Stages and Processes of Change in Managing Compulsive Behaviour
Prominent researchers Prochaska and DiClemente (1983) found that individuals aiming to change their compulsive behaviour moved through a series of phases, advancing linearly from pre-contemplation to contemplation, from preparation to action and finally into maintenance.
Research highlights the importance of pinpointing the precise moment when transformation takes place. This clarification helps elucidate the roles of patient-related and treatment-related factors and enables a deeper understanding of behavioural change.
Stages of Change
The stages feature a period of time and a set of undertakings needed to advance to the next step. Although the time an individual spends in each stage may differ, the tasks are supposed to be invariant. For each phase of change, different change procedures generate optimal enhancement.
Pre-contemplation
At the pre-contemplation stage, there is no intention to modify behaviour in the conceivable future. Many people in this phase are unaware of their issues. As G. K. Chesterton once said, “It isn’t that they can’t see the solution. It is that they can’t see the problem.” Colleagues, neighbours, friends and families are often well aware that pre-contemplators have difficulties. Pre-contemplators often present for psychological therapy because of pressure from others. Generally, they feel forced into modifying the compulsive behaviour by a partner or spouse threatening to leave, a manager threatening to terminate them, parents threatening to reject them or judges threatening to penalise them.
Resistance to acknowledging a problem is the main characteristic of pre-contemplation.
Contemplation
This is the phase at which people start to recognise that a problem exists and seriously consider overcoming it. However, they have not yet committed to taking action. People can persist in the contemplation phase for a long time. In a nutshell, contemplation is about knowing where you want to go but not being prepared yet. Another significant aspect of the contemplation phase is weighing off the advantages and disadvantages of the problematic behaviour and its solutions. Individuals seriously thinking of changing their behaviour in the next six months fall into the category of contemplators. Sincere consideration of problem resolution is the focal part of contemplation.
Preparation
The preparation phase is the combination of intent and behavioural factors. People in this phase are willing to start actions in the following month and, typically, have unproductively taken steps towards the change in the past year. Usually, people ready for action report some minor behavioural modifications. Although their problematic behaviours become less frequent, they have not yet reached a condition of effective action. They are willing, however, to start such activity in the nearest future. Preparation is sometimes seen as the early stage of the action phase. However, it is better known as a decision–making step.
Action
In the action phase, people alter their environment, experiences or behaviour to solve their problems. The action involves overt behavioural modifications and requires an extensive commitment of energy and time. Alterations of any problem behaviour during the action phase tend to be most evident and receive great external appreciation. People, including experts, often mistakenly compare action with change. As a repercussion, they oversee the mandatory work that prepares changers for acting and the substantial efforts needed to sustain the changes following the action. Individuals are in the action stage if they have productively modified their compulsive behaviour for a period from one day to half a year. Effectively changing the compulsive behaviour means arriving at a particular condition (discontinuation).
Maintenance
The maintenance phase aims to prevent deterioration and merge the gains achieved during the action stage. Conventionally, people see maintenance as a static phase. However, maintenance is a continuation of change but not the absence of change. For compulsive behaviours, this period extends from half a year to an unspecified period past the first action. For some behaviours, a maintenance phase lasts a lifetime. Discontinuing compulsive behaviours and steadily engaging in a new adaptive behaviour for more than six months are the conditions for staying in the maintenance stage.
An individual’s phase of change offers perspective information on therapies of choice. Action-oriented treatment may be beneficial for people who are in the preparation or action stages. However, the same programmes may be unproductive or harmful for individuals in the pre-contemplation or contemplation stages.
Competing systems of psychological treatment have distributed seemingly competing processes of change. However, conflicting methods can become balancing when set in the stages of change. For instance, change processes conventionally linked to the psychoanalytic, cognitive and experiential influences are most valuable during the pre-contemplation and contemplation periods. Conversely, change processes conventionally related to behavioural and existential traditions are most beneficial during action and maintenance.
Processes of Change
The phases of change feature a chronological dimension that lets us understand when particular shifts in behaviours, intentions and attitudes happen. The processes of change are a second key characteristic of the transtheoretical model that enables us to realise how these moves occur.
Prochaska et al. (1993) have identified eight processes of change in their remarkable work In Search of How People Change.
- Raising of consciousness,
- Dramatic relief,
- Environmental reevaluation,
- Self-reevaluation,
- Self-liberation,
- Reinforcement management,
- Supporting relationships,
- Counter-conditioning.
Pre-Contemplation and Contemplation Stage Processes
They observed that during the pre-contemplation stage, people utilised eight change processes substantially less than those in any other stage. Precontemplators needed less information about their issues, dedicated less energy and time to re-evaluating themselves and expressed fewer emotions associated with their problems. In treatment, these are the most resistant patients.
People in the contemplation stage were most ready for consciousness-raising procedures, including observations, confrontations, and interpretations, using bibliotherapy and other educational sources. Contemplators were also open to dramatic relief, involving expressing emotions and feelings about their difficulties and solutions. As people become more conscious of themselves and their problems, they are more likely to reassess themselves, their issues and their values both cognitively and emotionally. Contemplators also re-examine the effects their compulsive conduct has on their surroundings, particularly the closest people.
Preparation, Action and Maintenance Stage Processes
Individuals in the preparation stage start taking small steps towards action. They utilise counter-conditioning (alternatives for problematic behaviours, including positive self-statements, assertiveness and relaxation) and stimulus control (avoiding stimuli that provoke problem behaviours, restructuring their environment to circumvent high-risk cues). These processes help reduce engagement in compulsive behaviours or controlling the circumstances in which they relied on such behaviour.
In the action stage, people’s willpower markedly increases. They progressively believe they have the self-sufficiency to change their lives significantly. Successful action also involves effective behavioural processes, such as stimulus control and counter-conditioning, to alter the conditional appeals that often provoke relapse. As the action phase is particularly stressful, individuals increasingly count on support and empathy from the environment.
Just as being ready for action is crucial for success, so is preparation for maintenance. The function of the maintenance stage is to assess the circumstances under which a person is likely to relapse. Above all, maintenance involves elaborating alternative responses for coping with triggering situations without resorting to pathological reactions. Perhaps most important is the sense that one is becoming the person one wants to be.
The change processes have been identified as strong predictors of transformation compared to other predictor variables (withdrawal symptoms, demographics, etc.).
Counselling Compulsive Behaviour: Conclusion
In counselling, it’s essential to assess the individual’s current stage of change. Aligning the processes of change with the specific phase of change can be a crucial strategy in navigating the complex process of personal transformation.
Bibliography
- https://doi.org/10.1037/0022-006X.51.3.390
- https://doi.org/10.1037/0003-066X.47.9.1102
- doi: 10.1007/978-1-4419-1005-9_1180
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