Time To Make A Change – Optimising Behaviour Change

Posted on April 30, 2015 by Jenny Cromack

Are you the type of person who is always procrastinating about achieving your health and fitness goals, will your new fitness regime start on Monday? Are you constantly trying to motivate yourself to achieve your goals? Well no more procrastinating….now is the time to make a change!

Following on from last week’s blog about motivation and physical activity we are going to look at the whole picture and how we can optimise the journey between starting exercise and seeing it through, and making it a regular occurrence.

It helps to understand the stages of behaviour change we go through as it may help us increase the longevity of peoples’ engagement with physical activity and health related behaviours. It is estimated that 50% of people who start a program drop out within 6 months, this is a big figure and simple methods and understanding how we can change our mind set will help reduce this number (Estabrooks, 2000).

Trans-Theoretical Model (TTM) of Behaviour Change…

It is said that as human beings we go through stages when it comes to modifying our behaviour. The TTM is a model based on the key concepts of many theories of behaviour modification and conceptualises the process of change (Prochaska & DiClemente, 1983). People can stay within different stages for variable amounts of time, but all need to processes taken to move between stages are fairly consistent.

The model itself consists of several stages these are; pre-contemplation, contemplation, preparation, action, relapse or maintenance, termination. People progress through these stages until a behaviour becomes routine or they relapse back to initial stages. The following model is based upon the original by Prochaska and DiClemente (1983).

Pre-contemplation…

This is the stage where people are not quite ready engage in a new activity or change their behaviour. There may be some thought about it but no attempt to get ready to carry it out. Usually this stage is due to people being uninformed or unsure about what the new behaviour entails. A lot of individuals in this phase will express things as “maybe after the next 6 months or within the next year” but have no initial intention or getting ready to progress with it. For example, people may hit a point in their life where they say I should really exercise, or “I need to be healthier” and then propose a change in the next 6 months or in the New Year. These people are in this phase.

Contemplation…

This phase is when things start to move on, the time frame in which the thoughts of change is reduced, so usually within that 6 month period is their intention to change and time frames may be physically set. They are basically now getting ready to change their behaviour. People are more aware of the benefits and costs of their new behaviour and they are weighing up the options in this phase rather than being blind to the benefits and costs. Once the benefits outweigh the costs then people tend to advance to preparation and action phases. In terms of exercise behaviour people may recognise the health and social benefits, and say that they are definitely getting involved within the next few months.

Preparation…

This phase is the phase where individuals are now actually ready to change. They have been taking action to prepare for their new behaviour. Their intended time of action is now the immediate future, usually within a month. They now have a plan of action in place and things are ready to go. This may mean that people may have looked organised health club membership, bought new training clothes, bought books about health and exercise.

Action…

In this phase things are much more observable, people will have now made specific modifications to their lifestyle specific to their new behaviour, and initiating its incorporation into their lifestyle. Those engaging in exercise or physical activity may now be walking instead of driving, or attending a class once a week in an attempt to increase their activity and health. The actions usually start small and progresses.

Maintenance…

This phase continues the modifications in behaviour and they may have progressed from the previous stage. Within this phase people focus on preventing any relapse but are much more resistant to relapse than the action phase, once people are in this phase it tends to be fairly longer term (between 6 months and 5 years). Exercisers may now be training more per week, and engaging in different exercise activities as part of their lifestyle.

Relapse…

This is when the action phase has failed to be maintained and individuals may return back to their original behaviours or lifestyles. They usually fall back to pre-contemplation. Exercisers may have simply stopped attending classes or the gym and falling back into a habit of being sedentary taking them back to before they contemplated being healthier and exercising.

Termination…

This is a powerful place to be in terms of the stages activities are now pretty nailed into the lifestyle of individuals, they are near 100% confident in their activity, and are no longer tempted to relapse or return to bad habits or behaviours regardless of mood or emotional status. Activities are now almost an automatic habit. In the exercise world these people are the individuals who will train regularly without thought as part of a routine. They will not be tempted to avoid exercising even on the days when they feel down, depressed or stressed.

Processes of Change:

These processes explain how changes can occur and how behaviour modification can be encouraged and aided. There are two groups of processes Experiential and Behavioural.

Experiential Processes…

The following processes are important in moving people through the pre-contemplation and contemplation stages.

Consciousness Raising:

This involves informing people, or yourself, about any effects of a problem behaviour or the behaviour they, or you, are wanting to revert from. In those who are inactive we could help raise awareness about the risks of inactivity on their health. A lot of people are not aware of the true facts and therefore see no reason to change. Therefore informing them about any consequences may help progress them to and through pre-contemplation stages.

A good strategy for this is to sit down and map out yours or your clients current behaviour and the risks associated with this behaviour. This is may prompt thoughts of change and highlight the risks and negatives of the current behaviour.

