, J., Zweben, A., Morrel, T., & Lee, R. E. (2001). Motivation hypothesis causal chain analysis. In Longabaugh, R. & Wirtz, P. W. (Eds.), Project MATCH : A Priori Matching hypotheses, Results, and Mediating Mechanisms (National Institute on Alcohol Abuse and Alcoholism Project MATCH Monograph Series) Vol. 8 (pp. 206–222). Rockville, MD: National Institute on Alcohol Abuse and Alcoholism.Google Scholar
DiClemente, C. C., Carroll, K. M., Miller, W. R., Connors, G. J., & Donovan, D. M. (2002). A look inside treatment: Therapist effects, the therapeutic alliance, and the process of intentional behavior change. In Babor, T. F. & DelBoca, F. K. (Eds.), Treatment Matching in Alcoholism (pp. 166–183). London: Cambridge University Press.Google Scholar
DiClemente, C. C., Delahanty, J. C., Havas, S. W., & Van Orden, O. R. (2015). Understanding self-reported staging of dietary behavior in low-income women. Journal of Health Psychology, 20, 741–753. https://doi.org/10.1177/1359105315580213Google Scholar
DiClemente, C. C., & Hughes, S. O. (1990). Stages of change profiles in outpatient alcoholism treatment. Journal of Substance Abuse, 2, 217–235. https://doi.org/10.1016/S0899-3289(05)80057-4Google Scholar
DiClemente, C. C., Prochaska, J. O., Fairhurst, S. K., Velicer, W. F., Velasquez, M. M., & Rossi, J. S. (1991). The process of smoking cessation: An analysis of precontemplation, contemplation, and preparation stages of change. Journal of Consulting and Clinical Psychology, 59, 295–304. https://doi.org/10.1037/0022-006X.59.2.295Google Scholar
Dijkstra, A., Conijn, B., & De Vries, H. (2006). A match–mismatch test of a stage model of behaviour change in tobacco smoking. Addiction, 101, 1035–1043. https://doi.org/10.1111/j.1360-0443.2006.01419.xCrossRefGoogle ScholarPubMed
Goldfried, M. (1980). Toward the delineation of therapeutic change principles. American Psychologist, 35, 931–950. https://doi.org/10.1037/0003-066X.35.11.991CrossRefGoogle ScholarPubMed
Griffin-Blake, C. S., & DeJoy, D. M. (2006). Evaluation of social-cognitive versus stage-matched, self-help physical activity interventions at the workplace. American Journal of Health Promotion, 20, 200–209. https://doi.org/10.4278/0890-1171-20.3.200Google Scholar
Hartzler, B., Witkiewitz, K., Villarroel, N., & Donovan, D. (2011). Self-efficacy change as a mediator of associations between therapeutic bond and one-year outcomes in treatments for alcohol dependence. Psychology of Addictive Behaviors, 25, 269. https://doi.org/10.1037/a0022869Google Scholar
Heather, N., Hönekopp, J., & Smailes, D. (2009). Progressive stage transition does mean getting better: A further test of the transtheoretical model in recovery from alcohol problems. Addiction, 104, 949–958. https://doi.org/10.1111/j.1360-0443.2009.02578.xGoogle Scholar
Ilgen, M. A., McKellar, J., Moos, R., & Finney, J. W. (2006). Therapeutic alliance and the relationship between motivation and treatment outcomes in patients with alcohol use disorder. Journal of Substance Abuse Treatment, 31, 157–162. https://doi.org/10.1016/j.jsat.2006.04.001CrossRefGoogle ScholarPubMed
Ilgen, M., Tiet, Q., Finney, J., & Moos, R. H. (2006). Self-efficacy, therapeutic alliance, and alcohol-use disorder treatment outcomes. Journal of Studies on Alcohol, 67, 465–472. https://doi.org/10.15288/jsa.2006.67.465CrossRefGoogle ScholarPubMed
Janis, I. L., & Mann, L. (1977). Decision Making. New York: Free Press.Google ScholarPubMed
Krebs, P., Norcross, J. C., Nicholson, J. M., & Prochaska, J. O. (2018). Stages of change and psychotherapy outcomes: A review and meta‐analysis. Journal of Clinical Psychology, 74, 1964–1979. https://doi.org/10.1002/jclp.22683CrossRefGoogle ScholarPubMed
Marcus, B. H., Rossi, J. S., Selby, V. C., Niaura, R. S., & Abrams, D. B. (1992). The stages and processes of exercise adoption and maintenance in a worksite sample. Health Psychology, 11, 386–395. https://doi.org/10.1037//0278-6133.11.6.386Google Scholar
Mee-Lee, D. (Ed.). (2013). The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-occurring Conditions. Bethesda, MD: American Society of Addiction Medicine.Google Scholar
Miller, W. R. (1999). Enhancing Motivation to Change in Substance Abuse Treatment. Treatment Improvement Protocol Series, Vol. 35. Rockville, MD: US Department of Health and Human Services.Google Scholar
Norcross, J. C., Krebs, P. M., & Prochaska, J. O. (2010). Stages of change. Journal of Clinical Psychology: In Session, 67, 143–154. https://doi.org/10.1002/jclp.20758Google Scholar
Penberthy, J. K., Hook, J. N., Vaughan, M. D. et al. (2011). Impact of motivational changes on drinking outcomes in pharmacobehavioral treatment for alcohol dependence. Alcoholism: Clinical and Experimental Research, 35, 1694–1704. https://doi.org/10.1111/j.1530-0277.2011.01516.xGoogle Scholar
