Transtheoretical Model of Change

by

Shelley L. Craig, Sandra D'Souza

• LAST REVIEWED: 27 June 2018
• LAST MODIFIED: 27 June 2018
• DOI: 10.1093/obo/9780195389678-0268

Introduction

The Transtheoretical Model (TTM) outlines the process of altering behavior by integrating leading principles and theories on behavior change. The TTM is comprised of a number of core constructs that include the Stages of Change, Processes of Change, Decisional Balance, Self-Efficacy, and Temptation. The previously identified Stages of Change (or readiness to change) construct is an important dimension of the TTM, as it reflects the model’s critical assumption—behavior change occurs through a series of six stages: precontemplation, contemplation, preparation, action, maintenance, and termination. The Processes of Change construct outlines the ten activities that individuals use to progress from stage to stage. Interventions that employ the TTM for behavior change should aim to accurately identify and match an individual’s specific processes of change to their stage of change to maximize efficacy. The Decisional Balance construct refers to an individual’s weighing of the pros and cons of their behavior change. Lastly, the Self-Efficacy construct outlines an individual’s confidence in their ability to not relapse when in high-risk situations that tempt them to engage in a specific behavior. Although the majority of the applications of TTM have focused on smoking cessation, the model has also been applied to other problem behaviors such as alcohol and substance abuse, eating disorders, and domestic violence. In addition to providing a comprehensive overview of the model, this article discusses the various applications of the TTM. This annotated bibliography contains a comprehensive summary of literature on TTM outlining its empirical evidence, effectiveness in various settings, limitations, and future research directions with an emphasis on resources that are relevant to social work practice.

Introductory Works

Development of the Transtheoretical Model (TTM) began in 1977 through the identification of change processes through a comparative analysis of leading theories of psychotherapy and behavior change (see Prochaska and Norcross 2018). This analysis led to the identification of the ten distinct processes of change and the framework for the TTM, however it remained as a theoretical construct with no empirical basis. It was through an initial comparative analysis of self-changers compared to smokers in professional treatments that the ten processes of change were revealed to be predictive of successful quitting (see DiClemente and Prochaska 1982). Findings from this study led to the revelation that behavior change unfolded through a series of stages, which fundamentally shaped the development of the TTM (see Prochaska and DiClemente 1983). These initial studies on smokers also rapidly expanded the TTM to include a broader range of health and mental health behaviors, such as alcohol and substance abuse, eating disorders, and depression, and demonstrated the need for staged-matched interventions for at-risk populations (see Prochaska and Velicer 1997). Over time, these studies have also validated, expanded, and challenged the core constructs of the TTM. For example, the decisional balance construct of the TTM was originally based on the model of decision making in Janis and Mann 1977, however after multiple studies this construct has become simplified to just the pros and cons of changing. The core construct of self-efficacy was integrated from the self-efficacy theory of Bandura 1982. The popular book Changing for Good, which was based on fifteen years of research on the TTM, presents the fourteen variables on which to intervene in order to accelerate progression across the five stages of change.

• Bandura, A. 1982. Self-efficacy mechanism in human agency. American Psychologist 37.2: 122 47.

  DOI: 10.1037/0003-066X.37.2.122

  Elements of Bandura’s self-efficacy theory are integrated in the self-efficacy core construct of the TTM. With regards to the TTM, the self-efficacy mechanism can be applied to reflect an individual’s confidence in maintaining their desired behavior and not relapse in high-risk situations.

• DiClemente, C. C., and J. O. Prochaska. 1982. Self-change and therapy change of smoking behavior: A comparison of processes of change in cessation and maintenance. Addictive Behaviors 7.2: 133 42.

  DOI: 10.1016/0306-4603(82)90038-7

  Using the model of change that was developed by Prochaska and Norcross 2018, this study analyzes how frequently the ten processes of change are predictive of successful smoking cessation in individuals who quit on their own or through professional treatments. Participants applied the ten processes of change differently during the stages of change.

• Janis, I. L., and L. Mann. 1977. Decision making: A psychological analysis of conflict, choice, and commitment. New York: Free Press.

  Presents a comprehensive model of decision making under stress that was the foundation for the decisional balance core construct of the TTM. A decisional “balance sheet” is an analytical model that reflects an individual’s measurement of the pros and cons of changing.

• Prochaska, J. O., and C. C. DiClemente. 1983. Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology 51.3: 390–395.

  DOI: 10.1037/0022-006X.51.3.390

  The authors conducted a study on 872 individuals quitting smoking on their own. The ten processes of change were expected to receive differential emphasis by participants from different stages of change. The results provided substantial support for the TTM and suggested important modifications for the model, as individuals were found to move through a series of stages.

• Prochaska, J. O., and J. C. Norcross. 2018. Systems of psychotherapy: A transtheoretical analysis. 9th ed. Oxford and New York: Oxford Univ. Press.

  Originally published in 1979, in the ninth edition of this pioneering work, the authors provide a comparative analysis of fifteen leading systems of psychotherapy and behavior change. They discuss the emergence of the TTM through integrating similarities and differences in the processes producing behavior change from leading psychotherapy theories.

• Prochaska, O., J. C. Norcross, and C. C. DiClemente. 1994. Changing for good. New York: Avon Books.

  This classic book discusses how behavior change is not linear, but rather occurs through stages. The authors provide informative case studies and examples of each stage and process, and highlight how the applications of the TTM can be expanded to help individuals overcome a variety of bad habits. Although published in 1994, this book has been used in many programs involving behavior change.

• Prochaska, J. O., and W. F. Velicer. 1997. The transtheoretical model of health behavior change. American Journal of Health Promotion 12.1: 38–48.

  DOI: 10.4278/0890-1171-12.1.38

  Provides in-depth overviews of the core constructs of the TTM, including basic research support for each construct and the applications of stage-matched interventions. In contrast to earlier versions of the TTM that viewed relapse as a separate stage, the authors clarify that relapse is the return from action or maintenance to an earlier stage. The positive outcomes of computer-based programs that are stage-matched to an individual are also discussed.