Stages of Change Model/Transtheoretical Model (TTM)

Stages of Change Model/Transtheoretical Model (TTM).

Prochaska and DiClemente


Transtheoretical Model of Change, a theoretical model of behavior change was originally explained by Prochaska & DiClemente, 1983.
Transtheoretical model of change has been the basis for developing effective interventions to promote health behavior change.
The model describes how people modify a problem behavior or acquire a positive behavior.
The TTM is a model of intentional change. This model focuses on the decision making of the individual.
The transtheoretical model may help to explain differences in persons’ success during treatment for a range of psychological and physical health problems.
This model has been widely applied in behaviour modification techniques.


The core constructs of the TTM are

the processes of change
decisional balance
self-effi cacy, and

Processes of change

Processes of change are the covert and overt activities that people use to progress through the stages.
There are ten such processes as explained by Prochaska:
Consciousness Raising (Increasing awareness)
Dramatic Relief (Emotional arousal)
Environmental Reevaluation (Social reappraisal)
Social Liberation (Environmental opportunities)
Self Reevaluation (Self reappraisal)
Stimulus Control (Re-engineering)
Helping Relationship (Supporting)
Counter Conditioning (Substituting)
Reinforcement Management (Rewarding)
Self Liberation (Committing)
The first five are classified as Experiential Processes and are used primarily for the early stage transitions.
The last five are labeled Behavioral Processes and are used primarily for later stage transitions.

Decisional Balance

Decisional Balance reflects the individual’s relative weighing of the pros and cons of changing.
The Decisional Balance scale involves weighting the importance of the Pros and Cons.


Self-efficacy represents the situation specific confidence that people have that they can cope with high-risk situations without relapsing to their unhealthy or high-risk habit.
This concept was adapted wfrom Bandura’s self-efficacy theory.


reflects the intensity of urges to engage in a specific behavior when in the midst of difficult situations.
Temptation is the converse of self-efficacy.
The most common types of tempting situations are;
negative affect or emotional distress
positive social situations, and


People pass through a series of stages when change occurs.
The stages discussed in their change theory are:
action, and

PRECONTEMPLATION (Not ready to change)

The individual is not currently considering change: “Ignorance is bliss”
People are not intending to take action in the foreseeable future, usually in the next six months.
Validate lack of readiness
Encourage re-evaluation of current behavior
Encourage self-exploration, not action
Explain and personalize the risk
Traditional health promotion programs are often not designed for such individuals and are not matched to their needs.(Velicer, 1998)

CONTEMPLATION (Thinking of changing)

Ambivalent about change: “Sitting on the fence”
Not considering change within the next month.
Encourage evaluation of pros and cons of behavior change.
Re-evaluation of group image through group activities.
Identify and promote new, positive outcome expectations

PREPARATION (Ready to change)

Some experience with change and are trying to change: “Testing the waters”
Planning to act within 1month.
The individual needs encouragement to evaluate pros and cons of behavior change.
The therapist needs to identify and promote new, positive outcome expectations in the individual.
Encourage small initial steps .
These individuals ahve taken some actions in the past year such as joining a health education class, consulting a counselor, talking to their physician, buying a self-help book or relying on a self-change approach.
These group of individuals ar suitablefor action- oriented programs for smoking cessation, weight loss, or exercise programs.

ACTION (Making change)

The active work toward desired behavioral change including modifi cation of environment, experiences, or behavior have been taken.
At this stage people have made specific overt modifications in their life-styles within the past six months.
At this stage measures should be taken against relapse.
Help the individual on restructuring cues and social support.
Enhance self-efficacy for dealing with obstacles.
Help to guard against feelings of loss and frustration.

