We have all been there. The desire to do something different, to change, to better ourselves. We think about it, visualize a goal and maybe even make a tentative plan to start. Then BOOM! Something “happens”, we slip back into our old habits and self-sabotage with justification of our lack of change because we are “too busy”, “too tired” or “work, school, kids, family…(insert excuse here)”. Why do we do this?
We see this all the time in Physical Therapy in relationship to the home exercises we give patients. Compliance can be difficult for a lot of people, even when it means a good versus a poor recovery from an injury.
Modern neuropsychology has many ideas about this poor ability for humans to make a positive change. The first model I’d like to discuss is the Transtheoretical Model of intentional behavioral change; basically, starting at square one and learning the stages a person moves through when undergoing a behavior change.
Stage 1: Precontemplation
Precontemplation stage is a stage where a person does not intend to act in the foreseeable future, usually measured as the next six months. These are the folks that are often seen as resistant and unmotivated. “There is no way I’d ever give up chocolate”, “I’m so out of shape that there is no point going to the gym, it will just hurt”.
Stage 2: Contemplation
Contemplation is the stage in which people intend to change in the next six months. They are very aware of the pro’s and con’s of changing, “I would really feel better I lost weight, but waking up an hour earlier to go to the gym is really hard”. This pro/con weighing can create A LOT of ambivalence and people can stay in this stage for a long time… Think about your friend who is always talking about losing weight and spends a long time doing that… talking about it, but not doing it.
Stage 3: Preparation
Preparation is the stage in which people intend to take action in the immediate future and typically, they have already taken some significant action in the past year. These are the folks who have joined a gym, followed everyone on social medial with their common interest or made an appointment with their Physical Therapist for example.
Stage 4: Action
Action is the stage in which people have made specific modifications in their lifestyles within the past six months. For example, they are going to the gym 2-3x a week, they are consistently eating out of their own kitchen 5 days a week and they lost 15 pound in the last 3 months, wow!
Stage 5: Maintenance
Maintenance is the stage in which people have made specific modifications in their lifestyles and are working to prevent relapse into old behaviors. These people grow increasingly more confident that they can continue their changes. This stage can last between 6 months to 5 years. After that 5-year mark of Maintenance, we now have full on behavior change! YAY! The chance of going back to, let’s say smoking, is almost zilch.
Now the important thing to remember about “The Stages of Change” is that some approaches will or won’t work with a person depending on the stage they are in. A pre-contemplative person is very unlikely to respond to a lecture from their spouse about losing weight… they don’t have the desire or see the need to. Now if their doctor or physical therapist discusses it, maybe we can bump them into at least the Contemplative stage. People in the Preparation stage respond very well to examples of success such as a role model, and Action folks need to see progress within themselves and have positive feedback from a supportive group (family, friends, church, etc) to continue to the Maintenance stage.
What stage are you in in relationship to your life, health, or fitness goals? Do you think you need to change?
In future blog posts we will explore the main personality types when it comes to behavior change, creating and crushing SMART goals, and tips to keep you motivated to sail into the Maintenance stage of behavior change.
Fawn Lintner, DPT
Doctor of Physical Therapy