Why is it so hard to change behavior?

Have you ever tried to get a loved one to change a habit that was unhealthy? Maybe someone else has tried to get you to change? It seems like no matter how hard you try, and how obvious the problem may be, they are just not willing to improve. If this scenario sounds familiar, the transtheoretical model (TTM) may offer an explanation for you.

The main premise of the TTM is that behavior change is most likely to happen when individuals engage in the right activity at the right time. The TTM was first introduced in 19811 and uses constructs from several other health behavior theories in a model that offers a view of when, how, and why individuals change their (health) behavior.

There are two levels to the TTM. The first is called the “stages of change”, also sometimes called the “stages of readiness.” This refers to the degree of readiness towards making the change. Basically, the commitment level towards making the health behavior change (ie…quitting smoking, exercising more, healthy eating, etc…) is analyzed and the individual is put into one of five stages.

The first stage of change is precontemplation. At this level, there is no consideration of behavior change at all. The individual probably does not think that their behavior is really all that bad, and it would not be worth the effort to change.

The next step is contemplation, in which the individual is aware that change is needed but may still be ambivalent about it. At this point, they may begin to realize that there are benefits to changing the behavior, but they are also aware that there are costs.

Next follows preparation, when change will inevitably occur soon (generally within about a month). In this stage, the individual has taken concrete steps to begin their change (ie…joining a gym, buying nicotine patches, speaking to a health care professional etc…).

Action is the stage in which individuals have specific modifications in their behavior within the last six months (ie…reducing the number of cigarettes smoked, cooking without any added salt or butter, etc…).

Once the behavior change occurs, the individual is in the maintenance stage. In this stage, the individual is working to not relapse back into the old behavior; however, they are less tempted to revert back as they were in previous stages.

It is important to note that these five stages are, in fact, stages. They are NOT points in time. For example, once the individual, “Ben”, decides to exercise 3X/week. Once he takes concrete steps such as joining a gym, he would be in the preparation STAGE. He remains in this stage until he advances to the action stage, meaning he would be exercising 3X/week. Also, keep in mind that although the stages are numbered 1-5, and individuals must pass through them in order, relapsing and starting over are very common. For example, one may get to the action stage, and then realize that it is just not worth it to exercise, and relapse back to the precontemplation stage, and then due to rising blood pressure begin the process all over again.

Going back to the original question, can you guys relate to the stages of the TTM? Can you think of a time when you tried to get someone else to change their habits (or your own), but they/you were just not at the right stage for this to occur? Thoughts/ opinions?

In the next post, I will outline perhaps the most important part of the TTM; the “processes of change.” These have to do with specific stage-based strategies to move along the TTM stages of change until reaching the maintenance stage (and staying there); you would not try the same approach in the precontemplation stage as you would in the action stage.

(1) Prochaska JO & DiClemente CC (1982) Transtheoretical therapy: toward a more integrative model of change. Psychotherapy: Theory, Research & Practice: 19(3) 276-288.

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