Stages of Change

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Stages of Change Chart

The Stages of Change Model (SCM) dates back to the late 1970s and early 1980s. It was initially developed by James Prochaska and Carlo DiClemente from the University of Rhode Island during the study of smokers’ habits. The model has been applied to various behaviors, including weight loss, injury prevention, and alcohol and drug problems.1

The SCM is based on the theory that behavior change happens in a series of steps rather than just one, and that progression through various stages is necessary for successful change. Moreover, the rate at which people progress through the stages varies by individual. This means you can’t simply prescribe that someone in the “pre-contemplation” stage attend a specific number of AA meetings and expect them to advance to the next stage. Each individual must determine for themselves when they are ready to move to the next stage. It’s a decision that can only come from the person and cannot be a decision imposed on them externally.1

There are different issues and tasks that a person has to deal with as they struggle through the different stages.1

The Stages of Change
Stages of Change Drawing

    Precontemplation (no acknowledgement of a problem behavior that needs to be changed)
    Contemplation (acknowledgement that a problem exists but not yet ready to make a change)
    Preparation/Determination (getting ready to change)
    Action/Willpower (changing the behavior)
    Maintenance (maintaining the behavioral change)
    Relapse (when old behaviors return) 1

Stage One: Precontemplation1
In the precontemplation stage, people are neither interested in changing their behavior nor are they interested in seeking help. Behavior in this stage may be characterized by defense of bad habits and refusal to believe that there is a problem. No attention is placed on quitting, and the bad habit is not typically discussed with others. Essentially, people in this stage do not feel they have a problem.

What Can You Do?2
A client in the pre-contemplative stage does not yet recognize or acknowledge the need to change their behavior. To help a client who is in the pre-contemplative stage, promote supportive interventions as follows:

    • Build a rapport with your client
    • Ask about the presenting issues but do not label them “a gambling problem”
    • Emphasize to your client that they have the ability to make their own decisions and to take responsibility for their consequences
    • Ensure that the client feels comfortable talking about the issue at a later time by keeping the door open and keeping the discussion low-key.
    • Explore the surrounding issues
    • Follow up as appropriate
    • Employ motivational interviewing techniques

Stage Two: Contemplation1
The second stage, contemplation, is characterized by increased awareness about the personal consequences of a habit and more time spent thinking about the problem. The possibility of change is something that’s considered, and the person begins to weigh the pros and cons of quitting or modifying behavior. They think about the negative aspects of their habit but may wonder if the long-term benefits of quitting will outweigh the short-term costs. During this stage, people are generally more open to new information about their bad habit and more likely to use educational interventions. The amount of time that people spend in the contemplation stage may vary from weeks to a lifetime.

What Can You Do?2
If your client is in the contemplation stage, they are considering change but are not yet committed. You should attempt to guide them toward desiring to change their behaviors. You can do that by:

    • Encouraging self-reflection
    • Acting as a sounding board
    • Using strategies that encourage rational thinking, including motivational interviewing
    • Directing your client to visit our gamblers website
    • Keeping things “low key”
    • Reminding your client of the discrepancy between their goals and their behavior
    • Prompting self-motivational statements

Stage Three: Preparation/Determination1
A commitment to change is a hallmark of the preparation/determination stage. The desire to change is reflected by statements reflecting definite intent, such as “I’ve got to do something about this, this is serious” or “Something has to change. What can I do?”

The preparation/determination stage is characterized by gathering information about what it will take to change behavior. People may call clinics in an effort to learn about helpful strategies and resources. This is a critical stage that people sometimes skip. If they move directly from contemplation to action, they may be unsuccessful because they don’t fully understand or accept what it will take to make a major change in their lifestyle.

What Can You Do?2
If your client is in the determination stage, you have an excellent opportunity to move your client into action. They recognize the need to change, and are ready and willing to alter their gambling behavior. Some of the things you can do at this stage include:

    • Help your client develop an appropriate and effective change strategy
    • Help plan activities for change to reinforce and support their decision
    • Offer our gamblers website as a resource
    • Connect your client directly to their local GA meeting
    • Follow up on the assisted referral

Stage Four: Action/Willpower1
The action/willpower stage is when people believe they have the ability to change their behavior and are actively using a variety of techniques to change their bad behavior. This is the shortest of the stages, generally lasting about six months. However, the amount of time people spend in this stage varies; for some it can be as short as an hour!

