Readiness to adaptively change under three conditions: Clinical,careers, and natural change situations

The Adaptive Change Model (ACM) was developed as an alternative form of the Transtheoretical Model of Change to address some of the criticisms of early operationalisation. Both models provide a framework for measuring the potentialities of change and to facilitate targeted behaviour change in general and clinical settings. In this research, the eight factors of the Adaptive Change Questionnaire (ACQ) operationalising the ACM were validated using confirmatory factor analysis, involving 238 respondents. The findings indicated a good fit between the model and data. A comparison of the mean scores of the factors of the ACM showed respondents seeking clinical therapy (n = 85) were lower on self‐rating of factors related to adaptive change than a group receiving career counselling (n = 88) and a non‐therapy group (n = 65). The ACQ factors correctly predicted the allocation of 79.3% of the clinical and non‐therapy respondents which confirmed previous research. The relevance of the findings for therapeutic interventions and future research are discussed.     

A randomized clinical trial of a population- and transtheoretical model-based stress-management intervention.

Stress has been associated with a variety of chronic and acute conditions and with higher use of health care services. This research reports on 18-month outcomes of a randomized clinical trial of a stress-management program based on the transtheoretical model (TTM; J. O. Prochaska & C. C. DiClemente, 1986). A national sample of 1,085 individuals participated (age range = 18-91 years, M = 55.33; 68.9% female, 31.1% male; 84.8% Caucasian; 15.2% non-Caucasian). Both the treatment and control groups received assessments at 0, 6, 12, and 18 months. In addition to the assessments, the treatment group received 3 individualized reports (0, 3, 6 months) and a manual. The 18-month assessment was completed by 778 individuals (72%). A random effects model indicated that participants completing the study in the treatment group had significantly more individuals reporting effective stress management at follow-up time points than did completers in the control group. Results also indicate that the intervention had significant effects on stress, depression, and specific stress-management behaviors. Results provide evidence for the effectiveness of this TTM population-based stress-management intervention.     

Differential effects of pretraining influences on readiness to change

Training and development are integral to organizational change but are difficult to accomplish effectively in dynamic and complex work environments. Such environments can lead to nonoptimal training conditions that reduce individuals' readiness to change and training effectiveness. On the basis of the transtheoretical model of change (J. O. Prochaska, C. C. DiClemente, & J. C. Norcross, 1992), the authors examined pretraining influences (choice, social support, and motivation to learn) on readiness to change under nonoptimal training conditions. They examined specific dimensions of readiness to change rather than a global readiness to change construct. Participants were 183 driving under the influence (DUI) offenders participating in a court-mandated, alcohol-related Weekend Intervention Program. Perceived choice to attend training, social support, and motivation to learn affected readiness to change when individuals were resisting, considering, acting on, or maintaining behavior or attitude change. These effects were also dependent on age. Results suggest how training effectiveness could be improved when trainees are least likely to learn.     

Using a three-stage model of change to understand people’s use of bicycle,public transport,and car

More active ways of travelling (e.g., walking, cycling, and public transport) would benefit both individuals and society. To encourage people’s transition to more active travelling, it is important to understand the decision-making process regarding modal choice. The first aim of this study is therefore to combine a three-stage version of the transtheoretical model of change (TTM; Prochaska & DiClemente, 1983) with the theory of planned behaviour (TPB; Ajzen, 1991) to advance our understanding of the nature of the TTM stages. The second aim is to examine certain characteristics (i.e., age, gender, importance of everyday exercise, importance of environmental issues, perceived accessibility, and satisfaction with travel) of these three stages of change. The study used a web-based questionnaire, an app-based questionnaire, and an app-based travel diary completed by 306 people in the Stockholm area. The observed behaviour measured using the app-based travel diary showed that the three-stage model used in this study was consistent with the participants’ self-reported travel behaviour in using bicycles, public transport, and cars. Interventions focusing on attitude, subjective norm, and perceived behavioural control appear to have potential to move people from one stage to another regardless of initial stage. To make interventions as effective as possible, the stage of change as well as the behavioural, normative, and control beliefs underpinning attitude, subjective norm, and perceived behavioural control must be considered. Finally, more research is needed to advance our knowledge of the relationship between the three stages of change and other variables.     

