Understanding Change: Expect a Few Bumps

Tuesday, January 2, 2007

Healthy behavior change, when it does happen, doesn't happen overnight, experts know. They have urged doctors to help patients understand this so they won't become discouraged so quickly and think they've failed.

On its Web site, the American Academy of Family Physicians (AAFP) posts a 2000 journal article describing a classic model of the steps involved in undergoing personal change. The "Stages of Change" model was developed by James O. Prochaska, co-author of "Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward" (Collins).

Here is an excerpt from the article posted on the AAFP site. The full text is available at http://www.aafp.org/afp/20000301/1409.html.

The Stages of Change model shows that, for most people, a change in behavior occurs gradually, with the patient moving from being uninterested, unaware or unwilling to make a change (precontemplation), to considering a change (contemplation), to deciding and preparing to make a change.

Genuine, determined action is then taken and, over time, attempts to maintain the new behavior occur. Relapses are almost inevitable and become part of the process of working toward lifelong change.

· Precontemplation Stage During this stage, patients do not even consider changing. Smokers who are "in denial" may not see that the advice applies to them personally. Patients with high cholesterol levels may feel "immune" to the health problems that strike others. Obese patients may have tried unsuccessfully so many times to lose weight that they have simply given up.

· Contemplation Stage During this stage, patients are ambivalent about changing. Giving up an enjoyed behavior causes them to feel a sense of loss despite the perceived gain. Patients assess barriers (for example, time, expense, hassle, fear, "I know I need to, doc, but . . . ") as well as the benefits of change.

· Preparation Stage During this stage, patients prepare to make a specific change. They may experiment with small changes as their determination to change increases. For example, sampling low-fat foods may be an experimentation with or a move toward greater dietary modification. Switching to a different brand of cigarettes or decreasing the consumption of alcohol can signal a decision that a change is needed.

· Action Stage This stage is the one that most physicians are eager to see their patients reach. Many failed New Year's resolutions provide evidence that if the prior stages have been glossed over, action itself is often not enough. Any action taken by patients should be praised because it demonstrates the desire for lifestyle change.

· Maintenance and Relapse Prevention These steps involve incorporating the new behavior "over the long haul." Discouragement over occasional "slips" may halt the change process and result in the patient giving up. However, most patients find themselves "recycling" through the stages of change several times before the change becomes truly established.

© 2007 The Washington Post Company