MAITANANCE (Staying on track)

Here, the focus is on ongoing, active work to maintain changes made and relapse prevention.
At this stage people are are less tempted to relapse and increasingly more confident that they can continue their change.
lan for follow-up support
Reinforce internal rewards
Discuss coping with relapse

RELAPSE (Fall from grace)

This stage is not explained in the original article. It is a form of regression to previous stages.
It refers to falling back to the old behaviors after going through other stages.
Regression occurs when individuals revert to an earlier stage of change.
Evaluate trigger for relapse
Reassess motivation and barriers
Plan stronger coping strategies


The model has been applied to a wide variety of problem behaviors like;
smoking cessation
low fat diet
radon testing
alcohol abuse
weight control
condom use for HIV protection
organizational change
use of sunscreens to prevent skin cancer
drug abuse
medical compliance
mammography screening, and
stress management.
Rhode Island Change Assessment Scale (URICA) is a 32-item questionnaire designed to measure the stages of change across diverse problem behaviors.
Motivational Enhancement Therapy (MET) is based on the Prochaska and
DiClemente’s stages of change model, which is applicable in smocking sessation and alcohol abuse.


Prochaska JO, DiClemente CC, Norcross JC (1992). In search of how people change. Applications to addictive behaviours. Am Psychol 47:1102.
Velicer, W. F, Prochaska, J. O., Fava, J. L., Norman, G. J., & Redding, C. A. (1998) Smoking cessation and stress management: Applications of the Transtheoretical Model of behavior change. Homeostasis, 38, 216-233.
Prochaska JO , Velicer WF , Rossi JS , et al. ( 1994 ) Stages of change and decisional balance for 12 problem behaviors . Health Psychology 13, 39 – 46 .
Prochaska JO and DiClemente CC ( 1984 ) The Transtheoretical Approach: Towards a Systematic Eclectic Framework . Dow Jones Irwin , Homewood, IL, USA .
The web page of UCLA Centre for Human Nutrition.

Stages of Change Model/Transtheoretical Model (TTM)

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Transtheoretical model of change (TTM).

Transtheoretical model of change (TTM)..

The treatment model most likely to be effective

with a suicidal and substance abusing person is:

a.Mindfulness-based treatment.

b.Transtheoretical model of change (TTM).

c.Motivational interviewing (MI).

d.Dialectical behavior therapy (DBT).

e.Self-determination theory (SDT).

5 points

Question 2

Addiction professionals today:

A. May have a background that includes personal recovery from addictive behavior.

B. Have to meet credentialing requirements that include education in theories of addiction.

C. Frequently cling to a favorite theory and disregard other theories.

D. Need to be flexible to tailor individualized or customized care to clients.

E. All of the above.

5 points

Question 3

Behaviorists expect relapses to occur early in recovery because:

A. The addicted individual’s condition has not progressed to the disease stage.

B. Many of the rewards of recovery come only after long periods of sobriety.

C. Negative consequences for addictive behavior are quickly forgotten.

D. Poor impulse control.

E. They have not hit bottom.

5 points

Question 4

Voucher-based treatment for cocaine dependence:

A. Pays addicts for clean urine specimens.

B. Includes relationship counseling.

C. Is a community reinforcement approach to treatment.

D. Behavioral treatment component had better results than those in 12-Step drug counseling.

E. All of the above.

5 points

Question 5

This approach has been shown

to be more effective than peer-based CBT (cognitive-behavioral therapy)

groups to reduce high-severity substance-related behaviors among ethnic minority youth:

A. BSFT (Brief Strategic Family Therapy).

B. FFT (functional family therapy).

C. MDFT (multidimensional family therapy).

D. MST (multisystemic family therapy).

E. None of the above (they are about equal).

5 points C

Question 6

The model of addiction enjoying the greatest support

from the law enforcement and prison industries is:

A. Alcoholics Anonymous.

B. Moral models of addiction.

C. Disease models of addiction.

D. Psychological models of addiction.

E. Social models of addiction.

5 points

Question 7

The foundations of addiction treatment in the United States today are the:

A. Moral models of addiction

B. Disease models of addiction

C. Psychological models of addiction

D. Social models of addiction

E. All of the above

5 points

Question 8

Family roles in a family suffering from the disease of addiction may:

