Prochaska, Change and Stress

BEHAVIORAL CHANGE expert, Dr. James Prochaska believes that people don’t suddenly change overnight. He believes that change is a process that takes months and sometimes years. “Traditional health promotion programs are based on the action paradigm,” says Prochaska. So smoking cessation programs, exercise programs and diet programs only appeal to a thin slice of people who are at the action stage of the whole change continuum.

Change doesn’t just happen all at once, it occurs in stages.

In Prochaska’s model there are six stages (or levels) of change. The first level is the pre-contemplation stage. This is the stage where a person first starts thinking about making a behavioral change, but sees it happening at some point in the future. Smokers often stay in this stage for years, knowing they want to quit, but never setting a specific date. Here Prochaska often cites a highly successful tobacco-cessation program he helped design for smokers not ready to quit. (In other words, a health promotion program for people NOT ready to take action.) As research shows, when programs are designed around the stages of change model, they are much more likely to be successful and draw more people in. People in pre-contemplation just want to learn something about what they are contemplating doing in the future. It’s first step of the change continuum.

The next stage in the process, Prochaska calls the contemplation stage. (People in this stage are thinking about making a change in the near future, usually within 3-6 months.) People who quickly drop out of a wellness program they just signed up for, may be in this stage and not even know it. They are not ready to quit smoking for example, but they want to know why they should do this. This is also the stage where they weigh the cons of keeping the old behavior vs. the pros of adopting a new healthier behavior. They won’t make a change until they are thoroughly convinced that the pros outweigh the cons.

How you know when a person is ready to start the change process.

After contemplation, comes the preparation stage. This is where people plan to make a change soon. In this stage, they may come to a wellness professional for advice, or ask their friends about a smoking cessation program, or a diet plan or a good gym to join. Essentially they are doing their research on the best ways to accomplish their behavioral change goals. When it comes to making behavioral changes, these are the people who are more likely to succeed because they’re ready for action. Most wellness programs begin in this action stage (the fourth stage) no matter where people fall in the stages of change continuum.

The number one reason why people relapse is stress.

The fifth stage is called maintenance. In the maintenance stage, people need to understand the dangers of relapsing into their old behaviors and to be realistic about dealing with setbacks. (Three to four setbacks are common.) Maintaining the change over the long haul is the hardest job of all. (Support groups can help.) According to Prochaska, 40% of the people who quit smoking for a whole year will relapse back into their old habit. Why does this happen? As Prochaska explains, "the number one reason why people relapse into old behaviors is emotional stress."

How you can help people maintain their objectives.

People have to learn how stress affects their choices and how it affects the change process. When they are ready to move into the maintenance phase, they need the tools and resources to manage stress. This ability to handle stress is probably the most important determining factor in who makes it through to the finish line, or to what Prochaska calls the termination stage, where people are not the least bit tempted to go back to their old behaviors.

To illustrate the termination stage , Prochaska often asks his audiences: “How many people have given up drinking whole milk?” (And many people raise their hands) He then asks: “Are you even the least bit tempted to buy a gallon of whole milk?” (Most people agree that they actually like the skim better and would never go back.) He then concludes: “That’s termination.” The old behavior has been completely terminated.

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Book Spotlight

Changing for Good
By: James O. Prochaska, John Norcross, Carlo DiClemente

Changing For Good To uncover the secret to successful personal change, three acclaimed psychologists studied more than 1000 people who were able to positively and permanently alter their lives without psychotherapy. They discovered that change does not depend on luck or willpower. It is a process that can be successfully managed by anyone who understands how it works. Once you determine which stage of change you're in, you can:

  • create a climate where positive change can occur
  • maintain motivation
  • turn setbacks into progress
  • make your new beneficial habits a permanent part of your life

This groundbreaking book offers simple self-assessments, informative case histories, and concrete examples to help clarify each stage and process. Whether your goal is to start saving money, to stop drinking, or to end other self-defeating or addictive behaviors, this revolutionary program will help you implement positive personal change . . . for life.