Stages of Change Model
The Stages of Change model was first developed by researchers in the field of addiction. They found that people who overcame their various addictions (alcohol, drugs, overeating) generally moved through six identifiable “stages” as they changed their thoughts and behaviors. It quickly became evident that these stages of change were applicable in many types of positive behavioral change. The Stages of Change Model has been used to assist people with everything from managing their diabetes to leaving an abusive relationship.
The six stages of change are:
- Relapse or Termination
Individuals in the precontemplation stage of change are not even thinking about changing their behavior or environment. They may not see it as a problem, or they think that others who point out the problem are exaggerating.
Factors that often keep a person in Precontemplation are referred to as the “the Four Rs” — reluctance, rebellion, resignation and rationalization:
- Reluctance The impact of the problem has not become fully conscious. The person lacks awareness of the severity of the problem and they have not recognized that their state of discomfort is related to the addiction, or relationship, or other issues.
- Rebellious Precontemplators have a heavy investment in their addiction or relationship, and in making their own decisions. They are resistant to being told what to do.
- Resigned Some Precontemplators have given up hope about the possibility of change and seem overwhelmed by the problem. Many have made attempts to change but “nothing works.”
- Rationalizing Precontemplators may feel they have all the answers; they have plenty of reasons why the problem is not a problem: “Lots of people drink after work, why are you on my back?” or they justify that their partner treats them poorly because “He had a bad childhood” or “He doesn’t mean it, he just has a lot of stress.”
Individuals in this stage of change are willing to consider the possibility that they have a problem, and the possibility offers hope for change. However, people who are contemplating change are often highly ambivalent. They are on the fence. Contemplation is not a commitment or a decision to change. People at this stage are often quite interested in learning about their problem.
In the contemplation stage, often with the help of a treatment professional, people make a risk-reward analysis. They consider the pros and cons of their behavior and situation, and the pros and cons of change. They think about the previous attempts they have made to change, and what got in the way.
Deciding to change the specific problem is the hallmark of this stage of change. All the weighing of pros and cons, all the risk-reward analysis, finally tips the balance in favor of change. Not all ambivalence has been resolved, but ambivalence no longer represents an insurmountable barrier to change. Individuals in this stage appear to be ready and committed to action.
This stage represents determination as well as preparation. The next step in this stage is to make a realistic plan. Commitment to change without appropriate skills and support can create a fragile and incomplete action plan.
Often with the help of a treatment professional, individuals will make a realistic assessment of the level of difficulty involved in a life change. They will begin to anticipate problems and pitfalls and come up with concrete solutions that will become part of their ongoing change plan.
Individuals in this stage of change put their plan into action. The decision has been made and specific steps are within reach. A person in the action phase will likely have supportive people or programs that can help, hold them accountable, and cheer them on. However, there may be people who try to sabotage or hold back the changing person, people who may secretly, or not so secretly, hope the person will fail. A solid plan involves ways to work around any negative influences. People who make and maintain positive, healthy changes for themselves have learned that special sense of pride in proving the naysayers wrong!
Nothing succeeds like success. A person who has implemented a good plan begins to see it work, making adjustments over time. The many joys that a substance or bad habit or toxic relationship may have taken from the person begin to be restored, along with hope and self-confidence and continued determination to be healthy.
Change requires building a new pattern of behavior over time and continues its own momentum. These different stages and changes can take days, months, or years. Timelines are different for everyone. Whatever pace you are going is the right pace for you!
Maintenance is the stage when a person can maintain their changed behavior over a sustained period of time. New behavior becomes self-sustaining and takes the place of the problem and associated behaviors.
The real test of change is long-term sustained change over many years. This stage of successful change is called maintenance. In this stage, the healthy new life is becoming firmly established, and the threat of a return to old patterns becomes less intense and less frequent.
The possibility of relapse is always present. Individuals may experience a strong temptation to drink or return to the abuser. Sometimes relaxing their guard or “testing” themselves begins a slide back. A person trying to maintain their sobriety or self-esteem may encounter many influences to return to their old ways: “Don’t ruin the party by not drinking the champagne” “Don’t be disrespectful to your mother by not eating seconds” “Divorce is a sin/failure/selfish,” etc. People at this stage of change are armed with a variety of relapse prevention skills. They know where to get the supports they need. Even so, relapse can happen. A relapse is not a failure, it is part of that person’s change journey. Returning to health after a relapse often strengthens a person’s resolve to stay healthy.
The goal in the change process is termination. At this stage, the substance, habit or relationship no longer presents a temptation. A person in this phase has no desire for the substance or relationship or other problem. They can’t imagine being in that past unhealthy place again.
The costs of the problem behavior (such as drug use or an abusive relationship) are not yet recognized. The individual is in denial and is not seriously considering changing their behavior. Their focus is often on justifying the problem.
The individual is experiencing ambivalence about change. They can see reasons to change their behavior, but they are still hesitant. The problem behavior continues.
The individual has decided to change their behavior, and they begin to think about how to do so. During this stage they will begin to make minor changes to support their goal, but they might not have completely ended the unwanted behavior.
Significant steps are taken to end the problem behavior. The individual might be avoiding triggers, reaching out for help, or taking other steps to avoid temptation.
The changes made during the action stage are maintained. The individual may continue to face challenges, but at this point they have successfully changed their behavior for a significant period of time.
Relapse and/or Termination