Transtheoretical Model

Front 1

What principals/ factors should you consider before judging a person’s motivation to make a change?

Back 1

- current state of thinking

- potential presence of problematic behaviours

- precipating factors that may of led to current thinking

- developmental events that may of led the cause of the issue

Hardcastle (2015)

Front 2

Explain how the unconscious mind is involved with decision making behaviour and behaviour change? Reference.

Back 2

- the unconscious mind is thought to have everything to do with behaviour change.

- it’s thought that most of our internal thoughts and feelings are related to our experiences, and so play a huge part in how we make decisions.

- we are constantly intertwining our conscious feelings with our unconscious thoughts.

- therefore positive experiences and feedback can influence how our minds deals with making deciosns and changes.

(Mlodinow, 2013)

Front 3

Provide an example relating to health how this unconscious mind may effect health behaviour change?

Back 3

- for example previous negative experiences throughout life that may of decreased confidence regarding health decisions such as negative feedback from pe at school or lack of knowledge regarding healthy food, social stereotypes or reactions and pressures to weight or size (and many other reasons) will, unconsciously affect decision making behaviours in the future regarding health behaviours, therefore the role of the professional, would be to guide through stages of change and turn the negatives into positive whilst setting appropriate diet and activity regimes based on their stage of change and motivation.

- if they do not believe the change will happen then motivation is lost.

Front 4

Provide a background/ introduction to the Transtheoretical model of behaviour change?

Back 4

- this model presents the most important principals involved in the processes of making a change, it uses leading theories of counselling and behaviour change.

-It is a catorised multistage psychological model which assumes change is a multi-stage process.

- the model includes stages of change meaning the influences on behaviour change will vary depending on what category someone is in.

- idea is it can be applied to a variety of behaviours, populations and settings.

- the time a person stays in a particular stage is variable, but the level of motivation needed to move stages is not.

(Behaviour change models, 2018).

Front 5

Why are the processes of change important in each stage and what are the 3 principals?

Back 5

certain principals and processes of change work best at each stage in order to reduce resistance, facilitate progress and prevent relapse, the activation of the processes of change is what causes the progression through stages of ttm:

The principals include:

- decisional balance

- self efficacy

- processes of change

Front 6

Explain the principal of processes of change and which stage of change they fit into.

Back 6

1. Processes of change- these help explain how changes occur throughout the stages.

- it includes processes which must be implented before moving up a stage.

- these include:

(Precontemplation- contemplation)

1. Consciousness raising: increasing awareness of healthy behaviours.

2. Dramatic relief: positive or negative emotional arousal about the health behaviour.

3. Environmental re-evaluation: realising how their unhealthy behaviour affects others.

(Contemplation)

4. Self re-evaluation: realising their unhealthy behaviour is not who they want to be.

(Preparation)

5. Self-liberation- commitment to change the unhealthy behaviour with the belief that change is now posssible

(Action-maiontance)

6. Helping relationships: finding support for making the desired change.

7. Reinforcement management: increasing rewards from positive behaviour and reducing awards from negative behaviour.

8. Counter- conditioning: substituting unhealthy behaviours and thoughts with healthy ones.

9. Stimulus control: rearranging the environment to have stimulus that will influence healthy behaviours and removing stimulus that will influence unhealthy behaviours.

Front 7

Explain the principal of descional balance.

Back 7

- this involves Janis and mann’s Conflict model for decision making.

- involves a balance sheet to compare the pros and cons of doing something, to help make a decision.

- this is the core concept of the Ttm.

Stages:

Precontemplation- pros outweigh the cons, so no change is made.

Contemplation- pros and cons are equal, could tip either way.

Maintainance- pros outweigh the cons.

Front 8

Explain the principal self efficacy.

Back 8

- this is the indiviual’s belief that have the power or capacity to produce a desired effect.

This integrate bandura’s self efficacy theory, which reflects the degree of confidence indivuals have in maintaining desired behaviour change in situations that often trigger relapse.

- it is also measured by the degree in which individuals are temped to revert to old habits.

