Stages of Change

Stages of Change
Egg, Larva, Pupa, Butterfly . . .

If you’re sexually active, do you remember the first time you had sex?

(If you don’t, stop reading this right now and seek professional help. You have a serious memory problem. And don’t use those herbal cures you see at GNC shops. Those herbs will cause hair loss. Or else they grow hair on your feet, I can’t remember which.)

Of course you remember. Okay, now the first time, did you use a condom? Have you ever used a condom? Do you know what a condom is?

Yeah, this is a real mixed bag. Some people have never even heard of a condom. Some people are interested and learning more about how effective they can be. Other folks are making plans; yeah the next time, stop by the pharmacy and pick up a pack. Some people are actually using them sometimes. And other people always use them. In other words different people are in different stages of change regarding condoms.

From a practical standpoint this little idea of stages of change has big implications. Some people know nothing about condoms while some people always use condoms. And then there are several flavors in between. These different stages define different kinds of people. And clearly you must use different persuasion tactics on people depending upon what stage they are in. Think about it.

Let’s get more explicit about this idea of stages. We’ll use the Transtheoretical Model (yes, really) as our guide. This model says that people are in one of five different stages. Here they are.

The Transtheoretical Model

Stage One Precontemplation: Huh?

In Stage One, you don’t even know condoms exist. You’ve never heard of them, never even seen one. You also probably don’t know about sexually transmitted diseases either. You are in a state of benign ignorance where you think what you don’t know won’t hurt you.

Stage One is the ignorance stage regarding the behavior in question. And it is fairly common. A lot of people know nothing about the relationship between diet and exercise and health. Some people still don’t know about the risks of tobacco use. You don’t know about the Problem, so you don’t even care about it either.

We would also include in Stage One all those people who know about the behavior, but see absolutely no reason to perform it. Maybe you have made a committment to virginity and will not have sex until marriage. Therefore, why use condoms, you’re not having sex? Or maybe you are deeply in love with only one person and you know your partner is loyal to you. Why do you need to use condoms?

Thus, Stage One is composed of all those people who are not performing the behavior due to ignorance or lack of perceived need. And if you think about it, most of us are in Stage One a lot of time.

Stage Two Contemplation: Oh, that’s how!

In Stage Two, you’ve heard about the Problem, realize that maybe you are vulnerable, and are seeking information about the Solution. People in this stage go to the library and read up on condoms. When a news story about condoms pops up on Headline News, they pay close attention and think about it. They talk with their friends about condoms.
And as important as information seeking, you also do a lot of thinking about the Problem. It becomes a major issue in your life and something that is involving and personally relevant. Okay, so you’re in touch and concerned here and learning all about it. What next?

Stage Three Preparation: What do I need?

Stage Three is the planning phase. People here intend to actually perform the new behavior, but first they have to get organized. If you’re gonna use a condom during sex you know that you have to:

Buy it.

Know how to put it on correctly.

Put it in a handy location for later use.

Stage Three is composed of all those things people must do to be able to perform the behavior. A lot of comedy routines are based in planning and preparation failures. (Or more homey examples of parents buying a special gift for a child only to discover on Christmas day, Some Assembly Required, and Dad can’t even change a light bulb.) Once Stage Three is complete, we’re ready for action. Literally.

Stage Four Action: Try it on for size.

In Stage Four, you perform the behavior. You use the condom. You jog 30 minutes a day for a week. You actually go to every class session! You just do it.

Now, some people think that if you just get started doing the thing, you’re set for life. But we all know from painful personal experience that “starting” and “maintaining” are two different worlds. Lots of people make New Year’s Resolutions and hang tough for a few weeks with the new diet, but then, ahhh, what can I say. I forgot. And the action stops. There is still one more step to take.

Stage Five Maintenance: Do it all the time.

Stage Five is the consolidation or habit phase. You do the behavior all the time and you do it pretty much without planning or thinking. It’s just a part of your normal routine like buying toothpaste and brushing your teeth every night. You stay on the diet. You keep exercising. You never use tobacco again.

How long does it take to make a habit? Well, it depends upon the behavior in question. If the new behavior is using an automatic garage-door opener, you’ll probably acquire the habit in just a few days. If the new behavior is flossing your teeth every day, it might take six to eight weeks of constant action before you establish the habit. And if the new behavior requires beating a physical addiction like smoking tobacco, it can take years before you become tobacco-free. (I can testify to this. I smoked for nearly fifteen years. I spent the last ten years of that dependency trying to get free of it. By contrast when I turned 40 in 1992, I acquired a new exercise habit in just a couple of weeks and it’s still going although a bit more painfully nowadays. I also quickly learned how to use our automatic garage-door opener when we built our new house.)

