James O. Prochaska

Bio: James O. Prochaska is an academic researcher from University of Rhode Island. The author has contributed to research in topics: Transtheoretical model & Behavior change. The author has an hindex of 97, co-authored 320 publications receiving 73265 citations. Previous affiliations of James O. Prochaska include American Heart Association & Rush University Medical Center.

In search of how people change: Applications to addictive behaviors.

Abstract: How people intentionally change addictive behaviors with and without treatment is not well understood by behavioral scientists. This article summarizes research on self-initiated and professionally facilitated change of addictive behaviors using the key transtheoretical constructs of stages and processes of change. Modification of addictive behaviors involves progression through five stages—precontemplation, contemplation, preparation, action, and maintenance—and individuals typically recycle through these stages several times before termination of the addiction. Multiple studies provide strong support for these stages as well as for a finite and common set of change processes used to progress through the stages. Research to date supports a transtheoretical model of change that systematically integrates the stages with processes of change from diverse theories of psychotherapy.

The Transtheoretical Model of Health Behavior Change

Abstract: The transtheoretical model posits that health behavior change involves progress through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. Ten processes of change have been identified for producing progress along with decisional balance, self-efficacy, and temptations. Basic research has generated a rule of thumb for at-risk populations: 40% in precontemplation, 40% in contemplation, and 20% in preparation. Across 12 health behaviors, consistent patterns have been found between the pros and cons of changing and the stages of change. Applied research has demonstrated dramatic improvements in recruitment, retention, and progress using stage-matched interventions and proactive recruitment procedures. The most promising outcomes to date have been found with computer-based individualized and interactive interventions. The most promising enhancement to the computer-based programs are personalized counselors. One of the most striking results to date for stag...

Transtheoretical therapy: Toward a more integrative model of change.

Abstract: 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-

Stages of change and decisional balance for 12 problem behaviors

Abstract: This integrative study investigated the generalization of the transtheoretical model across 12 problem behaviors. The cross-sectional comparisons involved relationships between two key constructs of the model, the stages of change and decisional balance. The behaviors studied were smoking cessation, quitting cocaine, weight control, high-fat diets, adolescent delinquent behaviors, safer sex, condom use, sunscreen use, radon gas exposure, exercise acquisition, mammography screening, and physicians' preventive practices with smokers. Clear commonalities were observed across the 12 areas, including both the internal structure of the measures and the pattern of changes in decisional balance across stages.

Using Multivariate Statistics

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ACSM's guidelines for exercise testing and prescription

Abstract: SECTION I: HEALTH APPRAISAL AND RISK ASSESSMENT 1 Benefits and Risks Associated with Physical Activity 2 Preparticipation Health Screening SECTION II: EXERCISE TESTING 3 Preexercise Evaluation 4 Health-Related Physical Fitness Testing and Interpretation 5 Clinical Exercise Testing 6 Interpretation of Clinical Exercise Test Results SECTION III: EXERCISE PRESCRIPTION 7 General Principles of Exercise Prescription 8 Exercise Prescription for Healthy Populations With Special Considerations and Environmental Considerations 9 Exercise Prescription For Patients With Cardiovascular and Cerebrovascular Disease 10 Exercise Prescription for Populations With Other Chronic Diseases and Health Conditions 11 Behavioral Theories and Strategies for Promoting Exercise SECTION IV: APPENDICES Appendix A Common Medications Appendix B Medical Emergency Management Appendix C Electrocardiogram Interpretation Appendix D American College of Sports Medicine Certifications Appendix E Contributing Authors to the Previous Two Editions