Transtheoretical Model: The Five Stages Of Change And What They Mean

Medically reviewed by Audrey Kelly, LMFT
Updated October 8, 2024by BetterHelp Editorial Team
Content warning: Please be advised, the below article might mention substance use-related topics that could be triggering to the reader. If you or someone you love is struggling with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357). Support is available 24/7. Please see our Get Help Now page for more immediate resources.

Everyone experiences different changes throughout the course of their lives. Sometimes these changes are exciting and welcomed, while other times, they’re difficult to deal with. Change can be positive, negative, or neutral. When someone decides they’d like to adjust something about themselves, they often move through five distinct stages in the process.

The history of the five stages of change

The transtheoretical model, also known as the Stages Of Change Model or the five stages of change, can help explain why and how people choose to change their lives, whether it’s about their behavior patterns, habits, motivations, or something else entirely. Developed by researchers in the 1970s, this model provides insights into coping strategies and self-efficacy that can guide individuals in changing behavior and maintaining a new behavior to successfully avoid falling back into old behaviors or the status quo.

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The Transtheoretical Model and the five stages of change

To better understand the process of change, two researchers, James O. Prochaska and Carlo C. DiClemente, studied people struggling with alcoholism. Prochaska and DiClemente wanted to know more about change so they could better motivate their clients and help them adjust their lives in positive ways. Those living with an addiction often have the most difficult time changing their behaviors, so these two researchers decided this would be one of the most valuable groups to study. What they discovered is that people typically go through five stages of change as they work to overcome addiction or other problem behaviors.

Understanding the five stages of change according to the transtheoretical model

Here are the five stages of change:

  1. Precontemplation
  2. Contemplation
  3. Determination
  4. Action
  5. Maintenance

More recently, researchers have found this model can apply to many different types of concerns, including mood disorders, eating disorders, substance use, and other concerns. If you have a problem behavior that you’d like to alter or a concern to address, you may find The Five Stages Of Change Model beneficial. This framework can help you understand the process of change and improve your chances of success. Working toward a goal, such as breaking a harmful habit, can be difficult. However, understanding how the mind works when going through adjustments may allow you to move through each stage with more ease.

Precontemplation

Just as the name implies, someone in the precontemplation stage is not yet thinking about behavior change. Often, this is because they do not realize they have a problem with their current behavior or bad habit. During pre contemplation, others may recognize that there is a problem, but the person with the problem may be oblivious to it or in denial. They may even believe that others are exaggerating the situation or worried about nothing. Due to the tension, someone in this stage may experience conflict in their relationships, and that may be what causes them to seek help or re evaluate their situation.

People in the pre-contemplation stage may not personally choose to seek therapy. If they are pushed into therapy by social support or even required by their work or the court to attend, they may not cooperate very well with the process. During the precontemplation stage, therapists are often most focused on helping the person identify what the problem is so that they can become more open to the process of therapy and making changes in their life, eventually moving to the preparation stage with increased self-confidence in their ability to change behavior.

Contemplation

In contrast to the precontemplation stage, people in the contemplation stage are considering that they might have a problem. This creates some interest in taking steps to make a change, but with some lingering uncertainty. This is referred to as ambivalence. There is thought and consideration, but no clear decision or commitment to adjusting.

During this stage, therapists often help by providing more information (also called psychoeducation) that can increase knowledge. This information can make things clearer so that people can be more certain whether they have a problem that they want to change. Therapists also use an approach called motivational interviewing, which is intended to increase an individual’s motivation to modify their behaviors. What often entails is consideration of the pros and cons associated with the possibility of change.

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Determination

With support from therapy and techniques to increase interest and commitment toward change, or sometimes on their own, people then move into the determination stage. At this point, people are aware they have a problem that they need and want to change. As the name suggests, by now, they are determined to make some kind of modification to their behaviors and life. They are ready and committed to taking action in order to get to where they’d like to be.

