Friday, May 14, 2010

Habits That Threaten Your Health - Do You Have the Commitment to Change?

I’ve written here and elsewhere about how hard it is to break a habit and establish new behavior patterns. This is particularly true when it comes to changing health habits, like losing weight and quitting smoking. For example, two-thirds of Americans are overweight, a condition that endangers their health. It’s revealing to discover why in spite of the health risks, so many people don’t do anything about it.

Twenty-five years ago, psychologists James O. Prochaska and Carlo DiClemente wanted to know why overweight people, alcoholics, smokers and others had such a hard time changing their health habits, even when their health was in danger. The answer was simple. A change like that means altering lifelong patterns that are reinforced by powerful needs. That kind of change requires a lot of commitment. You have to be psychologically ready for it, and many people aren’t.

Based on their research, they developed what has come to be known as the "Transtheoretical Model of Change," which is now widely used in health behavior change programs. The model describes five stages of readiness. 

Stage 1 - Precontemplation. You’re in denial. Even if you have a serious health problem, you don’t believe it and you resist any information that contradicts your belief. You may not appreciate how grave the consequences really are, or you may have already tried to change and have given up. Whatever the reason, at this point you have no commitment to change.

Stage 2 - Contemplation. You recognize that you have a problem, and now you’re concerned enough about your health that your commitment to change is growing. You’d like to make a change sometime in the future, and you’ve started learning more about your condition. You’re weighing the costs of change, but at this point you haven’t made up your mind.

Stage 3 - Preparation. Maybe your habit has started to cause problems, or maybe your doctor scared you with straight talk. Your commitment is now strong enough that you’ve taken preliminary steps such as seeing a doctor, setting goals, checking out your options and deciding what you want to do. You plan to start a serious program in the very near future.

Stage 4 - Action. You’re fully committed and carrying out your program to create new health habits. You monitor your progress and continue working towards your goal. When you have setbacks, you deal with them, make adjustments and get back on track.

Stage 5 - Maintenance. You have already achieved your goal. You’re committed to making the change permanent. As you continue making a conscious effort to establish new health habits, you gain confidence and have fewer setbacks.

 It also illustrates that a setback doesn’t mean failure, but is rather a predictable part of the process. You can get back on track and keep moving forward until you have enough commitment to succeed.  

And it aligns nicely with Maslow's model of behavior change. The "Precontemplation" stage is equivalent to "unconscious incompetence" don't know that you need to change. "Contemplation" and "Preparation" relate to "conscious incompetence" know you have a problem, but you haven't started the work on it yet. The fourth stage, "Action" is the same as "conscious competence," in which you're actively applying the new behavior pattern, but it hasn't become an automatic behavior pattern yet. That happens in the final stage, "Maintenance," is parallel with unconscious competence," in which you enjoy the new behavior pattern and refine it throughout life.

Both models affirm that changing a health habit takes a lot of work, and being able to assess your level of commitment helps people determine whether they're ready for something like this. They can what it will take to move forward. It helps people appreciate that changing a health habit is a journey, not a single event. 

Post by Dennis E. Coates, Ph.D., Copyright 2010. Building Personal Strength . (License to use the above photo purchased from


Sean said...

I think most people are at step 3, because most people recognize they have a problem and they know what they need to change to improve themselves. It's just hard to keep committed to the lifestyle changes.

Anonymous said...

I have gone back and forth between step 2 and step 3 for over 15 years. This model helps me see that and I am going to work hard to move on to step 4. Thanks for sharing your wisdom.

Camille Harris said...

Great post, Denny. So, I'm at Step 4 on on my weight/healthy eating goal, but I do slip sometimes! It's helpful to think of it as a "journey," as you say. I can see opportunities to use this model with our coaching clients to encourage them to keep taking steps toward their goals! Thanks! Camille