OK, so we are a few weeks into 2016, and many of us may already be wavering from our New Year’s resolutions, if not completely forgotten them. Why is it so hard to make changes? James Prochaska, from the University of Rhode Island, has studied this question for more than thirty years, and has applied his theory to many health behaviors, including behaviors important in diabetes management.
Prochaska has found that people who have successfully made positive change in their lives go through five specific stages: precontemplation, contemplation, preparation, action, and maintenance.
- "Precontemplation is the stage at which there is no intention to change behavior in the foreseeable future. Many individuals in this stage are unaware or under-aware of their problems." Some people call this phase "denial."
- "Contemplation is the stage in which people are aware that a problem exists and are seriously thinking about overcoming it but have not yet made a commitment to take action." Many people in this stage can be described as ambivalent. They want to improve their blood sugar, but are not yet ready to cut back on eating sweets.
- The Preparation stage can be considered the information gathering and planning stage. The preparation stage is the most important. Fifty percent of the people who attempt behavior change and skip this stage will relapse within 21 days, according to Prochaska in his book, Changing for Good.
- "Action is the stage in which individuals modify their behavior, experiences, or environment in order to overcome their problems. Action involves the most overt behavioral changes and requires considerable commitment of time and energy." During the action stage, one implements the plans developed and information gathered in the preparation stage.
- "Maintenance is the stage in which people work to prevent relapse and consolidate the gains attained during action. For addictive behaviors this stage extends from six months to an indeterminate period past the initial action."
Most people I work with, who have diabetes, could be categorized in the contemplation stage. They are seriously thinking about life changes, but have not yet made a commitment to take action. Therefore, I think it valuable to further explore this stage.
Within each stage, specific actions called, "processes of change," help someone mentally move through each stage successfully. In the contemplation stage, the processes of change are “consciousness raising” and “self-reevaluation.”
Consciousness raising is the process of actively becoming more aware, mindful or conscious of the current situation. Some activities include, keeping a food diary to learn more about how much I am eating, monitoring blood sugar to learn how well or if my treatment plan is working, or reading food labels to learn about how much carbohydrate is in different foods.
Self-reevaluation flows naturally from consciousness raising. Self-reevaluation means taking stock or appraisal of the behavior that needs to be changed, and reveals how your values conflict with the problem behaviors.
An activity which will help clarify your values, or "why" you want to change is called “decisional balance”. The decisional balance takes into consideration the pros and cons of behavior change. Understanding pros and cons helps one acknowledge that behavior change has good consequences, but requires sacrifice.
Take a piece of paper. Divide the paper into two columns. Label one "pros" and the other column "cons". Under each column answer each question: What will be the consequences of my behavior change be for me?
- What will the consequences of my behavior change be for others (family, friends, coworkers)?
- What will my reactions be to my new self?
- What will the reactions of others (family, friends, coworkers) be to my new self?
- If the pros of change outweigh the cons, then one is ready to move into the preparations stage! This sets the foundation for the preparation, action and maintenance stages.
I once heard a radio interview with James Prochaska. He said that making a behavior change should be approached as if you were getting ready for a major surgery. How much pre-planning would you do? How much support would you solicit from friends and family? How much mental attention would you put towards it? It would be your number one priority, and you would choose a time when there would be nothing else within your control that would take precedence. You would not choose a time when you are making a marital change, job change, major vacation, getting ready to move to a new house, etc. Healthy behavior change is that difficult, and it is that important.
Cecelia Health Diabetes Health Coach
Cancer Prevention Research Center. University of Rhode Island, 2016. Web. 10 Jan. 2016. <http://web.uri.edu/cprc/about-ttm/>
Prochaska, J. O. and W. F. Velicer (in press). “The transtheoretical model of health behavior change.” American Journal of Health Promotion.
Prochaska, PH.D., James O., John C. Norcross, PH.D., and Carlo C. Diclemente, PH.D. Changing For Good. New York, NY: Harperollins Publishers, 1994. Print.