23 April 2018
Do you want to make a change? Perhaps be a more effective hypnotist or hypnotherapist? Maybe make a positive health or wellbeing change? Stop smoking? Lose weight? Get fit? How do you move yourself or your client from “it’s a nice idea” to “achieved!” For many clients, they can get stuck at some point in their change process. How do you move them (or you) forward? You might think that change is simply a matter of deciding to do, or not do, something different. Although some people might say it isn’t as simple as that, you would not be wrong. However, that decision is just a small part of a larger change process.
In the 1970s, yes that long ago, James Prochaska of the University of Rhode Island, together with Carlo DI Clemente and colleagues considered a range of theories of psychotherapy, and analysis, and found that the change process can be described in terms of ‘progressive stages’. As the outcomes of this process incorporated many theories, they formulated a ‘transtheoretical model of change’. Since the 1970s, this model has been widely researched, and also adapted for specific change applications, such as health. A look at some of the applications of the ‘stages of change’ model shows some positive outcomes on topics relevant to a hypnotist or hypnotherapist.
A stress-management study, with 1085 participants found 62% of those following the model were better able to mange their stress than the control group. Furthermore, the study showed there were also positive effects on depression and specific stress-management behaviours.
A study of 1000 patients, showed that 73% of the group that were following the process were medication/treatment compliant, in comparison to the control group, where only 57% were compliant.
For weight management, a study of of 1277 overweight or obese adults (BMI 25-39.9) either had a no-treatment control or followed the change model with a home-based intervention. The intervention group showed significant improvements in healthy eating, exercise, managing emotional distress and weight reduction, compared to the control group.
Other popular areas for research (and positive outcomes) have included decision-making, smoking cessation, addictions, adolescent delinquent behaviours, safer sex, sunscreen use and active exercise.
This ‘stages of change’ model focuses on behavioural modification and can be widely applied to a vast number of client’s presenting issues, from smoking cessation to better study habits. It considers that each stage is progressive, rather than change being a single event. People may move in a linear manner through the process, or, they may revert back a stage (or more) at times, before then progressing again. Although many versions of the Transtheoretical Model of Prochaska and Di Clemente has five stages, from a therapy perspective, it can be useful to add in a sixth stage. These six stages being:
In the pre-contemplation stage (stage 1), you are either not aware of any potential for change, are unaware of your behaviour being a problem, or having negative consequences, or, you are not ready to consider, or engage in, any thoughts of change. There may be a lack of available information or, where there is appropriate information, you may simple be uninformed. However, you may also be resistant to change, particularly if you have had unsuccessful attempts to change in your past. In these circumstances, often you are overestimating the disadvantages of change, and underestimating the advantages of changing behaviour. To move yourself, or someone else, beyond this stage, there is a need to provide appropriate persuasive information. Consider, for a moment, what have you tried to do and then given up as you became demotivated? What would have, or did, motivate you to try again?
The contemplation stage (stage 2) is about you getting ready for change. There are thinking (cognitive) feeling (emotional) and action (behavioural) processes at this stage. Generally, this includes fact-finding and consciousness-raising activities, together with an awareness of, and connection to, the emotions that the prospect of change may evoke. This is where you become aware of the possibility of change. This may include the realisation that an aspect of your present behaviour is problematic, or, causing you negative consequences. Here, you are considering the advantages and disadvantages of changing (such as effort/cost versus benefit/rewards). At this stage, you will tend to give an equal emphasis to both pros and cons. It is this evaluation of costs and benefits that can keep you in a holding pattern for a while, as a form of behavioural procrastination. To move yourself, or someone else, through this stage, it can be helpful to provide persuasive information relating to the advantages that will result from change.
When you are ready to take action, you will enter the preparation stage (stage 3); getting ready to take action in the immediate future. There will be a process of commitment, which may be either instant, or progressive. It is likely that you will also have a plan of action, or a specific intention, and you may take small steps towards the behavioural change. To motivate someone else when they are at this stage, it can be helpful to provide, or support, a route to achieving their desired outcome.
