scispace - formally typeset
Search or ask a question
Journal ArticleDOI

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

01 Sep 1992-American Psychologist (American Psychological Association)-Vol. 47, Iss: 9, pp 1102-1114
TL;DR: In this article, the authors summarized research on self-initiated and professionally facilitated change of addictive behaviors using the key transtheoretical constructs of stages and processes of change.
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.
Citations
More filters
Journal ArticleDOI
TL;DR: If results with stage-matched interventions continue to be replicated, health promotion programs will be able to produce unprecedented impacts on entire at-risk populations.
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...

6,389 citations

Journal ArticleDOI
TL;DR: The results indicated that feedback may be more effective when baseline performance is low, the source is a supervisor or colleague, it is provided more than once, and the role of context and the targeted clinical behaviour was assessed.
Abstract: Background Audit and feedback continues to be widely used as a strategy to improve professional practice. It appears logical that healthcare professionals would be prompted to modify their practice if given feedback that their clinical practice was inconsistent with that of their peers or accepted guidelines. Yet, audit and feedback has not been found to be consistently effective. Objectives To assess the effects of audit and feedback on the practice of healthcare professionals and patient outcomes. Search strategy We searched the Cochrane Effective Practice and Organisation of Care Group's register up to January 2001. This was supplemented with searches of MEDLINE and reference lists, which did not yield additional relevant studies. Selection criteria Randomised trials of audit and feedback (defined as any summary of clinical performance over a specified period of time) that reported objectively measured professional practice in a healthcare setting or healthcare outcomes. Data collection and analysis Two reviewers independently extracted data and assessed study quality. Quantitative (meta-regression), visual and qualitative analyses were undertaken. Main results We included 85 studies, 48 of which have been added to the previous version of this review. There were 52 comparisons of dichotomous outcomes from 47 trials with over 3500 health professionals that compared audit and feedback to no intervention. The adjusted RDs of non-compliance with desired practice varied from 0.09 (a 9% absolute increase in non-compliance) to 0.71 (a 71% decrease in non-compliance) (median = 0.07, inter-quartile range = 0.02 to 0.11). The one factor that appeared to predict the effectiveness of audit and feedback across studies was baseline non-compliance with recommended practice. Reviewer's conclusions Audit and feedback can be effective in improving professional practice. When it is effective, the effects are generally small to moderate. The absolute effects of audit and feedback are more likely to be larger when baseline adherence to recommended practice is low.

4,946 citations

Book ChapterDOI
01 Jan 2000
TL;DR: In this paper, the structure of self-regulatory systems, social and physical environmental context influences on self-regulation, dysfunctions in selfregulation, and selfregulatory development are discussed.
Abstract: Perhaps our most important quality as humans is our capability to self-regulate. It has provided us with an adaptive edge that enabled our ancestors to survive and even flourish when changing conditions led other species to extinction. Our regulatory skill and lack thereof is the source of our perception of personal agency that lies at the core of our sense of self. Understanding how this capability develops, its various subcomponents, and its functions has been a major thrust of social cognitive theory and research. Of equal importance is the explanation for common dysfunctions in self-regulatory functioning, such as biased self-monitoring, self-blaming judgments, and defensive self-reactions. This chapter will define self-regulation, and will discuss the structure of self-regulatory systems, social and physical environmental context influences on self-regulation, dysfunctions in self-regulation, and self-regulatory development. (http://books.google.fr/books?id=u9e1RWMbtjEC&lpg=PP1&hl=fr&pg=PA13#v=onepage&q&f=false)