During this stage, people must start preparing for the change that is to come. This often involves learning more about their problem, identifying what exactly they need to do differently, and then figuring out the steps to get there. To make a change, people sometimes need to develop skills and solutions they can use to overcome their problems. This is where therapy can be particularly beneficial. A therapist can help identify which new skills may be needed and provide instruction on how to utilize them most effectively.

Action

After committing to change and preparing for it, in the action stage, people start to take steps that can make a difference. Often, the work they are doing becomes more public and therefore noticeable. Others in their life will often be more aware, and some may be able to help by supporting the change in whatever ways they can. Sometimes, as people step into the action stage, they decide that they need to reduce contact with anyone who could derail their progress.

Therapy continues to be very important at this stage. A therapist can provide support, helping to keep things on track. If there are setbacks, they can explore what happened and identify ways to combat that setback and avoid a similar problem in the future. Sometimes, after one change begins, people realize there are other areas of their life they are not happy with, and they want to alter those too. Therapy allows an individual to talk about all of this.

Maintenance

Though many people are in need for immediate gratification, creating change is not instant. It often requires time and effort. Most people are in the action stage for three to six months since it takes time to create new patterns of behavior. A few weeks of change is usually not enough to ensure things will stay that way long-term, though every situation is different. However, once the new status quo has been present for some time, the individual can then move into the maintenance stage.

During the maintenance stage, the goal is to maintain any changes that were made and avoid relapse. While those changes may have become well-established, it does take some attention to ensure old patterns do not return. Therapy can offer vital support throughout the maintenance stage by helping to identify signs that a relapse may occur. They can also teach relapse-prevention skills and, if a relapse occurs, they can assist people in getting back on track.

Get help navigating life changes, behavior change, and the potential for relapse

As you think about the stages of change, it is helpful to keep in mind that people do not always progress through these in a sequential, irreversible process. Often, people may start to move into one stage, only to slip back for a while into a previous stage. This can feel difficult and discouraging, but therapy can offer encouragement and support to keep people on track.

Additionally, sometimes people are struggling with multiple concerns that they want or need to change. Working to make multiple changes may feel more complex and daunting than making just one, and people might find themselves in different stages for different components.

For example, someone could be struggling with anxiety that prevents them from going to work. They may be feeling ready to start going to work regularly and thus be in the determination stage. At the same time, they could also be self-medicating with frequent marijuana use that they believe reduces their anxiety. Initially, they may not think this is a problem, and so they might be in the pre-contemplative stage. Therapists can help by directing the focus to one concern at a time before moving on to the next, allowing change to feel more attainable.

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Online therapy with BetterHelp

In many cases, therapy can be beneficial for anyone wanting or needing to make a change. No matter where you’re at in the process of change, confiding in a therapist at BetterHelp could help you get where you’d like to be with greater speed and ease. BetterHelp is an online therapy platform that connects those in need with licensed counselors experienced in a variety of issues.

It can be difficult to admit you have a problem or need help, especially when it comes to having an addiction. Online therapy allows you to open up about your feelings in a safe, supportive environment. 

Online therapy for behavior change and relapse

Online therapy has been proven to be effective in treating a variety of mental health issues. Change can often cause symptoms of panic or anxiety, which can be difficult to cope with on your own. Research has shown that online cognitive behavioral therapy (CBT) can be effective in improving symptoms of conditions such as anxiety and depression. CBT is a therapeutic approach that teaches people to replace their unhelpful thoughts with more positive ones, allowing them to make behavioral changes as a result.

Takeaway

Change doesn’t always happen in sequence, and it can take both time and effort to see the results you want. You may need different things in the various stages of change, so it’s important to stay aware of your progress and recognize when something is or isn’t working. Whether you’re wanting to reduce unwanted old behavior, manage mental health symptoms, or simply want to feel better, online therapy may spur the process along or at least make it more manageable.

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