At one time or another, most of us have embarked with an effort to change some part of ourselves or our lives. We’ve chose to stop smoking, to start saving, to decrease a few pounds, or to get a new job. As a rule, these sorts of changes don’t occur overnight. They are hard. And they tend to evolve through a multistage process — one that many behavior-change experts know as the Transtheoretical Model of Change, or TTM.
Conceived in the early 1980s by psychologist James O. Prochaska, PhD, this theoretical tool (sometimes known as the “readiness-to-change” model) has encouraged many to rethink their assumptions about the most effective, appropriate ways to support themselves in accomplishing their goals. Read on to get a sense of where you are in your own change process, and just what actions and attitudes are likely to help you create forward momentum.
Six Stages of Change
There’s something so commanding about those three simple words that Nike was compelled to trademark them. And wisely so. Believe to invoke the appeal of go-get-’em action — and to reject all the pointless dilly-dallying that so often appears to lead up to it?
Most of us also know from hard-won experience, though, that when it comes to making significant changes, launching ourselves into action is usually harder than it sounds, and less productive than we hoped.
In fact, it turns out that “just doing it” — before you are emotionally ready and effectively prepared to take on a particular goal — may be one of the fastest ways to sabotage your ability to succeed.
What Prochaska’s six-stage model illuminates is exactly what many earlier models tended to read — namely, that lasting change rarely occurs as the result of a single, ongoing decision to do something.
More often, as Prochaska points out, change evolves from the subtle, complex and sometimes circuitous progression — one which involves thinking, hesitating, stepping forward, stumbling backward, and, potentially, starting all over again.
Prochaska’s Transtheoretical Model (TTM) acknowledges that lasting change generally proceeds through six key stages: from Precontemplation to Contemplation, then to Preparation and Action. But that’s only the beginning, and we can easily coast right back into preparation or contemplation when we lose our nerve, focus or steam. For our behavior change to prove sustainable, it has to enter a Maintenance phase (generally, 6 months or more of consistent action) until it finally becomes ingrained as a stable habit. This final, ongoing phase is known as Termination, which implies that the change is now a permanent part of our lifestyle.
Most “just do it” programs fail to embrace a realistic look at this complex and fluid progression. Instead, they persuade folks to jump straight into action, leapfrogging over all those messy preparatory steps.
Unfortunately, those may be precisely the steps that give our change efforts the best chances of success. And so it happens that many of us who jump directly into action wind up falling right back out of it — again and again.
Once you take stock of Prochaska’s model, all of this seems self-evident. And it seems curious that these insights became part of the modern psychological canon only relatively recently.
“Thirty years ago, psychotherapy was made up of over 300 different theories,” recalls Prochaska, who now serves as director of the Cancer Prevention Research Center and professor of clinical and health psychology in the University of Rhode Island. “I had been looking for a way to integrate some of these theories,” he says. “So my research team and I went out and interviewed ordinary folks who were struggling with quitting smoking. We asked them concerning the various processes they’d gone through, and they said, ‘Early on Used to do this; later I did this.’ They were talking about stages of change. But that wasn’t in any of the 300 models of therapy known at that time. We realized that was the missing link that could allow us to integrate different processes from different theories.”
Prochaska also recognized the requirement for stage-appropriate support systems, and eventually founded a behavior-change research and development consultancy — Pro-Change Behavior Systems — according to this area of expertise. “For a long time,” he says, “the dominant model was an action model, where people were seen as changing only if they took action.” Accordingly, he notes, resources and support were focused exclusively for the reason that phase. “The problem is,” he says, “action-oriented programs don’t work for the majority of people.”
At any given time, about only 20 percent of people needing to change an unhealthy behavior are actually prepared and able to do so, says Prochaska’s collaborator and wife, Janice M. Prochaska, PhD, who serves as CEO of Pro-Change Behavior Systems. “This model works with the whole at-risk population, not just those people who are ready for change right then. And studies have shown that if we can get someone to move only one stage forward, we double their likelihood of being successful six to Twelve months down the road.”
Not all experts see TTM like a perfect tool. And there’s no be certain that stage-appropriate interventions and support systems will prove effective for a particular individual. But if you’ve been striving to put your own change efforts into perspective, understanding your “readiness to change” might actually be a step in the right direction.
What Would be the Stages of Change?
Want to be more successful in making the changes that matter for you? Here’s a detailed look at the stages of change, and how you can move through them with confidence.
Stage 1: Precontemplation
People in this stage may wish to change, but for the immediate future have no plans to do so. Why? They may 't be fully aware of all the potential benefits, or they might feel disinclined to try because of past failed attempts, or a lack of available energy.
