9 Processes of Change

5 11 2010

This post represents further information from Dr. Prochaska’s book, Changing for Good.  It is a great follow up to the last post from a couple of days ago.  This will describe 9 processes, or strategies, that we can use to help us work our way through the 6 stages of change described in the last post.  As you will see there are certain stages where each process will be more helpful, and some where they would NOT be so helpful.  WHY IS ANY OF THIS IMPORTANT?  To increase our chances at successfully changing a habit or behavior, it will help us to know 2 things.  First, regarding the particular behavior in question, what stage am I in right now (contemplation, preparation, etc)?  Second, what strategies can I apply during this, and subsequent stages that increase my chances of moving forward, and ultimately, of lasting success.  So by taking the info from the last post and this one, we can consider ourselves armed and ready to proceed.  Read on.

1.  Consciousness-raising:   Raising your level of awareness, increasing the amount of knowledge, thereby improving your chances of making solid, intelligent choices regarding any problem behaviors.   The new knowledge might involve something like, “why I eat when I am in stressful situations,” or “what is it about my family that always makes me want to smoke?”  Or the new knowledge may be less personal like how exercise works to lower the risk for several different chronic diseases.  Consciousness-raising is very useful early in the change process, primarily during the precontemplation and contemplation stages.

2. Social liberation:  This involves any new alternatives that the environment can give you to begin or continue to move through the stages of change.  The easiest example is all the Smoke-free restaurants, clubs and work-places that have sprung up over the last several years.  Other examples include the “healthy menu” items that are popping up on many restaurant menus, and advocacy groups like Weight Watchers, mental health support groups and others.  I differ slightly from the book here, and feel that this process can be used beginning in the contemplation stage and continue really all the way through the maintenance stage.

3. Emotional arousal:  I had mentioned the importance of creating and using emotion in an earlier post.  Emotion is a powerful process and motivator.  It is similar to consciousness-raising but on a deeper and usually more personal, feeling level.  Like consciousness-raising, it too is helpful early in the change process, contemplation and preparation.  Examples may include watching videos showing the devastation caused by accidents involving drunk drivers, or shows such as the Biggest Loser for help with emotional motivation to lose weight. 

This is a good time to describe how using a process at the wrong time may be detrimental.  If emotional arousal is used too early, it may backfire.   For example, having a family/friend intervention with an obese person whose lifestyle is putting him at risk for diabetes, heart disease and other health issues, but who is still in the precontemplation stage, perhaps in denial about the existence of any problem at all, or not yet taking personal responsibilty for the problem, and instead blaming other people and circumstances for his eating problem, then he may strike out at those same people who are trying to help, and his wall of denial may be strenghthened and extended.  Likewise, if emotional arousal is used too late, such as during the maintenance stage, then the (usual) negative emotion may counteract any positive feelings and emotions associated with, and fueling,  the progress that the changer is currently making. 

4.  Self-reevaluation:  Involves assessing your values, and determining what kind of person you would have to become to  change you habit or behavior.   This enables you to see how your current behavior is in conflict with your personal values.  Personally, as a physician, with a special interest in health and wellness, I had to ask myself how would it look if I was advising others to be active, exercise and eat healthier if I was overweight, sedentary and running out to McDonald’s for lunch every day.  As I have started this blog and other similar efforts recently, I have had little choice but to start to exercise again, eat healthier, and lose the extra poundage I have been toting around for some time.  Just like emotional arousal, Self-reevaluation is useful during contemplation and preparation.

5.  Commitment:  Ever heard of this one?  Most useful during preparation, action and maintenance, this is where we accept FULL responsibility for where we are and where we want to be, and then consciously choose to make the change.  The first step is private, telling yourself you are going to change, and the second part is public, letting others know of your intentions to change.  Some try to keep their commitments private, but the shame, guilt or embarrassment of public failure make public commitments much more powerful.

6.  Countering:  Simply, substituting a healthy response for unhealthy ones.  So instead of the morning cigarette to help us wake up, we go for a nice brisk walk.  Instead of having to drink alcohol to socialize with family or friends, we choose  a delicious (diet) Shirley Temple instead (this was getting too serious, needed to lighten it up some, read on please.)  Countering obviously is used during the action and maintenance stages.