4,809 citations

Book
01 Oct 2000
TL;DR: Maruna as discussed by the authors argues that to truly understand offenders, we must understand the stories that they tell - and that in turn this story-making process has the capacity to transform lives, and provides a fascinating narrative analysis of the lives of repeat offenders who, by all statistical measures, should have continued on the criminal path but instead have created lives of productivity and purpose.
Abstract: Can hardened criminals really reform? "Making Good" provides resounding proof that the answer is yes. This book provides a fascinating narrative analysis of the lives of repeat offenders who, by all statistical measures, should have continued on the criminal path but instead have created lives of productivity and purpose. This examination of the phenomenology of "making good" includes an encyclopedic review of the literature on personal reform as well as a practical guide to the use of narratives in offender counseling and rehabilitation.The author's research shows that criminals who desist from crime have constructed powerful narratives that aided them in making sense of their pasts, finding fulfillment in productive behaviors, and feeling in control of their future. Borrowing from the field of narrative psychology, Maruna argues that to truly understand offenders, we must understand the stories that they tell - and that in turn this story-making process has the capacity to transform lives. "Making Good" challenges some of the cherished assumptions of various therapy models for offenders and supports new paradigms for offender rehabilitation. This groundbreaking book is a must read for criminologists, forensic psychologists, lawyers, rehabilitation counselors, or anyone interested in the generative process of change.

2,695 citations

Journal ArticleDOI
TL;DR: These findings demonstrate the feasibility of developing standardized definitions of BCTs included in behavioral interventions and highlight problematic variability in the reporting of intervention content.
Abstract: Objective: Without standardized definitions of the techniques included in behavior change interventions, it is difficult to faithfully replicate effective interventions and challenging to identify techniques contributing to effectiveness across interventions. This research aimed to develop and test a theory-linked taxonomy of generally applicable behavior change techniques (BCTs). Design: Twenty-six BCTs were defined. Two psychologists used a 5-page coding manual to independently judge the presence or absence of each technique in published intervention descriptions and in intervention manuals. Results: Three systematic reviews yielded 195 published descriptions. Across 78 reliability tests (i.e., 26 techniques applied to 3 reviews), the average kappa per technique was 0.79, with 93% of judgments being agreements. Interventions were found to vary widely in the range and type of techniques used, even when targeting the same behavior among similar participants. The average agreement for intervention manuals was 85%, and a comparison of BCTs identified in 13 manuals and 13 published articles describing the same interventions generated a technique correspondence rate of 74%, with most mismatches (73%) arising from identification of a technique in the manual but not in the article. Conclusions: These findings demonstrate the feasibility of developing standardized definitions of BCTs included in behavioral interventions and highlight problematic variability in the reporting of intervention content.

2,321 citations

References
More filters
Journal ArticleDOI

8,264 citations


"In search of how people change: App..." refers background or methods in this paper

  • ...For seven years we worked with a four-stage model, omitting the stage between contemplation and action ( Prochaska & DiClemente, 1983, 1985, 1986 )....

    [...]

  • ...Norcross, Prochaska, & DiClemente, 1991; Prochaska & DiClemente, 1983,1984 )....

    [...]

  • ...At least 10 subsequent principal component analyses on the processes of change items, conducted on various response formats and diverse samples, have yielded similar patterns (Norcross & Prochaska, 1986; Prochaska & DiClemente, 1983; Prochaska & Norcross, 1983; Prochaska, Velicer, DiClemente, & Fava, 1988)....

    [...]

Journal ArticleDOI
TL;DR: Prochaska et al. as mentioned in this paper studied how individuals change on their own compared with change in formalized treatments, and identified five basic processes of change, which can be applied at either the level of the individual's experience or environment.
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-

3,750 citations


Additional excerpts

  • ...In our original research we had identified five stages ( Prochaska & DiClemente, 1982 )....

    [...]

