Transtheoretical Model: The Five Stages of Health Behavior Change

How many stages are in the psychological theory?

The term "the psychological theory" is broad, as psychology encompasses numerous theories, many of which involve stages. However, within the context of health, fitness, and behavior change, the most widely referenced and applied model with distinct stages is the Transtheoretical Model (TTM) of Change, which outlines five core stages.

Clarifying "The Psychological Theory"

Psychology is a vast scientific discipline, and over its history, numerous theories have been developed to explain various aspects of human thought, emotion, and behavior. Many of these theories indeed propose developmental or sequential stages. For instance, Jean Piaget's theory of cognitive development outlines stages of intellectual growth, Erik Erikson's theory describes psychosocial development across the lifespan, and Abraham Maslow's hierarchy of needs presents stages of human motivation.

Given the domain of exercise science and kinesiology, when discussing "stages in a psychological theory" related to health and fitness, the focus most commonly turns to models that explain how individuals adopt and maintain new behaviors, or cease old ones. The preeminent model in this area is the Transtheoretical Model.

The Transtheoretical Model (TTM) of Change: A Core Framework for Health Behavior

Developed by Prochaska and DiClemente, the Transtheoretical Model (TTM), often referred to as the Stages of Change Model, is a comprehensive theory of behavior change that integrates processes and principles from across major theories of intervention. It posits that behavior change is a process that unfolds over time, progressing through a series of stages. Understanding these stages allows fitness professionals and health educators to tailor interventions and support strategies to an individual's readiness to change.

The Five Core Stages of Change in the TTM

The Transtheoretical Model identifies five primary, distinct stages through which individuals progress when attempting to modify a health behavior. It's important to note that progression is not always linear, and individuals may relapse to an earlier stage before moving forward again.

• Precontemplation: In this initial stage, individuals have no intention of taking action to change their behavior in the foreseeable future, typically defined as the next six months. They may be unaware of the problem, unwilling to change, or have tried to change before and failed, leading to demoralization. For example, someone in precontemplation regarding exercise might not see the benefit of physical activity or believe they are already active enough.
• Contemplation: Individuals in the contemplation stage intend to change their behavior within the next six months. They are more aware of the pros of changing, but are also acutely aware of the cons, leading to ambivalence. They are thinking about making a change but are not yet committed to taking action. A person contemplating exercise might be thinking about joining a gym but hasn't taken any concrete steps.
• Preparation: This stage is characterized by the individual's intention to take action in the immediate future, usually within the next month. They have typically taken some significant steps toward change, such as researching workout plans, buying new athletic shoes, or consulting with a personal trainer. They are developing a concrete plan of action.
• Action: In the action stage, individuals have actively modified their behavior, experiences, or environment to overcome their problem behavior or acquire new healthy behaviors. This stage requires significant commitment of time and energy. It is generally defined as having sustained the new behavior for less than six months. For instance, consistently exercising three times a week for the past two months.
• Maintenance: Individuals in the maintenance stage have sustained their behavior change for six months or longer. The focus here shifts from initiating the behavior to preventing relapse and consolidating the gains achieved. The new behavior has become more automatic, and the individual has developed strategies to cope with temptations and challenges.

While these are the five core stages, some interpretations of the TTM also include a Termination stage, where the individual has zero temptation to return to the old behavior and 100% self-efficacy, or acknowledge Relapse as a common, albeit temporary, return to an earlier stage.

Why These Stages Matter for Fitness and Health

Understanding the stages of change is crucial for fitness professionals, coaches, and individuals seeking to make lasting health improvements because it:

• Allows for Tailored Interventions: Strategies that work for someone in the action stage (e.g., reinforcing positive behaviors) will be ineffective for someone in precontemplation (who needs awareness and motivation).
• Sets Realistic Expectations: Recognizing that change is a process with distinct phases helps manage expectations for both the client and the coach, reducing frustration from perceived lack of progress.
• Enhances Client Readiness Assessment: Professionals can assess a client's current stage of change and apply appropriate "processes of change" (e.g., consciousness-raising, self-liberation, counter-conditioning) to help them progress.
• Promotes Personalized Coaching: It moves away from a "one-size-fits-all" approach to coaching, leading to more effective and sustainable outcomes.

Beyond Stages: Processes of Change in the TTM

Beyond the stages, the TTM also incorporates "processes of change," which are the covert and overt activities that people use to progress through the stages. These include cognitive processes (like increasing awareness or re-evaluating one's self-image) and behavioral processes (like using rewards or creating supportive environments). Additionally, the model considers other core constructs such as decisional balance (weighing pros and cons of changing) and self-efficacy (confidence in one's ability to change), which fluctuate across the stages and influence progression.

Conclusion: Leveraging Psychological Insights for Lasting Change

While "the psychological theory" is an imprecise term, the Transtheoretical Model of Change stands out as the most relevant and widely applied staged model in exercise science and health promotion. By recognizing the five core stages—Precontemplation, Contemplation, Preparation, Action, and Maintenance—fitness professionals and individuals can navigate the complex journey of behavior change with greater insight, strategy, and success, fostering lasting health and fitness habits.