17.6.2 Proschaska's Model of Behaviour Change

• Prochaska & DiClemente (1983) developed a ‘stages of change’ model during a study they were conducting into quitting smoking
• The model, known as Prochaska’s model of behaviour change (PMBC) suggests that those addicted to harmful behaviours commonly try several times unsuccessfully before they successfully change their behaviour
• PMBC identifies an individual’s readiness for change and tries to get them to a position where they are highly motivated to change their behaviour
• The six stages outlined below do not necessarily happen in order, as the process is often a cycle, and some stages may be missed, or might be repeated before moving on
• The six stages of PMBC:

1. Pre-contemplation stage - the individual has no intention of changing and does not even think they have a problem
2. Contemplation stage - the individual is aware that they have a problem and thinks they should do something about it, but they do not feel ready to do this yet
3. Preparation stage - this is an important stage, as the individual is intending to make behaviour changes in the very near future and may even be planning their course of action
   
4. Action stage - the individual gives up their addictive behaviour, making the necessary changes to their situation and environment, relying on the support of others to help them through this stage, lasting six months
   
5. Maintenance stage - this comes after the individual has abstained from their behaviour for six months, and is when they take all steps necessary to prevent relapse and to maintain their change in behaviour
6. Termination - this stage was not part of the original model, and is when the individual has no desire to return to their previous behaviour and is sure they will not relapse, but as people tend to stay in the maintenance stage this part of the model is often not considered in health promotion programmes  

Prochaska’s original stages of change model (Prochaska & DiClemente, 1983).

• The model was designed to help people overcome addictions and problematic behaviours such as alcohol or drug abuse, overeating and smoking
• The model can be applied to smoking in the following way:
  1. Pre-contemplation stage - the individual feels that they are ‘only a social smoker’ and ‘could give up any time they choose to’ 
  2. Contemplation stage - the individual becomes aware that their smoking is a problem (maybe after medical advice) and thinks they should do something about it, but they do not feel ready to do this yet
  3. Preparation stage - possibly after intervention from family and friends, or after illness, the individual prepares to give up smoking by stopping buying cigarettes, stating their intention and planning how and when they will stop smoking
  4. Action stage - the smoker has given up their addictive behaviour and needs a lot of support from family and friends at this stage
  5. Maintenance stage - now the individual has not smoked for six months and has no cigarettes or lighters in their vicinity and thinks of themselves as an ‘ex-smoker’, though they may still be subject to temptation when they smell cigarette smoke or see a someone smoking
  6. Termination - this stage - added later by Prochaska et al (1992) -  is when there is no desire whatsoever for the addictive substance or behaviour, and may eventually be reached after several years, but with smoking and other    addictive behaviours it may never be achieved
• Prochaska et al (1992) suggested that relapse should be normalised, as it was very likely during the action and maintenance stages
• Prochaska et al (1984; 1986) also noted that only 15 per cent of those who relapsed went back to the pre-contemplation stage, with the remainder recycling back to the contemplation stage or preparation stage, meaning that they were ready to start quitting again

Exercise is one way to avoid relapse in the holiday season (Ussher et al, 2019).

Research which investigates Proschaska's model of behaviour change

• Noel (1999) developed a modified version of the model, in which the stages are more like ‘influences’ on anyone going through the process and are less fixed and determined than in PMBC 
• Velicer et al (2007) conducted a review of five studies and found that there was a 22 - 26 per cent success rate with PMBC for males and females of all ages, which compares well with other interventions 
• Baumann et al (2015) carried out a study as part of a randomised controlled trial with individuals addicted to alcohol in what would be identified as the pre-contemplation stage and found staged intervention had no benefits over any other mode of intervention

Evaluation of Proschaska's model of behaviour change

Strengths

• PMBC is used widely by healthcare professionals and this shows that there is a practical application to the theory, and that appropriate interventions can be used depending on the stage the individual has reached (Hashemzadeh et al, 2019)
• The model is flexible and reflects the changing attitudes and intentions of individuals regarding their condition, as well as reducing stigma and feelings of failure by normalising relapse

Weaknesses

• PMBC neglects the influence of social factors such as living conditions and unemployment and also the influence of cultural norms on smoking as, for example, in some cultures cigarettes are still given out at social events (Daoud et al, 2015)
• The difference between stages in the PMBC is often vague and difficult to distinguish, especially the boundary between contemplation and preparedness, which can make it difficult to tailor interventions

Link to Issues & Debates: 

PMBC is an example of soft determinism, as although it is a theory of behaviour change with fixed stages from pre-contemplation to termination, the individual’s progression through these stages is flexible and personal and somewhat subject to their free will.

PMBC was also shown by Velicer et al (2007) to be equally effective with males and females, suggesting there is no gender bias in the model, though a lack of consideration of cultural norms that make relapse more likely means there is a cultural bias.

Link to Approaches:

Prochaska et al (1992) argued that PMBC is relevant to several approaches, with the pre-contemplation and contemplation stages being associated with the cognitive approach and the psychodynamic approach, as they focus mainly on conscious and unconscious internal mental processes. 

Conversely, the action stage and the maintenance stage are most associated with the behavioural approach, as the individual is focused on avoiding the triggers (called cue reactivity in classical conditioning) that might cause relapse, while replacing the undesired behaviour with something more positive, like sport. Social learning is also relevant, as positive role models who do not engage in the addictive behaviour will be of most support in the action and maintenance stages.