“In Precontemplation, people underestimate the advantages of changing, and overestimate the cons, or costs,” says Prochaska. “But they’re not particularly mindful of that, so it’s not really a focused, rational decision-making process.”
Weighing the advantages and disadvantages of a behavior is an important component within the Transtheoretical Model. In the beginning, the apparent cons have a tendency to outweigh the perceived pros. As a person moves through the six stages, however, that balance shifts.
“If I’m handling a patient in Precontemplation, I assign them the task of thinking at least once each day about all the benefits they’d expect from changing whatever behavior they’re trying to stop or start,” says Alex Lickerman, MD, a primary-care physician at the University of Chicago, who uses the stages-of-change model together with his patients. “That may be enough to maneuver an individual into Contemplation,” he notes. “Considering making a change is what gets people used to the idea of actually making it.”
You’re within the Precontemplation stage if: You’ve heard plenty of times (from your doctor, your partner, your friends, or maybe your own conscience) that you ought to make a change — but you’re not seriously considering addressing the issue anytime soon. It may seem like too much work, or just plain not for you. When someone tries to talk to you about it (e.g., cutting back on drinking, losing weight, giving up cigarettes), you tune out, shut down or change the subject.
Moving from Precontemplation to Contemplation: It might take a scary test result or a major life event (such as the birth of a child or death of the loved one) to get you motivated to start thinking differently about your prospects for change. Meanwhile, recognize that “just thinking about it” has potential value, too, and can help open your mind to new possibilities.
Stage 2: Contemplation
Those in the Contemplation stage are thinking about following through, but aren’t quite ready or don’t know how to get started. Contemplators often think they may make the behavior change over the following six months, and they’re available to information and feedback. Within this stage, the pros and cons of potential change feel about equal.
“At this stage, identifying and amplifying a person’s internal motivators for behavior change — the things uniquely important to them being an individual — is very important to tipping the scales,” notes master certified life coach Kate Larsen, in Progress Not Perfection: Your Journey Matters (Expert Publisher, 2007).
Since contemplators are open to new information (unlike precontemplators, who have a tendency to reject it), they can build their enthusiasm for change by connecting to those core values or motivations, gathering information, exploring new perspectives, asking others regarding their experiences and learning from the types of those who have already made the modification they are considering. All of these discovery processes might help shift how the contemplator is thinking — an important step for making forward progress.
“Just like we have behavioral habits, we have thinking habits,” says Larsen. “And generally, those mental patterns have to shift before lasting behavior change can occur.”
Larsen encourages clients to spend a while visualizing what their lives is going to be like after the change, asking: The way I look, act and feel when I’ve made this change? What will I be doing differently? This can turn up their enthusiasm, and also help reveal unaddressed obstacles or anxieties for which they might need support.
You’re within the Contemplation stage if: You’re no more opposed to making a change in your life, but you’re still located on the fence. Your ears may perk up when you hear someone talking about related subjects. And while you’re not actively trying to find information or supportive resources, whenever you happen to stumble across them, you take a look. You’re gaining the boldness to imagine changing, and becoming more aware that it might very well be worth the effort.
Moving from Contemplation to Preparation: This can be a great time to do the low-commitment work of envisioning your better self and your better life — perhaps journaling or making a “vision board” that represents the change you’d like to accomplish. It’s also a good time to recognize that if you have been thinking about change for a while and not doing the work, there’s probably a reason: You might lack some of the necessary skills, knowledge or confidence. You might be concerned about the prospect of leaving behind familiar patterns. If so, reaching out for the support of a coach, mentor or counselor could be very helpful. Hearing the first-person accounts of others who have already made this change could be inspiring and reassuring, too.
Stage 3: Preparation
People within the Preparation stage are getting prepared to take action. They are more decisive, confident and committed; they’re developing a plan and may have already taken small steps. At this point, the pros of making the change clearly outweigh the cons — but there’s some try to be done before meaningful action can take place.
The Preparation stage is all about building confidence — and troubleshooting from the obstacles or weaknesses that stand the best chance of undermining it. This is the time to develop an “if-then” plan for the various challenges and temptations you are likely to face when you make the change, says Lickerman. It's much harder to think of success strategies and temptation-management techniques on the fly than it is to prepare for them ahead of time.
People tend to get stuck in Preparation (or ricochet backwards and forwards between it and Contemplation) when they misjudge their level of readiness or impatiently jump right to Action. That can undermine their confidence and make them wary about trying again.
At this stage, Lickerman says, “I encourage people to pick a specific day which they’ll officially begin their planned change. I keep these things make key adjustments to their environment and schedule, and rally the support of family and friends.”