Processes and Stages of Change: Counseling With the Transtheoretical Model of Change

Technical eclecticism and theoretical integration literature has typically examined how multiple approaches to counseling practice may lead to more comprehensive and functional outcomes. Few have proposed an integration of approaches from a scientist‐practitioner perspective; many others have neglected the richness found in the body of existing theory. The purpose of this synthesis is to highlight the contributions that the Transtheoretical Model of Change (J. O. Prochaska & C. C. DiClemente, 1984; J. O. Prochaska & J. C. Norcross, 1994) has for technical eclecticism and theoretical integration. The intervention implications of processes and stages of change are discussed.     

Matched and mismatched interventions with young adult smokers: testing a stage theory.

This experiment tested the transtheoretical model (J.O. Prochaska & C.C. DiClemente, 1983) of smoking cessation by matching or mismatching interventions to smokers in a particular stage. The interventions were tested against a no-intervention condition with 92 college-aged daily smokers in the precontemplation stage of change. The stage-matched intervention asked smokers to think more about quitting smoking; the stage-mismatched intervention provided action-oriented activities typically used for those ready to quit smoking. The results failed to support the value of matching interventions to a smoker's stage of change. Instead, more smokers who received the action intervention tried to quit smoking. Matching interventions to an individual's current stage may be less important than the transtheoretical model suggests.     

Stages of change and stuttering: a preliminary view

As a way to better understand the process of change that occurs in stuttering, Craig [Craig, A. (1998). Relapse following treatment for stuttering: a critical review and correlative data. Journal of Fluency Disorders, 23, 1-30] compared the behavioral changes that people who stutter often experience with and without treatment to those that have been observed for certain (non)addictive behavior disorders such as smoking, overeating, phobia and anxiety disorder. The process underlying these behavioral changes has been described by the transtheoretical or "stages of change" model, which is a model of behavior change that can illuminate "where" a person is in the process of change, and how this may relate to the outcome of either treatment or self-change attempts [Prochaska, J. O., & DiClemente, C. C. (1986). The transtheoretical approach. In J. C. Norcross (Ed.), Handbook of eclectic psychotherapy. New York: Brunner/Mazel]. The purpose of the present study was to analyze the extent to which the responses of adults who stutter on a modified Stages of Change Questionnaire yield interrelations among questionnaire items that are consistent with a stage-based interpretation. Results of both confirmatory and exploratory factor analyses indicated that while the modified questionnaire was a relatively good fit for participant responses, the structure derived from the exploratory analysis provided a significantly better fit to the observed data. Results suggest that a questionnaire incorporating items that better reflect the unique behavioral, cognitive and affective variables that characterize stuttering may better discriminate stages of change in people who stutter as they move through therapy, or are engaged in self-directed change. Educational objectives: After reading this paper, the learner will be able to: (1) describe the transtheoretical or "stages of change" model; (2) describe the various processes that are associated with different stages of change; (3) summarize research findings in stages of change as they apply to a variety of clinical populations; (4) discuss the applicability of the findings from the present study to stuttering treatment, and (5) relate conventional strategies and techniques used in stuttering therapy to different stages in the process of change.     

Integrating stage and continuum models to explain processing of exercise messages and exercise initiation among sedentary college students.

Concepts from the transtheoretical model (J.O. Prochaska, C.C. DiClemente, & J.C. Norcross, 1992), theory of planned behavior (I. Ajzen, 1985), and the elaboration likelihood model (R.E. Petty & J.T. Cacioppo, 1986b) were used to examine how exercise readiness impacted processing of exercise messages and exercise initiation. Sedentary college students (n = 147) were assessed for exercise attitude, intent, behavior, and stage of change. Students also listed their thoughts after reading messages with either strong or weak arguments for exercise. Attitude predicted depth of message processing, but stage of change did not. Stage of change and intent at baseline predicted exercise adoption at 1- to 3-month follow-up (n = 134), with baseline activity moderating the effect of intent. Tailoring messages to recipients' depth of processing and interactive effects of intent and behavior on exercise adoption should be considered in future research.     

A longitudinal study of the determinants and outcomes of career change

The present longitudinal field study investigated the antecedents and consequences of an actual career change. The framework for this study was Rhodes and Doering's (1983) model of career change. We examined the effect of individual and organisational characteristics on career change behaviour. The individual characteristics were: traits (Openness to Experience, Extraversion, Conscientiousness and general self-efficacy), demographic factors (age, gender, marital status, and children), human capital (education level and occupational tenure), job satisfaction, job search activity and intentions to leave; and organisational factors (job security and salary). The findings showed that a range of individual characteristics were associated with career change including, Openness to Experience, Extraversion, gender, age, educational level, and occupation tenure. However, job security was the only organisational factor related to career change. One year after career change, individuals reported higher job satisfaction, improved job security and a reduction in the number of hours worked.     

