The Transtheoretical Model of Behavior Change

The Transtheoretical model (TTM) of behavior change is one of the most popular and tested models of behavior change and focuses on changes that are time sensitive.

TTM hypothesizes that people progress through several stages of change from a precontemplation stage, to a contemplation stage, to a preparation stage, to an action stage, and then to a maintenance stage. Termination is a term used to describe having fully changed a behavior with no possibility of returning to the previous behavior.

Within these stages, the TTM further describes 10 processes of a persons need for behavior change that encompasses raising awareness about the issue(s), emotional arousal, environmental evaluation for its influence on behavior, self-reevaluation, self-liberation, replacing unhealthy behaviors with new behaviors, reinforcements for changes, environment modification to enhance cues to action, helping relationships, and social liberation.

Though I won’t go into great detail of the stages and processes here as the information is readily available elsewhere, it is important to note that the TTM has been applied with success in many areas of behavioral research, and in primary, secondary, and tertiary prevention interventions.

It is also important to note that the TTM model has its limitations and criticisms as it largely ignores social aspects of behavior change including the built environment, has limited criteria for determining stages of change, lacks clarity in determining the time needed for change, ignores an individual’s ability for decision making, and has limited empirical evidence of a persons sequential movement through all stages.

The TTM seems to be best fit for understanding general stages of behavior change and some factors that influence behavior from a clinicians perspective to assist individuals in their behavior change endeavors.

As with all behavior change, a persons need for autonomy, self-efficacy, and mastery play a significant role in changing behaviors and a clinician or public health intervention specialist ought to always consider these factors and utilize evoking techniques to assist an individual through their desired changes.

Often, a person has little desire to change or does not feel a need to change so asking the right open-ended questions may get them to reconsider their feelings and desires and move them toward health behavior change.

A mastery of open-ended questioning coupled with an understanding of stages and processes needed for change, can help a professional walk an individual through the stages while making them feel that they are the one desiring and mastering the behavior changes.

Few individuals want to be told what to do, instead their desires ought to be drawn out from their internal motivations and self-determinations to help motivate healthy behavior changes.