- the movement through the stages of change is matched with increase of self efficacy.

Stages:

Precontemplation and contemplation- temptation to engage in problem behaviours is far greater than self efficacy to change.

Preparation to action- self efficacy is improved and increased so temptations are less risk.

- relapse often happens when feelings of temptation trump self efficacy to maintain desired change.

Front 9

Explain each stage of change

Back 9

1. Precontemplation:

- people to not intend to take action to change in the next 6 months.

- may be unaware or resist confronting the problem behaviour.

- they may make many unsuccessful attempts to change but are not motivated and not ready for help.

- people may say they want to make a change but lack the motivation to do so.

- they must address their problem in order to move to next stage.

2. Contemplation:

- become aware and acknowledge the exsistance of the problem.

- seriously considering the possibility of change built are worried about it.

- weighing up the pros and cons can mean people stay in this stage for long periods.

- approach must be careful, most likely to after a quick fix.

- being stuck in this stage is known as chronic contemplation.

3. Preparation:

- they have committed to make the change.

- most people in this stage will make an attempt to change in the next 3 months.

- although committed they are still not confinement and still is decision making process.

- meaning change is not inevitable and care is required not to hurry into action.

4. Action:

- changes start taking place.

- tends to be shortest stage

- reassurance is seemed so others become aware of change.

- important they are made aware this stage doesn’t guarantee success.

- high risk of slipping back into contemplation.

- strategy for relapse needs to be in place.

- may take several attempts.

5. Maintenance:

- stage where progress aims to be sustained

- aim to avoid relapse and are anxious of temptations.

- where most people end up.

- at ideal target.

- must be sustainable to prevent going backwards.

6. Relapse:

- natural in any stage.

- important to introduce awareness of relapse.

- permission to relapse can aid success in long term.

Front 10

What are the advantages of the ttm ?

Back 10

- can aid health related programmes in assisting people in the correct make to make a desired change, with a deeper undstanding of current motivation.

- can be used to motivate change by enhancing the understanding of pros and decreasing cons.

- caters for those at risk populations who are not prepared to make a change, helping people set more realistic targets based on their stage of change.

- it focuses on decision making abilities of the individual rather than social and biological influences.

- focuses on that change is a process that occurs over time (something other theories have not).

- treats behaviour change as non-linear and dynamic rather than all or nothing approach.

- ttm is generalisable across a wide range of common problemed behaviours and populations.

- Romain et al. (2015) found that there were different principals of change depending on the activity, meaning it can be more tailored to an individual's sport/ specialism.

Front 11

What do Prochaska and Velicer outline in the 7 assumptions that drive the ttm?

Back 11

1. No one single theory can account for all complexities of behaviour change.

2. Behaviour change is a process through time and stages/

3. Stages are open and stable to change.

4. Without planned interventions people will get caught in early stages as there is no motivation for development.

5. Majority of at risk populations are not ready for action so won’t be served by traditional style programmes.

6. Specific process and principals need to be applied to specific stages.

7. Stages are primarily designed to increase self controls.

Front 12

What are the critisms of the ttm ?

Back 12

- human functioning is too versatile and multidimensional to be categorised into discrete stages.

- Bandura suggests qualitiave transformations across stages are violated where the first 2 stages are only different by their degrees of intention rather than actual behaviour change.

- time frames within stages are not accurate as behaviour change is too dynamic.

- studies suggest the ways stages are measured are based on time periods that are not accurate and do not measure the discrete changes.

- suggests theory ignores some social contexts like income.

- there is no set criteria on how to determine a persons stage of change.

- Model assumes people make coherent and logical plans in decision making when this is not the case.

- critised for not being applicable to less common problemed behaviours and so therefore isn’t generalisable to everyone.

- Han et al (2017) recognise that the use of the Ttm model for sedentary behaviours has been abandoned, meaning more needs to be done in order to increase the use of this model for helping those at risk populations improve health behaviours.

Front 13

How are the stages of change generally measured?

