Introduction
The renowned Transtheoretical Model (TTM) formulated by Prochaska & DiClemente (1983) is a behaviour change model used to theorise the process an individual goes through planned behaviour change. Some concepts of behaviour change limit themselves on certain aspects of change (for example biological or social influences), but the TTM includes and integrates primary arguments from other concepts and theories to create a broad theory of change that applies to various behaviours, environments, and populations, hence, referred to as Transtheoretical. As such, a model is used by clinicians trying to change certain behaviours or adjustments. For example, it could be utilised for those who want to stop smoking, who seek to adjust their lifestyle after an accident incapacitating their movements. This paper applies the model to someone who attempts to quit smoking.
Stages of change in the model
As explained by Paveyard, et al. (2008) stages or change are the central elements of the TTM. Paveyard et al. (2008) explained that studies have established that individuals go through a sequence of steps when changing behaviour. Though the duration an individual can remain in each phase differs, the tasks needed to pass to the next stage are same. Paveyard et al. (2008) noted that specific principles and process underlining change work efficiently at a particular stage to lessen resistance, promote progress, and stop relapse. Some of these principles are decision balance, processes of change, and self- efficacy. Paveyard et al. (2008) observe than an only small percentage (normally below 20%), of the selected population at risk, is ready to change in a given period. Therefore, guidance provided using TTM has shown to increase participation by individuals in the change process since it’s attractive to the whole population and not merely a small percentage willing to take action.
According to Paveyard, et al. (2008) the stage/phase contract signifies a temporal dimension; changes entail phenomena happening within a given period. However, conventional theories of therapy lack a central contract that represents the duration of time. Usually, behaviour change has been viewed as one time happening, for example, stopping smoking. TMM has filled this gap by understanding that changes are a process that takes time and goes through different stages. Whereas movement through the established phases could happen in a linear method, a nonlinear progression is also widespread. Usually, people may relapse to initial stages after moving to the next one.
John’s Case of quitting smoking
Smokers often require help to stop smoking successfully. It’s hard to stop a long-term behaviour or addiction when a person does not get assistance from a professional. The application of TTM in a situation of smoking cessation is meant to assist the patient to move from one stage to another. Quitting smoking is a gradual process that requires time and individuals do not usually move through various stages at a single time. As stated before, we will examine how this model can be applied to a person who wants to quit smoking. TMM has five stages has shown in the diagram below, which guides the patient.
Stage 1: Precontemplation:
A person at this point is not ready to undertake the behaviour change. As mentioned by Armitage, & Arden (2008). Individuals at this stage have no intention of taking action about their conduct, and this stage is typically thought to last for six months. Having no information or being misinformed regarding the possible consequences particular behaviour could cause the individual to stay in the pre-contemplation stage. When a person tries to change on multiple occasions and fails, it could result in demoralisation regarding his/her ability to change; as such a person is commonly viewed in other models and theories as unmotivated, resistant or unwilling to get help. The implication is that traditional approaches were not prepared for these kinds of persons and were not created to meet their needs and requirements.
At this point John was not even thinking about quitting smoking, he used to say that “I have been smoking for the last 20 years, and I cannot do without my cigarette.” Whereas he knew that smoking harmful, he had never thought of its adverse effects to his body, he was not considering changing his smoking behaviour. John was not motivated to quit because he could not imagine a day passing without inhaling the cigarette smoke.
Contemplation stage
As mentioned by Armitage & Arden (2008) the contemplation stage is where people purpose change within a short period, say in six months. A person understands the benefits of change and the challenges. As such, the person weighs between the advantages and the disadvantages that will arise from changing, and this can result in a person remaining in this phase for a prolonged period. Armitage & Arden (2008) explains that this phenomenon refers to as behavioural procrastination or constant contemplation, traditional action-focused programs are not effective to people at this stage.
John entered into this stage when one of his friends was diagnosed with lung cancer, and the doctors told him that smoking could have contributed to his condition. On hearing this news, John started to seriously think about the pros of smoking, the possibility of suffering from cancer or other conditions like it has happened to his friend. Indeed, John started to ask me questions about the dangers of smoking. I informed John that smoking was associated with many diseases and complications that included but were not limited to cancer (many forms), cardiovascular diseases, and respiratory diseases, stroke and even death. I reminded him that estimates from CDC indicate that 480,000 people die each year in the United States from cigarette smoking related diseases (CDC, 2017). After hearing this information, John was ready to change; he starts to think about quitting. However, he did not have any plan on how to quit, and I told him that I would assist him since he was ready.
Preparation
Prochaska et al. (2008) point out that preparation stage is where individuals plan to take action within a short time, normally within a month. Naturally, people at this stage have already taken some action within the previous six or twelve months. Such people have formulated a plan of action, for example consulting a counsellor or depending on self-change approaches. These people are enlisted in action-oriented programs. Accordingly, at this stage, I started to help John to prepare an action plan that will allow him to quit smoking. Most of the action plan involved mental and psychological preparation, though this could include changing his lifestyle. Accordingly, the mental preparation entailed setting a possible quit date on the calendar. I requested him to inform his wife about that date so that there is some level of accountability when that date comes.
Action
The action is the stage where individuals have made sure of visible changes in their lifestyles in the previous six months. Since actions are observable, the general process of behaviour change usually is equated to action. However, using the TTM, an action is among the five stages in the model. Still, not all changes of behaviour require action. In many applications, individuals have to particular criteria that professionals agree are not enough to reduce the risk from a particular condition or behaviour. For instance, in our case of John, the action involved completely quitting smoking and not reducing the number of cigarettes smoked. As such, when the quitting date arrived, John stopped smoking. I warned him that falling back to smoking will be a significant setback for the whole program, and it was not acceptable. Good enough John did not smoke, even though he admitted that the urge was too much, he was able to quit.
Maintenance
Maintenance is the final stage where individuals have already taken certain changes concerning their lifestyle as the case of John, and are working to ensure that they do not relapse. Nonetheless, they do not require the change process regularly as those individuals in the Action stage. Armitage & Arden, (2008) noted that in this stage, persons have less temptation to relapse and get more self-assured about continuing with their change. Researchers have established that this stage takes between six months and five years. A study by Prochaska et al. (2008) showed that after quitting smoking for one year, 43% of the people relapse to regular smoking. The risk of going back to smoking reduced to 7% after five years of abstinence. Bearing this in mind, I advised John to look at this data and understand that it is quitting required patience and consistency. I was afraid that John would relapse back to smoking that when we met after one year and he was still maintaining his new behaviour of non-smoker I knew that he would manage. Still reminded him he has to continue those efforts.
References
Armitage, C& Arden, M (2008). How useful are the stages of change for targeting interventions? A randomised test of a brief intervention to reduce smoking. Health Psychology, 27 (6), 789-798 DOI: 10.1037/0278-6133.27.6.789
CDC (Centers for Disease Control and Prevention (2017). Health Effects of Cigarette Smoking. Retrieved from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm
Paveyard, L Massey, A Parsons, S Manaseki, C Griffin (2008). The effect of Transtheoretical Model based interventions on smoking cessation Social Science & Medicine DOI: 10.1016/j.socscimed.2008.10.036
Prochaska, J.O., Butterworth, S., Redding, C.A., Burden, V., Perrin, N., Lea, Michael, Flaherty, Robb M., and Prochaska, J.M. (2008). Initial efficacy of MI, TTM tailoring, and HRI’s in multiple behaviours for employee health promotion. Preventive Medicine, 46, 226-231