Is the sequencing of change processes by stage consistent across health problems? A meta-analysis.

Clinicians and researchers applying the transtheoretical model (J.O. Prochaska, C.C. DiClemente, & J.C. Norcross, 1992) to health promotion often assume that relationships of processes and stages observed in smoking cessation can be generalized to other problems. A reanalysis of 47 cross-sectional studies determined that use of change processes varies by stage, but the sequencing of processes is not consistent across health problems. In smoking cessation, cognitive processes were used in earlier stages than were behavioral processes. In exercise adoption and diet change, use of behavioral and cognitive processes increased together. Results for substance abuse and psychotherapy were less consistent. Substituting new behaviors, making a commitment, considering consequences, seeking information, controlling cues, and using rewards varied most by stage. Future longitudinal studies should assess these processes as potential mediators of lifestyle change.     

The Effectiveness of Individual Wellness Counseling on the Wellness of Law Enforcement Officers

The purpose of this exploratory study was to determine the effectiveness of wellness counseling on increasing wellness among law enforcement officers. The study also examined whether position in the Transtheoretical Model (J. O. Prochaska & C. C. DiClemente, 1982) and self‐efficacy influenced the effectiveness of counseling on wellness. These findings indicate that counseling may increase wellness among law enforcement officers.     

Stages of Learning Motivation: Development and Validation of a Measure1

Prochaska and colleagues’(e.g., Prochaska, DiClemente, & Norcross, 1992) stages‐of‐change theory was employed in the current study to reconceptualize the assessment of motivation to learn. We used the stages‐of‐change framework to develop and test a multidimensional measure of learning motivation using 3 independent samples. The pattern of relationships among the learning stages and learning criteria provided strong support for the appropriateness of using a stage‐based perspective to frame learning motivation. In addition, hierarchical regression analysis showed that the Stages of Learning Motivation Inventory (SOLMI) explained variance in the criteria (e.g., exam average, class satisfaction) beyond controls and a commonly used measure of learning motivation. Implications for practice and future research are discussed.     

Matching therapeutic interventions to drug and alcohol abusers’ stage of motivation: The clients’ perspective

The present study aims to explore the issue of matching the appropriate therapeutic intervention according to the stage of readiness for change in addictive clients, following the model proposed by Prochaska and DiClemente in the 1980s. The study focuses solely on the perspectives of people with drug and alcohol problems, in contrast to previous ones which have been concerned with the researchers’ understandings and postulations of the issue under exploration. One of the most important findings of this study is that participants in the “early” stages of their readiness to change their addictive behaviour, irrespective of their gender or whether they had seen a therapist significantly prefer non-action-oriented therapeutic interventions than action-oriented interventions. Similarly, participants in the “later” stages, showed a significant preference to action-oriented than non-action interventions, irrespective of their gender or previous experience of counselling. It is suggested then that careful assessment of the stage of motivation and individual-tailored intervention should be an essential element of any treatment program for drug and alcohol addicted clients.     

Eating disorders in the course of life: A qualitative approach to vital change

Eating disorders (EDs) have become one of the biggest mental-health problems in the last decades, especially among youth and women. The present study aims to analyse the suitability of Prochaska and DiClemente’s Transtheoretical Model of Change when applied to the living experiences of people diagnosed with ED and their carers. For this purpose, we applied a narrative biographic approach to the ways in which people face their problems and vital development in the ED domain. Through the narrative analysis of these autobiographies, we aimed to study the patients’ own notions of ‘change’, ‘problem’ and ‘vital trajectory’. We focused on five autobiographic interviews of persons diagnosed as ED (four women and a man). The analysis yields three discourses which organize and give sense to our participants’ vital transitions: a discourse of functional adaptation to events and experiences; one that pays attention to random events and people entering your life; and one that has the personal initiative and agency of an individual agent at its core. It also illuminates particular ways of understanding determination, contemplation and pre-contemplation. These ways of understanding change are shown to extend the possible ways of thinking about people’s lives and ED patients’ perspectives.     

Variations in Self-Determination Across the Stages of Change for Exercise in Adults

This study explored the relationship between self-determination in the regulation of exercise behavior and stage of change for exercise. Deci and Ryan (1985, 1990) outlined a continuum of behavioral regulation that ranges from non-self-determined regulation (external regulation) to completely self-determined regulation (intrinsic regulation). Prochaska and DiClemente (1984) outlined five stages of behavior change that range from no thoughts of changing (precontemplation) to maintenance of change (maintenance). In our study, 314 individuals completed measures of regulation in exercise behavior and stage of change for exercise. Discriminant function analysis revealed that those in the latter stages of change were more self-determined in their behavioral regulation than those in the early stages of change. An analysis of variance indicated that self-determination increased from the lower to the upper stages of change. Results endorse the importance of motivational considerations in understanding the change process.     

