characteristics, the next challenge was to understand how one could move

from one stage to the next. To explain this complex movement, they

identified ten different processes and the stages where they seem most

relevant.

The ten processes (and some examples of how the different forms they could

take in an intervention) are:

1. Consciousness-raising ? locating and learning new facts and suggestions

supporting the change (e.g., reading a book; watching a TV show; talking

with a friend, teacher, or doctor)

2. Dramatic Relief ? experiencing and expressing negative feelings about a

person's problems such as worry or fear (e.g., communicating with a friend,

partner, partner, counselor; writing in a journal)

3. Self Re-evaluation ? realizing that the behavioral change is part of a

person's identity (e.g., seeing yourself as a non-tobacco user or a fit

person)

4. Environmental Re-evaluation ? assessing how a person's problem affects

the physical environment (e.g., realizing that second-hand smoke may affect

non-smoking children and partners or even pets)

5. Self Liberation ? selecting and committing to act on a belief that change

is possible (e.g., making a New Year's resolution); accepting responsibility

for changing.

6. Social Liberation ? societal support for healthier behaviors (e.g.,

smoke-free workplaces; discussions about safer sex in school and

communities)

7. Counter-conditioning ? substituting healthier alternatives for problem

behaviors (e.g., using relaxation or meditation techniques instead of eating

to deal with stress)

8. Stimulus Control ? avoiding triggers and cues (e.g., avoiding bars,

friends who still smoke, dessert parties)

9. Contingency Management ? increasing the rewards of positive behavioral

change and decreasing the rewards of the unhealthy behavior (e.g., buying

new clothes after losing weight instead of eating dessert)

10. Helping Relationships ? seeking and using a strong support system of

family, friends, and fellow employees.

In addition to the stages and processes, the model features several other

unique insights:

? Decisional Balance: Weighing Pros and Cons. Prochaska and DiClemente

understood that at each stage, an individual weighs the pros and cons of

adopting a new behavior. For precontemplators and contemplators, the cons

loom large. They may feel the change is too challenging or not worth the

effort. Giving up pleasures ? be they food, alcohol, tobacco, or just the

pleasure of being a couch potato ? is a lot to ask. For most behavior

changes, the sacrifices are immediate but the benefits are not.

Prochaska and DiClemente call this weighing of pros and cons "decisional

balance." For counselors, health educators, and others who want to intervene

in the change process and assist individuals move along its continuum, the

task is to tip the scales: to make the pros outweigh the cons.

? Self-efficacy. Self-efficacy ? the confidence that one will be able to

take action ? is a feature of many health education and health promotion

models. It is incorporated as a primary element of the Stages of Change

model since one of the pros that outweighs the many cons eventually takes

the form of confidence that one can try the behavior change and sustain it.

Confidence can be built in a variety of ways ? such as role playing and

preparing for situations that may be challenging, or practicing individual

skills (such as negotiation or refusal), or even giving oneself pep talks

("You've done this before ? you can do it again!").

? Temptation. As mentioned previously, relapse is built into the Stages of

Change model as a realistic sense that change is challenging and that a

combination of cravings, emotional stress, and social situations or prompts

can lead us back to old habits. Instead of viewing these events as failures,

however, the model asks us to learn from each relapse: to recognize the

signs of craving for what they are, to remove ourselves from social

situations that don't support our behavior change, and/or to deal with

stress in other ways.