Back 13

Questionnaires can be completed by the client beforehand in order to determine what stage of change they are in.

however consider this is not standardised meaning it may not be accurate, this could be crucial for the success of making the desired change, also if the client is unaware or reluctant to admit problem behaviour they may not be truthful in the questionnaire.

(Romain, 2015)

Han et al (2017)

- a newly developed readiness to change motivational questionnaire is now commonly used, this asked true and false style questions with the outcome to place an individual into one of the stages of change.

- there is also the use of the prossess of change questionnaire which involves questions relating to the frequency individual undergo certain processes in their lives.

Front 14

What is motivational interviewing? and what factors are important in order to achieve success? and what factors must be careful with?

Back 14

A collaborative conversation style for strengthening a person's motivation to change.

- this addresses the issues with making the change and aims to turn them into positives.

- used when people have 'chronic contemplation', their pros and cons are equal (contemplation stage) and they can't decide what to do.

- This was developed by Miller and Rollnick.

- it involves techniques in order to increase motivation and tip the scales so the pros outweigh the cons by giving self motivating statements.

- it is directional but not directive.

- core values: a partnership, acceptance, compassion,

- reflective listening is important.

- type of wording used.

- empathy is essential for success- the ability to accurately understand your client's meaning.

- must be careful to avoid 'righting reflex' task is to focus on a goal not to fix it.

Front 15

How can motivational interviewing be used to help people move up a stage in the ttm?

Back 15

- Mainly for those in contemplation stage, where pros and cons are equal are they are in a situation of chronic contemplation.

- Also used for those who relapse often or are shifting back and forth through stages.

- therefore addressing the issues and giving self motivating statements to the client will help tip the scales and improve motivation.

Front 16

What are the references for this topic?

Back 16

1.background info on cognitive bahviour change- Mlodinow, 2013.

2. Intro to ttm- Lerdal, 2009.

3. Stages of ttm- Prochaska et al., 2008

4. Principals of change- Romain et al., 2015

5. Advantages and disadvantages-Lenio, no date.

6. Motivational interviewing- miller and rollnick, 2008 and 2010/

7. self determination theory- Ryan and Deci, 2017.

8. goal setting-

Front 17

What did romain et al's research look into ? explain

Back 17

They looked at the validity of the structure of the ttm regarding weight loss in obese adults.

- they measured participants responses to previously shown reliable questionnaires (in order to determine stage of change), and followed the principals in ttm in order to set weight loss interventions for individuals.

- they found the knowledge of processes of change and the principals of change within this were successful at designing an effective weight loss programme in which the participants responded well too.

Front 18

what is self-determination theory?

Back 18

ryan and deci (2017) distinguish 2 types of motivation:

1. intrinsic

- what is desirable

- dependant on competence and autonomy (controlling coaches can decrease motivation)

- rewards and increase or decrease intrinsic motivation depending on if they are controlling.

- offering choices can increase intrinsic motivation- needs to be challenging but achievable.

- positive feedback will increase it.

2. extrinsic:

- behaviour driven by external rewards such as money, fame, grades and praise.

- arises from outside the individual.

Front 19

explain the importance of goal setting?

Back 19

- goal setting is essential for achieving targets, it helps maintain motivation and is something to work towards.

- goals should be realistic,

- the length of the goals need to be considered, short, medium and long term goals should be set.

- set specific goals that are measurable.

- recorded identified goals.

- evaluate goals achieved to goals set.

- follow SMART principals.

Front 20

what are the 4 fundamental processes in motivational interviewing?

Back 20

1. planning- determining readiness for action, assisting with changing any plans, distinguishing level of determination.

2. evoking-drawing out a client's intrinsic motivation and their own ideas for change, recognising change talk.

3. focusing- ensuring focus on what is important to them, helping them to identify targets.

4. engaging- relating to the client, listening, being empathetic, reflective listening etc.

(miller and rollnick, 2010)

Front 21

Practice question from past paper:

Critically discuss, in relation to exercise, the transtheoretical model for behaviour change. Include in your answer how you can use this model to influence an individual’s stage of change. ..

Back 21

write out and plan answer beforehand