Dramatic Relief:

This involves providing emotional stimulation and attribution to the old and new behaviour. This may help them realise that the new behaviour can provide relief from any negative emotions that may be linked with an old behaviour. Association between negative emotions and the old behaviour can help compel some change.

This strategy may involve striking fear of health risks, or linking any feelings of anxiety or low self-esteem to current health and behaviour state. This can be facilitated by providing positive emotional attributes to the new behaviour. For example providing or seeking out success stories which will allow emotionally attachment to these and become inspired. This will help push people through the pre-contemplation and contemplation phases.

 Environmental Re-evaluation:

This combines affective and cognitive evaluation of how the old and new behaviour may affect one’s social environment and relationships to others.

This strategy may include yourself or a client identifying any interaction between their current bad behaviour and their social environment. This may include highlighting how being unhealthy or inactive affects the relationship and interaction between an individual and their family or friends. This may be that they need to be aware that they may not be able to do some of the things their family or friends do as a result of their current behaviour or health or that what they do has a negative impact on the lifestyle of others. For example, someone with children may eat lots of junk food and do not activity, their children may then copy this lifestyle putting their health at risk.  On the flip side we could highlight how being more active and healthy could create a positive role model to others.

Self-Re-evaluation:

This involves assessing one’s current self-image compared with the image they would portray with the new behaviour and the values that this would include. This process can include identifying positive healthy role models, creating a healthy self-identity and being aware of how one may feel with this new image and identity.

A good way to approach this is to ask the individual where they see themselves now in terms of image and identity and where they want to be. For example making someone imagine them in a state of being a “couch potato” who is unmotivated, lazy and unhappy to being an active “exerciser” who’s values may include commitment, determination and motivation. This process works between pre-contemplation and contemplation phases but also is useful to push through the preparation phase also and get the individual into the action phase.

Social Liberation:

This involves making people aware of the way society is changing to accommodate the new behaviour and identify the vast opportunities for its accessibility. This may include, for us, highlighting the new outdoor exercise facilities, walking trails, bicycle lanes etc. as an example that you do not have to join a busy, expensive gym etc. This will help make the new behaviour be more appealing and achievable, showing that society is in support of the new behaviour.

Behavioral Processes…

Self-Liberation:

This involves instilling the belief into an individual that they can change and solidify their commitment. This can be done by encouraging people to discuss their commitment to be active with others, or even engage in a contract of commitment to an activity to strengthen the commitment and willpower. This is most beneficial into moving from the preparation phase to the action phase.

 Counter Conditioning:

This involves educating individuals on good substitutes for old behaviours that relate to the new desired behaviour. Find ways that the new behaviour can be incorporated into yours or a clients lifestyle in place of old habits. For example, highlighting that instead of driving to the shops walking may actually be easier and prevent traffic stress or hold ups, or provide healthier food alternatives for their current unhealthy options. This encourages them to learn about better alternatives to any current bad thoughts or behaviours.

Helping Relationships:

This process involves encouraging the creation of relationships with like minded individuals and social support during any behaviour change. This can be by building a rapport with any clients as a trainer or by encouraging group training or buddy sessions. This will help create a point of support socially helping with behaviour modifications.

A good strategy is to organise support or progress calls between trainer and client, or organising social meetings between similar individuals. Highlighting the importance the change to an individual to the persons family and friends so they can provide support and encouragement throughout.

Reinforcement Management:

This can involve punishment for relapses or positive rewards for progress. External rewards from others may not be as frequent as people would like so encouraging self-reward is an effective way of achieving reinforcement. For example encourage positive self-talk when progress is made or when temptation is resisted. It is also a good idea to map out milestones and allow self-treats on these days when goals are achieved. This will encourage future positive behaviours to be repeated such as performance based goals, or simply achieving a goal of 3 sessions of activity a week for 3 months.

Stimulus Control:

This basically requires the removal of any cues or reminders of any old habits and adding prompts for the new habit. This includes removing any unhealthy foods from the house, or having your gym kit packed in your work bag as a reminder to train after work. This removes the temptation or excuse to eat unhealthy foods or to go home and not train after work.

Each process can be applied at specific stages to help optimise behaviour change, but each individual is different so find out what works best for you as someone looking to change or what is best for your client if you are a trainer looking to help a client.

Take Home Message:

If you are someone looking to change your behaviour or someone working with others who are looking to change. Consider where you or they may be on this continuum of change. Understand the factors that are present in each stage and how progressing from one stage to the next can be optimised. Remember not all processes will work the same for everyone, so get to know what stimulates you or your client and pick the best processes to progress.

It is important to understand where a person is in their stage of change to ensure that any interventions used aren’t too intense and therefore put the individual off the new behaviour or force them into relapse.

References:

Estabrooks, P. A. (2000). Sustaining exercise participation through group cohesion. Exercise Sport Science Reviews, 28, 63-67.

Prochaska, J. O. and DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390-395.