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Introduction
The Stages of Change
How to Use the Stages of Change Model
Overview
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What Are the Stages of Change and How do they Relate to Treatment?
In recent years, researchers into therapeutic change for psychological problems have come to realize that individuals who suffer from psychological problems are at different points of readiness to change. This idea is based on the observation that change occurs only when the individual seeking change is willing to engage in those behaviors that result in change. Depending on the type of therapy that has been selected or the type of symptom being targeted, the requirements for action on the part of the individuals who seek change may vary. Because the type of behavior demanded may differ, the willingness of the individual to engage in those behaviors may also differ. For example, one treatment approach for panic disorders may require a person to examine and disclose to a therapist intimate details of his/her thoughts and feelings in an attempt to uncover factors believed to be at the root of the panic problem. In another treatment approach based on a biological view of panic attacks, the behavioral requirement may be to take medicines on a prescribed basis. In this latter case, the panic sufferer must be willing to take the medicine as prescribed. In the approach advocated in our intervention-based on cognitive and behavioral principles-the panic sufferer must be willing to learn and apply coping strategies. They must then be willing to apply the strategies systematically in increasingly threatening situations. Sometimes the panic sufferer may be willing to learn the coping strategies, but they are not ready or willing to try them in previously avoided situations. These differences in readiness to take an active part in the change process are referred to as the Stages of Change.
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The Stages of Change
The stages of change have been divided into five levels:
- Pre-contemplation. At this level, the individual may or may not be aware that they have a problem, even though a problem may be obvious to others. Such is the case, for example, when someone has a drinking problem but its negative consequences are not apparent to the one abusing alcohol, only to his friends and family. Whether the individual is or is not aware of a problem, he remains in the pre-contemplation stage until he starts to actively consider changing the problem. Such individuals may even attend therapy sessions at the request of someone else with no intention of changing their own behavior.
- Contemplation Stage. In this stage, an individual acknowledges she has a problem and actively considers some behavioral change to help in alleviating the problem. Such a change may involve seeing a therapist, talking to a friend, or taking medications. It may involve thinking about buying and reading a self-help book. In this stage the individual is thinking about the problem and weighing the pros and cons of changing it. Another definition of the Contemplation Stage is that one has a timeline equal to or less than one month for beginning to change. In the Contemplation Stage, an individual is not yet seeking to change or even preparing to change. She may as yet still be unconvinced she has a problem requiring attention. Change in such a case may mean seeking out information to determine if she has a problem that needs to be addressed.
- Preparation Stage. In this stage, an individual takes specific steps to prepare to make changes. He may make an appointment with a therapist or identify a specific plan to begin a program of change. He may seek out information preparatory to taking more specific action steps for change. Another definition of the Preparation Stage is a timeline of a week or less for taking specific action.
- Action Stage. In this stage, the suffering individual is actively engaged in the prescribed intervention program. In one form of therapy, she would take her prescribed medications as directed. In another, she may actively explore her conflicts or be actively involved in conflict resolution. If a person with a panic problem were utilizing our cognitive-behavioral approach, she would learn and practice coping strategies, first in situations of low threat and then in situations of increasing threat.
- Maintenance Stage. In this stage, many of the goals of therapy have been achieved and the individual is engaged in an active program to maintain the changes. Such a program would likely include becoming aware of factors that contribute to relapse and taking active steps to deal with those factors. In the case of an alcoholic who was no longer drinking, such relapse-prevention tactics might take the form of continued attendance at meetings of Alcoholics Anonymous. In the case of a panic disordered individual who no longer had panic attacks, it might take the form of placing himself in situations of high threat, of establishing a support system, or in helping others deal with their panic problems.
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How To Use the Model
Several principles are helpful in putting the Stages of Change model to best use:
- Be aware that there are different stages of change. Armed with this awareness, you can better understand your own readiness to make changes in your life. You will also have increased awareness that it is you who have to engage in behaviors that result in change. Even when taking medications, you may need to work actively with your physician to determine the most effective dose and schedule. It is then your role to make every effort to maintain the dosage schedule. When utilizing psychologically based change techniques, it is important to know your level of readiness. Such knowledge can help determine what you have to do to ensure you stay on the road to self-improvement.
- Be aware that the strategies you select to use and the sequence you identify to sequence these strategies will be enhanced by the awareness of your stage of change. Such awareness will include:
- recognition that you cycle through different stages and can simultaneously be operating at more than one stage; and
- recognition that coping strategies can be matched to stage of change.
In trying to match strategy to change, consider the definitions of each stage and then try to apply the techniques of the approach you have chosen to the stage you are in. As an example, consider our cognitive-behavioral approach to the treatment of panic. Almost all panic sufferers go through a period of being unaware or unsure of what problem they actually have. In this stage-pre-contemplation or contemplation-you may accidentally come across an article or television show that makes you aware that you have a problem. You may then enter the Preparation Stage and buy a book on panic or make an appointment to see your physician. When convinced that you have a problem to deal with, you may then decide to take specific action and consult an expert for how to order your plan and carry it out. Finally, after having achieved your goals, you need to realize the potential for relapse and take steps to prepare for such an occurrence.
- Be aware that the stages of change are not fixed in concrete. Rather than proceeding uniformly from one stage to the next, you are likely to cycle back and forth between stages or even to be at two or more stages simultaneously. Again, being aware of such cycling can reduce discouragement when you find yourself wondering if the treatment program you have started is really the one you should be pursuing. In such circumstances, you may cycle between the Contemplation, Preparation and Action stages. Such cycling requires the identification of strategies appropriate to the stage in which you are operating.
- Be aware that therapy or change programs are also organized hierarchically. This means the tasks you face and are required to master will change as the intervention proceeds. In the cognitive-behavioral approach for panic discussed in our manuals, you are first provided with information, followed by specific techniques you are required to practice and learn, and then a series of applications of these techniques. Moving from one intervention stage to another often produces a change in your stage of change. For example, you may decide to purchase and read our materials. They may represent an Action Stage behavior. Next, having read the materials, you may find your fears reduced with no interest in learning the specific coping strategies. You have returned to the pre-contemplation stage. If you experience another panic attack or find yourself avoiding situations, you may decide further action is needed and begin to learn and practice the strategies. You have returned to the Action stage employing a whole new set of behaviors.
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Overview
The Stages of Change is an important concept for planning your self-change program. It helps you understand where you are in the process of change. It then allows you to better understand and plan your treatment program. The materials offered in our Panic Solutions program are integrated in the Stages of Change model. Thus, information (pre-contemplation, contemplation and preparation stages) is provided first. The information is provided in the form of feedback from the initial assessment and in the first few chapters of the book Coping With Panic. Information is followed by specific strategies (preparation and action stages) that are included in the Coping With Panic book, as well as a program for implementing these strategies, provided in the Workbook to Accompany Coping With Panic. After you have completed the program - approximately 8-weeks later - you take a second assessment that provides additional information comparing your progress with others in our program. This information provides you with a basis for deciding whether to continue the intervention process (action stage). Finally we provide you with additional strategies to prevent you from having a relapse (maintenance stage). The entire program is designed to take you through each of the five stages of change.
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