Most people depend on their own willpower at this stage and are at the greatest risk for relapse. They review their commitment to themselves and develop plans to handle the pressure (both personal and external) that can cause slips. People in this stage are generally open to seeking and accepting help from others, a critical element in sustaining change.

What Can You Do?2
A client in the action stage is more than determined to change their behavior; they are actually doing something about it. At this juncture, it’s important that you support your client by providing strategies to help them change their behaviors, such as the following:

    • Set goals for your clients to achieve
    • Work on other related and underlying issues
    • Prepare for possible relapses
    • Cultivate new skills to cope with gambling urges, including stress management, anxiety management and avoiding dangerous situations
    • Help your client to engage tactics that delay, distract and desist from gambling
    • Encourage your client to participate in alternative activities
    • Emphasize building resilience
    • Work with your client to examine tactics that are working
    • Direct your client to visit our gamblers website
    • Provide your client with information about the nature and types of services offered in California and refer them to a local service

What Can We Do?
Our website can offer your client a variety of services during the action stage, including a self-exclusion program.

Stage Five: Maintenance1
Maintenance is the final stage of change. The goal of this stage is to maintain the new status quo and to avoid temptations to return to the previous behavior. People in the maintenance stage frequently remind themselves of the new rules they must follow to deal with life and avoid relapse. They can anticipate situations that may cause a relapse and prepare coping strategies in advance.

There is an awareness that they are striving for a new lifestyle that is worthwhile and meaningful. They exercise patience with themselves and have an appreciation for the amount of time and effort it takes to create new behavioral patterns so that they become second nature.

What Can You Do?2
People in the maintenance stage are actively working on their new behaviors. You should support your client to maintain the changes they have made by:

    • Encouraging and fostering personal development
    • Working to keep your client from feeling discouraged
    • Keeping your client focused on contemplating change so they maintain their determination and continue the actions which have created change
    • Discussing lifestyle issues outside of gambling, such as parenting, budgeting, relationships, education and employment
    • Help your client cultivate behaviors that provide self-protection
    • Reminding them about strategies that have been successful
    • Keeping your client vigilant for possible triggers for relapse

It can be helpful to re-evaluate progress as it moves up and down through the stages. Progression through the stages of change is not always a smooth, linear process. Remind your client that it’s normal and natural to regress — and that one stage can be attained only to fall back to the previous stage. Movement between the stages of changes is a normal part of changing behavior.

Relapse1
Most people experience relapse as they work to permanently change a bad habit. It’s actually more common to have at least one relapse than to not have one. Many people cycle through the five stages of change before achieving a stable life change. In fact, the Stages of Change Model considers relapse to be a normal part of the process.

When relapse occurs, feelings of discouragement and failure may result, which can seriously undermine self-confidence. When people do slip — i.e., gamble — it’s important that they don’t see themselves as having failed. Instead, they should work to understand how the slip happened and to use it as an opportunity to change the way they cope. In this way, relapses can provide opportunities for learning and strengthening new patterns of behavior.

It’s helpful to think of relapse as someone falling off a horse. Just as it’s best to get right back on a horse after one falls off, it’s important for someone who slips in their pursuit of new behavior to restart the new behavior as soon as possible. When someone relapses, it’s important that they pick up the change process at preparation, action or maintenance rather than fall back to the pre-contemplation or contemplation stages. People should review the high-risk situations that contributed to their relapse so they can ultimately develop a stronger sense of control and ability to get back on the right track.

What Can You Do?2
Relapse is not uncommon when clients are recovering from an addiction. It does not mean that your client cannot or will not change. When relapse occurs, you should work with your client to identify ways of avoiding future relapses and to encourage them to learn from conditions leading to the slip. Some of the things you can do include:

    • Identify the occurrence of a relapse
    • Re-establish your client’s commitment and ability to change
    • Provide crisis intervention as appropriate
    • Avoid blame
    • “Name and normalize” the relapse behavior
    • Ensure that your client understands that relapse is a common part of the change process
    • Review the triggers causing the relapse
    • Develop strategies to avoid repeating the bad habit
    • Reinforce your client’s ability to maintain change

Transcendence1
There is one more stage that is not part of the Prochaska-DiClemente Stages of Change model:
Stages of Change Graph

When new behavior is maintained for a long period, people reach a point where they can work with their emotions to understand their behavior and view it in a different perspective. This stage is called transcendence — transcendence to a new life. When this stage is reached, one can see their bad habit as no longer an important part of their life, and a return to it would seem atypical and abnormal. When transcendence has been achieved in the process of change, a new person has emerged, one who no longer needs the old behaviors to sustain them.

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