This is also a great time to hire a coach, if you choose to, or to join a support group that focuses on your desired change. And now is when you want to make any other necessary arrangements: In case your goal is to start a fitness program, for example, mark your calendar with a firm date and time when you intend to begin working out, sign up for a fitness class, arrange childcare, and buy the proper shoes and workout clothes for the chosen activity.
You’re within the Preparation stage if: You’re actively gathering information, support, possibly even gear and supplies — and feel nearly prepared to take your first steps. You’re feeling motivated to learn the skills that will help you be successful in making this change. You’re inclined to simply accept appropriate support, and you welcome invitations and incentives to participate in activities that will move you forward.
Moving from Preparation to Action: This is when you sign up for that class, attend a support group, buy a health-club or yoga-studio membership, or buy a pamphlet for services that may help you make the change you desire. If you’re going to eat healthier, this might be when you begin clearing the junk food from your pantry and stocking on wholesome stuff. Any initial steps — even if they are experimental — move you much closer to Action and the sense of momentum that comes with it. Ask yourself: What, if anything, do I need to do to embrace this change in my life and be prepared for the obstacles I’m probably to encounter?
Stage 4: Action
Beyond just considering it or preparing to act, an individual in this phase has actually begun doing something (or a lot of things) differently, and may be tinkering with expanding his or her efforts. Whether or not the changes are small to date, he or she is building momentum, knowledge and self-confidence, all of which encourage continued action. “This stage is how all those small steps, small choices, and mini sacrifices make a huge difference,” notes Larsen.
During the Action stage, when individuals are working to strengthen their resolve for the change, external support is crucial, says Prochaska. Even though they may not be inclined to inquire about it, people in this stage benefit from offers of emotional and physical support, and from having people around them recognize their progress and help to keep them accountable.
Because encountering situations that trigger old, unhealthy behaviors is a real risk at this point, Prochaska advises individuals Action to consciously focus on substituting their “old ways” with healthier environments, situations and people. You might post visual reminders or inspirations on your fridge or in your cube at work to keep you focused on your goal.
But Action is an ongoing process, notes Larsen, so the focus here needs to be on progress, not perfection. “You don’t need to do everything flawlessly,” she says. “You just need to keep cultivating the willingness and positive momentum that brought you this far.” Look for ways to acknowledge your ongoing efforts, to deal with new obstacles as they emerge, and to reward yourself for even small successes, she advises. Quick course corrections and positive reinforcement can help you stay committed and motivated.
You’re in the Action stage if: You’re implementing your action plan. Perhaps you ate your first healthy meal, completed your first round of workouts, or got through your first few days or weeks as a nonsmoker. Congrats! Now you just have to keep going.
Moving from Action to Maintenance: Prochaska’s model specifies that after six months of consistent action, you transition into Maintenance. Dealing with that point mostly involves doing whatever keeps you strong, motivated and focused. Finding methods to integrate your chosen behavior become your social life and feeling of identity can be a big help.
Stage 5: Maintenance
Individuals within the Maintenance stage have managed to stay in Action mode for a minimum of six months. That means they’ve successfully avoided or overcome the obstacles that could have caused them to slip back into old behaviors. Through practice, they’ve attained a greater level of confidence and capacity. Their new behaviors have started to become a more integrated part of their lifestyle and identity, and their risk of relapse is much lower than when they began.
Yet several things can trigger individuals Maintenance to relapse: stress, crisis, apathy, boredom, a loss of revenue of environmental or emotional support, or perhaps a frustrating plateau in progress. Major life events — just like a job change, romantic breakup, location change, birth or death in the household — can also trigger a relapse.
What constitutes a lapse in maintenance depends upon the behavior change in question. To have an alcoholic who has committed to total sobriety, it might be a single drink. For those who have embarked on a fitness routine, it may mean missing a few workouts in a row.
Whenever you drop out of Action for long enough that there’s an issue about whether or not you’ll be back on track tomorrow, you’re probably stepping out of Maintenance and back into Action, Preparation, or even Contemplation. The thing to keep in mind, says Prochaska, is that “the only real mistake you can make in changing is to give up on your ability to change.”
You’re within the Maintenance stage if: For at least the past six months, you’ve been diligent and consistent in performing the actions you committed to as part of your desired behavior to alter. They now seem fairly routine.
Moving from Maintenance to Termination: Treat obstacles and unanticipated challenges as possibilities to develop new strengths. Ward off boredom by taking on new challenges and expanding your skills. Stay on the maintenance path for two years or more, rallying even through stresses and setbacks, and you’ll reach a point where you can’t really imagine ever returning to the way things were before.
