As I pointed out in the last blog, all habit changes occur on a behavioral change continuum (whether we're trying to change our diet, quit smoking, reduce stress or take up exercising). In other words, change generally occurs in stages. Still, some of us are more ready to "take action" (in other words, start right away) than others are. Smokers tend to dive in and take action when they can tie their quitting to a life-changing event, like getting pregnant, having their tonsils out, moving in with a non-smoker or taking up an exercise program or a new sport.
But most of us like to contemplate change for a long time before we actually set the wheels of change in motion. We think about how, why and when we might make a particular lifestyle change in great detail. In other words, we move slowly through stages one, two or three (see chart below). And as Prochaska's extensive research with thousands of former smokers shows, when you gear your wellness curriculum to where people are in the stages of change, these graduated programs tend to be much more successful than programs that ignore the six stages.
Prochaska loves to talk about how he dramatically increased the response rate to a smoking cessation program by simply renaming it "a smoking cessation program for people NOT ready to quit." Prochaska feels it is important not try to force people into taking action too quickly. And if you catch them where they are, you can guide them gradually through the stages, one step at a time.
Stages of Change
Here's how the stages of change works for smokers. But it's essentially the same for any behavior you'd like to change. The Pre-contemplation stage begins when a smoker knows he or she needs to quit but isn't planning on doing it anytime soon. Contemplation begins when they start to seriously consider making a change and plan on doing so, within the next few months. Preparation begins when they start looking around for the methods or programs they plan to use to set the change in motion: They compare smoking cessation programs, talk to friends who have already quit and talk to wellness advisors, coaches and doctors.
The Action Stage is when they actually hit the stop button. (Most health promotion programs make the mistake of expecting people to be ready for action right away - without acknowledging the previous three steps.) For a smoker, this stage begins when he throws away the Marlboros and puts away the ashtrays.
The Maintenance stage immediately follows action and takes into account that cultivating a new habit takes time and that there will inevitably be setbacks. For smokers there are usually about three or four setbacks on average. So it's better to prepare people for this possibility than to pretend it's never going to happen. Joining a support group will really help a person get through this stage.
After maintenance comes the Termination stage. In this stage the new habit is firmly entrenched and the person has absolutely no desire to go back to his or her old ways. In the case of smoking this can take several years. Other new habits don't take nearly so long to establish.
Prochaska likes to use the example of switching from whole milk to skim milk. Once a person makes this transition they often don't even like drinking whole milk any more. The same is true of smoking. Once they hit termination, they find the whole business of smoking to be disgusting. So there's no longer ANY pull to engage in the old behavior. The urge is terminated.
In our next blog we'll talk about how to apply Prochaska's stages of change to reducing stress. For now you might be interested in reading Prochaska's book Changing For Good.