Adolescent offenders and stages of change

Two hundred twenty-five adolescent offenders completed the Stages of Change Scales (SOCS; E. A. McConnaughy, J. O. Prochaska, & W. F. Velicer, 1983), which were designed to measure 4 stages of psychological and behavioral change. The goals of this research were to obtain norms among adolescent offenders for the SOCS, to examine the factor structure of the SOCS, and to investigate the convergent and discriminant validity of the SOCS by examining associations among these scales and the Paulhus Deception Scales (PDS; D. L. Paulhus, 1994, 1999) and Multidimensional Anger Inventory (MAI; J. M. Siegel, 1986). Means and alpha coefficients for the SOCS were similar to those reported in a previous normative clinical sample of adult patients. However, relatively large intercorrelations among the 4 scales of the SOCS, and results from factor analyses of SOCS items, suggested that fewer than 4 factors represented the SOCS items among our sample of adolescent offenders. Patterns of correlations with the PDS and with the MAI provided convergent and discriminant validity for the SOCS. Implications of the findings for research and clinical practice are discussed.     

Convergent and discriminant validity of three measures of stage of change

The University of Rhode Island Change Assessment (E. A. McConnaughy, J. O. Prochaska, & W. F. Velicer, 1983), the Stages of Change Readiness and Treatment Eagerness Scale (W. R. Miller & J. S. Tonigan, 1996), and the Readiness to Change Questionnaire (S. Rollnick, N. Heather, R. Gold, & W. Hall, 1992) are commonly used multidimensional measures of stage of change. The authors examined the convergent and discriminant validity of drug-use versions of these 3 measures through multitrait-multimethod analysis in a population of indigent, out-of-treatment drug users (N = 377). Agreement in stage-of-change assignment and the relationship between stage of change and drug-use behaviors were also examined. Confirmatory factor analysis suggests that the Stages of Change Readiness and Treatment Eagerness Scale may have questionable convergent validity with the University of Rhode Island Change Assessment and Readiness to Change Questionnaire. There was moderate agreement in stage assignment. Analysis of behavior did provide some support for the construct validity of the measures. The results suggest that these drug-use stage-of-change measures may not be equivalent.     

Do processes of change predict smoking stage movements? A prospective analysis of the transtheoretical model.

The transtheoretical model (TTM) posits that processes of change and the pros and cons of smoking predict progressive movement through the stages of change. This study provides both a cross-sectional replication and a prospective test of this hypothesis. As part of a larger study of worksite cancer prevention (the Working Well Trial), employees of 26 manufacturing worksites completed a baseline and 2 annual follow-up surveys. Of the 63% of employees completing baseline surveys, 27.7% were smokers (N = 1,535), and a cohort of these smokers completed the 2-year follow-up. Cross-sectional results replicated previous studies with virtually all the processes of change and the cons of smoking increasing in linear fashion from precontemplation to preparation (all ps < .00001), and the pros of smoking decreasing (p < .01). However, contrary to the hypothesis, the baseline processes of change and the pros and cons of smoking failed to predict progressive stage movements at either the 1- or the 2-year follow-ups. Possible explanations for these findings and concerns about the conceptual internal consistency of the TTM are discussed.     

Five-factor model (Big Five) personality traits and universal-diverse orientation in counselor trainees

In this study the authors explored the relationship between five-factor model (FFM: Big Five) personality traits (J. M. Digman, 1990; R. R. McCrae & O. P. John, 1992; J. S. Wiggins & P. D. Trappnell, 1997) and universal-diverse orientation (UDO; M. L. Miville et al., 1999) in counselor trainees. FFM traits were measured using the NEO-Personality Inventory-Revised (P. T. Costa & R. R. McCrae, 1992). Statistically significant relationships were found between UDO and one of the Big Five personality traits (Openness to Experience) in counselor trainees. Further regression analysis suggested a relationship between UDO and a particular facet of Openness to Experience, Openness to Aesthetics. This finding suggests that counselor trainees who are open to the creative expressions of others may be comfortable working with a wide variety of clients. These results suggest that counselor training that encourages experiences of aesthetic diversity in addition to an exploration of values may promote trainees' ability to work with diverse clients.