Prochaska's 6 step model

• Prochaska’s model of behaviour change

  Prochaska and DiClemente (1983) noticed that smokers’ behaviour changed during the time that they were trying to quit. The six stage model recognises that overcoming addiction does not happen quickly or necessarily in a linear fashion. 

  It is a cyclical process - people progress through stages but can also return to previous ones, some stages may be missed altogether and some never reached
• Prochaska’s model of behaviour change

  The model is based on two major insights:

  1. People who are addicted differ in how ready they are to change their behaviour. Some are thinking about it, some are already doing something about it and some have decided to do nothing.

  The usefulness of treatment intervention depends on the stage the person is currently in. Some interventions will be most effective at an early stage but less useful later on.
• What is the first stage of behavior change?

  Precontemplation
• What does "Ignorance is bliss" signify in the precontemplation stage?

  The person is unaware of the need to change
• How long does a person in the precontemplation stage plan to change their behavior?

  Not within the next 6 months
• What is the second stage of behavior change?

  Contemplation
• What does "Sitting on the fence" mean in the contemplation stage?

  The person is considering changing their behavior
• Stage 1 - Precontemplation

  People in this stage are not thinking of changing 

  their behaviours in the near future. 

  This may be due to denial ‘I don’t believe I have a problem’ or demotivation ‘I’ve tried to quit before and never managed it’. So the person doesn’t intend to try again. 

  Intervention at this stage should focus on helping the addicted person consider the need for change
• How soon does someone in the contemplation stage think about changing their behavior?

  Within the next 6 months
• What is the third stage of behavior change?

  Preparation
• What does "OK I’m ready for this" indicate in the preparation stage?

  The person is ready to change their behavior
• What is the time frame for behavior change in the preparation stage?

  Within the next month
• What is the fourth stage of behavior change?

  Action
• What does "Let’s do this" signify in the action stage?

  The person has taken steps to change behavior
• How long has the person changed their behavior in the action stage?

  In the last 6 months
• What is the fifth stage of behavior change?

  Maintenance
• What does "Stay on track" mean in the maintenance stage?

  The behavior change has been sustained
• Stage 2 - Contemplation

  Someone at this stage is thinking about changing their behaviour in the next six months. 

  They have not decided to change but are increasingly aware of the need to (the benefits) but also of the potential costs. 

  People can stay in this state of chronic contemplation for a long time so the most useful intervention at this point would help the person finally weigh up the pros over the cons of quitting
• How long must the behavior change be maintained in the maintenance stage?

  For more than 6 months
• What is the sixth stage of behavior change?

  Termination
• What does "I’m free!" signify in the termination stage?

  The behavior change is now automatic
• What does it mean when a person no longer relies on their addiction in the termination stage?

  They have achieved automatic behavior change
• Stage 3 - Preparation

  Now the individual believes the benefits are greater than the costs so decides to change their addiction behaviour in the next month

  The most important thing to consider is that the person has not yet decided HOW to change their behaviour! 

  The most useful intervention therefore is supporting the person is constructing a plan of change and presenting them with options
• Stage 4 - Action 

  People at this stage have done something to actually change their behaviour.

  It is at this stage that cognitive and behavioural therapies may be the most effective. 

  Effective intervention at this stage focuses on developing coping skills the client will need to quit and maintain their behaviour

  A note on significance of this change

  The change taken by the client must substantially reduce their risk i.e. throwing away all their cigarettes or pouring all their alcohol down the sink - they can’t only slightly reduce this - it has to be fairly significant
• Stage 5 - Maintenance 

  The person has maintained some change of behaviour for more than six months. 

  The focus now is on relapse prevention, avoiding situations where cues might trigger the addiction. The person becomes more confident that abstaining can be continued in the longer term because it’s genuinely becoming a way of life.

  Intervention focuses on relapse prevention and aims to help the client apply the coping skill they have learnt and use sources of support available to them
• Stage 6: Termination 

  At this stage, newly acquired abstinence behaviours become automatic. The person no longer returns to their addiction to cope 

  This stage might not be possible or realistic for some people to achieve. 

  It may be that the most appropriate goal for many is to prolong maintenance for as long as they can, accepting that relapse is inevitable but being aware and continuing to use the support systems and coping skills they have developed to work through the stages again as and when they can

  No intervention required
• AO3- Evaluation

  (+) Dynamic process

  This model views recovery as a dynamic process. Earlier theories by comparison tend to very recovery as a single ‘all or nothing’ event (also the general societal view). 

  In contrast the six-stage model emphasises the importance of time - overcoming the addiction in a continuing process. 

  This is why the model suggests that the six stages vary in duration for each person. People move through them in the same order but not in a linear way necessarily. 

  This model is therefore a very realistic view of recovering from addiction
• AO3- Evaluation

  (+) Positive view of relapse

  Another strength is the model views relapse realistically

  The six stage model does not view relapse as failure but as an inevitable part of the non-linear, dynamic process of behaviour change. Even so, relapse is more than just a slip, so the model also takes it seriously. 

  Recovering from addiction often requires several attempts to get right and this model acknowledge that well. Therefore it has good face validity with clients and is more acceptable because they also learn to view relapse realistically
• AO3- Evaluation

  (-) Contradicting research

  However, there is evidence that challenges this model. 

  Taylor et al. (2006) conducted a major review for NICE analysing 24 reviews and meta-analysis of the six stage model. They concluded that the model was no more effective than appropriate alternatives i.e. the TPB in changing nicotine related addiction behaviour. 

  Even more critically they also concluded that the concept of defined stages in behaviour change could not be validated by available data. 

  As such the overall research picture is negative, despite optimistic claims about the model