The Transtheoretical Model of Change (TTM) is not a theory, but it can employ multiple behavioral theories within its framework, combining various processes that are needed to understand how behavioral change happens. The TTM is based on the belief that people go through multiple stages when thinking about and implementing change. The model proposes six steps to which one can adhere: pre-contemplation, contemplation, preparation, action, maintenance, and termination. Each person completes these stages differently, and most activities do not have a set time frame, although the stages of action and maintenance are timed.
Moreover, the TTM considers self-initiated change and intentional action as the focus of its structure. For example, people following a TTM process are encouraged to modify their habits, start performing desired activities, or stop participating in behaviors that they find problematic. To achieve the established goals, individuals can engage in a variety of evaluative and cognitive processes.
The critical part of TTM is the six steps that people go through during their efforts to change. These are:
- Precontemplation. During this stage, a person may not consider that their behavior needs to change. As such, they do not intend to take action in the next six months. Here, one does not think about the negative consequences of a particular behavior, focusing more on the drawbacks of change instead.
- Contemplation. When a person starts considering a change in behavior as possible or required, they enter the stage of contemplation. In this step, one becomes interested in information about change-related processes, outcomes, and advantages. While not acting in a way to start altering their behavior, people become more prepared for the change to happen in the next six months.
- Preparation. This step starts when an individual is ready to enact change within a month. The person can take some preliminary actions – contact a health care provider, talk about the issue with family or friends, or develop a plan for future action. Here, one considers behavior change as a way to improve life.
- Action. People enter this stage when they perform actions to change their behavior. However, it is not a single event – one needs to maintain such activity for at least six months and wish to continue with the processes. For instance, an individual may eliminate a harmful habit or replace it with a healthy one.
- Maintenance. If a person has succeeded in sustaining their behavior change for six months, they enter the stage of maintenance. Here, people should continue to move forward, focusing on relapse prevention and positive reinforcement.
- Termination. The final step is assurance that a person will not want to go back to the old behavior. People are certain that they will not relapse. This step is difficult to reach as the exposure to triggers often remains.
To move through these steps, a person can participate in various cognitive and affective processes. These include revaluation of the self and the environment when a person assesses the harm that behaviors can bring to themselves and their family. People may use stimulus control to understand and limit the exposure to factors encouraging relapse, as well as reinforcement management to reward themselves for enacting change. They can also develop helpful relationships and utilize counter-conditioning as a support network for lowering the risk of moving backward (Gökbayrak et al. 2015).
References
Gökbayrak, NS, Paiva, AL, Blissmer, BJ & Prochaska, JO 2015, ‘Predictors of relapse among smokers: transtheoretical effort variables, demographics, and smoking severity’, Addictive Behaviors, vol. 42, pp. 176-179.
Harris, KK, Zopey, M & Friedman, TC 2016, ‘Metabolic effects of smoking cessation’, Nature Reviews Endocrinology, vol. 12, no. 5, pp. 299-308.
Lindson-Hawley, N, Banting, M, West, R, Michie, S, Shinkins, B & Aveyard, P 2016, ‘Gradual versus abrupt smoking cessation: a randomized, controlled noninferiority trial’, Annals of Internal Medicine, vol. 164, no. 9, pp. 585-592.
Stead, LF, Carroll, AJ & Lancaster, T 2017, ‘Group behaviour therapy programmes for smoking cessation’, Cochrane Database of Systematic Reviews, no. 3, pp. 1-106.