Stages of Change: Background

New Years resolutions are a time-honored tradition. After eating our way through the holidays, we promise to change our diet or pick up a new exercise routine. Statistics don’t offer us much hope, though — few resolutions stick with us for long, except for those of us who have made the same resolutions, year after year, without making much progress in between.

Watching Oprah and reading self-help books brings us into contact with another supposed trigger of change: Hitting bottom. The bottom can be high (not-so-severe consequences), low (homeless, lying in a gutter), or in between, but the common wisdom is that we’re likely to change afterward. But, if that’s the case, why have addiction treatment success rates (measured as continuous abstinence for a year) generally fallen under fifty percent?

James Prochaska wondered about those kinds of things as he watched his dad struggle with depression and addiction, and die prematurely. His questions about how we might better understand what is working when folks do change their behavior propelled him deeper into his psychology research. If we could just understand the common characteristics of those who have changed, how might the folks who are still struggling use that to improve their odds?

He started by taking a broad look at all of the major approaches to psychotherapy. Lester Luborsky set the stage for his work in 1975, noting that:

when patients are professionally treated, they get better, but symptomatic improvement is not related to the type of therapy they receive, […with] the improvement [being] about the same whether patients receive psychodynamic psychotherapy, cognitive therapy, behavioral therapy or pharmacotherapy.

In 1979, Prochaska published the first edition of Systems of Psychotherapy: A Transtheoretical Analysis, in which he showed that most therapeutic approaches rely on a few core processes.

But the fact remained that rates of actual change were low — only 10-25% of folks with drinking, obesity, or mental health issues seek out therapy, and 45% of those who do drop out prematurely. (And many of the folks who never get help change independently anyway.)

Dr. Prochaska and his colleagues, John Norcross, Ph.D., and Carlo DiClemente, Ph.D., decided to turn the question around. Instead of starting by looking at specific therapies and processes, they studied folks who had changed their behavior successfully. Since none of the familiar factors — New Years resolutions, hitting bottom, or specific therapies or programs — would explain behavior change consistently on their own, what might the successful changers have in common?

They laid out their results, in readable form for laypeople like you and me, in their 1994 book, "Changing For Good". It turns out that 80% of us who could benefit from change are not acting on it at any given time because we’re not yet fully prepared. And, the effective changes we make (with professional help or independently — success rates are comparable for both) generally follow well-defined stages.

On page 14 of the book, Dr. Prochaska described the existing approaches to change as the “action paradigm,” which:

has dominated behavior change programs for the past three or four decades. Following this model, clients are enrolled in relatively brief programs designed to conquer smoking, weight, alcohol, or other problems; within weeks they are expected to take action and adopt healthier lifestyles. If they fail to take or maintain action, the clients themselves are blamed for lack of willpower or motivation.

Does that scenario sound as familiar to you as it does me? Ever bought a promising self-help book that never got finished, or produced only limited action? Signed up for a weight-loss program but still see the same numbers on the scale? Made a genuine promise to yourself, only to wonder later if you were in denial? Ever blamed — or shamed — yourself when things didn’t come together as hoped?

But that’s the outdated perception of how change works. Here’s the more accurate, evidence-based understanding: Most of us follow a predictable series of stages on our way to change. Willpower has little to do with our success; it is much more about whether we invest sufficient time and energy in the preparatory stages.

Continue reading: Stages of Change

Convictions are more dangerous enemies of truth than lies. by poker network