Prochaska's Model of Behaviour Change (AQA A Level Psychology): Revision Note

Prochaska's model of behaviour change (PMBC)

• Prochaska & DiClemente (1983) developed a ‘stages of change’ model during a study they were conducting into quitting smoking

• They recognised that overcoming addiction is a complex process that does not happen quickly or in a tidy linear order from first to final stage, but is a cyclical process where there is some orderly progression through stages but also a lot of returning to previous ones

  • The model is based on two major insights:

    • people who are addicted differ in how ready they are to change their behaviour

    • the usefulness of a treatment intervention depends on the stage the person has reached

• PMBC identifies an individual’s readiness for change and tries to get them to a position where they are highly motivated to change their behaviour

• The six stages outlined below do not necessarily happen in order, as the process is often a cycle, and some stages may be missed or might be repeated before moving on

The six stages of PMBC

1. Pre-contemplation stage – the individual is not thinking about changing in the next six months, either through denial (not believing they have a problem) or demotivation (having tried and failed before)

2. Contemplation stage – the individual is thinking about changing in the next six months but remains ambivalent, aware of both the benefits and the costs

3. Preparation stage – the individual decides the benefits outweigh the costs and intends to change within the next month, but has not worked out exactly how or when

4. Action stage – the individual has changed their behaviour within the last six months, and this is the point at which behavioural and cognitive treatments become effective

5. Maintenance stage – the individual has sustained the change for more than six months, focusing on relapse prevention by avoiding situations where cues might trigger a return to the behaviour

6. Termination – abstinence becomes automatic and the individual no longer returns to addictive behaviour to cope with stress or loneliness, requiring no intervention

The role of the PMBC in changing addictive behaviour

• The model was designed to help people overcome addictions and problematic behaviours such as alcohol or drug abuse, overeating and smoking

• The model can be applied to smoking in the following way:

  1. Pre-contemplation stage – the individual feels that they are ‘only a social smoker’ and ‘could give up any time they choose to’ 

  2. Contemplation stage – the individual becomes aware smoking is a problem, perhaps after medical advice, but remains ambivalent because they still value what smoking does for them

  3. Preparation stage – possibly after intervention from family and friends or after illness, the individual prepares to give up smoking by stopping buying cigarettes, stating their intention and planning how and when they will stop smoking

  4. Action stage – he smoker has stopped smoking within the last six months and needs substantial support from family and friends

  5. Maintenance stage – now the individual has not smoked for six months and has no cigarettes or lighters in their vicinity, and thinks of themselves as an ‘ex-smoker’, though they may still be subject to temptation when they smell cigarette smoke or see someone smoking

  6. Termination – added later by Prochaska et al. (1992), this is when there is no desire whatsoever to smoke, which may take several years and with smoking may never be achieved at all

• Prochaska et al. (1992) suggested that relapse should be normalised, as it was very likely during the action and maintenance stages

• Prochaska et al. (1984; 1986) also noted that only 15 per cent of those who relapsed went back to the pre-contemplation stage, with the remainder recycling back to the contemplation stage or preparation stage, meaning that they were ready to start quitting again

Research which investigates Prochaska's model of behaviour change

• Taylor et al. (2006) conducted a major review of the available evidence for the National Institute for Health and Care Excellence (NICE) and concluded that stage-based approaches are no more effective than alternatives in treating nicotine addiction

  • A later review by Cahill et al. (2010) came to precisely the same conclusion, so the overall research picture is negative despite the over-optimistic claims made for the model by some

• Velicer et al. (2007) reviewed five studies and found a 22 to 26 per cent success rate with PMBC for males and females of all ages, which compares well with other interventions

• Baumann et al. (2015) carried out a study as part of a randomised controlled trial with individuals addicted to alcohol in what would be identified as the pre-contemplation stage, and found that staged intervention had no benefits over any other mode of intervention

Evaluation of Prochaska's model of behaviour change

Strengths

• PMBC is used widely by healthcare professionals, and this shows that there is a practical application to the theory and that appropriate interventions can be used depending on the stage the individual has reached (Hashemzadeh et al, 2019)

• More traditional theories have ignored the importance of dynamic process, considering recovery from addiction as a single 'all-or-nothing' event, whereas the six-stage model emphasises the importance of time and views overcoming an addiction as a continuing process

  • This is why the model proposes that behavioural change occurs through six stages of varying duration for each person, and that the stages are recycled backwards and forwards to different degrees, so a strength of the model is that it recognises that changing addictive behaviours is a dynamic process

Limitations

• PMBC neglects the influence of social factors such as living conditions and unemployment, and also the influence of cultural norms on smoking, as in some cultures cigarettes are still given out at social events (Daoud et al, 2015)

• The difference between stages is probably quite arbitrary, e.g., Sutton (2001) points out that if an individual plans to stop smoking in 30 days' time they are in the preparation stage, but if they plan to give up in 31 days' time they are in the contemplation stage

  • Bandura (1997) claims that the first two stages are not even qualitatively different, because the only difference between them is how much the individual wants to change, which is a quantitative measure

Issues & Debates

• PMBC supports the idea of free will, as it recognises individuals make active, conscious decisions at each stage of change

  • This contrasts with deterministic models of addiction (e.g. genetic or biological), which assume addictive behaviour is beyond conscious control

• The model adopts an idiographic approach by acknowledging that recovery is non-linear, with individual variation in how people move through the stages

  • However, it also has nomothetic value, offering a general framework to structure treatment and interventions for large groups