Helping Populations Progress Through Stages of Change
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A scientific revolution is occurring in the field of behavior change. This revolution involves a shift from an action paradigm to a stage paradigm in which c...

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I came across this video about the 5 Stages of Change, and what those stages usually look like. Dr. Prochaska relates some of the examples directly to addiction and mental health, but many of the concepts can also be applied to broader changes in your own or someone else’s life.

I thought many of the points were pretty spot on, such as the myth that a person with addiction needs to hit a certain “rock bottom” to initiate a change in the addictive behavior. The lecture is through the lens of a healthcare provider but delivers the speech without a lot of medical jargon. Here are some notes I took while watching it:

Stages of Change

  1. Pre-contemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance

Pre-contemplation

  • lack of recognition
  • resistant

Contemplation

  • Person recognizes need for change but is ambivalent (conflicting feelings)

  • not like child development (i.e., intrinsically motivated)

  • Two Forces:

  • Developmental Events - e.g., smokers usually experience this at age 39, to live on the track the person is on or change the quality of projected life
  • Environmental Events - e.g., dog dies from lung cancer
  • myth that addiction needs to “hit rock bottom”
  • Importance of identifying the pros and cons: patient practices taking part in their own care and feel more in control
  • more likely to follow through makes it more approachable

Preparation

  • make people as prepared as possible

Action

  • people have to work the hardest / most demanding
  • about 6 months

Maintenance

  • still have to work, just not as hard
  • period: less clear how long in recovery: you are always “in recovery”
  • about 40% of smokers relapse within 5 years
  • Reasons for relapse: distress (weakest points): depression, anxiety, boredom, hostility, stress, loneliness
  • planned strategies is best
  • talking/therapy
  • exercise/physical activity
  • meditation/prayer (some way to let go)

Defining termination (not going back): “total confidence across all high-risk situations, that I will not go back to my self-defeating, self-destructive, unhealthy pattern of behavior.”

  • one indication: the person stops dreaming of their substance of choice

Consciousness Raising and Education

  • does not lead to immediate action, they lead to contemplation (during pre-contemplation)
  • also, fear. Evoke emotions.
  • changes in behavior usually involve changes in self image / self identity

Self Liberation

  • the belief that “I have the power to change my behavior”
  • people tend to mistakenly think of this as a trait (e.g., “I didn’t have enough will-power”)
  • giving people 2-3 choices make them more likely to follow-through

Giving Support

  • people tend to think there will be more praise than they actually get
  • “Depression is the stress equivalent to smoking a pack of cigarettes per day.”
  • People with depression who randomly received follow-up home visits within one year (social relationships) had 50% fewer deaths
  • Replace / find alternatives for behavior we tend to think of depression as a passive problem