THE STAGES OF CHANGE

I have been recently studying the work of a noted Psychologist and his colleagues regarding the way that people learn to overcome bad habits such as smoking, gambling, sex addiction, overeating, and drug addiction.

The stages of change are:

1)Precontemplation (also known as Denial)--In the precontemplation stage, people are not thinking seriously about changing and are not interested in any kind of help. People in this stage tend to defend their current bad habit(s) and do not feel it is a problem. They may be defensive in the face of other people’s efforts to pressure them to quit.

2) Contemplation--In the contemplation stage people are more aware of the personal consequences of their bad habit and they spend time thinking about their problem. Although they are able to consider the possibility of changing, they tend to be ambivalent about it.


3) Preparation/Determination--In the preparation/determination stage, people have made a commitment to make a change. Their motivation for changing is reflected by statements such as: “I’ve got to do something about this — this is serious. Something has to change. What can I do?”


4) Action/Willpower--This is the stage where people believe they have the ability to change their behavior and are actively involved in taking steps to change their bad behavior by using a variety of different techniques.

This is the shortest of all the stages. The amount of time people spend in action varies. It generally lasts about 6 months, but it can literally be as short as one hour! This is a stage when people most depend on their own willpower. They are making overt efforts to quit or change the behavior and are at greatest risk for relapse.


5) Maintenance--Maintenance involves being able to successfully avoid any temptations to return to the bad habit. The goal of the maintenance stage is to maintain the new status quo. People in this stage tend to remind themselves of how much progress they have made.

People in maintenance constantly reformulate the rules of their lives and are acquiring new skills to deal with life and avoid relapse. They are able to anticipate the situations in which a relapse could occur and prepare coping strategies in advance.


6) Relapse --Along the way to permanent cessation or stable reduction of a bad habit, most people experience relapse. In fact, it is much more common to have at least one relapse than not. Relapse is often accompanied by feelings of discouragement and seeing oneself as a failure.


Several key points that the psychologists found out:

1) Relapse is normal in the early attempts at making permanent changes.

2) A majority of people cannot change on their own. The psychologists studied the 10% who could.

3) An individual usually cannot move directly from contemplation to action without failure. A good amount of time needs to be involved in preparation.

Nice post in a lot of ways, Phat. I'll add one thing.

Relapses. What the good help tries to do is encourage people to view reversions to previous behaviours (experienced by many) as normal problems rather than a failure - a lapse rather than a relapse, perhaps. Many ex-smokers might have a cigarette in a stressful circumstance (for me, recently, my father's death), and it can be important for the person to see that such lapses are not necessarily the failure of previous efforts.

The scientists who studied these stages of change were quite thorough in their research. they found, for instance, that in order to successfully change a given behavior, one must spend time in the preparation/determination stage in order to increase their perception of the "pros" of change and decrease their perception of the "cons" of change.

Failure to plan is in essence planning to fail...and research indicated that jumping to quickly into action would inevitably lead to relapse. As you mentioned, lapses do happen and are often caused by unforeseen stress. The difference between a lapse and relapse is a matter of a one time event versus a 180 degree turn back into addictive behavior for an extended period of time.

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"If I had simply asked what the people wanted, they would have said faster horses."
Henry Ford

It seems to me that most of us spend most of our lives in Stage 1 and Stage 2 with our "bad habits". Around New Years, we might go into Stage 3 or even Stage 4 for a while. But most of us have never been near Stage 5.

I can see that the Stages model applies to serious addictions (that is, to the minority who overcome them) but it doesn't seem to fit "everyday life".

_________________
What we really need to do is fix the public.
-- Jon

Many are called but few are chosen. And few choose to take responsibility for changing their bad behaviors and compulsions.

When I gambled, I never actually even wanted to change until I realized that I was beyond broke and would likely end up on the corner with a sign if I continued my addiction. It still was not easy to quit...I relapsed numerous times before actually counter conditioning myself to take up good habits and compulsions to replace that particular bad one.

The 12 Step model emphasizes an individuals powerlessness over their addiction, yet I had to assume responsibility in some manner. God was not simply going to step out of the sky and destroy my desire for my addiction....but He did give me a brain and the wisdom to finally understand the destruction I was causing myself....and others.

Most people never get beyond contemplation unless their addictions are ruining their lives.

An overeater may sneak quite a few midnight cheesecake slices into their lives until something major such as gross obesity, a heart attack, or an impending divorce jolts them out of their obsession.

A gambler (such as myself) may gamble for many years if they have the money to do so.

A sex addict may view their pornography addiction as harmless "since it hurts no one but themselves" and may never see their addiction as a problem.

Perhaps that brings up a question of when does an addiction become a problem?

_________________
"If I had simply asked what the people wanted, they would have said faster horses."
Henry Ford

That's my point exactly. If most people don't go through the stages because they're not convinced the behaviour is "ruining their lives" - and often it isn't - then what's the value of the model?

(I'm not saying there is no value. I'm asking what it is.)


If we're talking about a model of successful recovery from addiction, shouldn't the model be able to answer that question?

_________________
What we really need to do is fix the public.
-- Jon

I would agree.

The model is quite old and we don't need to get to the point that the habit is ruining our life for us to change. All we need to see is that it is better to change than not change and any motivational interiviewing technique can be used to achieve that cognitive change.

The book mentions counter conditioning as a method to substitute bad behaviors for good ones. What is an example of a motivational interviewing technique?

_________________
"If I had simply asked what the people wanted, they would have said faster horses."
Henry Ford

Counter conditioning is simply conditioning: a conditioned stimulus is like a bell that causes a dog to come out to get his food. To 'condition' adaptive behaviours a behavioural experiment is devised (collaboratively) to allow the patient to gain rewards from positive behaviours while contradicting the negative predictions generated (worry). Avoidance is prevented and the negative behaviour is extinguished.

A good place to look for addiction management is the Matrix Model (Rawson et al, 2002). I don't it as it takes about 16 weeks (too long for primary care).



It's honestly very simple: you get the patient to point out the pros of continuing with the negative behaviour. This may sound counter intuitive but getting someone to defend the very issue they come to you to solve is a powerfull device when it comes to motiviating change.

Often addicts don't face how much they need their hit of choice and getting them to say how much they relly on their hit of choice is a big eye openner to them.

I've lost count of the number of times I have heard a client say "I've never looked at it that way" after this technique.

The point is to show the patient that their behaviour is solely the result of their choice and they decide what they do based on what they want to achieve. The power over themselves is based in them (locus of control and all that), not that they are powerless (and must turn say, to the xian god to help them out): that is just a manipulation of cognition that has no place in modern therapy.