Stage 6: Termination
When individuals the Maintenance stage continue their healthier behavior for at least two years, they enter into Termination (sometimes also referred to as “Adoption”). In Termination, the behavior change is completely integrated, and the temptation to revert to the former behavior is entirely gone. This element of behavior change is no longer something have to “do” — it’s just who you're.
But this doesn’t necessarily mean that the evolution is complete. People in Termination often opt to keep building on their initial change, adding bigger and broader goals and having even more success.
According to Prochaska, about only 15-20 percent of people ever make it to Termination. Still, he notes, any significant forward progress you make between the stages brings real and important rewards, for example confidence, knowledge, momentum and growth.
Until you enter Termination, hitting a wall or falling back to an earlier stage is very common. So don’t be way too hard on yourself. As long as you can identify the stage you are at within TTM, you'll always know what you need to do to get back on track, recommit to your goal making forward progress. And you’ll possess a clear sense of where you’re headed next.
You’re within the Termination stage if: After 2 yrs or more in Maintenance, you’ve been at this long enough that it now doesn’t seem like “behavior change” at all. It’s only the way you live — an integrated, almost effortless a part of who you are. You’ve likely become adept enough at the required skills and awarenesses that you’ve learned how you can apply them in new ways, perhaps to new goals in other areas of your life. You’re confident enough now within this realm that you may even coach or mentor others in making the changes you’ve mastered.
Enjoying Termination: The entire point of mastering the art of behavior change would be to create the life of your highest choosing. Successfully integrating a chosen life-style change is a clear indication that you have the skills to do that. Look for new methods for you to leverage those skills. Explore the way you might use the strength, self-knowledge and wisdom you’ve gained to undertake new areas of challenge or learning, and to be of service and support to others.
You now know a secret that few fully appreciate — that there’s more to making change than meets the eye, a lot more than those who like to invoke the “simply do it” imperative may care to admit.
“Too often,” says Prochaska, “we’ve presented people with a false choice: Take immediate action, or do nothing at all. And those are bad choices for most people. If they take action and they aren’t ready, half will fail. And when they don’t take action, they’ll continue with their unhealthy lifestyle.” The greater choice? Start where you are, go ahead and take steps forward that are appropriate for you now, and then just keep on going.
This article has been updated. It originally appeared within the November 2011 issue of expertise Life.
More on the Stages of Change
1. Precontemplation
Not ready. Not now.
What Holds You Back: A sense that making the necessary changes will require an excessive amount of work or discomfort. Hopelessness from previous failed attempts. Limiting beliefs by what is possible or permissible for you personally.
What Moves You Forward: A negative or positive life event. Becoming conscious of the negative consequences of not changing. Recognizing that benefits of changing might be worth it. Challenging old beliefs. Creating a stronger sense of self-worth and confidence.
2. Contemplation
Maybe soon – thinking about it.
What Can Hold You Back: Lacking a powerful sense of urgency or motivation. Difficulty balancing competing priorities. Fear of change. A sense that now isn't time, or that you aren't equipped to help make the change you desire.
What Moves You Forward: Feeling excited about the possibility of a positive shift in your lifetime. Connecting with core motivations. Being inspired by role models or success stories. Experiencing “last straw” negative consequences of old behaviors. A motivation or change in your environment. Learning a brand new skill or acquiring a new perspective.
3. Preparation:
Ready, taking small steps.
What Can Hold You Back: Underestimating your need to prepare, and skipping straight to the action phase without adequate skills, knowledge or confidence. Being afraid to inquire about or acknowledge that you need help. Not knowing where to turn for information and support.
What Moves You Forward: Taking initial steps, for example doing research, acquiring equipment, or engaging a coach or mentor. Establishing a start date on the calendar. Telling friends and family about your plan to change. Building excitement and confidence by accomplishing preparatory actions.
4. Action
Doing the healthy behavior.
What Can Hold You Back: Expecting tangible results too quickly. Resistance to change. Fear of failure, feeling inept. Slipping into old behaviors from stress or habit. Competing commitments. Lacking social support. Insisting on perfection instead of progress.
What Moves You Forward: Developing good support systems. Prioritizing key activities. Concentrating on action, not just outcomes. Addressing and overcoming obstacles as they come up. Celebrating small successes. Treating setbacks and challenges as opportunities for self-discovery. Evolving your goals.
5. Maintenance
Keeping on.
What Can Hold You Back: Hitting a plateau. Getting bored or distracted. Losing track of your original motivation after a preliminary success. An unexpected setback or injury. Feeling depleted, tired or overwhelmed by life events.
What Moves You Forward: Continuing to hone supportive and stress-management skills. Avoiding situations that may trigger relapse. Spending time with others who engage in the same positive behaviors or attitudes. Concentrating on refinement, awareness and mastery.
6. Termination
Change fully integrated. Not returning.
