Transtheoretical therapy is presented as one alternative within the Zeitgeist seeking a synthesis for the increasing proliferation of therapeutic systems. From a comparative analysis of 18 leading systems, five basic processes of change were identified. Each process can be applied at either the level of the individual's experience or environment. In studying how individuals change on their own compared with change in formalized treatments, four stages of change have been identified. Individuals changing within and without therapy appear to apply three verbal processes of change in the contemplation and determination stages and then apply two behavioral processes in the action and maintenance stages. Rather than being theoretically incompatible, the verbal processes are most important in preparing clients for action, while the behavioral processes become most important once clients have committed themselves to act. Psychotherapy appears to be approaching a crisis or a new wave of creativity. The potential for crisis comes in part from the unprecedented pace at which new therapies are being placed on the market (Prochaska, 1979). In 1975 Parloff reported that there were 130 therapies on the therapeutic marketplace (or jungleplace as he more aptly described it). By 1979 Time magazine was reporting that there were over 200 therapies, and that the confusion of over-choice was adding to the depression of psychiatry. Divergence has dominated the past decade of development within the field of psychotherapy (Prochaska, 1979). Yet divergent 1 This work was partially supported by Grant CA27821 from the National Cancer Institute. * Requests for reprints should be sent to James O. Prochaska, Dept. of Psychology, University of Rhode Island, Kingston, RI 02881. CARLO C. DI CLEMENTE Texas Research Institute of Mental Sciences thinking has been characterized by Guilford (1956), among others, as a necessary part of creativity. The increased divergence in psychotherapy thus provides the potential for a new wave of creativity. What is needed to prevent the increasing divergence from leading to fragmentation, confusion and chaos and allow it to be the foundation for a more fertile future? Heinz Werner's (1948) theory of development may serve as a guide in this regard. Development, as opposed to other forms of change, such as regression or chaos, is characterized by a combination of increasing differentiation and hierarchic integration. The increasing production of new forms of psychotherapy may indeed be an expression of the increasing differentiation of a growing discipline like psychotherapy. Increasing differentiation alone, however, can become like a cancer of uncontrolled growth that threatens to destroy the very body of knowledge in which it is growing. Unless increasing differentiation is matched by more effective forms of integration, then crisis rather than creativity will be the result. In Guilford's (1956) terms an increase in divergent thinking needs to be followed by higher levels of convergent thinking. What have been some of the professional responses to the increasing divergence in psychotherapy? Psychiatry's depression over the increased confusion is being treated in part by an increased reliance on chemotherapy. The emphasis on medication has the advantage of reaffirming psychiatry's medical identity and of relying on treatments that have perhaps the most consistent empirical support {Time, 1979; Luborsky, 1975). Clinical social workers have mounted a se-

http://psycnet.apa.org/doi/10.1037/h0088437

Transtheoretical therapy: Toward a more integrative model of change.

The concept of self-efficacy is receiving increasing recognition as a predictor of health behavior change and maintenance. The purpose of this article is to facilitate a clearer understanding of both the concept and its relevance for health education research and practice. Self-efficacy is first defined and distinguished from other related concepts. Next, studies of the self-efficacy concept as it relates to health practices are examined. This review focuses on cigarette smoking, weight control, contraception, alcohol abuse and exercise behaviors. The studies reviewed suggest strong relationships between self-efficacy and health behavior change and maintenance. Experimental manipulations of self-efficacy suggest that efficacy can be enhanced and that this enhancement is related to subsequent health behavior change. The findings from these studies also suggest methods for modifying health practices. These methods diverge from many of the current, traditional methods for changing health practices. Recommend...

/pdf/the-role-of-self-efficacy-in-achieving-health-behavior-4tn7k3n9g8.pdf

The Role of Self-Efficacy in Achieving Health Behavior Change

Self-efficacy and health

This paper makes two contributions to the modeling of addiction. First, we provide new and convincing evidence that smokers are forward-looking in their smoking decisions, using state excise tax increases that have been legislatively enacted but are not yet effective, and monthly data on consumption. Second, we recognize the strong evidence that preferences with respect to smoking are time inconsistent, with individuals both not recognizing the true dife culty of quitting and searching for self-control devices to help them quit. We develop a new model of addictive behavior that takes as its starting point the standard “ rational addiction” model, but incorporates time-inconsistent preferences. This model also exhibits forward-looking behavior, but it has strikingly different normative implications; in this case optimal government policy should depend not only on the externalities that smokers impose on others but also on the “ internalities” imposed by smokers on themselves. We estimate that the optimal tax per pack of cigarettes should be at least one dollar higher under our formulation than in the rational addiction case.

/pdf/is-addiction-rational-theory-and-evidence-4mk4e0hyw8.pdf

Is Addiction “Rational”? Theory and Evidence

Predicting change in smoking status for self-changers.

The study compared 38 maintainers and 24 relapsers who had quit smoking on their own. The results suggest that successful self-changers relied more on inner-directed, experiential processes of change, while the relapsers relied more on environmental change processes. Successful changers experienced markedly higher levels of self-efficacy, while relapsers reported least confidence in coping with situations that evoke negative emotions. The maintainers experience high congruence between their basic self-concepts and their concepts of self as non-smokers. The relapsers see themselves as more anxious, dependent, and helpless in their role as smokers. The results are discussed in terms of how greater reliance on experiential processes of self-change can lead to more successful attempts at cessation of smoking than reliance on environmental processes of change.

Self-change processes, self-efficacy and self-concept in relapse and maintenance of cessation of smoking.

Positive and negative life changes in the 6 mo. prior to treatment were related to cessation and maintenance of smoking. 20 subjects who initially quit smoking during treatment and those 8 who maintained cessation at 4 mo. reported significantly fewer positive life changes prior to treatment. Negative life changes were unrelated to success in therapy. The results support Sarason, Johnson, and Siegel, who in 1978 argued for the utility of differentiating between positive and negative life changes

Duane V. Lapsanski

Papers

Self-change processes, self-efficacy and self-concept in relapse and maintenance of cessation of smoking.

Life Changes, Cessation and Maintenance of Smoking: A Preliminary Report: