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The number one concern of those in Preparation is, “When I act, will I fail?”
This is a realistic concern, since across almost all chronic behaviors, the rule of an action attempt is relapse rather than sustained action. These individuals can be helped by being prepared for how long the Action stage lasts. They usually believe the worst will be over in a few weeks or a few months. But, if they ease up on their efforts too soon, they will regress rather than progress, since the action stage lasts about six months.
After about six months, people progress into Maintenance where they don’t have to work as hard to keep progressing. They need to be prepared for the most common cause of relapse, namely, times of stress and distress. Times of depres- sion, anxiety, anger, boredom, and loneliness are the times when most people are at their emotional and psychological weakest. A majority of Americans cope with tough times by drinking more alcohol, smoking more cigarettes, eating more junk food, or taking more over-the-counter or under-the-counter drugs. A posi- tive form of oral behavior for coping with distress is talking. Another is exercise and a third is some form or relaxation, such as yoga, meditation, prayer or deep muscle relaxation. People prepared to cope with times of distress with such positive approaches are much more likely to keep progressing. Maintenance is assumed to last about five years.
Termination is the stage in which people have total self-efficacy or confidence that they will not go back to unhealthy behaviors like drinking or smoking to deal with distress, and they have no temptation to return. Historically, mental models said that people with such addictions are always in recovery and never recovered. We prefer a more optimistic model from such self-defeating and self- destructive patterns. Fortunately, we have found that about 20% of alcoholics and 20% of smokers abstinent for less than five years have already reached the criteria for termination.
Steps for helping people progress include assessing what stage they are start- ing in. Another step is to help set realistic starting goals like progressing to the next stage rather than being pressured to move immediately to action.
The first principle for progressing from Precontemplation to Contemplation is that the person’s appreciation of the pros or positives of changing must increase.
A sample technique would be to ask couch potatoes in Precontemplation to list all the positives that could come from regular exercise. They typically list four or five. The challenge is to see if they can double their list. As their list starts to include more positives, like enhanced self-esteem, better moods, less stress, better sex life and better sleep, they are progressing and changing.
Across 55 behaviors from 140 studies, the pros of changing always increased from Precontemplation to Contemplation. These behaviors ranged from chronic addic- tions to anorexia, depression to obesity, smoking to stress. The point is that a lim- ited number of principles of progress can hold for a large number of behaviors.
The second principle is that the negatives, or cons of changing must decrease for people to progress from Contemplation to Action. As positive psychology would predict, the positives (pros) of changing and the negatives (cons) are not correlated.
Change (Stages of ) 127 So, just reducing the cons does not increase the pros. Each needs to be improved independently.
In Contemplation, the pros and cons are about equal, reflecting the profound ambivalence of this stage. “Is it worth it?” “Is it not?” “Should I keep progressing or should I put it off ?” The average American makes the same New Year’s Resolu- tion about three years in a row before they finally take significant action.
What is particularly remarkable is that from Precontemplation to Action the pros increase exactly 1.00 standard deviations (SD), while the cons decrease from Contemplation to Action about .5 SD. One SD is like increasing our IQs about 15 points, which could have major impact on our lives. Helping people increase their behavior change IQs can also have profound impacts on their lives. Since the positives have to increase twice as much as the negatives have to decrease, our programs place twice as much time and emphasis on increasing the pros.
When people are prepared to take action, they can apply their long list of positives. With physical activity, for example, they can place on a “To-Do List,”
“This week I am walking for my heart – next week for my brain, then my immune system, my children or grandchildren, my vitality, and my partner.” Pretty soon they are running. Since there are more than 60 scientific benefits of regular exercise, people can go more than a year with a different benefit each week. In the process, they are affirming so much of their body, self and society.
There are other principles for progressing from Precontemplation, such as consciousness raising (e.g., education, information and feedback); dramatic relief (e.g., inspiration and catharsis); and environmental reevaluation (e.g., how chang- ing will enhance the well-being of others). Progressing from Contemplation also entails self-reevaluation which is how I think and feel about myself now (e.g., as a pessimistic person) and how I will think and feel about myself after changing (e.g., a more optimistic person).
Progressing from Preparation includes self-liberation which is my belief in my ability to change and my commitment to act on that belief. Once in Action, reinforcement or rewarding progress is important, particularly self-reinforcement, since others will soon take changes for granted. Helpful relationships or social support from others is particularly important in tempting or distressing times.
Counter-conditioning or substituting positive alternatives for negative ones con- tinues from Action on as does stimulus control or transforming one’s environment to promote more positive behaviors.
By applying different principles and processes of change at different stages of change, programs can be designed to help entire populations progress and not just the small minority who are motivated or prepared. One of the messages is,
“Wherever you are at, we can work with that.” By proactively reaching out to entire populations with such messages and such stage-matched interventions we can reach the vast majority of people who can benefit from programs designed to enhance health and well-being.
Examples of such programs include smoking cessation, where a large majority of smokers are reached, but the large majority is not motivated to quit. These
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programs give participants individualized feedback on which principles and processes they are applying appropriately compared to their peers who progress the most, which they are underutilizing and which they are relying on too much.
With just three 20-minute interactions over six months, about 25% of the par- ticipants are not smoking at long-term follow-up. This is about the same efficacy rates as traditional action-oriented programs that reached only about 1 percent of smokers who are motivated. But the impact of our programs is much greater because they reach 70 and 80 percent of a population. Furthermore women are as successful as men, adolescents as adults, African Americans as Caucasians, and depressed smokers as nondepressed. We have also demonstrated that with such help populations can be effective in changing three or four behaviors and still achieve about 25 percent abstinence from smoking. With populations who are not managing stress effectively, similar programs help 60 percent to take effective action during treatment and maintain that progression for the next 12 months. This is particularly important given the role that stress and distress play in relapse across behaviors. A demonstration of this program is provided at www.prochange.com/stressdemo.
The list of effective population based interventions continue to grow and include tackling the following behaviors: diet; sun exposure; medication adherence;
partner abuse; and depression.
A recent innovation is to develop more creative methods for changing multiple- behaviors rather than just working on each behavior separately. Integrated approaches are particularly promising where a higher order constant is targeted to change a broader rage of related roles and behaviors. An example is with bullying prevention – bullying is the number one daily health and mental health worry of children and youth in the US. With a population approach the aim was to not only help bullies change but also victims and passive bystanders. Passive bystanders were encouraged to be part of the solution even if they didn’t see them- selves as part of the problem. A broad range of bullying behaviors were targeted including hitting, shoving, threatening, mean gossiping, ostracizing, and stealing or damaging belongings.
The higher order construct or theme was relating with respect. Again with just three brief interventions, all three roles of bully, victim or passive bystander were reduced by 30 to 40 percent in separate clinical trials in elementary, middle and high schools. These three programs are included in SAMHSA’s National Registry of Effective Programs and Practices (NREPP) and the Office of Juvenile Justice and Delinquency Model Programs Guide.
Positive psychology is particularly well positioned to apply stage of change and principles and processes of change to positive constructs, like respect, and to help populations progress on a broad range of roles and related behaviors. Such progress can help many more individuals and populations to enhance health and well-being.
SEE ALSO: Coping Intentional self-development