Prochaska's model of behaviour change

Assumptions of the model

Overcoming addiction is complex process which doesn't happen quickly or linearly - it is a cyclical process: some orderly progression through the stages but can return to previous ones, and some may be missed altogether

1. People who're addicted differ in how ready they are to change their behaviour, some think about doing it, some are doing something about it and some decide not to change at all

2. How useful a treatment intervention is depends on the stage the person has reached; some interventions will be most effective at early stages of recovery process but less useful later on

Six stages of behavioural change

1. Pre-contemplation - not thinking about changing their behaviour in the near future (next 6 months)

> may be due to denial - haven't considered changing as don't believe they have a problem

> may be due to demotivating - tried many times to tackle addiction but without success, so now demoralised and doesn't currently intend to try again

{intervention at this stage should focus on helping addicted person consider need for change}

2. Contemplation - thinking about making a change about their behaviour in the next 6 months

> doesn't mean they've decided to change: they're ambivalent

> increasingly aware of the need for change, want the benefits of change, but very aware of costs

{not helpful to introduce drug treatment intervention as this stage (as may remain in chronic contemplation) but any attempt to convince person of pros of overcoming addiction outweigh the cons is helpful}

3. Preparation - believes benefits are greater than costs or decide to change their addiction related behaviour within next month

> haven't decided how and when to change

{support a constructing plan or presenting them with options e.g. drug counsellor or GP appointment or helpline}

4. Action - have done something to change their behaviour in the last 6 months

> point at which behavioural and cognitive treatments become potentially effective

> may do something less formal but no less meaningful e.g. cut up cigarettes

> action taken must reduce their risk e.g. giving up fags altogether opposed to low tar versions

{effective intervention focuses on developing coping skills client needs to quit and maintain change of behaviour into next stage}

5. Maintenance - maintained some change of behaviour for more than 6 months

> focus on relapse prevention - avoiding situations where cues might trigger reversion to addictive behaviours

> accompanied by growing confidence that changes can be continued in longer term (becoming a way of life)

{intervention helps client apply coping skills learned and use sources of support available to them}

6. Termination - newly acquired behaviours e.g. abstinence become automatic

> person no longer returns to addictive behaviours to cope with stress, anxiety or loneliness etc.

> may not be possible or realistic for some to achieve this stage - may be most appropriate goal for many is to prolong maintenance as long as they can and accept relapse is inevitable but providing person with skills to work through earlier stages of process quickly

{no intervention needed}

Evaluation: Dynamic nature of behaviour

> more traditional theories ignore importance of dynamic process, considering recovery from addiction as an all or nothing event

> six-stage model emphasises importance of time, viewing overcoming addiction a continuing process

> therefore strength is model recognises that changing addictive behaviours is a dynamic process

Evaluation: Contradictory research evidence

Taylor et al

> from review of available evidence from NICE, concluded stage based approaches are no more effective that alternatives in treating nicotine addiction

> Cahill et al - came to same conclusion

> overall research picture is negative, despite overoptimistic claims made by model for some

West

> suggested there's serious issues of the model, saying it should be discarded and is "no more than a security blanket for researchers and clinicians"

Evaluation: Arbitrary nature of the stages

Sutton

> highlights if individual plans to stop smoking in 30 days time, the are in the preparation stage, but if they plan to give up in 31 days, they're in contemplation stage

Bandura

> claims first two stages aren't qualitatively different because the only difference between them is how much (quantitative measure) the individual wants to change

Kraft et al

> argues stages can be reduced to 2 useful ones: precontemplation and all the others combined

Evaluation: Attitude to relapse

DiClemente et al

> relapse is the rule rather than the exception

> model doesn't view relapse as failure but as an inevitable part of the non-linear, dynamic process of behaviour change

> model task relapse seriously and doesn't underestimate its potential to completely change the course of recovery; lots of changes to behaviour require several attempts to get it right, make it last or reach the maintenance or termination stages

Evaluation: Description rather than prediction

> most research applying to model describes stages are at in recovery and correlates it with addiction related and treatment seeking behaviours

> research has produced mixed findings - suggests its unclear whether or not the model is a good predictor of who is likely to make changes (which is the main aim of a useful model)