Stages of Readiness to Change

There are a series of stages through which people pass in making changes in their behaviors. At each stage a person is thinking and feeling differently about the problem behavior and finds that different processes and interventions help them move on to the next stage.

The model can be pictured in a diagram as a circle. Before entering this cycle of change a person can be said to be in pre-contemplation. Pre-contemplators are not interested in change. Sometimes this is because they do not see their behavior as a problem. Sometimes they do not know that it is causing, or putting them at risk of problems. Sometimes, even though they may be fully aware of the risks, they may value it so much for other reasons that they do not wish to change. For some others, previous failed attempts at quitting make them believe that they cannot change.

Raised awareness or concern about the risks and problems can lead to the person moving into contemplation. In this stage the person is torn two ways – aware that he or she ought to change but still feeling attached or drawn to the behavior. They are not ready to change yet and may stay for years, continually thinking about change. Those in preparation are planning to take action very soon. They are beginning to make small changes and trying out different ways of behaving. They may tell others about their intention to change and make clear plans on how they are going to do it.

In action people visibly make changes and put considerable effort into it. This is often the time that people seek out professional help. This action phase is followed by maintenance in which change in behavior is continued and consolidated, temporary changes become part of a more settled pattern. Unless this consolidation takes place the person may move into relapse and return from there to pre-contemplation or contemplation.

Successful changers move systematically through all the stages until maintenance, where they consolidate the change sufficiently to exit the cycle. The change becomes an established new way of life.

Processes helpful in change

In order to change their behavior people also need to change many other aspects of their lives. While the modification of the target behavior – in this case stopping tobacco use – is the most visible change and receives the most attention, other less visible changes that they make, help to move from one stage of change to the next.

There are nine key processes that people seem to apply to their problems as they go through the stages of change:

i). Becoming informed (Consciousness raising): Becoming aware of one’s own behavior patterns by keeping a smoking diary or feedback from others (physician) about the relationship of their tobacco use to their personal consequences or even reading health information material. People use consciousness-raising most in the pre-contemplation and contemplation stages.

ii). Increasing alternatives (social liberation): This is an external supportive force arising out of environmental changes. Such changes may influence people in different stages differently. If offices, restaurants or trains are made ‘No Smoking’, pre-contemplators may become more aware of how important smoking is to them and how difficult it is to pass a few hours without smoking. This in turn may raise their consciousness about their dependence on the habit. People in the maintenance stage might find it supportive in finding a risk-free environment at a high-risk point in their day.

iii). Emotional arousal: A major emotional experience triggered by tragedy in someone’s life (People often report that ill health or death of a relative moved them from pre-contemplation into contemplation). Films and dramatic recreations in role-plays can also provoke emotional arousal. This process is most useful in contemplation and preparation.

iv). Creating a new image (self-re-valuation): Thinking through how one perceives oneself, what one’s important values and goals are and how the ‘problem’ behavior fits in with, or conflicts with these. This involves weighing the costs of the behavior and the benefits of changing. Most often used in the contemplation and preparation stages.

v). Commitment: Comes with accepting responsibility for choosing to make changes and taking appropriate action and is important in the preparation and maintenance stages. Publicly announcing the decision to stop, to family and friends creates social pressures to support the change.

vi). Rewards: People can reward themselves for making change by using self-praise, eliciting praise from friends or colleagues or gifting themselves and others with the money saved from not buying tobacco. In the action phase, such rewards are most important as the intrinsic benefits of the change take time to become evident. In fact immediately after stopping people feel worse not healthier until a few weeks, when the changed behavior begins to provide its own rewards.

vii). Using substitutes (Countering): Substituting healthy or harmless behaviors for the one who is trying to give up is very effective in the action and maintenance stages. Mood changing activities (listening to music, physical or relaxation exercises) are a way of countering the emotional need previously provided by the nicotine high. Any activity distracting from thinking about or craving for tobacco is another.

viii). Environmental control: Controlling one’s environment in order to reduce temptations or triggers to use are helpful in the action or maintenance stage. Not drinking alcohol which is tied to the smoking behavior and would lower one’s inhibition and vigilance, or throwing away all ashtrays, which are likely to remind one of the previous behavior, are examples. Others may write themselves notes and reminders and put them in the pocket that held the tobacco or in strategic places at home or work.

ix). Helping relationships: Anyone can provide a helping relationship; health professionals, family members, colleagues and friends or members of self-help groups. Such help is supportive in all the stages. People need different types of help at different stages (e.g. someone to listen and ask pertinent questions to help self-evaluation, or someone to provide rewards).