The Processes of Behavior Change

Once Prochaska and DiClemente identified the stages of change and their characteristics, the next challenge was to understand how one could move from one stage to the next. To explain this complex movement, they identified ten different processes and the stages where they seem most relevant.

The ten processes (and some examples of how the different forms they could take in an intervention) are:

1. Consciousness-raising — finding and learning new facts and suggestions supporting the change (e.g., reading a book; watching a TV show; talking with a friend, teacher, or doctor)

2. Dramatic Relief — experiencing and expressing negative feelings about a person's problems such as worry or fear (e.g., communicating with a friend, partner, partner, counselor; writing in a journal)

3. Self Re-evaluation — realizing that the behavioral change is part of a person's identity (e.g., seeing yourself as a non-smoker or a fit person)

4. Environmental Re-evaluation — assessing how a person's problem affects the physical environment (e.g., realizing that second-hand smoke may affect non-smoking children and partners or even pets)

5. Self Liberation — choosing and committing to act on a belief that change is possible (e.g., making a New Year's resolution); accepting responsibility for changing.

6. Social Liberation — societal support for healthier behaviors (e.g., smoke-free workplaces; discussions about safer sex in school and communities)

7. Counter-conditioning — substituting healthier alternatives for problem behaviors (e.g., using relaxation or meditation techniques instead of eating to deal with stress)

8. Stimulus Control — avoiding triggers and cues (e.g., avoiding bars, friends who still smoke, dessert parties)

9. Contingency Management — raising the rewards of positive behavioral change and decreasing the rewards of the unhealthy behavior (e.g., buying new clothes after losing weight instead of eating dessert)

10. Assisting With Relationships — seeking and using a strong support system of family, friends, and fellow employees.

In addition to the stages and processes, the model features some other unique insights:

• Decisional Balance: Weighing Pros and Cons. Prochaska and DiClemente understood that at each stage, an individual weighs the pros and cons of adopting a new behavior. For precontemplators and contemplators, the cons loom large. They may feel the change is too challenging or not worth the effort. Giving up pleasures — be they food, alcohol, tobacco, or just the pleasure of being a couch potato — is a lot to ask. For most behavior changes, the sacrifices are immediate but the benefits are not.

Prochaska and DiClemente call this weighing of pros and cons "decisional balance." For counselors, health educators, and others who want to intervene in the change process and help individuals move along its continuum, the task is to tip the scales: to make the pros outweigh the cons.

• Self-efficacy. Self-efficacy — the confidence that one will be able to take action — is a feature of many health education and promotion models. It's incorporated as a main element of the Stages of Change model since one of the pros that outweighs the many cons eventually takes the form of confidence that one can try the behavior change and sustain it. Confidence can be built in a wide variety of ways — such as role playing and preparing for situations that may be challenging, or practicing individual skills (such as negotiation or refusal), or even giving oneself pep talks ("You've done this before — you can do it again!").

• Temptation. As mentioned previously, relapse is built into the Stages of Change model as a realistic sense that change is challenging and that a combination of cravings, emotional stress, and social situations or prompts can lead us back to old habits. Instead of viewing these events as failures, however, the model asks us to learn from each relapse: to recognize the signs of craving for what they are, to remove ourselves from social situations that don't support our behavior change, and/or to deal with stress in other ways.