In Search of How People Change: Applications to Addictive Behaviors

The University of Scranton, Scranton, Pennsylvania, United States
American Psychologist (Impact Factor: 6.87). 10/1992; 47(9):1102-14. DOI: 10.3109/10884609309149692
Source: PubMed


How people intentionally change addictive behaviors with and without treatment is not well understood by behavioral scientists. This article summarizes research on self-initiated and professionally facilitated change of addictive behaviors using the key trans-theoretical constructs of stages and processes of change. Modification of addictive behaviors involves progression through five stages--pre-contemplation, contemplation, preparation, action, and maintenance--and individuals typically recycle through these stages several times before termination of the addiction. Multiple studies provide strong support for these stages as well as for a finite and common set of change processes used to progress through the stages. Research to date supports a trans-theoretical model of change that systematically integrates the stages with processes of change from diverse theories of psychotherapy.

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    • "While the total amount of variance explained by these variables was about 5% on the contemplation and action scores, the combination of benefits, self-efficacy, and cues to action scores explained 15.5% of the variance in precontemplation scores. According to the TTM, individuals in the precontemplation stage of change are least likely to have sought help for their hearing (Milstein & Weinstein 2002) and/or other health conditions (e.g.,Prochaska et al. 1992;Rumpf TABLE 6et al. 1998). It is therefore our objective to develop and evaluate a counseling/education intervention that can help individuals move from the precontemplation stage to a more advanced stage of change by changing perceived benefits, self-efficacy and by providing cues to action. "
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    ABSTRACT: Objectives: Several models of health behavior change are commonly used in health psychology. This study applied the constructs delineated by two models-the transtheoretical model (in which readiness for health behavior change can be described with the stages of precontemplation, contemplation and action) and the health belief model (in which susceptibility, severity, benefits, barriers, self-efficacy, and cues to action are thought to determine likelihood of health behavior change)-to adults seeking hearing help for the first time. Design: One hundred eighty-two participants (mean age: 69.5 years) were recruited following an initial hearing assessment by an audiologist. Participants' mean four-frequency pure-tone average was 35.4 dB HL, with 25.8% having no hearing impairment, 50.5% having a slight impairment, and 23.1% having a moderate or severe impairment using the World Health Organization definition of hearing loss. Participants' hearing-related attitudes and beliefs toward hearing health behaviors were examined using the University of Rhode Island Change Assessment (URICA) and the health beliefs questionnaire (HBQ), which assess the constructs of the transtheoretical model and the health belief model, respectively. Participants also provided demographic information, and completed the hearing handicap inventory (HHI) to assess participation restrictions, and the psychosocial impact of hearing loss (PIHL) to assess the extent to which hearing impacts competence, self-esteem, and adaptability. Results: Degree of hearing impairment was associated with participation restrictions, perceived competence, self-esteem and adaptability, and attitudes and beliefs measured by the URICA and the HBQ. As degree of impairment increased, participation restrictions measured by the HHI, and impacts of hearing loss, as measured by the PIHL, increased. The majority of first-time help seekers in this study were in the action stage of change. Furthermore, relative to individuals with less hearing impairment, individuals with more hearing impairment were at more advanced stages of change as measured by the URICA (i.e., higher contemplation and action scores relative to their precontemplation score), and they perceived fewer barriers and more susceptibility, severity, benefits and cues to action as measured by the HBQ. Multiple regression analyses showed participation restrictions (HHI scores) to be a highly significant predictor of stages of change explaining 30% to 37% of the variance, as were duration of hearing difficulty, and perceived benefits, severity, self-efficacy and cues to action assessed by the HBQ. Conclusions: The main predictors of stages of change in first-time help seekers were reported participation restrictions and duration of hearing difficulty, with constructs from the health belief model also explaining some of the variance in stages of change scores. The transtheoretical model and the health belief model are valuable for understanding hearing health behaviors and can be applied when developing interventions to promote help seeking.
    Full-text · Article · Jan 2016 · Ear and hearing
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    • "ctive and had not even thought about it , to ( 5 ) I was not active since it is not necessary to be active on a regular basis . Participants who stated that they had either been active on a regular basis ( 1 ) or had tried to become active ( 2 ) were included in this study . Non - intenders ( Schwarzer , 1992 , 2008a ) or ( pre - ) contemplators ( Prochaska et al . , 1992 ) , or those who decided not to act ( Weinstein and Sandman , 1992 ) , that is , people without intentions or attempts to become more active were disregarded given that they did not enter the behavior change process . Furthermore , at Waves 2 and 3 participants indicated whether they had increased physical activity since the last measur"
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    ABSTRACT: Although outcome expectancies are regarded as key determinants of health behavior change, studies on the role of their degree of fulfillment in long-term activity changes are lacking. This study investigated the impact of (un-)fulfilled outcome expectancies (OE) on (un-)successful attempts to increase physical activity, assuming that disengagement is the logical consequence of perceived futility. Participants (n = 138) of a longitudinal cohort study with three measurement waves were assigned to eight different groups according to a staging algorithm of their self-reported, one-year-long physical activity behavior track. Stages were validated by objective changes in objective fitness, e.g. Physical Working Capacity (PWC). Social cognitive variables, self-efficacy, proximal and distal OE and fulfillment of OE, were assessed via self-report. Discriminant analyses revealed that OE fulfillment was the predominant predictor for differentiating between successful and unsuccessful behavior change. Amongst OE, proximal OE concerning emotional rewards, in conjunction with action self-efficacy, further improved discriminatory power. OE adjustment warranting hedonic rewards appears to be a crucial mechanism as it facilitates long-term changes through interventions aimed at increasing physical activity rates. Theoretical models might benefit by including the concept of fulfilled expectations acting in terms of feedback loops between volitional and motivational processes.
    Preview · Article · Dec 2015 · Frontiers in Psychology
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    • "Three theoretical perspectives on communication campaigns are found in the literature; viz., stage-based psychological perspectives; diffusion of innovation; and social marketing perspectives (McGuire, 1989; Prochaska, DiClemente, & Norcross, 1992; Maiback, Kreps, & Bonaguro, 1993;Rogers, 1995). Prochaska et al. (1992) note that change happens in stages that run from pre-contemplation stage (the target person is unaware of a risky behavior to be changed) to contemplation (the person begins considering how to make a change in behavior) to actionstages (the person modifies a risky behavior). Persuasive communications are tailored to the needs of the person at a particular stage. "
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    ABSTRACT: Based on an overview of over half a century of research on persuasive communication and information campaigns in the West and the assumptions and challenges of a successful communication and information campaign, the present paper basically outlines a holistic communication intervention strategy in the service of crowd management in the Islamic Holy places (Masha'er). The objectives and characteristic of the strategy in general are described. Theoretical rationale and a prototype of a set of on-site messages for creating a communication ambience in the Arafaat area are also given. These particular messages aim at preventing crowd congestion around the mount al-Rahmah (Jabal al-Rahmah).
    Full-text · Article · Dec 2015 · Al-Shajarah
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