The action stage (stage 4) is the part of the process involving active change. For some, this will be a polar opposite change, from doing something one way, to doing it another way. For others, it will be a process of progressive change, perhaps evaluating each element and either keeping that element, or changing it slightly, before evaluating again. Here there is likely to be some consideration of the effect of their change on the thoughts (cognitions) and feelings (emotions) of others. At this stage there may also be further active processes, such as substituting one action or way of responding for another (behavioural counter-conditioning). It is at this stage that someone may get disillusioned if their change process falters, becomes too challenging, or they lack the necessary skills or resources to continue or overcome setbacks. In this context, encouragement and support can be beneficial, as can promotion of self-efficacy (belief that they can), especially relating to resilience and motivation (confidence to carry on despite any setbacks). From a hypnotherapy perspective, general and specific ego strengthening suggestions/approaches can be highly beneficial at this stage.
Sometimes, the change process happens quickly. At other times, the change may take a while to become established. Then, there follows the stage of maintenance (stage 5). This stage can be highly significant as to whether the change persists. There is a risk for relapse, reverting to the earlier behaviour, particularly if it is easier in any way. However, this relapse potential reduces as you persist with your new behaviour. Thus, the more the new behaviour or way of responding is repeated, the easier it becomes to repeat it the next time. It could be thought of as a ‘law of diminishing resistance’. The easier it becomes, the more the individual is motivated and gains confidence in their change. For some people, all their attention is given to making the actual change, and effort and/or attention reduces after that. Yet, just as ego strengthening can help with the process of active change, so it can be immensely helpful in helping to focus positive attention on maintaining the change achieved. As your intention to maintain your behaviour and your belief in your capacity to conduct the new behaviour is important, further work on your self-efficacy can be helpful to keep sufficiently motivated.
Through this process, there tends to be a movement in ‘decisional-balance’. Your ‘decision’ scales may initially have ben weighed down with the disadvantages and costs of change (such as effort to change, ease of existing a behaviour), particularly in the precontemplation stage. The contemplation stage process tends to help you develop an even balance initially, and there is a risk here of uncertainty. However, with a focus of intention, there develops a shift of weight towards the advantages and benefits of change. This positive shift tends to increase through the maintenance stage, when effectively managed. The potential for or risk of relapse tends to decrease correspondingly. Homework is an essential part of the maintenance stage for hypnotherapy clients, ensuring that they are actively involved in their own maintenance process.
Many ‘stages of change’ models consider there are just five stages of change, and that the process ends with maintenance. However, we consider that there is a further element in the change process; that of evolution (stage 6). Here, your new behaviour, or way of responding becomes sufficiently incorporated that you integrate and synthesise it into your thoughts, feelings, emotions and attitudes, making it a seamless and congruent part of the ‘whole’ you, with those initial changes developing and evolving within your self-image, sense of self and interactions with your environment.
By becoming aware of the implications and benefits of the stages of change model within your hypnotherapy sessions (or self-help process), the likelihood of achieving changes, and ensuring they remain in the long-term, is greatly improved. We hope this blog on stages of change has been helpful, and if you have any questions relating to this blog, do please get in touch, because we’re always happy to help!
References & further reading
Evers, K. E., Prochaska, J. O., Johnson, J. L., Mauriello, L. M., Padula, J. A., & Prochaska, J. M. (2006). A randomized clinical trial of a population-and transtheoretical model-based stress-management intervention. Health Psychology, 25(4), 521.
Johnson, S. S., Driskell, M. M., Johnson, J. L., Prochaska, J. M., Zwick, W., & Prochaska, J. O. (2006). Efficacy of a transtheoretical model-based expert system for antihypertensive adherence. Disease Management, 9(5), 291-301.
Johnson, S. S., Paiva, A. L., Cummins, C. O., Johnson, J. L., Dyment, S. J., Wright, J. A., … & Sherman, K. (2008). Transtheoretical model-based multiple behavior intervention for weight management: effectiveness on a population basis. Preventive medicine, 46(3), 238-246.
– written by Dr Kate Beaven-Marks