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Change is a process. Mahoney (1991)

noted three assumptions for change:

1. Humans can, in fact, change.
2. Human can help others change.
3. Some forms of helping are more
than others in encouraging
facilitating change.


(Prochaska et al, 1992)

Pro change programs are grounded in

the proven effective Transtheoretical

Model of Behavior Change (TTM)
sometimes called the Stages of
The TTM groups the change process

into distinct stages of readiness and

provides approaches to help move
people forward through the stages.

TTM was developed through analysis of successful


changers. It has six (6) stages of change:

Stage 1. Pre-contemplation (not ready)

At this stage the person do not intend to start the

healthy behavior and maybe unaware of the need
to change.
Pre-contemplators understimate the pros of
changing, and overestimate the cons. (here they
are encouraged to be mindful of their decision
making and to be more conscious of the multiple
benefits of changing

Stage 2.



At this stage, the person is intending

to start the healthy behavior within
the next 6 months. However, they are
still ambivalent about changing which
can cause them to keep putting off
their taking action.

Stage 3: Preparation (ready)

At this stage, the person is ready to

start action say, within the next 30
days. He/she takes small steps that
he/she believes can help him/her
make the healthy behavior a part of
his/her life. For ex.,, he/she begin to
tell friends and family of his/her
desire to change his/her behavior.

During this stage, he/she is

encouraged to seek support from

trusted friends; to tell people
about his/her plan to change.
The no. 1 concern is when
he/she acts, will he/she fail? At
this stage the person learns that
the better prepared he/she is,
the more likely he/she is to keep

Stage 4: Action
At this stage there have been changes in
behavior within the last 6 months, and the need
to work hard to keep moving ahead. The person
need to learn how to strengthen his/her
commitments to change and to fight urges to slip
Strategies taught here include substituting
activities related to the unhealthy behavior with
positive ones, rewarding themselves for taking
steps toward changing & avoiding
people/situations that tempt them to behave in
unhealthy ways.

Stage 5: Maintenance

At this stage change in behavior have taken place

more than 6 months ago. It is important for people in
this stage to be aware of situations that may tempt them
to slip back into doing the unhealthy behavior
particularly stressful situations.
The person at this stage should learn to seek support
from and talk with people he/she trusts; spends time
with people who behave in healthy ways, and remember
to engage in alternative activities to cope with stress
instead of relying on unhealthy behavior.

In general, for people to progress, they

A. A growing awareness that the advantages
(pros) of
changing outweighs the disadvantages (cons).
calls this decisional balance.
B. Confidence that they can make and maintain
in situations that tempt them to return to the
unhealthy behavior. TTM calls this self-

The Ten Processes include:

1. Conciousness Raising increasing

awareness via
info, education, personal feedback about
2. Dramatic Relief- feeling fear, anxiety, or
worry due to unhealthy behavior or feeling
inspiration & hope when they hear about how
people area able to change.
3. Self-Reevaluation realizing that the
healthy behavior is an important part of who
they are and want to be.

5.. Self-Liberation believing in ones ability to change and

making commitments to act on that belief.
6. Social Liberation realizing that society is more supportive
to the healthy behavior.
7. Helping Relationships- finding people who are supportive
supportive to their change.
8. Counter Conditioning substituting healthy ways of acting
and thinking for unhealthy ways.
9. Reinforcement Management increasing rewards that
from positive behavior & reducing those that come from
negative behavior.
10.Stimulus Control using reminders and cues that encourage
healthy behavior.

Different strategies are most effective at

different Stages of Change. For ex.; Counter

Conditioning and Stimulus Control can really
help people in the Action and Maintainance
stages. BUT these processes are not helpful
for someone who is not intending to take
Consciousness raising and dramatic relief
work better for someone in pre-contemplation
Most studies conducted have involved
addictive and other problem behaviors such
as smoking cessation, excessive drinking,

Sample Statements per stage

EX. Obesity:
1. I have not thought of changing my habit of

eating chocolates and cakes. (precontemplation)

2. I am not sure if I want to give up chocolates
and cakes.
3. I am thinking about doing something about
thisI have thought about it a lot
4. I have actually tried not eating cakes and
chocolates during the birthday party of ___ & I
am consistently avoiding these for some
months already.