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Stages in Behavior Change

This document discusses factors that contribute to successful lifestyle changes and why changing unhealthy behaviors can be difficult. It provides the following key points: 1. Making lasting lifestyle changes is most effective when motivated from within through positive thinking rather than fear or guilt. Goals should be specific and limited in number. 2. Research shows the least effective strategies for behavior change arouse fear or regret. Having practical plans to reach goals helps with success. 3. Adopting healthier habits takes time and effort, with setbacks common. Any steps taken in a positive direction are worthwhile.

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Arbab Usman Khan
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177 views

Stages in Behavior Change

This document discusses factors that contribute to successful lifestyle changes and why changing unhealthy behaviors can be difficult. It provides the following key points: 1. Making lasting lifestyle changes is most effective when motivated from within through positive thinking rather than fear or guilt. Goals should be specific and limited in number. 2. Research shows the least effective strategies for behavior change arouse fear or regret. Having practical plans to reach goals helps with success. 3. Adopting healthier habits takes time and effort, with setbacks common. Any steps taken in a positive direction are worthwhile.

Uploaded by

Arbab Usman Khan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Why its hard to change unhealthy

behavior and why you should


keep trying
Many of us think about changes wed like to make in our lives. When it comes to health
recommendations, we mostly know the drill: Exercise most days of the week; eat a varied
and nutritious diet; keep your body mass index between 18.5 and 24.9; get enough sleep;
keep up with medical screenings for blood pressure, cholesterol, and blood sugar; get
mammograms and Pap smears at recommended intervals; dont smoke; and limit alcohol to
seven drinks a week. Reducing stress, improving relationships, and developing new
interests or hobbies also contribute to healthy living.
Making healthy lifestyle changes affects not only our risk for disease and the way we feel
today but also our health and ability to function independently in later life (see Lifestyle
factors reduce the need for nursing home care). What we do for ourselves is often more
important than what medicine can offer us. Yet making healthy changes is easier said than
done. Even when were strongly motivated, adopting a new, healthy habit or breaking an
old, bad one can be terribly difficult.

What helps?
Considerable research has been aimed at identifying factors that contribute to successful
lifestyle change as well as more effective tools for clinicians especially in the context of a
brief office visit to counsel their patients on adopting healthier habits. One problem may
be that were motivated too often by a sense of guilt, fear, or regret. Experts who study
behavior change agree that long-lasting change is most likely when its self-motivated and
rooted in positive thinking. In October 2006, the Economic and Social Research Council, a
British research group, released findings on 129 different studies of behavior change
strategies. The survey confirmed that the least effective strategies were those that aroused
fear or regret in the person attempting to make a change.
Studies have also shown that goals are easier to reach if theyre specific (Ill walk 20
minutes a day, rather than Ill get more exercise) and not too numerous (having too many
goals limits the amount of attention and willpower you can devote to reaching any single
goal). Another recurring theme is that its not enough to have a goal: You also need practical
ways to reach it. For example, if your goal is to stick to a low-calorie diet, have a plan in
place for quelling hunger pangs (for example, keep a bottle of water or cup of tea nearby, or
chew sugarless gum).

Research has also produced models that help account for success and failure, and explain
why making healthy changes can take so long. The expert conclusion is that any effort you
make in the right direction is worthwhile, even if you encounter setbacks or find yourself
backsliding from time to time.

Lifestyle factors reduce the need for nursing home care


A study published in the May 8, 2006, issue of the Archives of Internal Medicine followed
nearly 6,500 middle-aged and elderly people for 20 years. Among the more than 3,500
participants ages 4564 when the study began, those who were obese, were physically
inactive, smoked, or had diabetes or uncontrolled high blood pressure at the start of the
study were much more likely to be admitted to a nursing home.
Middle-age smoking increased the chance of a nursing home admission by 56%, physical
inactivity by 40%, and uncontrolled high blood pressure by 35%. Diabetes more than
tripled the risk. (Middle-age obesity was also associated with higher risk, but the
association wasnt statistically significant that is, the numbers could have resulted from
chance.) All of these conditions, of course, can be modified with lifestyle changes.

