Dr. Val Farmer
Rural Mental Health & Family Relationships

A Vision Of Change For The New Year

December 23, 1996

The new year is upon us. Our thoughts turn from holiday joy and family togetherness to self-evaluation and self-improvement. Change is hard, especially when it comes to habitual, compulsive or addictive behavior.

In a new book, "Changing for Good," by psychologists James Proshaska, John C. Norcross and Carlo C. DiClemente, they outline five stages of change. These stages are universal whether the change is made while in therapy, in a self-help group or if people change on their own.

Stage one: Precontemplation. In this stage people have no intention to change in the future. They may be unaware of their problems or deny that their behavior as a problem. Many of these people are sent to treatment because others see their behavior as a problem. They display change as long as the pressure is on.

Stage two: Contemplation. During this stage people are aware that a problem exists, They are seriously thinking of overcoming it - typically within the next six months. Contemplators gather information about the problem while weighing the pros and cons of change. They are still caught up in a positive evaluation of their habitual or addictive behavior and are hesitant to commit the effort, energy and loss it will cost to overcome the problem.

Stage three: Preparation. This is the decision-making stage. People intend to take action with the next month and are trying out some the action steps. They are making small behavior changes before a full commitment. Part of the struggle to commit is a secret trial run on some changes that will be required.

Stage four: Action. This stage is where a person actively takes major steps to modify their behavior or their environment in an attempt to overcome their problems. These are highly visible steps that will be recognized by others. Most people regard the action stage as synonymous with change without recognizing the other stages. People are in the action phase if they work at change for at least a day to six months.

Stage five: Maintenance. During this stage, people work to prevent a relapse and to stabilize the changes. Maintenance is change that lasts for six months or longer. Most people don't maintain their gains on their first attempt at action steps. For smokers, successful self-changers need three or four action attempts before being able to maintain their change successfully. They may repeat the cycle (five stages) several times before they get it right.

Cycling through stages. The vast majority of addicted people are not in the action stage. For smokers, 10 to 15 percent are ready for action, 30 to 40 percent are in the contemplation stage while 50 to 60 percent are in the precontemplation stage. For smokers, the 85 percent who fail in the action or maintenance phase recycle back to the contemplation or precontemplation stages.

A key to change is moving from one stage to the next. In moving from the contemplation stage to the preparation and action stages, people shift from thinking about doing something about their problems to actually doing something about them.

Most relapsers do not revolve endlessly in circles nor do they regress all the way back to where they began. Each time a relapser recycles through the stages, they potentially learn from their mistakes and can try something different next time. Every step is a positive step in the direction of long term success.

How does change occur? Proshaska adds another element to the change process besides readiness to change. He identifies 10 techniques people use to make changes.

1. Consciousness raising - information about the self or the problem.

2. Self-reevaluation - how does one think and feel about oneself regarding the problem.

3. Self-liberation - choosing, commitment to act, belief in ability to change.

4. Counterconditioning - substituting alternatives for problem behavior.

5. Stimulus control - avoiding or blocking things in the environment that lead to the problem behavior.

6. Reinforcement management - rewarding oneself or being rewarded by others for making changes.

7. Helping relationships - social support, open and trusting about problems with someone who cares.

8. Dramatic relief - experiencing or expressing feelings about one's problems and solutions.

9. Environmental reevaluation - assessing how a problem affects others, learning to empathize.

10. Social liberation - increasing alternatives for non-problem behaviors available in society, empowerment, policy interventions.

Certain processes lend themselves to certain types of problems. Weight control relies on self-liberation and stimulus control. Efforts to change involve matching the stage people are in with effective strategies for that stage.

For example, smokers in the contemplation stage rely on consciousness raising, dramatic relief and a consideration of how their behavior affects their environment. In the preparation stage, they begin to take small steps and reevaluate themselves.

During the action stage, they emphasize self-liberation and willpower. They also use counterconditioning, stimulus control and rely on support from helpful friends and family.

Change involves doing the right things (processes) at the right times (stages). People need both insight - awareness, decision-making, readiness - about their lives and appropriate behavioral techniques - reinforcement management, stimulus control and counterconditioning to be successful.

The most important factor propelling the hard work of change is the hope and vision of becoming the kind of person we want to be. During this next year, let's take a couple of steps toward that lofty goal.