Hello,

My name is Jamie Diersing and I am a second year Masters of Public Health Student at the University of North Florida. This presentation is on the Basics of the Transtheroretical Model (TTM). I chose this model because I find it interesting and it can be widely applied across a variety of behavior change programs. I geared this presentation on understanding the basics of the Transtheoretical Model and hoped to make it user friendly for new public health professionals that may have not had much experience with this model.

Please be aware that the Transtheoretical Model is also known as the Stages of Change and the terms may be used interchangeably throughout the rest of this presentation.

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This is my goal and my objectives for this presentation.

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In late 1970’s James Prochaska and Carlos DiClemente developed the Transtheroetical Model.The model arose from psychotherapy after Prochaska and DiClemente, trying to find the commonality that makes all people change.

• Conducted a comparative analysis of 18 therapy systems and a critical review of over 300 therapy outcomes in search of the commonality (Prochaska).

This model evolved through several studies examining the experiences of smokers who quit on their own with those requiring further treatment to understand why some people were capable of quitting on their own. It was determined that people quit smoking if they were ready to do so.

• Found that change is a process that happened over time • This was the one common thing that Prochaska and DiClemente

found.

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The Transtheoretical Model (TTM) is an integrative framework for understanding how individuals and populations progress towards adopting and maintaining healthy behavior change for optimal health.

• Looks at individuals readiness to make behavior change• Important to note that not all individuals are at the same level in

their readiness to change. It is always important to remember that there are various levels and stages of readiness to change that change depending on the person

• Allows for tailoring program to the individual and the individual’s level of readiness/ stage of change that they are currently in

• More beneficial for individuals to have interventions that correlate with their level of readiness/stage of change and allows for higher participation rates.

• TTM Focuses on the decision-making of the individual and is a model of intentional change

• Realizes that people do not change behaviors quickly and decisively, it’s a continuous process

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This model is not only based on the four constructs (stages of change, processes of change, decision balance, and self efficacy) but it also works under 5 critical assumptions. These five assumptions are:1. There is no single theory that can account for all of the complexities of behavior

change. 2. Behavior change is a process that unfolds over time through a sequence of stages3. The stages are both stable and open to change 4. Majority of at-risk populations are not prepared for action and will not be served

by traditional action oriented prevention programs5. The specific processes and principles of change should be applied at specific

stages if progress through the stage is to occur

The Transtheoretical Model is on of the most popular models used in planning programs in public healthTypes of health behavior changes it has been applied to include:Alcohol and substance abuse, anxiety and panic disorders, delinquency, eating disorders and obesity, exercise, high-fat diets, HIV/AIDS prevention, unplanned pregnancy prevention, and sun exposure, just to name a few.

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The stages help to represent the temporal dimension of change because behavior change happens over time.

Precontemplation is the stage in which people do not intend to take action, usually measured as the next six months. May be due to the fact that they simply do not know that there is a problem with whatever they are currently doing or because they are not interested or motivated to change yet.

EX: Not understanding consuming high fat foods and not exercising is bad for the individuals health and can lead to obesity.

Contemplation: A person is aware problem exists, is thinking about changing in the future (within the next six months) and is weighing the pros and cons. They are not quite ready to take action yet.

EX: The individual weighs the pros and cons of getting a gym membership to try an loose weight.

Preparation: The person is finally ready to do something. Individuals in this stage are intending to take action in the next month and they have some kind of plan or idea about what they want to do. In this stage including programs that provide action steps are a great idea.

EX: The individual is ready to start going to gym and purchases a membership to a local gym.

Action: The person has recently taken action toward a change. Individuals modify their behavior, experiences, or environment in order to overcome their problems. These actions are ones that are known to be steps in preventing or reducing the risks for the health problem that is being reduced.

EX: The individual starts going to the gym and working out. Maintenance: In this stage the person has made significant change in their behavior in terms of health risk, and is now focused on keeping the behavior change going, and not falling back into bad habits. This stage usually requires serious work and dedication as people work to prevent relapse and consolidate the gains attained during action. This stage can last any where from 6 months to 5 years.

EX: Individual routinely goes to the gym 3 times a week to work out.

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Completed the process of behavior change-have zero temptation and 100 percent self-efficacy. Whether they are depressed, anxious, bored, lonely, angry, or stressed, they are sure they will not return to their old unhealthy behaviors.