Change is a process, not an event


There are several models of behavior change, but the one most widely applied and tested in
health settings is the transtheoretical model (TTM). First developed in the 1980s by
alcoholism researchers James O. Prochaska and Carlo C. DiClemente, TTM presumes that
at any given time, a person is in one of five stages of change: precontemplation,
contemplation, preparation, action, or maintenance.
The idea is that people move from one stage to the next. Each stage is a preparation for the
following one, so hurrying through or skipping stages is likely to result in setbacks. Also,
different strategies are needed at different stages. For example, a smoker whos at the
precontemplation stage that is, not even thinking about quitting smoking probably isnt
ready to make a list of alternatives to smoking.
Most of the evidence for this model comes from studies of alcohol, drug abuse, and
smoking cessation, but its also been applied to various health behaviors, including exercise
and dieting. Clinicians and health educators use TTM to counsel patients, but you dont
need to be an expert to try this approach. Anyone motivated to change can use it to assess
her situation and formulate strategies. Below are the TTM stages of change and some ideas
about how people move through them:

Precontemplation. At this stage, you have no conscious intention of making a


change, whether through lack of awareness or information (Overweight in my family is

genetic; its just the way we are) or because you have failed in the past and feel
demoralized ("Ive tried so many times to lose weight; its hopeless). You tend to avoid
reading, talking, or thinking about the unhealthy behavior, but your awareness and interest
may be sparked by outside influences, such as public information campaigns, stories in the
media, emotional experiences, illness, or a clinicians or family members concern. To move
past precontemplation, you must sense that the unhealthy behavior is at odds with
important personal goals, for example, being healthy enough to travel or to enjoy your
children or grandchildren.

Contemplation. In some programs and studies that employ TTM, people who say
theyre considering a change in the next six months are classified as contemplators. In
reality, people often vacillate for much longer than that. In this stage, you are aware that the
behavior is a problem and are considering doing something about it, but you still arent
committed to taking any action. Ambivalence may lead you to weigh and re-weigh the
benefits and costs: If I stop smoking, Ill lose that hacking cough, but I know Ill gain
weight, or I know smoking could give me lung cancer, but it helps me relax; if I quit, stress
could kill me, too!
Health educators use several techniques to help people unstick themselves and move on to
the next stage. One is to make a list of the pros and cons of making a change, then
examine the barriers the cons and think about ways to overcome them. For
example, many women find it difficult to get regular exercise because its inconvenient or
they have too little time. If finding a 30-minute block of time to exercise is a barrier, how
about two separate 15-minute sessions? Could someone else cook dinner so you can take
a walk after work? If you feel too self-conscious to take an exercise class, how about buying
an exercise tape to use at home?

Preparation. At this stage, you know you must change, believe you can, and are
making plans to change soon say, next month. Youve joined a health club, purchased a
supply of nicotine patches, or added a calorie-counting book to the kitchen shelf. At this
stage, its important to anticipate potential obstacles. If youre preparing to cut down on
alcohol, for example, be aware of situations that provoke unhealthy drinking, and plan ways
around them. If work stress triggers end-of-day drinking, plan to take a walk when you get
home. If preparing dinner makes you want a drink, plan to have seltzer water instead of
wine. If social situations are a problem, make a list of alternatives, such as going to the
movies instead of having drinks or dinner with friends.
At the same time, create a realistic action plan with achievable goals. If youve been
sedentary and want to exercise more, start by making it your goal to avoid using the

elevator for two-, three-, or four-story trips. Or plan to walk 15 minutes every day. This can
help you work your way up to more ambitious goals.

Action. At this stage, youve changed stopped smoking, for example (according
to Prochaska, cutting down would not be action but preparation for action) and youve
begun to experience the challenges of life without the old behavior. Youll need to practice
the alternatives you identified during the preparation stage. For example, if stress tempts
you to eat, you can use healthy coping strategies such as yoga, deep breathing, or
exercise. At this stage, its important to be clear about your motivation; if necessary, write
down your reasons for making the change and read them every day. Engage in self-talk to
bolster your resolve. Get support. Let others know youre making a change.

Maintenance. Once youve practiced the new behavior change for at least six
months, youre in the maintenance stage. Now youre working to prevent relapse and
integrate the change into your life. That may require other changes, especially avoiding
situations or triggers associated with the old habit. It can be tough, especially if it means
steering clear of certain activities or friends while you work to fully assimilate your new,
healthier habit.

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