Dr. Val Farmer
Rural Mental Health & Family Relationships

Lasting Change Takes Place In Steps

January 1, 2007

Are New Year's resolutions a waste of time? Not according to psychologists Joseph Rossi, J.O. Proshaska and their colleagues from the Cancer Prevention Research Center at the University of Rhode Island. They say they believe any amount of serious thinking about change or any attempts to change are positive.

Rossi and Proshaska have developed a five-stage model of how change takes place. Their ideas, first developed with smoking cessation, are effective with weight control, exercise, alcohol abuse, reduction of risky sexual behavior and other problem behaviors. Whether people make these changes during therapy, in a self-help group or on their own, the process for going through the five stages is the same.

The five stages in the change process are pre-contemplation, contemplation, preparation, action and maintenance. Each stage is accompanied by coping activities and events that match the stage and lead to successful change.

Furthermore, Rossi and Proshaska have found a clear developmental progression from one stage to the next in the change process. People in the first three stages don’t differ in their habits but in their readiness to change. Here's how it works.

- Precontemplation. At this stage, people deny the need to change. They are not ready. They are stable in their behavior patterns.

They may give lip service to change, but they are vague about commitments or time frames. For people in this stage, "consciousness raising" is one of the key interventions. They need to be exposed to information about the problem.

A powerful emotional experience that creates self-examination also breaks through and unfreezes existing thoughts and feelings. This happens when people or someone close to them experience a close call. The consequences become real.

A dramatic commercial or some other emotionally arousing portrayal can cause people to think seriously about what they are doing. Scare tactics work if success is defined as moving people from the pre-contemplation stage to the contemplation stage.

- Contemplation. This stage is characterized by serious thinking and a growing appreciation for the need to change. Rossi and Proshaska feel the intention to do something about the problem within the next six months is a mark of real intent.

Also, people increase their general awareness of how society views the problem behavior and how it may affect their family and friends. During this stage, people begin to look at themselves. They figure out what kind of person they have been and how they want to be. They begin to develop a vision of themselves as functioning without having the problem.

- Preparation. People who have progressed to this stage plan to do something about the problem in the next 30 days. They also have made at least one previous attempt to quit or change within the past year. This shows that their commitment has gone beyond intentions.

At this point, the "cons" for getting rid of a behavior start to outweigh the "pros" for keeping it. There is movement - a shift into action. The person then makes a decision, a conscious choice - a commitment to change.

In the case of cigarettes, this might mean cutting back as few as five cigarettes a day or delaying the first cigarette of the day for 30 minutes. This may be enough to give the person a feeling of control over the habit. Any small step toward change is progress.

The preparation stage is an unstable and difficult time. There is a lot of conflict. Any crisis might throw the person back into a previous stage. This is a small window of time in which people proceed on to the "action" stage or regress to a previous stage.

- Action. This is the actual step of quitting the problem behavior or adopting new behavior. There are several behavioral strategies people employ to make this step successful.

Briefly stated, people substitute other activities or ways of thinking for the problem behavior. They rally social support among their friends and family for the changes they are making. They need special encouragement and support because of the emotional trauma and edginess that accompany the change.

People need to eliminate troubling people and situations that make the problem behavior more tempting. This means being aware of even small or mundane factors within the environment that make it easy to relapse.

Finally, they need to reward themselves or be rewarded by others for the changes they are making.

- Maintenance. This stage means having maintained the new behavior for more than six months. The same behavioral techniques used in the action step continue to apply.

Rossi sees a relapse episode as a learning opportunity and as priming the pump for a future quit. Relapse is a common step on the way to permanent change.

The contemplation and preparation stages are building blocks in the process of change. The work that takes place during these stages may not be visible to others. Thoughts and feelings about the behavior are important. Intentions to quit are important. Specific and imminent intentions to quit are important. Any attempts to quit are definitely important.

Happy contemplation...er...New Year!

These five stages of change are further described in a book, "Changing for Good," by James Proshaska, John Norcross, and Carol C. DiClemente.