1. Tara Walton HOW TO USE THE STAGES OF CHANGE The Transtheoretical Model

2.  Review the 4 constructs of the TTM  Review the 5 stages of behavior change  Learn how to apply TTM to change a behavior  Review strengths and limitations of TTM OBJECTIVES

3.  A model used to explain individual behavior change  Consists of 4 main constructs: STAGES OF CHANGE/ TRANSTHEORETICAL MODEL (TTM) Stages of Change Processes of Change Decisional Balance Self-efficacy

4. Pre contemplation “ignorance is bliss” Contemplation “fence sitting” Preparation “testing the waters” Action “go for it” Maintenance “steady as she goes” Relapse “Fall from grace” 1. THE STAGES OF CHANGE Termination

5. 2. THE PROCESSES OF CHANGE  The covert and overt activities that people use to progress through stages (Prochaska et al., 2002)  These strategies can be:  Cognitive  Affective  Behavioural  Application to specific stages can facilitate movement  Processes can help guide development of stage-specific interventions

6. 3. DECISIONAL BALANCE  Relative weighing of the costs and benefits of changing the behaviour  motivation/readiness to change varies with each stage, relative to the balance of pro’s versus con’s of changing

7. 4. SELF-EFFICACY  The situation-specific confidence that you have in your ability to change the behaviour

8. APPLYING THE STAGES OF CHANGE Self Efficacy Decisional Balance Processes of change Stages of Change HOW WHEN The stages of change help identify WHEN a person is ready to change Self efficacy, decisional balance, & process of change help to explain HOW to facilitate movement through the stages of change

9. APPLYING THE STAGES OF CHANGE PrecontemplationContemplationPreparationActionMaintenance Consciousness Raising Dramatic Relief Environmental Re-evaluation Self-Re-evaluation Self-liberation Counter-conditioning Helping Relationships Reinforcement Management Stimulus Control Pro’s of changing increasing Self-efficacy increasing

10. HOW TO USE STAGES OF CHANGE TO INCREASE SLEEP

11. PRECONTEMPLATION TO CONTEMPLATION increase the pro’s of changing Goal: Consciousness raising (increase awareness) Dramatic Relief (emotional arousal) Environmental Re-evaluation Process:

12. PRECONTEMPLATION TO CONTEMPLATION This illustration can be used as educational material to help an individual understand some of the costs of sleep deprivation

13. CONTEMPLATION TO PREPARATION decrease the con’s of changing Goal: Self re-evaluation (self-reappraisal) Process:

14. CONTEMPLATION TO PREPARATION Con’sPro’s -Less time for friends -Can’t watch as much tv -Less time to study -Might miss deadlines -Helps repair the body -Reduce stress -Improve memory -Control body weight -Reduce mood disorders

15. PREPARATION TO ACTION Pro’s of changing must outweigh con’s Increase self-efficacy Goal: Self-liberation (committing) New Year’s resolutions Provide several options vs one choice ie: 8 hrs of sleep 3 nights a week, 1 extra hr of sleep each night going to bed by midnight 5 nights/week Process:

16. ACTION TO MAINTENANCE Increase self-efficacy Goal: Counter-conditioning (substituting) Helping relationships (supporting) Reinforcement Management (rewarding) Stimulus Control (re-engineering) Process:

17. STIMULUS CONTROL This process includes using avoidance, environmental reengineering, and self-help groups Example: Tips to help you sleep  Keep a regular sleep/wake schedule  Avoid caffeine 4-6 hrs before bed  Minimize daytime use  Avoid alcohol/heavy meals before bed  Get regular exercise  Minimize noise, light & excess temperatures where you sleep

18. STRENGTHS OF TTM  Individual focus: can be personally tailored  Recognizes behaviour change as dynamic and non-linear  Can help identify readiness to change  Link between stages & processes allows for targeted interventions

19. LIMITATIONS OF TTM  Does not consider:  environmental factors  social determinants  Focuses on primary prevention  Reducing risks vs preventing risks  May not be applicable to:  Specific populations  Complex health behaviors  Population health interventions

20. SUMMARY OF THE TTM  People move through different stages over time  Movement depends on:  the balance of pro’s and con’s  a person’s self-efficacy  Processes of change help move through stages  The model can be:  useful for facilitating individual behavior change  difficult to apply at the population health level

21. RESOURCES  Cancer prevention research center:  http://www.uri.edu/research/cprc/TTM/detailedoverview.htm http://www.uri.edu/research/cprc/TTM/detailedoverview.htm  Mississippi State University:  http://www2.msstate.edu/%7Ebhunt/Stages_of_Change_Theory/transtheoretical.html http://www2.msstate.edu/%7Ebhunt/Stages_of_Change_Theory/transtheoretical.html  Prochaska, J. O. & DiClemente, C. C. (1984). The transtheoretical approach: Crossing traditional boundaries of treatment. Melbourne, Florida: Krieger Publishing Company.  Prochaska, J.O., DiClemente, C.C., and Norcross, J.C. 1992. In Search of How People Change: Applications to Addictive Behaviors. American Psychologist 47(9): 1102-1114.  Prochaska, J.O., Johnson, S., and Lee, P. The Transtheoretical Model of Behavior Change. In: Shumaker, S.A., Schron, E.B., Ockene, J.K., and McBee, W.L. [Editors]. 1998. The Handbook of Health Behavior Change, 2nd Ed. Springer Publishing Company.