Prochaska, J. O. (1979). Systems of Psychotherapy: A Transtheoretical Analysis. Homewood, IL: Dorsey Press.Google Scholar
Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research and Practice, 19, 276–288. https://doi.org/10.1037/h0088437Google Scholar
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390–395. https://doi.org/10.1037/0022-006X.51.3.390Google Scholar
Prochaska, J. O., & DiClemente, C. C. (1984). The Transtheoretical Approach: Crossing the Traditional Boundaries of Therapy. Malabar, FL: Krieger.Google Scholar
Prochaska, J. O., & DiClemente, C. C. (1986). Toward a comprehensive model of change. In Miller, W. R. & Heather, N. (Eds.), Treating Addictive Behaviors (pp. 3–27). Boston: Springer.CrossRefGoogle Scholar
Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to the addictive behaviors. American Psychologist, 47, 1102–1114. https://doi.org/10.1037/0003-066X.47.9.1102Google Scholar
Prochaska, J. O., DiClemente, C. C., & Velicer, W. F. (1985). Predicting change in smoking status for self-changers. Addictive Behaviors, 10, 395–406. https://doi.org/10.1016/0306-4603(85)90036-XGoogle Scholar
Prochaska, J. O., DiClemente, C. C., Velicer, W. F., & Rossi, J. S. (1993). Standardized, individualized, interactive and personalized self-help programs for smoking cessation. Health Psychology, 12, 399–405. https://doi.org/10.1037//0278-6133.12.5.399Google Scholar
Prochaska, J. O. & Norcross, J. (2016). Systems of Psychotherapy: A transtheoretical analysis (8th ed.). New York: Brooks Cole.Google Scholar
Prochaska, J. O., Norcross, J. C., & DiClemente, C. C. (1994). Changing for Good. New York: Morrow.Google Scholar
Prochaska, J. O., Norcross, J. C., Fowler, J. L., Follick, M. J., & Abrams, D. B. (1992). Attendance and outcome in a work site weight control program: Processes and stages of change as process and predictor variables. Addictive Behaviors, 17, 35–45. https://doi.org/10.1016/0306-4603(92)90051-VCrossRefGoogle Scholar
Prochaska, J. O., Velicer, W. F., DiClemente, C. C., & Fava, J. L. (1988). Measuring the processes of change: Applications to the cessation of smoking. Journal of Consulting and Clinical Psychology, 56, 520–528. https://doi.org/0022-006 X/88/S00.75Google Scholar
Prochaska, J. O., Velicer, W. F., Redding, C. et al. (2005). Stage-based expert systems to guide a population of primary care patients to quit smoking, eat healthier, prevent skin cancer, and receive regular mammograms. Preventive Medicine, 41, 406–416. https://doi.org/10.1016/j.ypmed.2004.09.050Google Scholar
Prochaska, J. O., Velicer, W. F., Rossi, J. S. et al. (1994). Stages of change and decisional balance for 12 problem behaviors. Health Psychology, 13, 39–46. https://doi.org/10.1037/0278-6133.13.1.39Google Scholar
Project MATCH Research Group. (1997). Matching alcoholism treatments to client heterogeneity: Project MATCH post-treatment drinking outcomes. Journal of Studies on Alcohol, 58, 7–29. https://doi.org/10.15288/jsa.1997.58.7Google Scholar
Quinlan, K. B., & McCaul, K. D. (2000). Matched and mismatched interventions with young adult smokers: Testing a stage theory. Health Psychology, 19, 165–171. https://doi.org/10.1037/0278-6133.19.2.165Google Scholar
Rosen, C. S. (2000). Is the sequencing of change processes by stage consistent across health problems? A meta-analysis. Health Psychology, 19, 593–604. https://doi.org/10.1037/0278-6133.19.6.593CrossRefGoogle ScholarPubMed
Shaw, M. A. & DiClemente, C. C. (2016). Relapse vulnerability measure of the alcohol abstinence self-efficacy scale predicting time to first drink and amount of drinking. Journal of Studies on Alcohol and Drugs. 77, 521–525. https://doi.org/10.15288/jsad.2016.77.521CrossRefGoogle Scholar
Sloane, R. B., Staples, F. R., Cristol, A. H., Yorkston, N. J., & Whipple, K. (1975). Psychotherapy Versus Behavior Therapy. Cambridge, MA: Harvard University Press.CrossRefGoogle ScholarPubMed
Substance Abuse and Mental Health Services Administration (2013). Systems-Level Implementation of Screening, Brief Intervention, and Referral to Treatment. Technical Assistance Publication (TAP) Series 33, HHS Publication No. (SMA) 13–4741. Rockville, MD: USDHHS Center for Substance Abuse Treatment.Google Scholar
Sutton, S. (2001). Back to the drawing board? A review of applications of the transtheoretical model to substance use. Addiction, 96, 175–186. https://doi.org/10.1080/09652140020017049CrossRefGoogle Scholar
Velasquez, M., Crouch, C., Stephens, N., & DiClemente, C. C. (2015). Group Treatment for Substance Abuse: Stages of Change Therapy Manual (2nd ed.). New York: Guilford Press.Google Scholar
West, R. (2005). Time for a change: Putting the transtheoretical (stages of change) model to rest. Addiction, 100, 1036–1039.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×