The six stages of change model of behaviour change

Prochaska and DiClemente

The diagram demonstrates the “Stages of Change” model of behaviour change espoused by James Prochaska and Carlo DiClemente.

The model can be applied to any behaviour change whatsoever, but we are going to look at it from the point of view of a smoker.

The diagram is read from the top downwards.

So, the first stage of behaviour change is “Pre-contemplation”. This is the stage when we feel everything is OK about our particular behaviour. We will justify this behaviour to ourselves.

For example, if I personalise this and apply it to my own smoking behaviour as a young person, my self talk might go something like this:

“I am fitter and more healthy than most people. There are heaps of people my age who don’t smoke and, who are no where near as fit as I. Therefore it is OK for me to smoke!”.

The second stage of change in this model is “Contemplation”. Once again, I shall personalise it by way of example. You may recall that in the early part of my career, I was a Health and Physical Education teacher. Naturally I did have some knowledge of the dangers associated with smoking. And, on occasions I would think thoughts such as, “perhaps I should think about quitting and this time staying stopped”.

You will notice on the right side of the diagram there is a box marked relapse, with arrows going up from each of the lower stages to the upper stages of behaviour change. This does typify most behaviour changes.

Behaviour change is normally a dynamic process. It is cyclical.  We progress through stages and then drop back to earlier stages. For example after my thinking that it may be a good idea for me to never smoke again on occasions, I would relapse back to my earlier stage of “Pre-contemplation”. That is, “everything is OK!”

The third stage of behaviour change is “Preparation”. This is when you are actually getting ready to make the behaviour change. The thought processes could go something like this: “Well, I am going on holidays the week after next. With the change from my regular routine, that could well be an appropriate time for me to try  to quit and stay stopped.”

The fourth stage of behaviour change is “Action”. This is when you do actually make an effort to make that behaviour change. For example, my holidays may have come along, and I did actually stop smoking. But for how long? Was it for a couple of hours, was it for a day? People, after taking action to change a behaviour, will generally relapse back to one of the earlier stages of behaviour change to go through the cycle once again.

But let’s suppose I maintained that new behaviour for a week or maybe two weeks or whatever. This is now the fifth stage of behaviour change called “Maintenance”. But as with all the earlier stages, people will typically relapse after a time to an earlier stage.

You will notice on the left side of the diagram there is a box which has arrows going downwards for each of the earlier stages. This box is labeled “Eliminating Ambivalence - Reducing Resistance”.

This “eliminating ambivalence” and “reducing resistance” is of course referring to the behaviour change. The more these things are done, the faster the client will move through the various stages of change of behaviour.

People who smoke who wish to be people who don’t smoke, will generally go through this cycle several times. It depends on which study you read, but we do know the average number of times through the cycle for smokers is at least six.

To reiterate: Most smokers will attempt to stop smoking on average at least six times before they finally become nonsmokers.

Here are some statistics which are relevant for Health Professionals as well as for those who are trying to quit.

We do know that the more often that people get to the higher stages of the “Stages of Change” model, the more likely they are to be successful.

Often smokers who attempt to stop, and only stay stopped for a short time, or even a longer time, think of themselves as failures. Although they realise the IMPORTANCE of making the behaviour change, they seem to lack the CONFIDENCE to be able to make the change.  They think along the lines of , “Well I have blown it”. 

I would suggest, taking the research into account, that this is the wrong way of thinking. Having an understanding of the “Stages of Change” model of behaviour change; the thinking should go along these lines: “I did try, but unfortunately I was not successful in my attempts to stay stopped this time, but next time I should be more successful”.

The “Stages of Change” model has six stages. So far, we have mentioned five. The sixth stage is represented by the green box at the bottom of the diagram which is labeled, “Permanent exit from cycle - New behaviours embedded”.

In this case, the client has become a nonsmoker.

This model of behaviour is applicable to any behaviour change. It may be to change the diet, to exercise more regularly, to reduce weight, to cut down or eliminate alcohol consumption, to stop using recreational drugs or whatever.

I am certain that if you apply it to any behaviour that you have tried to change you will be able to identify with it.

These issues of IMPORTANCE of the behaviour change to the person attempting to change behaviour and having the CONFIDENCE to be able to make that change, are important considerations in Motivational Interviewing which I shall discuss in more detail on the following page for Health Professionals.

Web Design Ian McKenzie

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