A Different Kind of Illustration

Let me make the Stages of Change more general and get out of the health arena. Consider the behavior of good study habits.

The research on this one is abundant, consistent, and clear. Regular study of learning material produces better academic success. People who spend a couple of hours each day “practicing” their lessons (re-reading chapters, making and studying notes) will perform better on a variety of academic indicators (quizzes, tests, question-answer, demonstrations). So, given this knowledge, all students always employ good study habits? Right.

Some people are in Stage One. They are clueless about studying and success. They think that test-taking is more like playing the Lottery: All a matter of luck.

Others are in Stage Two. They have a roommate who studies regularly and then seems to get better grades. So they talk with Rooms about this and Rooms says, “Hey, buy a vowel,
Vanna.” Rooms gives them the straight skinny on studying.

We move to Stage Three. Go to the Bookstore. Buy a handful of those groovy yellow highliter pens. Get one of those Notebook Organizers with folders and colors and tabs. Hey, attend class. Hey, hey, buy the text book. Hey, hey, hey, plan to succeed!

Now Stage Four. Do it. Take good lecture notes. Rewrite them that night. Keep notes organized and re-read them every couple of days. Read the text book chapter two or three times, highlighting as you go. Try this for a few weeks and check out your grades.

Wow, Stage Five. It worked. Now my life is easy. I automatically record old episodes of Seinfeld while I’m studying. Then as a reward when I’m done, I laugh at Kramer. And I do it every night.

Practical Implications

Okay, big deal. The transtheoretical model and five stages. Precontemplation, contemplation, preparation, action, maintenance. (Or ignorance, learning, planning, doing, habit.) So what? Here’s what.

1. Tailor the tactic to the stage.

Only a fool would approach somebody in Stage One (ignorance) the same way they’d approach somebody in Stage Three (planning). Thus, you should determine where your target receiver stands in the Stages.

This implication also gives you a highly focused goal with your influence attempts. Your goal is to move to the next stage. So, if my target is at Stage Two (contemplation-learning), my persuasion goal is to move them to Stage Three (preparation-planning).

2. Move one stage at a time.

You can’t expect to move people from Stage One (ignorance) to Stage Five (habit) in one fell swoop. The smart play is to influence your target through all stages one at a time. Thus, you are building bridges across stages (a nice image there).

3. Build in enough time.

If you can’t skip stages, then you know that the final stage of maintenance make take a long time to achieve, especially if your target receiver is starting at Stage One or Two. While your ultimate goal is habit, it simply takes time to move your receiver to that goal. Therefore, build in enough time to move through all the stages or else accept the very likely probability that you will not reach your ulimate goal.

4.  The Model is NOT a Persuasion Tactic.

The Transtheoretical Model is silent on what you do to produce change in the Other Guy.  It simply provides an effective classification system for sizing up all the Other Guys and placing them into different profiles that varying on prior behavior, knowledge, and motivation.  Those profiles suggest you need to handle each Stage differently, but does not provide any kind of theoretical or practical persuasion play for each Stage.

If you are already a Persuasion Wizard or just skipped ahead in this Primer, you know that there are many different persuasion tactics.  You could use For Me? or Why? Because or both or neither for each Stage and be effective.  You’d use the Transtheoretical Model to help focus the tactic with specific content or direction.  Don’t view the Model as a tool of persuasion, but rather as a means of planning and profiling the Other Guys.

Outro

The Transtheoretical Model provides a very useful descriptive model of change. Notice that it doesn’t tell you how or why people change. It does tell you, however, what category a person is in. And even this simple description is handy. For me the Model provides a nice practical overview of organizing and implementing influence and persuasion. It gives a reasonable schema for approaching change and implementing it with a good chance of success.

References and Recommended Readings

Prochaska, J. (1994). Strong and weak principles for progressing from precontemplation to action on the basis of twelve problem behaviors. Health Psychology, 13, 47-51.

Prochaska, J. & DiClemente, C. (1983). Stages and processes of self-change in smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychlogy, 51, 390-395.

Prochaska, J. O., & Norcross, J. C. (2001). Stages of change.  Psychotherapy: Theory, Research, Practice, Training, 38, 443-448.