Chapter 4
Building Motivation: How Ready
Are You?
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Chapter Overview
• Transtheoretical Model of Behavior Change (TTM)
• Decisional balance
• Self-efficacy
• Stage paradigm
• Avoiding boredom
• Relapse prevention
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The Transtheoretical Model of Behavior
Change (TTM)
• Stages of Change model
• Assess client readiness
• Deliver tailored messages
• Success of TTM-based interventions
• Change as process over time
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The Transtheoretical Model of Behavior
Change (TTM) – cont’d
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TTM: Precontemplation Stage
• Not intending to conduct physical activity in next 6
months
• Three D’s
• Perceived barriers
• Low self-efficacy
• Lack of information
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TTM: Contemplation Stage
• Intending to conduct physical activity in next 6 months
• Aware of pros
• Unaware of cons
• Ambivalent
• Chronic contemplation
• Lack confidence and commitment
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TTM: Preparation Stage
• Ready to conduct physical activity in 30 days
• Have taken steps toward this goal
• Great candidates for traditional messaging programs
• More committed and confident
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TTM: Action Stage
• Adopted exercise within past 6 months
• Actively create new habit
• Likely to experience a setback if experience a challenge
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TTM: Maintenance Stage
• Have been exercising regularly for over 6 months
• More confident
• Low confidence/self-efficacy lead to discontinuation
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Moving Forward in TTM
• Individual’s stage has implication on intervention design
• Forward stage movement predicts success
• Encourage behavior change strategies specific to stage
• Decisional balance, self-efficacy, and ten processes of
change
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Decisional Balance
• Individual’s relative weighting of pros and cons
• Relationship of pros and cons across the stages
• Raising pros is twice as important as lowering cons
• Crucial to raise pros at early stages
• Contemplation is time to address barriers
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Self-efficacy
• Individual’s confidence to make and sustain changes
• Low in Precontemplation; increases across stages
• Important to raise early with small goals
• Build confidence for increasingly difficult challenges
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The Processes of Change
• Behavior change strategies to progress through TTM
• Experiential processes are emphasized in earlier stages
• Behavioral processes are emphasized in later stages
• Process use differs throughout stages
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Stage Paradigm
• Majority of individuals are not ready to change
• Employ most effective strategies at right time
• Encourage using specific processes
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Stage Paradigm: Step 1
• Assess readiness to change
• Match intervention program to client needs
• How ready is client to meet public health
recommendations?
• Determine physical limitations
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Stage Paradigm: Step 2
• Target intervention to readiness
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Stage Paradigm: Precontemplation
Goal: Encourage clients to view success as progress to
Contemplation
• Increase pros
• Raise consciousness
• Social liberation
• Environmental reevaluation
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Stage Paradigm: Contemplation
Goal: Encourage clients to view success as progress to
Preparation
• Make pros outweigh cons
• Raise consciousness
• Self-reevaluation
• Dramatic relief
• Encourage small steps
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Stage Paradigm: Preparation
Goal: Encourage clients to view success adoption of
regular physical activity
• Counterconditioning
• Stimulus control
• Helping relationships
• Reinforcement management
• Self liberation
• Self-efficacy
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Stage Paradigm: Action
Goal: Help clients continue to conduct physical activity
regularly
• Self liberation
• Helping relationships
• Self-reevaluation
• Counterconditioning
• Self-efficacy
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Stage Paradigm: Maintenance
Goal: Help clients make regular physical activity a life-long
habit
• Stimulus control
• Counterconditioning
• Reinforcement management
• Get support
• Recycling
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Stage Paradigm
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Avoiding Boredom
• Boredom may cause relapse to sedentary behavior
• Incorporate variety in routines
• Vary route
• Change music
• Invite different friends
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Strategies to Avoid Boredom
• Reconceptualize boredom as an opportunity
• Identify what your client gets out of exercise and what
types of activities could provide that outcome
• Look for other helpful information
• Explore other types of exercise
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Strategies to Avoid Boredom (cont.)
• Internalize motivation
• Ask for help (friends, family, or coworkers)
• Realistically evaluate goals and expectations
• Track progress daily
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Strategies to Avoid Relapse
• Foresee setbacks
• Recognize times tempted to skip workout
• Develop strategies to avoid temptation
• Recognize previous accomplishments, successes, and
new knowledge
• Reward self for accomplishments
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Strategies to Avoid Relapse (cont.)
• Identify other people or groups that may help
• Identify cues that trigger sedentary behavior
• Substitute negatives with positives
• Stay updated with exercise strategies, opportunities, and
benefits
• Monitor exercise routines, progress, goals, and setbacks
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Behavior Change Resources: Websites
• Centers of Disease Control:
http://www.cdc.gov/physicalactivity/index.html
• National Institutes of Health:
http://health.nih.gov/topic/ExercisePhysicalFitness
http://health.nih.gov/topic/ExerciseForSeniors
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Behavior Change Resources:
Computer-Tailored Intervention
• LifeStyle Management Suite:
www.prochange.com/myhealth
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Take-Home Messages
• Use stage-appropriate strategies with entire population
of clients
• Assess client’s readiness
• Tailor interventions to stage of change
• Recognize unique needs of individuals
• Prepare prior to taking action to decrease relapse rates
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