A. Become overly flexible.

B. May result in a scapegoat who also acts as a family clown.

C. May result in a lost child who acts out and may become delinquent.

D. May result in a family hero who attempts to do everything right.

E. May result in a mascot who withdraws in order to cope.

5 points

Question 9

The social learning theory (SLT) proposed by Albert Bandura is also known as:

A. Self-efficacy.

B. A cognitive model.

C. Social cognitive theory.

D. Self-efficacy theory.

E. All of the above.

5 points

Question 10

Public Health

A. Is concerned with promoting and protecting health of populations.

B. Is often contrasted with medicine which focuses on the individual.

C. Replaced a focus on miasma (invisible toxic matter from the earth) as the cause of disease.

D. Replaced the sanitary movement in many cities in the late 1800s.

E. All of the above.

5 points

Question 11

Relapsing to addictive behavior is viewed as a learning experience

that can be used to strengthen gains made in treatment by the:

A. Moral models of addiction.

B. Disease models of addiction.

C. Psychological models of addiction.

D. Social models of addiction.

E. All of the above.

5 points

Question 12

LifeSkills Training (LST):

A. Is today one of the most widely used, evidenced-based prevention programs.

B. Is restricted to high school students in predominantly white neighborhoods.

C. Trains students on actions of drugs and medical and legal consequences.

D. Is conducted in week-long sessions during summer breaks.

E. All of the above.

5 points

Question 13

Respondent conditioning (classical conditioning, Pavlovian conditioning)

helps explain why repeated drug use in the same environment may result in:

A. Overdose.

B. Addiction.

C. Drug tolerance.

D. Withdrawal.

E. Paranoia.

5 points

Question 14

Behaviorists believe that adaptive behaviors as well as maladaptive behaviors

like addiction are the result of:

A. Conditioning.

B. Learning.

C. Genetic inheritance.

D. A disease process.

E. Immoral behavior.

5 points

Question 15

The recommendation to address cognitive, behavioral and

social factors in efforts to overcome addictive behavior is best represented by:

A. Alcoholics Anonymous.

B. Moral models of addiction.

C. Disease models of addiction.

D. Psychological models of addiction.

E. Social models of addiction.

5 points

Question 16

Delay discounting is when behavioral consequences

or reinforcers are delayed into the future and as a result they:

A. Increase their value and effectiveness in influencing choices.

B. Decrease their value and effectiveness in influencing choices.

C. Decrease the chance of relapse.

D. Increase the likelihood of maintaining sobriety.

E. Depends on the individual.

5 points

Question 17

It may be convenient to refer to addiction as a “brain disease” but:

A. This is insufficient and possibly misleading.

B. Singular and absolute explanations for addiction are ill-informed

or championing a social/political cause.

C. Addiction is extremely complex and arises from multiple pathways.

D. There is not one way to explain addiction.

E. All of the above.

5 points

Question 18

During the 13 years of Prohibition in the United States (1920-1933):

A. The early movement to medicalize alcoholism gained strength.

B. Alcohol consumption decreased by an estimated 70%.

C. Drug addiction increased rapidly.

D. Physicians prescribed alcohol for more medical ailments like diabetes and old age.

E. All of the above.

5 points

Question 19

Harm reduction approaches to addiction treatment:

A. Are most appropriate for persons not in treatment and not highly motivated to change

B. Are highly controversial especially in the United States

C. Incorporate stages of change thinking from the transtheoretical model (TTM)

D. Encourages autonomy similar to motivational interviewing

(MI) and self-determination theory (SDT)

E. All of the above.

5 points

Question 20

Due to evidenced-based practice (EBP) and changes in health care law,

it is projected that all counselors in the addictions field will soon be

required to possess at least:

A. A high school diploma and some certification training.

B. A bachelor’s degree in an addiction-related field (psychology, nursing).

C. A master’s degree.

D. A doctorate (PhD or MD).

E. Three years of sobriety.

5 points

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Transtheoretical model of change (TTM).

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