People know that smoking is bad for their health, but still choose to smoke. People know they ‘should’ go for that run, but still choose to sleep in. People know that the McDonalds drive through is not the healthiest option for dinner, but still use it on a Friday night after work. People are informed and educated around healthy behavioural choices, however still make unhealthy choices. Even when an individual has a serious health scare, they still may not want to change or know how to change the behaviours that have led them to their condition.
The Transtheoretical Model (Stages of Change) can explain why.
Social psychological research into dietary change and levels of physical activity are often the forgotten piece in understanding how to promote healthy behavioural change, long term.
Health Behaviour Models
The contribution of social psychology is now becoming more and more influential in affecting long term dietary and exercise change. The most important contribution has been the advancement and application of various health behaviour models to initiate and promote change.
Some of the most popular models of health behaviour include: the health belief model; social cognitive theory; protection motivation theory; the theory of planned behaviour; and finally, and importantly, the transtheoretical model of change.
The Transtheoretical Model of Change (Stages of Change Model)
Developed by Prochaska and DiClemente, the model’s central concept is that all individuals pass through similar stages of change regardless of the problematic behaviour that they are trying to change.
These stages are:
- Pre-contemplation
- Contemplation
- Preparation
- Action
- Maintenance
With relapse common in the attempt to maintain any new behaviour.
Think of a current behaviour in your life that is potentially unhealthy. It doesn’t need to be anything too sinister; perhaps your partner has been telling you to drink less wine during the week, or you’re staying up past midnight binging on Netflix, or you’ve only exercised once in the past month. Look at each stage outlined below and see if you can identify which stage you are currently in, where you have been, and most importantly, where you would like to be!
Pre-contemplation: This is where a person has little to no awareness that their current behaviour is unhealthy or problematic. People in the pre-contemplation stage have no intention to change their behaviour in the foreseeable future. This is your husband or wife who you have desperately wanted to exercise for the past ten years, and despite your every attempt to change his or her behaviour, they haven’t even walked past the gym!! They’re thinking… “What problem?! It’s not a problem!”
Contemplation: This is where a person is thinking about making a change, but they haven’t yet taken any kind of action. This may have been you before joining the gym. People in contemplation see the advantages and disadvantages of their problematic behaviour… “I know that half a bottle of red wine each night isn’t great for my waist line, but it really helps me to relax once the kids have gone to bed.” Sound familiar?!
Preparation: This is the third stage where a person shows intent to act and has gone about planning for changing their behaviour. This may have been you when you hired a personal trainer and started arranging for a regular time to be available in your week for exercise.
Action: Once a person is engaging in their new healthy behaviour, they are in action. For example, doing your first exercise session!! This is also known as the “doing” stage.
Maintenance: Once a person has continued with their new behaviour for 6 months or more, they are in the final stage of change.
Relapse: A relapse or a ‘lapse’ is a normal part of changing an unhealthy behaviour. A relapse is defined as going back to the problematic behaviour (or worse), whereas as a ‘lapse’ is like a little slip up. The important thing is to learn from any lapses or relapses by identifying the trigger, and then putting strategies in place for preventing another one from occurring in the future.
As you pass through each identified stage of change, so too does your level of self-efficacy. In other words, once you progress to maintenance (especially if you have been following a detailed program) you will find it easier to identify and overcome any common barriers in the future. Therefore, when you relapse or lapse (which is very normal), you can re-implement your new learnt and healthful behaviours. The goal is to move towards maintenance, while increasing your levels of self-efficacy.
It is important to note however, that ‘at-risk’ populations are often not prepared for the action stage and will not be served by traditional educational programs. Therefore, helping people set more realistic goals and assisting them in moving towards action with a trained professional is a very important step in this process. Professionals who have the right skills can guide you in changing your thinking and attitudes.
If you have issues with self-worth, or anxiety around changing your behaviour, or perhaps a belief that prevents you from acting, this is completely normal! Seeing a psychologist may be a crucial step for you in changing your problematic behaviour. Psychologists are well trained in dealing with ambivalence. It is very common for people to be ‘stuck’ in the contemplation stage. If this sounds like you, a psychologist can guide you in working through the pros and cons of changing your behaviour and collaborate with you to start preparing for change.
Take Home Message
Changing life long behaviours and creating new healthy habits can be incredibly difficult. The first and most crucial step to the process is about identifying the behaviours in your life that are problematic. If you believe that you don’t have the ability to change, it is recommended that you seek professional help from a psychologist to guide you in commencing the process of change. Everybody can change a problematic behaviour; you may just have to change your attitude towards the behaviour first!
Simone Chartres is an endorsed Clinical Psychologist with the Australian Health Practitioner Regulation Agency (AHPRA). She has over 10 years of clinical experience working with young people and adults with complex presentations in the public and private sector. Simone has extensive clinical experience in the assessment, diagnosis and treatment of anxiety disorders, mood disorders, substance use disorders and eating disorders.