Book
01 Jan 1986
TL;DR: The NIMH Treatment of Depression Collaborative Research Program: Where We Began and Where We Are (I. Elkin, et al. as discussed by the authors ) presents a methodology, design, and evaluation in psychotherapy research.
Abstract: Methodology, Design, and Evaluation in Psychotherapy Research (A. Kazdin). Assessing Psychotherapy Outcomes and Processes (M. Lambert & C. Hill). The NIMH Treatment of Depression Collaborative Research Program: Where We Began and Where We Are (I. Elkin). The Effectiveness of Psychotherapy (M. Lambert & A. Bergin). Research on Client Variables in Psychotherapy (S. Garfield). Therapist Variables (L. Beutler, et al.). Process and Outcome in PsychotherapyNoch Einmal (D. Orlinsky, et al.). Behavior Therapy with Adults (P. Emmelkamp). Cognitive and Cognitive-Behavioral Therapies (S. Hollon & A. Beck). Psychodynamic Approaches (W. Henry, et al.). Research on Experiential Psychotherapies (L. Greenberg, et al.). Psychotherapy for Children and Adolescents (A. Kazdin). The Process and Outcome of Marital and Family Therapy: Reseach Review and Evaluation (J. Alexander, et al.). Experiential Group Research (R. Bednar & T. Kaul). Research on Brief Psychotherapy (M. Koss & J. Shiang). Behavioral Medicine and Health Psychology (E. Blanchard). Medication and Psychotherapy (G. Klerman, et al.). Research on Psychotherapy with Culturally Diverse Populations (S. Sue, et al.). Overview, Trends, and Future Issues (A. Bergin & S. Garfield). Indexes.

3,009 citations


"In search of how people change: App..." refers background in this paper

  • ...Hundreds of psychotherapy outcome studies have demonstrated that people successfully change with the help of professional treatment (Lambert, Shapiro, & Bergin, 1986; Smith, Glass, & Miller, 1980)....

    [...]

Journal ArticleDOI
TL;DR: This study tested the transtheoretical model of change that posits a series of stages through which smokers move as they successfully change the smoking habit, and results strongly support the stages of change model.
Abstract: Traditionally smoking cessation studies use smoker and nonsmoker categories almost exclusively to represent individuals quitting smoking. This study tested the transtheoretical model of change that posits a series of stages through which smokers move as they successfully change the smoking habit. Subjects in precontemplation (n = 166), contemplation (n = 794), and preparation (n = 506) stages of change were compared on smoking history, 10 processes of change, pretest self-efficacy, and decisional balance, as well as 1-month and 6-month cessation activity. Results strongly support the stages of change model. All groups were similar on smoking history but differed dramatically on current cessation activity. Stage differences predicted attempts to quit smoking and cessation success at 1- and 6-month follow-up. Implications for recruitment, intervention, and research are discussed.

2,360 citations


"In search of how people change: App..." refers background or methods in this paper

  • ...Stages of change have been ascertained by two different self-report methods: a discrete categorical measure, which assesses the stage from a series of mutually exclusive questions (DiClemente et al., 1991), and a continuous measure, which yields separate scales for precontemplation, contemplation, action, and maintenance (McConnaughy et al....

    [...]

  • ...As a group, individuals who are prepared for action report some small behavioral changes, such as smoking five cigarettes less or delaying their first cigarette of the day for 30 minutes longer than precontemplators or contemplators (DiClemente et al., 1991)....

    [...]

  • ...They used counterconditioning and stimulus control to begin reducing their use of addictive substances or to control the situations in which they relied on such substances (DiClemente et al., 1991)....

    [...]

Book ChapterDOI
01 Jan 1986
TL;DR: In 1984, a group of researchers, theorists, and therapists gathered at an international conference in Scotland to contribute to the development of a more comprehensive model of change for the treatment of addictive behaviors as mentioned in this paper.
Abstract: In 1984, a group of researchers, theorists, and therapists gathered at an international conference in Scotland to contribute to the development of a more comprehensive model of change for the treatment of addictive behaviors. The conference and this book that grew out of the conference are signs of the Zeitgeist; they are part of a new attempt to integrate diverse systems of psychotherapy (Prochaska, 1984). In his classic call for a rapproachment across competing systems of therapy, Goldfried (1980) signaled that it is time to move beyond parochial approaches to treatment. It is time to move toward more comprehensive models of change.

1,949 citations


"In search of how people change: App..." refers background or methods in this paper

  • ...For seven years we worked with a four-stage model, omitting the stage between contemplation and action ( Prochaska & DiClemente, 1983, 1985, 1986 )....

    [...]

  • ...Approximately 15% of smokers who relapsed in our selfchange research regressed back to the precontemplation stage ( Prochaska & DiClemente, 1986 )....

    [...]