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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.
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