This stage is usually only seen in dealing with behaviors involving addictions-Substance usage, alcohol abuse, or even OCD-There are only about 20% who reach this stage-Literature suggests that this stage may not be a practical goal to reach for a majority of people and it has had less attention in research.

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These are two representations of the stages of change model.

It is important to remember that often, the stages do not follow a linear pattern, they instead follow a more circular one.

It is also important to realize that during any point in this process an individual may exit and re-enter at any stage.

They can also relapse and have to start again.

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The slide is discussed and the chart about the instructional strategies that are effective in each of the stages is discussed.

****Please remember that as Health Educators, your goal is not to change someone's behavior, but to help the individual move from one stage of readiness to another****

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The 10 Processes:

1. Conscious RaisingInvolves increased awareness about the particular problem behavior and its consequences.Interventions that increase awareness include feedback, confrontations, interpretations, media campaigns.2. Dramatic ReliefInitially produces an increased emotional experience followed by reduced affect if appropriate action is taken.This would include role-playing, personal testimonies, media campaigns.3. Self-reevaluationCombines both cognitive and affective assessments of one’s self image with and without the unhealthy habit/life style.Techniques used are: clarifying values, healthy role models, mental imagery.4. Environmental re-evaluationCombines both the affective and cognitive assessments of how the absence or presence of the behavior effects one’s social environment. It can also include the awareness that one can serve as a role model for others (such as family).5. Self-liberationThe belief that one can change and the commitment and recommitment to act on that belief.Resolutions, public testimonies, multiple rather than single choices can enhance willpower.6. Helping RelationshipsCombine caring, trust, openness, acceptance and support for the change.Rapport building, therapeutic alliances, and buddy systems can be sources of social support.7. Counter-conditioningThe learning of positive/healthy behaviors which can substitute for problem behaviors.This would include relaxation, positive self-statements, and assertion.8. Contingency ManagementProvides consequences for taking steps in a particular direction. Much more effective when rewards are utilized more frequently than punishments.Contingency contracts, group recognition procedures are used and increase the probability that positive behavior will be repeated.9. Stimulus ControlRemove cues for unhealthy behaviors and add prompts for healthier alternatives.Self-help groups can provide the stimulus for change.10. Social LiberationRequires an increase in the social opportunities for people who are relatively deprived or oppressed.Advocacy, empowerment procedures, and appropriate policies/legislation can help people change.

***Some processes are more relevant to a specific stage of change than other processes***

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This chart depicts the processes that are most appropriate for each stage that an individual may be in. These processes should be emphasized in their particular stages.

You will notice that the Experimental Set of Process (consciousness rising, dramatic relief, self-reevaluation, and social liberation) are often emphasized in the earlier stages of the model (Precontemplation, Contemplation, and Preparation) to increase intention and motivation.

The behavioral set of processes (helping relationships, counter conditioning, reinforcement management, stimulus control and self-liberation) are more often used in the later stages of preparation, action, and maintenance as observable behavior change efforts are underway and need to be maintained.

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This is when the individual weighs the pros and cons of the behavior change and considers how important the pros and cons are to them.

The person looks at the benefits of changing and the costs of changing Individual will ask themselves if the benefits of changing outweigh the costs that may be associated with it.

This usually happens during the contemplation stage and it can be the decisive factor in whether or not the person will continue on to the next stage.

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Starts to develop in the maintenance stage and is achieved in the termination stage and self efficacy looks at 2 key things: confidence and temptation.

Self-efficacy is the situation-specific confidence that people can cope with high-risksituations without relapsing to their former behaviors.

Temptation - describes the intensity of urges to engage in a specific habit when in the midst of difficult situations. The three most common are: emotional distress (ex: the individual who is trying to overcome his addiction to alcohol, is very upset from a break up and drinks alcohol to feel better), positive social occasions (ex: The individual that is trying to overcome alcohol habit is at a celebration and consumes a drink to partake in the festivities and join the crowd), and cravings ( The individual that is trying to overcome alcohol habit really, really wants a drink and just cannot say no when it is offered to him by a colleague).

**Temptation does decrease as individuals move through the stages, but it is still present even in the maintenance stage.

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Here are my reference

Thank you for taking the time to look at my presentation. Please let me know if you have any questions.

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