Transtheoretical Model (TTM)

Overview

• Uses an integrative framework—incorporating processes and principles of change across major theories—for understanding behavior change
• Based on the idea that individuals engaging in intentional behavior change follow a common pathway that can be broken down into various steps (or stages)
• Each stage of the change process correspond to specific tasks that must be accomplished in order to progress to the next stage of the behavioral change pathway
• Focuses on the process of intentional behavior change, including:
  • Initiating desired behaviors (i.e., beginning an exercise regimen)
  • Modifying habitual behaviors (i.e., cutting down on caloric intake)
  • Terminating problematic behaviors (i.e., quitting smoking)

Key Constructs

Stages of Change:

• According to the TTM, the behavior change process can be conceptualized as progressing through a series of five sequential Stages of Change.

• Each of the stages represents important tasks that individuals need to accomplish in order to achieve long-term sustained health behavior change (i.e., quitting tobacco use).

Stage	A tobacco user in this stage…
Precontemplation	Gives no thought to quitting use, and has no intention to quit in the near future (i.e., within next 6 months)
Contemplation	Has begun to examine their tobacco use and desire to quit; Is weighing the pros and cons of quitting tobacco
Preparation	Has made a commitment to quit (usually within next 30 days), and has begun developing a plan for quitting
Action	Has put their plan for quitting tobacco into action (< 6 months)
Maintenance	Has successfully sustained abstinence for at least 6 months

 

 

 

 

 

 

 

 

 

 

 

 

 

Associated Measures:

                                          Algorithm for determining Stage of Change

                  Readiness Ruler for determining an individual’s readiness to quit tobacco

Processes of Change:

• There are also cognitive/experiential and behavioral Processes of Change that have been identified as central to movement through the Stages.
  • Cognitive/Experiential processes identify ways of thinking and feeling that create change.
  • Behavioral processes are oriented toward making a commitment and taking action to quit tobacco use.

Cognitive/Experiential Processes	Description (for Tobacco Users)
Consciousness-Raising	Knowledge and awareness about the individual and their tobacco use is increased.
Emotional Arousal	Emotions about the individual’s tobacco use, and available treatments or solutions, are aroused.
Self-Reevaluation	Cognitions and emotions regarding the individual, especially with respect to their tobacco use, are reassessed.
Environmental Reevaluation	The impact that the individual’s tobacco use has on their environment is reassessed.
Social Liberation	Attempts are made to decrease tobacco use in society.

 

Behavioral Processes	Description (for Tobacco Users)
Self-Liberation	Choosing a course of action to quit tobacco, and committing to that choice.
Stimulus Generalization/Control	Stimuli that may trigger lapse back to tobacco use are prepared to be coped with, removed, or avoided.
Conditioning/Counterconditioning	Positive alternative behaviors are substituted for the individual’s tobacco use.
Reinforcement Management	Positive behavioral changes are rewarded.
Helping Relationships	Trusting and open discussion about tobacco use is received by a supporting individuals

Associated Measure: Processes of Change Questionnaire

Markers of Change:

Decisional Balance identifies the relationship between the pros and cons for change and acts as an important marker of movement through the earlier stages of change (i.e., contemplation)

Associated Measure: Decisional Balance Scale

Self-Efficacy/Temptation reflect the degree of confidence an individual has in their ability to maintain their desired behavioral change in situations that often trigger relapse.

Associated Measures:

Smoking Self-efficacy Scale

Temptation to Smoke Scale

Context of Change:

The context of change consists of the areas of functioning that complement or complicate movement through the stages of change.

Context	Description
Current Life Situation	Current internal and external environment in which the change is to take place (i.e., level of anxiety/depression, financial situation, etc.)
Beliefs and Attitudes	Basic beliefs about how change should happen, what is needed for successful change, general beliefs about oneself, etc.
Interpersonal Relationships	Interactions with significant individuals (i.e., spouse, close friends, etc.)
Social Systems	Family system, social network, societal and work systems provide social norms, social reference, as well as incentives or barriers to change
Enduring Personal Characteristics	Personality characteristics (i.e.,  impulsivisy, self-esteem, conscientiousness, etc.)

 

Strategies to Use with Tobacco Users:

• Determine which Stage of Change (see table above) your client is in for tobacco use cessation (or for initiation if you plan to implement a prevention program).
• For individuals progressing through the Stages of Change for tobacco use cessation, certain techniques or strategies may be more useful at a particular stage of change. To identify which stage-specific tasks would be helpful for your client(s), read the Stage Tasks pdf.
• Motivational Interviewing is an effective tool for helping clients resolve ambivalence regarding quitting tobacco use.