Decision Making in the Transtheoretical Model of Behavior Change

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Decision Making in the Transtheoretical Model of Behavior Change
Publication Date: 
December, 2008
Medical Decision Making

Prochaska’s article explains that two decision-making variables (motivation and confidence) emerged in a meta-analysis … “across more than 48 health behaviors including compliance with a variety of medications, mammography screening, colorectal screening, smoking cessation, exercise, diet, stress management, depression management, partner violence, bullying prevention, and anorexia and bulimia. These patterns emerged from more than 140 studies from 10 countries involving 9 languages. 

One might think that so much variability in behaviors, populations, and studies would result in so much noise that no clear signal would be detected. Instead, it appears that the underlying relationships between stages of change and decision-making variables are common across a multitude of behaviors.” 

Here’s the graph created by the meta-analysis researchers showing how well the levels of pros and cons align with five stages of readiness to change across 48 behaviors, including pre-contemplation (no way), contemplation (on the fence), preparation (getting ready), action (doing it), to maintenance (automatic).

Given that the readiness to change a behavior is determined by a decisional balance: the balance of the pros for change (improve motivation) and the cons or barriers to change (which reduce confidence) take time to contemplate what you want to change in 2019:

  1. Reflect on motivation, all of the small and large, short term and long term, benefits of a change.
  2. Take even more time to consider all of the obstacles and barriers to a change.

Making the decision is not enough.

It’s important to develop strategies to deal with challenges, such as any temptations to lapse, or ways to recover quickly when a temptation wins. Another approach is to enlist help from others, especially coaches, for support and recharging motivation and confidence along the way. And of course don’t forget Carol Dweck’s growth mindset – set your focus on learning and getting better, and let go of lapses and failures.

Medical Decision Making, 28(6), 845–849.

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