What is The Stages of Change Model?

Image Copyright British Journal of Nursing

What is The Stages of Change model?

The Stages of Change is a model based on Intention to Change. When applied to health what this means is that you are thinking about, or actively doing something, which you know is good for your health.  The steps through which you pass, to get to that healthier way of behaving are considered cyclical. We all have capacity to move through the stages of change.

How do I change?

Most people do not change behaviours quickly and decisively. Before you even feel the desire to change you live in PRE-CONTEMPLATION. This is a stage where you may not realise your behaviours are unhealthy, or you may know but have no desire to change. For some reason, or many reasons,  you then  start thinking about changing – we call this CONTEMPLATION. This stage can last months, even years. You might think it’s not worth changing as the actions seem too much, too difficult, involve too much time. Or, you might only spend weeks thinking about things, then you decide to commit.

PREPARATION is next.  You might buy equipment, or stop an unhelpful subscription. You  might set aside time, or ask someone to buddy with you. Professional help might be sought, family and friends involved. Again, you can spend weeks or months in this stage, as you get yourself ready to take that first real step. Most usually, once you have decided to work on something, you spend less than 4 months in this stage.

Now it’s the time for ACTION. You are making changes to how you more usually behave. One of the objectives of the action stage is to look to new habits to work upon, and to embed them in your life. You learn confidence and believe you can continue with the changes you have begun to action. Despite temptation to return to previous habits, the action stage serves to remind you that if you can change across one day, you can change across  another day.  You usually spend around 6 months in this stage, though often it takes less time to feel like a habit is embedded. Everyone is different.

The MAINTENANCE stage of the cycle looks to where you no longer really look to the older behaviours. Instead, the positives associated with changing feel so good, it is worth keeping going with those changes. Previous ambivalence resolves. Making behavioural  changes into habits can still be challenging, but they no longer involve conflict. You are different now.

Do I pass straight through from one stage to the next?

Usually not! The illustration describes LAPSE and RELAPSE.  If you have ever tried to change anything in your life you may be familiar with lapsing. This is where you have slipped from what you had been trying to do on a single occasion. A slip can be a one off, or could lead to a series of slips or lapses. When we spend more time lapsing versus carrying out the new behaviour, we are considered to have relapsed. We have returned to our old habits. The illustration shows how we can slip in and out of all of the stages. Even a habit you have carried out for 6 months can be dropped.  But the longer you stay in the action and maintenance stages, the more likely you are to change your health status for the good.

What do clinicians  do? What do I do?

Clinicians will use different tools to move you from one stage of the cycle to the next, or to keep you in a stage as best fits with your life right now. Our goals are always to support you and your physical and mental health. We aim to keep you steady with  changes you have already adopted, or move you to a position where you feel able to implement change.

I use strategies such as the ones below.

1. Raise consciousness

I might talk to you about a healthier way of being, versus staying the way you are now

2. Dramatic Relief

I might help you to explore the feelings you have when you think about keeping the unhealthy behaviour or behaviours. These can be feelings like anxiety, or guilt, or shame. I help you to explore feelings you have when you think about behaving differently, perhaps feelings of optimism and hope

3. Evaluating the Self

I use tools such as imagining how things would be if you did change, what being and feeling healthier might look like, what you would gain through the process

4. Evaluating your environment

I help you think about how your  unhealthy behaviours might impact others, and what they want for you

5. Liberation of the environment

I  assist you in exploring your environment so that you see opportunities for change, and that society supports what you are trying to do for yourself

6. Liberation of Self

I guide you to believe in the possibility of change and then commit to doing so

7. Helping Relationships

I work with you to identify people who can support you in your endeavour; individuals who will help you to achieve your desired outcomes, not get in your way

8. Counter Conditioning

I work with replacing particular ways of thinking or behaving with other healthier ways of thinking and behaving

9. Reward systems

I ask you to think through rewards for yourself, things that might keep you motivated along the way – these could be experiences, or gifts, or even just time for your self

10. Stimulus Control

Together we figure ways to help you  change your environment, whether at work or at home, so that you have cues towards the carrying out of the healthy behaviour or behaviours. Those cues associated with the unhealthy behaviours are removed.

If you would like me to help you move forward with your healthier way of being, please get in touch. I would be delighted to support you through the stages of change model, to better health.