The transtheoretical model of behavior change is an integrative theory that assesses how ready you are to act on a new healthier behavior or a life change. This model provides strategies to guide the individual through the process of change.

Stage 1: Precontemplation (Not Ready)

People at this stage do not intend to start healthy behavior shortly (within six months) and may be unaware of the need to change. People here learn more about healthy behavior: they are encouraged to think about the pros of changing their behavior and understand how their emotions potential transfer their negative behavior on others.

Precontemplators typically underestimate the pros of changing, overestimate the cons, and often are not aware of making such mistakes. These individuals are encouraged to become more mindful of their decision making and more conscious of the multiple benefits of changing unhealthy behavior.

Stage 2: Contemplation (Getting Ready)

At this stage, participants intend to start healthy behavior within the next six months. While they are usually now more aware of the pros of changing, their cons are about equal to their Pros. This ambivalence about changing can cause them to keep putting off taking action.

People here learn about the kind of person they could be if they changed their behavior and learn more from people who behave in healthy ways. They’re encouraged to work at reducing the cons of changing their behavior.

Stage 3: Preparation (Ready)

People at this stage are ready to start taking action within the next 30 days. They take small steps that they believe can help them make healthy behavior a part of their lives. For example, they tell their friends and family that they want to change their behavior.

People in this stage are encouraged to seek support from friends they trust, tell people about their plan to change the way they act, and think about how they would feel if they behaved more healthily. Their number one concern is: when they act, will they fail? They learn that the better prepared they are, the more likely they are to keep progressing.

Stage 4: Action (Doing)

People at this stage have changed their behavior within the last six months and need to work hard to keep moving ahead. These participants need to learn how to strengthen their commitments to change and to fight urges to slip back.

People in this stage are taught techniques for keeping up their commitments, such as substituting activities related to unhealthy behavior with positive ones, rewarding themselves for taking steps toward change, and avoiding people and situations that tempt them to behave in unhealthy ways.

Stage 5: Maintenance (Sustaining)

People at this stage changed their behavior more than six months ago. It is essential for people in this stage to be aware of situations that may tempt them to slip back into doing the unhealthy behavior— particularly stressful situations.

It is recommended that people in this stage seek support from and talk with people whom they trust, spend time with people who behave in healthy ways, and remember to engage in healthy activities to cope with stress instead of relying on unhealthy behavior.

How do People Move from One Stage to Another?

• The cons of changing outweigh the pros in the Precontemplation stage
• The advantages surpass the disadvantages in the middle stages
• The pros outweigh the cons in the Action stage

In general, for people to progress they need:

1. A growing awareness that the advantages (the “pros”) of changing outweigh the disadvantages (the “cons”)—this is called decisional balance
2. Confidence that they can make and maintain changes in situations that tempt them to return to their old, unhealthy behavior = self-efficacy
3. Strategies that can help them establish and sustain change:

• Consciousness-Raising—increasing awareness via information, education, and personal feedback about healthy behavior
• Dramatic Relief—feeling fear, anxiety, or worry because of the unhealthy behavior, or feeling inspiration and hope when they hear about how people can change to healthy behaviors
• Self-Reevaluation—realizing that healthy behavior is an essential part of who they are and want to be
• Environmental Reevaluation—realizing how their unhealthy behavior affects others and how they could have more positive effects by changing
• Social Liberation—realizing that society is more supportive of healthy behavior
• Self-Liberation—believing in one’s ability to adapt and making commitments and recommitments to act on that belief
• Helping Relationships—finding people who are supportive of their change
• Counter-Conditioning—substituting healthy ways of acting and thinking for unhealthy habits
• Reinforcement Management—increasing the rewards that come from positive behavior and reducing those that come from negative behavior
• Stimulus Control—using reminders and cues that encourage healthly bevarior as substitutes for those that encourage the unhealthy behavior