Researchers in the 1970s created a “model of change” to help people stop harmful behaviors. Today, the model is useful for preventing habits from worsening.
When the transtheoretical model (TTM) was developed in the 1970s and early 1980s by researchers James O. Prochaska and Carlo DiClemente, it was revolutionary in its explanation of how behavioral change can take root and how it’s maintained over time.
TTM became popular in substance use disorder treatment.
But research from the early 2000s questioned whether TTM was helpful in this way, because of the difficulty in pinpointing a person’s readiness to change.
Another criticism was that TTM excluded people who succeeded in quitting an addiction cold turkey. Yet another criticism noted that TTM may oversimplify substance use disorder and recovery.
The TTM gauges a person’s readiness to change and the likelihood they will continue that change forward.
There are six stages of change in this framework. It begins with no desire to change and ends with maintaining new behavior and the completion of treatment.
The stages of change may be most effective by defining what each level means to you, how your experience fits into a stage, and whether you can preemptively adopt a behavior change.
I need to change my behavior. How can TTM help?
To make a long-term behavioral change using TTM, first identify your present stage. A therapist or psychologist may be best able to help identify which stage you’re in:
Once you’ve done that, you can speak with a professional who specializes in the type of change you want to make.
You can learn about behavior-changing programs and which one will assist you in your particular path, and you might be motivated to commit to following it.
Like G.I. Joe says, “Knowing is half the battle.” TTM helps you know where you are, and what stages you can look forward to next.
What are the stages of change?
The stages of change identify a person’s readiness to make behavioral changes in their life. The stages range from denial to acceptance. Going back to the behavior, or relapse, may occur. A person may cycle through the stages of change more than once on their journey, too.
There are six stages of change in the TTM:
This stage is marked by denial. Folks at this juncture have not acknowledged that there’s problematic behavior.
Someone, like a therapist, friend, or family member, may have hinted at there being an issue or cause for concern, but you don’t believe them yet.
The indecision is real at this stage. You might be wavering if you can or should try to change the behavior, and what losing it may mean for everyday life.
You could be making a pros and cons list. Maybe you’re speaking with a therapist, family member, or friends about what might change in your life.
When considering changing a behavior, visualizing yourself having made the change — or not — in the future can help you decide next steps.
When you’ve decided to make a behavior change and are ready to take action, you’re in the prep stage.
You might still be gathering facts about the exact method you will use to make your change, such as finding a support group.
You’re actively changing in this stage! You’ve put the pedal to the metal.
You may be attending a support group, openly discussing your new behaviors with family and friends, referencing the negative behavior in the past tense, and keeping track of your progress.
In the maintenance stage, you’re focused on keeping the changes you’ve made for the long term. You’ll be working to keep your forward momentum so you don’t regress to old habits.
Your focus may shift from making changes and reinforcing them to changing your environment and enlisting support. At this point, you likely understand that life stressors may make adhering to the changes you’ve made more difficult, and so you may create action plans to help you manage stress.
In this stage, you might, after a length of time, stop active treatment.
In this stage, the old behavior is fossilized in your past. The habit may have lost its appeal entirely. You’re certain you won’t go back to it.
Not all TTM programs agree that termination is the final stage, as lapses are understood to be part of the journey in ongoing recovery.
Stages of change examples
Let’s say a doctor tells someone that they’re at risk of developing heart disease unless they make healthier choices, like daily walks and a better diet. Here’s what the stages may look like for them:
- Precontemplation. The person may initially think there’s nothing wrong with them, and that their doctor is overreacting to one bad test result.
- Contemplation. They start asking folks close to them, who have tried overhauling their own health habits before, for advice. They might also start making a pros and cons list about switching to a nutritious diet and exercising daily.
- Preparation. They start looking up specific heart-healthy diets and researching exercise programs that will work for them.
- Action. They begin a new nutritious meal plan and a daily workout.
- Maintenance. As unhealthy behaviors are incrementally replaced with healthier ones, they may join a support group to discuss keeping up their efforts long term.
- Termination. Finally, they’re able to experiment with other nutritious diets and dive even deeper into more rigorous workout plans. They’re fully committed to living with these changes.
The processes of change in the TTM is the work a person does to progress through the stages of change.
These are where a person’s motivations to change become actions.
Processes within TTM include:
Making a commitment to change is a public acknowledgment of your willingness to switch up your behavior. But it also represents a belief in yourself — that you will change and maintain that change.
This is swapping unhealthy behaviors for healthy ones. For example, if you’re committed to stop smoking, you may call a friend instead of smoking a cigarette when you go for a stroll.
Treat yourself for following through with healthy habits. For example, each day you don’t engage in negative self-talk, you might snap a happy selfie or buy a refreshing beverage at the local coffee shop.
You might try to avoid places that will trigger the behavior you’re trying to change, and find places that encourage your new, healthy behaviors.
For example, if you’re trying to stop drinking, that could mean not going to a favorite neighborhood bar or restaurant that serves alcohol, and trying a new juice bar or coffee shop instead.
To set yourself up for success, you can also consider making adjustments to your home environment so it’s full of foods and items that can contribute to your mental health and well-being.
You can surround yourself with people who support the changes you’re making as well.
You may want to observe how the modifications you’re making affect the people around you. Embrace the people who react positively to your behavior changes.
The transtheoretical model (TTM) of change, introduced in the 1970s, was based on its creators’ observations of people trying to change substance use behaviors.
The TTM combined different psychological theories to present a new way of treating substance use disorders.
But ultimately, it’s been shown to be more effective at preventing habits before they solidify into a condition.
Depending on your readiness to change a behavior, you could fall into one of six stages of change, and treatment can be tailored to your openness for change.