7.  Environmental Control:  Like countering, is action oriented, used during action and maintenance stages.  But instead of choosing different responses to external stimuli, we are manipulating our environment to decrease the exposure to the triggering external stimuli.  For instance, I choose a different route home from work so that I do not pass the bar where I stop to socialize every night.  I remove all alcohol (cigarettes, unhealthy foods, etc.) from my home.  I choose to change the people with whom I associate to further remove temptation.  Hey no one said this is going to be easy.  Sacrifice will usually be necessary.  To quote Prochaska, “Quitting a habit can require not only an enormous sacrifice of energy, but the pain of others’ disapproval…,” including their disapproval at seeing you choose a healthier habit while they maintain their unhealthy ways.

8.  Rewards:  Like the previous two, used during action and maintenance, and is fairly self explanatory.  Don’t be like me however, and think you can reward yourself just for contemplating change!  Rewards can be as simple as self-praise, but can be more substantial such as a vacation paid for with the money saved by quitting smoking, or one to show off the newly discovered 6 pack of abs that appeared after weeks of healthier choices.  Also rewards can be self-administered, or under the control of others.

9.  Helping relationships:  This one is easy.  This process is helpful throughout the entire process of change.  Even in Precontemplation, the constant encouragement from family and friends, the helpful, non-pushy suggestion of a book or movie, and letting a person know, in a non-threatening way how his habit or behavior effects them and others.  Once a person has voluntarily entered into the process of change, they can request support, and offer others specific requests on how best to help.  Remember, we may elect to change without “professional” help, but that doesn’t mean we should “go it alone” and fail to use the support and caring of those closest to us.  This process is used throughout all the stages of change.

By understanding all of the above, we can not only increase our own chances for success with self change, but can increase our effectiveness in our role of a Helping Relationship for others who are taking on the challenge of change themselves.

Until next time, blessings.

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3 responses

8 11 2010
Sarah

Ok, made it through contemplation and started working out again today. I am a yo-yo worker-outer. I will try to do “something” every day. Today I started with the TV On Demand Gillian Michaels Pilates work out. My back will be cussing me later. I suppose the tv show I am using is the social liberation. Emotional arousal? – looking in the mirror, lol. My self-reevaluation involves wanting to feel physically good again, less old… My commitment has usually waned when I have been at it for a while and am working out alone. I am too social for that. We’ll see if I can stick with this. Thanks for putting this “out there” Dane. I would love to hear what anyone else is doing too. Join us people, and share!!! (Glad to hear of your success Ollie!! I am sure you are quite a great example for many folks.)

8 11 2010
Dane Treat

Good for you Sarah! Can’t wait to see how you do. I too am a “yo-yo worker-outer”, with long cycles. I worked out well for just over a year, then nada for about 3, then worked out great for 2 years, thinking I had made it a permanent part of my life for sure, and then…. WHAM! Nothing for 2 years, until I just started up again. I feel your pain. We have to think about what we’ve tried before – what has worked, and what hasn’t. For me what works is having a goal and a deadline, what doesn’t work is not preparing for what happens when the goal and deadline come to pass. What also works for me is using a trainer to work out at least once every one to two weeks. Yes a little $$pendy, but I get great results, and have learned a lot that I take back to the gym with me on days I work out alone. What doesn’t work for me in general is running, but currently I am overcoming that with an aggressive and strategic use of iPod playlists, and the goal of running a half marathon in January. What works the most for me is blogging about health and telling anybody from BAHS Class of 1986 who will listen that I plan to show up with about 10% body fat. Putting it out there like that, the risk of public failure is too great, so I drag my butt out of bed at dark-thirty and go hit the pavement when I would rather be sleeping another hour.

Sarah, remember that we are motivated to move away from pain/unpleasantness or towards some pleasure. It sounds like maybe you are primarily motivated to move away from pain or unpleasantness. Once you have been at it awhile the pain or unpleasantness wanes, and you lose the fuel that was moving you forward. So you have to manufacture additional unpleasantness, or even better, some pleasure to move towards. Also, on a less airy-fairy note, YOU NEED A WORK OUT BUDDY! And someone to briefly check in with each day about doing your “something”. Feel free to post on my wall if you like. Hey try this on if you haven’t already, I saw a class recently and it looks like a blast . Keep it up

8 11 2010
Dane Treat

New to me. Click above on the “Keep it up” as it is a link to the site I was trying to recommend.

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